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Biomedical subjects

J Bleiberg

Publications and source records attributed to J Bleiberg.

At least 19 recordsLinked to original sources
PubMed2006

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.

Adult↗
PubMed2001

Persistent prolongation of simple reaction time in sports concussion.

A baseline computerized cognitive assessment was completed by 483 military cadets before their initial school year. Fourteen cadets concussed during physical education boxing were retested <1 hour after injury and again on return to full activity 4 days later. Compared with baseline testing, postinjury performance on simple reaction time and continuous performance tests was significantly slowed, even after cadets experienced resolution of physical symptoms and were cleared to resume full activity. These findings may be relevant to current concussion management guidelines.

Brain Concussion↗
PubMed2001

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. BACKGROUND: Migraineurs frequently report symptoms of cognitive impairment during migraine. The efficacy of sumatriptan for treatment of migraine-related cognitive impairment is undocumented. METHODS: This open-label, single-attack study of 28 subjects used the Headache Care Center-Automated Neuropsychological Assessment Metrics, a computerized neuropsychological assessment battery, to measure cognitive function under three patient conditions: migraine-free, untreated migraine, and following sumatriptan (primary outcome). Headache response and pain-free response, percent effectiveness, and clinical disability were measured. RESULTS: Cognitive function (simple reaction time, sustained attention/concentration, working memory, visual-spatial processing) and alertness/fatigue were adversely affected during migraine compared with migraine-free performance (P<.05), and rapidly restored following sumatriptan nasal spray, 20 mg (P<.05). Headache and pain-free response were 86% and 68%, respectively, at 135 minutes postdose. Changes in migraine pain severity, clinical disability, and percent effectiveness following treatment with sumatriptan nasal spray, 20 mg, were significantly correlated with cognitive function measures across all subtests (P<.001). CONCLUSIONS: Sumatriptan nasal spray, 20 mg, restored migraine-related cognitive function and clinical disability.

Acute Disease↗
PubMed2001

Delineation of clinical privileges in rehabilitation medicine.

The American Academy of Physical Medicine and Rehabilitation (AAPM&R) in 1995 developed a list of 75 clinical privileges (in laundry-list format) that are typical of physiatric practice. This list has been used by some hospitals as a template for physiatric staff privileging. The National Association of Medical Staff Services has advocated a short list of core privileges, supplemented by a list of highly specialized procedures. To assess current practices in physiatric privileging, we surveyed 35 rehabilitation facilities. Results showed that 66% (20/30) of the respondents were not aware of the AAPM&R recommendations. Furthermore, we found an almost even split between facilities using core (16/30) versus laundry list (14/30) privileges. We also found evidence that the Joint Commission on Accreditation of Healthcare Organizations has recommended both types of approaches to different facilities in the recent past.

Academies and Institutes↗
PubMed2000

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. METHOD: The Headache Care Center-Automated Neuropsychological Assessment Metrics was administered to 10 migraineurs, three times without a migraine, once during a migraine, and three times after administration of sumatriptan injection (6 mg). RESULTS: The results demonstrated a significant drop in cognitive efficiency during migraine and recovery 15 minutes after therapeutic injection. CONCLUSIONS: This pilot study is the first to document a significant drop in cognitive functioning during migraine and recovery after administration of a migraine-specific medication.

Cognition↗
PubMed2000

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.

Adolescent↗
PubMed1999

Repeated measures of cognitive processing efficiency in adolescent athletes: implications for monitoring recovery from concussion.

OBJECTIVE: The objective of this study was to determine whether an adolescent athlete, in the absence of concussion, would be expected to show an improvement in cognitive function during the course of a high school football season. BACKGROUND: At least 60,000 American high school football players suffer cerebral concussion every year, and symptoms may persist for 4 or more years in as many as 24%. METHOD: 34 members of a cohort of healthy athletes, aged 13-18, were administered a computerized neuropsychologic test battery from the Automated Neuropsychological Assessment Metrics (ANAM) before and after the 1997 high school football season, with a mean interval of 16.1 (range 12.3-20.4) weeks between tests. Preseason and postseason scores on eight tests were compared, with significance determined by paired t-test. For those tests in which an improvement was noted, one-way analysis of variance and Wilcoxon tests were used with both preseason and postseason data to determine if there was a measurable difference in cognitive processing efficiency between older and younger subjects. RESULTS: Improvements in processing efficiency (p < 0.001) were noted on tests designed to measure visual scanning and sustained attention (CDS), immediate recall (CDI), and short-term memory (CDD). Older subjects generally performed better on each of these tests, though the difference was significant in only one case (postseason CDI, 17-18 year olds vs. 13-14 year olds, Wilcoxon, p = 0.043). CONCLUSIONS: Our findings suggest that ANAM is sensitive to differences and improvements in cognitive function during a 4 month interval in adolescence. They also suggest that using "return to baseline" cognitive function as the criterion for evidence of recovery from concussion may be insufficient, especially when the baseline measurement was obtained 4 or more months prior to the date of "full recovery."

