Beverly A. Bush

Cognitive and functional recovery at 6 and 12 months post-TBI

Outcome studies examining recovery from traumatic brain injury (TBI) often fail to provide a clear understanding of the time course of cognitive, emotional, and behavioural recovery. The present study represents an effort to prospectively study individuals with TBI at fixed intervals, specifically 6 and 12 months post-injury with a window of §1 month. Seventy-two individuals with new-onset TBI underwent neuropsychological evaluation and clinical interview at 6 and 12 months post-injury. Results revealed significant improvements in cognitive abilities, including memory, processing speed, language abilities, and constructional skills. There were significant gains in community integration and involvement in productive activities, but limitations in driving activitie s remained. Although individuals with mild± moderate TBI performed better than individuals with severe TBI, both groups demonstrated equivalent rates of recovery across domains. The results of this study provide important information regarding the time course of TBI recovery.Outcome studies examining recovery from traumatic brain injury (TBI) often fail to provide a clear understanding of the time course of cognitive, emotional, and behavioural recovery. The present study represents an effort to prospectively study individuals with TBI at fixed intervals, specifically 6 and 12 months post-injury with a window of +/- 1 month. Seventy-two individuals with new-onset TBI underwent neuropsychological evaluation and clinical interview at 6 and 12 months post-injury. Results revealed significant improvements in cognitive abilities, including memory, processing speed, language abilities, and constructional skills. There were significant gains in community integration and involvement in productive activities, but limitations in driving activities remained. Although individuals with mild-moderate TBI performed better than individuals with severe TBI, both groups demonstrated equivalent rates of recovery across domains. The results of this study provide important information regarding the time course of TBI recovery.

Validity of the Orientation Log, relative to the Galveston Orientation and Amnesia Test.

Objective: To establish the validity of the Orientation Log (O-Log) by comparison with the Galveston Orientation and Amnesia Test (GOAT). Design: Correlation of daily measures of orientation. Setting: Acute rehabilitation hospital. Subjects: Sixty-eight inpatients receiving rehabilitation following traumatic brain injury (TBI). Primary measures: The O-Log and GOAT. Results: There was a significant correlation between the GOAT and O-Log (r = .901, P < .001). A cutoff of 25 on the O-Log was found to be comparable with the 75 cutoff on the GOAT. The scales were equivalent in measuring duration of posttraumatic amnesia. Conclusions: The O-Log is a valid measure of orientation for people with TBI and offers some advantages in administration over the GOAT.

Major life events as risk factors for post-stroke depression.

Depression is a significant sequela of stroke which contributes to increased morbidity and mortality in stroke survivors. Psychosocial stressors, such as major life events, pose risk factors for developing depression in non-stroke populations. This study evaluated major life events as a risk factor for developing post-stroke depression (PSD) during the first year post-stroke. One hundred and eleven patients who completed the Center for Epidemiological Studies-Depression Scale at four time periods during the first year post-stroke were assessed for PSD and asked if they had experienced a major life event in the prior 6 months (other than the stroke). The subjects completed the evaluations acutely (7-10 days), and at 3, 6, and 12 months post-stroke. At 6 months post-stroke patients were significantly more likely to be depressed if they had a major life event in the prior 6 months (other than the stroke) than if they had not, chi 2 (df = 1) = 4.83, p < 0.028, relative risk = 2.31, 95% confidence interval 1.15-4.62. Life events pose significant risks for developing PSD at 6 months post-stroke. Stroke patients need to be asked about these events and treated for PSD.

Social problem-solving abilities predict pressure sore occurrence in the first 3 years of spinal cord injury.

Objective: To test the hypothesis that social problem-solving abilities of persons with recent-onset spinal cord injury (SCI) would be predictive of pressure sore occurrence in the 1st 3 years following discharge from initial inpatient rehabilitation. Design: Prospective study of persons with recently incurred SCI and their subsequent pressure sore evaluations over a 3-year period in annual clinic evaluations. Setting: Inpatient SCI rehabilitation center and outpatient clinic. Participants: 188 persons with recent-onset SCI approaching discharge from initial inpatient SCI rehabilitation, with outpatient pressure sore evaluations for those who returned for pressure sore evaluations. Main Outcome Measure: Pressure sore occurrence as determined in annual outpatient evaluations conducted over the 1st 3 years of SCI. Results: 2 separate statistical models indicated that social problem-solving abilities significantly contributed to the prediction of pressure sore occurrence. Conclusions: Social problem-solving abilities are implicated in the development of pressure sores. Persons with ineffective problem-solving abilities may be at risk for pressure sores; these individuals might require strategic monitoring and training from clinical programs.

