Robert K. Heaton

Relationship of neuropsychological status to everyday functioning in healthy and chronically Ill persons

Three hundred and three patients with chronic obstructive pulmonary disease and concomitant neuropsychological impairment plus 99 healthy control subjects matched on the basis of socio-demographic variables were administered an expanded version of the Halstead-Reitan Battery and a battery of instruments measuring the quality of everyday-life functioning. The results indicated that neuropsychological measures can be used to predict everyday-life functioning in impaired persons, but few significant relationships were observed in the normals. Neuropsychological status was more consistently related to activities of daily living and basic social role performance than to emotional status. Complex, multifunctional neuropsychological tasks were found to be the best overall predictors of life functioning, whereas more specific tasks served as better predictors of specific dimensions of life functioning.

Neuropsychological findings in myotonic dystrophy

Although the literature contains several references to clinically apparent cognitive deficits in patients with myotonic dystrophy (MYD), efforts to support these observations with formal testing have been lacking. The current study compared 17 MYD patients with 25 normal controls on an expanded Halstead-Reitan Battery. The MYD group scored worse than the controls on nearly every neuropsychological measure. Significant neuropsychological impairment was present even when tests of motor skills were excluded. There was no relationship between general neuropsychological impairment and degree of weakness, myotonia, or muscle atrophy in the MYD patients. These findings suggest that cognitive impairment can be an important and relatively independent component of the disability in MYD, which should be considered in the clinical evaluation and counselling of persons with this disease.

Use of demographic variables to predict full scale IQ: A replication and extension

The evaluation of current level of neuropsychological functioning is handicapped by the lack of validated actuarial methods for estimating premorbid intellectual functioning. The present study cross-validated and attempted to improve the one existing method of using demographic variables in a systematic way to predict WAIS Full Scale IQ (Wilson et al., 1978). A sample of 491 neurologically normal subjects was used. The results generally supported the IQ prediction equation, but did reveal systematic differences in accuracy of prediction and direction of prediction error for IQs in the high and low ranges. Also, a simpler IQ prediction formula that uses only years of education was developed and compared with the 5-variable Wilson et al. formula.

A standardized evaluation of psychosocial factors in chronic pain

Abstract A number of psychosocial factors are generally considered to be important in exacerbating and maintaining chronic pain problems. However, standardized and reliable methods of evaluating these factors are needed. We have developed such an evaluation system, called the Psychosocial Pain Inventory (PSPI), and have obtained normative data from a large sample of chronic pain patients. Scores on the PSPI were approximately normally distributed and had good inter‐rater reliability. Patients with high PSPI scores were more likely to be considered exaggerating their symptoms during their physical examinations, but they did not show less evidence of an organic basis for pain. Significant correlations were obtained between PSPI scores and some measures from the McGill Pain Questionnaire, but scores on the PSPI were essentially unrelated to personality disturbance as measured by the Minnesota Multiphasic Personality Inventory (MMPI). The PSPI and MMPI appear to provide different types of information that can be used in a complementary way in evaluating pain patients. Results of a small pilot study suggest that high scores on the PSPI predict poor response to medical treatment for pain.

Comparison of preferred and nonpreferred hand performance on four neuropsychological motor tasks

Abstract This study explored the intermanual difference scores in 426 normal subjects on four neuropsychological tests, taking into consideration the effects of age, education, sex, and lateral preference. For the Finger Tapping Test and Hand Dynamometer measures, subjects who consistently demonstrated right lateral preference had greater intermanual differences than did left-handed subjects, while analyses on the Grooved Pegboard revealed that females tended to have larger percent difference scores than did males. Analyses on the fourth measure, the Tactual Performance Test (TPT), did not reveal differences related to lateral preference or sex. However, older and less well educated subjects tended not to improve from Trial 1 to Trial 2 of the TPT, possibly due to less efficient learning. These results suggest that interpretation of intermanual differences in neuropsychological assessment would benefit from consideration of demographic and lateral preference variables, in combinations that differ for spec...

Wechsler intelligence scale profiles, the cholinergic system, and alzheimer's disease

Abstract Forty-one patients with putative Alzheimers Disease (AD) were evaluated to determine the diagnostic utility of a profile of Wechsler Adult Intelligence Scale (WAIS) subtests which has been proposed by Fuld (1984) to identify cholinergic dysfunction. Only nine (21.9%) of these patients had positive Wechsler profiles. Half (n = 21) of the AD patients had been given the WAIS, and the other half (n = 20) the Wechsler Adult Intelligence Scale-Revised (WAIS-R). Positive profiles occurred more often in the AD subgroup given the WAIS-R, but this difference was not statistically significant. Specificity of the formula was evaluated using Wechsler results of 42 older normals and 30 patients who were being evaluated for dementia but who did not have AD. One of the 42 normals (2.4%) and five of the patient controls (16.7%) showed a positive Wechsler profile. Because of the Fuld formulas low sensitivity, a negative Wechsler profile cannot be used to help rule out AD. Although specificity of the formula is h...

