Juan Carlos Arango-Lasprilla

Epidemiology of Idiopathic Normal Pressure Hydrocephalus: A Systematic Review of the Literature.

BACKGROUNDnIdiopathic normal pressure hydrocephalus (iNPH) is an important cause of gait disturbance and cognitive impairment in elderly adults. However, the epidemiology of iNPH is relatively unknown, largely as a result of the paucity of specifically designed population studies. This systematic review aims to assess the prevalence and incidence of iNPH.nnnMETHODSnA systematic literature review on the epidemiology of iNPH was conducted using MEDLINE/PubMed searching for articles published up to June 2014.nnnRESULTSnThe inclusion criteria were met by 21 studies. Of the studies, 12 were specifically designed for detecting cases of iNPH; however, only 4 were prospective. In people >65 years old, pooled prevalence obtained from specific population studies was 1.3%, which was almost 50-fold higher than that inferred from door-to-door surveys of dementia or parkinsonism. Prevalence may be higher in assisted-living and extended-care residents, with 11.6% of patients fulfilling the criteria for suspected iNPH and 2.0% of patients showing permanent improvement after cerebrospinal fluid diversion. The only prospective population-based survey that reported iNPH incidence estimated 1.20 cases/1000 inhabitants/year, 15-fold higher than estimates obtained from studies based on hospital catchment areas. The incidence of shunt surgery for iNPH and shunt-responsive iNPH obtained from incident cases of hospital catchment areas appears to be <2 cases/100,000 inhabitants/year and 1 case/100,000 inhabitants/year, respectively. No population-based study reporting the real values for these 2 parameters could be found.nnnCONCLUSIONSniNPH appears to be extremely underdiagnosed. Properly designed and adequately powered population-based studies are required to characterize the epidemiology of this disease accurately.

Life expectancy following rehabilitation: a NIDRR Traumatic Brain Injury Model Systems study.

Objective:To characterize overall and cause-specific mortality and life expectancy among persons who have completed inpatient traumatic brain injury rehabilitation and to assess risk factors for mortality. Design:Prospective cohort study. Setting:The Traumatic Brain Injury Model Systems. Participants:A total of 8573 individuals injured between 1988 and 2009, with survival status per December 31, 2009, determined. Interventions:Not applicable. Main Outcome Measures:Standardized mortality ratio (SMR), life expectancy, cause of death. Results:SMR was 2.25 overall and was significantly elevated for all age groups, both sexes, all race/ethnic groups (except Native Americans), and all injury severity groups. SMR decreased as survival time increased but remained elevated even after 10 years postinjury. SMR was elevated for all cause-of-death categories but especially so for seizures, aspiration pneumonia, sepsis, accidental poisonings, and falls. Life expectancy was shortened an average of 6.7 years. Multivariate Cox regression showed age at injury, sex, race/ethnic group, marital status and employment status at the time of injury year of injury, preinjury drug use, days unconscious, functional independence and disability on rehabilitation discharge, and comorbid spinal cord injury to be independent risk factors for death. Conclusion:There is an increased risk of death after moderate or severe traumatic brain injury. Risk factors and causes of death have been identified that may be amenable to intervention.

Multi-level modelling of employment probability trajectories and employment stability at 1, 2 and 5 years after traumatic brain injury.

Abstract Primary objectives: To examine trajectories of employment probability and stability over the first 5 years after traumatic brain injury (TBI) by using multi-level modelling and multinomial logistic regressions. Research design: A longitudinal cohort study. Methods and procedures: One hundred and five individuals with moderate-to-severe TBI who had been admitted to the Trauma Referral Centre for the Southeast region of Norway were followed up at 1, 2 and 5 years after the injury. Main outcomes and results: Employment status was dichotomized into employed and unemployed, while employment stability was categorized into stably employed, unstably employed and unemployed at 1, 2 and 5 years after injury. Being single, unemployment prior to injury, blue collar occupation, lower Glasgow Coma Scale (GCS) score at hospital admission and greater length of post-traumatic amnesia (PTA) were significantly associated with being unemployed at 1, 2 and 5 years post-injury. Further, younger patients, those with a lower GCS, greater length of PTA and greater length of hospital stay were negatively associated with employment stability. Conclusions: It could be wise to target patient population with these demographic and injury characteristics for more extensive follow-ups and vocational rehabilitation to help improve employment outcomes following injury.

