Biomedical subjects

R H Benedict

Publications and source records attributed to R H Benedict.

At least 19 recordsLinked to original sources

PubMed2001

Fluid-attenuated inversion recovery magnetic resonance imaging detects cortical and juxtacortical multiple sclerosis lesions.

BACKGROUND: Autopsy studies showed cortical and juxtacortical multiple sclerosis (MS) plaques. Fluid-attenuated inversion recovery (FLAIR) is an advanced magnetic resonance imaging sequence that reveals tissue T2 prolongation with cerebrospinal fluid suppression, allowing detection of superficial brain lesions. OBJECTIVES: To assess FLAIR, T1-weighted, and T2-weighted images for detecting lesions in or near the cerebral cortex in patients with MS and to explore the relation between cortical lesions and cortical atrophy. DESIGN, SETTING, AND PATIENTS: Cross-sectional study in a university MS clinic of 84 patients with MS and 66 age-matched healthy controls receiving 1.5-T fast FLAIR, T2-weighted, and T1-weighted images. MAIN OUTCOME MEASURES: Regional cortical atrophy was rated vs controls. Cortical and juxtacortical lesions were ovoid hyperintensities involving the cortex and/or gray-white junction. RESULTS: A total of 810 cortical and juxtacortical lesions were seen by FLAIR in patients (mean, 9.6 per patient), most commonly in the superior frontal lobe. Cortical and juxtacortical lesions were identified in 72 patients and 6 controls. Fourteen percent of cortical and juxtacortical lesions were seen on T1-weighted images and 26% were seen on T2-weighted images. More cortical and juxtacortical lesions were present in secondary progressive disease than relapsing-remitting disease. The total number of cortical and juxtacortical lesions correlated significantly with disease duration and the regional number correlated with the degree of regional atrophy. After taking into account noncortical (white matter) lesions, only the cortical and juxtacortical lesion count predicted atrophy in that region. CONCLUSIONS: FLAIR can detect many cortical and juxtacortical lesions in MS, which were appreciated previously in autopsy studies but usually missed by magnetic resonance imaging during life. Cortical and juxtacortical plaque formation may contribute to cortical atrophy in MS.

Adult↗

PubMed2001

Regional brain atrophy is associated with physical disability in multiple sclerosis: semiquantitative magnetic resonance imaging and relationship to clinical findings.

OBJECTIVE: Brain atrophy may occur early in the course of multiple sclerosis (MS) and may be associated with disability. Brain magnetic resonance imaging (MRI) of 114 MS patients (group A) were analyzed for regional atrophy (vs age-/gender-matched controls) and T1 and T2 lesions using 4-point rating systems. Thirty-five separate patients (group B) were analyzed for cortical atrophy (ordinal scale), third ventricular width, and total T2 hyperintense lesion volume (computer assisted). In group A, regression modeling indicated that inferior frontal atrophy (P = .0003) and T2 lesions in the pons (P = .02) predicted physical disability (Expanded Disability Status Scale [EDSS] score). Secondary progressive (SP) versus relapsing patients were predicted by inferior parietal (P = .002), superior parietal (P = .006), temporal (P = .008), inferior frontal (P = .01), superior frontal (P = .01), cerebellum (P = .01), occipital (P = .01), and midbrain (P = .02) atrophy. SP patients were also predicted by total atrophy (P = .01) and third ventricular enlargement (P = .03) but not T1 or T2 lesions. In group B, the regression model predicting EDSS score included only superior frontal atrophy (r = 0.515, P = .002). Mean kappa coefficients of ordinal ratings were 0.9 (intraobserver) and 0.8 (interobserver). Ordinal ratings correlated well with quantitative assessments. The authors conclude that brain atrophy is closely associated with physical disability and clinical course in MS patients and can be appreciated using a semiquantitative MRI regional rating system.

Adult↗

PubMed2001

Personality disorder in multiple sclerosis correlates with cognitive impairment.

Previous studies of personality change in multiple sclerosis (MS) relied on brief, nonstandardized assessments or tests that are confounded with symptoms of acute psychiatric disorder. Objectives of the present study were to evaluate character change in MS by using comprehensive trait measures of personality and to determine if there is an association between personality change and cognitive dysfunction. Thirty-four MS patients and 14 healthy volunteers were studied. All underwent comprehensive neurologic and neuropsychologic evaluation. Personality assessments included both self and informant reports on the Hogan Empathy Scale and the NEO Personality Inventory. Abnormalities were found among MS patients indicating elevated neuroticism and reduction in empathy, agreeableness, and conscientiousness. Large patient/informant discrepancies were observed in the MS but not the control group. Three neuropsychological tests emphasizing executive control predicted the presence of these abnormalities; this association suggests a neurogenic, frontal lobe syndrome.

Adult↗

PubMed2001

Evaluation of practice effects in language and spatial processing test performance.

