PubMed Health⌕ Search

Biomedical subjects

Anthony Feinstein

Publications and source records attributed to Anthony Feinstein.

At least 19 recordsLinked to original sources
PubMed2006

Unexplained neurologic symptoms: an fMRI study of sensory conversion disorder.

We investigated three subjects with unexplained sensory loss meeting criteria for conversion disorder using brain fMRI during unilateral and bilateral vibrotactile stimulation. In each subject, stimulation of the affected limb did not produce activation of the contralateral primary somatosensory (S1) region, whereas bilateral limb stimulation did. These findings implicate selective alterations in primary sensorimotor cortex activity in conversion disorder, and may also reconcile the discordant results of previous studies.

Adult↗
PubMed2006

Mood disorders in multiple sclerosis and the effects on cognition.

BACKGROUND: Depression and cognitive dysfunction are common in patients with multiple sclerosis. However, it is unclear whether depression may cause or exacerbate cognitive problems as data remain equivocal. The current review attempts to clarify the relationship between these behavioral disorders. METHOD: The literature pertaining to the influence of depression on cognition in MS patients has been reviewed. RESULTS: Early studies consistently failed to find an association and concluded that cognitive dysfunction in MS patients occurred independently of depression. A more recent literature has found fault with this, citing numerous methodological flaws in the studies undertaken. Newer data now suggests that core symptoms of depression reduce cognitive capacity, in particular exerting an adverse effect on the executive function component of working memory. CONCLUSIONS: Depression may exacerbate cognitive dysfunction in MS patients. Whether treating depression will lead to cognitive improvement is not yet known, but warrants further exploration.

Cognition↗
PubMed2006

The impact of major depression on outcome following mild-to-moderate traumatic brain injury in older adults.

BACKGROUND: Major depression is common following traumatic brain injury (TBI), yet no studies to date have explored its relationship to psychosocial outcome in older adults with TBI. METHODS: A consecutive sample of seventy-seven older patients with mild-to-moderate TBI was assessed for the presence of major depression within 2 months of injury, and followed prospectively for 1 year. Those with major depression were compared with those without on measures of psychosocial outcome, instrumental activities of daily living (IADL). RESULTS: Patients with major depression (15.6%) reported higher degrees of psychological distress, psychosocial dysfunction, and post-concussive symptoms than those without, and were rated as having poorer IADL performance. LIMITATIONS: The present study was limited to a clinical population, and there were significant attrition rates. CONCLUSIONS: Major depression in the first few months after TBI in older adults has persisting adverse effects on outcome, highlighting its significance in this population, and suggesting early attention to treatment.

Activities of Daily Living↗
PubMed2006

Randomized treatment trial in mild traumatic brain injury.

OBJECTIVE: To determine whether multidisciplinary treatment of mild traumatic brain injury (MTBI) improves neurobehavioral outcome at 6 months postinjury. METHODS: Subjects with MTBI were randomly assigned to treatment (n=97) or nontreatment (control, n=94) groups. Treated patients were assessed within 1 week of injury and thereafter managed by a multidisciplinary team according to clinical need for a further 6 months. Control subjects were not offered treatment. Six-month outcome measures included: severity of postconcussive symptoms (Rivermead Post-Concussion Disorder Questionnaire), psychosocial functioning (Rivermead Follow-up Questionnaire), psychological distress (General Health Questionnaire), and cognition (neurocognitive battery). RESULTS: Treatment and control subjects were well-matched for demographic and MTBI severity data. In addition, the two groups did not differ on any outcome measure. However, in individuals with preinjury psychiatric difficulties (22.9% of the entire sample), subjects in the treatment group had significantly fewer depressive symptoms 6 months postinjury compared with untreated controls (P=.01). CONCLUSIONS: These findings suggest that routine treatment of all MTBI patients offers little benefit; rather, targeting individuals with preinjury psychiatric problems may prove a more rational and cost-effective approach.

Adult↗
PubMed2006

Outcome after traumatic brain injury sustained in older adulthood: a one-year longitudinal study.

