Intermittent lumbar drainage with functional testing in the diagnosis of normal-pressure hydrocephalus.
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Adult↗
Biomedical subjects
R I Naugle
Publications and source records attributed to R I Naugle.
Comparability of the expanded WMS-III standardization protocol to the published WMS-III among right and left temporal lobectomy patients.
We examined whether differences between the expanded standardization protocol (SP) used to derive norms for the final published version (PB) of the Wechsler Memory Scale - Third Edition (WMS-III; Wechsler, 1997a) would result in differences on the Primary Indexes in a neurologic sample. Specifically, we examined the comparability of the performances of 63 patients with temporal lobectomy (TL) who were administered either the expanded SP protocol (n = 33: 22 left TL and 11 right TL) or the PB battery (n = 30: 11 left TL and 19 right TL). Patients who were administered the SP or PB were comparable in terms of age, sex, education, seizure duration, postsurgical seizure status, and Full Scale IQ. Postoperative intervals were significantly longer for the SP group, although correlational analyses demonstrated no significant relationship between postoperative follow-up interval and WMS-III performance. A series of t tests revealed no significant differences on any of the eight Primary Index scores between patients taking the two versions of the WMS-III for either left or right TL groups. Furthermore, repeated measures analyses of variance failed to show significant differences on modality-specific memory scores between the SP and PB for the left and right TL groups. The current study indicates that temporal lobectomy patients obtained comparable scores on the two versions of the WMS-III.
Adult↗
Does presurgical IQ predict seizure outcome after temporal lobectomy? Evidence from the Bozeman Epilepsy Consortium.
PURPOSE: Considerable debate exists concerning whether the presence of low preoperative IQ should be a contraindication for focal resective epilepsy surgery. METHODS: We examined the relationship between baseline IQ scores and seizure outcome in 1,034 temporal lobectomy cases from eight epilepsy surgery centers participating in the Bozeman Epilepsy Consortium. RESULTS: Those patients who continued to have seizures following surgery had statistically lower preoperative IQ scores than those who were seizure-free (p < 0.009), but only by 2.3 points. This small but statistically significant relationship was fairly robust; it was observed across seven of the eight centers, and indicates that the findings can be generalized. Among patients with IQ scores of < or = 75, 32.8% continued to have seizures following surgery, whereas 23.8% and 16.9% were not seizure-free when IQ scores were between 76 and 109 and > or = 110, respectively. Relative risk analyses revealed no significant increase in risk among patients with low IQ scores who had no structural lesions other than mesial temporal sclerosis. However, patients with IQ scores of < or = 75 had nearly a fourfold (390%) increase in risk for continued seizures as compared with those with higher IQ scores if structural lesions were present. CONCLUSIONS: While our results suggest that preoperative IQ scores alone are not good predictors of seizure outcome and should not be used to exclude patients as potential surgical candidates. IQ scores can be useful for counseling patients and their families concerning the relative risks of surgery.
Comorbidity↗
Evaluation of two brief and reliable estimates of the WAIS-R.
Performance of 200 mixed neuropsychiatric patients on the WAIS-R were compared to the summary scores for Kaufman's Brief Intelligence Test (K-BIT) and a seven subtest short form of the WAIS-R. Correlations between verbal, non-verbal, and composite of the full WAIS-R with the K-BIT were significantly lower than the correlations with the WAIS-R shore form. The percentage of cases on the short forms that fell within 5 points of the full WAIS-R was higher for the seven subtest version of the WAIS-R than the K-BIT. Specifically, Verbal, Nonverbal/Performance, and Composite/Full Scale scores on the WAIS-R short form feel within 5 points for 89%, 74%, and 92% of the cases while on the K-BIT only 52%, 40%, and 50% fell within 5 points.
Adult↗
Empirical methods for assessing meaningful neuropsychological change following epilepsy surgery.
