Implications from neurologic assessment of brain protection for total arch replacement from a randomized trial.

Objective: The study objective was to perform a randomized trial of brain protection during total aortic arch replacement and identify the best way to assess brain injury.

Methods: From June 2003 to January 2010, 121 evaluable patients were randomized to retrograde (n = 60) or antegrade (n = 61) brain perfusion during hypothermic circulatory arrest. We assessed the sensitivity of clinical neurologic evaluation, brain imaging, and neurocognitive testing performed preoperatively and 4 to 6 months postoperatively to detect brain injury.

Memory performance in older adults before and after temporal lobectomy for pharmacoresistant epilepsy.

Little is known about the effects of epilepsy surgery on memory in older adults. The purpose of this study was to determine if older adults exhibit greater memory decline than younger adults after anterior temporal lobectomy (ATL). Patients 55 years and older at time of surgery (23 left, 14 right ATL, range 55-66 years) were compared to patients age 25-35 years (44 left, 33 right ATL) to assess differences in preoperative to postoperative change in WMS-III index scores.

Word-finding difficulties confound performance on verbal cognitive measures in adults with intractable left temporal lobe epilepsy.

This study sought to determine if word-finding difficulties (WFDs), which are common in adults with dominant temporal lobe epilepsy (TLE), are related to performance on verbal cognitive measures, including memory. One hundred six individuals with left TLE and pathologically confirmed mesial temporal sclerosis completed comprehensive preoperative neuropsychological evaluations. Patients were divided into two groups based on the degree of benefit received from phonemic cueing on a confrontation naming task.

Working memory and intelligence are associated with victoria symptom validity test hard item performance in patients with intractable epilepsy.

Loring et al. (Journal of clinical and experimental neuropsychology, 2005:27;610–617) observed relationships between VSVT hard item performance and IQ and memory indices in epilepsy surgical candidates, with a potential confound of low FSIQ on VSVT performance. The present study replicated the Loring et al.

Computerized neuropsychological assessment devices: joint position paper of the American Academy of Clinical Neuropsychology and the National Academy of Neuropsychology.

This joint position paper of the American Academy of Clinical Neuropsychology and the National Academy of Neuropsychology sets forth our position on appropriate standards and conventions for computerized neuropsychological assessment devices (CNADs). In this paper, we first define CNADs and distinguish them from examiner-administered neuropsychological instruments. We then set forth position statements on eight key issues relevant to the development and use of CNADs in the healthcare setting.

Computerized neuropsychological assessment devices: joint position paper of the American Academy of Clinical Neuropsychology and the National Academy of Neuropsychology.

This joint position paper of the American Academy of Clinical Neuropsychology and the National Academy of Neuropsychology sets forth our position on appropriate standards and conventions for computerized neuropsychological assessment devices (CNADs). In this paper, we first define CNADs and distinguish them from examiner-administered neuropsychological instruments. We then set forth position statements on eight key issues relevant to the development and use of CNADs in the healthcare setting.

Pre-surgical mood predicts memory decline after anterior temporal lobe resection for epilepsy.

This study examined pre-surgical depressed mood as a predictor of post-surgical memory change in adults who underwent temporal lobe resections (TLRs; n = 211). Patients completed the Wechsler Memory Scale-III and Beck Depression Inventory-Second Edition (BDI-II) before and after TLR (left = 110, right = 101) and were divided into two groups (clinically elevated depressive symptoms or not depressed) based on BDI-II score. Left-TLR patients with poorer pre-surgical mood had greater verbal memory declines after surgery compared with nondepressed left- or right-TLR patients and right-TLR patients with poor mood.

Poor presurgical performance on both verbal and visual memory measures is associated with low risk for memory decline following left temporal lobectomy for intractable epilepsy.

Studies have shown a lower risk for verbal memory decline following dominant anterior temporal lobectomy (ATL) among patients with poor, presurgical verbal memory scores. It is unclear however, if the risk of decline is increased in patients who also have reduced visual memory. Objective and subjective memory outcome following left ATL was examined in twelve patients with reduced presurgical visual and verbal memory scores.

The Family Pictures subtest of the WMS-III: relationship to verbal and visual memory following temporal lobectomy for intractable epilepsy.

This study examined the extent to which the Family Pictures (FP) subtest of the Wechsler Memory Scale-Third Edition (WMS-III) is related to verbal memory measures and right mesial temporal integrity. Epilepsy patients who underwent temporal lobectomy did not differ in the extent to which FP scores changed from before to after surgery, although postoperative FP performance was worse in those who underwent right temporal lobectomy than in those who underwent left temporal lobectomy. FP was most strongly related to the Logical Memory subtest from the WMS-III.

APOE epsilon4 is associated with postictal confusion in patients with medically refractory temporal lobe epilepsy.

This study examined the relationship between the APOE epsilon4 allele and postictal confusion in patients with medically intractable temporal lobe epilepsy (TLE). Patients with at least one epsilon4 allele (n=22) were three times more likely to exhibit postictal confusion (68%) than the 63 patients without epsilon4 (43%). These preliminary results demonstrate that APOE epsilon4 is associated with an increased risk of postictal confusion in patients with medically intractable TLE, suggesting possible dysfunction in neuronal recovery mechanisms.

Relationship between presurgical memory performance on the Wechsler Memory Scale-III and memory change following temporal resection for treatment of intractable epilepsy.

