Biomedical subjects

W Mittenberg

Publications and source records attributed to W Mittenberg.

At least 19 recordsLinked to original sources

PubMed2001

Identification of malingered head injury on the wechsler adult intelligence scale - 3rd edition.

Head injured patients show an IQ subtest pattern that can be discriminated from the profile produced by individuals who attempt to malinger intellectual decline due to head trauma. The current paper demonstrates that previously replicated methods for making this discrimination on the WAIS - R generalize to the WAIS - 3. The discriminant function equation accurately classified 83% of nonlitigating head-trauma patients with documented injuries and 72% of persons simulating intellectual impairment due to head trauma. A total of 45% of litigating mild head-trauma patients with purported intellectual decline but no documented loss of consciousness, hospitalization, or CT abnormality were classified as malingering by the discriminant function. A Vocabulary-Digit Span difference score provided 71% overall diagnostic accuracy, and may be informative when screening profiles by visual inspection or when complete WAIS - 3 results are unavailable.

Adult↗

PubMed2001

Treatment of post-concussion syndrome following mild head injury.

Approximately 38% of patients who sustain head trauma characterized by a brief disturbance of consciousness and clinically unremarkable neuroradiologic findings meet International Classification of Diseases 10th edition (ICD-10) diagnostic criteria for postconcussion syndrome (PCS). Physicians treat a majority of cases with nonsteroidal analgesics or antidepressants, and refer about 40% for psychological consultation. Psychological treatment typically involves education, reassurance, and reattribution of symptoms to benign causes. A review of controlled treatment outcome studies conducted over the past 2 decades in Scandinavia, Great Britain, Canada, and the United States suggests that early single session treatment can prevent the syndrome as effectively as traditional outpatient therapy. Several standardized, empirically supported treatment manuals are available.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMed2001

Practices in forensic neuropsychology: perspectives of neuropsychologists and trial attorneys.

Members of the National Academy of Neuropsychology and the Association of Trial Lawyers of America were surveyed concerning current practices in forensic neuropsychology. The majority of neuropsychologists and attorneys reported that attorneys never observe neuropsychological testing. Attorneys reported receiving raw data in almost all of their brain injury cases, but neuropsychologists reported that they produce raw data in only a minority of their forensic cases. Similarly, fewer neuropsychologists than attorneys acknowledged that they are asked to provide information to assist the lawyer in preparing for the cross-examination of the opposition's expert or to prepare the plaintiff for the opposition's evaluation. Lawyers typically spend up to an hour preparing their clients for neuropsychological evaluations and commonly cover test content, detection of malingering, and brain injury symptoms. Other topics addressed include attorney influence on findings, fees and billing, board certification, use of technicians, and methods used to generate referrals or locate experts. Areas of agreement and divergence between the groups were identified and ethical issues raised by identified practices were examined.

Journal Article↗

PubMed2000

Prospective study of the MMPI-2 correction factor after mild head injury.

Gass (1991) proposed a correction factor composed of 14 MMPI-2 items that were characteristically endorsed by patients with closed-head injury. Their frequency of occurrence suggested that the items reflected the neurological rather than emotional consequences of head injury. The current study was designed to evaluate the interpretive significance of correction factor items after mild head trauma. Patients were examined immediately upon hospitalization and followed prospectively for at least 3 months. Correction factor items were endorsed more frequently during acute hospitalization than in the MMPI-2 standardization sample. At follow-up, none of the items were endorsed more often by patients with chronic mild head injury than by uninjured controls. These results suggest that the correction factor is sensitive to the acute neurological consequences of mild head trauma, but that these symptoms can typically be expected to resolve. Chronic endorsement of the items in this population is therefore most likely related to psychological factors.

Adult↗

PubMed2000

Diagnosis of mild head injury and the postconcussion syndrome.

