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Objective interpretation of the Luria-Nebraska neuropsychological battery: A methodological contribution based on cluster and profile analysis
Abstracts
271
and all had memory functioning assessed in a posttest 8 weeks later using different forms of the same tests. Memory retraining occurred in groups of 4 to 8 men who met 1 hour per week for 8 weeks. The major techniques used in memory retraining were attention training, visual imagery, verbal strategies, and external strategies. Data analysis indicated that the memory battery might provide an efficient and useful assessment of memory in alcoholics, and that there was great variability in performance between alcoholics. Some subjects showed no deficits while others were quite impaired. No significant differences in memory post-test scores occurred between memory retraining subjects and controls.
Computer-Based Cognitive Rehabilitation with Brain Injured Young Adults Roseann Hannon, Janice Blalock, Susan Risi, Cheryl Bene, Christine Robisch and Carol Lynn Day (University of the Pacific) This study investigated the effectiveness of using computer-based cognitive rehabilitation programs for improving attention and concentration, visual-spatial, and memory skills in brain injured young adults. The programs used were developed by Odie L. Bracy, Ph.D., and were purchased from Psychological Software Services, Indianapolis, Indiana. Subjects were six young adults who were at least two years post head injury or vascular disorder. All subjects had chronic cognitive deficits ranging from mild to severe as determined by performance on extensive neuropsychological test battery. Rehabilitation exercises on the computer occurred for one hour per day in a community college learning disabilities laboratory. Treatment extended from five to eight months for each subject, and subjects were then readministered the same neuropsychological test battery used for pre-testing. Some areas of cognitive functioning improved by at least one standard deviation for each subject. Specific areas of improvement varied from one subject to the next. Overall, positive changes in functioning occurred with significantly greater frequency than negative changes.
Objective Interpretation of the Luria-Nebraska Neuropsychological Battery: A Methodological Contribution Based on Cluster and Profile Analysis. Michael McCue (University of Pittsburgh School of Medicine), Gerald Goldstein, Carolyn Shelly (Pittsburgh Veterans Administration Medical Center and University of Pittsburgh School of Medicine), and Robert L. Kane (East Orange Veterans Administration Medical Center) An attempt was made, through the application of cluster and ipsative profile analysis, to determine whether or not the Luria-Nebraska Neuropsychological Battery (LNNB) is amenable to configural profile analysis in a heterogeneous neuropsychiatric population and in an age and education matched subsample of cases with well defined brain lesions. Five hundred neuropsychiatric patients were used as the data base. Cluster analyses performed suggested that a four cluster solution was appropriate, with level rather than pattern of performance producing the differences among the clusters. The four clusters were described as an essentially neuropsychologically normal group, a group with minimal neuropsychological deficit, a moderate-
272
Abstracts
ly impaired group and a severely impaired group. Cluster differences in age and education were noted but not in sex distribution. The use of age and education corrected scores elevated all of the profiles, but did not substantially alter the relationship among them. Analysis of the subsample with lateralized and diffuse brain lesions indicated that right hemisphere, left hemisphere and diffuse lesion cases did not fall into different clusters, nor did they form significantly different LNNB profiles. In general, there was no relationship found between cluster membership or profile configuration and diagnosis, with the exception that more brain damaged subjects were included in the severely impaired subgroup.
Neuropsychological Deficits Following Minor Head Injury: Scientific Fact or Litigious Fiction. T. Schenkenberg and Elliot J. Williams (Salt Lake City Veterans Administration Medical Center) An increasing number of personal injury law suits are being filed in an attempt to recover financially for various losses experienced by the injured party. When significant head injury occurs and results in demonstrable physical damage to the brain with obvious neurological and neuropsychologic sequelae (e.g., paralysis, ataxia, aphasia), the basis for the claim of loss is often apparent (even though responsibility must be determined in court). In the case of so-called “minor” head injury which often includes various forms of closed head injury the nature of the deficits is far less easily demonstrated. Many of these cases are now appearing in the court room, the deficits being defined in terms of psychologic and neuropsychologic dysfunction. At times the injuries themselves do not include basic indicators of even temporary brain dysfunction such as loss of consciousness or amnesia. This paper will review the limited evidence associating neuropsychologic deficits with truly minor head injury and will review the definitions of “minor head injury” which have been used in the literature. For both legal and ethical reasons neuropsychologists are encouraged to scrutinize this original literature.
Complex Partial Seizures Presenting as a Psychological Disorder. Thomas L. Bennett (Colorado State University) and Michael P. Curie1 (Private Practice, Fort Collins) Patients with complex partial seizures of temporal lobe origin are of special interest to neuropsychology and neuropsychiatry as they can first present with emotional problems. Because these patients apparently experience a hyperexcitability of the limbic system, portions of which are in the temporal lobe, and because of this system’s important role in emotion, it is not surprising that a major feature of complex partial seizures is alterations in emotional behavior. Other phenomena commonly experienced by these patients include dissociative episodes, perceptual hallucinations, memory flashbacks, illusions of familiarity, and heightened emotionality. Differential diagnosis is critical in determining appropriate psychotherapeutic and medication approaches to treatment.
