Slower gait speed increases risk of falling in older adults with depression and cognitive complaints

Slowed gait is one of the strongest predictors of fall risk in older adults. The present study investigated whether gait speed mediated the relationship between depression and fall history in 147 older adults presenting to a memory clinic for cognitive complaints. Depression, cognitive status, gait speed, and number of falls within the last year were the primary measures. Results revealed fallers, relative to non-fallers, had slower gait speed and higher depression scores. As hypothesized, analyses using the PROCESS macro found that gait mediated the relationship between depression and fall history. Additionally, the combination of depression and mild cognitive impairments (MCI) associated with a significantly greater likelihood of falling. Our findings indicate that combined depression and MCI have additive effects on fall risk, likely through the destabilizing effect of slowed gait on balance. Better understanding the underlying pathophysiology involved in MCI and depression-related gait disturbances may lead to improved intervention targets for fall risk prevention.

Dual-Task Gait Assessment in a Clinical Sample: Implications for Improved Detection of Mild Cognitive Impairment

OBJECTIVES

Research has longitudinally linked dual-task gait dysfunction to mild cognitive impairment (MCI) and dementia risk. Our group previously demonstrated that dual-task gait speed assessment distinguished between subjective cognitive complaints (SCC) and MCI in a memory clinic setting, and also found that differences in dual-task gait speed were largely attributable to executive attention processes. This study aimed to reproduce these findings in a larger diverse sample and to extend them by examining whether there were group differences in single- versus dual-task cognitive performance (number of letters correctly sequenced backward).

METHOD

Two-hundred fifty-two patients (M age = 66.01 years, SD = 10.46; 119 MCI, 133 SCC) presenting with cognitive complaints in an academic medical setting underwent comprehensive neuropsychological and gait assessment (single- and dual-task conditions).

RESULTS

Patients with MCI walked slower and showed greater decrement in cognitive performance than those with SCC during dual-task conditions. Neuropsychological measures of executive attention accounted for significant variance in dual-task gait performance across diagnostic groups beyond demographic and health risk factors.

DISCUSSION

Reproduction of our results within a sample over four times the previous size provides support for the use of dual-task gait assessment as a marker of MCI risk in clinical settings.

Posterior cortical atrophy of a suspected non-Alzheimer type: a case report

OBJECTIVE

A case of Posterior Cortical Atrophy syndrome of a suspected non-Alzheimer disease pathology type is presented to illustrate prospective diagnosis and course.

METHOD

A 54-year-old woman with vague memory complaints underwent serial neuropsychological assessment, MRI, PET, and CSF screening; data are reviewed.

RESULTS

While early diagnosis was confounded by multiple factors, classic visuospatial symptoms were later demonstrated using routine neuropsychological methods. Serial MRI, PET, and CSF screening argued strongly for an alternative underlying pathology to AD. At age 59, her condition had progressed to dementia.

CONCLUSIONS

Findings underscore the need for further research on suspected non-amyloid-based pathologies.

Therapeutic effect of increased openness: Investigating mechanism of action in MDMA-assisted psychotherapy

A growing body of research suggests that traumatic events lead to persisting personality change characterized by increased neuroticism. Relevantly, enduring improvements in Post-Traumatic Stress Disorder (PTSD) symptoms have been found in response to 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy. There is evidence that lasting changes in the personality feature of "openness" occur in response to hallucinogens, and that this may potentially act as a therapeutic mechanism of change. The present study investigated whether heightened Openness and decreased Neuroticism served as a mechanism of change within a randomized trial of MDMA-assisted psychotherapy for chronic, treatment-resistant PTSD. The Clinician-Administered PTSD Scale (CAPS) Global Scores and NEO PI-R Personality Inventory (NEO) Openness and Neuroticism Scales served as outcome measures. Results indicated that changes in Openness but not Neuroticism played a moderating role in the relationship between reduced PTSD symptoms and MDMA treatment. Following MDMA-assisted psychotherapy, increased Openness and decreased Neuroticism when comparing baseline personality traits with long-term follow-up traits also were found. These preliminary findings suggest that the effect of MDMA-assisted psychotherapy extends beyond specific PTSD symptomatology and fundamentally alters personality structure, resulting in long-term persisting personality change. Results are discussed in terms of possible mechanisms of psychotherapeutic change.

