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Material-specific memory changes following unilateral temporal lobectomy: statistical versus clinical significance
Abstracts /Archives
of Clinical Neuropsychologv
709
I5 (2000) 653450
category fluency are disproportionately impaired in AD, whereas executive abilities are more affected in FTD. Thirty-six patients served as subjects. Twenty-six patients had a diagnosis ofprobable AD, based on the NINCDS-ADRDA criteria, and 10 were diagnosed with the bifrontal variant of FTD, based on the Neary criteria and neuroimaging data. There were no differences between the groups in overall level of dementia, as measured by the Mini-Mental State Examination. Neuropsychological measures included the California Verbal Learning Test-Short Form, measures of letter and category fluency, and the Harbor/ UCLA versions of the Rey-Osterreith Complex Figure and Trail Making Test. Discriminant function analysis correctly classified 92% of the cases (x2 = 17.58, p < 0.004). Ninety-six percent of the AD cases and 80% of the FTD cases were classified correctly. The category-fluency (Animals) and letter-fluency (D-words) tasks, and a rate-of-forgetting measure from the CVLT-SF (i.e., long-delay recall minus trial 4 recall) were found to be the best discriminators in the model. Although cross-validation is necessary, these results demonstrate the diagnostic utility of a theoretically driven bedside screening battery that taps cognitive constructs known to be differentially affected in AD and FTD.
Olfactory functioning in Alzheimer’s Duf K, McCafiey RJ Solomon GS.
disease, vascular dementia,
and major depression
Recently, olfactory dysfunction has been reported in a number of different patient populations. Odor identification testing has also proved useful in discriminating between various patient and nonpatient samples. The present study was conducted to assess the utility of odor identification testing in discriminating between patients with Alzheimer’s disease (AD), vascular dementia (VaD), or major depression (MD). Sixty elderly patients meeting the DSM-IV criteria for either AD (n = 20), VaD (n= 20), or MD (n = 20) underwent assessment with the Pocket Smell Test (PST), a 3-item screening measure of odor identification, and the Mini-Mental State Examination (MMSE). Patients in the AD group scored significantly worse than the VaD and MD patients on the PST, even when covarying out the MMSE scores. Olfactory assessment continues to add to the diagnostic utility in the differential diagnosis of Alzheimer’s disease vs. vascular dementia vs. major depression in elderly patients.
Material-specific memory clinical significance Gleason CE.
changes
following
unilateral
temporal
lobectomy:
statistical
versus
Ninety-eight subjects from the Northern California Comprehensive Epilepsy Center were evaluated pre- and postunilateral temporal lobectomy. Patients’ verbal and nonverbal memory performance was examined for statistically and clinically significant postsurgery changes. Statistical differences between the groups were found on verbal memory measures only. The left temporal lobectomy group on average performed worse than the right temporal lobectomy group on verbal memory tests. An analysis of clinical significance was conducted on verbal memory findings. The majority of subjects (83.2%-100%) did not evidence clinically significant change on various verbal memory indices. Among the small number who showed clinically significant change, some patterns were evident: declines outnumbered improvements and left temporal lobectomy subjects were more likely than right temporal lobectomy subjects to demonstrate declines. Further analyses revealed that regression to the mean was a statistical artifact. Corrections were made and analysis of clinical significance reconducted. Failing to correct for this artifact appeared to inflate estimates
710
Abstracts /Archives of Clinical Neuropsychology 15 (2000) 653450
of change to a small lobectomy are minimal, temporal lobe surgery.
degree. These data suggest that real-world changes following temporal and that analyses of statistical change are likely to overstate the impact of
Group and individual level performance on the WMS-III auditory and visual memory suhtests in patients with temporal lobe epilepsy Martin R, Sawrie S, Mackey M, Faught E, Knowlton R, Kuzniecky R. Recent revision of the Wechsler Memory Scale (WMS-III) includes new modality-specific memory tests and updating of previous subtests. The present study compared individual WMS-III memory subtest profiles in patients with let? (n = 2 1) and right (n = 11) temporal lobe epilepsy. Patients in the LTLE and RTLE groups were similar in terms of demographics, seizure variables, and WAISIII IQ indices. A series of t-tests revealed statistically significant group differences on the Family Pictures subtest (immediate, p
A closer look at individual with epilepsy Ringe WK, Cullurn CM.
factors affecting overall quality of life ratings in patients
Although most definitions of quality of life (QOL) stress its multifaceted nature, there is no universally accepted conceptualization of the specific life domains which influence QOL ratings. The Texas Quality of Life Scale (TQLS), a l-to-10 likert-like self-rating scale of overall QOL, has shown promise as a brief index of QOL in patients with epilepsy (Ringe and Cullum, 1999). To determine how various facets of QOL relate to overall QOL ratings, the TQLS was compared with individual domains of the Washington Psychosocial Seizure Inventory (WPSI; Dodrill, Batzel, Queisser, and Tempkin, 1980) and the Quality of Life Inventory (QOLI; Frisch, Cornell, Villanueva, and Retzlaff, 1992) in a sample of 5 1 epilepsy surgery candidates. TQLS ratings were significantly correlated with all individual scales from the WPSI, and the Emotional Adjustment and Vocational Adjustment scales were most predictive of TQLS scores in a stepwise regression. Of the 16 life areas represented by the QOLI, health, selfesteem, money, work, play, learning, friends, relatives, home, and community were significantly correlated with the TQLS, although stepwise regression analysis revealed that the areas of self-esteem, friendships, and money were most predictive of TQLS ratings. These results provide information regarding the influence of particular domains of life upon QOL ratings. Specifically, it appears that aspects of emotional and vocational adjustment, social support, and financial status are important determinants of QOL ratings in patients with epilepsy.
