RESUMEN

IMPORTANCE: GAAB Syndrome was recently discovered and coined by Rodríguez, Azariah, Ritter, et al.. (2024). It is characterized by bifrontal brain injury, visual pathway damage involving bilateral enucleation, generalized and visual anosognosia and lack of emotional processing with visual anosognosia being more prominent in the clinical presentation of the patient given the context of bilateral enucleation. The syndrome was not explained by delirium nor by amnesia, not either by multiple shunt adjustments or psychological denial. OBJECTIVE: To describe the clinical presentation and syndrome length of the patient one year after injury. Results show that most of the syndrome symptoms are resolved after nine months, with just visual anosognosia not resolving completely. The patient improved cognitively as shown by the same tests one year later.

RESUMEN

Visual anosognosia, associated with confabulations and cortical blindness in the context of occipital lobe injury, is known as Anton syndrome. Patients with this syndrome strongly deny their vision loss and confabulate to compensate for both visual loss and memory impairments. In this article, we present a case of a patient with some similarities to Anton syndrome, however, with several differences in clinical presentation. Bifrontal brain injury, bilateral enucleation, affective indifference (anosodiaphoria), generalized anosognosia, and the conviction that vision will resume mark clear clinical differences with Anton syndrome. Differentiating these findings from Anton syndrome will help occupational therapists, neuropsychologists, speech-language pathologists, physical therapists, and physicians when assessing frontal lobe brain injury with total and partial visual loss. This case demonstrates that visual anosognosia and confabulations can occur without occipital lobe dysfunction or cortical blindness.

Asunto(s)

Agnosia , Alucinaciones , Humanos , Agnosia/etiología , Agnosia/diagnóstico , Masculino , Alucinaciones/etiología , Lesiones Encefálicas/complicaciones , Adulto , Ceguera Cortical/etiología , Enucleación del Ojo

RESUMEN

OBJECTIVE: The aim of the study was to demonstrate the feasibility, tolerability, and effectiveness of robotic-assisted arm training in incomplete chronic tetraplegia. DESIGN: Pretest/posttest/follow-up was conducted. Ten individuals with chronic cervical spinal cord injury were enrolled. Participants performed single degree-of-freedom exercise of upper limbs at an intensity of 3-hr per session for 3 times a week for 4 wks with MAHI Exo-II. Arm and hand function tests (Jebsen-Taylor Hand Function Test, Action Research Arm Test), strength of upper limb (upper limb motor score, grip, and pinch strength), and independence in daily living activities (Spinal Cord Independence Measure II) were performed at baseline, end of training, and 6 mos later. RESULTS: After 12 sessions of training, improvements in arm and hand functions were observed. Jebsen-Taylor Hand Function Test (0.14[0.04]-0.21[0.07] items/sec, P = 0.04), Action Research Arm Test (30.7[3.8]-34.3[4], P = 0.02), American Spinal Injury Association upper limb motor score (31.5[2.3]-34[2.3], P = 0.04) grip (9.7[3.8]-12[4.3] lb, P = 0.02), and pinch strength (4.5[1.1]-5.7[1.2] lb, P = 0.01) resulted in significant increases. Some gains were maintained at 6 mos. No change in Spinal Cord Independence Measure II scores and no adverse events were observed. CONCLUSIONS: Results from this pilot study suggest that repetitive training of arm movements with MAHI Exo-II exoskeleton is safe and has potential to be an adjunct treatment modality in rehabilitation of persons with spinal cord injury with mild to moderate impaired arm functions.

Asunto(s)

Vértebras Cervicales/lesiones , Traumatismos del Cuello/rehabilitación , Modalidades de Fisioterapia/instrumentación , Robótica/métodos , Traumatismos de la Médula Espinal/rehabilitación , Adulto , Brazo/fisiopatología , Estudios de Factibilidad , Femenino , Mano/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Movimiento/fisiología , Traumatismos del Cuello/fisiopatología , Proyectos Piloto , Fuerza de Pellizco , Recuperación de la Función , Traumatismos de la Médula Espinal/fisiopatología , Resultado del Tratamiento

