Results Of Neuropsychological Evaluation Research Articles

H - 13 Examining the Cultural Sensitivity of a Novel Neuropsychological Assessment in Distinguishing between Cognitively Unimpaired (CU) and Amnestic Mild Cognitive Impairment (aMCI) in Hispanic Older Adults.

Common neuropsychological measures are not sensitive in capturing early cognitive changes associated with prodromal Alzheimer's Disease (ad) and vary across cultural groups. The Cognitive Stress Test (CST) is a novel assessment with high levels of sensitivity and specificity that measures maximum learning, proactive interference (PSI), retroactive interference, and the ability to recover from PSI (FrPSI). Authors evaluated the utility of the CST in distinguishing between aMCI versus CU Hispanic older adults. 18 aMCI and 15 CU older adults (mean age = 73.06; SD = 7.94, 42.4% male) were compared using the CST. Participants were categorized into the aforementioned groups using the Clinical Dementia Rating and results of neuropsychological evaluation. CST was not used in categorization to avoid circularity. CST includes the presentation of 18 target words from two semantically related wordlists (occupations, household items, and transportation) and assesses FrPSI over repeated trials. Data was analyzed utilizing an ROC curve to measure differences between CU and aMCI. The ROC curve demonstrated an area under the curve of 0.92, indicating that PSI was significant in differentiating participants. Findings suggest that PSI may be an early feature of aMCI groups who are at higher risk of progression to clinical ad. The CST was deemed to be an effective and culturally sensitive memory measurement tool among Hispanic older adults. In future studies, this paradigm may be particularly useful in deconstructing cognitive processes that can be compared to structural and functional MRI, amyloid and tau PET imaging, and emerging plasma biomarkers of ad.

Pain in the Context of Virtual Neuropsychological Assessment of Older Adults.

Pain and cognitive impairment are prevalent and often co-occur in older adults. Because pain may negatively affect cognitive test performance, identification of pain in the context of neuropsychological evaluation is important. However, pain detection based on self-report presents challenges, and pain is often under-detected in this population. Alternative methods (e.g., video-based automatic coding of facial biomarkers of pain) may facilitate pain identification and thus enhance interpretation of neuropsychological evaluation results. The current study examined pain in the context of virtual neuropsychological assessment in 111 community-dwelling older adults, first seeking to validate the use of software developed to automatically code biomarkers of pain. Measures of pain, including self-report of acute and chronic pain and automatic coding of pain, were compared while participants completed neuropsychological testing. Self-reported pain was negatively associated with poorer performance on a measure of executive function (both acute and chronic pain) and a global cognitive screening measure (acute pain only). However, self-reported acute and chronic pain did not correlate significantly with most neuropsychological tests. Automatic coding of pain did not predict self-report of pain or performance on neuropsychological tests beyond the influence of demographic factors and psychological symptoms. Though results were largely not significant, correlations warrant further exploration of the influence of pain on neuropsychological test performance in this context to ensure that pain does not influence test performance in individuals with higher levels of pain and in other samples.

Self-perception of cognitive functions in patients with neurological impairments as measured against a translated Cognitive Change Index.

The primary purpose of the study was to compare the results of neuropsychological assessments with results obtained using a translated Cognitive Change Index (CCI) on patients with diagnosed brain pathology. Our study included 54 patients diagnosed with neurologic pathology (stroke, TBI, or brain tumor) at the University Rehabilitation Institute Soca (average age = 51 years, SD = 15 years). The results of neuropsychological evaluations and anamnestic data were also obtained for the clinical subsample. Confirmatory factor analysis of the translated CCI performed on responses of 151 normative elderly participants supported a one-factor structure of the questionnaire. Cronbach's α was 0.77 in the clinical sample. A significant correlation was found between lower scores for attention and visual abilities using objective measurement tools and a person's self-assessment of impairment in their own cognitive functions (score on CCI). Individuals can perceive that their attention and visual abilities are impaired when those abilities also score low in diagnostic tests.

Factors Influencing Post-Stroke Cognitive Impairment in Patients with Type 2 Diabetes Mellitus.

