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UFOV performance and driving ability following traumatic brain injury.

PRIMARY OBJECTIVE: To investigate the relationship between performance on the Useful Field of View Test (UFOV) and driving performance following traumatic brain injury (TBI). PARTICIPANTS: Sixty people with TBI referred for driving evaluation. MEASURES: Useful Field of View Test, Global Rating Scale and Driver Assessment Scale. RESULTS: Subject performance diminished as the complexity of the UFOV sub-tests increased. There was a significant relationship between UFOV performance, particularly on the second sub-test, and on-road driving performance. Subject age and Trail Making Test, Part B were also predictive of driving performance. CONCLUSIONS: The UFOV can be used as a screening measure to determine readiness to participate in an on-road driving assessment.

Adolescent↗

Neurocognitive impairment: the unrecognized component of dual diagnosis in substance abuse treatment.

Brief neuropsychological tests were administered to an inpatient substance abuse population to (1) evaluate the status of neurocognitive functioning at admission, (2) assess changes that may occur during the treatment program, and (3) compare various testing devices for clinical application in this setting. Patients entering a 14-day inpatient substance abuse unit were tested within a few days of admission with the Neurobehavioral Cognitive Status Examination (NCSE), the screening test for the Luria-Nebraska Neuropsychological Battery, and the Trail Making Test. Impaired neurocognitive performance was observed in approximately two-thirds of patients; the most frequently compromised areas of functioning involved attention and memory, calculation, abstraction, ability to follow complex commands, and visuospatial skills. Readministration of the NCSE prior to discharge detected a statistically significant improvement in attentional abilities, and a tendency toward improvement for verbal comprehension and abstraction. Discussion of these findings addresses several issues: (1) the frequency and degree of impairment in this population; (2) the observed variability of cognitive functioning; (3) the question of clinical improvement in neurocognitive functioning observed during a program of this length; and (4) a preference for the NCSE in this setting. The authors argue for the routine neuropsychological assessment of substance abusers, and discuss the above issues in terms of their implications for treatment at both the individual and programmatic level. Discussion of two cases illustrates the application of the NCSE, and the effect of finding organic impairment on staff attitudes and treatment issues.

Adult↗

Some observations on the use of the Woodcock-Johnson Tests of Cognitive Ability in adults with head injury.

Current research specifies the varied cognitive and psychoeducational deficits in the adult with head injury, and the clinical assessment of this population is widespread, though often only traditional intellectual measures are used. This article provides descriptive data in the first reported study using the Woodcock-Johnson Tests of Cognitive Ability (WJTCA) (Woodcock & Johnson, 1977) in an outpatient sample of 39 adults with closed head injury. The study also addressed (a) the relationships between the various cognitive clusters of the WJTCA and a measure of injury severity (coma duration) and (b) the relationships between the WJTCA and several Halstead-Reitan neuropsychological measures. Correlational analyses indicated significant relationships between coma duration and performance on the Perceptual Speed and Memory clusters of the WJTCA. No relationships were found between the Halstead Category test and any of the WJTCA cognitive clusters, though the Trail Making test correlated significantly with many of the WJTCA clusters. Time since injury did not correlate with any of the WJTCA test results. Other findings are presented, and the advantages and disadvantages of this set of cognitive tests in relation to other psychoeducational and cognitive measures are reviewed.

Adolescent↗

[Executive and amnestic functions of a group of first-degree relatives of schizophrenic patients].

