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Impact of facial fractures on neuropsychological functioning of trauma patients
Abstracts of 16th Annual Meeting
361
Folstein Mini-Mental State Examination (MMSE) to determine the usefulness of the NCSE as a cognitive screen. Most neuropsychological measures lack norms on African-American seniors. Participants were recruited from local senior centers, clubs, and churches. All 80 participants were given the MMSE and NCSE in a nonrandom order by a neuropsychologist and completed a historical questionnaire. The group averaged 71 years of age and 12 years of education and largely were healthy with minimal problems in daily functioning. The Proc GLM analyses of the NCSE, and particularly the memory measure, significantly differentiated participants with/without self-described memory problems, p < .05. In general, the NCSE was more sensitive in detecting mild cognitive impairment than the MMSE.
Lynch, M. D., Russell, M. L., & Harvey, S. C. Neuropsychological Analysis of Anosodiaphoria in Left Hemispheric Tumors: A Disconnection Syndrome. Anosodiaphoria, the apparent lack of concern regarding either a significant neurological impairment or loss of function, is commonly associated with an acute insult to right parietal structures. Two cases of this syndrome are discussed in which the lesion was within the left temporal-parietal region. In each case, the patient's initial presentation was viewed primarily as functional, with variable organic elements. While atypical in nature, these cases offer evidence that a disruption of the sub-cortical white matter pathways in the parietal region in the left hemisphere areas may produce an organically bases of "la belle indifference" in non-psychiatric patients. Macciocchi, S. N., Diamond, P. T., & Burgess, E. J. Predictors of" Functional Outcome in lschemic Stroke. A prospective clinical trial of ischemic stroke (N = 327) using standardized medical criteria for inclusion was undertaken to examine factors affecting outcome. Stroke survivors received initial assessments at 7-10 days, 1 month and 3 months post stroke. Patients were evaluated using the Unified Neurologic Stroke Scale (UNSS). The Glascow Outcome Study (GOS) and the Barthel Index (BI). Patients received CT scans at 7-10 days post stroke. All outcome measures were highly correlated (.75-.85). Several outcome models were tested using logistic regression procedures. Analysis of maximum likelihood estimates revealed a significant impact of age (p .0001); initial UNSS score (p .0001); cortical,parietal and left lesions (p. 0005) as well as prior stroke (p .03) on Barthel Score at 3 months. Issues related to predicting outcome and relationships of variables to outcome are discussed.
Markosian, N., Smith-Seemiller, L., & Lovell, M. R. Impact of Facial Fractures on Neuropsychological Functioning of Trauma Patients. The purpose of this study was to examine the relationship between facial fractures and the cognitive sequelae of closed head injury (CHI). Existing studies examining the association between CHI and facial fractures rely only on neurological examination and/or cranial computerized tomography (CT) to determine the extent of neurological injury. This study used neuropsychological measures in order to evaluate more subtle changes in cognitive in a sample of 83 patients with trauma related facial fractures and normal CT scans. Subjects were drawn from a large database of trauma patients hospitalized at a large urban teaching hospital, and were placed into one of four groups based on the location of facial fracture: Group 1 had fractures in the lower facial region (n = 19), Group 2 had fractures in the midfacial region (n = 35), Group 3 had fractures in the upper facial region (n = 12), and Group 4 had fractures in more than one facial region (n = 17). The groups did not differ significantly on the variables age, gender, or mechanism of injury. A series of ANCOVAs (analysis of covariance) were performed with education and Glascow Coma Scale score as
362
Abstracts of 16th Annual Meeting
covariates, group membership as independent variable, and selected indices from the Control Oral Word Association Test, Wisconsin Card Sorting Test, Wechsler Memory Scale-Revised, and Trail Making Test as dependent variables. The results of this study suggest that number as well as location of facial fractures have important implications for cognitive functioning regardless of overall injury severity.
