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PubMed1976

The identification of brain damage by an abbreviated form of the Halstead-Reitan Neuropsychological Battery.

In recent years there has been an increased interest in the development of neuropsychological tests that can diagnose accurately brain damage. The most successful of these test are represented in the Halstead-Reitan Neuropsychological Battery, which has been shown to be 90% or more effective in the diagnosis of brain damage. However, this battery is not available to many psychologists or clients because of its length, cost, and the considerable background required to use it properly. The present study tested 121 Ss (30 normal, 91 brain-damaged) to develop an abbreviated version of the battery that is relatively brief (1 hour) and inexpensive, but accurate. It was found by discriminant analysis that the abbreviated battery is capable of diagnosing brain damage equally as well as the full battery 93% of the time. The limitations and advantages of the abbreviated battery are discussed.

Adolescent↗
PubMed1985

A short screening device for identification of cerebral dysfunction in children.

Many psychologists have been interested in the development of a screening battery for cerebral dysfunction. The purpose of the present study was to identify a short screening battery, drawn from the Halstead-Reitan Battery, that had a high degree of accuracy in differential identification of brain-damage and normal children. Fifty brain-damaged children and 50 controls (age 9-14 years) were identified and subdivided into two groups of 25 children in each category. The data based on the first pair of groups (25 brain-damaged and 25 control children) were processed with a discriminant analysis with linear transformation of the results, and a weighted screening index was developed based on eight measures. This screening index had an accuracy rate of 92% in differentiating the brain-damaged subjects from the controls. The screening index then was applied to the validational groups (25 brain-damaged and 25 normal children), and an 86% accuracy rate was achieved. Computation of the screening index, which requires less than an hour of testing, is illustrated in this paper.

Adolescent↗
PubMed2005

Chemical shift magnetic resonance spectroscopy of cingulate grey matter in patients with minimal hepatic encephalopathy.

Minimal hepatic encephalopathy (MHE) is frequently diagnosed in patients with liver cirrhosis who do not show overt clinical cirrhosis-associated neurological deficits. This condition manifests primarily with visuo-motor and attention deficits. We studied the association between visuo-motor deficits and magnetic resonance spectroscopic parameters in cingulate grey matter and white matter of centrum semiovale in patients with liver cirrhosis. The data revealed an increase in the glutamate-glutamine/creatine ratio and a decrease in choline/creatine and inositol/creatine ratios in patients with liver cirrhosis. The analysis of the data showed that cirrhosis-associated deterioration of the visuo-motor function significantly correlates with a decrease in the choline/creatine ratio and an increase in N-acetylaspartate/choline in cingulate grey matter but not in the neighbouring white matter. Furthermore, the increase in the glutamate-glutamine/creatine ratio correlated significantly with the increase in the N-acetylaspartate/creatine ratio. These data suggest an association between altered choline, glutamate-glutamine and NAA metabolism in cingulate grey matter and symptoms of MHE, and underline the importance of differentiation between grey and white matter in magnetic resonance spectroscopic studies on patients with cirrhosis-associated brain dysfunction.

Aspartic Acid↗
PubMed2006

Cognitive dysfunction in advanced heart failure and prospective cardiac assist device patients.

BACKGROUND: Extended periods of hypoperfusion in an advanced heart failure (HF) places patients at high risk for neurobehavioral compromise, which has not been studied systematically. It is also not clear how intravenous inotropic therapy and mechanical cardiac assist devices (MCAD) affect cognitive function. METHODS: This prospective cross-sectional cognitive preliminary study evaluated 252 potential heart transplant candidates assessing functions in memory, motor, and processing speed. Patients were divided into three HF groups based on severity of disease: group 1 outpatients (n = 113), group 2 in-patients requiring inotropic infusion (n = 83), and group 3 inpatients likely requiring MCAD support (n = 56). Aggregate z-scores for memory, motor, and processing speed and independent samples t tests assessed intergroup differences on 13 cognitive measures. RESULTS: A broad pattern of cognitive impairment was observed within the advanced HF group; fewer deficits were found in group 1 outpatients and more severe deficits in group 3 MCAD subjects. A difference in motor functions was observed as the earliest abnormality, with group 3 showing significant changes compared with group 1. The most dramatic changes were seen in domain mental processing speed along with specific verbal and visual memory functions, which were slower in group 3 compared with groups 1 and 2. CONCLUSIONS: Cognitive deficits are common in advanced HF and worsen with increasing severity of HF. Appropriately designed and randomized studies will be needed to demonstrate if earlier MCAD implantation is warranted to arrest cognitive dysfunction and better postimplantation adaptation.