RESUMEN

OBJECTIVE: To provide clarification on the distinction between cognitive screening, cognitive testing, and neuropsychological assessment and highlight practical implications. METHOD: Non-systematic brief clinical review. RESULTS: There is a present lack of explicit distinction between the various levels of measurement of cognitive functioning with regard to goals, indications for use, levels of complexity, and outcome. There is also a lack of guidance regarding the identification of who should be responsible for the administration and interpretation at each level. CONCLUSIONS: There is a growing awareness of the importance of cognitive health and disability, and of the importance of measurement of cognitive functions across the lifespan. For example, cognitive screening has been mandated by the Patient Protection and Affordable Care Act of 2010, and language contained within new psychiatric diagnostic criteria and healthcare regulatory changes reflect increased consideration of the importance of measurement of cognition. Changes such as these necessitate greater clarity on this important issue as it bears implications for professional practice, which ranges from education and training competencies, practice standards, and the way that neuropsychologists clarify and advocate for the value of specialty referrals for comprehensive assessment in a competitive and ever-changing healthcare market.

Asunto(s)

Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/psicología , Cognición , Pruebas Neuropsicológicas , Diagnóstico Diferencial , Humanos , Neurólogos , Práctica Profesional , Psicología

RESUMEN

PURPOSE: The purpose was to compare the effectiveness of robotic-assisted body weight supported treadmill training using the Lokomat(®) to over-ground gait training (OGT) in adults with chronic stroke. METHODS: Participants were randomly assigned to the Lokomat(®) or OGT interventions. Both protocols included 40 sessions over 8 weeks. Primary outcome measures were the 10-meter walk test and 6-minute walk distance. Secondary measures included the Functional Independence Measure(TM) locomotion score, Fugl-Meyer Lower Extremity Motor Score (FM-LE), Barthel Index, and Stroke Impact Scale. Blinded assessors tested the participants at baseline, post-intervention, and 3-month follow-up. RESULTS: Eleven Lokomat(®) and nine OGT participants completed the study. Within group differences in the FM-LE score and Barthel Index occurred over time from baseline to post-intervention and baseline to 3-month follow-up. No other within group differences and no between group differences were observed. CONCLUSIONS: Although walking measures did not show significant changes between groups, LE motor function and physical functional levels improved over time within both groups. The Lokomat(®) may allow aggressive locomotor training, particularly for the lower functioning patients who wish to improve walking ability due to apparent eased therapist physical burden, when compared to OGT, although an increased risk of skin breakdown is present.

Asunto(s)

Terapia por Ejercicio/métodos , Trastornos Neurológicos de la Marcha/rehabilitación , Robótica/instrumentación , Rehabilitación de Accidente Cerebrovascular , Caminata/fisiología , Adulto , Factores de Edad , Anciano , Análisis de Varianza , Enfermedad Crónica , Método Doble Ciego , Prueba de Esfuerzo/métodos , Femenino , Estudios de Seguimiento , Trastornos Neurológicos de la Marcha/etiología , Trastornos Neurológicos de la Marcha/fisiopatología , Humanos , Locomoción/fisiología , Masculino , Persona de Mediana Edad , Valores de Referencia , Medición de Riesgo , Robótica/métodos , Índice de Severidad de la Enfermedad , Factores Sexuales , Accidente Cerebrovascular/complicaciones , Análisis y Desempeño de Tareas , Resultado del Tratamiento

RESUMEN

CASE REPORT: A 28-year-old woman, with incomplete spinal cord injury at the C2 level, classified as American Spinal Injury Impairment Scale C (AIS), participated in a robotic rehabilitation program 29 months after injury. Robotic training was provided to both upper extremities using the MAHI Exo-II, an exoskeleton device designed for rehabilitation of the upper limb, for 12 × 3-h sessions over 4 weeks. Training involved elbow flexion/extension, forearm supination/pronation, wrist flexion/extension, and radial/ulnar deviation. RESULTS: Outcome measures were Action Research Arm Test, Jebsen-Taylor Hand Function Test, and AIS-upper extremity motor score. Safety measures included fatigue, pain and discomfort level using a 5-point rating scale. Following training, improvements were observed in the left arm and hand function, whereas the right arm and hand function showed no improvement in any of the functional outcome measures. No excessive pain, discomfort or fatigue was reported. CONCLUSION: Data from one subject demonstrate valuable information on the feasibility, safety and effectiveness of robotic-assisted training of upper-extremity motor functions after incomplete spinal cord injury.

