Personality disorder symptomatology and neuropsychological functioning in closed head injury

Despite an emerging literature characterizing the neuropsychological profiles of borderline, antisocial, and schizotypal personality disorders, relations between personality disorder traits and neurocognitive domains remain unknown. The authors examined associations among Millon Clinical Multiaxial Inventory-III personality disorder scales and eight neuropsychological domains in 161 patients referred for neuropsychological evaluation following closed head injury. Most personality disorder scales were associated with some decrement in cognitive function, particularly speeded processing, executive function, and language, while histrionic and narcissistic scales had positive relations with neuropsychological functioning. Results suggest that many personality disorder traits are related to neurocognitive function, particularly those functions subserved by frontal and temporal regions.     

Memory function after closed head injury: a review of the quantitative research

Studies which provide quantitative analyses of memory function following closed head injury were reviewed. Specific issues covered include criteria for assessing post-traumatic amnesia (PTA), PTA duration, relation of PTA duration to later memory impairment, memory functions within PTA, and comparisons between PTA and other amnesic conditions. Issues associated with the assessment of retrograde amnesia were also reviewed. With regard to memory function after PTA has terminated, we described and discussed normative data, the time course of recovery, and issues related to the nature of the later memory impairment. Directions for future work which seem particularly useful from a practical and theoretical viewpoint were also considered.     

Prospective memory in patients with closed head injury: a review

This paper aimed to review the limited, but growing literature on prospective memory (PM) following closed head injury (CHI). Search of two commonly used databases yielded studies that could be classified as: self- or other-report of PM deficits; behavioral PM measures in adults with CHI, behavioral PM measures in children and adolescents with CHI, and treatment of PM in adults with CHI. The methodology and findings of these studies were critically reviewed and discussed. Because of the small number of studies, meta-analysis was only conducted for studies that used behavioral PM measures in adults to integrate findings. PM deficits were found to be commonly reported by patients with CHI and their significant others and they could be identified using behavioral measures in adults, children and adolescents with CHI. However, more work is needed to clarify the nature and mechanisms of these deficits. Although some promising results have been reported by studies that evaluated PM treatment, most studies lack tight experimental control and used only a small number of participants. The paper concluded with some suggestions for future research.     

Attention in closed head injury: a critical review

Closed head injury (CHI) is one of the commonest causes of physical disability and cognitive impairment in young people. In patients with CHI both in the acute and sub-acute phases it is possible to demonstrate a disturbance of cognitive functions that affects their performance in a wide variety of neuropsychological tasks. The most frequent deficits pertain to attention and memory.In reviewing the literature on attention in CHI patients it appears that a debate is still alive about how to interpret the cognitive attentional defect, i. e. whether it is due to a slowing of information processing, to a deficit of 'executive' frontal functions, to a reduction of arousal level, to deficits of selective or divided attention, or to a combination of factors.After a brief general explanation of the neuropsychological cognitive models of attention, an overview of the various studies on attention in CHI will be provided. For the purposes of the review, the studies are grouped according to the different theoretical interpretations in the literature concerning the nature of attentional deficits in CHI patients. Finally, a tentative general interpretation of attentional deficits in CHI, in light of the anatomo-pathological aspects of the brain of CHI patients and of some methodological considerations, is offered.     

Dysprosody after severe closed head injury: an acoustic analysis

OBJECTIVES—Neurological speech disorders(dysarthria and dysprosody) are known to be frequent sequelae aftersevere closed head injury. These disorders may dramatically altercommunicative intent and accentuate social isolation. The aim was toprovide an instrumental evaluation for prosodic production in a groupof patients with severe closed head injury and todetermine the correlations between prosodic production andneurobehavioural status.
METHODS—Fifteen patients, at the subacute stageafter severe closed head injury, were studied and comparedwith 11 controls, matched for age, sex, and duration of education. Eachsubject was required to read aloud a French sentence "Je m'en vaissamedi matin" (I am leaving saturday morning) under six differentprosodic intonations (neutral, affirmation, interrogation, happiness,sadness, anger). The recorded sentences were analysed using a soundsignal analysis software (Signalyse) allowing the measurement of signalintensity and fundamental frequency. Statistical analyses were carriedout using repeated measures analysis of variance (ANOVA).
RESULTS—Patients with closed headinjury were significantly less able than controls to modulate speechoutput (pitch and intensity) according to prosodic context. Thisdeficit was particularly pronounced for the intonation feature ofanger, question, and statement. No consistent correlations could befound between prosodic production and cognitive or behavioural data.
CONCLUSIONS—Acoustic analysis of pitch andintensity may show impairments of prosodic production aftersevere closed head injury, which may be useful inrehabilitation planning. This impairment does not seem to reflect theeventual cognitive and behavioural deficits of the patients, but rathera specific disorder of modulation of speech output.

