Showing papers in "Neuropsychology Review in 2004"

The association between delirium and cognitive decline: a review of the empirical literature.

Abstract: Delirium is a common neurobehavioral syndrome that occurs across health care settings which is associated with adverse outcomes, including death. There are limited data on long-term cognitive outcomes following delirium. This report reviews the literature regarding relationships between delirium and cognitive impairment. Psych Info and Medline searches and investigation of secondary references for all English language articles on delirium and subsequent cognitive impairment were carried out. Nine papers met inclusion criteria and documented cognitive impairment in patients following delirium. Four papers reported greater cognitive impairment among patients with delirium than matched controls. Four papers reported higher incidence of dementia in patients with a history of delirium. One study found 1 of 3 survivors of critical illness with delirium developed cognitive impairment. The evidence suggests a relationship between delirium and cognitive impairment, although significant questions remain regarding the nature of this association. Additional research on delirium-related effects on long-term cognitive outcome is needed.

Neuropsychological functioning associated with high-altitude exposure.

Abstract: This article focuses on neuropsychological functioning at moderate, high, and extreme altitude. This article summarizes the available literature on respiratory, circulatory, and brain determinants on adaptation to hypoxia that are hypothesized to be responsible for neuropsychological impairment due to altitude. Effects on sleep are also described. At central level, periventricular focal damages (leuko-araiosis) and cortical atrophy have been observed. Frontal lobe and middle temporal lobe alterations are also presumed. A review is provided regarding the effects on psychomotor performance, perception, learning, memory, language, cognitive flexibility, and metamemory. Increase of reaction time and latency of P300 are observed. Reduced thresholds of tact, smell, pain, and taste, together with somesthetic illusions and visual hallucinations have been reported. Impairment in codification and short-term memory are especially noticeable above 6,000 m. Alterations in accuracy and motor speed are identified at lower altitudes. Deficits in verbal fluency, language production, cognitive fluency, and metamemory are also detected. The moderating effects of personality variables over the above-mentioned processes are discussed. Finally, methodological flaws found in the literature are detailed and some applied proposals are suggested.

Clinical Implications and Methodological Challenges in the Study of the Neuropsychological Correlates of Cannabis, Stimulant, and Opioid Abuse

Abstract: Chronic consumption of several drugs of abuse (cannabis, stimulants, opioids) has been associated with the presence of neuropsychological impairments in a broad range of functions. Nevertheless, in recent years neuropsychological research on substance abuse has focused on the study of impairments in the executive functions linked to the prefrontal cortex and their influence on the personality, cognitions, and behaviors of the substance abusers. The aim of our review is, first, to summarize the main neuropsychological impairments shown by classic studies, as well as these new discoveries in executive functioning; second, to consider the mediating role of neuropsychological status on treatment outcomes and analyze the impact of these impairments in clinical practice with drug addicts; and third, to review the principal methodological challenges associated with research in the field of the neuropsychology of substance abuse. We also highlight the convenience of intervening in those functions most relevant to the abusers' persistence in consumption and risk of relapse.

Quality of Life of Caregivers

Abstract: This article is a descriptive analysis of various features of the quality of life (QoL) of the caregivers in different pathological conditions. Definitions of the concept of QoL, caregiver goals and burdens, caregiver stress and coping with factors that could contribute to or impact the QoL in caregivers are discussed both through a review of literature and an analysis of empirical evidences. The QoL in caregivers of patients with Parkinson’s disease is also discussed. An original Scale of QoL of Caregivers is described and compared with other existing measures. The concepts of patient–caregiver dyad in research and in interventions is stressed.

The role of cognitive deficits in the development of eating disorders.

