Predictors of work status and quality of life 9-13 years after aneurysmal subarachnoid hemorrahage.

BACKGROUND: Aneurysmal subarachnoid hemorrhage (SAH) causes long-term psychosocial impairments even in patients who regain functional independence. Little is known about predictors of these impairments. We studied how early clinical data and neuropsychological results predict work status and health-related quality of life (HRQoL) 9-13 years after SAH. METHODS: One hundred one patients performed a neuropsychological test battery and returned their self-rating and partner's rating of a psychosocial impairment questionnaire approximately 1 year after SAH. These data were analyzed for association to the patients' work status and self-rated HRQoL approximately 10 years later. RESULTS: Age inversely, lower levels of self-rated impairments, employment and higher levels of education at the first follow-up independently predicted employment at the long-term follow-up. Although most cognitive test results were significantly associated with employment status at the long-term follow-up, they were of limited additional value as predictors of work status. The best predictor combination for long-term high HRQoL was good performance in a face recognition test and lower levels of self-rated impairments at the first follow-up as well as male sex. Problems in usual activities at the long-term follow-up were predicted by poor results in the face recognition and in a word list-learning task. CONCLUSION: Questionnaire ratings of patients' psychosocial impairments 1 year after SAH give important information for the long-term prediction of their work status and HRQoL. In the long run, patients' unemployment becomes strongly associated with higher age, while their performance of usual activities can be predicted with learning and memory results.

Memory functions in recreational pistol sport shooters: does lead matter?

OBJECTIVE: The aim of our study was to examine the memory functions of pistol sport shooters using powder charges when exposure to lead is expected to be considerably lower than in occupational circumstances. METHODS: A neuropsychological battery of memory and intelligence tests was administered to 20 sport shooters and 20 controls whose mean ages (SDs) were 55 (9.6) and 54 (9.3) years respectively. Memory functions were evaluated with three subtests of the Wechsler Memory Scale - Revised (WMS-R) and an incidental memory test. Intelligence was assessed with four subtests of the Wechsler Adult Intelligence Scale - Revised (WAIS-R). The level of alcohol consumption and depression were examined in both groups. Blood lead level was determined among the shooters. RESULTS: The shooters performed worse than the controls in the tests of incidental and logical memory. The groups did not differ in intelligence, mood or alcohol consumption. The mean (SD) blood lead level of the sport shooters was 0.52 mumol/L (0.40), responding 10.76 mug/dl (8.28). CONCLUSIONS: Low lead exposure in recreational shooting conditions may impair verbal memory. Therefore it is important to ensure that lead exposure is prevented among those shooting for sport.

Relationship of the Met allele of the brain-derived neurotrophic factor Val66Met polymorphism to memory after aneurysmal subarachnoid hemorrhage.

OBJECTIVE: The brain-derived neurotrophic factor (BDNF) Val66Met polymorphism has been shown to be related to variability in episodic memory. We studied whether the Met allele is associated with poor learning and memory in survivors of aneurysmal subarachnoid hemorrhage (SAH). METHODS: Ninety-six patients were examined with a neuropsychological test battery approximately 1 year after SAH. Their deoxyribonucleic acid samples were genotyped for the BDNF Val66Met polymorphism. The Met carriers were compared to the Val/Val homozygous patients on the test performances. RESULTS: In the total sample, there was no difference between the genotype groups. However, among the patients with no cerebral infarction, the Met carriers had inferior learning and memory performance than the Val/Val homozygotes, but the groups did not differ on the nonmemory test performances. The patients with left and bilateral infarctions had deficits in verbal memory, which may have concealed the effect of the BDNF Val66Met polymorphism on memory in the total sample. CONCLUSION: As a whole, the BDNF Val66Met polymorphism was not associated with learning and memory performance in patients recovering from SAH. However, the Met allele might predict poor memory function among patients with SAH not complicated by a cerebral infarction. These findings support earlier reports of an association between the Met allele and low memory performance. Longitudinal studies comparing functional recovery from SAH between Met and Val/Val patients without cerebral infarctions are warranted.

The Met allele of the BDNF Val66Met polymorphism predicts poor outcome among survivors of aneurysmal subarachnoid hemorrhage.

BACKGROUND AND PURPOSE: Brain-derived neurotrophic factor (BDNF) plays a role in neuronal survival, plasticity and neurogenesis. The BDNF gene contains a common Val66Met polymorphism; the Met allele is associated with lower depolarization-induced BDNF release and differences in memory functions and brain morphology. We hypothesized that the Met allele is associated with poor recovery from subarachnoid hemorrhage. METHODS: A sample of 105 survivors was assessed at 3 months after subarachnoid hemorrhage using Glascow Outcome Scale. Poor outcome was defined as severe disability or worse. DNA samples were genotyped for the Val66Met polymorphism. RESULTS: Higher percentage of the Met carriers had a poor outcome (29%) as compared with the Val/Val group (10%; P=0.011). In multiple logistic regression, this association between the Met allele and poor outcome was independent of several other prognostic factors such as patient age, clinical condition, and radiological severity of the bleeding (odds ratio 8.40; 95% CI, 1.60 to 44.00; P=0.012). CONCLUSIONS: Genetically influenced variation in BDNF function plays a role in recovery from subarachnoid hemorrhage. These data indicate that augmentation of BDNF signaling may be beneficial to recovery from brain injury.