Several lines of evidence seem to indicate that some neurocognitive measures could be phenotypic markers of predisposition to schizophrenia. The aim of this study was to investigate 21 patients with schizophrenia, 51 of their first-degree relatives and 46 nonpsychiatric controls, with a series of tests known to be sensitive to prefrontal cortical damage--the Trail Making Test, part B (TMT B), the Wisconsin Card Sorting Test (WCST) and a verbal fluency test (VFT)- and/or sensitive to temporo-hippocampic dysfunctions: verbal and visual memory and verbal learning tests from the Wechsler Memory Scale-Revised (Wechsler, 1987). Since parents and siblings share on average 50% of their genes with the schizophrenic proband, firstly we predicted that the first-degree relatives' performance would be at an intermediate level between patients and control subjects and secondly, we expected that a higher proportion of relatives than of control subjects would be impaired. The patients demonstrated deviant patterns of neuropsychological performance on the three tests sensitive to frontal dysfunctions and on most of the memory and learning tests. In the relative group, performance on the TMT B, VFT, immediate verbal recall and verbal learning was at an intermediate level between both other groups and significantly impaired compared to control subjects. However, the relative group did not differ from the control group on the WCST, immediate visual recall, and delayed verbal and visual recalls. Furthermore, compared to the control group, the percentages of patients and relatives who scored one standard deviation below the mean control group were significantly higher for the VFT and immediate verbal recall scores. Among all the tests studied, the verbal fluency and the immediate verbal recall appeared to be valuable phenotypic markers of schizophrenia since: (i) their mean scores were poorer in the patient and in the relative groups, (ii) the percentages of patients and relatives with poor performance were higher than the percentage of controls, (iii) these deficits were not due to poorer general intellectual abilities in the relative group, (iv) these deficits did not correlate with anxiety or depression scores.

Adult↗

The relationship between pain, neuropsychological performance, and physical function in community-dwelling older adults with chronic low back pain.

OBJECTIVE: Chronic pain and cognitive impairment are prevalent and disabling in older adults (OA), but their interrelationship has not been rigorously tested. We did so in OA with chronic low back pain (CLBP). DESIGN: A total of 323 OA (160 pain-free, 163 CLBP; mean age 73.5 years, 45% female) had neuropsychological (NP) testing with the Repeatable Battery for the Assessment of Neuropsychological Status, Trail Making Test, and the Grooved Pegboard Test. Pain intensity was measured with the McGill Pain Questionnaire Short Form. Physical performance (gait speed, functional reach, chair rise, trunk rotation, and static/dynamic lifting), psychosocial disruption (Geriatric Depression Scale, the Short Form-36 Mental Health and Role Limitations-Emotional Composite scale), and self-reported disability (Functional Status Index, the Short From-36 Physical Functioning/Role-Physical Composite scale) were also measured. SETTING: Outpatient research laboratory. RESULTS: There were no group differences in age, gender, or educational level, but significant differences in NP scores (P = 0.01) were found. Five scales accounted for the differences: immediate memory (P = 0.002), language (P = 0.004), delayed memory (P = 0.04), mental flexibility (Trails B [P = 0.02]), and Grooved Pegboard (P = 0.05). NP scores were significantly correlated with physical performance (R2= 0.30, P < 0.001), but not self-reported disability (R2= 0.04, P = 0.52) or psychosocial disruption (R2= 0.05, P = 0.46). NP function was correlated with pain intensity (R2= 0.17, P < 0.001), and NP function mediated the relationship between pain and physical performance. CONCLUSIONS: OA with CLBP demonstrated impaired NP performance as compared with pain-free OA. Further, pain severity was inversely correlated with NP performance, and NP performance mediated the relationship between pain and physical performance. Future research should examine whether cognitive function and impaired physical performance can be improved with pain reduction.

Activities of Daily Living↗

Effect of oral testosterone undecanoate on visuospatial cognition, mood and quality of life in elderly men with low-normal gonadal status.

OBJECTIVES: The effects of supplemental testosterone on cognition, mood and wellbeing in ageing men are unclear. This study aimed to assess the effect of 12-months of oral testosterone supplementation on cognitive function, mood and quality of life in elderly men with low-normal gonadal status, not specifically selected for cognitive or mood defects. METHODS: A standard oral dose (80 mg twice daily) of testosterone undecanoate (TU) or placebo was administered for one year to 76 healthy men 60 years or older. All men had a free testosterone index (FTI) of 0.3-0.5, which represents a value below the normal lower limit for young men (19-30 years), but remains within the overall normal male range. A neuropsychological assessment including the trail making test (part B), visuospatial (VSP) block design test, mini mental state exam (MMSE), Geriatric Depression Scale (GDS), a 5-point Likert and a 10-point visual analogue quality of life (QoL) scale, along with serum hormone measurements were obtained at baseline, 6, and 12 months. RESULTS: Although calculated bioavailable testosterone (cBT) and FTI were higher, and muscle mass increased after 12 months, there was no difference in scores on the trail making or VSP block tests, the MMSE, GDS or either of the QoL scales between the testosterone and placebo group. There was no relationship between baseline cBT or FTI and treatment effect for any of the outcome measures. CONCLUSIONS: 12-month supplementation with oral TU does not affect scores on visuospatial tests or mood and quality of life scales in older men with low-normal gonadal status.

