Mark C. Wilde

The Validity of the Repeatable Battery of Neuropsychological Status in Acute Stroke

The construct validity of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was investigated in a sample of 210 acute ischemic stroke patients seen on an inpatient rehabilitation unit. Intercorrelations between the six index scores were found to be relatively consistent with previously published work. A principal components analysis yielded a two-factor (Language/Verbal Memory and Visuospatial/Visual Memory) solution that accounted for 61% of the variance. Correlations generated between the resulting factor scores, the Controlled Oral Word Association Test (COWA), the Visual Form Discrimination Test (VFD), Boston Diagnostic Aphasia Examination (BDAE) Complex Ideational Material Test (CIM), the presence of neglect as determined by Line Bisection Test performance, and the Mini Mental Status Examination (MMSE) supported the validity of these factors. A comparison of the obtained factor scores in a subgroup of 111 left and right hemispheric stroke patients showed that the left hemispheric stroke patients performed more poorly on the Language/Verbal Memory factor score than did right hemispheric stroke patients while the converse was true for the Visuospatial/Visual Memory factor score. Implications for the construct validity of the RBANS and its use and interpretation in clinical assessment are discussed.

Do recognition-free recall discrepancies detect retrieval deficits in closed-head injury? an exploratory analysis with the california verbal learning test

The present study examined the validity of the Recognition Discriminability-Long Delay Free Recall discrepancy from the California Verbal Learning Test (CVLT) as a sign of retrieval deficits in closed-head injury (CHI). Discrepancy and nondiscrepancy groups who differed in their Recognition Discriminability performance but were equated on Long-Delay Free Recall were compared on indices hypothesized to reveal performance patterns consistent with retrieval deficits. Results showed that the discrepancy group produced fewer intrusions. The two groups did not differ in their consistency of recall or relative degree of benefit from semantic cuing. Additional analysis using a discrepancy group with normal Recognition Discriminability scores but abnormal Long-Delay Free Recall performance did not alter these results. The hypotheses were not supported when patients with language deficits were excluded. The findings did not support the use of this discrepancy from the CVLT as a marker for retrieval deficits in CHI.

Lesion Location and Repeatable Battery for the Assessment of Neuropsychological Status Performance in Acute Ischemic Stroke

The validity of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was evaluated in a sample of acute ischemic stroke patients. A total of 164 ischemic stroke patients with anterior fossa lesions were divided into groups according to lesion laterality (left, right, or bilateral) and location (cortical versus subcortical) as determined by CT and/or MRI findings. The hypotheses for this study were: (1) that left hemispheric stroke patients would perform better than their counterparts on the Visuospatial/Constructional and Attention Indexes; (2) that right hemisphere stroke patients would outperform their counterparts on the Immediate Memory, Delayed Memory, and Language Indexes; (3) that patients with subcortical lesions would outperform those with cortical lesions on the Language, Immediate Memory, and Delayed Memory indexes; and (4) that patients with cortical lesions would outperform those with subcortical lesions on the Attention and Visuospatial/Constructional Indexes. A multivariate analysis of variance (MANOVA) disclosed significant main effects for both lesion side and location, with no location by side interaction. Group comparisons of the five RBANS index scores disclosed modest effects for side of lesion, with right hemisphere patients outperforming those with left sided and bilateral lesions on the Immediate and Delayed Memory, and Language Index Scores. Right hemisphere stroke patients also outperformed left and bilateral lesion patients on the Attention Index. The left hemisphere patients outperformed the right hemisphere and bilateral patients on the Visuospatial/Constructional Index. The effect for location was significant only for the Visuospatial/Constructional Index where the subcortical patients outperformed the cortical patients.The validity of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was evaluated in a sample of acute ischemic stroke patients. A total of 164 ischemic stroke patients with anterior fossa lesions were divided into groups according to lesion laterality (left, right, or bilateral) and location (cortical versus subcortical) as determined by CT and/or MRI findings. The hypotheses for this study were: (1) that left hemispheric stroke patients would perform better than their counterparts on the Visuospatial/Constructional and Attention Indexes; (2) that right hemisphere stroke patients would outperform their counterparts on the Immediate Memory, Delayed Memory, and Language Indexes; (3) that patients with subcortical lesions would outperform those with cortical lesions on the Language, Immediate Memory, and Delayed Memory indexes; and (4) that patients with cortical lesions would outperform those with subcortical lesions on the Attention and Visuospatial/Constructional Indexes. A multivariate analysis of variance (MANOVA) disclosed significant main effects for both lesion side and location, with no location by side interaction. Group comparisons of the five RBANS index scores disclosed modest effects for side of lesion, with right hemisphere patients outperforming those with left sided and bilateral lesions on the Immediate and Delayed Memory, and Language Index Scores. Right hemisphere stroke patients also outperformed left and bilateral lesion patients on the Attention Index. The left hemisphere patients outperformed the right hemisphere and bilateral patients on the Visuospatial/Constructional Index. The effect for location was significant only for the Visuospatial/Constructional Index where the subcortical patients outperformed the cortical patients.