OBJECTIVE: The objective of this study was to explore the effects of traumatic brain injury (TBI) on cognition and functioning in older adults in a one-year longitudinal study. METHODS: Participants with mild-to-moderate TBI were compared with an age-, gender-, and education-matched healthy comparison group on aspects of cognition. Neuropsychologic tests were administered at one year. Self-reported measures of functioning were completed at baseline, six months, and one year. Informants rated instrumental functioning at one year. RESULTS: Sixty-nine subjects aged 50 years and over (mean: 67 years; standard deviation: 7.9) and a comparison group of 79 participants were assessed. Patients with TBI had poorer processing speed, verbal memory, language, and executive function; they self-reported more psychologic distress, psychosocial dysfunction, and postconcussive symptoms; and they were rated as more impaired in functioning than the comparison group. TBI of moderate severity accounted for most of the between-group differences. CONCLUSION: TBI, particularly of moderate severity, led to poorer cognitive and psychosocial functioning one year postinjury among older adults. The clinical significance of this may become more evident with time in this vulnerable population.

Aged↗
PubMed2006

The effect of major depression on subjective and objective cognitive deficits in mild to moderate traumatic brain injury.

The effect of major depression on subjective and objective cognitive deficits 6 months following mild to moderate traumatic brain injury (TBI) was assessed in 63 subjects. Patients with subjective cognitive complaints (n=63) were more likely to be women, with higher Glasgow Coma Scale (GCS) scores and have a diagnosis of major depression. They also performed significantly more poorly on various measures of memory, attention and executive functioning. Group differences on most but not all cognitive measures disappeared in a multivariate analysis when controlling for depression. In mild to moderate TBI, subjective cognitive deficits are linked in large measure to comorbid major depression. However, other mechanisms may also account for these deficits.

Adolescent↗
PubMed2006

Treatment of neuropsychiatric conditions associated with multiple sclerosis.

This article reviews the treatment of behavioral disturbances associated with multiple sclerosis. Pharmacological and psychotherapeutic treatment data, when available, are presented for five discrete conditions: major depression, bipolar affective disorder, anxiety, psychosis, pseudobulbar affect and cognitive dysfunction. Despite the paucity of empirical treatment data that characterizes all of these conditions, with the exception of pseudobulbar affect, the message from open-label trials and anecdotal experience is that therapy is often successful, leading to improvements in quality of life for patients. Thus, all health professionals involved in the care of multiple sclerosis patients should have a good working knowledge of the neurotherapeutics of multiple sclerosis-related behavioral disorders.

Humans↗
PubMed2005

Embedded journalists in the Iraq war: are they at greater psychological risk?

The current war in Iraq saw an alliance between the media and the military, a process called embedded journalism. The aim of this study was to explore whether this process affected the journalists' vulnerability to psychological distress. Eighty-five of 100 journalists approached agreed to participate; 38 (44.7%) were embedded. There were no differences between embedded and unilateral (non-embedded) journalists on demographic measures or in their exposure to traumatic events. Similarly, the two groups did not differ on indices of posttraumatic stress disorder, depression, psychological distress, and substance use. Based on General Health Questionnaire scores, one third of all journalists were psychologically distressed. There is no evidence from the recent war in Iraq suggesting that embedded journalists are at increased risk for psychological problems.

Adult↗
PubMed2005

Detecting cognitive dysfunction in multiple sclerosis with a magnetic resonance imaging rating scale: a pilot study.

