Dong Y. Han

Pb Neurotoxicity: Neuropsychological Effects of Lead Toxicity

Neurotoxicity is a term used to describe neurophysiological changes caused by exposure to toxic agents. Such exposure can result in neurocognitive symptoms and/or psychiatric disturbances. Common toxic agents include heavy metals, drugs, organophosphates, bacterial, and animal neurotoxins. Among heavy metal exposures, lead exposure is one of the most common exposures that can lead to significant neuropsychological and functional decline in humans. In this review, neurotoxic lead exposures pathophysiology, etiology, and epidemiology are explored. In addition, commonly associated neuropsychological difficulties in intelligence, memory, executive functioning, attention, processing speed, language, visuospatial skills, motor skills, and affect/mood are explored.

Cognitive Outcome of Cerebral Fat Embolism

Cerebral fat embolism is an uncommon but serious complication of long-bone fracture. We report a young adult patient who sustained fat embolism after a femoral fracture. He developed stupor and coma within 24 hours from his injury. His acute recovery was characterized by marked frontal dysfunction. A comprehensive neuropsychological evaluation 4 months later revealed overall normal cognitive function, except for mild residual frontal dysfunction and weakness of verbal memory.

Neuropsychiatric Symptom Assessments in Toxic Exposure

The goal of this review is to provide guidelines for evaluating psychiatric and mood changes that result from neurotoxicity. Mood changes that are often seen to varying degrees in neurotoxicity include increased anxiety, depression, irritability, impulsiveness, and psychosis. Some common agents that induce neurotoxicity include drugs, heavy metals, and organophosphates with presentations varying somewhat depending upon the mechanism of toxicity. The authors discuss in detail psychiatric assessment for patients with suspected of having neurotoxicologic syndrome.

Development of neurocognitive disorders in HIV/AIDS

Correspondence: Brandon C Dennis Department of Neurology, University of Kentucky College of Medicine, 740 S Limestone St, Ste L-445, Lexington, KY 40536-0284, USA Tel +1 859 218 5051 Fax +1 859 323 3753 email brandoncdennis@uky.edu Abstract: The introduction of highly active antiretroviral therapy has had an enormous impact on the management of human immunodeficiency virus (HIV) infection and has led to an increase in survival and decrease in HIV-associated dementia. However, minor neurocognitive disturbances across various neurocognitive domains remain common in 50% or more of HIV patients according to recent estimates. Increased longevity has led to the investigation of several moderating and complicating factors, including vascular disease, neurotoxicity, aging, substance abuse, hepatitis C coinfection, and psychiatric illness. This article provides a review of the history of HIV-associated neurocognitive disorders (HAND), revised diagnostic terminology, factors moderating development of HAND, assessment techniques and neurocognitive profiles, current treatment and limitations, and future research directions.

A brief review of cognitive assessment in neurotoxicology.

Among commercial and industrial chemicals, cosmetics, food additives, pesticides, and medicinal drugs, there are more than 50,000 substances distributed. Neurotoxic insults to the brain can manifest in many different ways, especially involving cognition. Given many possible differences in the pathophysiology of neurotoxic exposure and related cognitive sequelae, a systematic method of cognitive assessment is important for appropriate management of neurotoxic exposure. In the context of Neurotoxicology, this article briefly reviews the contemporary literature and the utility of cognitive assessment tools that are used in neuropsychology.

Chronic Neuropsychological Sequelae in a Patient with Nontumorous Anti-NMDA-Receptor Encephalitis

Anti-N-methyl-D-aspartate receptor encephalitis is a neurological, autoimmune disorder tightly conceptualized only as recently as the mid-2000s. It presents itself in a combination of psychiatric, neurological, and autonomic features. We observe a unique case with probable earlier episode (prior to the mid-2000s conceptualization of the disease) and a later relapse, accompanying a comprehensive neuropsychological profile tracked after the relapse and subsequent improvement. Neurocognitive findings revealed residual frontal deficits with mood changes even in the state after plasmapheresis. This case is the first to describe posttreatment cognition in anti-NMDAR encephalitis after probable serial autoimmune episodes.

Comparing the Trends of Elevated Blood Pressure in Appalachian and Non‐Appalachian Regions

As an established risk factor for cardiovascular disease and stroke, hypertension risks are often thought to be more prevalent in Appalachian mountain ranges when compared with other neighboring counterpart regions. This study evaluated blood pressure (BP) readings among 2358 Kentucky residents attending community stroke risk screening events held in 15 counties, including nine Appalachian counties (n=1134) and six non‐Appalachian counties (n=1224). With high BP being operationally defined as ≥140/90 mm Hg, 41.5% of Appalachian county residents had elevated BP compared with 42.6% among those from non‐Appalachian counties. Although the counties with the highest rates of elevated BP did tend to reside in the Appalachian region, there was no significant difference between rates of elevated BP in Appalachia vs non‐Appalachian counties. This dataset is proposed as a pilot project to encourage further pursuit of a larger controlled project.

Behavioral outcome measures used for human neural stem cell transplantation in rat stroke models

Stroke is a leading cause of death and disability, leading to the development of various stroke models to test new treatments, most commonly in the rat. Human stroke trials focus on disability, related primarily to neurological deficits. To better model the clinical application of these treatments, many behavioral tests have been developed using the rat stroke model. We performed a systematic review of all the behavioral outcome measures used in published studies of human neural stem cell transplantation in rat stroke models. The reviewed tests include motor, sensory, cognitive, activity, and combination tests. For each test, we give a brief description, trace the origin of the test, and discuss test performance in the reviewed studies. We conclude that while many behavioral tests are available for this purpose, there does not appear to be consensus on an optimal testing strategy.

Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and Depressive Complaints in Older Adults

The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a commonly administered test used to identify cognitive impairment in geriatric patients. To date, no published studies have examined the relationship between depressive symptoms and performance on the RBANS in older adults. Using a clinical sample of 45 older adults, we found a significant negative correlation between depression scores (measured by Geriatric Depression Scale-15) and RBANS Immediate Memory Index. Further examination showed that the List Learning subtest was associated with depression, but Story Memory was not. All other RBANS indices and related subtests were not associated with depression scores. Clinical implications are discussed.

Convergent and discriminant validity of the Immediate Postconcussion Assessment and Cognitive Testing Battery (ImPACT) in young athletes

ABSTRACT Sports concussions are recognized as significant injuries among young athletes. Research demonstrates that return-to-play prior to becoming asymptomatic has significant repercussions including sustained cognitive deficits. Many programs have begun to use computerized testing rather than traditional neuropsychological tests to (a) determine baseline performance, (b) track symptoms, and (c) measure symptoms following concussion. Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) is one such tool. The current study examined ImPACT’s convergent and discriminant validity by comparing scores from sports-related concussion athletes (SRC) to those from nonconcussed controls (CTL). SRC included 29 athletes, ages 12–16, referred for neuropsychological assessment following sports-related concussions. CTL included 25 healthy athletes, ages 12–16, who were concussion-free in the past year. Overall, results showed general support for ImPACT, when used to screen cognition. In fact, all ImPACT domains successfully differentiated between SRC and CTL athletes. Evidence supporting appropriate convergent validity was best for the Visual Memory domain. Further, ImPACT domains demonstrated variable discriminant validity. Overall examination of validity demonstrated that ImPACT has some weaknesses but may have utility in detecting postconcussion cognitive impairment.