Performance on the African neuropsychology battery using the learning ratio in a sample of healthy Congolese.

OBJECTIVE: Using the African Neuropsychology Battery (ANB), we seek to develop normative data by examining the demographic effects for two learning process scores: initial learning (Trial One) and learning ratio (LR, the percentage of items learned relative of to-be-learned material following Trial 1). METHODS: Healthy participants from the Democratic Republic of Congo completed the four memory tests of the ANB: the African Story Memory Test (ASMT), African List Memory Test (ALMT), African Visuospatial Memory Test (AVMT), and African Contextual Visuospatial Memory Test (ACVMT). We developed indices of learning for each subtest, as well as aggregate learning indices for Trial 1 and LR, and composite indices examining verbal, visual, contextual, and noncontextual learning, and grand indices comprising all four subtests. RESULTS: Trial 1 and LR scores each demonstrated acceptable intercorrelations across memory tests. We present normative data for Trial 1 and LR by age and education. CONCLUSION: These data provide normative standards for evaluating learning in Sub-Saharan Africa.

Neurocognitive functioning in adults with congenital heart disease.

OBJECTIVE: Adults with congenital heart disease (CHD) are at increased risk of psychological disorders and cognitive deficiencies due to structural/acquired neurological abnormalities and neurodevelopmental disorders as children. However, limited information is known about the neuropsychological functioning of adults with CHD. This study screened neuropsychological abilities and explored group differences related to cardiac disease severity and neurological risk factors in adults with CHD. DESIGN: Participants completed brief neuropsychological testing. Information about neurobehavioral and psychological symptoms, employment, education, and disability were also collected from the patient and a family member. RESULTS: Forty-eight participants with adult CHD completed neuropsychological testing. Visuospatial skills and working memory were worse than expected compared to the typical population. Frequency of neurological comorbidities (e.g., stroke, seizures) was higher in those with more severe heart disease (e.g., single ventricle or cyanotic disease), and executive functioning was weaker in those with neurological comorbidities. Those with more severe heart disease were more likely to be unemployed and to receive disability benefits, but educational attainment did not differ. Those who received disability performed worse on tasks of executive functioning. CONCLUSIONS: Findings suggest concerns about neuropsychological functioning that need to be more comprehensively assessed in adults with CHD. Understanding the cognitive limitations of this aging population can help guide access to resources, transition of care, and medical care engagement, thus improving quality of care and quality of life.

Cognitive rehabilitation practice patterns: a survey of American Hospital Association Rehabilitation Programs.

Results of a survey of cognitive rehabilitation (CRT) practice patterns are reported. Of 270 programs contacted, 45% responded. Most patients were under age 65, had a stroke or brain injury, and underwent individual CRT for attention or memory problems while hospitalized. CRT typically lasted 1-6 months and cost $130 per session. Rehearsal and compensation approaches were employed equally, while computer-based procedures were infrequent. Speech and occupational therapists provided services more than neuropsychologists and few programs incorporated neuropsychological testing. Results suggest opportunities for research and expansion of neuropsychological practice and highlight the need for better communication between researchers and clinicians.

Ethnographic analysis of traumatic brain injury patients in the national Model Systems database.

OBJECTIVE: To compare demographics, injury characteristics, therapy service and intensity, and outcome in minority versus nonminority patients with traumatic brain injury (TBI). DESIGN: Retrospective analysis. SETTING: Twenty medical centers. PARTICIPANTS: Two thousand twenty patients (men, n=1,518; women, n=502; nonminority, n=1,168; minority, n=852) with TBI enrolled in the Traumatic Brain Injury Model Systems database. INTERVENTIONS: Not applicable. MAIN OUTCOMES MEASURES: Age, gender, marital status, education, employment status, injury severity (based on Glasgow Coma Scale [GCS] admission score, length of posttraumatic amnesia, duration of unconsciousness), intensity (hours) of therapy rendered, rehabilitation length of stay (LOS), rehabilitation charges, discharge disposition, postinjury employment status, FIM instrument change scores, and FIM efficiency scores. Independent sample t tests were used to analyze continuous variables; chi-square analyses were used to evaluate categorical data. DEMOGRAPHICS: overall, minorities were found to be mostly young men who were single, unemployed, and less well educated, with a longer work week if employed when injured. ETIOLOGY: motor vehicle crashes (MVCs) predominated as the cause of injury for both groups; however, minorities were more likely to sustain injury from acts of violence and auto-versus-pedestrian crashes. Minorities also had higher GCS scores on admission and shorter LOS. Rehabilitation services: significant differences were found in the types and intensity of rehabilitation services provided; these included physical therapy, occupational therapy, and speech-language pathology, but not psychology. CONCLUSION: Minority patients who sustain TBI generally tend to be young men with less social responsibility. Although MVCs predominate as the primary etiology, acts of violence and auto-versus-pedestrian incidents are more common in the minority population. Minorities tend to have higher GCS scores at admission. Also, the type and intensity of rehabilitation services provided differed significantly for the various interdisciplinary subspecialties. Rehabilitation charges, discharge disposition, and postinjury employment status were similar for the 2 groups, even though LOS is typically 3 to 4 days shorter for the minority group. A more detailed investigation is warranted to explain these findings.