Abstract: Eating disorders (ED), including anorexia and bulimia nervosa, are chronic illnesses with periods of symptom exacerbation and remission. Because symptoms are usually present from 6 to 24 months before a diagnosis is made, aetiological agents are believed to be active well before symptoms appear. It is proposed that neuropsychological deficits in various cognitive domains preexist and underlie the aetiology of ED. This paper provides a comprehensive review of the literature relevant to neuropsychological deficits in ED patients and explores the relationship between cognitive deficits, psychosocial development, and the development of ED. Although the role of neuropsychological deficits in the evolution of ED requires further research, the proposed association has significant implications for clinical practice.

A Critical Review of the Clinical Effects of Therapeutic Irradiation Damage to the Brain: The Roots of Controversy

Abstract: We critically examined the damaging affects of therapeutic irradiation by comparing results from cross-disciplinary studies of early- and late-delayed radiotherapy effects Focus is attained by concentrating on clinical treatment issues (volume of brain, dose, timing of effects, age, modality types, and stereotactic treatment techniques), rather than on methodological means or problems, which is necessary to understand the mechanisms and characteristics of radiotherapy-induced behavioral dysfunction including cognition We make observations and hypotheses about the actual risks from radiotherapy that could be informative in the treatment decision process, and which may lessen the concerns of some patients and their families about the risks they take when receiving radiation Conditions that predispose to radiation injury are reviewed: (1) higher doses even to part of the brain versus lower doses to the whole brain, (2) combined treatment modalities, (3) malignancy itself, (4) radiation early during postnatal brain development, and (5) late-delayed effects (more than 3 years posttreatment) Current neurocognitive frameworks for understanding cognitive change over time in children and adults are summarized, along with the literature on effects of brain tumors and treatment on depression No studies have as yet identified candidate brain regions that are more sensitive to radiotherapy Two studies have provided early, preliminary evidence for a specific vulnerability of visual attention/memory to the early stage of late radiation damage Furthermore, radiation effects appear severe only in a minority of patients Risk is related to direct and indirect effects of cancer type, concurrent clinical factors, and premorbid risk factors

Depression after traumatic brain injury: a review of evidence for clinical heterogeneity.

Abstract: Depression represents a major source of disability among individuals who have suffered a traumatic brain injury (TBI), with estimates of prevalence in this population ranging over 50%. In comparison with other sequelae of TBI, depression is often poorly conceptualized and treated among acute care and rehabilitation professionals. One reason for this is the lack of clear etiological models for the development of depression following TBI. This paper argues that post-TBI depression actually represents a heterogeneous category, with multiple etiologic pathways and clinical implications. The literature in this area is reviewed, with an emphasis on an appreciation of the diversity within this clinical population. Conclusions focus on suggestions for differential diagnosis and treatment options.

Clinical perspectives on neurobiological effects of psychological trauma.

Abstract: Physical trauma to the brain has always been known to affect brain functions and subsequent neurobiological development. Research primarily since the early 1990s has shown that psychological trauma can have detrimental effects on brain function that are not only lasting but that may alter patterns of subsequent neurodevelopment, particularly in children although developmental effects may be seen in adults as well. Childhood trauma produces a diverse range of symptoms and defining the brain's response to trauma and the factors that mediate the body's stress response systems is at the forefront of scientific investigation. This paper reviews the current evidence relating psychological trauma to anatomical and functional changes in the brain and discusses the need for accurate diagnosis and treatment to minimize such effects and to recognize their existence in developing treatment programs.

Sequential memory: a developmental perspective on its relation to frontal lobe functioning.