Recent research demonstrates that practice effects are attenuated through the administration of alternate-form memory tests. However, little is known about the degree of practice that can be expected when alternate forms of nonmemory tests are administered repeatedly. Two groups of healthy older adults were assigned to either a same- or alternate-forms condition. Participants completing the same forms of a confrontation naming task improved significantly over 4 testing sessions. On verbal fluency, participant performance significantly improved when completing only alternate forms. No significant practice effects were observed on tests of spatial processing. Practice effects caused by item-specific practice may be reduced via alternate test forms. However, similar reductions will be less apparent when practice effects are the result of test-specific practice.

Aged↗

PubMed2000

Neuropsychological counseling improves social behavior in cognitively-impaired multiple sclerosis patients.

We studied the effectiveness of a newly-developed cognitive-behavioral intervention in 15 patients with marked cognitive impairment and behavior disorder. The design was a single-blind test of a neuropsychological intervention, with pre- and post-treatment assessments of personality and social behavior. MS patients underwent neurological examination and neuropsychological testing at baseline. The patients were then randomly assigned to neuropsychological counseling or standard, non-specific supportive psychotherapy. The active 12-week treatment emphasized enhancement of insight through education, social skills training, and behavior modification. All patients were re-examined within 2 weeks of the termination of treatment. Neuropsychological technicians were blind to treatment condition. Both groups showed evidence of cognitive impairment and personality/behavior disorder prior to treatment and were well matched on demographic, disability, and cognitive measures. Patients who underwent neuropsychological counseling showed significant positive response on measures of social behavior (e.g. excessive ego-centric speech) compared to those who underwent standard counseling. We conclude that these data support the use of non-pharmacological, neuropsychological counseling in patients with acquired, MS-associated behavior disorder.

Adult↗

PubMed1999

Construct and concurrent validity of the Hopkins Verbal Learning Test-revised.

The present investigation examined the validity of the revised Hopkins Verbal Learning Test (HVLT-R). In a principal components analysis with varimax rotation, measures of new learning and delayed recall loaded on a single factor distinguishable from measures related to general cognitive function and visual memory. The HVLT-R also correlated most strongly with other tests of verbal memory and relatively weakly with a test of general intelligence. Group comparisons showed that normal controls performed better than age- and education-matched patients with probable Alzheimer's disease (AD) or vascular dementia (VaD). Discriminant function analyses and Bayesian statistics revealed high classification accuracies for dementia patients versus controls. When scores on the HVLT-R and other neuropsychological tests were subjected to discriminant function analyses, performance on the HVLT-R delayed recognition task was found to be the most useful in discriminating patients with AD from those with VaD. We conclude that the HVLT-R is a valid test of verbal learning and memory that is best suited for use with elderly patients suspected of dementia.

Aged↗

PubMed1999

A preliminary study of the association between changes in mood and cognition in a mixed geriatric psychiatry sample.

The relationship between measures of mood state and cognitive function was investigated in a sample of geriatric psychiatry inpatients. All were admitted to an urban hospital with varying degrees of cognitive impairment. Patients with diminishing negative affects and depressive symptoms during the course of hospitalization improved significantly on three cognitive tests, and half of the group members were no longer impaired according to their performance on a mental status exam. Correlations between cognition and mood-scale change scores were significant on tests emphasizing spatial processing and learning. Although the effects were modest in this heterogenous sample, the data demonstrate a significant influence of changing mood state on neuropsychological test performance.

Affect↗

PubMed1998

Functional neuroimaging of attention in the auditory modality.

Previous functional neuroimaging studies of attention have emphasized the visual modality. We developed an auditory version of the continuous performance test (CPT) that included simple, focused and divided attention conditions. Positron emission tomographic (PET) scans were acquired during CPT performance in normal young adults and then submitted to statistical parametric mapping. Simple attention brought about a large region of activation involving the anterior cingulate gyrus and the right anterior/mesial frontal lobe. Focused and divided attention CPT conditions were compared but there were few significant differences. The findings are consistent with activation of an anterior attention network during auditory attention, without involvement of posterior attention structures which are more likely to vary in accordance with sensory modality.

Acoustic Stimulation↗

PubMed1998

Acquired oral reading vocabulary following the onset of amnesia in childhood.

While the neuropsychological literature includes few cases of child-onset amnesia, 2 previous case studies suggest that these patients may be able to learn new information of a semantic or academic nature. The previous studies were, in large part, based on neuropsychological testing performed during adulthood and a retrospective review of academic achievement test scores during childhood. We present patient A.C., who acquired severe anterograde amnesia at age 10 years but demonstrated average levels of performance on tests of reading, spelling and arithmetic upon examination at age 19 years. Episodic and semantic memory test scores were severely impaired, but near normal performances were found on tests of implicit and procedural memory. In a prospective study, A.C. learned to read new irregular and pseudowords and retained this learning over a 1-month period, similar to the performance of age-matched controls. This demonstration of postmorbid, acquired oral reading vocabulary supports a previous conclusion that oral reading can progress in childhood following the onset of severe anterograde amnesia. The data also suggest that this new learning probably reflects nondeclarative memory processes rather than preservation of semantic memory, as was proposed in an earlier case study.

