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74 The Impact of Motoric Dysfunction on Neuropsychological Test Performance Within an Electrical Injury Sample
- Maximillian A Obolsky, Humza Khan, Zachary J Resch, Jessica L Paxton, Jason R Soble, Joseph W Fink, Neil H Pliskin
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 67-68
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Objective:
Victims of electrical injury (EI) often experience injuries to the peripheral nervous system and neuromuscular damage that may diminish motor function, such as flexibility/dexterity. These difficulties may continue after rehabilitation due to the reorganization of muscle afferent projections during peripheral nerve regeneration. Therefore, understanding how patients with a history of thermal burn injuries perform on motoric measures is necessary to explain the impact neuromuscular damage has on both motor and non-motor tests of cognition. However, no studies have examined the impact of motor functioning on cognition in patients who experienced thermal and electrical injuries compared to an electrical shock injury. This study explored the impact of motor dysfunction and psychiatric distress measured by depression severity on psychomotor speed and executive test performances among EI patients with and without thermal burn injuries.
Participants and Methods:This cross-sectional study consisted of EI patients undergoing an outpatient neuropsychological evaluation, including tests of motor dexterity (Grooved Pegboard [GP]), psychomotor speed (Wechsler Adult Intelligence Scale-IV Coding, Trail Making Test [TMT] Part A), and executive functioning (Stroop Color and Word Test [SCWT] Color-Word trial, TMT Part B). The sample was 83% male and 17% female, 88% White, 3% Black, 5% Hispanic, and 2% other race/ethnicity, with a mean age of 43.9 years (SD=11.36), mean education of 12.9 years (SD=2.05), and mean depression severity of 20.05 (SD=12.59) on the Beck Depression Inventory-II (BDI-II). Exclusion criteria were: 1) injury history of moderate-to-severe head trauma, 2) >2 performance validity test failures, and 3) any amputation of the upper extremity. Regression analyses included GP T-Scores for dominant hand and BDI-II total score as independent variables and neuropsychological normative test data as dependent variables.
Results:Among validly performing patients with EI (n=86), regression analyses revealed GP performance accounted for significant variance (R2 =.153-.169) on all neuropsychological measures. Among EI patients with burn injuries (n=50), regression analyses revealed GP performance accounted for significant variance (R2 =.197-.266) on all neuropsychological measures. Among EI patients without burn injuries (n=36), analyses revealed that neither GP performance nor BDI-II severity accounted for significant variance across the neurocognitive tests (R2=.056-.142). Furthermore, among EI patients with burn injuries and the total sample, regression analyses revealed depression severity negatively predicted GP performance (R2 =.099-.13), however, in patients without burn injuries, depression did not predict GP performance (R2 =.052).
Conclusions:Overall, results showed that GP performance is a significant predictor of neurocognitive performance on both motor and non-motor measures in EI patients with burn injuries. Therefore, among EI patients with burn injuries, GP performance may have potential utility as an early indicator of injury severity, considering that it predicts neuropsychological test performance on measures of psychomotor speed and executive functioning. Lastly, depression predicted GP performance within the burn injury sample illustrating that psychological distress may negatively impact motor functionality.
52 Stable Cognitive Impairment and Increased Psychiatric Symptoms in a Patient with Neuropathologically Progressive Fahr’s Disease After 2-Year Repeated Neuropsychological Assessment
- Jessica Yang, Matthew S Philips, Maggie C Bailey-Bila, Mohammadi Khan, Joseph W Fink
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, p. 658
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Objective:
Fahr’s disease is a rare genetic neurological disorder characterized by abnormal idiopathic calcification of the basal ganglia, typically with extrapyramidal symptoms, speech difficulty, behavioral disturbances, and progressive neurologic dysfunction. A small number of case reports have explored the neuropsychological profile of Fahr’s disease patients, and even fewer have followed the course of neuropsychological functioning over time.
Participants and Methods:A 53-year-old Asian woman presented for a neuropsychological reevaluation (2021) after experiencing a recurrence of memory difficulties and mood changes. Relevant medical history was significant for systemic lupus erythematosus (SLE) and Fahr’s disease. Following an episode of acute confusion, the patient underwent a head CT (2019) which revealed extensive calcification throughout the cerebellum, central pons, and periventricular and subcortical white matter, suggestive of Fahr’s disease. Two months later, she underwent an initial neuropsychological evaluation (2019), which demonstrated prominent attention and processing speed deficits contributing to variably impaired new learning and memory along with spatial planning and problem-solving difficulties. The etiology of her cognitive deficits was determined to likely reflect metabolic and immune instability, consistent with her history of SLE and Fahr’s disease. An updated CT (2021) revealed increased calcification throughout the bilateral corona radiata, basal ganglia, cerebellar hemispheres, and midbrain, which was determined to be compatible with progressive Fahr’s disease.