ObjectiveType 2 diabetes mellitus (T2DM) and ischemic stroke, which are common diseases among older people, are closely related to cognitive impairment. This study aims to investigate the influencing factors of post-stroke cognitive impairment (PSCI) in patients with T2DM.MethodsWe enrolled 161 patients with T2DM who experienced acute ischemic stroke and were hospitalized in the Department of Neurology, Jinan Central Hospital, Shandong, China. Cognitive function was evaluated with the Montreal Cognitive Assessment scale. According to the results, patients were divided into three groups—the cognitively normal group, mild cognitive impairment group, and severe cognitive impairment group. We analyzed general demographic data, laboratory information, imaging data, the results of neuropsychological evaluation, and clinical features as well as influencing factors of PSCI in these patients and established a prediction model.ResultsThe three groups of patients were significantly different in terms of age, education level, course of diabetes mellitus (DM), recurrent cerebral infarction (RCI), and other factors. RCI, course of DM, and glycated hemoglobin (HbA1c) were independent risk factors of PSCI in patients with T2DM, with odds ratio (95% confidence interval): 7.17 (2.09, 30.37), 5.39 (2.40, 14.59), and 3.89 (1.66, 10.04), respectively, whereas female, senior high school, serum albumin were protective factors: 0.28 (0.07, 0.95), 0.05 (0.01, 0.21), 0.20 (0.08, 0.42), respectively. Furthermore, we constructed a prediction model using sex, age, education level, RCI, DM course, HbA1c and serum albumin and obtained a receiver operating characteristic (ROC) curve. The area under the ROC curve is 0.966, suggesting the significant association of these influencing factors with PSCI in patients with T2DM.ConclusionIn this study, the occurrence of PSCI in patients with T2DM was related to RCI, course of DM, and HbA1c, among other factors. Attention to influencing factors is needed in these patients for early diagnosis and timely intervention of cognitive impairment.

Vagus nerve stimulation for drug-resistant epilepsy induced by tuberous sclerosis complex

ObjectiveThis study investigated the dynamic and long-term efficacy of vagus nerve stimulation (VNS) in patients with drug-resistant epilepsy (DRE) induced by tuberous sclerosis complex (TSC). In addition, the impact of VNS on cognition and emotion after a one-year follow-up was evaluated. MethodsA total of 17 patients diagnosed with DRE induced by TSC were retrospectively recruited between 2008 and 2019. Dynamic changes in seizure frequency were observed in the responders (≥50% reduction of seizure frequency at last follow-up) and non-responders. Clinical characteristics and seizure outcomes were comprehensively analyzed to determine factors associated with seizure outcomes. The Wechsler intelligence scale was applied in a subgroup of six pediatric patients, whereas the Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were assessed in a subgroup of nine patients to determine the impact of VNS therapy on cognitive performance and emotional state. ResultsThe follow-up duration for the 17 patients who underwent VNS treatment ranged from 0.5 to 10 years (mean ± SD: 4.1 ± 3.2 years). Monthly seizures decreased significantly from three months to four years post-treatment (p < 0.05). At the last follow-up, 70.6% of the patients achieved at least a 50% reduction in seizure frequency, and three patients were completely seizure free. Comparatively, non-responder patients experienced deterioration of seizure frequency after the first year. Notably, after one-year follow-up the mean standard score of full-scale intelligence quotient increased from 67.33 to 69.5 (p = 0.078) while the mean, standard score of SDS decreased from 49.22 to 45.67 (p = 0.003) compared to preoperative neuropsychological evaluation results. ConclusionVNS is a safe and effective treatment for patients with DRE caused by TSC. Although early outcomes were encouraging, a follow-up of at least one-year was required to predict long-term outcomes in patients receiving VNS treatment. Moreover, VNS may improve depressive mood in patients with DRE caused by TSC. Further investigations are needed to validate the present results.

Brain Volume and Perception of Cognitive Impairment in People With Multiple Sclerosis and Their Caregivers.