Amnesia↗

PubMed1998

Practice effects during repeated administrations of memory tests with and without alternate forms.

Previous research indicates that practice effects are large with repeated versions of memory tests. In contrast, administrations of the same tests using alternate forms typically yield much smaller practice effects. However, most studies do not compare alternate- and same-form conditions directly, and differ widely in terms of test-retest interval, modality of stimuli (verbal, spatial), format of the memory test, and number of examinations. The present study investigated practice effects during repeated administrations of verbal and nonverbal memory tests which have the same administration format. Two groups of healthy participants, matched for age, education, estimated IQ, and baseline memory test performance, were assigned to either a same- or alternate-forms condition. Participants taking the same form every two weeks improved significantly over four sessions. Participants completing alternate forms of the nonverbal memory test produced a small practice gain, but the verbal memory test was resistant to practice effects when alternate forms were used.

Aged↗

PubMed1998

Normative data for equivalent, parallel forms of the Judgment of Line Orientation Test.

The Judgment of Line Orientation Test (JLO; Benton, Hamsher, Varney, & Spreen, 1983) permits assessment of visuospatial processing without making demands on motor skills. However, its administration can be time-intensive and frustrating for patients, particularly when used in a geriatric population. We present a single set of normative data to be used for both the odd-item and even-item forms derived from Form V of the JLO based on responses from a healthy geriatric sample. Mean scores and distributions of odd-item and even-item forms were nearly identical, and both forms showed significant correlations with the Developmental Test of Visual- Motor Integration. Cross-validation using the odd form of the JLO on an independent sample from a different geographic location suggested good generalizability of the normative data. We conclude that these JLO short-form normative data may be used in clinical screening situations or when serial assessments are needed.

Aged↗

PubMed1998

Occurrence and predictors of short-term mental and functional changes in older adults undergoing elective surgery under general anesthesia.

The authors studies the cognitive, affective, and functional status of 172 mentally healthy patients, age 55 and older, who were undergoing elective surgery under general anesthesia. Patients were interviewed before and after surgery; this report focuses on changes 1 month postoperatively. Authors compared the mental status and function of 190 nonsurgical patients of comparable age. Surgical patients showed a temporary functional decline. Linear regression predictors of affective, cognitive, and functional change at follow-up included demographics, baseline measures of mental status and function, surgery type, and intraoperative measures. Longer duration of anesthesia--but not type of surgery--predicted short-term decline in activities of daily living but not cognition or affect. Authors discuss results in the context of previous findings in which surgery had no impact on mental status or function at 10-month follow-up.

Activities of Daily Living↗

PubMed1997

Slowed reaction time during a continuous performance test in children with Tourette's syndrome.

The phenomonology of Tourette's syndrome (TS) not only includes tics but also apparent deficits in attention. These attentional deficits in TS likely involve anomalies in frontal-striatal circuits. In this study, performance of 22 boys with TS and 22 age-matched boys without TS was compared on a continuous performance test (CPT) of attention. TS children demonstrated a normal capacity for discriminating targets from nontargets during the task, but showed significantly slower reaction times than controls. Severity of complex vocal tics was predictive of reaction time performance. Possible explanations for these findings are discussed and include the presence of attentional difficulties in TS, interference associated with tic suppression, a conservative strategy taken by TS children, and a general impairment of motor performance.

Adolescent↗

PubMed1997

Neuropsychological predictors of adaptive kitchen behavior in geriatric psychiatry inpatients.

This study examined the degree to which demographic variables, psychiatric diagnosis, depression rating, and neuropsychological test performance predict adaptive kitchen behavior in geriatric psychiatry patients and normal elderly volunteers. Amixed group of 27 participants including 8 normal volunteers and 19 geriatric psychiatry inpatients underwent psychiatric evaluation, neuropsychological testing, and a kitchen skills assessment conducted in a natural setting. Both depression and dementia were prevalent among patients. The kitchen skills assessment was abnormal in 69% of patients, compared to none of the normal volunteers. Estimated premorbid IQs, psychiatric diagnosis, and neuropsychological test scores significantly predicted the pass/fail status on the kitchen skills assessment, but there was no effect for age, education, gender, or depression. The discriminant function analysis classified 92% of cases, and the canonical correlation coefficient was .84. Of the neuropsychological tests employed in the study, two tests involving visuospatial processing and attention were retained in the discriminant function analysis. The results are consistent with previous studies that suggest that visuospatial tasks are more predictive of instrumental activities of daily living than are cognitive tasks emphasizing verbal and memory abilities. In addition, we conclude that neuropsychological test data are useful and valid for the purpose of guiding clinical judgments regarding activities of daily living in geriatric psychiatry patients.

