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Mental impairment in Parkinson's disease. The role of anticholinergic drugs.

The trial has been carried out on 33 treated Parkinsonian patients and 14 healthy controls. A series of psychometric tests were employed in order to show a possible intellectual deterioration in Parkinsonian patients. Bender's test showed greater motor-perceptive deterioration in Parkinsonian patients respect to control, the Wechsler-Bellevue Intelligence Scale evidenced in patients significant deterioration of mnesic and psychomotor capacity. When considering drug treatments patients undergoing combined treatment or anti-cholinergics alone obtained worse results in all tests made whilst patients on L-Dopa alone obtained the best results.

Aged↗

[Psychometric and electromyographic studies in patients with chronic uremia subjected to periodic hemodialysis].

Twenty-five patients suffering from chronic renal insufficiency and who had been undergoing dialysis for a long time were tested on the Wechsler-Bellevue Intelligence Scale with a control of twenty-five subjects of the same age with a comparable educational and social background. The results of the statistical analysis of the difference between the two groups demonstrates a significant psychological deterioration in the group of uremic patients which was particularly noticeable in the performance test. The rate of deterioration was not significantly related to the duration of the dialysis. At the same time electromyography (motor conduction velocity of the S.P.E. nerve) show in 40% of the uremic patients evidence of neuropathy.

Adult↗

[Personality disorders in adolescents].

The aim of the study was the investigation of symptoms and origin of the disturbances in personality development of adolescents. The group of 50 patients (22 girls and 28 boys aged from 14 to 20 years) of the Young People's Unit and Outpatient Clinic of the Department of Child and Youth Psychiatry of the Institute of Mother and Child in Warsaw were examined. The study consists of the psychiatric, psychological and sociological types of investigation. The following methods were used in the study: the standard methods of the clinical investigation, Wechsler-Bellevue Intelligence Scale, R. B. Cattell, M. Choynowski and M. Nowakowska 's 16 PF; A. Roe and M. Siegelman 's "My Father" and "My Mother" questionnaires; E. S. Schaefer and R. Q. Bell's Parental Attitude Research Instrument and E. Kobia łka's Family Environmental Questionnaire. The control group was formed in the method of pairs and was investigated in the same way as patients. After the detailed analysis of the data, the final conclusions were formed. They are as follows: In the clinical picture of disturbances of the development of patients personality, the conduct disorders prevailed. The suicidal and parasuicidal behaviour occurred in 1/3 of the patients. Also the depressive and other neurotic symptoms took place. The intelligence level was average and dull normal. The following personality features were established: emotional instability, guilt proness , low self- sentiment , high ergic tension (both sexes); protension ( suspection jealous ), shrewdness (girls) and threat sensitive (boys). Patients attitudes toward both parents were disturbed and unfavourable for normal personality development. The declared mothers attitudes toward patients were also unfavourable for development of mature personality. The general family environment (also living standard) was significantly worse in the criterion group. It should be stressed in conclusion, that the results of the study showed among others that the disturbed family hinder the development of adjustment mechanisms, mainly of the adjustment to the small group, which are essential for the normal personality functioning.

Adolescent↗

[The level of various intellectual abilities in patients with vertebrobasilar arterial syndromes].

Several methods such as: Wechsler-Bellevue intelligence scale, memory scale of M. Choynowski, tests of Couve, Bourdon, Piéron, Baley, Graham-Kendall and Benton were used for establishing the level of certain intellectual abilities in patients with vertebrobasilar arterial syndrome. The tested group included 50 patients and a control group was selected which was matched for sex, age, educational level and number. Statistical analysis showed that the level of intellectual abilities in the patients with vertebrobasilar syndrome was lower than in healthy controls and this change was observed in the levels of many parameters of intelligence, memory, attention and visual perception.

Adult↗

[Controlled study of an abbreviated form of the Hamburg-Wechsler Intelligence Test for Adults (HAWIE, Dahl's WIP) in a heterogenous clinical group].

