- Email: [email protected]
Family behavioral change following neurologic impairment
Abstractsfwm the 17thAnnualMeeting
115
Haines,M. E., & Eubanks,J. D., 111 Scleroderma: Cognitive Deficits May Mean Further Disease.
Sclerodermais a diseaseof the connectivetissuethat is characterizedby the calcificationof the skin. Sclerodermaalso afflicts many other areas of the body; for example, vascular, gastrointestinal,lungs, heart, kidneys,muscles,and joints. However,most anecdotaland empiricalinformationindicatethat it causesfew or no changesin the brain.A neuropsychologicalassessmentin May 1997of a 44-year-oldwoman who was diagnosedwith Scleroderma in January 1997 indicated that she was having difficultieswith both executive functioningand verbalmemory.These impairmentswere inconsistentwith her educational and occupationalbackground.On self-reportsof affectivefunctioning,the patientindicated little psychologicaldistress. Rather, her performanceon the MMPI-2 indicated that she tended to experienceher psychologicaldistress in terms of physical problems, a likely validationof true physicalsymptoms.A neuropsychologicalassessmentwas integralin this case because the rarity of sclerodennacausing neuropsychologicaldeficits pointed to an alternateetiologyfor the deficits.For this particularpatient,the possibilityof a comorbid diagnosisof SystemicLupuswas increasedsecondaryto the neuropsychologicaldeficitsthat were found. Hamberger,M. J. Transient Anton Syndrome During Intracarotid Amobarbital Testing in a Patient with Preexisting Hemianopsia.
Thisis a casereportof a 32-year-oldrighthandedwomanwitha historyof earlyheadtrauma resultingin a right visual hemianopsia,mild right hemiparesis,and medicallyintractable epilepsy,withseizuresarisingfromthe left anteriortemporallobe.MRIshowedhemiatrophy of the left cerebralhemispherewith two large foci of encephaloma.lacia in the mid parietal lobe and posteriorparieto-occipitalregion.Becauseshe was a candidatefor temporallobe resectivesurgery,intracarotidamobarbital(ICA)testingwas requiredto assesshemispheric languageand memoryfunctioning.Languageassessmentindicatedleft hemispherelanguage dominance.Withrespectto memory,ICAmemorytestitemsat mostcenterstypicallyconsist of visuallypresentedpictures,real objects,printed words and abstractdesigns.Given her baseline right hemianopsia,however, injection of the right ICA resulted in functional blindness,in which the patientwould not acknowledgeloss of vision.This transientstate resembledAntonSyndrome,whichtypicallyresultsfrombilateralinfarctionof the posterior cerebralarteries.Right ICA testingwas thereforerepeatedwith nonvisualitems, including environmentalsounds,words,and proverbs.Due to memoryfailurefollowingthe left ICA injection, similar memory testing was performed with super-selectiveinjection of the posteriorcerebralarteries.In both instances,memoryperformancewas intactfollowingthe right injection, suggestingadequate verbal and auditory memory functioningof the left temporalregion. Findingsalso suggest that with appropriatestimuli,ICA testing can be performedin patientswith preexistinghemianopsia. Johnson,D. J. Family Behavioral Change Following Necrologic Impairment.
The assessmentof behavioralchangeassociatedwith necrologicimpairmenthas becomea new frontierof neuropsychological research.Despitethe recognitionthatpatientsexperience behavioralchangefollowingnecrologicillnessand/ortrauma,therehas not yet appeaxedany systematicassessmentfor family behavioralchangeswhich also follownecrologicimpairment. This project studiedand comparedthe behavioralchangesof the immediatefamiliesof two distinctlydifferentnecrologicimpairmentsfor TBI and Friedreich’sAtaxia.Behavioral
116
Abstracts@m the 17thAnnualMeeting
sequelae were assessed with the Behavior Change Inventory,a scale which measures behavioralstatusbefore and subsequentto centralnervoussysteminsult. Resultsindicatedthat membersof both family groupshad more significantDepression, Agitation,Renurnination,andApprehension.Therewas an absenceof behavioralchangefor Diftldence,SocirdDistance,EmotionalControl,and Hostilityfor bothfamilygroupsas well. TBI familymemberswerelessAffable,Content andhad lowEnergy.Theyalsohad more Fatigue.Friedreich’sAtaxiafamilymembersbecameless Introvertedbut more Distractible. Despite the presence of two distinctly different necrologic etiologies among family members, similar behavioralchanges have been identified.These findings indicate the profound behavioralresponse that family members have from their patient’s necrologic impairment.At the sametime,it is suggestedthatfamiliesimpactthe emotionalhealthof the patientas well. The need for comprehensivepatient/familytreatmentis clearlyindicated. Johnson,D. J., & Hartlage,L. C. Long-Term Neurobehavioral Differences of TBI and General Necrologic Patients.
