Results Of Neuropsychological Assessment Research Articles

School future of teenagers with a severe brain injury after a hospitalization at the Centre Médical et Pédagogique pour Adolescents in Neufmoutiers-en-Brie France

To study the school progress of teenagers with a severe brain injury at the end of their inpatient stay at rehabilitation center of the Centre Médical et Pédagogique pour Adolescents . All of them have benefited from both schooling and rehabilitation at the same time. Only patients aged between 12 and 17 years and hospitalized between 2012 and 2017 were included in the study. Demographic data (age, sex), initial Glasgow coma scale (GCS), duration of coma, duration of intubation, time between accident and hospitalization in rehabilitation, duration of stay in rehabilitation, neuropsychological assessment results, school level prior to the brain injury and at the end of the hospitalization were noted. Eighty-six brain injury cases were examined. Only 25 patients were included in the study among them 17 males and 8 females. The average age at admission was 15.8 ± 1.7 years. The average time between accident and hospitalization in rehabilitation was 145 ± 269 days. The average duration of stay in rehabilitation was 260 ± 197 days. The average GCS was 5.6 ± 1.8. The average duration of coma was 9.9 ± 4.1 days. The average duration of intubation was 14 ± 6 days. Twenty teenagers have resumed their school education. Ten students have returned to pre-traumatic brain injury level, four patients have increased to a level higher than before the accident. Two patients were redirected to apprentiship studies, two referred to Training and Orientation Assessment Unit and two have resumed their education with additional support. Teenagers with severe brain injury require multidisciplinary rehabilitation and appropriate school education. The follow up of this population should be extended beyond hospitalization in a rehabilitation center.

Нейропсихологическое исследование при судебно-психологической экспертной оценке сделкоспособности

Relevance of the research consists in consideration the forensic neuropsychological assessment in Russia. The new problem of use of neuropsychological methods in complex forensic psychological and psychiatric examination and forensic psychiatric examination is studied. The article presents the results of neuropsychological assessment of the persons, who could not understand the meaning of their actions, regulate and control them at the time of the transaction. The persons, who could not understand the meaning of their actions, regulate and control them at the time of the transaction, characterized by the presence of a decrease of the ability to control one's actions and the of spatial functions, the neuropsychological syndrome of memory and consciousness. The persons who were able to make decisions at the time of the transaction, such features were less. The importance of the use of neuropsychological methods in forensic examination was established.

OBSERVATIONAL LONGITUDINAL STUDY OF BRAIN MRI CHARACTERISTICS AND CLINICAL MEASURES OF FUNCTION AND DISEASE PROGRESSION IN PATIENTS WITH DEMENTIA

Longitudinal brain magnetic resonance imaging (MRI) has shown that changes in white matter and medial temporal atrophy are biomarkers of Alzheimer's disease (AD); however, the correlation with MRI findings and progression of AD has not been fully established. In this prospective, 12-month observational study, consecutive dementia outpatients were recruited from 29 centers across South Korea. Baseline assessments included confirmation of AD (brain MRI data), cognitive function, dementia severity, activities of daily living (ADL), and AD medication use. Follow-up assessments were conducted at 6 and 12 months. Among the 899 enrolled patients with dementia, 748 were diagnosed with AD based on MRI assessment; 654 (87%) were using AD medications. In AD patients, changes in cognitive deficit were not correlated with changes in white matter on brain MRI and changes in IADL, but not other cognitive function, correlated with the changes in hippocampal atrophy on brain MRI. These results were more prominent in untreated group. Positive drinking status and higher CDR score were correlated with more severe white matter changes and age, dementia family history, physical exercise, and the results of neuropsychological assessment were correlated with hippocampal atrophy. We confirmed that there is a relationship between the loss of hippocampal volume in MRI and changes in IADL decline with AD patients, especially untreated group, and showed that patient's lifestyle behaviors are more important than non-modifiable factors in the progression of the MRI findings in this study.