The "reduzierte Wechsler-Intelligenztest für psychiatrische Kranke (WIP)" by Dahl, a short form of the German version (HAWIE) of the Wechsler-Bellevue Intelligence Scale, comprising the subtests Information, Similarities, Picture Completion and Block Design was applied in a replication study to a heterogeneous group of 420 mental patients. Results show a sufficiently high level of agreement (multiple correlation) between the present test and the HAWIE-IQ. With this result and a sample independence of the correlation, two of the requirements of board clinical application of the WIP are met. On the other hand Dahl's assumption that the WIP represents the optimal (quadruple)combination of subtests of the full scale was not confirmed. Criticisms of the WIP in the literature are discussed. On the basis of previous studies and the present investigations it is held that the WIP is a useful contribution to measurement of general ability in a clinical setting.

Adult↗

Sex differences among non-brain-damaged adults on the Wechsler Adult Intelligence Scales: a review of the literature.

We reviewed studies of the performance of non-brain-damaged men and women on the Wechsler Adult Intelligence Scales (i.e., the Wechsler-Bellevue, Wechsler Adult Intelligence Scale, and Wechsler Adult Intelligence Scale-Revised) to determine if there were sex differences on specific test items, on specific subtests, or on Verbal IQ, Performance IQ, or the Verbal-Performance Discrepancy score. There were sex differences on some items of each of the three measures, but the number of such differences was small. A number of studies suggested differences on subtests of these scales. A meta-analysis indicated that females tended to outperform males by about a third of a standard deviation on the Digit Symbol subtest, while males tended to outperform females to the same extent or greater on the Arithmetic and Information subtests. Finally, in the few studies on IQ or discrepancy-score differences, there was no evidence of any consistent differences between the sexes in the Verbal-Performance Discrepancy, although there was some tendency for males to obtain higher Verbal IQs. This review, therefore, does not suggest that there are any major differences between non-brain-damaged males and females on the Wechsler adult intelligence scales.

Brain Damage, Chronic↗

Actuarial assessment of Wechsler Verbal-Performance Scale differences as signs of lateralized cerebral impairment.

Long-standing clinical lore holds that a discrepancy between Wechsler-Bellevue (W-B) Verbal/Performance Scale weighted scores is a more sensitive sign of lateralized brain damage than a discrepancy between Verbal/Performance Scale IQ. To assess this question, two step-wise discriminant functions using W-B Verbal and Performance Scale weighted scores (Function 1) and IQs (Function 2) as independent variables were derived and cross-validated on right- and left-hemisphere-lesioned subjects. Cross-validation hit rates were statistically comparable through disappointingly low (Function 1-67%, Function 2-64%). These results do not support the clinical lore which favors a weighted discrepancy score over an IQ-discrepancy as a sign of lateralized cerebral impairment.

Brain Damage, Chronic↗

[Neuropsychological defects in alcoholics with the withdrawal syndrome].

The aim of the present study was to analyse the correlation between the neuropsychological functioning and the intensity of the recent withdrawal syndrome. The authors compares two groups of alcoholics hospitalized for the acute withdrawal syndrome: of the predelirious character (N = 23) and alcoholic delirium (N = 21). Both groups of patients were treated identically in order to suppress the acute withdrawal syndrome. On the tenth day of the treatment the scores on the Gross Evaluation Scale and the Scale of Medical Risks were identical (p less than 0.01) in both groups of patients. On the fifteenth day of hospitalization, after five days without any psychopharmacological therapy, the patients underwent psychological testing: the Wechsler-Bellevue test, separately for the complete, verbal, and nonverbal scales and the Bender-Gestalt test. Statistically significant differences between the two groups of patients were found in the complete scale (p less than 0.05) and the verbal scale (p less than 0.05) of the Wechsler-Bellevue test, as well as in the subtests of the verbal scale: achievement (p less than 0.05), cognition (p less than 0.05), and concepts (p less than 0.01). These differences may be understood as a result of the intensity of the recent withdrawal syndrome, i.e., the patient just cured of delirium showed more serious disturbances in the complete scale and some subtests of the verbal scale of the Wechsler-Bellevue test.

Alcohol Withdrawal Delirium↗

[Epilepsy and intelligence. II. Correlation among 13 variables].

