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Cognitive dysfunction in patients with silicone gel breast implants
Abstracts of 15th Annual Meeting
409
timt~ and number correct with controls performing better than simulators. This would indicate that simulated malingerers can suppress performance on the priming tests and that they are able to utilize an explicit component of this task. On a mirror image reading task, participants were given 10 blocks of trials for repeated and nonrepeated word triads. The results showed no differences in performance as measured by speed of reading between controls and simulators. This would indicate that simulated malingerers are not able to suppress performance on the mirror image task. The findings suggest that priming tasks are not completely automated tasks while mirror image reading may be a more automated task since malingerers are not able to decrease performance when instructed to do so. Simulated malingerers may be able to suppress their performance on the priming tasks because it is susceptible to contamination by explicit knowledge. In contrast, the mirror image task is less susceptible to contamination with explicit knowledge.
Klebe, K. J., Davis, H. P., & Berry, B. Visuospatial Retention by Subjects Ranging From 5 to 89 Years of Age. Aging studies typically assess subjects after the age of maturity while developmental research focuses on changes before the age of maturity. There are few investigations of memory using the same assessment instrument in children, adults, and older adults. In the present study a computerized explicit memory task for visuospatial information was used to examine the effect of age on retention in subjects ranging in age from 5 to 89 years of age. It was hypothesized that visuospatial memory would decline with age, as has been demonstrated for verbal memory. Participants were administered a computerized version of the game of "concentration" or "memory cards." A grid display of 24 cards (4 rows × 6 columns) was presented on the computer screen. The subjects were instructed to turn over one card at a time to produce a picture and then match it by turning over the identical picture from the remaining cards. When a match was achieved the cards were taken out of play. Participants were instructed they would receive multiple trials and that the cards would remain in the sample place on all trials (five immediate trials and one 20 minute delayed trial). Subjects between 5 and 9 years of age performed significantly poorer than subjects 10-14 and 15-19 years of age. An age related memory decline was detected in subjects 40 years of age and older. Subjects in their 60s and 70s plus performed more poorly than all other age groups. In contrast to the poorer retention over a delay for verbal material demonstrated by the elderly, no delay related decline was detected for the visuospatial information in this task for any age group.
Klein, S. H. Cognitive Dysfqnction in Patients With Silicone Gel Breast Implants. Once considered biologically inert and harmless, silicone is now suspected of causing immunological abnormalities and connective tissue-like disorders. Some women with silicone gel breast implants have reported a variety of neurologic and rheumatologic symptoms including cognitive dysfunction. Abnormalities on brain MRI have been reported in some patients. This study presents data from 27 women referred by neurologists or rheumatologists with complaints of decreased cognitive functioning that developed generally 1 or more years following surgical placement of silicone gel breast implants. Patients were administered a battery of neuropsychological tests including Trailmaking, Rey Complex Figure Test, Boston Naming Test, Wechsler Memory Scale Revised, Rey Auditory Verbal Learning Test, Wide Range Achievement Test, Stroop, Raven, Shipley and Serial Sevens. Lower than expected scores were demonstrated on tests of verbal and visual memory, word finding, spelling, processing speed, and mental tracking with scores for the group as a whole falling
410
Abstracts of 15th Annual Meeting
between 1 and 1.5 standard deviations below the mean. Approximately one-quarte~ to one-third of the women demonstrated even greater deficits with scores two or more standard deviations below the mean. In contrast, satisfactory performances were obtained on measures of visual reasoning, vocabulary, verbal abstraction, and basic attentional abilities. While confounding variables such as pain, depression and fatigue may have influenced these womens' performances, the pattern of test results is suggestive of legitimate organic deficits.
Klitzke, M. J. The Sensitivity of Selective and Divided Attention Tasks in the Measurement of Psychostimulant Efficacy Following Traumatic Brain Injury Induced Attentional Deficits. Diminished attentional capacity is a frequent manifestation of cerebral pathology and often is a significant limiting factor in recovery. While a body of research supports the use of psychostimulant treatment following brain injury, an objective method of measuring a positive response to CNS stimulants has not been delineated. A single-subject ABAB reversal design was employed to demonstrate the relatively greater sensitivity of divided attention tasks (Trail B and Sternberg Dual Processing) over selective attention tasks (Continuous Performance Test and Johns Hopkins Brief Test of Attention). Improved performance on divided attention tasks corresponded with both patient and family m e m b e r ' s report of improved concentration and reduced distractibility.