Activities of Daily Living↗

PubMed1996

Neuroimaging criteria for vascular dementia.

OBJECTIVE: To examine published imaging criteria that separate cranial computed tomographic (CT) scans into grades of increasing support for a diagnosis of vascular dementia (VaD). DESIGN: Patients were divided into 4 grades of increasing extent of vascular lesions on CT. The frequency of VaD was compared between these grades. SETTING: A university department of neurology. PATIENTS: Forty-two consecutive patients who underwent neuropsychological assessment for possible dementia and who had a CT scan performed within 6 months following any stroke causing dementia. Patients with delirium, severe aphasia, and motor and/or sensory deficits that impaired neuropsychological testing and patients with mass lesions or nonvascular white matter disease shown on CT were excluded. MAIN OUTCOME MEASURE: The National Institute of Neurological Disorders and Stroke and the Association Internationale pour la Recherche et l'Enseignement en Neurosciences criteria for probable VaD. RESULTS: The frequency of VaD was greater in patients with grade 1 (7 [50%] of 14, P = .01), grade 2 (2[50%] of 4, P = .2), and grade 3(7[78%] of 9, P = .002) scans than the frequency of VaD with grade O scans (1[7%] of 15). There was a linear association of the frequencies of VaD between imaging grades (P = .0008). In a subgroup of patients with neuropsychological deficits caused by cerebrovascular disease, there was a linear association of the severity of the deficits between imaging grades (P = .007). CONCLUSIONS: We conclude that our criteria can separate CTs into increasing levels of support for a diagnosis of VaD. The extent of vascular lesions on CT reflects the severity of associated neuropsychological deficts.

Adult↗

PubMed1996

Short-form alternatives to the Judgment of Line Orientation Test.

The Judgment of Line Orientation Test (JLO; Benton, Hamsher, Varney, & Spreen, 1983) is frequently used as a motor-free method of evaluating visuospatial processing but can be time-consuming to administer. We investigated the internal consistency, validity, and utility of two parallel JLO short forms in a mixed clinical sample of 386 patients. Mean scores were equivalent, and correlational analyses supported the internal consistency and validity of both short forms. When compared to the standard JLO, the odd- and even-item short forms demonstrated good sensitivity, specificity, overall hit rate and predicted positive and negative accuracy. We conclude that the JLO short forms possess sufficient internal consistency, validity, and utility for serial assessment in research studies. The JLO short forms may potentially be used in clinical screening situations by applying a single cut-off score to differentiate levels of performance. However, more detailed clinical use of these JLO short forms will necessitate collection of normative data in order to generate accurate percentile rankings.

Adolescent↗

PubMed1994

Cognitive function after open-heart surgery: are postoperative neuropsychological deficits caused by cardiopulmonary bypass?

Despite the many technological developments in arterial perfusion and cardiac surgical procedures, open-heart surgery is still believed to pose a significant risk for cerebral injury. There are several potential causes of brain damage during open-heart surgery, including prolonged or severe arterial hypotension, as well as emboli emanating from the cardiopulmonary bypass circuit or the operative field. This article reviews the available neuropsychological studies of outcome following cardiac valve replacement and coronary artery bypass grafting. Because both procedures are life-saving operations, the research in this area has been quasi-experimental and fraught with methodological problems. Nonetheless, the findings converge to suggest that cognitive dysfunction occurs after open-heart surgery, and that the deficits are attributable, at least in part, to factors specific to the operation or to the patient being maintained on cardiopulmonary bypass. Preliminary findings suggest that embolization is the primary cause of perioperative deficits in uncomplicated operations. Studies have also consistently found preoperative deficits in this population, suggesting that neuropsychological dysfunction is caused by severe chronic cardiac disease as well as open-heart surgery.

Aged↗

PubMed1994

Effects of attention training on information processing in schizophrenia.

This study evaluated the impact of a cognitive retraining intervention designed to enhance the attention skills of schizophrenia patients. The dependent variables included measures of perceptual sensitivity and sustained vigilance derived from a visual continuous performance test, as well as visual span of apprehension and world-list recall. Sixteen subjects received approximately 15 hours of repeated practice with computer-mediated vigilance tasks. Seventeen subjects were assigned to a no-treatment control group. All subjects were rated on measures of negative and positive symptoms before treatment. Despite improved performance on the training tasks, no significant changes on the outcome measures were observed following treatment. Thus, it is suggested that cognitive rehabilitation interventions with schizophrenia patients stress the teaching of behavioral strategies that bypass deficits, rather than remediating deficiencies in basic abilities, such as attention.

Adult↗