Adult↗
PubMed2002

Neuropsychological performance in schizotypal personality disorder: evidence regarding diagnostic specificity.

BACKGROUND: Individuals with schizotypal personality disorder (SPD) share cognitive deficits with schizophrenic patients, suggesting that these deficits represent a core feature of the schizophrenia spectrum. We investigated the neuropsychological profile in SPD patients compared with two comparison groups: healthy volunteers (HV) and patients who met criteria for another non-schizophrenia spectrum personality disorder (NSS). METHODS: We tested 48 DSM-III-R SPD patients, 22 NSS and 32 HV on a neuropsychologic battery that included the California Verbal Learning Test (CVLT), Trail Making A and B, the DOT test of working memory, the Stroop Color-Word Interference, the Paced Auditory Serial Addition Test (PASAT), the Wechsler Memory Scale Visual Reproduction Test (WMSV-R), and the Wechsler Adult Intelligence Scale vocabulary and block design. RESULTS: Normative standards for performance were created using the HV group. SPD patients performed significantly worse compared with HVs; specifically, SPD patients demonstrated impaired performance on the PASAT and the WMSV-R immediate and delayed recall compared to HV. Moreover, SPD patients were impaired in the PASAT and the WMSV-R immediate condition compared with the NSS group. The NSS patients did not differ from HV on any of the cognitive tasks. The interpersonal factor of the schizotypal symptoms inversely correlated with the PASAT score (r = -.32, p <.006). CONCLUSIONS: Compared with HVs, SPD patients demonstrate modest cognitive impairment. These differences reached statistical significance for the PASAT (an auditory working memory task), and the WMSV-R immediate and delayed recall (a learning-recall test). In contrast, performance of NSS patients did not differ from that of HVs. The types of deficits observed in SPD patients are qualitatively similar to but milder than those seen in patients with schizophrenia.

Adult↗
PubMed2006

The Concept Shifting Test: adult normative data.

The Concept Shifting Test (CST) is a newly developed Trail Making Type test that measures concept shifting and executive functioning. The purpose of the present study was to determine whether CST performance was affected by age, gender, educational level, or handedness and to establish the normal range of test performance. The CST was administered to a large sample (N = 1,794) of cognitively intact adults (age range 24 to 81 years). The results showed that CST performance was superior in women, decreased with age, and increased with level of education. Handedness did not affect CST performance. Normative data that are corrected for the influences of these demographical variables were established with a regression-based normative approach.

Adult↗
PubMed1983

Triazolam concentration-effect relationships in healthy subjects.

Triazolam was used to study the plasma concentration-effect relationship of a benzodiazepine because it has a very short plasma t1/2. A standard hypnotic dose of 0.25 mg was given by mouth to six healthy subjects, and blood samples were drawn when the subjects had to perform a battery of psychologic tests. Only the digit-symbol substitution test, the card-sorting test according to numbers, and the visual analog scale (energetic-lethargic) gave significant results. Analysis of the concentration-effect relationship in individuals indicated a wide scatter of the data. Mean values revealed a trend for a learning effect in the card-sorting test. The results are consistent with the hypothesis that triazolam is well suited for a study of concentration-effect relationships, but better psychologic tests would be desirable.