Long-termfollow-upof the neurobehavioralsequelaeof necrologicimpairmenthas not been as rigorouslymonitoredas neurocognitivesequelae.Typicallyincreasedfrustrationduring variouspsychosocialactivitiesand limitedmeasurementprocedureshavebeen used for such long-termassessmentof neurobehavioraloutcome. Thisprojectstudiedandcompared12TBI survivorsand 12generalnecrologic(non-CVA) patientsover a 5-yearperiod in order to assesstheir neurobehavioralstatus3–5 years post insult. Pre-insultbehavioralchangeswere measuredwith the BehaviorChangeInventory. MMPI-2data obtainedon an annualbasis duringthe 5-yearperiodresultedin two distinct but consistentpersonrdityprofiles.AlthoughTBI survivorswere moreseverein the 1–2year period immediatelyfollowingthe head injury and remainedat a lowered level of severity over time, both groupsof patientpopulationsbecameprogressivelyworsein their levelsof depressionover the five year period.Relatedneurocognitivedata for both groupsindicated persistentproblemswith attention-concentration, memory,and reactiontime. It was previouslythoughtthat generalnecrologicpatientsadapt to their disorder.However,thisis not indicatedin thisstudy.Long-termriskof neurobehavioralproblemshasmajor rehabilitation,legal and psychosocialmeaning for TBI survivorsand general necrologic patientpopulations. Kozora,E., Rojas,S., & Make, B. Self-Report of Cognitive Functioning in Patients with Chronic Obstructive Pulmonary Disease.
Empiricalstudieshave documentedcognitivechangesin patientswith chronicobstructive pulmonarydisease (COPD), however,few studies have examinedself-reportedcognitive complaintsin thesepatients.The goalof this studywas to examinethe presenceof cognitive complaintsin COPDpatientscomparedto normalcontrols(NC).We also aimedto examine associationsbetweencognitivecomplaints,cognitivescoresand depression.The subjectsin this study included59 COPD patients and 21 NC subjects.The mean age of the COPD patients was 66.7 years comparedto 65.9 in the NC group. Sixty percent of the COPD subjectsand none of the NCShad a historyof neurologicalandlorpsychiatricevents. All subjectswere administereda two hour batteryof standardneuropsychologicaltests, the Beck DepressionInventory(BDI;Beck, 1987)and the Multi-AbilitySelf-ReportQuestionnaire(MASQ;Seidenberg& Haltiner,1991).The MASQ assessesself reportof performance in five domains:VisualMemory(VSM),Attentionand Concentration(AC), Verbal Memory (VM), Visuo-Perception(VP) and Language (L). Results indicate that COPD patientshavesignificantlyhigherdomainandtotalMASQscoresthanNCS.The MASQtotal
115
Haines,M. E., & Eubanks,J. D., 111 Scleroderma: Cognitive Deficits May Mean Further Disease.
Sclerodermais a diseaseof the connectivetissuethat is characterizedby the calcificationof the skin. Sclerodermaalso afflicts many other areas of the body; for example, vascular, gastrointestinal,lungs, heart, kidneys,muscles,and joints. However,most anecdotaland empiricalinformationindicatethat it causesfew or no changesin the brain.A neuropsychologicalassessmentin May 1997of a 44-year-oldwoman who was diagnosedwith Scleroderma in January 1997 indicated that she was having difficultieswith both executive functioningand verbalmemory.These impairmentswere inconsistentwith her educational and occupationalbackground.On self-reportsof affectivefunctioning,the patientindicated little psychologicaldistress. Rather, her performanceon the MMPI-2 indicated that she tended to experienceher psychologicaldistress in terms of physical problems, a likely validationof true physicalsymptoms.A neuropsychologicalassessmentwas integralin this case because the rarity of sclerodennacausing neuropsychologicaldeficits pointed to an alternateetiologyfor the deficits.For this particularpatient,the possibilityof a comorbid diagnosisof SystemicLupuswas increasedsecondaryto the neuropsychologicaldeficitsthat were found. Hamberger,M. J. Transient Anton Syndrome During Intracarotid Amobarbital Testing in a Patient with Preexisting Hemianopsia.
Thisis a casereportof a 32-year-oldrighthandedwomanwitha historyof earlyheadtrauma resultingin a right visual hemianopsia,mild right hemiparesis,and medicallyintractable epilepsy,withseizuresarisingfromthe left anteriortemporallobe.MRIshowedhemiatrophy of the left cerebralhemispherewith two large foci of encephaloma.lacia in the mid parietal lobe and posteriorparieto-occipitalregion.Becauseshe was a candidatefor temporallobe resectivesurgery,intracarotidamobarbital(ICA)testingwas requiredto assesshemispheric languageand memoryfunctioning.Languageassessmentindicatedleft hemispherelanguage dominance.Withrespectto memory,ICAmemorytestitemsat mostcenterstypicallyconsist of visuallypresentedpictures,real objects,printed words and abstractdesigns.Given her baseline right hemianopsia,however, injection of the right ICA resulted in functional blindness,in which the patientwould not acknowledgeloss of vision.This transientstate resembledAntonSyndrome,whichtypicallyresultsfrombilateralinfarctionof the posterior cerebralarteries.Right ICA testingwas thereforerepeatedwith nonvisualitems, including environmentalsounds,words,and proverbs.Due to memoryfailurefollowingthe left ICA injection, similar memory testing was performed with super-selectiveinjection of the posteriorcerebralarteries.In both instances,memoryperformancewas intactfollowingthe right injection, suggestingadequate verbal and auditory memory functioningof the left temporalregion. Findingsalso suggest that with appropriatestimuli,ICA testing can be performedin patientswith preexistinghemianopsia. Johnson,D. J. Family Behavioral Change Following Necrologic Impairment.