Background: Cognitive impairment (CI) is common in people with multiple sclerosis (pwMS). The assessment of CI is based on neuropsychological tests and accurate anamnesis, involving the patients and caregivers (CG). This study aimed to assess the complex interplay between self-perception of CI, objective CI and the brain atrophy of MS patients, also exploring the possible differences with CI evaluated by caregivers.Methods: Relapsing pwMS were enrolled in this study. Subjects underwent neuropsychological examination using the Brief Cognitive Assessment for Multiple Sclerosis (BICAMS) and evaluation of self-reported cognitive status using the patient-version of the Multiple Sclerosis Neuropsychological Questionnaire (p-MSNQ). Depression and anxiety were also evaluated using the Back Depression Inventory-version II (BDI-II) and Zung Anxiety Scale. Brain MRI images were acquired and brain volumes estimated. For each patient that was enrolled, we spoke to a caregiver and collected their perception of the patient's CI using the MSNQ- Caregiver version.Results: Ninety-five MS subjects with their caregivers were enrolled. CI was detected in 51 (53.7%) patients. We found a significant correlation (p < 0.001) between BICAMS T scores and lower whole brain (Rho = 0.51), gray matter (Rho = 0.54), cortical gray matter (Rho = 0.51) volumes and lower p-MSNQ (Rho = 0.31), and cg-MSNQ (Rho = 0.41) scores. Multivariate logistic regression showed that p-MSNQ is related to a patient's anxiety to evaluate by Zung Score (p < 0.001) while cg-MSNQ to patient's brain volume (p = 0.01).Conclusion: Our data confirm that neuropsychological evaluation results are related to the perception of CI and brain volume measures and highlight the importance of the caregiver's perception for cognitive assessment of pwMS.

A-113 A Case Study: Utilization of C3 Logix in Serial Evaluation of Concussion in a Multidisciplinary Medical Setting

Abstract Objective C3 Logix is a concussion assessment and management system addressing patient care, return to play standards, and rehabilitation or understanding of concussion. This case study demonstrates the utility of the C3 Logix screening measure with a concussion patient in a multidisciplinary medical setting. Repeat C3 Logix screening data was compared to reported symptoms on the Post-Concussion Symptom Scale (PCSS) and interpreted by a physician in medical setting. This case highlights the comparison of C3 Logix findings and a neuropsychological profile in a young adult with history of traumatic closed head injury. Method 25-year old, right-handed, Caucasian man with no significant medical history prior to sustaining a parenchymal hemorrhage along the left anterior inferior frontal lobe and left temporal lobe, as well as a left anterior frontal subdural hematoma in 2019. The patient reported a premorbid history of generalized anxiety with panic, and elevated emotionality post-injury. Results Estimated premorbid verbal functioning was average, consistent with his score as predicted by demographic variables. The patient exhibited decreased concussion symptom severity and improved cognitive performance across repeat C3 Logix administrations. On comprehensive neuropsychological evaluation, he demonstrated intact performance across cognitive domains, with relative weakness consistent with localization of injury, sustained eye injury, and expected recovery duration. Conclusions Repeat cognitive screenings were generally consistent with comprehensive neuropsychological evaluation results. This case study highlights that the C3 Logix tool should be further considered as a brief cognitive screening measure to inform treatment of traumatic head injuries within a multidisciplinary medical setting.

Cognitive assessment in patients with Hepatitis C submitted to treatment with Sofosbuvir and Simeprevir or Daclatasvir.

Hepatitis C can be defined as an infectious disease that develops an inflammatory activity, which may cause an impairment in the central nervous system, may cause cognitive impairments and symptoms of depression. The objective of this study was to verify the cognitive performance of patients with chronic hepatitis C before and after treatment with simeprevir, sofosbuvir, and daclatasvir. A prospective study was carried out in three stages: before, right after treatment, and six months after. Fifty-eight patients under clinical follow-up were evaluated at the Emílio Ribas Infectology Institute, in São Paulo, Brazil. The following instruments were used: sociodemographic questionnaire, Lawton's Scale, Beck's Depression Inventory, and a battery of neuropsychological tests that evaluated: intellectual function, memory, attention, executive function, and motor and processing speed). For statistical analysis, the analyses described (mean, frequency, and standard deviation), chi-square, and ANOVA were used. Most of the participants were male (n=30, 51.7%), with a mean of 58.23±8.79 years, mean schooling of 9.75±4.43 years. Comparing the results of neuropsychological evaluations (before, just after completion of drugs, and six months), a significant improvement was observed in relation to the acquisition of new knowledge (p=0.03), late visual memory (p=0.01), and tendency towards alternate attention (p=0.07). The treatment of the hepatitis C virus improved cognitive performance, especially in relation to memory.