Durability of improvement in post-traumatic stress disorder symptoms and absence of harmful effects or drug dependency after 3,4-methylenedioxymethamphetamine-assisted psychotherapy: a prospective long-term follow-up study

We report follow-up data evaluating the long-term outcomes for the first completed trial of 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for chronic, treatment-resistant post-traumatic stress disorder (PTSD) (Mithoefer et al., 2011). All of the 19 subjects who received MDMA-assisted treatment in the original trial participated in the long-term follow-up (LTFU), with 16 out of 19 completing all of the long-term outcome measures, which were administered from 17 to 74 months after the original study's final MDMA session (mean = 45.4; SD = 17.3). Our primary outcome measure used was the Clinician-Administered PTSD Scale (CAPS). Secondary outcome measures were the Impact of Events Scale-Revised (IES-R) and the Neuroticism Extroversion Oppenness Personality Inventory-Revised (NEO PI-R) Personality Inventory. We also collected a long-term follow-up questionnaire. Results for the 16 CAPS completers showed there were no statistical differences between mean CAPS score at LTFU (mean = 23.7; SD = 22.8) (t (matched) = 0.1; df = 15, p = 0.91) and the mean CAPS score previously obtained at Study Exit (mean = 24.6, SD = 18.6). On average, subjects maintained statistically and clinically-significant gains in symptom relief, although two of these subjects did relapse. It was promising that we found the majority of these subjects with previously severe PTSD who were unresponsive to existing treatments had symptomatic relief provided by MDMA-assisted psychotherapy that persisted over time, with no subjects reporting harm from participation in the study.

APOE genotype in the diagnosis of Alzheimer's disease in patients with cognitive impairment

BACKGROUND

Although an association between the apolipoprotein E (APOE) ε4 allele and increased risk of Alzheimer's disease (AD) is established, the utility of APOE genotyping in the clinical diagnosis of AD is still under investigation.

METHODS

Medical records of 89 patients with cognitive impairment and APOE genotype data underwent a retrospective review.

RESULTS

Comparison of age, age at onset, education, Mini-Mental State Examination, months of follow-up, and family history of dementia did not reveal statistical difference among the patients with different APOE genotypes. The APOE ε4 carriers had a higher percentage of AD diagnoses after a median 16 months follow-up than non-APOE ε4 carriers. The APOE ε4 designation had a high sensitivity and high positive predictive value for the diagnosis of AD but a low negative predictive value and specificity.

CONCLUSIONS

The APOE genotyping may be helpful in diagnosing AD especially in patients presenting with atypical features or early age of onset of dementia.

The impact of clinical and demographic variables on cognitive performance in methamphetamine-dependent individuals in rural South Carolina

Inconsistencies in reports on methamphetamine (METH) associated cognitive dysfunction may be attributed, at least in part, to the diversity of study sample features (eg, clinical and demographic characteristics). The current study assessed cognitive function in a METH-dependent population from rural South Carolina, and the impact of demographic and clinical characteristics on performance. Seventy-one male (28.2%) and female (71.8%) METH-dependent subjects were administered a battery of neurocognitive tests including the Test of Memory Malingering (TOMM), Shipley Institute of Living Scale, Paced Auditory Serial Addition Test (PASAT), Symbol Digit Modalities Test (SDMT), Grooved Pegboard Test, California Verbal Learning Test (CVLT), and Wisconsin Card Sorting Test (WCST). Demographic and clinical characteristics (eg, gender, frequency of METH use) were examined as predictors of performance. Subjects scored significantly lower than expected on one test of attention and one of fine motor function, but performed adequately on all other tests. There were no predictors of performance on attention; however, more frequent METH use was associated with better performance for males and worse for females on fine motor skills. The METH-dependent individuals in this population exhibit very limited cognitive impairment. The marked differences in education, Intellectual Quotient (IQ), and gender in our sample when compared to the published literature may contribute to these findings. Characterization of the impact of clinical and/or demographic features on cognitive deficits could be important in guiding the development of treatment interventions.