The assessmentof behavioralchangeassociatedwith necrologicimpairmenthas becomea new frontierof neuropsychological research.Despitethe recognitionthatpatientsexperience behavioralchangefollowingnecrologicillnessand/ortrauma,therehas not yet appeaxedany systematicassessmentfor family behavioralchangeswhich also follownecrologicimpairment. This project studiedand comparedthe behavioralchangesof the immediatefamiliesof two distinctlydifferentnecrologicimpairmentsfor TBI and Friedreich’sAtaxia.Behavioral
116
Abstracts@m the 17thAnnualMeeting
sequelae were assessed with the Behavior Change Inventory,a scale which measures behavioralstatusbefore and subsequentto centralnervoussysteminsult. Resultsindicatedthat membersof both family groupshad more significantDepression, Agitation,Renurnination,andApprehension.Therewas an absenceof behavioralchangefor Diftldence,SocirdDistance,EmotionalControl,and Hostilityfor bothfamilygroupsas well. TBI familymemberswerelessAffable,Content andhad lowEnergy.Theyalsohad more Fatigue.Friedreich’sAtaxiafamilymembersbecameless Introvertedbut more Distractible. Despite the presence of two distinctly different necrologic etiologies among family members, similar behavioralchanges have been identified.These findings indicate the profound behavioralresponse that family members have from their patient’s necrologic impairment.At the sametime,it is suggestedthatfamiliesimpactthe emotionalhealthof the patientas well. The need for comprehensivepatient/familytreatmentis clearlyindicated. Johnson,D. J., & Hartlage,L. C. Long-Term Neurobehavioral Differences of TBI and General Necrologic Patients.
Long-termfollow-upof the neurobehavioralsequelaeof necrologicimpairmenthas not been as rigorouslymonitoredas neurocognitivesequelae.Typicallyincreasedfrustrationduring variouspsychosocialactivitiesand limitedmeasurementprocedureshavebeen used for such long-termassessmentof neurobehavioraloutcome. Thisprojectstudiedandcompared12TBI survivorsand 12generalnecrologic(non-CVA) patientsover a 5-yearperiod in order to assesstheir neurobehavioralstatus3–5 years post insult. Pre-insultbehavioralchangeswere measuredwith the BehaviorChangeInventory. MMPI-2data obtainedon an annualbasis duringthe 5-yearperiodresultedin two distinct but consistentpersonrdityprofiles.AlthoughTBI survivorswere moreseverein the 1–2year period immediatelyfollowingthe head injury and remainedat a lowered level of severity over time, both groupsof patientpopulationsbecameprogressivelyworsein their levelsof depressionover the five year period.Relatedneurocognitivedata for both groupsindicated persistentproblemswith attention-concentration, memory,and reactiontime. It was previouslythoughtthat generalnecrologicpatientsadapt to their disorder.However,thisis not indicatedin thisstudy.Long-termriskof neurobehavioralproblemshasmajor rehabilitation,legal and psychosocialmeaning for TBI survivorsand general necrologic patientpopulations. Kozora,E., Rojas,S., & Make, B. Self-Report of Cognitive Functioning in Patients with Chronic Obstructive Pulmonary Disease.
Empiricalstudieshave documentedcognitivechangesin patientswith chronicobstructive pulmonarydisease (COPD), however,few studies have examinedself-reportedcognitive complaintsin thesepatients.The goalof this studywas to examinethe presenceof cognitive complaintsin COPDpatientscomparedto normalcontrols(NC).We also aimedto examine associationsbetweencognitivecomplaints,cognitivescoresand depression.The subjectsin this study included59 COPD patients and 21 NC subjects.The mean age of the COPD patients was 66.7 years comparedto 65.9 in the NC group. Sixty percent of the COPD subjectsand none of the NCShad a historyof neurologicalandlorpsychiatricevents. All subjectswere administereda two hour batteryof standardneuropsychologicaltests, the Beck DepressionInventory(BDI;Beck, 1987)and the Multi-AbilitySelf-ReportQuestionnaire(MASQ;Seidenberg& Haltiner,1991).The MASQ assessesself reportof performance in five domains:VisualMemory(VSM),Attentionand Concentration(AC), Verbal Memory (VM), Visuo-Perception(VP) and Language (L). Results indicate that COPD patientshavesignificantlyhigherdomainandtotalMASQscoresthanNCS.The MASQtotal