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Recovery process in closed head injury: Behavior and electrophysiological studies
284
Abstracts
abled children under stress experience difficulty recovering from failure. Thus, while learning problems may present, early on, as a neurological/processing disorder this may set the stage for the paradigm of a failure-aversion-failure or a phobic response as the child attempts to cope with stress.
The Utility of Neuropsychological Methods in the Differential Diagnosis of Depression and Dementia in the Elderly. Arlene I. Rattan, Jeffrey W. Gray and Raymond S. Dean (Ball State University, Muncie, IN) Approximately 15% of people over 65 years of age have some form of dementing disorders. This problem is compounded by the fact that the elderly comprise a growing portion of the United States population. Moreover, with this demographic shift, diagnostic questions involving dementia should become a growing concern to neuropsychologists. The present investigation was designed to examine the utility of a neuropsychological battery in the differential diagnosis of major depression, dementia, and general neurological impairment. The full Halstead-Reitan Neuropsychological Test Battery (HRNB) was administered to 80 adult patients. Of these, 30 were primary affectivedepressed (diagnosed by Research Diagnostic Criteria, RDC), 24 were neurologically impaired as evidenced by lesions documented through CT scans, and 26 were mildly demented, diagnosed on the basis of a structured interview and examination (Berg’s Initial Subject Protocol). Distinctly different neuropsychological patterns were found for demented and depressed elderly patients. Depressed patients were portrayed with moderate impairment in those Halstead Reitan tests seen to measure right parietal-temporal functioning while they scored within normal limits in those measures assessing left-hemispheric functioning. In contrast, patients in the demented and neurologically impaired groups displayed much more diffuse neurological impairment. These results were interpreted as lending support to the utility of the HRNB in differentiating depression from dementia in the elderly.
Recovery Process in Closed Head Injury: Behavior and Electrophysiological Studies. J. Spencer, P. Watkins and J. Beasley (Gallup Indian Medical Center) Closed head injury produces behavioral and physiological changes that can be subtle or obvious. Four cases, varying in subject age and length of unconsciousness but involving mostly left hemisphere damage, are followed for recovery of function. A 20.month-old infant initially in a coma for three weeks following a motor vehicle accident presented with left sided hemiparesis. CAT scan revealed a left frontal skull fracture with possible bleed. Mental and motor abilities were decreased to a lomonth level, four weeks post injury. A pre-injury 12 word vocabulary was absent. Brain stem potentials were present from both hemispheres but were less defined, longer latency for wave v and a noticeable I/p ratio difference from the left hemisphere. Repeat testing at three months post injury revealed a 4 month improvement in mental abilities and a six word vocabulary. Motor skills were increased by one month from previous testing. In other cases very slight abnormalities were
Abstracts
285
observed in the amplitude or conduction time of left brain stem or left midbrain potentials. Behavioral deficits were most obvious in verbal short term memory, speech and language processing, reading and spelling. Recovery of function six months later was noticeable for verbal short term memory rather than for basic school achievement.
Post-Concussion Syndrome: Etiology, Assessment, and Rehabilitation. Vincent A. Onorato (Private Practice, Honolulu) Recent evidence from post-mortem studies of mild-head injured patients with nonbrain injury related deaths provide evidence of microscopic brain tissue destruction. Interest in the etiology of post-concussive syndromes has been renewed with evidence of debate developing among those who hold an organic etiological base and those suggesting a psychological etiological base of symptoms. A multi-dimensional, rather than unitary, model of post-concussive changes is proposed as a guide to research, assessment and rehabilitation: Post-concussive symptoms occur as a function of the interaction among (1) pre-existing personality factors, (2) pre-existing CNS functioning, (3) CNS damage following injury, (4) psychological response following injury, and (5) situational factors, (6) occurring across time. The functional, theoretical and empirical support for the influence of each factor upon post-concussive symptom production is provided. Relevant interactions among the factors contributing to symptom production are discussed. Recommendations for further research validating the proposed model are given, along with suggestions for comprehensive assessment and management of the patient displaying post-concussive symptoms based upon the proposed model.
Factor Analysis of Wechsler Subtests for Learning Disabled Subjects. Wyman E. Fischer and Raymond S. Dean (Ball State University, Muncie, IN) Wechsler Intelligence Scale for Children-Revised (WISC-R) subtests were factor analyzed via a principal components analysis for a sample of 980 learning disabled subjects aged nine through 14. Separate analyses were conducted for the total sample, males only, females only, and age level groupings. The factor structure of the WISC-R was also compared with that of the Wechsler Intelligence Scale for Children (WISC) based on a separate sample of 287 learning disabled subjects with a similar age span. The three factor solution (Verbal Comprehension, Perceptual Organization, and Freedom from Distractibility), previously identified in normal samples, was found to be appropriate for the learning disabled subjects in the present study with both the WISC-R and WISC batteries. The Verbal Comprehension factor emerged as the most robust followed by Perceptual Organization and Freedom from Distractibility. Previous studies with small learning disabled samples offered strong support for a two factor solution (Verbal Comprehension and Perceptual Organization) but were inconsistent relative to the Freedom from Distractibility factor. In addition, sample sizes from previous studies, involving learning disabled subjects, were too small to provide information relative to possible gender effect on the factorial composition of the Wechsler scales.