Neuropsychological Impairments in Hematological Malignancies Patients Expected to Allo-BMT

Introduction: Hematological malignancies treatment is associated with various side effects, some of them are inversive, other - not. The psychiatric disorders including deficits in cognition functions frequently occur (Vybornykh et al. Int J. of Hematol Res 2016; 2 (1) 103-114). Cognitive impairments (for example, in attention, memory domains) in pre and post bone marrow transplantation (BMT) period are common disabling disturbance, associated with further decrease in quality of life among hematological malignancy patients. Neuropsychological impairment understanding can facilitate to patients future rehabilitation. It is very important to study of existing cognitive impairments in the pre-allo-BMT period.Aim: To define the main neuropsychological impairments before BMT.Materials: 32 patients with various hematological malignancies in pre-allo-BMT period with multiple myeloma (MM) (n=16), acute lymphoblastic leukemia (ALL) (n=10), acute myeloid leukemia (AML) (n=6). Mean age of the 32 study participants (13 men and 19 women) was 31.6 (+-8.5 years). Neuropsychological assessment was made by using Luria neuropsychological battery, also self-reported questionnaire was used. Statistical analyzes were performed using the licensed package Statistica for Windows 5.5.Results and discussion: In 75% (n=24) patients observed decrement (15.7% population norms) in one or more cognitive domain (more 1-1.5 st.dev.). Results in attention, memory, motor skills and complex executive function tests were most likely to be decreased (р. = 0.01). 1-1.5 st.dev. was denoted as mild deficiency and 2-3 st.dev denoted as moderate to total deficiency; within this criteria: 75% (n=24) of participants had at least mild deficits in psychomotor skills, 50 %(n=16) moderate to total (including impairment in kinetic and kinesthetic praxis). 37,5% had deficits in executive function (n=7 - mild and n=5 - moderate to total impairment). 87% (n=28) had deficits in verbal memory (n=10 mild and n=18 moderate to total). 34% (n=11) in attention (n=4 - mild, n=7 - moderate to total). Also it was found the significant correlation (р=0.05) between patients cognitive impairments self-reports and results of neuropsychological assessment which confirmed deficits. In 25% (n=8) patients were no observations of discernible symptoms of neuropsychological impairments. Therefore on the basis of qualitative and quantitative analysis of neuropsychological approach and results of neuropsychological assessment can be supposed that patient’s cognitive impairments probably connected with deficits in basal structures and left hemisphere.Conclusion: Memory, attention, motor skills and complex executive functions are most damaged cognitive domains (probably depends on preceded chemotherapy and some others risk factors) in patients with hematological malignancies before BMT, but their intimate investigation can help in prospective neuropsychological rehabilitation and socialization of patients, so further research of cognitive impairments in dynamics needed to be done. DisclosuresNo relevant conflicts of interest to declare.

Patients with essential tremor can have manual dexterity and attention deficits with no impairments in other cognitive functions.

Essential tremor (ET) was long believed to be a monosymptomatic disorder. However, studies have evidenced structural changes and attention is now being focused on non-motor symptoms. The objective of the study is to describe and compare ET patients with control groups according to their cognitive functions, and secondarily, to compare their sociodemographic characteristics and other clinical features. All participants were assessed using the Fahn-Tolosa-Marin Tremor Rating Scale for the severity of tremor; a neuropsychological assessment battery and a screening questionnaire for mood and anxiety symptoms. There were no significant age and gender differences between all groups. As for neuropsychological assessment results, a significant difference was found only in the Pegboard test. We also found a significant negative correlation between a poorer cognitive test results and disease severity and a significant differences regarding depression or anxiety symptoms in patients with ET. The study results suggest that patients with ET have impaired manual dexterity and attention.

Proton Magnetic Resonance Spectroscopy: Relevance of Glutamate and GABA to Neuropsychology.

Proton Magnetic Resonance Spectroscopy (MRS) has been widely used to study the healthy and diseased brain in vivo. The availability of whole body MR scanners with a field strength of 3 Tesla and above permit the quantification of many metabolites including the neurotransmitters glutamate (Glu) and γ-aminobutyric acid (GABA). The potential link between neurometabolites identified by MRS and cognition and behavior has been explored in numerous studies both in healthy subjects and in patient populations. Preliminary findings suggest direct or opposite associations between GABA or Glu with impulsivity, anxiety, and dexterity. This chapter is intended to provide an overview of basic principles of MRS and the literature reporting correlations between GABA or Glu and results of neuropsychological assessments.

Complementarity of visual and voxel-based FDG-PET analysis to detect MCI-like hypometabolic pattern in elderly patients with hypertension and isolated memory complaints.