Prognostic role of Mini-Mental State Pediatric Examination (MMSPE) on neuropsychological functioning.

The aim of this study was to evaluate the ability of the Mini-Mental State Pediatric Examinations (MMSPE) in the individuation of neuropsychological impairments. MMSPE was administered to 60 children attending a primary or lower secondary school suffering from neurological diseases, admitted to our neuropsychology services. All children performed both a MMSPE examination and a neuropsychological evaluation. Results of neuropsychological evaluation and MMSPE were dichotomized. Positive predictive value (PPV), negative predictive value (NPV), and accuracy were also calculated. The diagnostic performance of MMSPE showed a good overall accuracy (0.83, CI 95% 0.64-0.91), NPV (0.81, CI 95% 0.73-1.00), PPV (0.87, CI 95% 0.68-0.94), specificity (0.91, CI 95% 0.81-1.00), sensitivity (0.74, CI 95% 0.57-0.90), and odds ratio of 28.5 (CI 95% 6.6-123), p < 0.001. MMSPE has a good prognostic ability in predicting neuropsychological problems in the context of different neurological pediatric diseases. We suggest that this instrument could greatly improve pediatric clinical practice in identifying high-risk children.

PET-CT in Early Detection of Alzheimer’s Disease: A Case Report

The article describes a clinical case of a female patient with Alzheimer’s disease at an early stage of the neurodegenerative process. The patient did not have any complaints. She was taken to the neuropsychologist by her husband who was concerned by the patient’s family history (his mother-in-law suffered from Alzheimer’s disease) and some memory problems that his wife had recently encountered. The diagnosis was suspected based on the results of neuropsychological evaluation of cognitive functions corresponding to mild cognitive impairment. To confirm the presence of a neurodegenerative disease, brain positron-emission tomography with F-18 fluorodesoxyglucose (FDG) was performed. Hypometabolism of the radio-tracer was detected in the cortex of temporal and parietal lobes, in the association cortex of the left temporal and the right occipital lobes, and in the posterior part of the left cyngulate gyrus. These findings correlated with the patient’s cognitive evaluation and thus provided the nosological diagnosis at an early stage of the disease.

PET-CT in early detection of Alzheimer’s disease: а case report

The article describes a clinical case of a female Alzheimer disease patient at an early stage of the neurodegenerative process. The patient did not have any complaints. She was taken to the neuropsychologist’s by her husband that was concerned because of the patient's family history (his mother-in-law suffered of Alzheimer's disease) and the emergence of some memory problems in his wife. The diagnosis was suspected based on the results of neuropsychological evaluation of cognitive functions which corresponded to mild cognitive impairment. To confirm the presence of a neurodegenerative disease brain positron-emission tomography with F-18 fluorodesoxyglucose (FDG) was performed. Hypometabolism of the imaging agent was detected in the temporal and parietal lobes cortex, in the association cortex of the left temporal and the right occipital lobes, and in the posterior part of the left cyngulate gyrus. This findings correlated with the data of the patient’s cognitive evaluation and thus provided the nosological diagnosis at an early stage of the disease.

Perception of ethical misconduct by neuropsychology professionals in Spain

To examine the prevalence of perceived ethical misconduct in clinical practice, teaching, and research in the field of neuropsychology in Spain. Two hundred and fifteen self-identified mental health professionals who engage in neuropsychology practice in Spain completed an online survey from July to December of 2013. In the ethics section of the survey, participants were asked to identify if neuropsychologists they know who work in their country engaged in specific kinds of ethical misconduct. 41% reported receiving formal training in professional ethics. The clinical findings are as follows. The highest rate of perceived misconduct was found in the area of professional training and expertise, with an average of 40.7%, followed by research/publications (25.6%), clinical care (23.9%), and professional relationships (8.8%). Specifically, regarding training, over half of respondents (56.7%) know professionals who claim themselves to be neuropsychologists, even though they lack proper training or expertise and 46.0% know professionals in the field who do not have adequate training for experience to be working in the field. Regarding research/publications, 41.9% of respondents know professionals who appear as authors on publications where they have not made a significant contribution. Regarding clinical care, over one third of respondents endorse knowing professionals who (1) provide results of neuropsychological evaluations in such a way that patients or other professionals are not likely to understand (37.2%) and (2) do not have the skills or training to work with patients who are culturally different from them (34.9%). Less than half of survey respondents reported receiving ethics training. It is possible that introducing more or improved ethics courses into pre-graduate and/or graduate school curriculums, and/or requiring continuing ethics education certification may reduce perceived ethical misconduct among neuropsychological professionals in Spain.