Mild head injuries can cause acute transient cognitive inefficiency that typically resolves within 3 months. Postconcussion syndrome may initially be related to acute cerebral dysfunction but can also arise as a psychological consequence of head trauma. The syndrome persists beyond 3 months in a significant number of patients with mild head trauma as a psychological disorder. International Classification of Diseases diagnostic criteria for postconcussion syndrome are currently recommended for clinical purposes. These criteria are contrasted with research diagnostic criteria used in the Diagnostic and Statistical Manual of Mental Disorders. The differential diagnosis of persistent cognitive and postconcussive symptoms in forensic practice is reviewed.

Brain Concussion↗

PubMed2000

Stereoscopic visual impairment in vascular dementia.

Binocular depth perception is mediated by neural pathways that involve thalamic nuclei, the posterior parietal lobe and adjacent gyri, and white matter projections connecting these regions. Vascular dementia results from a variety of pathologic syndromes that can affect these areas, and in the current study is shown to produce associated impairment of stereoacuity or complete stereoblindness. Stereoacuity was relatively more impaired by right than left hemisphere pathology, by cortical than subcortical vascular processes, and by lesions that involved the parietal lobe. The extent of impairment was related to dementia severity as reflected by measures of intelligence, memory, and visual-spatial function. Stereoacuity was unimpaired in age-matched patients with depressive disorders.

Journal Article↗

PubMed1999

Diffuse Lewy body disease: clinical, pathological, and neuropsychological review.

The pathophysiological etiologies and clinical presentations of neurodegenerative dementias have been found to be complex and heterogeneous. Recently, Lewy body inclusions have been identified as an etiological factor in 20-34% of autopsied dementia cases. The term diffuse Lewy body disease (DLBD) is generally accepted as the diagnostic term representative of this currently under-reported and under-recognized disease. This article reviews the literature on the clinical, pathological, and neuropsychological features of this disorder. Differential diagnostic issues are discussed as well as current pharmacological treatment. Nine confirmed cases of DLBD are presented to demonstrate the various features of this disorder. The diagnostic implications of neuropsychological examination results are discussed in relation to other common dementing neurologic diseases.

Aged↗

PubMed1999

Postconcussion syndrome following sports-related head injury: expectation as etiology.

Mild head trauma is often complicated by a persistent set of symptoms known as postconcussion syndrome (PCS). Past research has suggested that an expectancy-guided, retrospective-recall bias may account for much of the variance in PCS symptom reporting. The present study examined the influence of symptom expectations on mild head trauma symptom reports among participants in contact sports. Head-injured athletes reported symptom rates that did not differ from those of uninjured athletes but consistently underestimated the preinjury incidence of symptoms. Athletes with no head trauma history overestimated the expected degree of pre- to postinjury change in symptom status. Results suggest that individuals with mild head injury tend to overestimate postconcussion symptom change in a manner consistent with their symptom expectations. A cognitive-behavioral model that explains the persistence of PCS is proposed.

Adolescent↗

PubMed1999

Astereopsis caused by traumatic brain injury.

Impaired depth perception (astereopsis) has been observed in a variety of cerebral pathologies affecting the posterior parietal lobe. In the current study of 93 consecutive head trauma admissions, 24% had complete astereopsis and 41% performed more than 2 SDs below the orthopedic control group mean. Degree of impairment was related to Glascow Coma Scale score, length of posttraumatic amnesia, reduced visuospatial and memory abilities, and the presence of intracranial pathology of the parietal lobes. Impairment was also related to trauma severity in patients without any visualized intracranial pathology, presumably due to diffuse axonal shearing. Clinically meaningful impairment was observed in 25% of this group; 10% had complete astereopsis. Stereoacuity screening requires 1 to 2 minutes. Undetected astereopsis may increase risk for subsequent motor vehicle accidents or falls.

Journal Article↗

PubMed1998

Bias in the use of standard American norms with Spanish translations of the Wechsler Memory Scale-Revised.

