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Postconcussional symptoms as predictors of neuropsychological deficits
Abstracts of 16th Annual Meeting
329
Haines, M. E., Holliday, S. L., & Clement, P. E Ependymoma, Oligodendroglioma, and Posterior Fossa Arachnoid Cyst: A Neuropsychological Study of Three Tumor Types. One factor that affects the neuropsychological deficits secondary to intracranial neoplasm is the location of the tumor. The current study is a comparison of three relatively uncommon types of neoplasm, their locations in three individuals, and the resultant neuropsychological deficits. The first patient was a 33-year-old woman with an ependymoma that obstructed the third ventricle resulting in hydrocephalus. Deficits included impairments in logical reasoning skills and memory, impairments that are consistent with hydrocephalus. Patient two, a 29-year-old man with a left temporal lobe oligodendroglioma, evidenced deficits of executive functioning, memory, and language abilities. These deficits are consistent with the left temporal lobe location of his tumor. The third patient, a 32-year-old woman, presented with a posterior fossa arachnoid cyst. Deficits for this patient included visuomotor problems and left motor impairment, which are consistent with the brainstem location of her neoplasm. All three patients retained premorbid levels of intellectual functioning. Relatedly, all three experienced affective functioning changes in the form of depression and anxiety, which were apparent reactions to their awareness of their neuropsychological deficits, in addition to the psychological burden that the diagnosis of a brain tumor contributes.
Hanna-Pladdy, B., Gouvier, W. D., & Bennett, T. The Effects of Minor Head Injuo, Postconcussive Sympwms, and Experimentally Induced Stress on Information Processing. The present study investigated the effects of head injury, postconcussive symptom reports, and experimentally induced stress on a complex, cognitively challenging task, the Paced Auditory Serial Addition Test (PASAT). Head injured patients have been found to perform below control group averages immediately after injury, however, their scores tend to return to normal within several months. Some researchers have suggested that the PASAT can be used to determine when a patient is ready to resume a normal social and vocational activity level without experiencing undue stress. This study hypothesized that if stress is a significant factor in the deterioration of test performance, the effect of this stressful repetitive task should be even more pronounced in individuals who are prone to be reactive to stress. The subject sample was divided into 4 groups each consisting of 22 members based on history of minor head injury and the presence of the postconcussive syndrome. Eleven members from each of the 4 groups were assigned to the high stress or relaxation conditions. The relaxation condition had dimmed lighting, restful music and deep breathing. The high stress condition used mental arithmetic, noise and bright lights. A repeated measures ANOVA was conducted on the four subtests of the PASAT, and revealed a main effect for symptomatic/asymptomatic subjects. However, no main effects were found for history of head injury or exposure to experimentally induced stress, and no interactions were found to be significant. Difference contrasts revealed that symptomatic individuals averaged lower PASAT scores than asymptomatic individuals. These results indicate that experimental stress was not a significant factor in the deterioration of test performance, and that head injured individuals did not perform significantly worse on the four subtests of the PASAT. However, individuals who report significant postconcussive symptoms (regardless of history of head injury) perform significantly worse on the PASAT.
Hanna-Pladdy, B., Gouvier, W. D., & Berry, Z. M. Postconcussional Symptoms as Predictors of Neuropsychological Deficits. In this study we examined subjective symptomatology to evaluate whether patient symptom reports are accurate predictors of neuropsychological deficits. Two hundred subjects were
330
Abstracts of 16th Annual Meeting
screened to exclude individuals with prior neurological disease, seizure disorder, or open head injury. The Postconcussion Symptom Checklist (PCSC) was used to classify the subjects as either asymptomatic or symptomatic, and 88 total subjects were included in the study. The proportion of individuals with minor head injuries were equal across the two groups, with one half of the subjects in each of the two groups having a prior history of head injury. The mean score on the PCSC for individuals placed in the asymptomatic group was 45.82 and 79.70 for the symptomatic group, creating two distinct groups based on symptom reporting. The results of the study indicate that neuropsychological functioning successfully differentiated symptomatic individuals from asymptomatic individuals. Symptomatic individuals, regardless of history of head injury, performed significantly worse on the Paced Auditory Serial Addition Task (PASAT), the Rey Auditory Verbal Learning Test (RAVLT), and the Shipley. These findings indicate that subjective symptom reports can be accurate predictors of neuropsychological functioning, and that subjects who report significantly more postconcussive symptoms have measurable cognitive deficits when compared to individuals who are asymptomatic.