Abstract: The multidimensional nature of the frontal lobes serves to organize and coordinate brain functionings playing a central and pervasive role in human cognition. The executive processes implicated in complex cognition such as novel problem solving, modifying behavior as appropriate in response to changes in the environment, inhibiting prepotent or previous responses, and the implementation of schemas that organize behavior over time are believed to be mediated by the frontal regions of the brain. Overall, the functioning of the frontal lobes assists individuals in goal directed and self-regulatory behavior. Additional theories of frontal lobe functioning have focused on its involvement in temporal, or time-related domains. The organizational and strategic nature of frontal lobe functioning affects memory processes by enhancing the organization of to-be-remembered information. Among the specific memory systems presumed to be based on anterior cerebral structures is the temporal organization of memory. An essential component of memory that involves temporal organization is sequential ordering entailing the ability to judge which stimuli were seen most recently and the temporal ordering of events in memory. Focal lesion studies have demonstrated the importance of the frontal lobes on retrieval tasks in which monitoring, verification, and placement of information in temporal and spatial contexts of critical importance. Similarly, frontal lobe damage has been associated with deficits in memory for the temporal ordering, or sequencing, of events. The acquisition of abilities thought to be mediated by the frontal lobes, including sequential memory, unfolds throughout childhood, serving to condition patterns of behavior for the rest of the brain. Development of the frontal regions of the brain is known to continue through late adolescence and into early adulthood, in contrast to the earlier maturation of other cortical regions. The developmental patterns of the frontal lobes are thought to involve a hierarchical, dynamic, and multistage process.

Neuropsychological assessment of mental capacity.

Abstract: The assessment of mental capacity to assist legal determinations of competency is potentially a growth area for neuropsychology, although to date neuropsychologists have published relatively little in this area. In this paper a systematic review of methods used to assess capacity is presented, including coverage of specialized tests and interviews used for this purpose. A neuropsychological model for conducting capacity assessments is proposed. This model involves comprehensive assessment of a wide range of cognitive abilities as well as assessment of specific skills and knowledge related to the type of capacity being assessed. The purpose of proposing this model is to stimulate further discussion and debate about the contribution neuropsychologists might make in this area.

Rohling's Interpretive Method for Neuropsychological Case Data: A Response to Critics

Abstract: In the September 2001 issue of Neuropsychology Review Miller and Rohling published a description of the Rohling Interpretive Method (RIM). These authors indicated that the RIM could be used to analyze an individual patient's test results obtained from a flexible neuropsychological battery. Two critiques of the RIM were submitted (Palmer, Appelbaum, & Heaton, 2004; Willson & Reynolds, 2004), both of which are printed in the current issue. This paper is a response to these two author groups concerns about the clinical and psychometric feasibility of the RIM. We provide both psychometric theory and data analyses to refute each of the two author groups' main objections. We conclude with a recommendation that neuropsychologists adopt the RIM for use in their day-to-day practice to improve their diagnostic accuracy and treatment planning skills. The main reason for use of the RIM is to avoid several common errors in clinical judgment that have been well documented in the literature (e.g., Dawes, Faust, & Meehl, 1989).

Rohling's Interpretive Method and Inherent Limitations on the Flexibility of "Flexible Batteries"

Abstract: Miller and Rohling (2001) proposed a 24-step algorithm, the Rohling Interpretive Method (RIM), for quantitative interpretation of results from flexible neuropsychological test batteries. We believe that the RIM as presented in that paper has several conceptual problems, including (a) a failure to distinguish “statistically significant” from pathological differences, (b) an assumption that declines in specific abilities can be inferred when a particular test score deviates from an estimate of general premorbid ability, and (c) confusion between the standard deviation associated with individual test scores versus that of a composite of those scores. As an alternative, we suggest the value of developing and using co-normed comprehensive neuropsychological test batteries from which test users might select subsets of tests.

A critique of Miller and Rohling's statistical interpretive method for neuropsychological test data.

Abstract: A critical review of the 24-step procedure of Miller and Rohling's (in press) proposed standardization of clinician's use of neuropsychological assessment batteries is presented. Each step is examined for statistical sources of invalidity. It was concluded that parts of the procedure are quite vulnerable to between-battery variability that cannot be easily estimated or controlled, leading to significant errors in analysis and classification. A second fatal flaw is the failure to distinguish in the procedures between standard error measurement and standard error of the estimate in calculations in several steps. The purpose of the process remains viable, however, and is an important contribution toward the improvement of clinical diagnosis.