Although most clinicians would readily agree that there is a need for Spanish translations and normative samples of major psychological tests because of the large number of individuals within the United States whose primary language is Spanish, there are in fact few well normed tests applicable to the Spanish-speaking client in the U.S. As a result, many clinicians administer cognitive tests normed on English-speaking American populations translated into Spanish, then interpret the test results using the standard American norms. The argument is generally made that such a procedure is a reasonable approximation and when cautiously interpreted can be useful. The present study investigated the impact of this practice by using the Wechsler Memory Scale-Revised (WMS-R) on Spanish-speaking adults. A group of 50 normal Hispanic Americans aged 25 to 34 years were administered the WMS-R translated into Spanish. Results showed that using English-language standard norms resulted in Spanish-speaking normal individuals getting scores an average of 1 standard deviation below "average." These findings were present not only for verbal but for nonverbal tests as well. Based on these results we strongly argue against the clinical practice of using translations of English language tests without renorming and running new validity tests.

Adult↗

PubMed1998

Brief cognitive behavioral interventions in mild traumatic brain injury.

Postconcussion syndrome is a common and persisting consequence of mild traumatic head injury. The development of treatments for the syndrome has been hampered by a lack of consensus in diagnostic criteria, confusion about the relative contribution of psychological and neurologic etiological factors, and a paucity of controlled treatment outcome studies. In this article, we review the literature relevant to prevention and treatment of persisting postconcussive symptoms. Studies in adults and children suggest that although symptoms may initially have a neurologic basis, the syndrome persists because of psychological factors. Brief psychological treatment appears to significantly reduce the severity and duration of symptoms following mild head trauma. The attribution of persisting symptoms to organic factors conversely appears to be iatrogenic. Potentially useful diagnostic and treatment protocols are outlined.

Journal Article↗

PubMed1997

Postconcussion syndrome occurs in children.

The consensus of evidence published since 1924 suggests that parents report attention deficits, hyperactivity, or conduct disorder after pediatric head injury rather than postconcussion syndrome. In this study, the symptoms reported by children after mild (n = 38) and moderate-severe (n = 27) head trauma were compared to those reported after orthopedic injury (n = 47) and to adults matched for injury severity and chronicity by using a structured interview based on diagnostic criteria for postconcussion syndrome. Pediatric head trauma caused significantly more subjective symptoms after 6 weeks than orthopedic injury. These symptoms were related to head injury severity and the child's anxiety level. When assessed in a similar manner, children report postconcussion syndrome similar to that seen in adults.

Adolescent↗

PubMed1997

Cross-validation of predicted Wechsler Memory Scale-Revised scores in a normative sample of 25- to 34-year-old patients.

Equations for prorating Wechsler Memory Scale-Revised General Memory (GM) and Delayed Recall (DR) index scores ([Woodard and Axelrod, 1995]) were confirmed in the [Mittenberg et al. (1992)] normative WMS-R sample of 50 subjects between the ages of 25 and 34, and confirmed in a separate clinical sample of 30 patients with closed head injury who were age, education, and gender matched with 30 subjects from that normative sample. Predicted GM and DR index scores fell within 6 points of the obtained scores for 98% of the [Mittenberg et al. (1992)] sample and 93% to 100% of the matched head injury and normative samples, despite statistically significant differences between these groups in obtained GM, DR, and percent retention of LM I and II and VR I and II. Six points is well within the standard error of measurement of these index scores. These findings confirm the earlier cross-validation results reported by [Axelrod et al. (1996)] in a mixed sample of traumatic brain injury and other neurological insult, and suggest that this method of estimating weighted score sums for WMS-R General Memory and Delayed Recall indices may be safely used in normative samples of patients in this age range as well as neurologically compromised patients without significantly impacting index score accuracy.

Journal Article↗

PubMed1996

Cognitive-behavioral prevention of postconcussion syndrome.