The safety and efficacy of {+/-}3,4-methylenedioxymethamphetamine-assisted psychotherapy in subjects with chronic, treatment-resistant posttraumatic stress disorder: the first randomized controlled pilot study

Case reports indicate that psychiatrists administered ±3,4-methylenedioxymethamphetamine (MDMA) as a catalyst to psychotherapy before recreational use of MDMA as 'Ecstasy' resulted in its criminalization in 1985. Over two decades later, this study is the first completed clinical trial evaluating MDMA as a therapeutic adjunct. Twenty patients with chronic posttraumatic stress disorder, refractory to both psychotherapy and psychopharmacology, were randomly assigned to psychotherapy with concomitant active drug (n = 12) or inactive placebo (n = 8) administered during two 8-h experimental psychotherapy sessions. Both groups received preparatory and follow-up non-drug psychotherapy. The primary outcome measure was the Clinician-Administered PTSD Scale, administered at baseline, 4 days after each experimental session, and 2 months after the second session. Neurocognitive testing, blood pressure, and temperature monitoring were performed. After 2-month follow-up, placebo subjects were offered the option to re-enroll in the experimental procedure with open-label MDMA. Decrease in Clinician-Administered PTSD Scale scores from baseline was significantly greater for the group that received MDMA than for the placebo group at all three time points after baseline. The rate of clinical response was 10/12 (83%) in the active treatment group versus 2/8 (25%) in the placebo group. There were no drug-related serious adverse events, adverse neurocognitive effects or clinically significant blood pressure increases. MDMA-assisted psychotherapy can be administered to posttraumatic stress disorder patients without evidence of harm, and it may be useful in patients refractory to other treatments.

Transient epileptic amnesia: a neurosurgical case report

One memory disorder that is potentially treatable with antiepileptic drugs is transient epileptic amnesia (TEA). Working diagnostic consensus criteria for TEA include: (1) a history of recurrent witnessed episodes of transient amnesia; (2) confirmation by a reliable witness that cognitive functions other than memory are intact during typical episodes; and (3) evidence for a diagnosis of epilepsy. We describe a case with both complex partial seizures and episodes of TEA. This is the first reported case of a neurosurgical intervention for symptoms resembling those described in refractory TEA. Video/EEG, 3-T MRI, neuropathology, and neurological as well as neuropsychological findings are presented with postsurgical clinical outcome. The patient underwent right anterior amygdalohippocampectomy for symptoms resembling refractory TEA with additional complex partial seizures at our epilepsy surgical center. She remained seizure free at the 15-month follow-up, and memory complaints remitted. This case report illustrates one memory disorder, transient epileptic amnesia, that is potentially treatable with antiepileptic drugs or surgery.

Establishment of a predominantly African-American cohort for the study of Alzheimer's disease: the South Carolina Alzheimer's disease clinical core

BACKGROUND/AIMS

The recruitment of culturally diverse subject populations into research studies, particularly African-Americans (AA), has been the focus of intense interest by many groups.

METHODS

In this paper, we present the methodology utilized to create a predominantly AA cohort for the longitudinal study of risk factors in Alzheimer's disease (AD). The underlying strategy was that of identifying geographically diverse clinical venues within South Carolina (SC) where large numbers of AA patients already come to seek medical care.

RESULTS

This strategy was successful, although recruitment rates for AA subjects (43.4%) still fell below those for white subjects (70.3%; p = 0.0025). Subject characteristics of AA subjects that chose to enroll were not substantially different from those that declined to participate. The demographic characteristics of this cohort were largely similar to those of the SC Alzheimer Disease Registry, a population-based database. The problems of standardization of subject recruitment and assessment across diverse clinical venues are also addressed.