Asunto(s)

Terapia por Ejercicio/métodos , Robótica/métodos , Traumatismos de la Médula Espinal/rehabilitación , Extremidad Superior/fisiopatología , Adulto , Terapia por Ejercicio/instrumentación , Femenino , Humanos , Movimiento , Recuperación de la Función , Traumatismos de la Médula Espinal/fisiopatología

RESUMEN

In this paper, we analyze the correlations between four clinical measures (Fugl-Meyer upper extremity scale, Motor Activity Log, Action Research Arm Test, and Jebsen-Taylor Hand Function Test) and four robotic measures (smoothness of movement, trajectory error, average number of target hits per minute, and mean tangential speed), used to assess motor recovery. Data were gathered as part of a hybrid robotic and traditional upper extremity rehabilitation program for nine stroke patients. Smoothness of movement and trajectory error, temporally and spatially normalized measures of movement quality defined for point-to-point movements, were found to have significant moderate to strong correlations with all four of the clinical measures. The strong correlations suggest that smoothness of movement and trajectory error may be used to compare outcomes of different rehabilitation protocols and devices effectively, provide improved resolution for tracking patient progress compared to only pre- and post-treatment measurements, enable accurate adaptation of therapy based on patient progress, and deliver immediate and useful feedback to the patient and therapist.

Asunto(s)

Trastornos del Movimiento/rehabilitación , Movimiento/fisiología , Rehabilitación/instrumentación , Robótica , Actividades Cotidianas , Brazo/fisiopatología , Terapia Conductista , Terapia por Ejercicio , Retroalimentación Fisiológica , Humanos , Paresia/rehabilitación , Garantía de la Calidad de Atención de Salud , Recuperación de la Función , Valores de Referencia , Rehabilitación de Accidente Cerebrovascular

RESUMEN

A standardized measure of neurological dysfunction specifically designed for TBI currently does not exist and the lack of assessment of this domain represents a substantial gap. To address this, the Neurological Outcome Scale for Traumatic Brain Injury (NOS-TBI) was developed for TBI outcomes research through the addition to and modification of items specifically relevant to patients with TBI, based on the National Institutes of Health Stroke Scale. In a sample of 50 participants (mean age = 33.3 years, SD = 12.9)

Asunto(s)

Lesiones Encefálicas/rehabilitación , Examen Neurológico/métodos , Índices de Gravedad del Trauma , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Reproducibilidad de los Resultados , Resultado del Tratamiento

RESUMEN

Previous research has demonstrated stability of cognitive ability and marked heritability during adulthood, but questions remain about the extent to which genetic factors account for this stability. We conducted a 35-year longitudinal assessment of general cognitive ability using the Armed Forces Qualification Test administered to 7,232 male twins in early adulthood and readministered to a subset of 1,237 twins during late middle age. The proportion of variance in cognitive functioning explained by genetic factors was .49 in young adulthood and .57 in late middle age. The correlation between the two administrations was .74 with a genetic correlation of 1.0, indicating that the same genetic influences operated at both times. Genetic factors were primarily responsible for stability, and nonshared environmental factors were primarily responsible for change. The genetic factors influencing cognition may change across other eras, but the same genetic influences are operating from early adulthood to late middle age.

Asunto(s)

Aptitud , Cognición , Genotipo , Medio Social , Gemelos/genética , Adulto , Análisis de Varianza , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estadística como Asunto , Adulto Joven

RESUMEN

Damage and/or disconnection of the primary somatosensory cortex (SI) after stroke leads to deficits in touch perception. We used magnetoencephalography to test whether specific patterns of functionality of the somatosensory cortex are associated with different degrees of postacute somatosensory deficit. Nineteen postacute unilateral stroke patients suffering different degrees of somatosensory deficit (six nonexistent, six moderate, and seven severe) and eight aged-matched controls underwent high-resolution MRI and whole-head magnetoencephalography recordings of somatosensory-evoked fields and of spontaneous slow oscillatory activity. Amplitude of SI activation after tactile stimulation in the affected and nonaffected hemispheres and delta dipole density (DDD) in the postcentral areas were estimated and compared across the four groups. Severe postacute somatosensory deficit was accompanied, in all cases, with absence of SI responses to stimulation in the affected hand and a significant asymmetry in postcentral DDD toward the affected hemisphere. Patients with moderate sensory loss showed asymmetry in their postcentral DDD (four cases toward the affected hemisphere and two toward the unaffected) but no atypical amplitudes in SI activation. Recordings in stroke patients without somatosensory deficit did not differ from those obtained in controls for SI amplitude or postcentral DDD. In stroke patients, amplitude of SI responses and postcentral DDD show a negative correlation. Lack of activation of SI cortex after stimulation of the affected hand and spontaneous slow oscillatory activity in postcentral areas are neurophysiological correlates of somatosensory deficit in the postacute phase of stroke.