Adolescent↗
PubMed1998

Future directions for the neuropsychological assessment of sports concussion.

This article argues in favor of using newly developed computerized, complex reaction time (RT)-based neuropsychological procedures for the study of sports-related concussion. Recent studies show that by using these complex RT procedures, significant differences between concussed and control samples can be observed. The magnitude of RT differences is 110 ms or less, levels that are not meaningfully measured with stopwatch-based procedures. RT-based procedures also have the advantage of permitting analysis of variability of RT, and several recent studies have shown that brain dysfunction is accompanied by erratic and inconsistent RT. A currently ongoing sports concussion study using measures of complex RT and variability of RT is described.

Athletic Injuries↗
PubMed1998

Cognitive and physical measures in rehabilitation of patients with lupus.

During the past 2 years, four papers describing new research studies and three papers reviewing the literature were published. These seven papers address longstanding issues, including 1) the presence or absence of cognitive impairment in systemic lupus erythematosus (SLE), 2) the prevalence of such impairment within SLE and related conditions (eg, antiphospholipid antibody syndrome, active vs inactive SLE), 3) the specific pattern of cognitive functions impaired and the possibility of a "lupus-specific" pattern, 4) the etiopathogenesis of cognitive impairments and the potential role of confounding factors such as corticosteroid use or depression, and 5) longitudinal studies examining the course of SLE-related cognitive impairment. The review period also includes two studies using both static and functional neuroimaging to identify the potential relation between neuroanatomic or neurophysiologic abnormalities and cognitive impairment in patients with SLE. No papers specific to Sjögren's syndrome were identified.

Brain↗
PubMed1997

Consistency of within-day and across-day performance after mild brain injury.

The objective of this study was to determine whether inconsistent and erratic within-day and across-day performance is a symptom of mild to moderate traumatic brain injury (TBI), and to determine whether impaired consistency of performance can coexist, in the same patient, with intact or "normal" performance on single administrations of neuropsychological and other cognitive tests. The design was a matched-pair study in which a computerized cognitive test battery was administered 30 times over 4 days to all subjects. Performance patterns between TBI and control subjects were compared. Subjects also received traditional neuropsychological testing. The setting was a rehabilitation hospital outpatient department. The subjects were 12 adult volunteers, six with documented TBI and six with no history of TBI, neurologic illness, or injury. Control subjects showed consistent improvement of performance over days 1 to 4, whereas subjects with TBI showed erratic and inconsistent performance across days. In addition to inconsistent performance, some subjects with TBI showed worsening performance across days. The main outcome measures were performance on the Automated Neuropsychological Assessment Metrics (ANAM) battery and performance on traditional neuropsychological tests. Some patients with TBI in the study who have normal initial performance on traditional clinical neuropsychological tests and newly developed computerized cognitive tests show abnormalities of sustained performance. Such abnormalities are most apparent when performance is observed over multiple days, and are characterized by erratic and inconsistent across-day performance. Inconsistent performance was observed even in those subjects with TBI whose initial performance was equal to or better than that of the control subjects. Deficits in dynamic performance may explain why some patients with TBI who have excellent neuropsychological test performance nonetheless complain of functional decrement from premorbid ability.

Adult↗
PubMed1987

Anticipatory behaviour deficits in closed head injury.

Closed head injured patients demonstrated greater anticipatory behaviour deficit than cerebral vascular accident patients on a shuttlebox-analog avoidance task, even though these two groups did not differ on escape behaviour and on performance on the individual tests of the Halstead-Reitan Battery and Wechsler scales. Neither clarification of instructions, additional trials, nor enhancement of the warning cue appeared to improve the anticipatory behaviour deficit. It was concluded that anticipatory behaviour deficit should be considered a relatively dense deficit that is not identified by standard instruments. Clinical and practical implications are discussed.

Adolescent↗
PubMed1986

Assessment of closed head injury in trauma-related spinal cord injury.

The complete medical records of 122 patients who sustained traumatic spinal cord injuries were reviewed to determine the frequency and results of emergency room assessments for loss of consciousness (LOC) and post-traumatic amnesia (PTA). Eighty-eight percent of the patients were assessed for LOC and 19% were assessed for PTA. Fifty patients (41% of the total population) admitted to LOC, PTA or both. Fourteen of these 50 patients underwent subsequent radiographic examinations of the skull, all of which were negative. Because of the association of intracranial complications and long-term cognitive sequelae with even brief LOC or PTA, early recognition of craniocerebral trauma is an important component of the acute management of spinal cord injured patients.