Administration, Oral↗

Reliable serial measurement of cognitive processes in rehabilitation: the Cognitive Log.

OBJECTIVE: To evaluate the reliability and utility of a brief quantitative measure of cognitive recovery, the Cognitive Log (Cog-Log), developed for daily use with rehabilitation inpatients to provide information about the recovery of higher neurocognitive processes including verbal recall, attention, working memory, motor sequencing, and response inhibition. DESIGN: Descriptive study of the Cog-Log's normative scores, reliability (interrater, internal consistency), and validity as shown by its relationship to standard neuropsychologic measures. SETTING: Inpatient rehabilitation hospital affiliated with a large university medical center. PARTICIPANTS: One hundred fifty neurorehabilitation inpatients with acquired brain injury; 83 young adults without acquired brain injury were included to provide normative data. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Cog-Log; standardized neuropsychologic measures of memory (Wechsler Memory Scale-Revised, Rey Auditory Verbal Learning Test), language, attention (Wechsler Adult Intelligence Scale-Revised), and reasoning (Trail Making Test). RESULTS: Reliability analysis showed strong interrater reliability across items (Spearman r, .749-1.00) and high internal consistency (Cronbach alpha=.778). Factor analysis of the Cog-Log using principal components extraction revealed a unitary factor (eigenvalue=3.48). Cog-Log items designed to measure working memory and immediate and delayed verbal memory were most strongly predictive of performance on similar standardized neuropsychologic measures administered on the same day. CONCLUSION: The Cog-Log appears to be a reliable and efficient tool for measuring ongoing neurocognitive recovery during inpatient rehabilitation.

Adolescent↗

Prevalence and natural history of subclinical hepatic encephalopathy in cirrhosis.

BACKGROUND AND AIMS: The natural history of subclinical hepatic encephalopathy (SHE) is unknown. The present study was conducted to study the prevalence and the natural history of SHE in patients with cirrhosis of the liver. METHODS: One hundred and sixty-five patients with cirrhosis of the liver were studied. A total of nine psychometric tests (trail making and Wechsler adult intelligence scale-performance (WAIS-P) tests) were administered. Subclinical hepatic encephalopathy was present if two or more psychometric tests were abnormal. Seventy-two patients (SHE 40, without SHE 32) also underwent serial psychometric testing on follow-up visits at 6-8 week intervals. RESULTS: Subclinical hepatic encephalopathy was present in 103 (62.4%) patients. The number and figure connection, block design and picture completion tests were the most useful in the detection of SHE. Severity of SHE, as assessed by the number of abnormal tests, was greater in patients with more severe liver disease. During follow up, SHE tended to persist or worsen in patients with poorer liver function. Although other clinical complications were similar in different groups, overt hepatic encephalopathy developed more commonly in those patients who had SHE at entry compared to those who did not (22.6 vs 5.6%, P = 0.044). Among the patients with SHE, the development of overt hepatic encephalopathy was more common in patients with Child's score of > 6 than with Child's score of <or= 6 (40 vs 5%, P = 0.019). CONCLUSIONS: We conclude that SHE is common in cirrhosis. The natural history of SHE is worse in patients with advanced cirrhosis and SHE probably predisposes the cirrhotic patient to overt hepatic encephalopathy.

Adult↗

A cross-sectional study to investigate long-term cognitive function in people with treated pituitary Cushing's disease.