Results:The patient’s neurocognitive profile from current neuropsychological testing (2021) was marked by notable deficits in attention and processing speed, delayed memory, problem solving, visuospatial reasoning, and motor dexterity. Compared to her initial evaluation, her cognitive profile remained stable save for a slight decline in processing speed. The largest change was seen within the psychiatric domain. Self-reported depressive symptoms involving anhedonia, concentration difficulties, and anxiety symptoms involving nervousness and tension were more pronounced in her current evaluation. In addition, she endorsed an increase in apathy compared to her initial evaluation.
Conclusions:The cognitive profile seen in this patient is consistent with the current literature relating to the clinical sequelae of Fahr’s disease in patients that eventually went on to develop dementia. Despite an increase in brain calcification seen on CT imaging over an 18-month interval, the patient’s neurocognitive profile remained relatively stable. An increase in psychiatric symptoms appeared to be the most prominent change over repeated neuropsychological assessment, which elucidates the heterogenous course of Fahr’s disease from a neuropsychological perspective. Further exploration of this disorder is warranted to better understand the clinical progression of symptoms over time.
Pain Influences Neuropsychological Performance Following Electrical Injury: A Cross-Sectional Study
- Katherine E. Dorociak, Jason R. Soble, Patricia A. Rupert, Joseph W. Fink, Raphael C. Lee, Magdalena Anitescu, David Weiss, Gerald Cooke, Zachary J. Resch, Neil H. Pliskin
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue 1 / January 2023
- Published online by Cambridge University Press:
- 18 January 2022, pp. 35-45
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Objective:
Electrical injury (EI) is a significant, multifaceted trauma often with multi-domain cognitive sequelae, even when the expected current path does not pass through the brain. Chronic pain (CP) research suggests pain may affect cognition directly and indirectly by influencing emotional distress which then impacts cognitive functioning. As chronic pain may be critical to understanding EI-related cognitive difficulties, the aims of the current study were: examine the direct and indirect effects of pain on cognition following EI and compare the relationship between pain and cognition in EI and CP populations.
Method:This cross-sectional study used data from a clinical sample of 50 patients with EI (84.0% male; M age = 43.7 years) administered standardized measures of pain (Pain Patient Profile), depression, and neurocognitive functioning. A CP comparison sample of 93 patients was also included.
Results:Higher pain levels were associated with poorer attention/processing speed and executive functioning performance among patients with EI. Depression was significantly correlated with pain and mediated the relationship between pain and attention/processing speed in patients with EI. When comparing the patients with EI and CP, the relationship between pain and cognition was similar for both clinical groups.
Conclusions:Findings indicate that pain impacts mood and cognition in patients with EI, and the influence of pain and its effect on cognition should be considered in the assessment and treatment of patients who have experienced an electrical injury.
Contributors
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- By Waiel Almoustadi, Brian J. Anderson, David B. Auyong, Michael Avidan, Michael J. Avram, Roland J. Bainton, Jeffrey R. Balser, Juliana Barr, W. Scott Beattie, Manfred Blobner, T. Andrew Bowdle, Walter A. Boyle, Eugene B. Campbell, Laura F. Cavallone, Mario Cibelli, C. Michael Crowder, Ola Dale, M. Frances Davies, Mark Dershwitz, George Despotis, Clifford S. Deutschman, Brian S. Donahue, Marcel E. Durieux, Thomas J. Ebert, Talmage D. Egan, Helge Eilers, E. Wesley Ely, Charles W. Emala, Alex S. Evers, Heidrun Fink, Pierre Foëx, Stuart A. Forman, Helen F. Galley, Josephine M. Garcia-Ferrer, Robert W. Gereau, Tony Gin, David Glick, B. Joseph Guglielmo, Dhanesh K. Gupta, Howard B. Gutstein, Robert G. Hahn, Greg B. Hammer, Brian P. Head, Helen Higham, Laureen Hill, Kirk Hogan, Charles W. Hogue, Christopher G. Hughes, Eric Jacobsohn, Roger A. Johns, Dean R. Jones, Max Kelz, Evan D. Kharasch, Ellen W. King, W. Andrew Kofke, Tom C. Krejcie, Richard M. Langford, H. T. Lee, Isobel Lever, Jerrold H. Levy, J. Lance Lichtor, Larry Lindenbaum, Hung Pin Liu, Geoff Lockwood, Alex Macario, Conan MacDougall, M. B. MacIver, Aman Mahajan, Nándor Marczin, J. A. Jeevendra Martyn, George A. Mashour, Mervyn Maze, Thomas McDowell, Stuart McGrane, Berend Mets, Patrick Meybohm, Charles F. Minto, Jonathan Moss, Mohamed Naguib, Istvan Nagy, Nick Oliver, Paul S. Pagel, Pratik P. Pandharipande, Piyush Patel, Andrew J. Patterson, Robert A. Pearce, Ronald G. Pearl, Misha Perouansky, Kristof Racz, Chinniampalayam Rajamohan, Nilesh Randive, Imre Redai, Stephen Robinson, Richard W. Rosenquist, Carl E. Rosow, Uwe Rudolph, Francis V. Salinas, Robert D. Sanders, Sunita Sastry, Michael Schäfer, Jens Scholz, Thomas W. Schnider, Mark A. Schumacher, John W. Sear, Frédérique S. Servin, Jeffrey H. Silverstein, Tom De Smet, Martin Smith, Joe Henry Steinbach, Markus Steinfath, David F. Stowe, Gary R. Strichartz, Michel M. R. F. Struys, Isao Tsuneyoshi, Robert A. Veselis, Arthur Wallace, Robert P. Walt, David C. Warltier, Nigel R. Webster, Jeanine Wiener-Kronish, Troy Wildes, Paul Wischmeyer, Ling-Gang Wu, Stephen Yang