18F-FDG PET can be used to aid in the diagnosis of Alzheimer's disease (AD) and clarify the diagnosis and prognosis of patients with mild cognitive impairment (MCI). To compare the results of a quantitative analysis of FDG-PET brain images to a standard visual analysis (SVA) with regards to the detection of MCI-like hypometabolic pattern in elderly patients with hypertension and subjective, isolated memory complaints. FDG-PET brain was performed in 71 patients (mean age, 76.4 ± 5.1 years; women, 53.5%). Images were analyzed for the presence of an MCI-like hypometabolic pattern using an SVA by 2 physicians and a voxel-based statistical procedure (statistical parametric mapping [SPM]) that compared each patient's images to normal reference samples from 19 elderly individuals obtained using the same PET camera. The reliability of these analyses was evaluated according to neuropsychological assessment results, including the Grober & Buschke Free and Cued Selective Reminding Test, and a combined analysis by a neuropsychologist. An MCI-like hypometabolic pattern was documented in 5 patients (7%) by SVA and 7 patients (10%) by SPM analysis; however, only 2 of these patients were selected by both methods. The group characteristics of the 7 patients identified by the quantitative method were consistent with the MCI pattern, which included a higher rate of abnormal GB-FCSRT in Free Recall (57% vs. 9%, p < 0.05) or in Total Recall (29% vs. 8%, p < 0.05) when compared with other patients. In contrast, the group identified by SVA did not exhibit these characteristics. A combined visual and quantitative analysis improves the diagnostic accuracy to detect an MCI-like hypometabolic pattern in elderly patients with hypertension and subjective, isolated memory complaints.

The Case of "Judith": A Neuropsychologist's Perspective

Executive Functioning (EF) deficits may be the most catastrophic form of brain injury, as they alter one’s personality and sense of self while impeding the ability to make use of rehabilitation, compensatory strategies, psychotherapy and social support. The injury itself can produce a loss of appreciation for the deficits, as well as depression, apathy and a lack of empathy. Although EF deficits can be nuanced, individuals with EF deficits are often presumed incapable of benefiting from higher order interventions. Ward and Hogan’s (2015) case study of Judith effectively contradicts this assumption. While this case does not offer traditional neuropsychological assessment results, it highlights how the value of such measures rests in their ecological validity. The years of psychotherapy and intervention that Judith underwent offer ample ecological data and an opportunity to comment on the neurobiological aspects of Judith’s injury and recovery beyond the assessment setting.

Utility of Frontal Assessment Battery in detection of neuropsychological dysfunction in Richardson variant of progressive supranuclear palsy

Progressive supranuclear palsy is characterized by motor, cognitive and behavioral features. In Richardson's syndrome of PSP (PSP-RS) executive dysfunction is quite prominent. Frontal Assessment Battery (FAB) is one of the most popular screening tests in the differential diagnosis of bradykinetic rigid syndromes. The study aimed at analyzing FAB subscores in relation to neuropsychological assessment results. Twenty patients with PSP-RS (12 with probable and eight with possible diagnosis) participated in the study. Sixteen PSP-RS patients scored below 15 on FAB. Among four patients having scored above cut-off (12 points) on FAB, two demonstrated both executive and language deficits, while the other two presented with only selective executive deficits on comprehensive neuropsychological evaluation. FAB is a useful screening measure in PSP, but it may not detect subtle executive deficits. Moreover, language performance seems to contribute significantly to FAB scores. Thus, FAB should be treated as “frontal” rather than “executive” screening task, in line with its name.

Cognitive and electrophysiological characteristics of children with specific language impairment and subclinical epileptiform electroencephalogram

The current study is a preliminary examination of cognitive profiles and cortical distribution of the spectral power of different electroencephalogram (EEG) rhythms in children with specific language impairment and subclinical epileptiform discharges. Although a number of empirical studies point to higher incidence of abnormal EEGs in children with specific language impairment, only a few studies were found examining electrophysiological characteristics, such as locus of discharges and connections with cognitive functioning in this population of children. The sample included 12 children with specific language impairment (SLI) and abnormal EEG who underwent testing of cognitive functioning using the Wechsler Intelligence Scale for Children (WISC). The control sample included 13 children with specific language impairment and regular EEG. Results point to lower scores on several subtests of the performance scale for children with abnormal EEG than for the group with regular EEG. Detailed EEG analysis of cortical distribution of the spectral power of different EEG rhythms partially confirms the results of neuropsychological assessment, pointing to abnormal function of frontal and temporal regions. Higher values of spectral power of the delta brain rhythm in frontal regions are associated with lower results on the WISC performance scale. Results are discussed in the context of subgroups of the population of children with SLI.