Marshall, R. M., Prettyman, E. E., Harris, D. P., & Gray, R. P. A Comparison of Neuropsychological and Electrophysiological Test Results in Adolescents with Conduct Disorder. The purpose of this study is to investigate the correspondence between neuropsychological tests and brain electrical activity mapping in adolescents with Conduct Disorder (CD). The study seeks to identify underlying brain abnormalities and to identify more precisely left/right and anterior/posterior differences in this population. Although such information is thought to provide valuable data for diagnosis and treatment (Lahey et al., 1993; Shapiro & Hynd, 1993) few studies directly address these issues. Subjects for this investigation include 10 males, ages 12-18 at a residential treatment center in Texas. All subjects meet DSM-IV diagnostic criteria for CD and none has neurological abnormalities nor major psychoses. Subjects' neuropsychological test results were compared to their topographic brain maps. The latter includes EEG, auditory cognitive evoked potentials, visual evoked potentials, and P300, all processed by Fast Fourier Transformation. Analyses of neuropsychological test results suggest indicators of organicity most frequently involved tests associated with left hemisphere functioning. Analyses of electrophysiology data revealed QEEG and EP abnormalities manifest as anterior/posterior and interhemispheric differences. Both sets of data suggest that underlying brain abnormalities characterize this group of adolescents with Conduct Disorder. Implications for diagnosis and treatment will be discussed. Martelli, M. F., Zasler, N. D., & Braith, J. A. Predicting Outcome Following Traumatic Brain Injury. (TB1): Utility of a Composite Prognostic Indicator Checklist. A growing body of literature is emerging which describes the variables that impact on long term outcome following TBI. Although much is becoming known about these different factors individually, much less is known about their collective influence. The current investigation employed a composite approach to rating prognostic indicators for a group of 28 TBI patients in order to evaluate their collective effect on outcome. Subjects were recruited over a 1-month period from volunteer participants who had sustained diffuse traumatic cerebral injuries and were receiving ongoing or follow-up treatment services by the first author. Data collection was completed for 28 subjects (16 males; mean age = 36.4; mean education = 13.9; mean estimated last 2 year GPA = 2.6/4.0; mean time post-injury = 2.9 years). Data collection included review of medical records, live and phone interview with subjects and family members, administration of an objective personality assessment instrument (MMPI), and completion of mood, structured symptom, and quality of life rating instruments by patient and relative. Data analysis employing a linear regression analysis revealed that a combination of Length of PTA, Premorbid Neurologic Status, Premorbid Psychiatric Status, Estimated Premorbid IQ, Post-Traumatic Seizures, Marital/Relationship Status, Collateral Injuries and Accident Victimization Perception was highly accurate in discriminating post-traumatic vocational (R2 = .51, p < .01) and disability status (R2 = .69, p < .01). Further analysis indicated that a simple linear combination of these variables and a composite index with a clinically derived cutoff score assigning subjects to High and Low Vulnerability groups was found to reliably predict vocational (i.e., 1/8 vs. 14/20) employed or in school for High and Low vulnerability groups, respectively; ×2 (5, N = 28) = 17.37, p
361
Folstein Mini-Mental State Examination (MMSE) to determine the usefulness of the NCSE as a cognitive screen. Most neuropsychological measures lack norms on African-American seniors. Participants were recruited from local senior centers, clubs, and churches. All 80 participants were given the MMSE and NCSE in a nonrandom order by a neuropsychologist and completed a historical questionnaire. The group averaged 71 years of age and 12 years of education and largely were healthy with minimal problems in daily functioning. The Proc GLM analyses of the NCSE, and particularly the memory measure, significantly differentiated participants with/without self-described memory problems, p < .05. In general, the NCSE was more sensitive in detecting mild cognitive impairment than the MMSE.
Lynch, M. D., Russell, M. L., & Harvey, S. C. Neuropsychological Analysis of Anosodiaphoria in Left Hemispheric Tumors: A Disconnection Syndrome. Anosodiaphoria, the apparent lack of concern regarding either a significant neurological impairment or loss of function, is commonly associated with an acute insult to right parietal structures. Two cases of this syndrome are discussed in which the lesion was within the left temporal-parietal region. In each case, the patient's initial presentation was viewed primarily as functional, with variable organic elements. While atypical in nature, these cases offer evidence that a disruption of the sub-cortical white matter pathways in the parietal region in the left hemisphere areas may produce an organically bases of "la belle indifference" in non-psychiatric patients. Macciocchi, S. N., Diamond, P. T., & Burgess, E. J. Predictors of" Functional Outcome in lschemic Stroke. A prospective clinical trial of ischemic stroke (N = 327) using standardized medical criteria for inclusion was undertaken to examine factors affecting outcome. Stroke survivors received initial assessments at 7-10 days, 1 month and 3 months post stroke. Patients were evaluated using the Unified Neurologic Stroke Scale (UNSS). The Glascow Outcome Study (GOS) and the Barthel Index (BI). Patients received CT scans at 7-10 days post stroke. All outcome measures were highly correlated (.75-.85). Several outcome models were tested using logistic regression procedures. Analysis of maximum likelihood estimates revealed a significant impact of age (p .0001); initial UNSS score (p .0001); cortical,parietal and left lesions (p. 0005) as well as prior stroke (p .03) on Barthel Score at 3 months. Issues related to predicting outcome and relationships of variables to outcome are discussed.