271
and all had memory functioning assessed in a posttest 8 weeks later using different forms of the same tests. Memory retraining occurred in groups of 4 to 8 men who met 1 hour per week for 8 weeks. The major techniques used in memory retraining were attention training, visual imagery, verbal strategies, and external strategies. Data analysis indicated that the memory battery might provide an efficient and useful assessment of memory in alcoholics, and that there was great variability in performance between alcoholics. Some subjects showed no deficits while others were quite impaired. No significant differences in memory post-test scores occurred between memory retraining subjects and controls.
Computer-Based Cognitive Rehabilitation with Brain Injured Young Adults Roseann Hannon, Janice Blalock, Susan Risi, Cheryl Bene, Christine Robisch and Carol Lynn Day (University of the Pacific) This study investigated the effectiveness of using computer-based cognitive rehabilitation programs for improving attention and concentration, visual-spatial, and memory skills in brain injured young adults. The programs used were developed by Odie L. Bracy, Ph.D., and were purchased from Psychological Software Services, Indianapolis, Indiana. Subjects were six young adults who were at least two years post head injury or vascular disorder. All subjects had chronic cognitive deficits ranging from mild to severe as determined by performance on extensive neuropsychological test battery. Rehabilitation exercises on the computer occurred for one hour per day in a community college learning disabilities laboratory. Treatment extended from five to eight months for each subject, and subjects were then readministered the same neuropsychological test battery used for pre-testing. Some areas of cognitive functioning improved by at least one standard deviation for each subject. Specific areas of improvement varied from one subject to the next. Overall, positive changes in functioning occurred with significantly greater frequency than negative changes.
Objective Interpretation of the Luria-Nebraska Neuropsychological Battery: A Methodological Contribution Based on Cluster and Profile Analysis. Michael McCue (University of Pittsburgh School of Medicine), Gerald Goldstein, Carolyn Shelly (Pittsburgh Veterans Administration Medical Center and University of Pittsburgh School of Medicine), and Robert L. Kane (East Orange Veterans Administration Medical Center) An attempt was made, through the application of cluster and ipsative profile analysis, to determine whether or not the Luria-Nebraska Neuropsychological Battery (LNNB) is amenable to configural profile analysis in a heterogeneous neuropsychiatric population and in an age and education matched subsample of cases with well defined brain lesions. Five hundred neuropsychiatric patients were used as the data base. Cluster analyses performed suggested that a four cluster solution was appropriate, with level rather than pattern of performance producing the differences among the clusters. The four clusters were described as an essentially neuropsychologically normal group, a group with minimal neuropsychological deficit, a moderate-
272
Abstracts
ly impaired group and a severely impaired group. Cluster differences in age and education were noted but not in sex distribution. The use of age and education corrected scores elevated all of the profiles, but did not substantially alter the relationship among them. Analysis of the subsample with lateralized and diffuse brain lesions indicated that right hemisphere, left hemisphere and diffuse lesion cases did not fall into different clusters, nor did they form significantly different LNNB profiles. In general, there was no relationship found between cluster membership or profile configuration and diagnosis, with the exception that more brain damaged subjects were included in the severely impaired subgroup.
Neuropsychological Deficits Following Minor Head Injury: Scientific Fact or Litigious Fiction. T. Schenkenberg and Elliot J. Williams (Salt Lake City Veterans Administration Medical Center) An increasing number of personal injury law suits are being filed in an attempt to recover financially for various losses experienced by the injured party. When significant head injury occurs and results in demonstrable physical damage to the brain with obvious neurological and neuropsychologic sequelae (e.g., paralysis, ataxia, aphasia), the basis for the claim of loss is often apparent (even though responsibility must be determined in court). In the case of so-called “minor” head injury which often includes various forms of closed head injury the nature of the deficits is far less easily demonstrated. Many of these cases are now appearing in the court room, the deficits being defined in terms of psychologic and neuropsychologic dysfunction. At times the injuries themselves do not include basic indicators of even temporary brain dysfunction such as loss of consciousness or amnesia. This paper will review the limited evidence associating neuropsychologic deficits with truly minor head injury and will review the definitions of “minor head injury” which have been used in the literature. For both legal and ethical reasons neuropsychologists are encouraged to scrutinize this original literature.
Complex Partial Seizures Presenting as a Psychological Disorder. Thomas L. Bennett (Colorado State University) and Michael P. Curie1 (Private Practice, Fort Collins) Patients with complex partial seizures of temporal lobe origin are of special interest to neuropsychology and neuropsychiatry as they can first present with emotional problems. Because these patients apparently experience a hyperexcitability of the limbic system, portions of which are in the temporal lobe, and because of this system’s important role in emotion, it is not surprising that a major feature of complex partial seizures is alterations in emotional behavior. Other phenomena commonly experienced by these patients include dissociative episodes, perceptual hallucinations, memory flashbacks, illusions of familiarity, and heightened emotionality. Differential diagnosis is critical in determining appropriate psychotherapeutic and medication approaches to treatment.