The profession of neuropsychology in Spain: results of a national survey

Abstract Objective: To examine the current status of professional neuropsychology in Spain, with particular focus on the areas of professional training, current work situation, evaluation and diagnostic practice, rehabilitation, teaching, and research. Methods: Three hundred and thirty-nine self-identified professionals in neuropsychology from Spain completed an online survey between July and December of 2013. Respondents had an average age of 35.8 years and 77% were women. Results: Ninety-seven percent of the respondents identified as psychologists; 82% of the sample had a master’s degree, and 33% a doctoral degree. The majority (91%) received their neuropsychological training at a graduate level; 88% engaged in neuropsychological evaluation, 59% in rehabilitation, 50% in research, and 40% in teaching. Average number of hours per week dedicated to work in neuropsychology was 29.7, with 28% of the respondents reporting working in hospitals, 17% in not-for-profit rehabilitation centers, 15% in universities, and 14% in private clinics. Clinicians primarily work with individuals with stroke, traumatic brain injury, and dementia. The top perceived barriers to development of neuropsychology in Spain included lack of clinical and academic training opportunities, and negative attitude toward professional collaboration. Conclusions: The field of neuropsychology in Spain is young and rapidly growing. There is a need to regulate professional neuropsychology, improve graduate curricula, enhance existing clinical training, develop professional certification programs, validate and create normative data for existing neuropsychological tests, and create new, culturally relevant instruments.

Profession of neuropsychology in Latin America

ABSTRACT The purpose of this study was to analyze characteristics of individuals working in the profession of neuropsychology in Latin America in order to understand their background, professional training, current work situation, assessment and diagnostic procedures used, rehabilitation techniques employed, population targeted, teaching responsibilities, and research activities. A total of 808 professionals working in neuropsychology from 17 countries in Latin America completed an online survey between July 2013 and January 2014. The majority of participants were female and the mean age was 36.76 years (range 21–74 years). The majority of professionals working in neuropsychology in Latin America have a background in psychology, with some additional specialized training and supervised clinical practice. Over half work in private practice, universities, or private clinics and are quite satisfied with their work. Those who identify themselves as clinicians primarily work with individuals with learning problems, ADHD, mental retardation, TBI, dementia, and stroke. The majority respondents cite the top barrier in the use of neuropsychological instruments to be the lack of normative data for their countries. The top perceived barriers to the field include: lack of academic training programs, lack of clinical training opportunities, lack of willingness to collaborate between professionals, and lack of access to neuropsychological instruments. There is a need in Latin America to increase regulation, improve graduate curriculums, enhance existing clinical training, develop professional certification programs, validate existing neuropsychological tests, and create new, culturally-relevant instruments.

Incidence of Idiopathic Normal-Pressure Hydrocephalus in Northern Spain

BACKGROUNDnAlthough the incidence of idiopathic normal-pressure hydrocephalus (iNPH) can be 1.20 cases/1000 inhabitants/year in individuals ≥ 70 years old, in most series, the incidence of shunt-responsive iNPH appears to be <1/100,000 inhabitants/year. We report the results of a prospective 10-year longitudinal study of the incidence of iNPH in a northern Spanish population.nnnMETHODSnIn a stable population of 590,000 inhabitants served by a single neurosurgical department, we periodically asked all primary care practitioners, neurologists, and geriatricians to refer for iNPH screening any patient with ventricular dilation who was complaining of motor disturbances, cognitive impairment, or sphincter dysfunction.nnnRESULTSnFrom January 2003 to December 2012, 293 patients were referred with suspected normal-pressure hydrocephalus. In 187 patients, iNPH was diagnosed; 89 of these patients were classified as probable iNPH, and 98 were classified as possible iNPH. Cerebrospinal fluid diversion was performed in 152 patients, and 119 showed a good outcome. The incidence of iNPH was significantly greater in male patients and patients >60 years old and increased exponentially with age. After age 60, the standardized age- and sex-adjusted incidence rates for iNPH, shunt surgery for iNPH, and shunt-responsive iNPH were 13.36 cases/100,000 inhabitants/year, 10.85 cases/100,000 inhabitants/year, and 8.55 cases/100,000 inhabitants/year. No differences were detected in the response rate between probable and possible iNPH (80.52% vs. 76.00%; P = 0.497).nnnCONCLUSIONSnEven with a protocol for patient referral in place, reported iNPH incidence was lower than predicted, reflecting a persistent problem of underdiagnosis in our population.

