Patterns of neuropsychological impairment after severe blunt head injury

Article Abstract:

The consequences of blunt (non-penetrating) head injury include a range of neuropsychological abnormalities of both cognition and behavior, but definitive patterns of impairment associated with this type of injury have not been described. To learn more about these patterns, 87 patients (between 15 and 45 years old when injured) were studied an average of six years after their injuries. Most had been injured in traffic accidents, and the injuries were severe. A control group (40 people) made up of patients' siblings was also studied. All subjects underwent testing with 15 standard neuropsychological tests (listed in an appendix) to test learning and memory, personality changes resulting from the trauma, speed of information processing, and basic neuropsychological skills. Results showed that 70 percent of the patients had significant neuropsychological impairment from their injuries. These deficits were not of the 'classical' sort, a category including aphasia (impairment of language), apraxia (inability to carry out planned, organized movements), and agnosia (inability to comprehend sensory, auditory, or visual information). Rather, language, orientation, and perception appeared unaffected in most patients. Fifty-six percent, however, had impairments of learning and memory, and 40 percent showed signs of posttraumatic personality change. Thirty-four percent demonstrated impaired rates of information processing. In one-third of the cases, the deficits were selective; only nine subjects had generalized, widespread impairment in all areas tested. The pattern of injury that emerged was diverse as well as selective, with considerable individual variation. A discussion is presented of the effects of even mild neuropsychological impairment on functioning in everyday life. Rehabilitative efforts, especially those begun soon after injury, should take these patterns into account. (Consumer Summary produced by Reliance Medical Information, Inc.)

Crash injuries, Head injuries, Wounds and injuries, Injuries, Blunt trauma

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Risk factors associated with persistence of neuropsychological deficits in persons with organic solvent exposure

Article Abstract:

There is growing awareness of the dangers of exposure to toxic chemicals. Estimates indicate that 9.8 million workers are exposed to organic solvents each year. Neuropsychiatric symptoms, such as decreased attention and memory loss, may result from exposure. Mental health clinicians can therefore expect to see an increase in related cases. Whether or not discontinuation of exposure to organic solvents is enough to reverse these adverse effects remains controversial. Some studies have shown that the neuropsychological effects continue to increase over time, even in the absence of continued exposure. For some patients, no improvements occurred at all; other studies have shown improvement over time in some patients. In the present study, 27 people with mild cases of impairment as a result of exposure to organic solids were investigated. They completed neuropsychological assessments of cognitive and perceptual functioning and a personality inventory at an average of 4.7 months after exposure, and again about 16 months later. The average length of exposure to organic solids was 5.2 years. By the second assessment, 50 percent of the subjects had improved on neuropsychological test scores and 50 percent failed to improve. Those who did not improve were significantly more likely to have had a brief peak exposure (an unusually high exposure that required medical attention) and also reported higher psychological distress than those with good outcomes. Peak exposure to toxins and psychological distress may therefore be predictors of poor neuropsychological outcome in persons who have been exposed to organic solvents. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Organic solvents, Neuropsychology

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Neuropsychological performance in patients with mild multiple sclerosis

Article Abstract:

Multiple sclerosis (MS), a chronic disorder characterized by the gradual loss of myelin (the material that insulates nerves, ensuring normal nerve conduction) and by neurologic abnormalities, is associated with changes in cognitive capacity. However, whether cognition is affected in the early stages of the disease is not known. The problem is complicated by the fact that MS may occur in alternating periods of remission and relapse, during which cognitive functions may vary. To learn more about cognition in MS, 86 patients (average age, 36.6) whose disease had a relapsing/remitting course were studied. Their performance on a battery of neuropsychological tests (while the disease was in remission) was compared with the performance of 46 matched control subjects. Results showed that MS patients differed from controls on 21 of 42 comparisons, of which only eight measured purely motor (movement) functions (on which MS patients would be expected to perform more poorly). Six tests on which MS patients did more poorly involved only cognitive functions; these measured such aspects as learning, verbal fluency, and memory, and required processing of new material. Verbal IQ, thought to be indicative of previously learned material, did not differ between MS patients and controls. The results suggest that cognitive changes can occur in the early stages of MS. (Consumer Summary produced by Reliance Medical Information, Inc.)

Testing, Development and progression, Multiple sclerosis, Cognition, Cognitive tests

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