Koffier, S. P., Campbell, E., Striepe, M. I., & Piatt, A. L. Neuropsychological Aspects of HIV/AIDS in Women. In many urban areas of the United States AIDS is the leading cause of death among women between the ages of 25 and 44. The number of AIDS cases in women continues to increase at an alarming rate, however, literature examining neurocognitive sequela of HIV among women remains sparse. The current investigation was undertaken to examine the neurocognitive aspects of HIV among this understudied population. Subjects consisted of 26 women who were HIV positive and 24 women who were seronegative. Seventy-four percent of the women with HIV were African American, 19% Caucasian, 5% Hispanic, and 2% multiracial. On average the women were 33.5 years old with 11.4 years of education. Disease status varied: 67% were asymptomatic, 21% were symptomatic, and 12% had AIDS. Women in the control group had similar demographic characteristics. Both groups of women completed the Neuropsychological Symptom Checklist (NSC) and a neuropsychological battery that assessed the following cognitive domains: sensory and motor functions, memory, reasoning, speed of mental processing, and academic abilities. Results revealed significant differences (p < .05) between seropositive and seronegative womer~ on the NSC Total score, and the Sensory, Motor, Thinking, and Medical subscale scores of the NSC. Additionally, the women with HIV were significantly slower on the Purdue Pegboard test for both hands (,p < .05). The results suggest that while these women with HIV disease experience subclinical neurocognitive symptoms, with the exception of a measure of dexterity, such deficits were not observed on standardized neuropsychological assessment. Possible insensitivity of standard neuropsychological test instruments to subtle indicators of HIV related CNS dysfunction is discussed. Further, the association of symptoms to level of emotional stress is evaluated. Koltai, D. C., Chelune, G. J., & Craggs, J. G. A Comparison of the Dissociation of Recall and Recognition Items on the Mattis DRS and Rey AVLT in an Elderly Sample.
409
timt~ and number correct with controls performing better than simulators. This would indicate that simulated malingerers can suppress performance on the priming tests and that they are able to utilize an explicit component of this task. On a mirror image reading task, participants were given 10 blocks of trials for repeated and nonrepeated word triads. The results showed no differences in performance as measured by speed of reading between controls and simulators. This would indicate that simulated malingerers are not able to suppress performance on the mirror image task. The findings suggest that priming tasks are not completely automated tasks while mirror image reading may be a more automated task since malingerers are not able to decrease performance when instructed to do so. Simulated malingerers may be able to suppress their performance on the priming tasks because it is susceptible to contamination by explicit knowledge. In contrast, the mirror image task is less susceptible to contamination with explicit knowledge.
Klebe, K. J., Davis, H. P., & Berry, B. Visuospatial Retention by Subjects Ranging From 5 to 89 Years of Age. Aging studies typically assess subjects after the age of maturity while developmental research focuses on changes before the age of maturity. There are few investigations of memory using the same assessment instrument in children, adults, and older adults. In the present study a computerized explicit memory task for visuospatial information was used to examine the effect of age on retention in subjects ranging in age from 5 to 89 years of age. It was hypothesized that visuospatial memory would decline with age, as has been demonstrated for verbal memory. Participants were administered a computerized version of the game of "concentration" or "memory cards." A grid display of 24 cards (4 rows × 6 columns) was presented on the computer screen. The subjects were instructed to turn over one card at a time to produce a picture and then match it by turning over the identical picture from the remaining cards. When a match was achieved the cards were taken out of play. Participants were instructed they would receive multiple trials and that the cards would remain in the sample place on all trials (five immediate trials and one 20 minute delayed trial). Subjects between 5 and 9 years of age performed significantly poorer than subjects 10-14 and 15-19 years of age. An age related memory decline was detected in subjects 40 years of age and older. Subjects in their 60s and 70s plus performed more poorly than all other age groups. In contrast to the poorer retention over a delay for verbal material demonstrated by the elderly, no delay related decline was detected for the visuospatial information in this task for any age group.
