John R. Crossen

Neurobehavioral sequelae of cranial irradiation in adults: a review of radiation-induced encephalopathy.

PURPOSE To examine behavioral dimensions of treatment outcomes for patients receiving cranial irradiation. Radiation encephalopathy is one of these and refers to significant cognitive and emotional dysfunction following radiation therapy to the brain. Issues of definition, estimated incidence, pathophysiologic mechanisms, and recommended research designs are reviewed in relationship to functional neurobehavioral outcomes. PATIENTS AND METHODS Twenty-nine studies of adults receiving therapeutic cranial irradiation (TCI) involving 748 patients and 18 studies of prophylactic cranial irradiation (PCI) involving 368 patients are reviewed. Assessment of patient outcomes are summarized for research published since 1980, with specific attention to adverse changes in cognitive and emotional functioning. RESULTS Analyses revealed that 213 TCI patients and 100 PCI patients showed encephalopathy attributed to radiation. Manifestations of the late delayed effects of radiotherapy on brain function are related to patient age, total dose of irradiation, fraction sizes, and timing of chemotherapy. Radiation encephalopathy appears to be more common than the pathologic tissue injury of radiation necrosis. Accurate diagnosis of these neurobehavioral sequelae can require follow-up over a period of years with sensitive assessment procedures. CONCLUSIONS It is likely that the true incidence of treatment-related side effects of cranial irradiation in adults who survive more than 6 months without brain tumor growth or recurrence has been significantly underestimated. Research designs that include formal neuropsychologic assessment in conjunction with other neurodiagnostic tests can provide more comprehensive evaluation of long-term neurobehavioral outcomes.

Primary CNS lymphoma treated with osmotic blood-brain barrier disruption: prolonged survival and preservation of cognitive function.

Combination chemotherapy with or without radiotherapy has had only modest efficacy in the treatment of primary CNS lymphoma. Median survival of these patients, treated primarily with radiotherapy, is 13 months; 5-year survival is less than 5%. Thirty consecutive non-acquired immune deficiency syndrome patients with primary CNS lymphoma were treated with barrier-dependent chemotherapy using intraarterial mannitol to open the blood-brain barrier (BBB). Follow-up included extensive neuropsychologic testing of all patients. Thirteen patients received cranial radiation 1 to 9 months before referral (group 1). Seventeen patients received initial BBB disruption chemotherapy with subsequent radiation only for tumor progression or recurrence (group 2). The difference in median survivals from diagnosis--17.8 months for group 1 and 44.5 months for group 2--was statistically significant (P = .039). Group 1 survival is comparable with the 20-month median survival of a historical series of patients (n = 208) treated with radiotherapy with or without chemotherapy. Group 2 patient survival represents an advance in the survival of CNS lymphoma and was associated with preservation of cognitive function in six of seven nonirradiated complete responders observed for 1 to 7 years. Patient toxicity was manageable in this intensive therapeutic regimen. In this series, a plateau in survival curves suggests that a major portion of these patients may be cured without the neuropsychologic sequelae associated with cranial radiation.

Rey auditory-verbal learning test: Development of norms for healthy young adults

Abstract The Rey Auditory-Verbal Learning Test (AVLT) has been widely used in clinical neuropsychology because of the usefulness of its multiple measures of learning and memory and its ease of administration. Normative data has been reported for some patient populations but little normative data exists for healthy individuals. This study reports AVLT data for 222 job applicants, presently employed in a variety of occupations, who had previously passed basic-academic-skills tests and physical examinations and were motivated to perform well on AVLT testing. AVLT normative data are presented by WAIS-R FSIQ, Age, Education, and by Age and FSIQ combined. We also present a proposal for sharing and pooling data to expand the data matrix we present.

Estimating WAIS-R FSIQ from the national adult reading test-revised in normal subjects

Abstract Examined the accuracy of the North American revision of the National Adult Reading Test (NART-R; Blair & Spreen, 1989) in predicting current WAIS-R FSIQ scores in a sample of 302 healthy job applicants. Also wished to establish adult norms for the NART-R according to age, education, and level of intelligence. Finally, also compared the accuracy of the NART-R in predicting WAIS-R FSIQ scores with that of the Reading Subtest of the Wide Range Achievement Test-Revised. Using the prediction equations developed by Blair and Spreen, estimated and obtained mean WAIS-R FSIQs were found to be nearly identical for the group as a whole, with r = .46 (p < 001). However, WAIS-R FSIQ was overestimated by NART-R performance among lower IQ groups, and underestimated among higher IQ groups. The WRAT-R Reading Score correlation with WAIS-R FSIQ was r = .45 (p < .001); the Reading Score also underestimated among higher IQ groups. Using the NART-R, 95% of the subjects had less than 15-point estimated-obtained IQ dif...