Asunto(s)

Potenciales Evocados Somatosensoriales , Corteza Somatosensorial/fisiopatología , Trastornos Somatosensoriales/fisiopatología , Accidente Cerebrovascular/fisiopatología , Tacto , Adulto , Anciano , Electroencefalografía , Femenino , Humanos , Masculino , Persona de Mediana Edad

RESUMEN

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. In this prospective study, an unselected series of adults with uncomplicated MTBI (N = 139) was assessed at 6 months postinjury with a brief neuropsychological battery and measures of psychiatric symptoms/disorders, social support/community integration, health-related quality of life, and global outcome. In parallel analyses, participants with PCD/PCS were compared to those without the disorder. Potential compensation was an equally significant factor in both criteria sets. Persistent PCS criteria were met 3.1 times more frequently than persistent PCD criteria. 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.

Asunto(s)

Manual Diagnóstico y Estadístico de los Trastornos Mentales , Clasificación Internacional de Enfermedades , Síndrome Posconmocional/diagnóstico , Síndrome Posconmocional/psicología , Estadística como Asunto/métodos , Adulto , Demografía , Emociones , Femenino , Escala de Coma de Glasgow , Estado de Salud , Humanos , Entrevista Psicológica , Masculino , Trastornos Mentales/etiología , Persona de Mediana Edad , Pruebas Neuropsicológicas , Evaluación de Resultado en la Atención de Salud , Síndrome Posconmocional/complicaciones , Estudios Prospectivos , Calidad de Vida , Apoyo Social , Estadísticas no Paramétricas , Adulto Joven

RESUMEN

CONTEXT: Cognitive deficits are associated with posttraumatic stress disorder (PTSD), but whether such deficits reflect sequelae or risk factors is not fully resolved. OBJECTIVE: To determine, in a representative sample, whether preexposure cognitive ability is associated with risk for PTSD, and whether that risk is genetically mediated. DESIGN, SETTING, AND PARTICIPANTS: The co-twin-control study involved 2386 male Vietnam-era twin veterans with a mean (SD) age of 41.9 (2.7) years, a population-based sample of men who were in military service during this era. Cognitive ability scores were obtained just before military induction at a mean (SD) age of 19.7 (1.5) years. Participants included only individuals who were exposed to potentially traumatic events and underwent preexposure cognitive testing. MAIN OUTCOME MEASURES: Armed Forces Qualification Test (of cognitive ability) percentile scores and PTSD diagnosed by means of structured interviews. RESULTS: We found a significant dose-response relationship between preexposure cognitive ability and risk for PTSD. After controlling for confounders, the highest cognitive ability quartile had a 48% lower risk than the lowest ability quartile (P<.001). Non-PTSD-concordant pairs had the highest scores; PTSD-concordant pairs had the lowest scores; and PTSD-discordant pairs had intermediate scores. Differences in Armed Forces Qualification Test scores within twin pairs were significant only in PTSD-discordant pairs (P=.04) and were accounted for specifically by the discordant dizygotic pairs (P=.002). Genetic influences on preexposure cognitive ability explained 5% of the variation in PTSD, but 100% of that relationship was explained by common genes. CONCLUSIONS: Preexposure cognitive ability is a risk or a protective factor for PTSD. The variance in PTSD explained by preexposure cognitive ability is accounted for entirely by common genetic factors. Lower cognitive ability may be a marker of less adaptive coping against adverse mental health consequences of exposure to potentially traumatic events. Further study of the potential mechanisms through which cognitive ability confers risk is needed.

