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Tc99m HMPAO brain SPECT with visuospatial and verbal activation in normal subjects
672
BIOL PSYCHIATRY 1995;37:593 683
School o f Medicine, Stanford, CA; D e p a r t m e n t of Veterans Affairs M e d i c a l Center, Palo Alto, C A 9 4 3 0 4 The P300 component of the event-related brain potential (ERP) is reduced in schizophrenia. Cross--sectional analyses suggest smaller P300 amplitudes are associated with worse clinical status. We used a longitudinal design to ask if P300 is a stable reflection of chronic severity or if it tracks short-term clinical fluctuations. Thirty-six male veterans with schizophrenia (DSM-III-R) participated in as many as seven ERP sessions, under various medication regimens, and sometimes over multiple hospitalizations. ERPs were collected during auditory and visual paradigms in which frequent events occurred on 80% of the trials, and rare events on 20%. Subjects pressed a button in response to rare events. The clinical status of the subject was assessed within several days of each ERP session using the Brief Psychiatric Rating Scale (BPRS). Relationships between P300 and clinical status were addressed using hierarchical multiple regression analyses in which BPRS scores were regressed on Subject, P300 (amplitude or latency), and their interaction. In no case was the interaction term significant, allowing a common slope of the BPRS-P300 regression lines to be assumed across subjects. The Subject effect was entered into the regression analysis at the first step, controlling for BPRS variation associated with intersubject differences, leaving only within-subject variation over time as the source of BPRS variance available for prediction. At the second step, P300 measures were entered and the increment in R 2 tested. Auditory and visual P300 amplitude, but not latency, significantly predicted total BPRS scores, but not positive or negative symptom subscores. Thus, within an individual patient over time, increases in both auditory and visual P300 amplitude track clinical improvement. (Supported by NIMH (MH30854) & Department of Veterans Affairs.)
SATURDAY,, MAY 20
285. Tc99m HMPAO BRAIN SPECT WITH VISUOSPATIAL AND VERBAL ACTIVATION IN NORMAL SUBJECTS I. Galynker, C. Ieronimo, E. Shalts, H. Finestone, F. Ongseng, & R. Gallagher Beth Israel Medical Center, N e w York, N Y 10003; Albert Einstein College o f Medicine, Bronx, N Y Cognitive activation paradigms are increasingly being used in functional brain imaging for studies of patients with schizophrenia, Alzheimer's disease, and other disorders. In order to interpret these results meaningfully, it is important to assess the effects of these paradigms in normal brains as well. The aim of the current study was to use such a paradigm to examine the traditional concept of hemispheric differences in visuospatial vs. verbal memory (right vs. left hemisphere, respectively). Normal subjects were injected with Tc-99m HMPAO while performing a visual memory task. Half of the subjects were instructed to remember a picture visuospatially, while the other half were instructed to remember the same information verbally. The scans were obtained using an ADAC overhead SPECT camera. Images were then analyzed in two ways: 1) left/right ratios were obtained using ADAC computerized sector analysis program; 2) cortical and striatal regions of interest (ROIs) were symmetrically defined in each hemisphere by two raters who were blind to subject condition. Cerebellar ROls were selected in the middle portion of each cerebellar hemisphere. Activity in cortical and striatal regions was expressed as an ROI/cerebellure ratio and evaluated for asymmetry. Cerebral perfusion data will be presented which support the hemispheric lateralization of visuospatial and verbal memory.
284. COGNITIVE IMPAIRMENT AS PREDICTOR OF INPATIENT HOSPITAL STAY
J. Rosenblum, C. Miner, & I. Galynker Beth Israel Medical Center, Albert Einstein College o f Medicine, N e w York, N Y We have recently reported that brief neuropsychological screening at the time of admission to an acute psychiatric unit was useful in predicting the length of inpatient hospital stay (LOS). The Mini-Mental State Examination (MMSE), the A and B Trails subtests from the Halstead-Reitan Neuropsychological Battery, the Visual Reproduction subtest (VR) of the Wechsler Memory Scale, and clinical and demographic data were used to develop the best fitting model, which accounted for 48% of the variance in LOS for the original group of 41 patients. The purpose of this study was to replicate these findings as well as to explore a number of additional demographic variables in a different group of patients. Fifty-one patients admitted consecutively to a general psychiatric unit were administered MMSE, VR, and Trails A and B within 72 hours of admission. The data were analyzed using a hierarchical stepwise regression model. The bestfitting model showed modest predictive validity: the Pearson correlation between estimated and actual LOS was 0.475, p = 0.006. Clinical and demographic values remained poor predictors; however, the stepwise effect for the neuropsychological measures remained significant, with Trails A measure providing the single strongest predictor of LOS (R z + .28 p = 0.0019). The results of this study support the original hypothesis and the previous finding that LOS is related to cognitive impairment. Further work is needed to develop a practical instrument that could be used clinically to predict LOS.