Effects of handcuffs on neuropsychological testing: Implications for criminal forensic evaluations

ABSTRACTNeuropsychological evaluations are increasingly performed in forensic contexts, including in criminal settings where security sometimes cannot be compromised to facilitate evaluation according to standardized procedures. Interpretation of nonstandardized assessment results poses significant challenges for the neuropsychologist. Research is limited in regard to the validation of neuropsychological test accommodation and modification practices that deviate from standard test administration; there is no published research regarding the effects of hand restraints upon neuropsychological evaluation results. This study provides preliminary results regarding the impact of restraints on motor functioning and common neuropsychological tests with a motor component. When restrained, performance on nearly all tests utilized was significantly impacted, including Trail Making Test A/B, a coding test, and several tests of motor functioning. Significant performance decline was observed in both raw scores and normative scores. Regression models are also provided in order to help forensic neuropsychologists adjust for the effect of hand restraints on raw scores of these tests, as the hand restraints also resulted in significant differences in normative scores; in the most striking case there was nearly a full standard deviation of discrepancy.

Thérapie par remédiation cognitive chez les enfants : données de la littérature et application clinique dans un service de psychiatrie de l’enfant et de l’adolescent

The hypothesis of cerebral plasticity in psychiatric disorders has encouraged clinicians to develop cognitive remediation therapy (CRT), a new therapeutic approach based on attention, memory, planning, and mental flexibility tasks. The first cognitive remediation programs were developed and validated for adults with schizophrenia and were shown to have a positive impact on executive functions as well as on quality of life. In children and adolescents, researchers emphasized the existence of executive dysfunction in neurodevelopmental disorders such as autistic spectrum disorder, attention deficit disorder, and eating disorders. For these disorders, neuropsychological studies suggest that memory, planning, attention and mental flexibility are impaired. Despite the paucity of studies on cognitive remediation (CR) in children, preliminary results have suggested, as in adults with schizophrenia, good compliance and optimization of executive functioning. Consequently, programs dedicated to young subjects were developed in English-speaking countries, and the Department of Child and Adolescent Psychiatry of Sainte Anne Hospital (Paris) developed a new CR program for children with attention deficit disorder, academic problems, or eating disorders. These programs complete the field of CRT proposed by Sainte Anne Hospital's Remediation and Psychosocial Rehabilitation Reference Center, initially designed for adults with schizophrenia. Our team used and adapted validated tools such as Delahunty and Wykes's CRT program (translated and validated in French by Amado and Franck) and Lindvall and Lask's CRT Resource Pack. One program was developed for an adolescent with anorexia nervosa and applied to the subject and her family, but the purpose of this paper is to present a CR approach for children with attention deficit disorder or academic disorder, a 6-month program based on paper-pencil tasks and board and card games. The team was trained in different kinds of cognitive remediation, and the program was applied by a clinical nurse with the supervision of a child and adolescent psychiatrist and the department's neuropsychologists. Paper-pencil tasks were adapted from the CRT program for adults; the card and board games used were geometric figures, illusions, Rush Hour(®), Set(®), Jungle Speed(®), Color Addict(®), etc. These games are available in stores and the program can be applied at home, which helps families set aside their preoccupations with their child's academic performance. Diagnostic and neuropsychological evaluations were done before the beginning of the therapy and repeated at the end of the 6-month program. This program does not ignore the metapsychological impact of the therapy, and work on self-esteem is also done. The presence of the therapist is necessary, which seems better than a computer program, which cannot encourage the young subject in the same personalized and empathetic way. We therefore conducted the first clinical feasibility trial of cognitive remediation in young subjects and present a clinical case of a 6-year-old boy with attention deficit disorder and academic disorder. The results of neuropsychological evaluations before and after therapy suggest improvement in executive functions and better self-esteem. Satisfaction for the boy and his family was high. Even if these results need to be replicated, cognitive remediation appears to be a new therapeutic tool, complementary to classical approaches used in childhood psychiatric disorders. The Department of Child and Adolescent Psychiatry will submit this program to a research program conducted by the National Health Department to study the impact of this approach in a controlled study.