Asunto(s)

Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/epidemiología , Enfermedades en Gemelos/epidemiología , Enfermedades en Gemelos/genética , Evaluación Educacional/estadística & datos numéricos , Acontecimientos que Cambian la Vida , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/genética , Adulto , Trastornos del Conocimiento/genética , Trastornos de Combate/diagnóstico , Trastornos de Combate/epidemiología , Trastornos de Combate/genética , Comorbilidad , Enfermedades en Gemelos/diagnóstico , Humanos , Masculino , Fenotipo , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Análisis de Regresión , Factores de Riesgo , Trastornos por Estrés Postraumático/diagnóstico , Gemelos Dicigóticos/genética , Gemelos Monocigóticos/genética , Veteranos , Guerra de Vietnam

RESUMEN

BACKGROUND: Limited data are available about the effectiveness of early rehabilitation after stroke. OBJECTIVE: This is the 1st randomized controlled trial of constraint-induced movement therapy (CIMT) in subacute stroke to investigate neurophysiologic mechanisms and long-term outcome. METHODS: Within 2 weeks after stroke, 23 patients with upper extremity (UE) weakness were randomized to 2 weeks of CIMT or traditional therapy at an equal frequency of up to 3 h/day. Motor function of the affected UE was blindly assessed before treatment, after treatment, and 3 months after stroke. Transcranial magnetic stimulation (TMS) measured the cortical area evoking movement of the affected hand. RESULTS: Long-term improvement in motor function of the affected UE did not differ significantly between patients who received CIMT versus intensive traditional therapy. All outcome comparisons showed trends favoring CIMT over intensive traditional therapy, but none was statistically significant except for improvements in the Fugl-Meyer (FM) UE motor scale immediately following treatment and in reported quality of hand function at 3 months. Improvement in UE motor function on the FM was associated with a greater number of sites on the affected cerebral hemisphere where responses of the affected hand were evoked by TMS. CONCLUSIONS: Future trials of CIMT during early stroke rehabilitation need greater statistical power, more inclusive eligibility criteria, and improved experimental control over treatment intensity. The relationship between changes in motor function and in evoked motor responses suggests that motor recovery during the 1st 3 months after stroke is associated with increased motor excitability of the affected cerebral hemisphere.

Asunto(s)

Terapia por Ejercicio/métodos , Rehabilitación de Accidente Cerebrovascular , Adulto , Anciano , Brazo/fisiopatología , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Actividad Motora/fisiología , Restricción Física , Método Simple Ciego , Accidente Cerebrovascular/fisiopatología , Factores de Tiempo , Estimulación Magnética Transcraneal , Resultado del Tratamiento

RESUMEN

PRIMARY OBJECTIVE: The Center for Epidemiologic Studies Depression scale (CES-D) is a frequently-used self-report measure of depressive symptom severity. Brief depression screening measures can be important in the identification and prediction of depression following traumatic brain injury. The objective of this study was to investigate the validity of the CES-D in measuring depressive symptoms in patients with mild-to-moderate TBI as it has been rarely used in neurologically compromised populations. RESEARCH DESIGN: Inception cohort. METHODS AND PROCEDURES: The CES-D was administered to 340 participants with mild-to-moderate TBI at 3-months post-injury. MAIN OUTCOMES AND RESULTS: Confirmatory factor analysis of the CES-D indicated that the data are a reasonable fit similar to that of Radloff 's original 4-factor model. CONCLUSIONS: These findings suggest that the CES-D may be appropriate for use in patients with mild-to-moderate TBI.

Asunto(s)

Lesiones Encefálicas/psicología , Depresión/diagnóstico , Adulto , Estudios de Cohortes , Depresión/etiología , Análisis Factorial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Reproducibilidad de los Resultados

RESUMEN

Preliminary assessments of the feasibility, safety, and effects on neuronal reorganization measured with transcranial magnetic stimulation (TMS) from Constraint-Induced Movement Therapy (CIMT) of the upper extremity were made in eight cases of subacute stroke. Within fourteen days of their stroke, patients were randomly assigned to two weeks of CIMT or traditional therapy. Baseline motor performance and cortical/subcortical representation for movement with TMS were assessed before treatment. Post-treatment assessments were made at the end of treatment and at three months after the stroke. The TMS mapping showed a larger motor representation in the lesioned hemisphere of the CIMT patients as compared to the controls at the three-month follow-up assessment. The enlarged motor representation in the lesioned hemisphere for hand movement correlated with improved motor function of the affected hand, suggesting a link between movement representation size as measured with TMS and functionality. These results suggest that TMS can be safely and effectively used to assess brain function in subacute stroke and further suggest that CIMT may enhance cortical/subcortical motor reorganization and accelerate motor recovery when started within the first two weeks after stroke.