OBJECTIVE: In multiple sclerosis (MS), magnetic resonance imaging (MRI) predictors of cognitive impairment are based on sophisticated computer-generated analyses that are difficult to apply in clinical settings. This study investigated the clinical usefulness of a new visual rating scale, the Cholinergic Pathways Hyperintensities Scale (CHIPS), in detecting cognitive dysfunction. METHODS: Forty clinically definite MS patients underwent a brain MRI. Based on the CHIPS, cholinergic pathway hyperintensities were rated in 10 regions on four axial slices. Computerized hyperintense lesion volumes were also obtained. For cognitive testing, The Neuropsychological Screening Battery for Multiple Sclerosis was used. "Low" and "High" lesion score groups were computed based on the mean of the total CHIPS score. Optimal sensitivity and specificity of the total CHIPS score in detecting cognitive impairment were determined using a receiver operator characteristic curve. RESULTS: Despite a similar demographic profile, subjects with a "High" lesion score performed significantly worse than the "Low" lesion score group on verbal (P = .007) and visuospatial (P = .02) memory, and on a global index of cognitive functioning (P = .001). Optimal sensitivity (82%) and specificity (83%) were reached with a threshold total CHIPS score of 18 points. Total CHIPS score and total hyperintense lesion load were correlated (sigma = 0.82, P < .0001). CONCLUSION: CHIPS is helpful in clinically predicting cognitive impairment in MS.

Brain↗
PubMed2005

Cognitive impairment associated with major depression following mild and moderate traumatic brain injury.

Traumatic brain injury (TBI) and major depression are neuropsychiatric conditions that have been associated with cognitive dysfunction. The aim of this study was to explore the relationship between major depression and cognitive impairment following mild and moderate TBI. Seventy-four TBI patients were assessed for the presence of major depression using the Structured Clinical Interview for the DSM-IV and completed a neurocognitive assessment battery. Subjects with major depression (28.4%), compared to those without, were found to have significantly lower scores on measures of working memory, processing speed, verbal memory and executive function. Potential mechanisms and implications for treatment are discussed.

Adolescent↗
PubMed2004

Six-month recovery from mild to moderate Traumatic Brain Injury: the role of APOE-epsilon4 allele.

The possession of at least one APOE-epsilon4 allele may be linked to poor outcome in patients with predominantly severe traumatic brain injury (TBI). In mild TBI, which accounts for approximately 85% of all cases, the role of the APOE-epsilon4 allele is less clear. Studies completed to date have relied on brief cognitive assessments or coarse measures of global functioning, thereby limiting their conclusions. Our study investigated the influence of the APOE-epsilon4 allele in a prospective sample of 90 adults with mild to moderate TBI in whom neuropsychiatric outcome 6 months after injury was assessed as follows: (i) a detailed neuropsychological battery; (ii) an index of emotional distress (General Health Questionnaire); (iii) a diagnosis of major depression (Structured Clinical Interview for DSM-IV); (iv) a measure of global functioning (Glasgow Outcome Scale); (v) an index of psychosocial outcome (Rivermead Head Injury Follow-up Questionnaire); and (vi) symptoms of persistent post-concussion disorder (Rivermead Post-Concussion Symptoms Questionnaire). No association was found between the presence of the APOE-epsilon4 allele and poor outcome across all measures. Given the homogeneous nature of our sample (mild to moderate injury severity), the uniform follow-up period (6 months) and the comprehensive markers of recovery used, our data suggest that the APOE-epsilon4 allele does not adversely impact outcome in this group of TBI patients.

Adult↗
PubMed2004

Outcome after mild to moderate traumatic brain injury: the role of dizziness.

OBJECTIVE: To assess the specific effect of dizziness on psychosocial outcome after mild to moderate traumatic brain injury (TBI). DESIGN: Six-month cross-sectional study. Setting An outpatient TBI clinic in a tertiary care referral center. Participants A consecutive sample of 207 adults with mild to moderate TBI, 138 (66.7%) of whom had subjective complaint of posttraumatic dizziness. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Psychosocial indices (Glasgow Outcome Scale [GOS], General Health Questionnaire [GHQ], Rivermead Head Injury Follow-Up Questionnaire [RHFUQ], return to work status) were collected from dizzy and nondizzy patients. RESULTS: Despite similar demographic, TBI, and global disability (GOS) profiles of both groups, psychosocial functioning (GHQ, RHFUQ, return to work) was significantly worse in dizzy subjects ( P <.01 for all indices). A logistic regression analysis identified dizziness ( P =.006), total GHQ ( P =.001), and psychotropic and analgesic use ( P =.05) as significant independent predictors of reemployment. CONCLUSIONS: Although dizziness was closely linked to psychologic distress at 6 months after head injury, it also emerged as an independent predictor of failure to return to work, suggesting that not all its adverse effects on outcome are psychologically mediated. Clinicians need to be alert to the presence of dizziness as an adverse prognostic indicator after mild to moderate TBI.

