Journal of clinical and experimental neuropsychology
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J Clin Exp Neuropsychol · Aug 2008
Randomized Controlled Trial Comparative StudyComparison of two patient-controlled analgesia techniques on neuropsychological functioning in the immediate postoperative period.
Pain may contribute to cognitive decline, which is a common complication in the early postoperative period. We compared the effects of two common pain management techniques, intravenous patient-controlled analgesia (PCA-IV) and patient-controlled epidural analgesia (PCEA), on cognitive functioning in the immediate postoperative period. Patients hospitalized for elective surgery were randomly assigned to one of the treatment groups (30 patients per group). ⋯ Nonoperated volunteers served as controls. Patients of the PCA-IV group exhibited significantly higher pain scores than did patients of the PCEA group. PCA-IV patients exhibited significant deterioration in the postoperative period in all the neuropsychological measures, while the PCEA patients exhibited significant deterioration only in one cognitive index, compared to controls.
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J Clin Exp Neuropsychol · Apr 2008
Comparative StudyCorrelates of persistent postconcussional disorder: DSM-IV criteria versus ICD-10.
Controversy surrounding the causation of symptom complaints after mild traumatic brain injury (MTBI) is reflected by the existence of alternative diagnostic criteria for postconcussional syndrome (PCS) in the International Classification of Diseases (ICD) and postconcussional disorder (PCD) in the Diagnostic and Statistical Manual of Mental Disorders-4th edition (DSM-IV). Previous studies of persisting symptoms have employed various symptom checklists rather than uniform criteria-based diagnoses. This is the first prospective study of persisting symptom complaints using the formal diagnostic criteria for PCD and PCS and comparing these criteria sets in terms of prevalence, relationship to potential compensation, and emotional/functional status. ⋯ Significant racial differences in fulfilling PCD/PCS criteria were found. No differences in emotional/functional status patterns or global outcome were found between the criteria sets except for minor dissimilarities in the social/community integration domain. The results demonstrate that despite large differences in the frequency of patients meeting the two diagnostic criteria sets, a clear basis for preferring either the PCD or PCS criteria remains to be determined.
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J Clin Exp Neuropsychol · Feb 2008
Measuring premorbid IQ in traumatic brain injury: an examination of the validity of the Wechsler Test of Adult Reading (WTAR).
Estimation of premorbid IQ in traumatic brain injury (TBI) is clinically and scientifically valuable because it permits the quantification of the cognitive impact of injury. This is achieved by comparing performances on tests of current ability to estimates of premorbid IQ, thereby enabling current capacity to be interpreted in light of preinjury ability. However, the validity of premorbid IQ tests that are commonly used for TBI has been questioned. ⋯ WTAR scores were also highly similar to scores on a demographic estimate of premorbid IQ. Thus, converging evidence--high stability during recovery from TBI and similar IQ estimates to those of a demographic equation suggests that the WTAR is a valid measure of premorbid IQ for TBI. Where word pronunciation tests are indicated (i.e., in patients for whom English is spoken and read fluently), these results endorse the use of the WTAR for patients with TBI.
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J Clin Exp Neuropsychol · Aug 2007
Long-term morbidities following self-reported mild traumatic brain injury.
The objective of this study was to examine the prevalence of long-term psychiatric, neurologic, and psychosocial morbidities of self-reported mild traumatic brain injury (MTBI). A cross-sectional cohort sample of three groups was examined: those who had not been injured in a motor vehicle accident nor had a MTBI (n = 3,214); those who had been injured in an accident but did not have a MTBI (n = 539); and those who had a MTBI with altered consciousness (n = 254). Logistic regression analyses were used to model odds ratios for the association between group and outcome variables while controlling demographic characteristics, comorbid medical conditions, and early-life psychiatric problems. ⋯ MTBI also was associated with peripheral visual imperceptions and impaired tandem gait. Similarly, the MTBI group had poorer psychosocial outcomes including an increased likelihood of self-reported disability, underemployment, low income, and marital problems. Results suggest that MTBI can have adverse long-term psychiatric, neurologic, and psychosocial morbidities.
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J Clin Exp Neuropsychol · Oct 2006
Comparative StudyPain, malingering, and performance on the WAIS-III Processing Speed Index.
Pain patients often report cognitive symptoms and many will include them in their claims of disability. The Processing Speed Index (PSI) of the WAIS-III was investigated as one aspect of cognitive functioning in six groups. ⋯ The lowest scores were found in a Simulator group instructed to fake cognitive impairment and a Clinical Pain group diagnosed as Malingering. Results suggest that PSI scores are only slightly reduced by laboratory-induced pain or chronic pain, and that unexpectedly low scores in the absence of significant/documented brain dysfunction suggest poor effort or deliberate misrepresentation.