- Edited by Alex S. Evers, Washington University School of Medicine, St Louis, Mervyn Maze, University of California, San Francisco, Evan D. Kharasch, Washington University School of Medicine, St Louis
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- Book:
- Anesthetic Pharmacology
- Published online:
- 11 April 2011
- Print publication:
- 10 March 2011, pp viii-xiv
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Neuropsychological changes following electrical injury
- NEIL H. PLISKIN, ALIA N. AMMAR, JOSEPH W. FINK, S. KRISTIAN HILL, AARON C. MALINA, ALONA RAMATI, KATHLEEN M. KELLEY, RAPHAEL C. LEE
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- Journal:
- Journal of the International Neuropsychological Society / Volume 12 / Issue 1 / January 2006
- Published online by Cambridge University Press:
- 23 January 2006, pp. 17-23
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The clinical presentation of electrical injury commonly involves physical, cognitive, and emotional complaints. Neuropsychological studies, including case reports, have indicated that electrical injury (EI) survivors may experience a broad range of impaired neuropsychological functions, although this has not been clarified through controlled investigation. In this study, we describe the neuropsychological test findings in a series of 29 EI patients carefully screened and matched to a group of 29 demographically similar healthy electricians. Participants were matched by their estimated premorbid intellectual ability. Multivariate analysis of variance was used to assess group differences in the following neuropsychological domains: attention and mental speed, working memory, verbal memory, visual memory, and motor skills. EI patients performed significantly worse on composite measures of attention/mental speed and motor skills, which could not be explained by demographic differences, injury parameters, litigation status, or mood disturbance. Results suggest that cognitive changes do occur in patients suffering from electrical injury. (JINS, 2006, 12, 17–23.)
11 - Semantic memory in neurodegenerative disease
- from PART II - Cognitive perspectives
- Edited by Alexander I. Tröster, Kansas University Medical Center
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- Memory in Neurodegenerative Disease
- Published online:
- 23 November 2009
- Print publication:
- 29 October 1998, pp 197-209
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Summary
INTRODUCTION
Semantic memory is a term for our repository of general knowledge about the world, our representation or ‘map’ of external reality that invests its referents with meaning. The concept of semantic memory can be traced to Tulving's (1972) bipartite model of long-term memory, in which declarative knowledge could be divided into episodic and semantic memories (Chapters 3 and 12). Whereas episodic memory refers to a system of storing contextually specific episodes or events, semantic memory includes general knowledge about the meaning of concepts, words and objects. According to Tulving (1995), ‘semantic memory makes possible the acquisition and retention of factual information in the broadest sense; the structured representation of this information, semantic knowledge, models the world’ (p. 841).
The goal of this chapter is to review how semantic memory is affected by various neurodegenerative diseases. We first review evidence that helps elucidate what neurocognitive systems subserve semantic memory. We then examine how semantic memory is affected when these neurocognitive systems are compromised by neurodegenerative disease, with emphasis on Alzheimer's disease (AD) as the prototypical cortical degenerative process. Along the way, we note the inferences that can be drawn about the structure and organization of semantic memory from its disorders in neurodegenerative diseases.
NEURAL SUBSTRATES OF SEMANTIC MEMORY
Before examining what is known about semantic memory in the dementia syndromes that result from neurodegenerative diseases, we will briefly review the neural systems that seem to be essential to semantic memory. The functional neuroanatomy of semantic memory is complex, but clues to its regional localization and organization come from lesion studies and from functional neuroimaging studies with normals.