Anti‐Yo mediated paraneoplastic cerebellar degeneration in the context of breast cancer: a case report and literature review

Paraneoplastic syndromes are of interest to psycho-oncologists because they may be misdiagnosed initially as primary psychiatric disorders and can have profound neuropsychiatric and psychosocial sequelae. Paraneoplastic cerebellar degeneration (PCD) is a paraneoplastic syndrome which destroys Purkinje cells of the cerebellum and causes trunk and limb ataxia, dysarthria, diplopia, and vertigo, which often precede the diagnosis of cancer. Anti-Yo PCD is a devastating syndrome that significantly worsens prognosis in terms of functional ability and survival. We present the case of a woman with progressive cerebellar deficits, which were misdiagnosed for several months before breast cancer and anti-Yo antibodies were discovered. PCD may be misdiagnosed as a primary psychiatric disorder. Results of neuropsychological assessment in this case found subtle attentional dysfunction but relatively preserved cognitive functioning in other domains. The literature relating to PCD and psychiatric manifestations of cerebellar disease are reviewed. The limitations of our current understanding of non-motor cerebellar function are highlighted, asserting the need for further study in this area.

Seizure-free and neuropsychological outcomes after temporal lobectomy with amygdalohippocampectomy in pediatric patients with hippocampal sclerosis

Temporal lobe epilepsy is an uncommon clinical syndrome in the pediatric population. The most common underlying pathologies include low-grade gliomas, cortical dysplasia, and, less commonly, hippocampal sclerosis (HS). There is a paucity of data on neuropsychological and seizure-free outcomes in these patients after temporal lobectomy. In this study, the authors reviewed their seizure-free and neuropsychological outcomes after temporal lobectomy for pediatric HS. The authors retrospectively reviewed the medical records of pediatric patients with HS who underwent anterior temporal lobectomy and amygdalohippocampectomy between 1998 and 2011 at the Cleveland Clinic. Results of neuropsychological assessment before and after surgery and seizure-free outcome at last follow-up were obtained. Forty-five patients met the inclusion criteria. Thirty-four (76%) patients had pathology of HS alone and 10 (22%) had HS and cortical dysplasia. The mean duration of follow-up was 60.2 months. Eighty-four percent of patients had postoperative Engel Class I or II outcomes. Neuropsychological outcomes remained unchanged or minimally improved postoperatively. Seizure-free outcomes in pediatric HS are similar to historical rates in adult HS. Neuropsychological assessments remain stable after temporal lobectomy. Standard temporal lobectomy should be considered in pediatric patients with medically intractable epilepsy secondary to HS.

Early biomarkers for post-stroke cognitive impairment

The aim of this study was to investigate whether some biomarkers could predict cognitive impairment after stroke. One hundred fifty-two first-ever stroke patients were recruited within 6-72 h after the onset of symptoms. Blood was drawn within 1 h after admission for determining biomarkers. Cognitive function was assayed 2 weeks after stroke. The patients were divided into four groups: stroke, vascular cognitive impairment with no dementia (VCIND), vascular dementia (VaD), and mixed dementia (MD). Forty healthy subjects were used as controls. The results indicated that lower soluble receptor levels for advanced glycation end products (sRAGE) and higher β-secretase enzyme (BACE1) and neprilysin (NEP) levels were found in the VCIND, VaD, and MD groups. In addition, the percentages of ε3/ε4 genotypes and ε4 alleles in the VCIND, VaD, and MD groups were higher than in the stroke group. Correlation analysis determined that sRAGE, BACE1, and NEP were significantly related to the results of neuropsychological assessments. Logistic regression analysis, however, suggested that only sRAGE and BACE1 changed ahead of cognitive impairment after stroke. In conclusion, only BACE1 and sRAGE, not NEP or APOE genotypes, may be biomarkers diagnosing post-stroke cognitive impairment.

“You Are a Cannibal”—A Case Report: Psychoanalysis of an Adolescent Boy with Bifrontal Lesions (Part 1: The First Year)

Accompanying a male adolescent out of the darkness of being unable to differentiate between inside and outside, between being a boy or a girl—the psychoanalytic journey is described from both a clinical and a theoretical perspective. Based on Sigmund Freud’s metapsychology, psychoanalytic concepts such as regression, defense mechanisms of the ego such as projection and introjection, and features of the primary process are illuminated. Special emphasis is placed on changes in body schema and the role of language in reality testing. The therapeutic process cannot be understood without reference to the psychoanalytic concept of the ego and its early development. Using neuroimaging evidence, results of neuropsychological assessment, and excerpts of the ongoing therapy sessions, the pieces of the boy’s history are put together alongside the reconstruction-surgery of the frontal cranial bones.