CONCLUSION

The utilization of geographically diverse sites for research recruitment where minorities already receive medical care is one practical solution to the problem of minority participation in research. Multi-site recruitment to improve minority recruitment can be accomplished with acceptable standardization and inter-rater reliability.

The role of personality and other factors in a mother's decision to initiate breastfeeding

The objective of the study was to measure the impact of personality and other factors on the decision to initiate breastfeeding. Mothers were enrolled (24-96 hours postpartum) and were classified as fully breastfeeding, formula-feeding, or combination-feeding. A semi-structured interview about maternal sociodemographics and attitudes and a standardized personality inventory (NEO-PI-R) were conducted. Eighty-seven mothers completed the study: 50 breastfeeders, 6 combination feeders, and 31 formula feeders. Because of small numbers, combination-feeder mothers (n = 6) were excluded from analyses. Maternal age, marriage, ethnicity, and socioeconomic status were significantly associated with breastfeeding. Breastfeeding and formula-feeding groups differed on 3 personality domains: extraversion (53.3 breastfeeding vs 46.9 formula-feeding, P = .002), openness (51.6 vs 46.2, P = .008), and agreeableness (48.5 vs 41.5, P = .01). In a multiple variable logistic regression model, extraversion (P = .03) and openness (P = .003) remained significant. Sociodemographics, experiential factors, and specific personality characteristics of mother were independently associated with maternal feeding decision.

Use of the Personality Assessment Inventory as an efficacious and cost-effective diagnostic tool for nonepileptic seizures

Video electroencephalographic monitoring (VEEG) is considered the "gold standard" for making the differential diagnosis between epileptic seizures (ES) and nonepileptic seizures (NES), but is a costly, time-consuming procedure and not readily available in all communities. Of the various diagnostic techniques and measures that have been used, the Personality Assessment Inventory (PAI) has shown promise as an effective psychological screening tool to aid in the differential diagnosis of ES/NES. Using VEEG results as the outcome measure, this study examined the diagnostic effectiveness of the PAI in a group of adults with treatment-refractory seizures. Results indicated that, on psychological screening, patients with NES endorse significantly greater functional consequences of their seizure-like episodes than participants with ES. A "NES Indicator" score, calculated from the PAI Somatization subscales, provided a sensitivity of 84% and specificity of 73% for the diagnosis of NES versus ES. The PAI appears to be a useful screening tool prior to hospital admission for VEEG.

The Test of Memory Malingering (TOMM): normative data from cognitively intact, cognitively impaired, and elderly patients with dementia

This research adds to the psychometric validation of the Test of Memory Malingering (TOMM) by providing data for samples of elderly patients who are cognitively intact, cognitively impaired (non-dementia), and with dementia. Subjects were 78 individuals referred for evaluation of memory complaints. Significant group differences emerged between the dementia group and the two other groups (normals and cognitively impaired), although the latter two did not differ from each other. One hundred percent of normals and 92.7% of the cognitively impaired group made fewer than five errors (the suggested cut-off) on Trial 2 or the Retention trial of the TOMM, yielding an overall correct classification rate of 94.7%. However, the rate of misclassification for persons with dementia was high whether using a cut-point score of five, eight, or ten errors. This investigation extends the validity and clinical utility of this instrument. Results suggest that the TOMM is an useful index for detecting the malingering of memory deficits, even in patients with cognitive impairment, but only when dementia can be ruled out.

Utility of a clinically derived abbreviated form of the WAIS-III

The Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) often poses problems for many populations due to the length of administration. Twenty geriatric subjects were administered the full WAIS-III. Three abbreviated forms of the WAIS-III (Satz-Mogel abbreviation; seven-subtest short form; and a clinically derived abbreviation) were evaluated by rescoring original full WAIS-III protocols. Results showed that the abbreviated WAIS-III protocols were highly correlated with complete protocols, and classification rules were the highest for the clinically derived abbreviation. The clinically derived abbreviation was reevaluated in a college LD/ADHD population yielding similarly high correlations. Results support the use of abbreviated forms of the WAIS-III in the evaluation of elderly patients and young adults, and point to the clinically derived abbreviation as providing the smallest discrepancies from FSIQ.