INTRODUCTION: It has been proposed that exposure to high levels of endogenous steroids in untreated pituitary Cushing's disease damages hippocampal structures leading to impairment in learning and memory processes. We hypothesised that patients with treated pituitary Cushing's disease would perform significantly worse on tests of cognitive ability than those with nonfunctioning pituitary adenomas. DESIGN: Sixteen adults with pituitary Cushing's disease (PCD) and 16 adults with non-functioning pituitary adenomas (NFA) undertook the following comprehensive neuropsychological assessments: National Adult Reading Test (NART: premorbid abilities), California Verbal Learning Test (CVLT 2 UK: learning and recall), Stroop (executive functioning), Trail-Making Test (TMT: executive functioning and attention), Adult Memory and Information Processing Battery (AMIPB: Information Processing Speed and Story Recall subtests). RESULTS: There was no significant difference in premorbid IQ scores (NFA mean=101 SD=13; PCD mean=102, SD=13), in verbal learning nor any significant difference in the percentage of verbal material retained in story recall (AMIPB). Performance on higher executive tasks Stroop and TMT and on measures of information processing was similar. However, there were significant decrements between some mean scores for both groups and published normative data with a clear association between higher HADS depression scores and impaired objective memory and attention which was not specific to PCD. CONCLUSIONS: We found no difference in cognitive function between patients with PCD and NFA. The results suggest a discrepancy between patients' subjective perception of functional cognitive impairments and objective findings on psychometric testing and point to the influence of affective symptoms on cognitive performance, particularly in Cushing's disease.

Adult↗

Neuropsychological changes after cardiopulmonary bypass for coronary artery bypass grafting.

BACKGROUND: An alarming incidence (1% to 83%) of neuropsychological dysfunction has been reported after operations using cardiopulmonary bypass (CPB). The present clinical study re-evaluates these complications with current CPB technology in a strictly selected low-risk group of coronary artery bypass (CABG) patients. METHODS: 76 CABG patients, without history of stroke or internal carotid artery stenosis, were examined before, 5 days after, and 2 months after surgery. A neuropsychological test battery was employed according to the "Statement of Consensus on Assessment of Neurobehavioral Outcomes after Cardiac Surgery". Tests include the Block Design Test (problem-solving strategies, recognition and analysis of forms), the Trail Making Test (cognitive achievement at speed), and the Digit Span Test (short-term memory and memory of figures). RESULTS: Both postoperative test scores were not significantly decreased as compared to preoperative values. In contrast, neuron specific enolase (NSE) and S100 b protein, biochemical markers of cerebral injury, increased markedly during and immediately after surgery (NSE preop.: 7.07 +/- 2.40 ng/ml, 1 h postop.: 13.64 +/- 4.50 ng/ml, p < 0.001; S100 b preop.: 0.04 +/- 0.07 ng/ml, after crossclamp: 0.90 +/- 0.69 ng/ml, p < 0.001). One patient displayed postoperative transitional syndrome, another patient suffered from transitory paresis and hypesthesia of the left arm, which disappeared during hospital stay. CONCLUSIONS: Biochemical markers demonstrate significant postoperative cerebral injury during and immediately after CPB. However, CPB for CABG does not lead to marked impairment of neuropsychological scores, and clinically relevant neurological findings were observed in one patient only.

Aged↗

Cognitive function and spirometry performance in the elderly.

A total of 65 ambulatory subjects over the age of 65 yr were studied to determine if mild impairment in cognitive function precludes reliable spirometric measures in the aged. Standardized questionnaires were used to obtain information on demographics, cigarette smoking, respiratory symptoms, and physician-diagnosed lung disease. Each subject performed several simple standardized tasks of cognitive function and underwent spirometric testing. A total of 36 women and 29 men participated. The mean age for the group was 74.9 +/- 5.6 yr; most were nonsmokers (never smokers, n = 28; former smokers, n = 29; and current smokers, n = 8). Of the 65 participants, 8 (12.3%) individuals were unable to perform at least three ATS-acceptable FVC maneuvers after suitable demonstration. These subjects were similar to the 57 subjects able to perform three acceptable maneuvers, except for worse scores on both the symbol-digit modalities test (23.3 +/- 3.6 versus 31.6 +/- 10.5, p < 0.001) and the trail-making test, Part B (244.3 +/- 87.1 versus 160.4 +/- 71.8, p < 0.01). Of the 57 subjects able to perform spirometry, 18 (31.6%) failed to meet ATS reproducibility criteria for FEV1, FVC, or both. Cognitive impairment was not associated with the ability to achieve reproducible measures. These results suggest that the vast majority of older subjects can perform reliable spirometry; those elderly unable to perform spirometry may have impairment in cognitive function requiring further evaluation.