286. CLINICAL SIGNIFICANCE OF NEGATIVE SYMPTOMS IN STROKE PATIENTS I. Galynker, J. Rosenblum, C. Ieronimo, E. Phillips, M.. Focseneanu, C. Miner, & R. Rosenthal Beth Israel Medical Center, Albert Einstein College o f Medicine, N e w York, N Y In order to evaluate the clinical significance of negative symptoms in stroke patients, 17 patients admitted to a physiatry unit were evaluated prospectively on the outcome of their poststroke rehabilitation. The patients were separated into two groups: those with negative symptoms (NS group, Positive and Negative Symptom Scale, Negative Symptom Subscale (PANSS-N) total score >_ 15, n = 8) and those without negative symptoms (PANSS-N >15, n = 9). Patients in the NS group also had significantly higher Scale for the Assessment of Negative Symptoms (SANS) scores (p < 0.001), Hamilton Rating Scale for Depression (HRSD) Scores (p < 0.001 ), and had significantly lower functional independence measure (FIM) scores (Mann-Whitney U = 13, p = 0.02). There was a significant negative correlation between PANSS scores and FIM scores (Pearson's r = ~).59, p = 0.01), and a positive correlation between negative symptoms and LOS (Pearson's r = 0.56, p = 0.02). There was no significant correlation between FIM and HRSD scores. These results indicate that negative symptoms in stroke patients are related to lower functioning, more difficult recovery, and longer hospitalizations. The same might not be true for the symptoms of depression.
BIOL PSYCHIATRY 1995;37:593 683
School o f Medicine, Stanford, CA; D e p a r t m e n t of Veterans Affairs M e d i c a l Center, Palo Alto, C A 9 4 3 0 4 The P300 component of the event-related brain potential (ERP) is reduced in schizophrenia. Cross--sectional analyses suggest smaller P300 amplitudes are associated with worse clinical status. We used a longitudinal design to ask if P300 is a stable reflection of chronic severity or if it tracks short-term clinical fluctuations. Thirty-six male veterans with schizophrenia (DSM-III-R) participated in as many as seven ERP sessions, under various medication regimens, and sometimes over multiple hospitalizations. ERPs were collected during auditory and visual paradigms in which frequent events occurred on 80% of the trials, and rare events on 20%. Subjects pressed a button in response to rare events. The clinical status of the subject was assessed within several days of each ERP session using the Brief Psychiatric Rating Scale (BPRS). Relationships between P300 and clinical status were addressed using hierarchical multiple regression analyses in which BPRS scores were regressed on Subject, P300 (amplitude or latency), and their interaction. In no case was the interaction term significant, allowing a common slope of the BPRS-P300 regression lines to be assumed across subjects. The Subject effect was entered into the regression analysis at the first step, controlling for BPRS variation associated with intersubject differences, leaving only within-subject variation over time as the source of BPRS variance available for prediction. At the second step, P300 measures were entered and the increment in R 2 tested. Auditory and visual P300 amplitude, but not latency, significantly predicted total BPRS scores, but not positive or negative symptom subscores. Thus, within an individual patient over time, increases in both auditory and visual P300 amplitude track clinical improvement. (Supported by NIMH (MH30854) & Department of Veterans Affairs.)