     

Psychological disturbance, incomplete effort, and compensation-seeking status as predictors of neuropsychological test performance in head injury

Indices from the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) representing cognitive and emotional disturbance as well as incomplete effort on the Recognition Memory Test (RMT; Warrington, 1984) were examined as predictors of performance on the Halstead-Reitan Neuropsychological Test Battery (HRB; Reitan & Wolfson, 1993). In the current study, which included a large sample (N = 369) of patients referred for neuropsychological (NP) evaluation after presumptive head injury, MMPI-2 measures of psychological disturbance accounted for as much as 25% of the variance in HRB test scores, resulting in a moderate overall effect size (median Adj. R(2) = .16; R = .40). When demographic variables, head injury severity, and compensation-seeking status were entered in previous steps, incomplete effort as defined by chance performance on the RMT accounted for between 2% and 13% of the variance in HRB test scores, with modest overall effect size (median R(2) Delta = .07; R = .26) in multiple regression equations. Additionally, when MMPI-2 indices of psychological disturbance were included in the last step, they accounted for 2% to 11% of additional variance, retaining a modest overall effect (median R(2) Delta = .03; R = .17). Compensation-seeking status and injury severity as measured by duration of post-traumatic amnesia were, at best, modestly related to NP test performance. Findings confirm the reliable relationship between test performance and psychological disturbance as well as incomplete effort when assessing dysfunction following head injury. In contrast to previous studies, incomplete effort was unrelated to compensation-seeking status.     

Clinical neurological trauma parameters as predictors for neuropsychological recovery and long-term outcome in paediatric closed head injury: a review of the literature

We present a review of recent prospective studies of long-term outcome in paediatric closed head injury. Special attention is given to the relationship between the neurological trauma parameters and neuropsychological outcome. First we discuss the most important methods of assessing the severity of the injury. We review the most prominent neurobehavioural and cognitive sequelae. Subsequently we address the question of prediction of residual sequelae in view of the early trauma parameters. The main problem when comparing different studies is the lack of procedural uniformity both in assessment of the severity of the injury as well as in measurement of neuropsychological outcome. Inconsistencies and discrepancies among various studies are pointed out. We summarise those results which are supported by many studies and hence are less controversial. In addition we present some recommendations for future investigations.     

Neurodiagnostic testing in patients with closed head injury

This brief review summarizes the current understanding of mild closed head injury with postconcussion syndrome. It is to be emphasized that objective evaluation be performed because it is critical to the assessment of the patient. Increased awareness of patients with symptoms in association with heightened sensitivity and caring will go a long way in helping the millions of patients yearly with mild to moderate head injury. Only with objective scientific data will the understanding of the causes of the varied symptomatology of the postconcussion syndrome be thoroughly understood.     

Aphasia in closed head injury and stroke

Abstract

The question of whether closed head injured (CHI) aphasic patients present communication impairments similar to post-stroke (CVA) aphasic patients was addressed by comparing two equated groups at 3–6 months post-onset. When age and time since onset were controlled, aphasic CHI and CVA patients were more similar than different in linguistic task performance and overall functional communication effectiveness.     

Mania following head injury: case reports and neuropsychological findings

Mania secondary to head injury is reported to be rare. Two cases of florid manic psychoses following head injury are reported along with neurological and neuropsychological investigations. Findings on the Luria Nebraska Neuropsychological Battery (LNNB) suggested residual cognitive deficits, predominantly of right hemisphere. Temporal proximity, clinical neurological findings, EEG changes and deficits on LNNB suggest a causal link between head injury and mania.     

Aphasic disorder in patients with closed head injury.

Quantitative assessment of 50 patients with closed head injury disclosed that anomic errors and word finding difficulty were prominent sequelae as nearly half of the series had defective scores on tests of naming and/or word association. Aphasic disturbance was associated with severity of brain injury as reflected by prolonged coma and injury of the brain stem.     

Somatosensory cortical atrophy after spinal cord injury: a voxel-based morphometry study

The authors used voxel-based morphometry to compare sensorimotor cortical gray and white matter volume on structural MR images of a group of 17 individuals with cervical spinal cord injury (SCI) and a group of 17 healthy subjects. SCI subjects had reduced gray matter volume bilaterally in primary somatosensory cortex (p < 0.001). These findings suggest that the somatosensory cortex of the human brain atrophies after SCI.     

Word-finding in the conversational discourse of children with closed head injury

Abstract

Despite the fact that dysnomia or word-finding difficulty is consistently documented as a characteristic feature of the language sequelae of childhood closed head injury (CHI), few studies have examined the effects of such wordfinding problems on language performance outside the constraints of a standard confrontation naming test. The present study examined evidence for word-finding difficulties in both confrontation naming and conversation in a group of 11 children (aged 9–17) who had experienced a severe CHI. Performance of the children with CHI was compared to that of a control group individually matched for age, gender and handedness. The children with CHI demonstrated inferior performance on the test of confrontation naming. In addition, the children with CHI were found to have a conversational error profile that was different from the control group. These findings are discussed with respect to the relationship between standard test performance and communicative competence in the conversational discourse setting.     