Asunto(s)

Mapeo Encefálico/instrumentación , Corteza Cerebral/fisiopatología , Terapia por Ejercicio/métodos , Mano/fisiopatología , Recuperación de la Función/fisiología , Rehabilitación de Accidente Cerebrovascular , Estimulación Magnética Transcraneal , Anciano , Anciano de 80 o más Años , Corteza Cerebral/fisiología , Técnicas de Ejercicio con Movimientos/métodos , Femenino , Estudios de Seguimiento , Mano/inervación , Mano/fisiología , Humanos , Masculino , Persona de Mediana Edad , Modalidades de Fisioterapia , Accidente Cerebrovascular/fisiopatología , Resultado del Tratamiento

RESUMEN

Twin studies are advantageous because sources of genetic and environmental variation are equated in ways that are not possible in standard case-control designs. We examined premorbid cognitive ability by comparing Armed Forces Qualification Test scores administered at the time of military enlistment in 21 schizophrenia-discordant twin pairs and 860 matched control twins. Scores were significantly lower in schizophrenia probands than in their nonpsychotic co-twins; co-twins were midway between probands and control twins. Effects were reduced when the discordant pairs were extended to include 33 psychosis-discordant pairs. Compared with controls, education at enlistment was significantly lower in psychosis probands and in co-twins from both schizophrenia- and psychosis-disordant pairs. Co-twins from psychosis-discordant pairs had significantly lower education at midlife than controls. Results suggest that cognitive ability is influenced by familial vulnerability for schizophrenia or psychosis, and that premorbid cognitive ability is lower in schizophrenia versus psychosis in general. Educational advancement may be slightly slowed by this familial vulnerability, but results were equivocal with regard to attenuation of one's ultimate educational attainment.

Asunto(s)

Trastornos del Conocimiento/diagnóstico , Trastornos del Conocimiento/epidemiología , Esquizofrenia/epidemiología , Gemelos Dicigóticos , Adulto , Anciano , Estudios de Casos y Controles , Humanos , Persona de Mediana Edad , Pruebas Neuropsicológicas , Índice de Severidad de la Enfermedad , Factores de Tiempo

RESUMEN

The Vietnam Era Twin Study of Aging (VETSA) is a large-scale investigation of cognitive aging from middle to later age. The intended sample of 1440 twin subjects is recruited from the Vietnam Era Twin Registry (VETR), a registry of middle-aged male-male twin pairs who both served in the military during the Vietnam conflict (1965-1975). VETSA employs a multitrait multimethod approach to cognitive assessment to focus on the genetic and environmental contributions to cognitive processes over time, as well as the relative contributions to cognitive aging from health, social, personality, and other contextual factors. The cognitive domains of episodic memory, working memory, abstract reasoning, and inhibitory executive functioning are assessed through neuropsychological testing. In addition, VETSA obtains the participant's score on the Armed Forces Qualification Test, taken at the time of induction into the military around age 20 years, and re-administers the test. Two other projects--VETSA Cortisol and VETSA Magnetic Resonance Imaging--are also in progress using subsamples of the VETSA twins. Prior waves of data collection by VETSA investigators using the VETR have provided historical data on physical and mental health, while future waves of VETSA data collection are planned every 5 years. These methods will provide data on multiple phenotypes in the same individuals with regard to genetic and environmental contributions to cognitive functioning over time, personality and interpersonal risk and protective factors, stress and cortisol regulation, and structural brain correlates of aging processes.

Asunto(s)

Envejecimiento/genética , Envejecimiento/psicología , Estudios en Gemelos como Asunto/métodos , Envejecimiento/patología , Encéfalo/patología , Cognición , Ambiente , Humanos , Hidrocortisona/metabolismo , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Sistema de Registros , Factores de Tiempo , Gemelos Dicigóticos , Gemelos Monocigóticos , Estados Unidos , Veteranos , Guerra de Vietnam

RESUMEN

This study evaluated the prevalence and specificity of diagnostic criteria for postconcussional syndrome (PCS) in 178 adults with mild to moderate traumatic brain injury (TBI) and 104 with extracranial trauma. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) and International Classification of Diseases (ICD-10) criteria for PCS were evaluated 3 months after injury. The results showed that prevalence of PCS was higher using ICD-10 (64%) than DSM-IV criteria (11%). Specificity to TBI was limited because PCS criteria were often fulfilled by patients with extracranial trauma. The authors conclude that further refinement of the DSM-IV and ICD-10 criteria for PCS is needed before these criteria are routinely employed.