In a group of 215 ambulatory adult patients the authors assessed links with full-scale IQ, verbal IQ, performance IQ and different Wechsler-Bellevue sub-tests. They revealed marked correlations in particular with the frequency of grand mal seizures, invalidity and the onset of the disease. More important than the close correlation of IQ and education is the finding that an earlier onset of the disease markedly reduces the opportunities of good education. Less marked but still significant are correlations with the known aetiology of the disease, the duration of the disease, the frequency of other seizures than grand mal and the course of the disease. Dramatically increased correlations with the frequency of other seizures than grand mal were recorded in a sub-group of 77 men whose data on the disease can be considered valid (in WPSI, the Washington Psychosocial Seizure Inventory, values of scale L within the range of 0-3). No marked correlations were found with seizures in relatives. The position of bachelors is often adverse also as far as intellectual performance is concerned. Patients with a history of contact with psychiatry have lower intellectual performance. Patients who admit subjective needs of psychiatric or psychological assistance have a markedly better performance. It is probable that rehabilitation procedures which improve the collaboration and adherence to the therapeutic regime, in particular as regards taking prescribed drugs may promote also better cognitive performance.

Adult↗

Relationships between measures of brain functions and general intelligence.

Relationships between measures of general intelligence (Wechsler-Bellevue Verbal IQ, Performance IQ, and Full-scale IQ) and a measure designed to reflect adequacy of brain functions (Halstead Impairment Index) were studied using a control group and groups with left, right and generalized cerebral lesions. The results confirmed earlier findings of (1) differential levels of Verbal and Performance intelligence depending on damage of the left or right cerebral hemisphere; and (2) the greater general sensitivity of the Impairment Index than IQ values to brain damage. Comparative data suggested particularly that IQ values may underestimate brain-dependent adaptive abilities among non-brain-damaged subjects. A significant relationship between IQ values and the Impairment Index was present. This finding permitted evaluation of use of a differing cut-off Impairment Index, as an indicator of cerebral damage, depending on the subject's IQ level. The results suggested that increased accuracy in classifying subjects as brain-damaged might be achieved using a cutting Impairment Index of .4 or greater when the IQ value is 100 or more and .5 or greater when the IQ value is below 100.

Adult↗

Long lasting blindness, availability of resources, and early aging.

The present paper studied the influence of long lasting blindness on processes of aging. It addressed the broader issue of the effects of familiarity with and earlier experience of stress on the capacity of individuals to deal successfully with similar stressful situations at a later point of development. 75 chronically blind men and women, aged 45 to 65, were compared with 75 sighted individuals (matched by age, sex, and cultural origin) on scores on the Shanan Sentence Completion Technique, an interview designed to assess perception of change in various areas of everyday living, and on scores on the Wechsler-Bellevue Intelligence Test. Blind subjects showed less psychological and less social engagement with the outer world. Availability of resources, education, and assistance considerably reduced differences between the nonsighted and sighted subjects. These findings were interpreted as pointing to a potentially preventable process of premature aging.

Adaptation, Psychological↗

Test complexity and brain damage at different educational levels.

This investigation attempted to determine whether the complexity (problem-solving component) of selected tests of the Reitan-Halstead Neuropsychological Test Battery was related to their ability to discriminate groups of brain-damaged and non-brain-damaged adults at different educational levels. Twenty tests from the Wechsler-Bellevue and the Reitan-Halstead Battery were administered to 51 brain-damaged and 51 non-brain-damaged adults at three educational levels (grade school, high school, university). Spearman rank-order correlations were obtained for the relationship of task complexity with global scores that reflected the effects of education and brain damage for each variable and with the differences between group means for each education level. The ability of these measures to discriminate the groups was correlated significantly with problem-solving level, whereas the effects of education were correlated negatively with this dimension.

Adult↗

Using a battery of tests to predict suicide in a long-term hospital: a quantitative analysis.

Examined the Wechsler-Bellevue, Rorschach, TAT and Word Association Tests of 40 Patients for quantitative indications of suicide potential. Ten of these patients had completed suicide, 10 "serious" attempts, 10 "mild" attempts and 10 had never made a suicide attempt. In addition to a study of the quantification of major aspects of the tests, various published hypotheses also were examined. No quantitative aspect of the data differentiated all four groups. When the "completed" and "serious" attempters were compared to the "mild" and "no" attempters, the more lethal patients were found to give more movement responses and more total responses. Those who completed suicide also had a larger difference than others between their Verbal and Performance IQs. Of the published hypotheses, only the Roth & Blatt and Sapolsky hypotheses received significant support.

Hospitals, Psychiatric↗

Clinical-actuarial detection and description of brain impairment with the W-B form I.