Outcome of a comprehensive neurorehabilitation program for patients with traumatic brain injury.

OBJECTIVE: To evaluate the outcome of a comprehensive neurorehabilitation program compared with that of conventional clinical care and rehabilitation for patients with traumatic brain injury (TBI). DESIGN: Nonrandomized, controlled trial with a 2-year follow-up. SETTING: Nationwide rehabilitation center and level I trauma center, both in Finland. PARTICIPANTS: We studied 19 consecutive adults with a significant TBI who underwent a comprehensive neurorehabilitation program and 20 control patients who received conventional rehabilitation referred by physicians in the general health care system. The outcome of the control patients was not known before the selection. The groups were similar in age, sex, education, injury severity (assessed on the Glasgow Coma Scale, radiologic and neuropsychologic findings, neurosurgical interventions), time from the injury, and preinjury employment status. INTERVENTIONS: A postacute, intensive, interdisciplinary, 6-week rehabilitation program for TBI patients who are considered to have adequate potential to achieve productivity by this means; focus on neuropsychologic rehabilitation and psychotherapy with vocational interventions and follow-up support. MAIN OUTCOME MEASURE: Status of productivity, judged as productive (defined as working, studying, or participating in volunteer activities) or nonproductive, evaluated on questionnaires filled in by patients and their significant others at the time of follow-up evaluation. RESULTS: At follow-up, 89% of the treated patients were productive compared with 55% of the controls. The rehabilitation program was significantly predictive of the productive status at follow-up (odds ratio=6.96; 95% confidence interval, 1.26-38.44; P=.017). Other factors did not explain the better productivity of the treatment group. Two neuropsychologist-evaluators, who were blind to the rehabilitation history of patients and to each other's evaluations, were perfectly consistent in their classification of patients' productivity statuses. CONCLUSIONS: The findings support the proposition that comprehensive neuropsychologically oriented rehabilitation programs can improve psychosocial functioning in terms of productivity in postacute patients with moderate to severe TBI. Additional larger controlled studies are needed to establish the efficacy of TBI rehabilitation interventions.

Relationship of local infarctions to cognitive and psychosocial impairments after aneurysmal subarachnoid hemorrhage.

OBJECTIVE: Previous studies suggest that cognitive and psychosocial impairments after subarachnoid hemorrhage (SAH) result from diffuse brain damage caused by the initial bleeding rather than from focal lesions. We describe the relationship of local infarctions to these impairments and explore how well test and questionnaire results explain psychosocial outcome. METHODS: A total of 170 patients, selected from a consecutive series of patients with aneurysmal SAH, underwent neurological and neuroradiological examinations, and 138 of them were assessed with neuropsychological tests and questionnaires 1 year after SAH. RESULTS: Patients with left and bilateral infarctions performed worse on verbal memory tests than the other patients, and patients with left infarctions had more impaired working capacity than those with no infarction. The indices of the severity of SAH were related to reductions in both working capacity and social activity but less clearly to poor test performances. Whereas the modified Rankin scale was the most important correlate of working capacity, performance on cognitive tests was associated with return to work, and questionnaire ratings of mental impairments correlated with reduced working capacity and decreased social activity. CONCLUSION: Left-hemisphere infarctions cause deficits in verbal memory and working capacity. The severity of SAH is associated with impairments in working capacity and social activity rather than with specific cognitive deficits. Patients' and partners' opinions on patients' mental impairments could provide complementary information to clinical grades and cognitive tests in the evaluation of outcome after SAH.

Time-sharing strategies in driving after various cerebral lesions.

PRIMARY OBJECTIVE: To analyse time-sharing strategies in patients with cerebral lesions when they performed everyday in-car tasks in real-life highway driving. A case-control study. METHODS AND PROCEDURES: Thirteen male patients with brain damage and 11 healthy controls participated. The frequency and duration of glances at the in-car tasks, total time of eyes-off the road during tasks, speed and lateral displacement of the car were recorded. MAIN OUTCOMES AND RESULTS: Long glances away from the road and consequent large lateral displacements were characteristic for patients with anterior damage, while the patients with more posterior lesions used frequent short glances at the in-car task. CONCLUSION: Two different time-sharing strategies that appeared to be related to different aetiology were found in the patients, indicating different control of the driving task. It is proposed that standardized on-road dual tasks should be used for detecting problems in allocation of attention during driving.

Interference in dual-fluency tasks after anterior and posterior cerebral lesions.

According to earlier findings, letter fluency, repetitive pattern drawing and figural fluency are more sensitive to anterior than to posterior brain lesions. The aim of this study was to demonstrate that the percentage impairments from the single-task results are more pronounced after anterior than after posterior lesions when letter fluency is performed simultaneously with pattern drawing or figural fluency. The single-task results showed no significant differences between the patients with anterior and posterior lesions. The patients with anterior lesions, especially those with left-anterior lesions, had more pronounced percentage dual-task impairment than the other patients in letter fluency but not in pattern drawing or figural fluency. The results did not confirm the prediction that the average of the percentage decrements of the concurrent performances (the combined dual-task cost) or the larger of the two decrements would be more pronounced after anterior than posterior lesions. However, the patients with left-hemisphere lesions were inferior to those with right-hemisphere lesions in the single letter-fluency task, and the combined dual-task cost was more pronounced after left-hemisphere lesions.