Transient Kluver-Bucy syndrome following complex partial status epilepticus

The characteristic features of Kluver-Bucy syndrome include hypersexuality, hyperorality, placidity, hypermetamorphosis, visual agnosia, changes in dietary habits, and memory impairment. Human cases have been reported with herpes simplex encephalitis, head injury, Pick's disease, transtentorial herniation, adrenoleukodystrophy, and Reye's syndrome, all involving bilateral temporal lobe pathology. We present the case of a patient with no evidence of a structural lesion in the temporal lobes and behavioral changes consistent with Kluver-Bucy syndrome following complex partial status epilepticus.

Firearm presence in households of patients with Alzheimer's disease and related dementias

OBJECTIVE

Attention has recently been drawn to the potential dangers of firearm use among patients with dementia. However, little is known about the actual prevalence of firearms in households with demented family members. This study seeks to determine the prevalence and loaded status of firearms in households with a demented family member in a sample of outpatients at a University memory disorders clinic.

DESIGN

Utilizing a cross-sectional design, subjects underwent a structured NINCDS-ADRDA criteria comprehensive evaluation to assess dementia and were also administered a questionnaire to assess level of mood disturbance. Family members were administered a behavioral checklist and surveyed about the number and loaded status of firearms in the patient's household.

SETTING

The study took place in an outpatient Medical University memory disorders clinic in the Southern United States.

PATIENTS

Subjects were 106 consecutive outpatients referred for symptoms suggestive of dementia.

MAIN OUTCOME MEASURES

Firearm presence was coded as "present," "not present," and "unsure." In cases where firearms were present, the number and loaded status were collected. Other outcome measures included the Clinical Dementia Rating of each patient, the Yesavage Mood Inventory, and the Revised Memory and Behavior Problems Checklist.

RESULTS

A high prevalence of firearm prevalence in households with demented family members was revealed (60.4%). Gun ownership was equally prevalent in households regardless of the severity of the dementia (chi-square, P = .426), severity of behavioral disturbance (ANOVA P = .88), or depressive symptoms (ANOVA P = .37). In households with firearms, 44.6% of the families reported that the guns were kept loaded; 38% reported that they did not know whether the guns were loaded. Only 16.9% of the families reported that guns were maintained in an unloaded state.

CONCLUSIONS

This study suggests that many family members living in households in which there are demented patients do not take appropriate action to remove or unload firearms in their households, regardless of the severity of dementia, behavioral disturbance, or depression. These findings suggest that clinicians need to ask families specifically about the presence of firearms and advocate for their removal.

The breast or the bottle? Determinants of infant feeding behaviors

Although various trends have placed breastfeeding in and out of vogue, in the twentieth century the greater availability of human milk substitutes mandates that a woman choose her infant's feeding method. It appears that intrapsychic factors or life experiences, as well as certain social conditions, influence that choice. For example, the economic state of society historically has had significant impact on the role of women and the value placed on woman's unique biologic contributions. Likewise, personality and attitudinal factors also may act as potential mediators of observed differences between lactating and nonlactating mothers in their mother-infant interactions. Finally, once the decision to breastfeed or bottle-feed has been made and carried through, additional physiologic mechanisms may mediate conscious behavioral intentions. The phenomenon of human lactation, then, is sensitive to a variety of interrelated factors that can be grouped as follows: (1) individual personality, (2) social forces, and (3) psychophysiologic mechanisms. An in-depth understanding of the specific factors that affect a woman's decision to breastfeed will have far-reaching implications for future educational and interventional programs.

The effect of recombinant TGFalpha, human milk, and human milk macrophage media on gut epithelial proliferation is decreased in the presence of a neutralizing TGFalpha antibody

OBJECTIVE

An in vitro model was devised to compare the relative effects of recombinant transforming growth factor-alpha (TGFalpha), aqueous human milk, and human milk macrophage (HMM) medium on human fetal small intestinal cell (FHs-74) proliferation.