Paced auditory serial addition test: Adult norms and moderator variables

This study examined the performance of a sample of 821 healthy job applicants on the Paced Auditory Serial Addition Test (PASAT). Subjects had previously passed basic academic skills tests and physical examinations and were deemed free of cognitive impairment and medical illness. They were also motivated to perform well on cognitive tests. Gender, ethnicity, and education were not significant moderator variables in our subjects. Age and IQ did significantly affect PASAT test results. Normative data are stratified by age and WAIS-R Full Scale IQ scores to be useful to those who administer the PASAT in clinical practice.

Comparison of the Auditory-Verbal Learning Test (AVLT) and California Verbal Learning Test (CVLT) in a sample of normal subjects

Compared performance on Rey Auditory-Verbal Learning Test and California Verbal Learning Test. Slightly higher scores were obtained on CVLT variables. No significant differences were found for order of test administration. Results were interpreted to show minimal practice effects for different list-learning tests administered in the same test battery.

California verbal learning test: A normative data study

Abstract This study examined the performances of a sample of 700 healthy job applicants on 26 California Verbal Learning Test (CVLT) variables. Normative data are provided separately for males and females and are further stratified by age and WAIS-R Full Scale IQ scores. Replication of the original factor analysis is also presented. Subjects had previously passed basic academic skills tests and physical examinations and were deemed to be free of medical illness and cognitive impairment. They were also motivated to perform well on cognitive tests. This normative data may be useful to those who administer the CVLT in clinical practice.

Evaluation of the THINK FIRST For KIDS injury prevention curriculum for primary students

THINK FIRST is a national non-profit organization whose mission is to educate young people about the prevention of brain and spinal cord injuries. This paper describes a study conducted by THINK FIRST of Oregon on one of its injury prevention curricula, THINK FIRST for KIDS.

Neuropsychological Assessment Outcomes of Nonacquired Immunodeficiency Syndrome Patients with Primary Central Nervous System Lymphoma before and after Blood-Brain Barrier Disruption Chemotherapy

The risk of neurotoxicity was evaluated in eight consecutive patients with non-acquired immunodeficiency syndrome (AIDS) primary central nervous system lymphoma who had survived disease free for more than 1 year after completion of treatment with osmotic opening of the blood-brain barrier and chemotherapy (methotrexate, cytoxan, procarbazine, and decadron). Trends in neuropsychological assessment results between baseline and follow-up (1 to 7 years) were analyzed for all eight nonradiated survivors. This serial assessment design addressed the specific issue of neurotoxic risk potential of treatment, when confounding factors of tumor persistence/recurrence and cranial irradiation were ruled out. Follow-up results of an extensive battery of tests to assess higher cortical function provided evidence of the safety of chemotherapy protocol with the blood-brain barrier disruption. These findings stand in contrast to well-known cognitive risks associated with cranial radiotherapy. Long-term follow-up suggests that chemotherapy can be given in conjunction with osmotic opening of the blood-brain barrier in nonradiated patients without cognitive manifestations of neurotoxicity.

Hostility as a health risk factor: Relationships with neuroticism, type a behavior, attentional focus, and interpersonal style

In order to investigate further the psychological construct of hostility measured on the Cook-Medley (Ho) Scale as a health risk factor, the present study examined relationships between hostility assessed on the Ho Scale and several measures of neuroticism, Type A behavior, and attentional and interpersonal style, using bivariate and hierarchical multiple regression analyses. Subjects were 204 psychologically normal, physically healthy males. Significant relationships were found between hostility, neuroticism, attentional overload, and interpersonal alienation. The present study provided normative data on several important health-related psychological dimensions in a sample of healthy normals. The findings also provided further support for the relationship between the hostility construct measured on the Ho Scale and measures of neuroticism as possible dimensions of disease-prone personality.