Aged↗

[Differential cognitive profiles of fronto-temporal dementia and Alzheimer's disease].

INTRODUCTION AND OBJECTIVE: When the clinical picture consists of prominent cognitive impairments (e.g. amnesia) with relatively mild behavioral symptoms, it can be very difficult to distinguish frontal lobe dementia (FLD) from Alzheimer disease (AD). However, these conditions may have distinct cognitive profiles that could be detected by means of neuropsychological testing. The objective was to examine the early differential cognitive feature between FLD and AD. PATIENTS AND METHODS: Twelve patients with FLD, 20 patients with AD, and 20 normal subjects matched for age and educational level were evaluated with the Folstein Mini Mental State Examination, the Signoret Memory Battery, the Boston Naming Test, Verbal Fluency (FAS), the Wechsler Adult Intelligence Scale, and the Trail Making Test. The FLD patients met the Lund and Manchester criteria, and the AD patients met the National Institute of Neurological Disorders and Stroke-Alzheimer Disease and Related Disorders Association (NINDS-ADRDA) criteria for clinically probable AD. RESULTS: FLD and AD patients were matched for the severity of dementia using the Global Deterioration Scale (3.8 +/- 0.3 versus 3.9 +/- 0.5 respectively). Mean Z scores were calculated in order to facilitate the comparison between the neuropsychological profiles obtained. FLD patients scored significantly better than AD patients in memory test, calculation, visuospatial abilities, and the naming test. AD patients performed better on executive tasks. CONCLUSION: These findings suggest that neuropsychological examination may be useful in differential diagnosis between FLD and AD

Adult↗

Patterns of cognitive decline in presymptomatic Alzheimer disease: a prospective community study.

BACKGROUND: Specific patterns of decline over time were evaluated across a spectrum of cognitive measures in presymptomatic Alzheimer disease (AD) within a community sample. METHODS: A total of 551 individuals completed a battery of standard cognitive tests 3.5 and 1.5 years before outcome (clinical onset of AD vs continued nondemented status) within a prospective community-based study of AD. Test score changes in 68 cases (who subsequently developed symptomatic AD) and 483 controls (who remained nondemented) on each of 15 cognitive measures were transformed into z scores adjusted for age, sex, and education. A case-control rate ratio of the proportions of individuals who showed "cognitive decline" on each test was calculated, representing the relative magnitude of cognitive decline on each test in presymptomatic AD compared with normal aging. RESULTS: Declines in Trail-Making Tests A and B and Word List delayed recognition of originals and third immediate learning trial had the highest rate ratios, larger than 3.0 (P<.01). These were followed by Word List delayed recognition of foils and delayed recall, Consortium to Establish a Registry for Alzheimer's Disease Praxis, Clock Drawing, the Boston Naming Test, and Orientation, with rate ratios between 1.7 and 3.0 (P<.05). CONCLUSIONS: Memory and executive dysfunction showed the greatest decline over time in individuals who would clinically manifest AD 1.5 years later. These findings might help us understand the underlying evolution of the early neurodegenerative process. They highlight the importance of executive dysfunction early in the disease process and might facilitate early detection of AD.

Aged↗

Neuropsychological frontal lobe tests indicate that bipolar depressed patients are more impaired than unipolar.