Depression Following Traumatic Brain Injury: The Validity of the CES-D as a Brief Screening Device

The validity, reliability, and factor structure of the Center for Epidemiological Studies-Depression Scale (CES-D) was examined with 253 patients seen for neuropsychological evaluation following traumatic brain injury (TBI). All patients completed the CES-D; 31 also completed the Beck Depression Inventory (BDI) and 17 completed the Minnesota Multiphasic Personality Inventory-II (MMPI-II). The CES-D demonstrated good concurrent, construct validity, significantly correlating with the BDI (r = .673, p < .0001) and the MMPI-II (Depression Scale T score r = .536, p = .027). The CES-D also demonstrated good internal consistency (coefficient alpha = .8195) and split-half reliability (Spearman–Brown r = .8284). Principal components factor analysis with varimax rotation resulted in a four-factor solution that accounted for 56.01% of the variance. The factor structure differed from the originally reported factor structure, and indicated that somatic difficulties were strongly associated with dysphoric affect in TBI patients. The CES-D is a valid and reliable screening instrument for use with TBI patients.

Cognitive orientation in rehabilitation and neuropsychological outcome after traumatic brain injury

This study evaluated the ability of the Orientation Log (O-Log) to predict cognitive outcome at rehabilitation discharge, as well as future neuropsychological outcome. The hypothesis was that patients who demonstrated better orientation upon admission would achieve superior functional cognitive outcome at discharge and on subsequent neuropsychological assessment. Sixty individuals receiving inpatient rehabilitation following a new-onset TBI participated. Orientation data was collected using the O-Log during morning bedside rounds. Outcome data was collected at 6 and 12 months post-injury. Significant correlations were found between the O-log and measures of memory, executive functioning, basic verbal skills, and estimated intellectual ability. When compared to the other predictor variables, step-wise multiple regression analyses revealed that the minimum O-Log score was the primary significant predictor of performance on six neuropsychological and functional outcome measures. Results of this study suggest that evaluating orientation with the O-Log during acute rehabilitation may reflect level of injury severity and aid in predicting cognitive outcome.This study evaluated the ability of the Orientation Log (O-Log) to predict cognitive outcome at rehabilitation discharge, as well as future neuropsychological outcome. The hypothesis was that patients who demonstrated better orientation upon admission would achieve superior functional cognitive outcome at discharge and on subsequent neuropsychological assessment. Sixty individuals receiving inpatient rehabilitation following a new-onset TBI participated. Orientation data was collected using the O-Log during morning bedside rounds. Outcome data was collected at 6 and 12 months post-injury. Significant correlations were found between the O-log and measures of memory, executive functioning, basic verbal skills, and estimated intellectual ability. When compared to the other predictor variables, step-wise multiple regression analyses revealed that the minimum O-Log score was the primary significant predictor of performance on six neuropsychological and functional outcome measures. Results of this study suggest that evaluating orientation with the O-Log during acute rehabilitation may reflect level of injury severity and aid in predicting cognitive outcome.

Glycoprotein gp120-mediated astrocytic dysfunction

Publisher Summary This chapter discusses that the human immunodeficiency viruses (HIV-1 and HIV-2) belong to the subgenus “primate lentiviruses” and are the etiologic agents of acquired immunodeficiency syndrome (AIDS). It describes the effects of the HIV-1 envelope glycoprotein (gp120) on astrocytes and the potential ramifications for HIV-1 neuropathogenesis. The most common clinical syndrome, termed AIDS dementia complex (ADC) or HIV associated dementia (HAD), presents as a subcortical dementia with cognitive, motor, and behavioral disturbances. The pathogenesis of ADC is still unknown. Because neurons are not directly infected with HIV-1, the causes of neuronal dysfunction are evidently indirect. It is believed to involve interactions among virally infected macrophages/microglia, astrocytes, and neurons. The chapter addresses the role of the astrocyte in the development of HAD. Astrocytes are the most numerous of the glial cells and have a complex function in maintaining homeostasis in the central nervous system (CNS). Astrocyte function is altered by HIV-1 infection, exposure to viral proteins, and soluble factors secreted by HIV-1 infected macrophages. The HIV-1 surface envelope glycoprotein gp120 is considered to be one of the principal mediators of viral toxicity. The alterations in astrocyte function in connection to gp120 exposure are also described in this chapter.