Wechsler Adult Intelligence Scale-Revised Block Design Broken Configuration Errors in Nonpenetrating Traumatic Brain Injury

Final broken configuration errors on the Wechsler Adult Intelligence Scale-Revised (WAIS-R; Wechsler, 1981) Block Design subtest were examined in 50 moderate and severe nonpenetrating traumatically brain injured adults. Patients were divided into left (n = 15) and right hemisphere (n = 19) groups based on a history of unilateral craniotomy for treatment of an intracranial lesion and were compared to a group with diffuse or negative brain CT scan findings and no history of neurosurgery (n = 16). The percentage of final broken configuration errors was related to injury severity, Benton Visual Form Discrimination Test (VFD; Benton, Hamsher, Varney, & Spreen, 1983) total score and the number of VFD rotation and peripheral errors. The percentage of final broken configuration errors was higher in the patients with right craniotomies than in the left or no craniotomy groups, which did not differ. Broken configuration errors did not occur more frequently on designs without an embedded grid pattern. Right craniotomy patients did not show a greater percentage of broken configuration errors on nongrid designs as compared to grid designs.

Assessing executive functions in traumatic brain injury: An exploratory study of the executive interview

Executive dysfunction is a frequent sequela of traumatic brain injury. Two correlational studies using samples of inpatients and outpatients diagnosed with traumatic brain injury were undertaken to evaluate the validity of a bedside screening test of executive functioning, the 1992 Executive Interview EXIT 25 by Royall, Mahurin, and Gray. In the first study of 23 inpatients receiving rehabilitation, the EXIT 25 was strongly related to both the Mini-Mental State Examination and the Modified Mini-Mental State Examination. In the second study of 20 outpatients, the EXIT 25 correlated with other executive function measures and with ratings of functional disability at discharge, although a ceiling effect raised questions about its utility for patients with mild to moderate disability. Further study of the EXIT 25 is justified with a larger sample of inpatients, although caution should be exercised when using the EXIT 25 in mildly impaired outpatients.

Sleep Disorders after Traumatic Brain Injury: Milestones in Perspective

This is a chronological review of our emerging knowledge about sleep/wake disorders associated with traumatic brain injury (TBI). The association of sleep/wake problems and TBI has been noted since the days of Hippocrates and Galen. During and after the First World War, there ensued a flurry of published reports concerning TBI and sleep disorders. As physicians and scientists learned about narcolepsy and cataplexy, there was an interest in “posttraumatic narcolepsy.” Then, as the new field of sleep medicine developed with electroencephalography and polysomnography, attention began to be directed to multiple types of sleep/wake disorders, which were either a consequence of TBI or a cause of it because of preexisting sleepiness. We now know that half of all TBI patients suffer from sleep/wake problems, which include insomnia, circadian rhythm disorders, obstructive sleep apnea, posttraumatic hypersomnia, narcolepsy, and recurrent hypersomnia. Some of these (e.g., sleep apnea) may be associated with neurocognitive defects more than what is seen with TBI alone. Modern objective diagnostic techniques (polysomnography, multiple sleep latency tests, actigraphy, etc.) are necessary to make a correct diagnosis, since there is poor correlation between objective and subjective methodologies in this patient population. Approximately 25 % of TBI patients have objectively defined excessive daytime sleepiness due to obstructive sleep apnea, posttraumatic hypersomnia, or narcolepsy. Insomnia is a common problem, especially in mild TBI, and some of these may be due to TBI-associated circadian rhythm disorders.