OBJECTIVES: The aim of this study was to compare the neuropsychological performance of patients with bipolar or unipolar mood disorders during acute episodes of depression using intelligence and frontal lobe tests. METHODS: Fifteen patients with bipolar depression (BP) and 30 with unipolar depression (UP) were studied. For the neuropsychological assessment, the following tests: the Wechsler Adult Intelligence Scale-Revised (WAIS-R), the Trail Making Test (TMT), the Stroop test, the verbal fluency test and the Wisconsin Card Sorting Test (WCST) were used. RESULTS: The mean intensity of depression and mean duration of illness were similar in both groups. Patients in the BP group achieved significantly lower levels of performance in the non-verbal part of WAIS-R, in both parts of the Stroop test, in the verbal fluency test and also showed a tendency to achieve poorer results in TMT-B than those in the UP group. Bipolar depressed patients also produced significantly poorer results with the WCST as they made twice as many perseverative errors and only completed half of the correct categories compared with the UP patients. The results of the TMT-A tests, which measure psychomotor slowness, were similar in BP and UP patients. No differences between the results of male and female patients were noted in either group. Deterioration of the results associated with duration of the illness was only observed in the UP patients. CONCLUSIONS: A higher degree of cognitive dysfunction connected with frontal lobe activity during an acute depressive episode was found in bipolar compared with unipolar depressed patients. These results may corroborate other findings pointing to pathogenic distinctions between bipolar and unipolar affective illness and to some similarities between bipolar illness and schizophrenia.

Adult↗

A double-blinded, placebo-controlled, randomized trial of the neuropsychologic efficacy of cranberry juice in a sample of cognitively intact older adults: pilot study findings.

OBJECTIVES: The aim of this research was to conduct the first known clinical trial of the short-term (i.e., 6 weeks) efficacy of cranberry juice on the neuropsychologic functioning of cognitively intact older adults. PARTICIPANTS: Fifty (50) community-dwelling, cognitively intact volunteers, > or = 60 years old, who reported no history of dementia or significant neurocognitive impairments, participated in this study. DESIGN: A 6-week, double-blind, placebo-controlled, randomized, parallel-group, clinical trial was utilized. Participants were randomly assigned to receive either 32 ounces/day of a beverage containing 27% cranberry juice per volume (n = 25) or placebo (n = 25) for 6 weeks, and administered a series of neuropsychologic tests at both pretreatment baseline and again after 6 weeks of either cranberry juice or placebo treatment to assess treatment-related changes. OUTCOME MEASURES: Efficacy measures consisted of participants' raw scores on the following standardized neuropsychologic tests: Selective Reminding Test, Wechsler Memory Scale-III Faces I and Faces II subtests, Trail Making Test (Parts A and B), Stroop Color and Word Test, and the Wechsler Adult Intelligence Scale- III Digit Symbol-Coding subtest. A subjective Follow-up Self-report Questionnaire was also administered to participants at the conclusion of the end-of-treatment phase assessments. RESULTS: Two-factor, mixed analyses of variance (ANOVA) revealed no significant group (cranberry juice and placebo) by trial (pretreatment baseline and end-of-treatment assessments) interactions across all of the neuropsychologic tests and measures utilized in this study when a Bonferroni corrected alpha level was used to correct for multiple comparisons (i.e., .05/17 group by trial comparisons = .003). Pearson Chi-Square analyses of the groups' self-reported changes over the 6-week treatment phase in their abilities to remember, thinking processes, moods, energy levels, and overall health on the Follow-up Self-report Questionnaire revealed no significant relationships. However, a nonsignificant trend (X2(1) = 2.373, p = 0.123) was noted for participants' self-reported overall abilities to remember from pretreatment baseline to the end-of-treatment assessment. Specifically, more than twice as many participants in the cranberry group (n = 9, 37.5%) rated their overall abilities to remember by treatment end as "improved" as compared to placebo controls (n = 4, 17.4%). CONCLUSIONS: Taken together, no significant interactions were found between the cranberry and placebo groups and their pretreatment baseline and end-of-treatment phase (after 6 weeks) standardized neuropsychologic assessments. A nonsignificant trend was noted, however, on a subjective, self-report questionnaire where twice as many participants in the cranberry group rated their overall abilities to remember by treatment end as "improved" compared to placebo controls.

Aged↗

Methylphenidate does not improve cognitive function in healthy sleep-deprived young adults.