of Clinical Neuropsychologv
709
I5 (2000) 653450
category fluency are disproportionately impaired in AD, whereas executive abilities are more affected in FTD. Thirty-six patients served as subjects. Twenty-six patients had a diagnosis ofprobable AD, based on the NINCDS-ADRDA criteria, and 10 were diagnosed with the bifrontal variant of FTD, based on the Neary criteria and neuroimaging data. There were no differences between the groups in overall level of dementia, as measured by the Mini-Mental State Examination. Neuropsychological measures included the California Verbal Learning Test-Short Form, measures of letter and category fluency, and the Harbor/ UCLA versions of the Rey-Osterreith Complex Figure and Trail Making Test. Discriminant function analysis correctly classified 92% of the cases (x2 = 17.58, p < 0.004). Ninety-six percent of the AD cases and 80% of the FTD cases were classified correctly. The category-fluency (Animals) and letter-fluency (D-words) tasks, and a rate-of-forgetting measure from the CVLT-SF (i.e., long-delay recall minus trial 4 recall) were found to be the best discriminators in the model. Although cross-validation is necessary, these results demonstrate the diagnostic utility of a theoretically driven bedside screening battery that taps cognitive constructs known to be differentially affected in AD and FTD.
Olfactory functioning in Alzheimer’s Duf K, McCafiey RJ Solomon GS.
disease, vascular dementia,
and major depression
Recently, olfactory dysfunction has been reported in a number of different patient populations. Odor identification testing has also proved useful in discriminating between various patient and nonpatient samples. The present study was conducted to assess the utility of odor identification testing in discriminating between patients with Alzheimer’s disease (AD), vascular dementia (VaD), or major depression (MD). Sixty elderly patients meeting the DSM-IV criteria for either AD (n = 20), VaD (n= 20), or MD (n = 20) underwent assessment with the Pocket Smell Test (PST), a 3-item screening measure of odor identification, and the Mini-Mental State Examination (MMSE). Patients in the AD group scored significantly worse than the VaD and MD patients on the PST, even when covarying out the MMSE scores. Olfactory assessment continues to add to the diagnostic utility in the differential diagnosis of Alzheimer’s disease vs. vascular dementia vs. major depression in elderly patients.
Material-specific memory clinical significance Gleason CE.
changes
following
unilateral
temporal
lobectomy:
statistical
versus
Ninety-eight subjects from the Northern California Comprehensive Epilepsy Center were evaluated pre- and postunilateral temporal lobectomy. Patients’ verbal and nonverbal memory performance was examined for statistically and clinically significant postsurgery changes. Statistical differences between the groups were found on verbal memory measures only. The left temporal lobectomy group on average performed worse than the right temporal lobectomy group on verbal memory tests. An analysis of clinical significance was conducted on verbal memory findings. The majority of subjects (83.2%-100%) did not evidence clinically significant change on various verbal memory indices. Among the small number who showed clinically significant change, some patterns were evident: declines outnumbered improvements and left temporal lobectomy subjects were more likely than right temporal lobectomy subjects to demonstrate declines. Further analyses revealed that regression to the mean was a statistical artifact. Corrections were made and analysis of clinical significance reconducted. Failing to correct for this artifact appeared to inflate estimates
710
Abstracts /Archives of Clinical Neuropsychology 15 (2000) 653450
of change to a small lobectomy are minimal, temporal lobe surgery.
degree. These data suggest that real-world changes following temporal and that analyses of statistical change are likely to overstate the impact of
Group and individual level performance on the WMS-III auditory and visual memory suhtests in patients with temporal lobe epilepsy Martin R, Sawrie S, Mackey M, Faught E, Knowlton R, Kuzniecky R. Recent revision of the Wechsler Memory Scale (WMS-III) includes new modality-specific memory tests and updating of previous subtests. The present study compared individual WMS-III memory subtest profiles in patients with let? (n = 2 1) and right (n = 11) temporal lobe epilepsy. Patients in the LTLE and RTLE groups were similar in terms of demographics, seizure variables, and WAISIII IQ indices. A series of t-tests revealed statistically significant group differences on the Family Pictures subtest (immediate, p
A closer look at individual with epilepsy Ringe WK, Cullurn CM.
factors affecting overall quality of life ratings in patients
Although most definitions of quality of life (QOL) stress its multifaceted nature, there is no universally accepted conceptualization of the specific life domains which influence QOL ratings. The Texas Quality of Life Scale (TQLS), a l-to-10 likert-like self-rating scale of overall QOL, has shown promise as a brief index of QOL in patients with epilepsy (Ringe and Cullum, 1999). To determine how various facets of QOL relate to overall QOL ratings, the TQLS was compared with individual domains of the Washington Psychosocial Seizure Inventory (WPSI; Dodrill, Batzel, Queisser, and Tempkin, 1980) and the Quality of Life Inventory (QOLI; Frisch, Cornell, Villanueva, and Retzlaff, 1992) in a sample of 5 1 epilepsy surgery candidates. TQLS ratings were significantly correlated with all individual scales from the WPSI, and the Emotional Adjustment and Vocational Adjustment scales were most predictive of TQLS scores in a stepwise regression. Of the 16 life areas represented by the QOLI, health, selfesteem, money, work, play, learning, friends, relatives, home, and community were significantly correlated with the TQLS, although stepwise regression analysis revealed that the areas of self-esteem, friendships, and money were most predictive of TQLS ratings. These results provide information regarding the influence of particular domains of life upon QOL ratings. Specifically, it appears that aspects of emotional and vocational adjustment, social support, and financial status are important determinants of QOL ratings in patients with epilepsy.