Assessed the clinical utility of four cross-validated discriminant functions derived on Wechsler-Bellevue (W-B) variables (Leli & Filskov, 1981) through a clinical-actuarial prediction paradigm. These functions were constructed to be actuarial indices of the presence, chronicity, extent, and lateralization of brain impairment. From W-B and demographic data gathered on brain-impaired and nonimpaired individuals, 6 students and 6 clinicians were asked to identify the presence and describe the nature of brain impairment with (Clinical-Actuarial condition) and without (Clinical Judgment condition) the four functions. Relative to the Clinical Judgment condition, Clinical-actuarial prediction was significantly better in identifying and determining the extent of brain impairment. Actuarial classification was significantly more superior in lateralizing deficits than were the other conditions. In both judgment conditions, students and clinicians did not differ significantly in classification accuracy. These results indicate that with actuarial indices, the adult Wechsler scales can be used accurately to identify and lateralize brain impairment.

Brain Damage, Chronic↗

[In what way can the clinical usefulness of the Wechslers-Bellevue test for general knowledge be improved for the testing of neuropsychiatric patients? An attempt at revalidation (author's transl)].

Questions related to general knowledge were adapted to the mental capacity of neuropsychiatric patients by means of regrouping and suitable modifications. The sequence of items according to the degree of difficulty, enables a more profitable use of the Wechsler-Bellevue test, since the questions relating to general knowledge need not begin with Question No. 1. The general knowledge subtest was changed into a psychopathometric method by means of an item analysis. In this manner, it is more adequately adapted to the mental capacities of neuropsychiatric patients. Moreover, irregular distribution of data which have not yet been evaluated and classified, is avoided, so that the intellectual performance of the patient can be explored in a fairer manner than before.

Adult↗

Wechsler VIQ versus PIQ differences in cerebral dysfunction: a literature review with emphasis on sex differences.

For the past three decades neuropsychologists have published results which indicated that left-sided cerebral dysfunction affected the Wechsler Verbal Scale whereas right-sided dysfunction affected the Performance Scale. Recent investigations have indicated that the effects of cerebral dysfunction on performance of the Wechsler Scales may be different for males and females. In view of these reports, the present review considered 24 studies (28 samples) which have reported Wechsler IQ scores in patients with unilateral or bilateral cerebral dysfunction. Eight studies (10 samples) used the Wechsler-Bellevue I, whereas 16 studies (18 samples) employed the WAIS. In these 28 published samples, there were four exceptions to the hypothesis of lower mean VIQ in patients with left-hemisphere lesions, and lower mean PIQ in patients with right-hemisphere dysfunction. Of the four exceptions to this "rule", two samples contained only women, while a third contained only patients with missile wounds of the frontal lobe. One sample appeared to be a true exception, and could not be accounted for by lesion location or sexual composition of the sample. The studies reviewed appear to add additional support to the hypothesis of sex differences in the effects of unilateral lesions. Therefore, insofar as published mean values for the Wechsler Scales are concerned, the specific effects on Verbal versus Performance IQ appear more prominently in males.

Brain Diseases↗

[Incidence of dementia in Parkinson disease].

UNLABELLED: The aim of our study was to assess the frequency of dementia in a highly selected (according to diagnostic criteria of Parkinson's disease and other causes of dementia) group of patients. MATERIAL AND METHODS: 46 patients (F 18, M 28), mean age--63.9 (39-80) years, with good response to L-Dopa. Besides the neurological examination, all patients underwent CT and psychological tests (Wechsler-Bellevue, Mini Mental and Hamilton test--to exclude severe depression as cognitive problem cause). In the group with dementia thyroxine and cholesterol tests and EEG were performed. RESULTS: Within the whole group the features of dementia (the index of deterioration in Wechsler test > 25% and/or 23 or less points in Mini-Mental) were recognized in 11 (23.9%) patients. In comparison to the rest of the patients, in the group with dementia the mean age was 8.1 years higher, mean age at onset of the disease was 6.4 years higher, mean time of the disease 1.5 years longer and the severity of the disease measured in Hoehn-Yahr rating scale was 0.76 points higher (2.20 vs 2.96). In the whole group severe depression (> 18 points in Hamilton test) was revealed in 6%, whereas moderate (8-17 points) occurred in 71%. CONCLUSIONS: Older age, later onset of symptoms and more advanced disease are the risk factors of dementia. Other causes--like dementia of Alzheimer's type may be suspected or two distinctive forms of Parkinson's Disease with and without dementia exist.

Adult↗