METHODS

Recombinant TGFalpha at increasing concentrations (range 0.01-1,000 ng/ml media), the aqueous fraction of human milk (AHM), or HMM medium was added to FHs-74 cells in the presence or absence of a neutralizing TGFalpha antibody (1 microgram/ml medium). At 24 h, cell proliferation was measured and expressed as percent control. The experimental variables were (1) activators of cell growth (TGFalpha, AHM, and HMM medium); (2) increasing concentrations of TGFalpha, and (3) neutralizing antibody to TGFalpha. The dependent variable for all experiments was cell proliferation.

RESULTS

Significant effects for growth stimulators and TGFalpha concentration as measured by cell proliferation were found. Specifically, there was a dose-dependent effect of TGFalpha on cell proliferation to the 5-ng/ml concentration, with a plateau reached in cell proliferation at higher concentrations. The stimulatory effect of TGFalpha was decreased in the presence of TGFalpha antibody (mean +/- SD 22 +/- 7. 1% decline, p < 0.001). In the presence of TGFalpha antibody, there was a 25 +/- 3.1% decline in HM-stimulated growth (p < 0.004), and a 27.6 +/- 3.2% decline in HMM medium-stimulated growth (p < 0.001).

CONCLUSIONS

Neutralization of recombinant TGFalpha and that present in human milk and HMM medium by TGFalpha antibody led to a consistent decrease in in vitro human fetal small intestine epithelial proliferation without affecting cell viability. These results support the hypothesis that TGFalpha, whether derived from human recombinant sources, human milk or HMM medium has a measurable, trophic effect on in vitro human gut epithelial cells.

Unawareness of cognitive deficit in Alzheimer disease and related dementias

The objective of this study was to determine whether unawareness of cognitive deficit is disease-specific. One hundred thirty-two patients were studied, grouped according to diagnosis of definite or probable Alzheimer disease, vascular dementia, geropsychiatric control, or geriatric control. Diagnosis was the independent variable, and unawareness of cognitive deficit was the dependent variable. The Mini-Mental State Examination score was used as a dementia severity covariate. Analysis of covariance was significant (F = 8.0, p < 0.0001). Follow-up mean comparisons showed the Alzheimer disease group to have significantly greater unawareness of cognitive deficit than all other groups. The vascular dementia group had significantly greater unawareness of cognitive deficit than the two control groups. These results support the premise that, independent of dementia severity, unawareness of cognitive deficit is disease specific.

Validity of a Recall and Recognition Condition to Assess Visual Memory in the CERAD Battery

This study assessed the validity of a measure of visual recall and recognition memory using a modified administration of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Constructional Praxis task to extend the capacity of the CERAD neuropsychological battery's ability to assess nonverbal free and recognition recall. The sample consisted of consecutive university hospital memory disorders clinic patients (n = 77). To test the measures' ability to discriminate dementia severity based on an independently derived clinical dementia rating, scores on Free Visual Recall showed expected group differences as a function of dementia severity (ANOVA, F = 12.7, p = .0001), but exhibited a floor effect in the moderately severe dementia range. Recognition Visual Recall was also able to discriminate dementia severity based on an independently derived clinical dementia rating (ANOVA, F = 10.6, p = .0001). Both Free Visual Recall and Recognition Visual Recall measures were found to have strong concurrent validity based on intercorrelations with the Wechsler Memory Scale-Revised (WMS-R; Wechsler, 1987) Visual Reproduction I and II. In addition, moderate to strong discriminant validity for Free Visual Recall was demonstrated based on correlations with a family member self-report of memory problems in everyday life.

Neuropsychological features of diffuse Lewy body disease

A case of a 60-year-old man with biopsy-proven diffuse Lewy body disease was presented with clinical and serial neuropsychological data. Findings showed a rapid decline over a 2-year period characterized by an atypical degenerative dementia, including a global mental decline with preserved orientation, profound perceptual deficits, and no specific relative progressive memory impairment. Few extrapyramidal signs were noted, but subtle visual hallucinations and vivid nightmares occurred throughout the course. He underwent an experimental trial of tacrine, but showed an adverse reaction. Of the few detailed neurocognitive case descriptions of this disease found in the literature, this article highlights the unique variability and clinical manifestations that differentiate this disorder from the dementia of the Alzheimer's type.