Markosian, N., Smith-Seemiller, L., & Lovell, M. R. Impact of Facial Fractures on Neuropsychological Functioning of Trauma Patients. The purpose of this study was to examine the relationship between facial fractures and the cognitive sequelae of closed head injury (CHI). Existing studies examining the association between CHI and facial fractures rely only on neurological examination and/or cranial computerized tomography (CT) to determine the extent of neurological injury. This study used neuropsychological measures in order to evaluate more subtle changes in cognitive in a sample of 83 patients with trauma related facial fractures and normal CT scans. Subjects were drawn from a large database of trauma patients hospitalized at a large urban teaching hospital, and were placed into one of four groups based on the location of facial fracture: Group 1 had fractures in the lower facial region (n = 19), Group 2 had fractures in the midfacial region (n = 35), Group 3 had fractures in the upper facial region (n = 12), and Group 4 had fractures in more than one facial region (n = 17). The groups did not differ significantly on the variables age, gender, or mechanism of injury. A series of ANCOVAs (analysis of covariance) were performed with education and Glascow Coma Scale score as
362
Abstracts of 16th Annual Meeting
covariates, group membership as independent variable, and selected indices from the Control Oral Word Association Test, Wisconsin Card Sorting Test, Wechsler Memory Scale-Revised, and Trail Making Test as dependent variables. The results of this study suggest that number as well as location of facial fractures have important implications for cognitive functioning regardless of overall injury severity.
Marshall, R. M., Prettyman, E. E., Harris, D. P., & Gray, R. P. A Comparison of Neuropsychological and Electrophysiological Test Results in Adolescents with Conduct Disorder. The purpose of this study is to investigate the correspondence between neuropsychological tests and brain electrical activity mapping in adolescents with Conduct Disorder (CD). The study seeks to identify underlying brain abnormalities and to identify more precisely left/right and anterior/posterior differences in this population. Although such information is thought to provide valuable data for diagnosis and treatment (Lahey et al., 1993; Shapiro & Hynd, 1993) few studies directly address these issues. Subjects for this investigation include 10 males, ages 12-18 at a residential treatment center in Texas. All subjects meet DSM-IV diagnostic criteria for CD and none has neurological abnormalities nor major psychoses. Subjects' neuropsychological test results were compared to their topographic brain maps. The latter includes EEG, auditory cognitive evoked potentials, visual evoked potentials, and P300, all processed by Fast Fourier Transformation. Analyses of neuropsychological test results suggest indicators of organicity most frequently involved tests associated with left hemisphere functioning. Analyses of electrophysiology data revealed QEEG and EP abnormalities manifest as anterior/posterior and interhemispheric differences. Both sets of data suggest that underlying brain abnormalities characterize this group of adolescents with Conduct Disorder. Implications for diagnosis and treatment will be discussed. Martelli, M. F., Zasler, N. D., & Braith, J. A. Predicting Outcome Following Traumatic Brain Injury. (TB1): Utility of a Composite Prognostic Indicator Checklist. A growing body of literature is emerging which describes the variables that impact on long term outcome following TBI. Although much is becoming known about these different factors individually, much less is known about their collective influence. The current investigation employed a composite approach to rating prognostic indicators for a group of 28 TBI patients in order to evaluate their collective effect on outcome. Subjects were recruited over a 1-month period from volunteer participants who had sustained diffuse traumatic cerebral injuries and were receiving ongoing or follow-up treatment services by the first author. Data collection was completed for 28 subjects (16 males; mean age = 36.4; mean education = 13.9; mean estimated last 2 year GPA = 2.6/4.0; mean time post-injury = 2.9 years). Data collection included review of medical records, live and phone interview with subjects and family members, administration of an objective personality assessment instrument (MMPI), and completion of mood, structured symptom, and quality of life rating instruments by patient and relative. Data analysis employing a linear regression analysis revealed that a combination of Length of PTA, Premorbid Neurologic Status, Premorbid Psychiatric Status, Estimated Premorbid IQ, Post-Traumatic Seizures, Marital/Relationship Status, Collateral Injuries and Accident Victimization Perception was highly accurate in discriminating post-traumatic vocational (R2 = .51, p < .01) and disability status (R2 = .69, p < .01). Further analysis indicated that a simple linear combination of these variables and a composite index with a clinically derived cutoff score assigning subjects to High and Low Vulnerability groups was found to reliably predict vocational (i.e., 1/8 vs. 14/20) employed or in school for High and Low vulnerability groups, respectively; ×2 (5, N = 28) = 17.37, p