Hart, C. C., Harter, S. L., Miller, S. A., & Harter, G. W. Design Fluency Within a Cognitive Battery: A Study of Test Order Effects'. The Design Fluency Test (DFF) has shown promise for its sensitivity to right lobe dysfunction, partly due to the unstructured nature of the task. Jones-Gotman and Milner (1977) have demonstrated a double dissociation between design fluency and verbal fluency tasks in the detection of right versus left hemisphere lesions. The DFT is often administered as part of a neuropsychological battery. Such batteries are often administered without reference to any specific test. Due to its unstructured nature, the Design Fluency Test may be especially sensitive to test order effects, such as visual priming. The current study investigated the influence of previous priming tasks on the DFT, including tasks that include scorable visual models (the visual recognition subtest of the Memory Assessment Scales) and tasks that include sequential reasoning strategies (a visual analogies task). Analogic verbal conditions served as controls. One hundred male and one hundred female college students were randomly assigned to four conditions, defined by the task that preceded administration of the DFT: visual memory, visual reasoning, verbal memory, verbal reasoning. Dependent variables were derived from a structured and expanded scoring system for the DFT (Harter, Harter, & Hart, in progress) and included number of novel designs produced, complexity of designs, number of strategic variations in designs, and design quality. MANOVA indicated no interaction effects between use of sequential reasoning and visual primes. There was also no main effect for the use of sequential primes. There appeared to be a trend for the use of visual primes (multivariate F = 2.05; p < .10) to increase the number of novel designs produced (univariate F = 5.47; p < .05). Use of primes did not affect complexity of designs, strategic variations, or design quality. Harter, S. L., Harter, G. W., & Hart, C. C. Expanded Scoring Criteria for the Design Fluency Test: Reliability and Construct Validation in a Diverse Neuropsvchological Sample. Jones-Gotman and Milner's (1977) Design Fluency Test (DFT) showed initial potential for specific sensitivity to right frontal dysfunction. However, criticisms of the lack of psychometric data and overly vague, global scoring procedures contributed to its failure to achieve the widespread use of analogous verbal fluency measures. The unstructured nature of this test likely adds to its sensitivity by increasing the initiation required of the patient (see Lezak, 1995). This sensitivity would more likely be preserved and enhanced by increasing structure and specificity in the scoring criteria, rather than in a more structured method of adminis-
329
Haines, M. E., Holliday, S. L., & Clement, P. E Ependymoma, Oligodendroglioma, and Posterior Fossa Arachnoid Cyst: A Neuropsychological Study of Three Tumor Types. One factor that affects the neuropsychological deficits secondary to intracranial neoplasm is the location of the tumor. The current study is a comparison of three relatively uncommon types of neoplasm, their locations in three individuals, and the resultant neuropsychological deficits. The first patient was a 33-year-old woman with an ependymoma that obstructed the third ventricle resulting in hydrocephalus. Deficits included impairments in logical reasoning skills and memory, impairments that are consistent with hydrocephalus. Patient two, a 29-year-old man with a left temporal lobe oligodendroglioma, evidenced deficits of executive functioning, memory, and language abilities. These deficits are consistent with the left temporal lobe location of his tumor. The third patient, a 32-year-old woman, presented with a posterior fossa arachnoid cyst. Deficits for this patient included visuomotor problems and left motor impairment, which are consistent with the brainstem location of her neoplasm. All three patients retained premorbid levels of intellectual functioning. Relatedly, all three experienced affective functioning changes in the form of depression and anxiety, which were apparent reactions to their awareness of their neuropsychological deficits, in addition to the psychological burden that the diagnosis of a brain tumor contributes.
Hanna-Pladdy, B., Gouvier, W. D., & Bennett, T. The Effects of Minor Head Injuo, Postconcussive Sympwms, and Experimentally Induced Stress on Information Processing. The present study investigated the effects of head injury, postconcussive symptom reports, and experimentally induced stress on a complex, cognitively challenging task, the Paced Auditory Serial Addition Test (PASAT). Head injured patients have been found to perform below control group averages immediately after injury, however, their scores tend to return to normal within several months. Some researchers have suggested that the PASAT can be used to determine when a patient is ready to resume a normal social and vocational activity level without experiencing undue stress. This study hypothesized that if stress is a significant factor in the deterioration of test performance, the effect of this stressful repetitive task should be even more pronounced in individuals who are prone to be reactive to stress. The subject sample was divided into 4 groups each consisting of 22 members based on history of minor head injury and the presence of the postconcussive syndrome. Eleven members from each of the 4 groups were assigned to the high stress or relaxation conditions. The relaxation condition had dimmed lighting, restful music and deep breathing. The high stress condition used mental arithmetic, noise and bright lights. A repeated measures ANOVA was conducted on the four subtests of the PASAT, and revealed a main effect for symptomatic/asymptomatic subjects. However, no main effects were found for history of head injury or exposure to experimentally induced stress, and no interactions were found to be significant. Difference contrasts revealed that symptomatic individuals averaged lower PASAT scores than asymptomatic individuals. These results indicate that experimental stress was not a significant factor in the deterioration of test performance, and that head injured individuals did not perform significantly worse on the four subtests of the PASAT. However, individuals who report significant postconcussive symptoms (regardless of history of head injury) perform significantly worse on the PASAT.