School-age follow-up of a single-dose prophylactic surfactant cohort

This study reports the school-age developmental and health status of a preventilatory surfactant cohort. The sample consisted of 39 surviving subjects (21 experimental and 18 controls) born at 25 to 29 weeks gestation who were studied at 6 and 12 months and 5 to 7 years of age. At 6- and 12-month follow-ups, the cohort was functioning close to the population normative mean. Although cognitive and motor assessments at school age also showed no group differences, 8 of 19 (42%) in the surfactant group and 9 of 17 (53%) in the normal saline group attained a McCarthy General Cognitive Index score of < or = 84 (abnormal range). On the Connors' Parental Questionnaire, both groups scored high on the Learning Disability Subscale. The surviving cohort at 5 to 7 years had no identified long-term sequelae due to surfactant therapy, yet both groups were at risk for neurodevelopmental and educational morbidity.

Functional significance of the subcortical vascular syndrome in the rehabilitative setting

The purpose of this study was to examine the effect of cortical versus subcortical and right versus left hemispheric vascular lesion site on rehabilitative functional status. Seventy patients were prospectively studied. A 2 x 2 ANOVA showed significant group differences with the cortical group being more impaired on both the initial admission and discharge Functional Independence Measure (FIM) scores (F = 14.2, p < .0004 and F = 12.2, p < .0009, respectively). Analysis of the component FIM profile showed that the cortical group was relatively more impaired on measures of self-care, language, and social cognition, but not sphincter control or ambulation status. This general pattern also was similar at discharge with the exception of self-care. Left hemispheric lesion site was a strong predictor of language-related deficits. In addition, a Chi-square analysis showed that the cortical group had a greater frequency of unsafe behaviors requiring physical restraints. The implication of cortical versus subcortical lesion site was discussed relative to rehabilitative treatment planning.

Neuroanatomic and neuropsychological predictors of unawareness of cognitive deficit in the vascular population

Unawareness of cognitive deficit following brain damage was investigated in a sample of 108 cerebrovascular accident patients and 30 orthopaedic controls. The purpose of this study was to: 1. investigate the incidence of unawareness, 2. test if neurocognitive factors were predictive of unawareness, and 3. determine which specific neuroanatomic lesion sites were predictive of the phenomenon. Neuroanatomic lesion site was identified by CT/MRI. Unawareness of cognitive deficit was assessed using a structured unawareness interview, while neurocognitive status was quantified on several indices. Results showed unawareness was associated with brain injury (p <.0001), occurred in varying degrees of severity in about 40% of the cerebrovascular group, was significantly correlated with various neurocognitive indices, and was more frequently associated with cortical verses subcortical lesion sites (p <.0001). The results could partially be explained by existing theoretical models, but showed that both degree of neurocognitive impairment and neuroanatomic lesion site are predictive variables of the unawareness phenomenon. The potential clinical use of unawareness screening as a part of routine neuropsychological evaluation was discussed.

The role of brain single photon emission computed tomography in the diagnosis of primary progressive aphasia

We present two cases of primary progressive aphasia studied with neuropsychologic measures, computed tomography or magnetic resonance imaging, and single-photon emission computed tomography with technetium Tc99m-labeled hexamethylpropyleneamine oxime. Clinical and neuropsychologic observations revealed a marked, progressive loss of language functions over time with relative preservation of nonlanguage cognitive functions in both patients. The brain single-photon emission computed tomographic scan revealed marked left frontal and minimal left temporal and parietal hypoperfusion in case 1 and marked left posterior frontal and minimal left temporal hypoperfusion in case 2. The value of brain single-photon emission computed tomography in distinguishing primary progressive aphasia from Alzheimer's disease is described.