Adult↗
PubMed1996

Cognitive functioning in patients with chronic fatigue syndrome.

A comprehensive battery of neuropsychological tests was administered to 35 outpatients suffering from Chronic Fatigue Syndrome (CFS). They were compared to 33 normal controls matched for age, gender, intelligence, and education. The patients displayed psychomotor slowing and impaired attention. The learning rate of verbal and visual material for patients with CFS was slower, and delayed recall of verbal and visual information was impaired. Because there was a high variability in cognitive impairment within the CFS group, it would be inappropriate to generalize results to the entire CFS population. Two neuropsychological variables indicating aspects of psychomotor performance and verbal memory were found to discriminate best between patients and controls.

Adult↗
PubMed1976

The relationship between independent neuropsychological and neurological detection and localization of cerebral impairment.

Seventy-eight patients referred to the Neurology Service of St. Louis Veterans Administration Hospital were independently diagnosed by a neurologist and a psychologist. The latter utilized the Halstead Neuropsychological Test Battery, a series of tests known to be a sensitive indicator of the presence and localization of cerebral impairment. The following diagnostic categories were used: no brain damage, localized left hemisphere impairment, localized right hemisphere impairment, diffuse, diffuse with greater left hemisphere impairment, and diffuse with greater right impairment. Diagnostic agreement was present in all but five cases. Statistical analyses of data from the Halstead Battery supported the clinical analyses in terms of indicating both the presence and, to a lesser degree, the location of organic impairment. Advantages of describing the consequences of organic impairment in objectively measured, quantifiable behavioral terms were discussed and an illustrative case history was presented. It was concluded that psychological test data are a clinically useful supplement to neurological diagnostic information.

Adult↗
PubMed1983

Effects of age of onset of partial and generalized seizures on neuropsychological performance in children.

Neuropsychological performance data from 106 children with epilepsy were evaluated to determine the effects of seizure type and age of onset. The performance of children with partial seizures (N = 49) was similar to that of children with generalized seizures (N = 57). Only one of 13 tests showed a significant difference between groups, with children with partial seizures performing better on that test. The effects of age of onset were also similar in the two seizure groups. Children whose seizures began before the age of 5 years performed significantly worse than children whose seizures began later on four measures (Verbal IQ, Performance IQ, Trails A, and Trails B) and performed more poorly, but not significantly so, on the other nine measures in the battery. A breakdown of the partial group into simple partial, complex partial, and secondarily generalized partial seizure groups found a significant difference between the groups on only one variable, but there were suggestions in the data that the performance of the partial secondarily generalized group was worse than the other two groups. These results indicate that variables associated with an early onset of seizures, regardless of type, place a child at risk for cognitive dysfunction.

Age Factors↗
PubMed2003

Assessment of cognitive recovery following sports related head trauma in boxers.

OBJECTIVE: To prospectively examine recovery of cognitive function within one month following subconcussive sports related head trauma. DESIGN: A prospective study of New York State licensed professional boxers who underwent testing of cognitive functioning before and after (within days, one week, and one month) a professional bout. SETTING: Male professional athletes recruited from the New York State Athletic Commission and local boxing gyms. PARTICIPANTS: Twenty-six licensed professional boxers were enrolled in the protocol. Data is presented on the 18 participants who completed testing on at least three of the four time points. INTERVENTIONS: Serial neuropsychological assessment before and after the athletes engaged in competition. MAIN OUTCOME MEASURES: Neuropsychological measures of cognitive functioning, including new learning and memory, information processing speed, and mental flexibility. RESULTS: A series of repeated measures MANOVAS revealed significant within subject differences across testing on complex information processing and verbal fluency. Post hoc analyses indicated significant differences between time 1 (baseline) and time 4 (one month post), with scores one month following the bout indicating significantly improved performance. Memory scores did not change significantly across testing; however, prior boxing exposure measured by total number of professional bouts was associated with poorer memory performance. CONCLUSIONS: Cognitive testing one month following participation in a professional boxing bout yielded scores suggestive of recovery to a level above the baseline. We conclude that baseline assessment taken during periods of intense training are likely confounded by other pre-bout conditions (i.e., sparring, rapid weight loss, pre-bout anxiety) and do not represent true baseline abilities. Instability of performance associated with mild head injury may complicate the interpretation of post-injury assessments. Practice effects may also confound the interpretation of serial assessments, leading to underestimation of the effects of sports related head trauma. Poorer cognitive performance was evident during the presumed recovery period in boxers with greater exposure to the sport (>12 professional bouts). This finding is consistent with reports of a cumulative effect of repetitive head trauma and the subsequent development of chronic traumatic brain injury. These data have implications for assessing recovery of function following head injury in players of other contact sports as well as determination of return-to-play following an injury.