Abstracts
abled children under stress experience difficulty recovering from failure. Thus, while learning problems may present, early on, as a neurological/processing disorder this may set the stage for the paradigm of a failure-aversion-failure or a phobic response as the child attempts to cope with stress.
The Utility of Neuropsychological Methods in the Differential Diagnosis of Depression and Dementia in the Elderly. Arlene I. Rattan, Jeffrey W. Gray and Raymond S. Dean (Ball State University, Muncie, IN) Approximately 15% of people over 65 years of age have some form of dementing disorders. This problem is compounded by the fact that the elderly comprise a growing portion of the United States population. Moreover, with this demographic shift, diagnostic questions involving dementia should become a growing concern to neuropsychologists. The present investigation was designed to examine the utility of a neuropsychological battery in the differential diagnosis of major depression, dementia, and general neurological impairment. The full Halstead-Reitan Neuropsychological Test Battery (HRNB) was administered to 80 adult patients. Of these, 30 were primary affectivedepressed (diagnosed by Research Diagnostic Criteria, RDC), 24 were neurologically impaired as evidenced by lesions documented through CT scans, and 26 were mildly demented, diagnosed on the basis of a structured interview and examination (Berg’s Initial Subject Protocol). Distinctly different neuropsychological patterns were found for demented and depressed elderly patients. Depressed patients were portrayed with moderate impairment in those Halstead Reitan tests seen to measure right parietal-temporal functioning while they scored within normal limits in those measures assessing left-hemispheric functioning. In contrast, patients in the demented and neurologically impaired groups displayed much more diffuse neurological impairment. These results were interpreted as lending support to the utility of the HRNB in differentiating depression from dementia in the elderly.
Recovery Process in Closed Head Injury: Behavior and Electrophysiological Studies. J. Spencer, P. Watkins and J. Beasley (Gallup Indian Medical Center) Closed head injury produces behavioral and physiological changes that can be subtle or obvious. Four cases, varying in subject age and length of unconsciousness but involving mostly left hemisphere damage, are followed for recovery of function. A 20.month-old infant initially in a coma for three weeks following a motor vehicle accident presented with left sided hemiparesis. CAT scan revealed a left frontal skull fracture with possible bleed. Mental and motor abilities were decreased to a lomonth level, four weeks post injury. A pre-injury 12 word vocabulary was absent. Brain stem potentials were present from both hemispheres but were less defined, longer latency for wave v and a noticeable I/p ratio difference from the left hemisphere. Repeat testing at three months post injury revealed a 4 month improvement in mental abilities and a six word vocabulary. Motor skills were increased by one month from previous testing. In other cases very slight abnormalities were
Abstracts
285
observed in the amplitude or conduction time of left brain stem or left midbrain potentials. Behavioral deficits were most obvious in verbal short term memory, speech and language processing, reading and spelling. Recovery of function six months later was noticeable for verbal short term memory rather than for basic school achievement.
Post-Concussion Syndrome: Etiology, Assessment, and Rehabilitation. Vincent A. Onorato (Private Practice, Honolulu) Recent evidence from post-mortem studies of mild-head injured patients with nonbrain injury related deaths provide evidence of microscopic brain tissue destruction. Interest in the etiology of post-concussive syndromes has been renewed with evidence of debate developing among those who hold an organic etiological base and those suggesting a psychological etiological base of symptoms. A multi-dimensional, rather than unitary, model of post-concussive changes is proposed as a guide to research, assessment and rehabilitation: Post-concussive symptoms occur as a function of the interaction among (1) pre-existing personality factors, (2) pre-existing CNS functioning, (3) CNS damage following injury, (4) psychological response following injury, and (5) situational factors, (6) occurring across time. The functional, theoretical and empirical support for the influence of each factor upon post-concussive symptom production is provided. Relevant interactions among the factors contributing to symptom production are discussed. Recommendations for further research validating the proposed model are given, along with suggestions for comprehensive assessment and management of the patient displaying post-concussive symptoms based upon the proposed model.
Factor Analysis of Wechsler Subtests for Learning Disabled Subjects. Wyman E. Fischer and Raymond S. Dean (Ball State University, Muncie, IN) Wechsler Intelligence Scale for Children-Revised (WISC-R) subtests were factor analyzed via a principal components analysis for a sample of 980 learning disabled subjects aged nine through 14. Separate analyses were conducted for the total sample, males only, females only, and age level groupings. The factor structure of the WISC-R was also compared with that of the Wechsler Intelligence Scale for Children (WISC) based on a separate sample of 287 learning disabled subjects with a similar age span. The three factor solution (Verbal Comprehension, Perceptual Organization, and Freedom from Distractibility), previously identified in normal samples, was found to be appropriate for the learning disabled subjects in the present study with both the WISC-R and WISC batteries. The Verbal Comprehension factor emerged as the most robust followed by Perceptual Organization and Freedom from Distractibility. Previous studies with small learning disabled samples offered strong support for a two factor solution (Verbal Comprehension and Perceptual Organization) but were inconsistent relative to the Freedom from Distractibility factor. In addition, sample sizes from previous studies, involving learning disabled subjects, were too small to provide information relative to possible gender effect on the factorial composition of the Wechsler scales.