Traditional methods for assessing the neurocognitive effects of epilepsy surgery are confounded by practice effects, test-retest reliability issues, and regression to the mean. This study employs 2 methods for assessing individual change that allow direct comparison of changes across both individuals and test measures. Fifty-one medically intractable epilepsy patients completed a comprehensive neuropsychological battery twice, approximately 8 months apart, prior to any invasive monitoring or surgical intervention. First, a Reliable Change (RC) index score was computed for each test score to take into account the reliability of that measure, and a cutoff score was empirically derived to establish the limits of statistically reliable change. These indices were subsequently adjusted for expected practice effects. The second approach used a regression technique to establish "change norms" along a common metric that models both expected practice effects and regression to the mean. The RC index scores provide the clinician with a statistical means of determining whether a patient's retest performance is "significantly" changed from baseline. The regression norms for change allow the clinician to evaluate the magnitude of a given patient's change on 1 or more variables along a common metric that takes into account the reliability and stability of each test measure. Case data illustrate how these methods provide an empirically grounded means for evaluating neurocognitive outcomes following medical interventions such as epilepsy surgery.
Adult↗
Neurocognitive studies in patients with supplementary sensorimotor area lesions.
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Animals↗
Intracarotid amobarbital procedure as a predictor of material-specific memory change after anterior temporal lobectomy.
Memory testing during the intracarotid amobarbital procedure (IAP) is used extensively to identify temporal lobe surgery candidates "at risk" for developing severe postoperative anterograde amnesia. However, the utility of the IAP in predicting commonly observed material-specific memory deficits has not been thoroughly investigated. We examined the utility of contralateral IAP memory testing, as an index of the functional capacity of the surgical temporal lobe, to predict postoperative material-specific memory changes on the Wechsler Memory Scale-Revised (WMS-R) in patients with left hemisphere speech dominance undergoing left (n = 32) and right (n = 31) temporal lobectomy (TL). Left TL patients who "passed" contralateral IAP memory testing (> or = 68% recognition of memory items) had significantly greater verbal memory decrements than those who "failed" the IAP, presumably as a result of removal of functional tissue. A similar relationship between contralateral IAP performance and visual memory performance was not observed among right TL patients. Thus, the functional adequacy of the tissue to be resected appears to be inversely related to postoperative verbal memory decrement, at least among left TL patients. This relationship is consistent with results of recent studies demonstrating an inverse relationship between verbal memory decrements after left TL and preoperative neuropsychological verbal memory performance, magnetic resonance imaging (MRI) hippocampal volumes, and degree of mesiotemporal sclerosis (MTS).
Adolescent↗
Detection of changes in material-specific memory following temporal lobectomy using the Wechsler Memory Scale-Revised.
To determine the utility of the Wechsler Memory Scale-Revised (WMS-R) in measuring material-specific memory changes, within-subject comparisons of the Verbal-Visual Memory Index discrepancy and discrepancy scores using short-term and delayed Logical Memory and Visual Reproduction subtests from the WMS-R were studied prior to and following temporal lobectomy among 30 patients with left temporal lobectomy, 30 with right temporal lobectomy, and 50 epileptic, non-surgical controls. The groups were matched on age, sex, handedness, age at seizure onset, duration of epilepsy, and presurgical Verbal and Performance IQ; the right temporal group had a higher mean educational level (p <.05). All surgical patients were left hemisphere dominant for speech; those who had persistent postoperative seizures were excluded from study. On retesting, left temporal lobectomy was associated with a marked change in short-term and delayed memory discrepancy scores primarily due to a drop in verbal memory. Right temporal lobectomy was not associated with a drop in visual memory, suggesting that the WMS-R appears to reflect decrements in material-specific memory following left but not right temporal lobectomy. The nonsurgical controls showed increases in both short-term and delayed memory discrepancy scores due to increases in short-term and delayed verbal memory. Relative to these controls, the absence of comparable increases in verbal memory among the right temporal patients suggests that right temporal lobectomy may be associated with risk to verbal memory.
Journal Article↗
Personality inventory responses of males with medically intractable seizures.