Adult↗
PubMed1975

The effect of early versus late onset of major motor epilepsy upon cognitive-intellectual performance.

Performance on the Wechsler Adult Intelligence Scale and Halstead neuropsychological measures were investigated in two groups of adult subjects with major motor epilepsy of early (0 to 5 yr) and later (17 to 50 yr) onset, and in two groups with early and later onset of brain damage without epilepsy. The two groups with early onset earned poorer scores on most tests than did the two groups with later onset. The findings suggest an adverse effect of cerebral dysfunction of early onset, whether accompanied by major motor seizures or not. Subjects with early onset of major motor seizures scored significantly lower on 9 of 14 measures than subjects in any other group, none of which showed significant intergroup differences in the dependent variables employed. The results support the conclusion that early age of onset of major motor seizures is more apt to result in impairment of mental abilities in adult life than is later onset of seizures or early or late onset of brain damage uncomplicated by epilepsy.

Adolescent↗
PubMed2001

Rehabilitation of Balint's syndrome: a single case report.

Very little research has been done in the area of rehabilitation of the visual perceptual deficits observed after Balint's syndrome. This syndrome is characterized by difficulties with visual scanning, dysmetria secondary to visual perceptual deficits, and an inability to perceive more than 1 object at a time. This article describes the effects of a neuropsychological treatment protocol on a 23-year-old patient who suffered a fat embolism involving the territory of the posterior cerebral arteries. A neuropsychological evaluation carried out 12 months after the brain embolism disclosed Balint's syndrome, alexia without agraphia, visual agnosia, prosopagnosia, and memory impairments. The rehabilitation protocol included both visuoperceptual retraining and a functional program designed to provide rehabilitation in contexts that were meaningful to the patient. After 1 year of treatment, a second neuropsychological evaluation was carried out. Significant improvement was demonstrated in terms of both objective testing and the return of an integrated and productive lifestyle.

Adaptation, Psychological↗
PubMedDate not supplied

Neuropsychiatric assessment of liver transplantation candidates: delirium and other psychiatric disorders.

Forty consecutive liver transplantation candidates underwent a standard psychiatric evaluation as part of a multidisciplinary preoperative examination. Psychiatric diagnoses were determined using DSM-III criteria and correlations between the psychiatric diagnoses and the results of bedside cognitive examinations, biochemical measures of hepatic function, and EEG's were made. Half of the patients could not be given a specific psychiatric diagnosis despite the fact of their being in terminal stages of a severe medical illness and being stressed by the uncertainty of whether they would be accepted for possible liver transplantation. Of the twenty patients given a psychiatric diagnosis, 60 percent were found to be delirious and 35 percent had an adjustment disorder. Delirium was associated with a serum albumin less than 3.0 g/dl, grades 1 through 3 EEG dysrhythmias, a Mini Mental State score less than 24 or impairment on Trailmaking Tests. In addition, discriminant analyses were performed to determine which batteries of tests best differentiated the delirious patients. A unique pattern of psychosocial stressors was noted in these patients where the severity of overall stress and of occupational dysfunction was high in most, yet family and social relationships were reported as less affected.

Delirium↗