Previous research demonstrated a relationship between preoperative memory measured by the Wechsler Memory Scale-Revised (WMS-R) and postsurgical memory change in patients who underwent left (LATL), but not right (RATL) anterior temporal lobectomy. The current study replicated previous efforts using the Wechsler Memory Scale-Third Edition (WMS-III) in a larger sample. The WMS-III was administered to 161 patients with medically intractable epilepsy prior to and approximately 6 months following LATL or RATL.

Relationships among victoria symptom validity test indices and personality assessment inventory validity scales in a large clinical sample.

The purpose of this study was twofold: (1) to examine the relationships among measures of cognitive symptom exaggeration (i.e., response accuracy and response latency) and (2) to examine the relationship between measures of cognitive and psychopathological symptom exaggeration.

The latent structure of cognitive symptom exaggeration on the Victoria Symptom Validity Test.

Previous studies have focused on the ability of cognitive symptom validity tests to identify simulated malingering or distinguish between clinical samples of individuals at low or high risk of cognitive symptom exaggeration. However, no published studies have examined the latent structure of negative response bias on cognitive tests: measures of cognitive symptom exaggeration may evaluate a continuum of poor effort/invalid responding or a dichotomy of adequate versus inadequate effort. The present study examined whether Victoria Symptom Validity Test (VSVT) indices evaluate a latent dimension or category of response distortion.

The latent structure of attention-deficit/hyperactivity disorder in a clinic-referred sample.

The question of whether attention-deficit/hyperactivity disorder (ADHD) represents a continuum of attentional and executive dysfunction or a natural category has yet to be extensively investigated. Subjective report and neuropsychological data from 437 individuals referred for neuropsychological evaluation were analyzed using latent class and taxometric analyses (mean above minus below a cut [MAMBAC], maximum eigenvalue [MAXEIG], and latent mode [LMODE]). Results indicated no significant evidence for a taxonic representation of ADHD across multiple procedures and indicator sets.

Evaluating the contributions of state-of-the-art assessment techniques to predicting memory outcome after unilateral anterior temporal lobectomy.

Purpose: Although anterior temporal lobectomy (ATL) is an effective treatment for many patients with medically refractory temporal lobe epilepsy (TLE), one risk associated with this procedure is postsurgical decline in memory. A substantial number of past studies examined factors that predict memory decline after surgery, but few have investigated multiple predictors simultaneously or considered measures that are currently in use.

Methods: This study compared the relative contributions made by presurgical neuropsychological test scores, MRI-based hippocampal volumetric analysis, and Wada test results to predicting memory outcome after ATL in a group of 87 patients.

Psychometric adequacy and comparability of the short and full forms of the Personality Assessment Inventory.

The 160-item short form of the Personality Assessment Inventory (PAI) was developed for situations in which respondents complete only the 1st half of the test. The present study evaluates the adequacy and comparability of the full and short forms of the PAI in terms of a wide range of psychometric characteristics. In all, 421 participants completed the full form as part of a neuropsychological evaluation.

Magnesium as a neuroprotectant in cardiac surgery: a randomized clinical trial.

Objective: We sought to evaluate magnesium as a neuroprotectant in patients undergoing cardiac surgery with cardiopulmonary bypass.

Methods: From February 2002 to September 2003, 350 patients undergoing elective coronary artery bypass grafting, valve surgery, or both were enrolled in a randomized, blinded, placebo-controlled trial to receive either magnesium sulfate to increase plasma levels 1(1/2) to 2 times normal during cardiopulmonary bypass (n = 174) or no intervention (n = 176). Neurologic function, neuropsychologic function, and depression were assessed preoperatively, at 24 and 96 hours after extubation (neurologic) and at 3 months (neuropsychologic, depression).

Patients' perceptions of memory functioning before and after surgical intervention to treat medically refractory epilepsy.

Purpose: One risk associated with epilepsy surgery is memory loss, but perhaps more important is how patients perceive changes in their memories. This longitudinal study evaluated changes in memory self-reports and investigated how self-reports relate to changes on objective memory measures in temporal or extratemporal epilepsy patients who underwent surgery.

Methods: Objective memory (Wechsler Memory Scale-Revised) and subjective memory self-reports (Memory Assessment Clinics Self-Rating Scale) were individually assessed for 136 patients approximately 6 months before and 6 months after surgery.

Increasing the reliability of ipsative interpretations in neuropsychology: a comparison of reliable components analysis and other factor analytic methods.

Ipsative approaches to neuropsychological assessment typically involve interpreting difference scores between individual test scores. The utility of these methods is limited by the reliability of neuropsychological difference scores and the number of comparisons between scores. The present study evaluated the utility of difference scores using factor analytic methods, including reliable components analysis (RCA), equally weighted composites and individual neuropsychological measures.

WMS-III performance in epilepsy patients following temporal lobectomy.

We examined performances on the Wechsler Memory Scale-3rd Edition (WMS-III) among patients who underwent temporal lobectomy for the control of medically intractable epilepsy. There were 51 right (RTL) and 56 left (LTL) temporal lobectomy patients. All patients were left hemisphere speech-dominant.

Indications for neuropsychological assessment.

A neuropsychological evaluation can help in narrowing the differential diagnosis of cognitive dysfunction, choosing treatments, and evaluating the efficacy of an intervention on an ongoing basis. In patients with documented neurologic disorders, information from neuropsychological assessment can define the patient's functional limitations or residual cognitive strengths. Proper use of neuropsychological assessment can improve the quality of care.