Threats to the Validity of the Interpretation and Conveyance of Forensic Neuropsychological Results

There are numerous threats to the validity of the interpretation and conveyance of forensic neuropsychological evaluation results. This article addresses a number of common threats, and uses them to illustrate ethical issues and potential means to reduce the threat to validity. An emphasis on ethical concerns and the potential resolution of these issues is offered.

Brain Injury as a Result of Whiplash Injury

The literature on whiplash and mild traumatic brain injury (MTBI) is reviewed and discussed, focusing on disagreements between authors and the type and severity of brain injuries that can and do occur following motor vehicle crashes. Despite disagreements, it is clear from the literature that brain injury can result from whiplash. The diagnosis of MTBI following whiplash injury is made based on the patient's history, neuropsychological evaluation results, and following the exclusion of competing disorders of the brain. Given the fact that whiplash injury can result in brain injury, it is essential that practitioners evaluating these cases be aware of MTBI as a possible diagnosis.

Usefulness of Neuroimaging Studies for Localization of the Epileptogenic Focus in Patients with Frontal Lohe Epilepsy Manifesting as Complex Gestural Automatisms

Purpose: The goal of this study was to evaluatc the usefulness of ncuroimaging studies for localization of thc epileptogenic focus in patients with frontal lobe epilepsy (FLE). The clinical manifestations werc complex partiel seizures, characterizedd by kicking and thrashing, groaning, occurrence in clusters, being brief (lasting for &lt;40 seconds), and cnding with minimal postictal confusion. Methods: Thc subjects werc 7 patients, aged 1040 ycars (mean agc, 24.3), with complex partial seizurcs, undergoing preoperative evaluations for intractable seizures. All seizurcs wcre documcuted as conforming to complcx geslural automatism by simultaneous EEG‐VCR recordings. We asscssed the clinical features, interictal and ictal electroencephalograms (EEGs), and results of magnetic resonance imaging (MRI), and interictal PVTc ethyl cysteinate dimcr (ECD) singlc photon emission computed tomography (SPECT). Additionally, we studied ictal ECD SPECT findings in 4 patients. We compared the usefulness of EEG, MRI, and SPECT for localization of thc cpileptogenic focus. Results: Thc patients comprised 6 nialcs and I female. The agc at seizurc onset was 1–25 years (mcan, 10.5). One patient had a family history of febrilc seizures and another of anoxia at birth. One patient had a history of ideas of persecution and refercnce. The results of neuropsychological evaluation revealed that their full intelligence quoticnt varied from 51–1 I I (mcan 88). Seizure frequencics at initial consultation varied from monthly to daily in thc 7 patients. Thrce of the 7 patients undcrwent surgical resection of the fronial lobe, and 2 of the 3 became frce of the intractable scizures. lnterictal dischargc such as spikcs or sharp waves were localized at F3 in 2 patients and at F4 in 5 patients. Ictal discharge at the onset of a paltcrn in scalp EEG recordings in 2 pati waves wcre seen at the left frontal lobe in I bilaterally in patient. The ictal scalp EEG recordings of the remaining 3 patients were distorted by electromyographic and movement artifacts. Finally, it was determined that the ictal scalp EEG is not always helpful for the localization of the epileptogenic focus. MRI revcaled focal cortical dysplasia in 2 patients: in the right middle frontal gyrus in I, and left basolateral frontal lobe i n the other. Interictal ECD SPECT revealcd no hypoperfused area in any of the 7 paticnts. We obtained ictal ECD SPECT i n 4 paticnts in cooperation with colleagues who controlled the violent movements of the patient during a seizure. In all 4 cases, ictal ECD SPECT revealed hypcrperftision in the frontal lobe, in the left frontal area in 2 patients and the right frontal area in 2 patients. Three of the 4 patients had undergone epilepsy surgery. Thc 2 patients who had cortical dysplasia underwent cxcision of the lesion and had excellent seizure control. The remaining I paticnt who had no abnormal CT findings continued to have seizures wcckly even after resection of the right orbitofrontal cortex. Conclusions: It is difficult to localize the epileptogenic focuin cases of complex gcstural automatism. The diagnostic yield in our study was maximal with ictal ECD SPECT even though thc seizure pattern could not be diagnosed clearly due to interference by electromyographic waves. A combination of MRI and ictal ECD SPECT is the key to localization of the cpileptic focus in casc of FLE with complex gestural automatism.