Hanna-Pladdy, B., Gouvier, W. D., & Berry, Z. M. Postconcussional Symptoms as Predictors of Neuropsychological Deficits. In this study we examined subjective symptomatology to evaluate whether patient symptom reports are accurate predictors of neuropsychological deficits. Two hundred subjects were
330
Abstracts of 16th Annual Meeting
screened to exclude individuals with prior neurological disease, seizure disorder, or open head injury. The Postconcussion Symptom Checklist (PCSC) was used to classify the subjects as either asymptomatic or symptomatic, and 88 total subjects were included in the study. The proportion of individuals with minor head injuries were equal across the two groups, with one half of the subjects in each of the two groups having a prior history of head injury. The mean score on the PCSC for individuals placed in the asymptomatic group was 45.82 and 79.70 for the symptomatic group, creating two distinct groups based on symptom reporting. The results of the study indicate that neuropsychological functioning successfully differentiated symptomatic individuals from asymptomatic individuals. Symptomatic individuals, regardless of history of head injury, performed significantly worse on the Paced Auditory Serial Addition Task (PASAT), the Rey Auditory Verbal Learning Test (RAVLT), and the Shipley. These findings indicate that subjective symptom reports can be accurate predictors of neuropsychological functioning, and that subjects who report significantly more postconcussive symptoms have measurable cognitive deficits when compared to individuals who are asymptomatic.
Hart, C. C., Harter, S. L., Miller, S. A., & Harter, G. W. Design Fluency Within a Cognitive Battery: A Study of Test Order Effects'. The Design Fluency Test (DFF) has shown promise for its sensitivity to right lobe dysfunction, partly due to the unstructured nature of the task. Jones-Gotman and Milner (1977) have demonstrated a double dissociation between design fluency and verbal fluency tasks in the detection of right versus left hemisphere lesions. The DFT is often administered as part of a neuropsychological battery. Such batteries are often administered without reference to any specific test. Due to its unstructured nature, the Design Fluency Test may be especially sensitive to test order effects, such as visual priming. The current study investigated the influence of previous priming tasks on the DFT, including tasks that include scorable visual models (the visual recognition subtest of the Memory Assessment Scales) and tasks that include sequential reasoning strategies (a visual analogies task). Analogic verbal conditions served as controls. One hundred male and one hundred female college students were randomly assigned to four conditions, defined by the task that preceded administration of the DFT: visual memory, visual reasoning, verbal memory, verbal reasoning. Dependent variables were derived from a structured and expanded scoring system for the DFT (Harter, Harter, & Hart, in progress) and included number of novel designs produced, complexity of designs, number of strategic variations in designs, and design quality. MANOVA indicated no interaction effects between use of sequential reasoning and visual primes. There was also no main effect for the use of sequential primes. There appeared to be a trend for the use of visual primes (multivariate F = 2.05; p < .10) to increase the number of novel designs produced (univariate F = 5.47; p < .05). Use of primes did not affect complexity of designs, strategic variations, or design quality. Harter, S. L., Harter, G. W., & Hart, C. C. Expanded Scoring Criteria for the Design Fluency Test: Reliability and Construct Validation in a Diverse Neuropsvchological Sample. Jones-Gotman and Milner's (1977) Design Fluency Test (DFT) showed initial potential for specific sensitivity to right frontal dysfunction. However, criticisms of the lack of psychometric data and overly vague, global scoring procedures contributed to its failure to achieve the widespread use of analogous verbal fluency measures. The unstructured nature of this test likely adds to its sensitivity by increasing the initiation required of the patient (see Lezak, 1995). This sensitivity would more likely be preserved and enhanced by increasing structure and specificity in the scoring criteria, rather than in a more structured method of adminis-