Joseph Bleiberg

Duration of cognitive impairment after sports concussion.

OBJECTIVE:We sought to determine the duration of cognitive impairment after sports concussion. METHODS:We conducted a study with a prospective design in which 729 athletes underwent preseason baseline testing by being administered a computerized neuropsychological test battery, followed by retesting at regular intervals after they sustained sports-related concussions. A control group consisting of nonconcussed athletes drawn from the same baseline population underwent testing at parallel intervals. RESULTS:Cognitive impairment in this primarily American Academy of Neurology Grade II sample of boxing concussions was apparent on the day of injury and at 1 to 2 days postinjury. Recovery of cognitive performance occurred during the 3- to 7-day interval. Comparison with control subjects showed that absent or attenuated practice effects, in addition to frank deterioration from baseline, were indications of recent concussion. CONCLUSION:The present findings of recovery during the 3- to 7-day interval postinjury are consistent with the American Academy of Neurology Grade II return-to-play practice parameters suggesting a 1-week time-out from participation in contact sports.

Factor analysis of computerized and traditional tests used in mild brain injury research.

The present study examines the relation between a set of computerized neuropsychological measures, Automated Neuropsychological Assessment Metrics (ANAM), and a set of traditional clinical neuropsychological tests. Both sets of tests have been employed in recent studies of mild brain injury. Factor analysis and stepwise regression indicate that both sets of tests measure similar underlying constructs of cognitive processing speed, resistance to interference, and working memory. The present findings indicate strong concordance between computerized and traditional neuropsychological measures and support the construct validity of ANAM and similar procedures.

Sumatriptan Nasal Spray and Cognitive Function During Migraine: Results of an Open‐Label Study

Objective.—To examine measures of cognitive function during acute migraine, before and after treatment with sumatriptan nasal spray, 20 mg.

The Met66 allele of the functional Val66Met polymorphism in the brain-derived neurotrophic factor gene confers protection against neurocognitive dysfunction in systemic lupus erythematosus

Background: A common functional polymorphism of the brain-derived neurotrophic factor gene (BDNF Val66Met) was previously associated with diminished episodic memory performance in healthy people. As cognitive function is commonly impaired in patients with systemic lupus erythematosus (SLE), the association of the BDNF Val66Met with neurocognitive function was studied. Objective: To study the association of the BDNF Val66Met with neurocognitive function in a cohort of patients with SLE. Methods: Cognitive function was assessed in 59 patients with SLE with no previous or current central nervous system involvement. Cognitive tests were grouped into five domains (memory, attention/executive function, visuospatial skills, motor function and psychomotor speed) and used to obtain domain Z scores, reflecting the difference between averaged scores of performance on individual tests and published norms in each domain. Genotyping was carried out using a 5′-nuclease assay with 99.9% accuracy. Unpaired t test was used to assess the relationship between genotypes and cognitive function, whereas the effect of possible confounders was assessed in a multivariate analysis. Results: Patients carrying the Met66 allele scored significantly higher on psychomotor, attention/executive and motor function tests, resulting in significantly higher domain Z scores for the psychomotor (p = 0.005) and motor (p = 0.002) domains. Conclusions: The BDNF Met66 allele was associated with better cognitive functioning in the psychomotor and motor domains, even after controlling for differences in ethnicity, sex, depression status and prednisone treatment. These data suggest that the BDNF Met66 allele confers protection against the decline of motor and psychomotor cognitive functions in patients with longstanding SLE.

Reference Values for Performance on the Automated Neuropsychological Assessment Metrics V3.0 in an Active Duty Military Sample

The Automated Neuropsychological Assessment Metrics (ANAM) is a computerized measure of processing speed, cognitive efficiency, and memory. This study describes performance and psychometric properties of ANAM in an active duty, healthy military sample (N = 2,371) composed primarily of young (18-46 years) adult males. Rarely have neuropsychological reference values for use with individuals in the military been derived from a large, active duty military population, and this is the first computerized neuropsychological test battery with military-specific reference values. Although these results do not provide demographically corrected, formal normative data, they provide reference points for neuropsychologists and other health care providers who are using ANAM data in research or clinical settings, with patients of comparable demographics to the present sample.

A Pilot Study to Measure Cognitive Efficiency During Migraine

Background and Objectives.—The measurement of cognitive efficiency during migraine has produced conflicting results primarily due to the types of tests used. The objectives of this pilot study were two‐fold: to measure cognitive efficiency during migraine, compared to a migraine‐free period, and to evaluate the effects of therapy with a 5‐HT1 agonist (sumatriptan injection, 6 mg) on the cognitive efficiency of migraineurs during a migraine.

Pain Reduction is Related to Hypnotizability but Not to Relaxation or to Reduction in Suffering: A Preliminary Investigation

Abstract The present study examined the facilitation of pain reduction through the use of a pain reduction protocol. The protocol emphasized converting pain sensations into visual and auditory representations, which then were manipulated through therapeutic suggestion. Hypnosis was not mentioned in the intervention, minimizing creation of expectancy effects related to hypnosis. At the conclusion of the study, the Stanford Clinical Hypnotic Scale was administered. Measures of relaxation and reduction of suffering were not related to hypnotizability. However, pain reduction was significantly related to hypnotizability (r =.55, P <. 001). High hypnotizables had a greater reduction in pain than low hypnotizables, even though both had equivalent degrees of relaxation.

Influence of Demographics on Computerized Cognitive Testing in a Military Sample

Computerized cognitive testing with software programs such as the Automated Neuropsychological Assessment Metrics (ANAM) have long been used to assess cognition in military samples. This study describes demographic influences on computerized testing performance in a large active duty military sample (n = 2366). Performance differences between men and women were minimal on most ANAM subtests, but there was a clear speed/accuracy trade-off, with men favoring speed and women favoring accuracy on the Continuous Performance Test (CPT) subtest. As expected, reaction time increased with age on most subtests, with the exception of Mathematical Processing Test (MTH). Higher education resulted in significant but minimal performance increases on Code Substitution (CDS), Matching to Sample (MSP), and Memory Search (STN) subtests. In contrast, substantial performance differences were seen between education groups on the MTH subtest. These data reveal that it is important to consider demographic factors, particularly age, when using ANAM to draw conclusions about military samples. These results also point to the importance of exploring demographic influences for all reaction time–based computerized assessment batteries.

Hemodynamic and cognitive effects of lofexidine and methadone coadministration : A pilot study

Study Objective. To determine the hemodynamic and cognitive effects of lofexidine and methadone coadministration.

Psychological Components of Rehabilitation Programs for Brain-Injured and Spinal-Cord-Injured Patients

This chapter is about clinical psychology as practiced in the rehabilitation hospital. Rehabilitation settings are fertile areas of practice for psychologists, and a wide range of clinical and consultation services is applicable. To practice most effectively, however, psychologists should understand the organization and “culture” of the rehabilitation hospital and the special needs of its patients and staff. The chapter is broken into three sections. First, the clinical and administrative environment of the rehabilitation hospital is described, with emphasis on how it affects the role definition and mode of practice of psychologists. The second and third sections examine two specific populations, spinalcord-injured and brain-injured patients, to identify and illustrate the issues specific to the psychological care of each group.