Janet Leathem

Questioning the Link Between PTSD and Cognitive Dysfunction

Posttraumatic stress disorder (PTSD) has been linked with impairment in cognitive functioning, but anomalies appear to arise on several levels, masking the true nature of the relationship. On one level, there is a blurring of the emotional and physical causes of cognitive dysfunction, especially with memory problems that are similar to those due to neurological disorders. At other levels, problems are evident due to issues such as overgeneralizing from specific populations to the general population, and the use of narrow-focused neuropsychological assessment instruments that neither dissociate among precise memory components nor relate to everyday situations. In this review we highlight methodological problems and concerns, and make suggestions to establish valid links between PTSD and cognitive dysfunction.

Incidence and outcomes of traumatic brain injury and substance abuse in a New Zealand prison population

The present study investigated the rates and perceived effects of past traumatic brain injury (TBI) and substance use in a prison population. Responses to a questionnaire indicated that 86.4% of the 118 respondents had sustained a TBI, with 56.7% reporting more than one, and rates of illicit substance use were higher than the general population. Maori reported 12% more TBI and more substance use than non-Maori. All those with TBI reported difficulties with general memory and socialization on a problem rating scale, but there was no relationship between level of difficulty and severity of TBI, problems with interpersonal relationships, family, and finances were associated with greater substance use.

Relatives' perceptions of role change, social support and stress after traumatic brain injury

There is general agreement between researchers and clinicians alike that relatives of people with head injuries experience heightened stress as a result of the injury and its consequences. In the present study a single structured interview, including both verbally administered and written response questionnaires, was completed by 18 parents and 11 partners. Measures included the Daily Hassles and Uplifts Scale, the Arizona Social Support Interview Schedule and questions regarding role change and health problems. The combined parents and partners group indicated that they experienced moderate levels of stress and role change. A relatively small proportion of participants reported experiencing health problems. Partners indicated a slightly higher degree of stress and a greater degree of role change than parents, and a larger proportion of partners indicated the presence of health problems. Qualitative differences between the two groups were found in terms of sources of stress. There was little quantitative or qualitative difference between the two groups in sources, utilization of and satisfaction with social support. Positive correlations were found between stress and role change and stress and health problems.

A study investigating the effects of Tai Chi Chuan: Individuals with traumatic brain injury compared to controls

Objective: To explore the effects of a 6-week course in Tai Chi associated with traumatic brain injury (TBI) symptoms. Method: Eighteen participants, with TBI assigned to a control (waiting list) group (n = 9) or Tai Chi group (n = 9) completed the Medical Outcome Scale Short Form 36 (SF-36) and Rosenberg Self-Esteem Scale (RSES) before, during, immediately after and 3 weeks after completion of the Tai Chi course. The Tai Chi group completed the Visual Analogue Mood Scales (VAMS) before and after each class. Results: Tai Chi was associated with significant improvement on all VAMS scores (except fatigue) with decreases in sadness, confusion, anger, tension, fear and increases in energy and happiness. There were no significant between-group differences on the SF-36 or RSES. Conclusions: Tai Chi provides short-term benefits after TBI, with rigorous outcome measurement needed to examine long-term benefits.

Mild traumatic brain injury and fatigue: A prospective longitudinal study

Primary objective: To examine fatigue prevalence, severity, predictors and co-variates over 6 months post-mild traumatic brain injury (MTBI). Research design: Longitudinal prospective study including 263 adults with MTBI. Procedures: Participants completed the Fatigue Severity Scale (FSS), Rivermead Post-concussion Symptoms Questionnaire (RPSQ), Hospital Anxiety and Depression Scale (HADS) and the Short Form 36 Health Survey-Version 2 (SF-36v2). Complete data were available for 159 participants. Key measures; prevalence—RPSQ Item 6: severity—FSS. The effect of time on fatigue prevalence and severity was examined using ANOVA. Multiple regression analysis identified statistically significant covariates. Main outcomes and results: Post-MTBI fatigue prevalence was 68%, 38% and 34% at 1 week, 3 and 6 months, respectively. There was a strong effect for time over the first 3 months and moderate-to-high correlations between fatigue prevalence and severity. Early fatigue strongly predicted later fatigue; depression, but not anxiety was a predictor. Fatigue was seen as laziness by family or friends in 30% of cases. Conclusions: Post-MTBI fatigue is a persistent post-concussion symptom, exacerbated by depression but not anxiety. It diminishes in the first 3 months and then becomes relatively stable, suggesting the optimum intervention placement is at 3 months or more post-MTBI.

Assessing executive performance during cognitive rehabilitation

Executive functioning influences a host of other cognitive processes and people who attend neuropsychological services are more likely to display executive dysfunction than any other cognitive deficit (Stuss & Levine, 2002). Impairment in executive functioning disrupts a persons ability to effectively employ their intact areas of functioning, and undermines effective self-management of other areas of dysfunction, hampering attempts to employ compensatory strategies. Therefore, assessment of a persons executive functioning is a high priority as part of a comprehensive neurorehabilitation plan. Guided by the International Classification of Functioning, Disability, and Health model (ICF model; Peterson, 2005), we suggest that an important development in the field is moving to formal assessment of executive performance in functional contexts, in addition to more traditional assessment of executive impairment. We outline a number of existing studies in this area, review current measures that can provide clinicians with useful information on these issues, and discuss how this research could be further advanced.

Subjective Cognitive Complaints and Objective Cognitive Function in Aging: A Systematic Review and Meta-Analysis of Recent Cross-Sectional Findings.