Asunto(s)

Lesiones Encefálicas/complicaciones , Síndrome Posconmocional/diagnóstico , Síndrome Posconmocional/etiología , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Examen Neurológico , Pruebas Neuropsicológicas/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud/métodos , Síndrome Posconmocional/epidemiología , Prevalencia , Estudios Prospectivos , Escalas de Valoración Psiquiátrica , Estudios Retrospectivos

RESUMEN

Little is known about the characteristics and outcomes of patients diagnosed with postconcussional disorder (PCD) under the provisionally proposed criteria in the DSM-IV and how they differ from patients diagnosed with postconcussional syndrome (PCS) under the International Classification of Diseases, 10th edition clinical (ICD-10) criteria. This study investigated differences in outcome based on a diagnosis of PCD (DSM-IV) versus PCS (ICD-10 clinical criteria) as to which criteria set might be preferred for clinical practice. A consecutive series of adult patients with mild (N = 319) to moderate (N = 21) traumatic brain injury was assessed at 3 months postinjury with a brief neuropsychological battery and measures of specific outcome domains. In two separate series of analyses, patients with PCD were compared with those without PCD, and those with PCS were compared with those without PCS. Although the two criteria sets resulted in markedly different incidence rates, there was no substantial pattern of differences between the DSM-IV and ICD-10 in the outcome domains of psychiatric symptoms and disorders, social and community integration, health-related quality of life, or global outcome as measured by the Glasgow Outcome Scale-Extended. In spite of significant differences between the two diagnostic criteria sets and different incidence rates for PCD/PCS, outcome in all measured domains was very similar at 3 months postinjury. There is no compelling evidence, based on these outcome domains, to suggest which of the two diagnostic criteria sets should be clinically preferred.

Asunto(s)

Manual Diagnóstico y Estadístico de los Trastornos Mentales , Clasificación Internacional de Enfermedades/estadística & datos numéricos , Síndrome Posconmocional/diagnóstico , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Adulto , Trastornos de Ansiedad/diagnóstico , Trastornos de Ansiedad/psicología , Lesiones Encefálicas/diagnóstico , Lesiones Encefálicas/psicología , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/psicología , Femenino , Estudios de Seguimiento , Estado de Salud , Humanos , Masculino , Pruebas Neuropsicológicas , Evaluación de Resultado en la Atención de Salud , Síndrome Posconmocional/clasificación , Síndrome Posconmocional/psicología , Calidad de Vida/psicología , Índice de Severidad de la Enfermedad , Índices de Gravedad del Trauma

RESUMEN

CONTEXT: Minimizing negative consequences of major depression following traumatic brain injury is an important public health objective. Identifying high-risk patients and referring them for treatment could reduce morbidity and loss of productivity. OBJECTIVE: To develop a model for early screening of patients at risk for major depressive episode at 3 months after traumatic brain injury. DESIGN: Prediction model using receiver operating characteristic curve. SETTING: Level I trauma center in a major metropolitan area. PARTICIPANTS: Prospective cohort of 129 adults with mild traumatic brain injury. MAIN OUTCOME MEASURES: Center for Epidemiologic Studies Depression Scale score and current major depressive episode module of the Structured Clinical Interview for the DSM-IV. RESULTS: A prediction model including higher 1-week Center for Epidemiologic Studies Depression Scale score, older age, and computed tomographic scans of intracranial lesions yielded 93% sensitivity and 62% specificity. CONCLUSION: This study supports the feasibility of identifying patients with mild traumatic brain injury who are at high risk for developing major depressive episode by 3 months' postinjury, which could facilitate selective referral for potential treatment and reduction of negative outcomes.

Asunto(s)

Lesiones Encefálicas/diagnóstico , Trastorno Depresivo Mayor/diagnóstico , Adulto , Atención Ambulatoria , Lesiones Encefálicas/complicaciones , Estudios de Cohortes , Trastorno Depresivo Mayor/etiología , Trastorno Depresivo Mayor/prevención & control , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Estudios de Factibilidad , Femenino , Humanos , Masculino , Tamizaje Masivo/métodos , Modelos Estadísticos , Probabilidad , Estudios Prospectivos , Escalas de Valoración Psiquiátrica/estadística & datos numéricos , Curva ROC , Factores de Riesgo , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X/estadística & datos numéricos , Centros Traumatológicos/organización & administración , Índices de Gravedad del Trauma