The psychosocial adjustment of 50 male patients to intractable seizures was assessed by comparing their responses to a combined version of the Minnesota Multiphasic Personality Inventory (MMPI) and the California Psychological Inventory (CPI) to the responses of 50 medical, psychiatric, or nonclinical controls who denied seizures. The two groups were significantly different (p < .01) on one MMPI and 10 CPI scales. Significant (p < .01) between-group differences were also reflected in 29 of the 704 personality inventory items. Those items were rationally clustered according to content into six conceptually identifiable subscales; 30 additional items with similar content that were significant at the .05 level were added to those subscales. Comparison of subscale scores of an additional 30 seizure and 30 nonseizure subjects using analysis of variance revealed F values that reached statistical significance (p < .05) in four cases and approached significance (p = .07) in another. Applying coefficients derived from discriminant analysis of the first samples correctly classified 99% of the original patients and 85% of the validation subjects. Results reveal a logical, understandable, and largely adaptive response to intractable seizures and offer little support for the concept of a dysfunctional or pathological interictal personality style.
Adaptation, Psychological↗
Prediction of cognitive change as a function of preoperative ability status among temporal lobectomy patients seen at 6-month follow-up.
The relationship between preoperative ability levels and postoperative changes in cognitive function was examined among 23 left (LTL) and 19 right (RTL) temporal lobectomy patients using a battery of memory, language, and visuospatial tasks administered approximately 3 months before surgery and at 6 months follow-up. Higher preoperative performances on the memory and language measures were associated with larger decrements in postsurgical scores among the LTL patients. The RTL group showed no consistent relationship between preoperative ability levels and subsequent postsurgical cognitive changes. Based on the present data, we constructed base-rate tables for the Wechsler Memory Scale-Revised indicating the likelihood of measurable gains or losses in memory as a function of presurgical ability level for patients undergoing LTL. While tentative, these data provide a useful and practical guide for counseling prospective epilepsy patients of the attendant cognitive risks of LTL.
Analysis of Variance↗
Neuropsychological sequelae of stroke as a function of handedness.
The preservation of visuospatial ability relative to verbal ability following right middle cerebral artery stroke was assessed in 19 left- and 19 right-handed male patients who were group-matched on the basis of age, education, and time elapsed since stroke. Analysis of covariance (covarying education) indicated that the left- and right-handed groups were significantly different with regard to the discrepancy between Verbal IQ and Performance IQ, with the left-handed patients showing a smaller difference than the right-handers. These results provide further evidence that sinistrality may be associated with less hemispheric specialization.
Brain Damage, Chronic↗
Limitations of the Mini-Mental State Examination.
The Mini-Mental State (MMS) Examination is perhaps the most frequently used bedside screening measure of cognition of psychiatric and neurologic patients. It represents a formal, more standardized qualitative approach to determining mental status than an unstructured interview. Initial validation efforts comparing MMS scores of psychiatric patients to the results of more informal mental status interviews were very encouraging. Subsequent research comparing the scale to other criteria has suggested some limitations of its use, however. It has been found to overestimate impairments in persons over age 60 and in persons with less than nine years of education. The MMS scale has been reported to be insensitive to cognitive impairments resulting from right hemisphere dysfunction as well as milder forms of cognitive dysfunction irrespective of cortical origin. Case studies that demonstrate its inaccuracy in identifying cognitive impairments in individuals with average and low-average verbal IQs are reviewed. These limitations have far-reaching implications for both research and clinical applications of the measure. Proper use of the MMS requires that the user be aware of instances when the scale is likely to produce misleading data.
Aged↗
Language in Alzheimer's disease.
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Alzheimer Disease↗
Handedness and dementia.
Some researchers have speculated that left-hand dominance is more prevalent among patients suffering from dementia of the Alzheimer's type which began prior to age 65 yr. and that, in those patients, the disease runs a more rapid course. In the present study, seven left-handed dementia patients were matched with seven right-handed dementia patients on the basis of age and years of education and were compared with regard to neuropsychological compromise. While the left-handed group was somewhat more impaired than the right-handed subjects, the difference between the two groups was not statistically significant.