The symptoms of postconcussion syndrome (PCS) are persistent, and no empirically tested treatment is available. The treatment group (n = 29) in this study received a printed manual and met with a therapist prior to hospital discharge to review the nature and incidence of expected symptoms, the cognitive-behavioral model of symptom maintenance and treatment, techniques for reducing symptoms, and instructions for gradual resumption of premorbid activities. The control group (n = 29) received routine hospital treatment and discharge instructions. Both groups had sustained mild head injuries characterized by Glascow Coma Scale scores of 13-15 on admission without any measurable period of posttraumatic amnesia. Group assignment was random. Groups did not differ significantly on age, Glascow scores, litigation status, gender, or initial number of PCS symptoms. Patients were contacted 6 months following injury by an interviewer who was unaware of group assignment to obtain outcome data. Treated patients reported significantly shorter average symptom duration (33 vs. 51 days) and significantly fewer of the 12 symptoms at followup (1.6 vs. 3.1). Subjects were also asked how often each symptom had occurred in the previous week, and how severe the symptom typically was. The treatment group experienced significantly fewer symptomatic days (.5 vs. 1.3) and lower mean severity levels. Results suggest that brief, early psychological intervention can reduce the incidence of PCS.

Clinical Trial↗

PubMed1996

Identification of malingered head injury on the Halstead-Reitan battery.

Heaton et al. (1978) demonstrated that the performance of malingerers and actual head trauma patients could be distinguished on the HRB by discriminant analysis. The present study replicated Heaton et al.'s methodology on a larger sample to provide a more stable function for discriminating simulated and real head trauma. Malingerers (n = 80) were instructed to fake severe deficits without being obvious. Patients (n = 80) had documented trauma and were not litigating for compensation. Groups were matched on age, gender, and overall Impairment Index to permit comparisons between patterns of performance. A crossvalidated step-wise discriminant function correctly identified 88.75% of the groups, with 83.8% true positives and 93.8% true negatives. This function was applied to several published data sets. Both malingerer and patient groups were accurately identified in Heaton et al. (1978) and Trueblood and Schmidt (1993). Faust et al.'s (1988) adolescent malingerer and the malingered performance of three litigating patients published by Cullum et al. (1991), were also correctly classified.

Journal Article↗

PubMed1995

Cognitive estimation in traumatic brain injury: relationships with measures of intelligence, memory, and affect.

Brain injury is associated with a reduced capcity to engage in effective cognitive estimation. The current study utilized two measures of this construct, the Cognitive Estimation Test (CET) and Luria Memory Test (Luria), to investigate the relationships between cognitive estimation and intelligence, memory, and affect in a sample of 30 traumatically brain-injured individuals. Results demonstrated significant correlations between cognitive estimation and tests of intelligence and memory. However, measures of depression and state anxiety were not meaningfully associated with cognitive estimation. The ability to recall stories accounted for the greatest portion of the variance for both the CET and Luria. Specifically, the 30-minute Logical Memory subtest from the Wechsler Memory Scale-Revised accounted for 38% of the variance in the CET, while the Logical Memory 30-minute savings score accounted for 47% of the variance in the Luria. Intellectual and affective variables explained only negligible amounts of variance on cognitive estimation tasks.

Adult↗

PubMed1994

A survey of treatments for post-concussion syndrome.

A survey of the members of the National Academy of Neuropsychology and the International Neuropsychological Society was conducted on current treatment approaches for post-concussion syndrome. The interventions that were found useful most frequently included education about the effects of head injury, reassurance that the symptoms are part of the normal recovery process, and support in coping with reactions to the symptoms. Graded resumption of activity, antidepressant medication, and cognitive restructuring were also regarded as useful. The relationships between type of treatment, factors contributing to the syndrome, ratings of treatment effectiveness, and duration of treatment were discussed.

Adaptation, Psychological↗

PubMed1994

Impaired depth perception discriminates Alzheimer's dementia from aging and major depression.

Parietal and temporal lesions are known to impair binocular depth perception. Clinically meaningful impairment was therefore suspected due to early degeneration of these regions in Alzheimer's dementia. Results supported the cortical localization described in focal lesion studies. Deficient stereopsis was common in dementia (80%) but relatively uncommon in elderly normals (14%) and major depressives with cognitive symptoms (31%). Performance was unrelated to age, IQ, or severity of cognitive impairment. Testing involves minimal patient effort and time (1-2 min). Stereopsis examination may be useful in the diagnosis of early dementia, and may reduce false positives associated with depression, limited premorbid ability, or normal aging.

Journal Article↗