Malingering or expected deficits? A case of herpes simplex encephalitis

ABSTRACT This study describes a patient with herpes simplex encephalitis. Brain MRI showed the expected finding of medial temporal damage. Neuropsychological assessment results were consistent with the location of damage, with profound memory impairment and mildly impaired naming, but normal visuospatial and executive skills. The patient also showed a typical testing pattern of insufficient effort and possible malingering, which was concerning as she was seeking disability compensation. In spite of this, we chose to place greatest weight on the finding of deficits consistent with the type, location, and severity of brain damage, considering this to be true cognitive impairment.

The Effects of Gender and a Co-occurring Depressive Disorder on Neurocognitive Functioning in Patients with Alcohol Dependence

The present study aims to examine neuropsychological impairments by comorbidity and gender among patients with alcohol dependence. The study sample is comprised of 123 subjects who fulfilled a Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV) diagnosis of alcohol dependence from January 2006 to December 2007. Subjects were asked to complete the following psychological tests: the Barratt Impulsivity Scale (BIS), Wechsler Adult Intelligence Scale, Wechsler Memory Scale and Color Trails Test. We compared the results of neuropsychological assessments based on two types of classifications: people with comorbid depression and people without comorbidity; females and males. The immediate visual memory and the BIS scores in patients with comorbid depression were significantly different from the scores in patients without comorbidity. In addition, females performed significantly poorer on the Working Memory Index than males and had a later age of regular drinking. Further investigation of the mechanism associated with the gender difference on cognition and exploration of the temporal relationship between alcohol dependence and depressive disorder on the cognitive aspect is needed.

Decompressive surgery in malignant dural sinus thrombosis: report of 3 cases and review of the literature

Cerebral venous and dural sinus thrombosis (CVDST) is a rare cause of stroke in young and middle-aged adults. When the clinical course is complicated by uncontrollable intracranial hypertension and brainstem compression due to edema or cerebral hemorrhage, the prognosis is poor. The authors evaluated the therapeutic role of surgical decompression in patients with clinical signs of impending herniation. Cerebral venous and dural sinus thrombosis complicated by impending brain herniation a very rare, life-threatening but potentially treatable clinical condition. Three patients with pupillary signs of transtentorial herniation due to brain edema and hemorrhage caused by CVDST (superior sagittal sinus in 1 patient and transverse and sigmoid sinus in 2 patients) were treated surgically. The intervention consisted of clot removal, infarcted tissue resection, and frontotemporoparietooccipital craniectomy with duraplasty. According to the Glasgow Outcome Scale, 2 patients were classified as having good recovery and 1, moderate disability. The results of neuropsychological assessment were normal in 2 patients and demonstrated a partial neuropsychological deficit (neglect) in the other. Surgery may be indicated in selected patients with CVDST whose condition is deteriorating because of intractable intracranial hypertension and impending brain herniation.

Subjective complaints compared to the results of neuropsychological assessment in patients with epilepsy: The influence of comorbid depression

The aim of the study was to compare subjective complaints of epilepsy patients with objective results of neuropsychological assessment and to investigate the possible influence of depression on self-reported complaints. 62 patients from the neurology clinic were included in the study. They were asked to fill the subjective complaints questionnaire, Beck Depression Inventory and a series of neuropsychological tests. The results indicated that self-reported cognitive complaints are not strongly associated with objective tests of different cognitive performance measures. We conclude that the discrepancy between subjective and objective cognitive functioning does not only affect the area of memory but a wide range of cognitive domains. Depression is an important factor influencing the level of different subjective complaints.

Neuropsychologie in der Psychiatrie – Möglichkeiten und Probleme

Neuropsychology is becoming increasingly important in psychiatric settings. A major aspect of clinical neuropsychology in this area is the assessment of cognitive functioning. Cognitive deficits are common in patients with psychiatric disorders. An accurate analysis of impairments can help to develop treatment strategies that fit the individual's specific needs. However, results of neuropsychological assessments have to be interpreted cautiously in psychiatric patients, the extent to which specific cognitive dysfunctions can be explained as a result of abnormalities in brain structure and specific functional impairments is often exaggerated.

Accuracy of Clinical Neuropsychological Versus Statistical Prediction in the Classification of Seizure types

Many studies have reported on the pattern of neuropsychological test performance across varied seizure diagnosis populations. Far fewer studies have evaluated the accuracy of the clinical neuropsychologist in formulating an impression of the seizure diagnosis based on results of neuropsychological assessment, or compared the accuracy of clinical neuropsychological judgment to results of statistical prediction. Accuracy of clinical neuropsychological versus statistical prediction was investigated in four seizure classification scenarios. While both methods outperformed chance, accuracy of clinical neuropsychological classification was either equivalent or superior to statistical prediction. Results support the utility and validity of clinical neuropsychological judgment in epilepsy treatment settings.