Zur Objektivität der Hirnstammaudiometrie bei Teilleistungsstörungen (sensorischen Integrationsstörungen)*

Diagnostic audiological tests performed in ten children from 1985 to 1991 showed remarkable differences between the results of behavioral audiometry (free field or pure tone audiometry) and those of auditory evoked response audiometry. Auditory brainstem response (ABR) was absent in seven children with sensory neural hearing loss. Neuropsychological evaluation was performed on four children, neuropsychological observation was performed on two children, pediatric examination was performed on three children and one child showed signs of neuropediatric disorder. The results of neuropsychological evaluation showed moderate to severe learning disabilities (sensory integration disorders, learning disorders) in all four children tested. Available neuropsychological observation also indicated the presence of sensory integration disorders in two children. Two children had multiple handicaps with cerebral abnormalities, two further children were diagnosed as suffering from "minimal cerebral dysfunction," one of which was mentally retarded. The fact that ABRs were absent in seven children indicates that a response desynchronisation in the auditory pathway may exist in these disorders. Thus, ABR might not be a reliable method for audiological testing in children with learning disabilities or other cerebral dysfunctions, but serves as an adjunct to conventional testing methods.

Computer-aided reporting of the results of neuropsychological evaluations of traumatic brain injury

The TBI Report Assistant is designed to perform the types of routine tasks that computers do well, while freeing the skilled psychologist to concentrate on tasks best done by knowledgeable humans. The Assistant is intended for reporting the results of neuropsychological evaluation of traumatic brain injury patients using a standard battery. The program encourages the inclusion of additional information by writing to a disk file suitable for editing with a word processor, rather than directly to the printer. The resulting file contains prompts for summary and interpretive statements by the psychologist.

S-100 protein in cerebrospinal fluid after aneurysmal subarachnoid haemorrhage: relation to functional outcome, late CT and SPECT changes, and signs of higher cortical dysfunction.

The concentration of S-100 protein measured in ventricular cerebrospinal fluid (CSF) from 32 patients with subarachnoid haemorrhage (SAH) during the acute phase was related to features on admission such as the Hunt and Hess neurological scale and the amount of blood at the first computed tomography (CT). The S-100 values were also related to functional outcome assessed by the Glasgow outcome scale (GOS) at 12 months. Twenty-two patients were re-examined more than 2 years after the SAH, and the initial S-100 values were related to signs of structural brain damage at CT and single photon emission computed tomography (SPECT) and to the results of neuropsychological evaluation (NPE). NPE included standardized tests for memory functions, intellectual functions, visuo-spatial abilities, sensory-motor functions, and concept formation. Life-adjustment was assessed by two separate questionnaires. Tests for agnostic dysfunction and the Western aphasia battery test (WABT) were also performed. Patients who were functionally disabled or ultimately died had significantly higher initial CSF concentrations of S-100 protein than patients showing good recovery. Patients with low-attenuated regions and/or increased ventricular size at CT and/or regionally decreased tracer uptake on SPECT had higher S-100 levels during days 2-8 than had patients showing no such changes. Logistic and multiple regression analysis of all characteristics assessed during the acute phase after SAH showed that the CSF S-100 concentration during days 2-8 was the factor best correlated to GOS and findings on CT and/or SPECT. All patients showed varying degrees of cognitive impairment at follow-up. The results of NPE and the WABT were related to outcome assessed by GOS and to increased ventricular size on CT. Women had a stronger feeling of maladjustment, but the scores for life adjustment were otherwise not related to other outcome criteria. It is concluded that the ventricular CSF S-100 concentration during the acute phase after SAH is related not only to the functional outcome as assessed by GOS but also to signs of brain damage seen on late CT and SPECT.