The influence of TBI impairments on family caregiver mental health in Mexico

Abstract Purpose: This study examined the influence of five types of impairments in individuals with traumatic brain injury (TBI)—and caregiver stress due to these impairments—on the mental health of family caregivers in Guadalajara, Mexico. Method: Ninety caregivers completed measures of TBI impairments and of their own mental health. The majority were female (92.20%) with a mean age of 47.12 years (SDu2009=u200912.67). Caregivers dedicated a median of 50 hours weekly to caregiving and had spent a median of 11 months providing care. Results: Two canonical correlation analyses suggested that these two sets of variables were broadly related, such that more severe impairments in individuals with TBI and more caregiver stress due to those impairments were associated with lower caregiver mental health. Across both analyses, social impairments were most associated with increased caregiver burden. Follow-up analyses also uncovered that caregiver stress due to cognitive impairments was uniquely associated with caregiver burden and anxiety. Conclusions: These results are the first to provide evidence that social and cognitive impairments in individuals with TBI from Latin America are the impairments most associated with caregiver mental health and highlight the need for interventions that target social and cognitive functioning.

Linking Family Dynamics and the Mental Health of Colombian Dementia Caregivers

This cross-sectional, quantitative, self-report study examined the relationship between family dynamics (cohesion, flexibility, pathology/ functioning, communication, family satisfaction, and empathy) and mental health (depression, burden, stress, and satisfaction with life [SWL]) in 90 dementia caregivers from Colombia. Hierarchical multiple regressions controlling for caregiver demographics found that family dynamics were significantly associated with caregiver depression, stress, and SWL and marginally associated with burden. Within these regressions, empathy was uniquely associated with stress; flexibility with depression and marginally with SWL; and family communication marginally with burden and stress. Nearly all family dynamic variables were bivariately associated with caregiver mental health variables, such that caregivers had stronger mental health when their family dynamics were healthy. Family-systems interventions in global regions with high levels of familism like that in the current study may improve family empathy, flexibility, and communication, thereby producing better caregiver mental health and better informal care for people with dementia.

Evaluation of a Group Cognitive–Behavioral Dementia Caregiver Intervention in Latin America

Research has identified unique cultural factors contributing to dementia caregiving in Latin America but very few caregiver interventions have been systematically piloted and evaluated in this region. The purpose of this study was to examine the effectiveness of a group cognitive–behavioral intervention in improving the mental health of dementia caregivers from Cali, Colombia. Sixty-nine caregivers of individuals with dementia were randomly assigned to the cognitive–behavioral intervention or an educational control condition, both spanning 8 weeks. Compared to controls, the treatment group showed higher satisfaction with life and lower depression and burden over the posttest and 3-month follow-ups although there was no effect of the condition on participants’ stress levels.

Connecting family needs and TBI caregiver mental health in Mexico City, Mexico

Abstract Purpose: This study examined relationships between caregiver mental health and the extent to which needs were met in families of individuals with traumatic brain injury (TBI) in Mexico City, Mexico. Method: Sixty-eight TBI caregivers completed Spanish versions of instruments assessing their own mental health and whether specific family needs were met. Results: Twenty-seven per cent of caregivers reported clinically significant depression levels, 40% reported below-average life satisfaction and 49% reported mild-to-severe burden. Several of the most frequently met family needs were in the emotional support domain, whereas the majority of unmet needs were in the health information domain. Family needs and caregiver mental health were significantly and highly related. When family needs were met, caregiver mental health was better. The strongest pattern of connections in multivariate analyses was between family instrumental support (assistance in the completion of daily life tasks) and caregiver burden, such that caregivers with less instrumental support had greater burden. Additional results suggested that instrumental support uniquely predicted caregiver satisfaction with life, burden and depression. Conclusions: Interventions for TBI caregivers, especially in Latin America, should help family members determine how best to meet their health information and instrumental needs, with the former being likely to improve caregiver mental health.