SATURDAY,, MAY 20
285. Tc99m HMPAO BRAIN SPECT WITH VISUOSPATIAL AND VERBAL ACTIVATION IN NORMAL SUBJECTS I. Galynker, C. Ieronimo, E. Shalts, H. Finestone, F. Ongseng, & R. Gallagher Beth Israel Medical Center, N e w York, N Y 10003; Albert Einstein College o f Medicine, Bronx, N Y Cognitive activation paradigms are increasingly being used in functional brain imaging for studies of patients with schizophrenia, Alzheimer's disease, and other disorders. In order to interpret these results meaningfully, it is important to assess the effects of these paradigms in normal brains as well. The aim of the current study was to use such a paradigm to examine the traditional concept of hemispheric differences in visuospatial vs. verbal memory (right vs. left hemisphere, respectively). Normal subjects were injected with Tc-99m HMPAO while performing a visual memory task. Half of the subjects were instructed to remember a picture visuospatially, while the other half were instructed to remember the same information verbally. The scans were obtained using an ADAC overhead SPECT camera. Images were then analyzed in two ways: 1) left/right ratios were obtained using ADAC computerized sector analysis program; 2) cortical and striatal regions of interest (ROIs) were symmetrically defined in each hemisphere by two raters who were blind to subject condition. Cerebellar ROls were selected in the middle portion of each cerebellar hemisphere. Activity in cortical and striatal regions was expressed as an ROI/cerebellure ratio and evaluated for asymmetry. Cerebral perfusion data will be presented which support the hemispheric lateralization of visuospatial and verbal memory.
284. COGNITIVE IMPAIRMENT AS PREDICTOR OF INPATIENT HOSPITAL STAY
J. Rosenblum, C. Miner, & I. Galynker Beth Israel Medical Center, Albert Einstein College o f Medicine, N e w York, N Y We have recently reported that brief neuropsychological screening at the time of admission to an acute psychiatric unit was useful in predicting the length of inpatient hospital stay (LOS). The Mini-Mental State Examination (MMSE), the A and B Trails subtests from the Halstead-Reitan Neuropsychological Battery, the Visual Reproduction subtest (VR) of the Wechsler Memory Scale, and clinical and demographic data were used to develop the best fitting model, which accounted for 48% of the variance in LOS for the original group of 41 patients. The purpose of this study was to replicate these findings as well as to explore a number of additional demographic variables in a different group of patients. Fifty-one patients admitted consecutively to a general psychiatric unit were administered MMSE, VR, and Trails A and B within 72 hours of admission. The data were analyzed using a hierarchical stepwise regression model. The bestfitting model showed modest predictive validity: the Pearson correlation between estimated and actual LOS was 0.475, p = 0.006. Clinical and demographic values remained poor predictors; however, the stepwise effect for the neuropsychological measures remained significant, with Trails A measure providing the single strongest predictor of LOS (R z + .28 p = 0.0019). The results of this study support the original hypothesis and the previous finding that LOS is related to cognitive impairment. Further work is needed to develop a practical instrument that could be used clinically to predict LOS.
286. CLINICAL SIGNIFICANCE OF NEGATIVE SYMPTOMS IN STROKE PATIENTS I. Galynker, J. Rosenblum, C. Ieronimo, E. Phillips, M.. Focseneanu, C. Miner, & R. Rosenthal Beth Israel Medical Center, Albert Einstein College o f Medicine, N e w York, N Y In order to evaluate the clinical significance of negative symptoms in stroke patients, 17 patients admitted to a physiatry unit were evaluated prospectively on the outcome of their poststroke rehabilitation. The patients were separated into two groups: those with negative symptoms (NS group, Positive and Negative Symptom Scale, Negative Symptom Subscale (PANSS-N) total score >_ 15, n = 8) and those without negative symptoms (PANSS-N >15, n = 9). Patients in the NS group also had significantly higher Scale for the Assessment of Negative Symptoms (SANS) scores (p < 0.001), Hamilton Rating Scale for Depression (HRSD) Scores (p < 0.001 ), and had significantly lower functional independence measure (FIM) scores (Mann-Whitney U = 13, p = 0.02). There was a significant negative correlation between PANSS scores and FIM scores (Pearson's r = ~).59, p = 0.01), and a positive correlation between negative symptoms and LOS (Pearson's r = 0.56, p = 0.02). There was no significant correlation between FIM and HRSD scores. These results indicate that negative symptoms in stroke patients are related to lower functioning, more difficult recovery, and longer hospitalizations. The same might not be true for the symptoms of depression.