Klein, S. H. Cognitive Dysfqnction in Patients With Silicone Gel Breast Implants. Once considered biologically inert and harmless, silicone is now suspected of causing immunological abnormalities and connective tissue-like disorders. Some women with silicone gel breast implants have reported a variety of neurologic and rheumatologic symptoms including cognitive dysfunction. Abnormalities on brain MRI have been reported in some patients. This study presents data from 27 women referred by neurologists or rheumatologists with complaints of decreased cognitive functioning that developed generally 1 or more years following surgical placement of silicone gel breast implants. Patients were administered a battery of neuropsychological tests including Trailmaking, Rey Complex Figure Test, Boston Naming Test, Wechsler Memory Scale Revised, Rey Auditory Verbal Learning Test, Wide Range Achievement Test, Stroop, Raven, Shipley and Serial Sevens. Lower than expected scores were demonstrated on tests of verbal and visual memory, word finding, spelling, processing speed, and mental tracking with scores for the group as a whole falling
410
Abstracts of 15th Annual Meeting
between 1 and 1.5 standard deviations below the mean. Approximately one-quarte~ to one-third of the women demonstrated even greater deficits with scores two or more standard deviations below the mean. In contrast, satisfactory performances were obtained on measures of visual reasoning, vocabulary, verbal abstraction, and basic attentional abilities. While confounding variables such as pain, depression and fatigue may have influenced these womens' performances, the pattern of test results is suggestive of legitimate organic deficits.
Klitzke, M. J. The Sensitivity of Selective and Divided Attention Tasks in the Measurement of Psychostimulant Efficacy Following Traumatic Brain Injury Induced Attentional Deficits. Diminished attentional capacity is a frequent manifestation of cerebral pathology and often is a significant limiting factor in recovery. While a body of research supports the use of psychostimulant treatment following brain injury, an objective method of measuring a positive response to CNS stimulants has not been delineated. A single-subject ABAB reversal design was employed to demonstrate the relatively greater sensitivity of divided attention tasks (Trail B and Sternberg Dual Processing) over selective attention tasks (Continuous Performance Test and Johns Hopkins Brief Test of Attention). Improved performance on divided attention tasks corresponded with both patient and family m e m b e r ' s report of improved concentration and reduced distractibility.
Koffier, S. P., Campbell, E., Striepe, M. I., & Piatt, A. L. Neuropsychological Aspects of HIV/AIDS in Women. In many urban areas of the United States AIDS is the leading cause of death among women between the ages of 25 and 44. The number of AIDS cases in women continues to increase at an alarming rate, however, literature examining neurocognitive sequela of HIV among women remains sparse. The current investigation was undertaken to examine the neurocognitive aspects of HIV among this understudied population. Subjects consisted of 26 women who were HIV positive and 24 women who were seronegative. Seventy-four percent of the women with HIV were African American, 19% Caucasian, 5% Hispanic, and 2% multiracial. On average the women were 33.5 years old with 11.4 years of education. Disease status varied: 67% were asymptomatic, 21% were symptomatic, and 12% had AIDS. Women in the control group had similar demographic characteristics. Both groups of women completed the Neuropsychological Symptom Checklist (NSC) and a neuropsychological battery that assessed the following cognitive domains: sensory and motor functions, memory, reasoning, speed of mental processing, and academic abilities. Results revealed significant differences (p < .05) between seropositive and seronegative womer~ on the NSC Total score, and the Sensory, Motor, Thinking, and Medical subscale scores of the NSC. Additionally, the women with HIV were significantly slower on the Purdue Pegboard test for both hands (,p < .05). The results suggest that while these women with HIV disease experience subclinical neurocognitive symptoms, with the exception of a measure of dexterity, such deficits were not observed on standardized neuropsychological assessment. Possible insensitivity of standard neuropsychological test instruments to subtle indicators of HIV related CNS dysfunction is discussed. Further, the association of symptoms to level of emotional stress is evaluated. Koltai, D. C., Chelune, G. J., & Craggs, J. G. A Comparison of the Dissociation of Recall and Recognition Items on the Mattis DRS and Rey AVLT in an Elderly Sample.