Research investigating how subjective cognitive complaints (SCCs) might reliably indicate impairments in objective cognitive functioning has produced highly varied findings, and despite attempts to synthesise this literature (e.g., Jonker et al. International Journal of Geriatric Psychiatry, 15, 983–991, 2000; Reid and MacLullich Dementia and Geriatric Cognitive Disorders, 22(5–6), 471–485, 2006; Crumley et al. Psychology and Aging, 29(2), 250–263, 2014), recent work continues to offer little resolution. This review provides both quantitative and qualitative synthesis of research conducted since the last comprehensive review in 2006, with the aim of identifying reasons for these discrepancies that might provide fruitful avenues for future exploration. Meta-analysis found a small but significant association between SCCs and objective cognitive function, although it was limited by large heterogeneity between studies and evidence of potential publication bias. Often, assessments of SCCs and objective cognitive function were brief or not formally validated. However, studies that employed more comprehensive SCC measures tended to find that SCCs were associated independently with both objective cognitive function and depressive symptoms. Further explicit investigation of how assessment measures relate to reports of SCCs, and the validity of the proposed ‘compensation theory’ of SCC aetiology, is recommended.

Neuropsychological outcomes of traumatic brain injury and substance abuse in a New Zealand prison population

Fifty subjects with a history of traumatic brain injury (TBI) and/or substance use, completed neuropsychological measures of short and long term verbal and visual memory, information processing, motor speed and co-ordination, executive functioning, and malingering. All subjects performed below norms on tests of verbal memory and verbal abstract thinking, but overall no differences were found due to either severity of TBI or level of substance use. Maori subjects obtained the lowest scores on tests of verbal ability, but also reported higher rates of TBI and substance use, which is presumed to account for this result. In conclusion, prison populations seem to have disproportionately high rates of TBI, recurrent TBI, and substance use, compared to the general population. Further, there are a group of individuals who have experienced both TBI and substance abuse, with associated impairments in verbal memory and learning, abstract thinking, and who report problems with general memory and socialization. These difficulties may affect functioning both in prison and following release.

Factors affecting performance in cross-cultural neuropsychology: From a New Zealand bicultural perspective

Of the many factors affecting test validity, ethnicity has received comparatively little attention. This has changed recently with a call for alternative norms or assessment measures that are appropriate for different cultural contexts and for examination of the impact of the variables of culture, ecological demands, primary language, and educational background (Ardila, 1995; Robinson, 1988; Sachdev, 1989; Segall, 1986). The Maori population of New Zealand (representing 12% of the total population) is one of a number of ethnic groups worldwide that have been identified has having particular difficulties in educational achievement. Maori are English speaking (although a small proportion are bilingual), attend the same schools as non-Maori (New Zealanders of European ancestry), and are integrated within the general population, yet Maori children perform less well than non-Maori on standard cognitive measures (McCreanor, 1988) and gain proportionally fewer passes on national examinations. Moreover, Maori are overly represented in negative social indicators such as having low standard of income, education and housing, and high unemployment, crime involvement, injury, and accident figures (Department of Statistics New Zealand, 1994) and are proportionately younger than the nonMaori population (62.5% under 30 years compared to 45.6%; Te Puni Kokiri, 1993). These factors are among the strong predictors for traumatic brain injury (TBI) which Maori sustain moreper capitathan non-Maori (Barnfield, 1995). It could be argued that these factors impact negatively on test scores of any group regardless of ethnicity. In two recent studies after head injury however, Maori, matched for age, education, and socioeconomic status, performed at lower levels on measures of neuropsychological functioning than their non-Maori counterparts (Barnfield, 1995; Grimmer, 1994). To begin exploring the sources of this discrepancy we conducted a pilot survey to determine how the neuropsychological examination experience was perceived. In consultation with recent Maori clients, we designed a questionnaire of satisfaction with our service. The 69 items covered demographics (adapted from Ratima et al., 1995), degree of identification with Maori culture (Prigatano & Leathem, 1991), preassessment anxiety and overall perception of neuropsychological assessment (Bennett-Levy et al., 1994), general satisfaction [Client Satisfaction Questionnaire (CSQ31); Larsen et al., 1979] and the degree to which the service was considered appropriate for Maori. Of 20 questionnaires sent out from our clinic, 15 were returned. Two participants now advised that they had decided not to continue after perusing the items, and the remaining three who said that they would return the questionnaire, either chose not to or forgot. Of the 15 respondents, 7 identified as Maori and 8 as nonMaori (9 male, 6 female). Their average age was 37 years (range 23–56). Half the sample had resided locally (Manawatu–Horowhenua) when they were seen initially. Ten of the respondents did not acknowledge an involvement with Maori community life, including 2 of the Maori sample. Of the 5 Maori who were involved, most acknowledged involvement withmarae (communal meeting place) activities,kohanga reo(Maori language kindergarten), iwi (tribe), andwhanau(extended family). Nine of the respondents (including 4 non-Maori) had attended at least one tangi (traditional Maori funeral) in the previous 12 months and 2 had consulted with atohunga(spiritual healer) in that period. This level of Maori cultural activities would suggest a reasonable understanding of the needs of Maori people. There was no measure of whakama(the tendency to hold back), rather it was assumed to be an inherent tendency in those Reprint requests to: J.M. Leathem, College of Psychology, Massey University, P.O. Box 11-222, Palmerston North, New Zealand. E-mail: J.M.Leathem@massey.ac.nz Journal of the International Neuropsychological Society (1999),5, 83–84. Copyright

Incidence and aetiology of head injury in a New Zealand adolescent sample

This study reports the major aetiological factors and incidence rates of head injury in an adolescent sample, and compares them with previous research in New Zealand and overseas. Subjects had come to medical attention, but also included were those who had sustained a head injury but had not sought medical attention. An overall incidence rate of almost 14% was reported, with the major cause of head injury in male students being sport, and collisions in the females.