Adult↗
PubMed2004

The neuropsychiatry of multiple sclerosis.

This review describes the many neuropsychiatric abnormalities associated with multiple sclerosis (MS). These may be broadly divided into 2 categories: disorders of mood, affect, and behaviour and abnormalities affecting cognition. With respect to the former, the epidemiology, phenomenology, and theories of etiology are described for the syndromes of depression, bipolar disorder, euphoria, pathological laughing and crying, and psychosis attributable to MS. The section discussing cognition reviews the prevalence and nature of cognitive dysfunction, with an emphasis on abnormalities affecting multiple domains of memory, speed of information processing, and executive function. The detection, natural history, and cerebral correlates of cognitive dysfunction are also discussed. Finally, treatment pertaining to all these disorders is reviewed, with the observation that translational research has been found wanting when it comes to providing algorithms to guide clinicians. Guidelines derived from general psychiatry still largely apply, although they may not always be most effective in patients with neurologic disorders. The importance of future research addressing this imbalance is emphasized, for neuropsychiatric sequelae add significantly to the morbidity associated with MS.

Bipolar Disorder↗
PubMed2004

Multiple sclerosis and alcohol: a study of problem drinking.

Multiple sclerosis (MS) patients are known to be at increased risk from mood disorders and suicidal ideation. Although these are often associated with alcohol disorders, the drinking habits of MS patients have not been well studied to date. Our study assessed drinking patterns in 140 MS patients, focusing on a possible link between problem drinking and mood and anxiety disorders. Lifetime psychiatric diagnoses were ascertained using the Structured Clinical Interview for DSM-IV disorders (SCID-IV). Results demonstrate that one in six MS patients drink to excess over the course of their lifetime. Those with a history of problem drinking display a higher lifetime prevalence of anxiety (P = 0.006), but not mood disorders. There were also significant associations between problem drinking and a lifetime prevalence of suicidal ideation (P = 0.006), substance abuse (P = 0.001), and a family history of mental illness (P = 0.008). Clinicians should be aware of the possibility of problem drinking in MS patients, and how this may complicate the course of their disease. Clues to problem drinking in MS patients are the presence of a positive family history of mental illness and prominent anxiety.

Adult↗
PubMed2002

Utility of simultaneous brain, CSF and hyperintensity quantification in dementia.

Improved methods of quantifying MRI are needed to study brain-behavior relationships in dementia. Rating scales are variable; lesion-tracing approaches can be subjective and ignore atrophy; segmentation of MRI hyperintensities is complicated by partial volume effects; and hyperintense lesions in different anatomical areas may have different effects. The goal of this study was to extend existing segmentation approaches to include hyperintensities and to demonstrate the utility of simultaneously assessing atrophy and lesion compartments in dementia. A semi-automated method was applied to quantify brain and cerebrospinal fluid (CSF) compartments and to subclassify hyperintensities into periventricular, deep white matter, thalamic and basal ganglia compartments. Twenty MR scans from participants in an ongoing dementia study were used to generate intra- and inter-rater reliability estimates. High intra- and inter-class correlation coefficients (0.83-0.99) were obtained for all measures and the semi-automated measurements were highly correlated with traced volumes. Brain, CSF and specific lesion volumes were significantly correlated with neuropsychological functions. In models using only total hyperintensity volumes, the effects of lesion compartments (such as thalamic) were masked. Simultaneous quantification of atrophy and anatomically distinct hyperintensities is important for understanding cognitive impairments in dementia.

Aged↗