The Clinical neuropsychologist
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The constellation of physical, cognitive, and emotional symptoms, collectively known as postconcussion syndrome (PCS), is not uniquely associated with concussion, making the etiology of chronic postconcussion symptoms controversial. The current study compared percentages of individuals meeting symptom-based criteria for PCS in a population-based sample of veterans composed of subgroups with various psychiatric diagnoses, a history of mild traumatic brain injury (MTBI), and healthy controls. Participants were identified from 4462 randomly sampled male U. ⋯ Army veterans who served during the Vietnam era. Only 32% of veterans with a history of MTBI met DSM-IV symptom criteria for PCS as compared to 40% of those diagnosed with post-traumatic stress disorder (PTSD), 50% with generalized anxiety disorder (GAD), 57% with major depressive disorder (MDD), and 91% with somatization disorder. Results were consistent with existing literature showing that the PCS symptoms are not unique to concussion, and also provide important base-rate information for neuropsychologists practicing in both clinical and personal injury forensic settings.
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Comparative Study
The utility of post-concussion neuropsychological data in identifying cognitive change following sports-related MTBI in the absence of baseline data.
Neuropsychological tests have become commonplace in the assessment of sports-related concussion. Typically, post-injury test data are compared to pre-injury "baselines." Baseline testing can be expensive and logistically challenging, yet the usefulness of neuropsychological baseline testing has not been tested empirically. This paper examines the extent to which baseline testing is useful for detecting neurocognitive deficits following sports concussion in a college-age population. ⋯ Although the GLN and JT methods demonstrated moderate to substantial agreement, the GLN method consistently identified more cognitively compromised athletes than the JT method. Post-injury scores alone identified a significant majority of athletes with a reliable decline on ImPACT. Although preliminary and in need of replication across age groups and instruments, these findings suggest that the majority of collegiate athletes who experience clinically meaningful post-concussion cognitive decline can be identified without baseline data.
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Sufficient sleep is essential for optimum cognitive and psychological functioning. Diminished sleep quality is associated with depression and anxiety, but the extent to which poor sleep quality uniquely impacts attention and executive functions independent of the effects of the common underlying features of depression and anxiety requires further exploration. Here 67 healthy young adults were given the Minnesota Multiphasic Personality Inventory, second edition (MMPI-2), the Pittsburgh Sleep Quality Index (PSQI), and tests of attention and executive functions. ⋯ In addition, PSQI component scores indexing poor sleep quality, duration, and medication use were associated with diminished attention and executive functions, even after controlling for emotional reactivity or demoralization (rs = 0.21-0.27). These results add to the concurrent validity of the PSQI, and provide further evidence for subtle cognitive decrements related to insufficient sleep even in healthy young adults. Future extension of these findings is necessary with larger samples and clinical comparison groups, and using objective indices of sleep dysfunction such as polysomnography.
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Pain-related fear is related to self-reported avoidance of physical activities that might induce pain (kinesiophobia), as well as diminished physical performance in non-headache chronic pain. A related concept, "cogniphobia," has been proposed by others, which suggests that individuals high in headache-related fear will avoid cognitive tasks (by putting forth less effort) in an attempt to minimize the risk of bringing on or exacerbating existing headache symptoms. ⋯ Latent variable analysis of the cogniphobia measure revealed a component focused on fear of headache pain and avoidance of behaviors that would induce pain, which was related to sustained attention performance, performance on a symptom validity measure, and pressure pain threshold on the head, consistent with existing kinesiophobia research in non-headache pain. Results have implications for neuropsychological assessment in headache; pain-related fear may be related to diminished effort on neuropsychological tasks.
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Case Reports
Long-term neuropsychological, neuroanatomical, and life outcome in hippocampal amnesia.
Focal bilateral hippocampal damage typically causes severe and selective amnesia for new declarative information (facts and events), a cognitive deficit that greatly impacts the ability to live a normal, fully independent life. We describe the case of 1846, a 48-year-old woman with profound hippocampal amnesia following status epilepticus and an associated anoxic episode at age 30. ⋯ In spite of severe amnesia 1846 lives a full and mostly independent adult life, facilitated by an extensive social support network of family and friends. Her case provides an example of a rare and unlikely positive outcome in the face of severe memory problems.