Aged↗
Catastrophic minor head trauma.
The neurologic and neuropsychologic sequelae of Acquired Immune Deficiency Syndrome (AIDS) have received an increasing amount of attention recently. A variety of neurologic disorders are now associated with AIDS or AIDS-Related Complex (ARC). To date, however, there have been no detailed accounts of the behavioral sequelae or course of illness of AIDS/ARC victims who have suffered brain trauma. This paper describes the case of a 39 year old male patient who tested positive for the retrovirus now associated with AIDS/ARC (Human T-Lymphatropic Virus Type III or "HTLV-III") and suffered a closed head injury as a consequence of a physical assault. His course was rapid and his symptomatology more profound than would be expected on the basis of his injury alone. The assault is regarded as a second, catalytic injury and is presumed to derive its pronounced effect from the ongoing neurologic disorder resulting from or associated with the HTLV-III virus. The possible role of head injury in the exacerbation of diffuse and subclinical cortical dysfunction is discussed. Relevant contributions from sports medicine literature and Alzheimer's Disease research are reviewed.
Journal Article↗
The relationship between cortical atrophy and ventricular volume.
Utilizing volumetric measures of brain morphology, the relationship between cortical atrophy and ventricular dilation was examined in a sample of 59 Alzheimer's Disease patients and 48 closed head injury patients. Correlation matrices were constructed and factor analyses performed in order to elucidate the various relationships. In the Alzheimer Disease sample there appeared to be a moderately strong relationship between cortical atrophy and ventricular volume. However, analyses also lent support to the position that cortical atrophy and ventricular dilation reflect processes which are related yet somewhat independent. Results obtained from the closed head injury sample indicated that focal damage effects were more evident in cortical atrophy measures, while generalized effects were relatively more important in ventricular dilation. Finally, the relationships between neuropsychological performance and various combinations of high and low cortical atrophy and ventricular volume measures were modest.
Adolescent↗
Neuropsychological signs of asymptomatic carotid stenosis.
Several investigators have reported cognitive deficits associated with symptomatic carotid artery disease. This paper reports the findings of a study investigating cognitive deficits associated with asymptomatic carotid stenosis. Experimental subjects consisted of six patients who, in the course of routine physical examinations, showed carotid bruits and, on carotid ultrasound studies, showed 70% or greater stenosis in one or both arteries. No clinical symptoms had been associated with that stenosis. Six control subjects who were group-matched in terms of age and years of education were drawn from a control group evaluated previously for comparison with a transient ischemic attack (TIA) sample. All patients received a battery of tests consisting of a Wechsler Adult Intelligence Scale-Revised, abbreviated Halstead-Reitan Neuropsychological Battery, Revised Wechsler Memory Scale, and a written word fluency measure. Findings were converted to Rating Equivalents according to standard guidelines and an average Impairment Index was computed for each subject. ANOVA revealed that the two groups were significantly different in terms of the average Impairment Index. The clinical significance of these findings is discussed and implications for future research are reviewed.
Journal Article↗
Neuropsychological characteristics and atrophic brain changes in senile and presenile dementia.
Groups of presenile (n = 41) and senile (n = 97) dementia patients were compared on neuropsychological measures and volumetric estimates of atrophy and ventricular enlargement as depicted on computerized axial tomography. Despite their significantly greater age, the senile patients were not markedly significant different on neuropsychological measures when the effect of education was covaried. Likewise, there were no significant differences between the two groups in terms of cortical atrophy despite that variable's known relationship with age. Ventricular size was not significantly different between groups when age effects were statistically controlled. It is concluded that the pathologic effects of presenile dementia are roughly equivalent to the total of the effects of both the disease and aging processes in senile dementia. Therefore, the disease appears to be more dramatic when it occurs in younger patients. It may be that younger patients are less healthy than older patients presenting with the disease and, consequently, are less able to withstand its effects. The present sample is compared with those of other studies reporting a markedly more pathologic presentation associated with presenile relative to senile dementia.
Journal Article↗