BACKGROUND: Abuse of methylphenidate, a treatment of attention-deficit/hyperactivity disorder, is reported to be increasing among students for the purpose of improving cognition. METHODS: A single capsule, containing methylphenidate (20 mg) or placebo, was administered to healthy young adults orally following 24 hours of sleep deprivation. Measurements included percent change in score from sleep-deprived baseline on four standardized tests of cognitive function: Hopkins Verbal Learning, Digit Span, Modified Stroop, and Trail Making tests. Measurements also included percent changes in blood pressure and heart rate from sleep-deprived baseline and plasma methylphenidate concentration. RESULTS: Differences in cognitive test performance were not observed between intervention groups. In subjects receiving methylphenidate, mean percent changes from baseline for systolic blood pressure and heart rate were increased relative to placebo between 90 and 210 minutes following capsule administration (maximum increases of 9.45% and 11.03%, respectively). The timing of peak differences in physiologic measures did not correlate with peak serum methylphenidate concentrations. Exit questionnaire ratings of "capsule effect" and perceived performance on the postcapsule administration of the most challenging cognitive test were both higher (p = .044 and p = .009, respectively) for the methylphenidate group than for the placebo group. CONCLUSIONS: Cognitive improvement among sleep-deprived young adults was not observed following methylphenidate administration. Benefits perceived by abusers may relate to increased confidence and sense of well-being, as well as to sympathetic nervous system stimulation. Moreover, methylphenidate administration results in physiologic effects that could be harmful to certain individuals.

Adult↗

Combination antiretroviral therapy improves psychomotor speed performance in HIV-seropositive homosexual men. Multicenter AIDS Cohort Study (MACS).

BACKGROUND: Combination antiretroviral therapy including protease inhibitors (combo+PI) is effective in suppressing systemic viral load in HIV infection, but its impact on HIV-associated cognitive impairment is unclear. OBJECTIVE: To determine whether psychomotor speed, a sensitive measure of impairment in HIV dementia, improves with combo+PI compared with other antiretroviral treatments. METHODS: A total of 411 HIV-seropositive (HIV+) homosexual men (with longitudinal neuropsychological testing) in the Multicenter AIDS Cohort Study and, in a separate analysis, 282 HIV+ homosexual men with psychomotor slowing at baseline were classified by treatment into four groups: antiretroviral naive (no antiretroviral medication treatment), monotherapy, combination antiretroviral therapy without protease inhibitors (combo-noPI), and combo+PI. We compared longitudinal performance on three tests of psychomotor speed: the Grooved Pegboard (GP) (nondominant and dominant hands), Trail Making Test B, and the Symbol Digit Modalities Test (SDMT). RESULTS: Relative to antiretroviral-naïve and monotherapy participants, on the GP nondominant hand test, combo+PI participants with abnormal baseline neuropsychological testing showed improved performance (difference = +0.63 standard deviation [SD], p = 0.02). For the SDMT, both combo+PI participants (difference = +0.26 SD, p = 0.03) and combo-noPI participants (difference = +0.29 SD, p = 0.01) with abnormal baseline neuropsychological testing improved compared with antiretroviral-naïve and monotherapy groups. CONCLUSION: Combo+PI and combo-noPI are associated with improved psychomotor speed performance in HIV+ homosexual men with abnormal neuropsychological testing.

Adult↗

Methadone dosage: patient characteristics and clinical correlates.

This paper summarizes data for 106 male opioid addicts which give evidence that there are demographic and clinical differences between groups of patients maintained in three ranges of methadone dosage (less than 35 mg, 36-59 mg, greater than 60 mg). At time of admission the Addiction Severity Index was administered. During the first month of treatment a routine battery of psychological tests--including the MMPI-168, 16PF, Shipley Institute of Living Scale, and Trail Making Test--was also administered. High-dose subjects were under greater emotional distress and experienced more anxiety (p less than .05), had more medical hospitalizations (p less than .05), and had been treated more frequently with psychoactive medications (p less than .05). They also had histories of greater use of barbiturates (p less than .001) and amphetamines (p less than .01). While in treatment they more frequently had urinalyses positive for illicit drugs during the first 6 months (p less than .05). Low-dose subjects had fewer friends (p less than .05). The 1-year program retention rates were found to be lower for the medium-dose group (p less than .05).

Adult↗