COMPARISON OF WECHSLER ADULT INTELLIGENCE SCALE INDICES OF CEREBRAL DYSFUNCTION

This study assessed and compared the diagnostic accuracies of eight cerebral dysfunction indices based upon the Wechsler Adult Intelligence Scale (WAIS). Patients with extreme values of the Halstead Impairment Index were used to compose Impaired and Not Impaired groups. The Impaired group did significantly worse than the Not Impaired group on all 11 WAIS subtests, and there was little overlap between the groups in Full Scale IQ. The WAIS cerebral dysfunction indices ignore such differences in over-all level of performance and instead use patterns of subtest scores in making diagnostic classifications. Seven of the eight indices predicted impairment status at levels which exceed chance, but the total correct classification rates were quite modest. Statistical correction for group age differences reduced classification rates even more. Deviation score analyses were employed to assess relative strengths and deficits on the WAIS subtests, controlled for over-all level of performance. Compared to the Not-impaired group, Impaired subjects did relatively poorly on Block Design and Object Assembly, and relatively well on Information, Comprehension, Vocabulary, and Picture Completion. Significant education effects and education by impairment status interactions also occurred for several subtests. It was concluded that the WAIS indices have limited value in screening for cerebral dysfunction, and reasons for this were discussed.

Utility of the seashore tonal memory test in neuropsychological assessment

This study assessed the diagnostic utility of the Seashore Tonal Memory Test in detecting and localizing cerebral lesions. A group of 238 subjects with focal or diffuse cerebral lesions and a group of 112 normal comparison subjects were administered the Seashore Tonal Memory Test and the Halstead-Reitan Battery. All brain-damaged subgroups did significantly worse than the normal group on the Tonal Memory Test. Patients with right-hemisphere lesions were more impaired on this test than were those with left-hemisphere lesions. In contrast, Seashore Rhythm Test scores were not significantly different for groups with right- versus left-hemisphere lesions. Tonal Memory performance was not found to be related to more precise location of structural lesions within the right hemisphere. Step-wise discriminate function analyses indicated that the Tonal Memory Test adds to the Halstead-Reitan Battery in discriminating left-hemisphere from right-hemisphere lesions and that, for this purpose, it was a better discriminator than all but one of the individual tests currently in the battery.

Level and variability of performance on neuropsychological tests

Compared non-specific variability across subtests and overall level of performance on the Wechsler Adult Intelligence Scale (WAIS) and the Halstead-Reitan Battery (HRB) for normal, schizophrenic, acute and chronic brain-damaged Ss. Both variability and level of performance measures for each of the two test batteries significantly distinguished normal from abnormal Ss, but the HRB measures were more sensitive. Intra-S variability across subtests had a significant negative correlation with level of performance on the HRB, but not on the WAIS. This correlation could not be accounted for fully by a ceiling effect and was thought to represent in part a characteristic feature of ts performance on the HRB. While WAIS variability appeared to be independent of level of performance, it was not much help in differentiating between the four S groups. It was concluded that non-specific variability across subtests is not a helpful independent measure of neuropsychological function on the two batteries studied.

Bartonella henselae Serostatus is not Correlated with Neurocognitive Decline in HIV Infection

Bartonella henselae has been implicated as a significant cause of HIV-associated dementia. We attempted to confirm this association by utilizing the database of the San Diego HIV Neurobehavioral Research Center, which collects longitudinal neurocognitive and laboratory data on over 500 HIV-infected participants. Utilizing an immunofluorescent assay we found that 11% of 177 subjects, half of whom had documented neurocognitive decline, were seropositive for B. henselae. There was no correlation between B. henselae seropositivity and neurocognitive decline. The role of B. henselae in HIV-associated dementia remains ambiguous.Bartonella henselae has been implicated as a significant cause of HIV-associated dementia. We attempted to confirm this association by utilizing the database of the San Diego HIV Neurobehavioral Research Center, which collects longitudinal neurocognitive and laboratory data on over 500 HIV-infected participants. Utilizing an immunofluorescent assay we found that 11% of 177 subjects, half of whom had documented neurocognitive decline, were seropositive for B. hensalae. There was no correlation between B. hensalae seropositivity and neurocognitive decline. The role of B. hensalae in HIV-associated dementia remains ambiguous.