Adolescent↗
PubMed1985

Closed head injury in spinal cord injured patients: retrospective study of loss of consciousness and post-traumatic amnesia.

Previous studies of trauma-related spinal cord injured patients suggest that 25% to 50% of these patients sustain a concomitant cranio-cerebral trauma. A loss of consciousness (LOC) of 20 minutes' duration or a post-traumatic amnesia (PTA) lasting 24 hours has been associated with deficits in concentration, attention, memory, and higher-level cognitive functions. These may present as significant factors influencing learning and adaptation during and after the formal rehabilitation process. A systematic review was performed of the medical records of 101 trauma-related spinal cord injured patients who were admitted to Northwestern Memorial Hospital and the Rehabilitation Institute of Chicago within seven days of injury. The reported incidence of LOC and PTA in spinal cord injured patients was evaluated, and these data were compared with the level and etiology of injury, and with radiographic work-up, if any, for head injury. Eighty-seven percent of all emergency room admissions and 67% of all rehabilitation admissions were assessed for LOC. Fewer than 25% of all patients in both settings were assessed for PTA. Forty-two percent of all patients reported LOC, PTA, or both occurring simultaneously with the spinal cord injury. Assessment and incidence were unrelated to level of injury but were influenced by etiology. One-third of the patients who reported LOC, PTA, or both underwent further evaluation with computed tomographic (CT) scan or radiography of the skull. Assessment of LOC is conducted more consistently in the ER than in the rehabilitation setting. Assessment of PTA is performed infrequently despite its relevance to the rehabilitation process. Head injury may frequently be associated with traumatic spinal cord injury.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Wheelchair push-ups: measuring pressure relief frequency.

Ischial pressure sores (PS) are a long-recognized complication of wheelchair confinement, yet teaching spinal-cord patients to establish lift-off behavior habitually and permanently remains a challenge. A new device was developed to record automatically and continuously the wheelchair lift-off behavior of spinal-cord injured patients. Data from seven patients who used the device for between 768 and 1800 hours each are reported. The device was used to monitor longitudinally the behavioral compliance of each individual with prescribed lift-off intervals using standard teaching procedures. Wide variability between patients and within patients over time was found. Experimental interventions including the use of an electronic timer and written and oral feedback of the previous day's data also varied in their effectiveness. Data from one patient who developed a pressure sore while being monitored suggest that there is no simple relationship between lift-off intervals and PS formation.

Adult↗
PubMed1985

Cognitive dysfunction and mild closed head injury in traumatic spinal cord injury.

Previous investigators have reported that 25%-50% of traumatic spinal cord injury (SCI) patients sustain loss of consciousness (LOC), posttraumatic amnesia (PTA), or both concurrently with their SCI. A LOC of 20 minutes or less, or a PTA of 24 hours has been associated with prolonged time off work, and deficits in attention, concentration, memory, and judgment. Consequently, many traumatic SCI patients may also be the victims of a concomitant closed head injury (CHI) with cognitive sequelae. To test this hypothesis, a prospective study was conducted of 30 consecutive trauma-related SCI patients admitted to the Rehabilitation Institute of Chicago to determine the incidence of CHI and cognitive dysfunction (CD). The Halstead Category Test (HCT) was administered to each patient between 8 and 12 weeks after injury, and was considered abnormal if the patient committed 51 or more errors. Fifty-seven percent (n = 11) of all patients had abnormal HCT scores suggestive of higher level cognitive dysfunction. Patients with a new CHI had a mean HCT score of 65.2, as compared to 63.5 for patients with a premorbid CHI, and 46.3 for patients without a history of CHI. Although there was a trend toward higher HCT scores in patients who had any history of CHI, these differences did not reach statistical significance. The results of this study suggest that many trauma-related SCI patients are at risk for CD eight weeks after injury. Such cognitive abnormalities would be expected to impede rehabilitation and retard the requisite learning of new skills.

Adolescent↗
PubMed1983

Learning goals during initial rehabilitation hospitalization.

While learning theory and various clinical applications play an increasingly significant role in the design and delivery of rehabilitation services, data to determine the extent that teaching/learning are integral to rehabilitation goals are lacking. Medical records of 20 first admission spinal cord injured patients were analyzed for the proportion of teaching/learning goals, plans, and activities entered by professional disciplines on the rehabilitation team. A classification system for medical chart entries was devised for this purpose. Results indicated that 65% of the total chart entries reflected teaching/learning or attempts to accelerate or decelerate specific behaviors. Across professional disciplines nursing showed the highest proportion of chart entries focused on patient teaching/learning. Present findings support recent trends toward systematic and more sophisticated application of learning theory and technology, and suggest that professional preparation of rehabilitation personnel should include training in how to teach and how to facilitate skill acquisition.

Adolescent↗