Ventricle shunting in young H-Tx rats with inherited congenital hydrocephalus: a quantitative histological study of cortical grey matter

Shunt surgery is the usual treatment for infantile hydrocephalus, but its precise effects on ventricles and cortex are not well understood. Infant H-Tx rats with inherited hydrocephalus, which have progressive enlargement of the lateral ventricles and thinned cerebral cortex, have been used to study the effect of ventriculosubcutaneous shunts by quantitative light microscopy. Two groups of rats received shunts at mean ages of 7 and 13 days after birth. The brains were processed for wax histology at either 14 or 21 days (n = 3 per group) together with age-matched control and unshunted (hydrocephalic) rats. Ventricle areas were measured and the volume calculated and the cortical layers in five cortical regions were measured. Shungting prevented further expansion of ventricles which were already enlarged at the time of operation, and resulted in volumes which were intermediate between those in control and unshunted rats. Cortical thinning was partially reversed by shunting and the thickness and number of discernible cortical laminae was improved. It is concluded that shunting was largely successful at preventing the pathological effects of hydrocephalus.     

Intracranial blood flow velocity after head injury: relationship to severity of injury, time, neurological status and outcome.

Middle cerebral artery (MCA) blood flow velocity was measured daily by transcranial Doppler ultrasonography in 121 patients with severe (50), moderate (16) and minor (55) head injury during their hospital stay, and the results compared with findings in control subjects. Admission MCA velocity was significantly lower after severe 35.8 (31.9-39.7) cm/s, mean (95% confidence limits), moderate 45.5 (40.0-51.0) cm/s and minor 51.7 (47.9-55.5) cm/s head injury when compared with normal controls 60.1 (56.9-63.3) cm/s. Initial mean velocity in severe head injury was significantly lower than in moderate and minor injury. At discharge, MCA velocity in severe injury remained below normal 46.2 (43.2-49.0) cm/s, whereas, in moderate and minor injury flow velocity had returned to normal. Correlation (r = 0.46, p less than 0.01) was found between MCA velocity and Glasgow Coma Score (GCS) on admission but not on discharge. Persistently low flow velocity was found in all 10 patients who died within 72 hours (early deaths). An admission MCA velocity of less than 28 cm/s correctly predicted 80% of the early deaths. Patients who made a good recovery or had only moderate disability at six months showed a significant increase in velocity from admission 36.2 (31.5-41.2) cm/s to discharge 47.8 (43.7-51.9) cm/s in contrast to those who were severely disabled, in whom velocity generally remained low.     

Parkinson's syndrome after closed head injury: a single case report

A 36 year old man, who sustained a skull fracture in 1984, was unconscious for 24 hours, and developed signs of Parkinson's syndrome 6 weeks after the injury. When assessed in 1995, neuroimaging disclosed a cerebral infarction due to trauma involving the left caudate and lenticular nucleus. Parkinson's syndrome was predominantly right sided, slowly progressive, and unresponsive to levodopa therapy. Reaction time tests showed slowness of movement initiation and execution with both hands, particularly the right. Recording of movement related cortical potentials suggested bilateral deficits in movement preparation. Neuropsychological assessment disclosed no evidence of major deficits on tests assessing executive function or working memory, with the exception of selective impairments on the Stroop and on a test of self ordered random number sequences. There was evidence of abulia. The results are discussed in relation to previous literature on basal ganglia lesions and the effects of damage to different points of the frontostriatal circuits.     

Brief report: anosmia and remote outcome in closed head injury

The value of posttraumatic anosmia as a predictor of late social outcomes was examined in a sample of closed head injury (CHI) patients. Unemployment rates were equally high in both the anosmic and nonanosmic closed head injury patients. The groups also did not differ in psychiatric or neuropsychological status. Anosmic patients had longer initial hospital stays and deeper initial comatose/confusional states. Anosmia does not appear to add incrementally to disability status and it does not automatically imply the presence of basal-frontal damage.     

Tau,amyloid, and hypometabolism in a patient with posterior cortical atrophy

Determining the relative contribution of amyloid plaques and neurofibrillary tangles to brain dysfunction in Alzheimer disease is critical for therapeutic approaches, but until recently could only be assessed at autopsy. We report a patient with posterior cortical atrophy (visual variant of Alzheimer disease) who was studied using the novel tau tracer [¹⁸F]AV‐1451 in conjunction with [¹¹C]Pittsburgh compound B (PIB; amyloid) and [¹⁸F]fluorodeoxyglucose (FDG) positron emission tomography. Whereas [¹¹C]PIB bound throughout association neocortex, [¹⁸F]AV‐1451 was selectively retained in posterior brain regions that were affected clinically and showed markedly reduced [¹⁸F]FDG uptake. This provides preliminary in vivo evidence that tau is more closely linked to hypometabolism and symptomatology than amyloid. Ann Neurol 2014.