Relationship of pain behavior to disease activity and health status in rheumatoid arthritis.

The purpose of the study was to investigate the contributions of disease activity, health status, and self-efficacy to the pain behavior exhibited by patients with rheumatoid arthritis. Measures included the Arthritis Impact Measurement Scales, the Arthritis Self-Efficacy Scale, a visual analogue scale for pain, and the McGill Pain Questionnaire. Joint counts and ratings of pain behavior also were obtained. All measures were collected at both baseline and 6 months. Hierarchical multiple regression analyses revealed that disease activity, as measured by joint count, was significantly related to a modified pain behavior index at both time intervals. With joint count entered into the regression model, no other variable consistently increased the predictive accuracy of the model. There were no significant correlations between the modified pain behavior index and either the visual analogue scale for pain or the McGill Pain Questionnaire scores. The results suggest that pain behavior in male rheumatoid arthritis patients is more closely related to disease activity than to self-reported pain, health status, or perceived self-efficacy.

The neuropsychology of Kuf's Disease: a case of atypical early onset dementia.

Adult Neuronal Ceroid Lipofuscinosis (Adult NCL), also known as Kuf's Disease, is a rare progressive encephalopathic disease that results in dementia. This report describes the presentation, diagnosis, neuroanatomy, and management of Adult NCL. A neuropsychological case study of Adult NCL is presented, emphasizing early onset of psychiatric symptoms, motor involvement, and severe diffuse cognitive impairment. The patient's neuropsychological course is documented over a 2-year period, with findings interpreted within the context of current models of cortical and subcortical dementia. The biopsychosocial impact of misdiagnosis and pharmaceutical management are discussed.

Clinical utility of a seven subtest WAIS-R short form in the neuropsychological assessment of traumatic brain injury.

Comparison of IQ scores from the standard Wechsler Adult Intelligence Scale-Revised (WAIS-R) and the Ward (1990) seven-subtest short form (WAIS-R/7 SF) was performed on a sample of 459 patients with traumatic brain injury due to head trauma. The results indicate that this short form provides Verbal, Performance, and Full Scale IQ scores that vary little from the complete WAIS-R, at approximately one-half the typical administration time. The seven subtest short form predicted WAIS-R Full Scale IQ within 6 points in 95% of this clinical sample, with Verbal-Performance IQ discrepancies that were highly correlated (r(s) =.85, p <.0001). No differential gender effect in proration of IQs was found. Applications and pitfalls of abbreviated neuropsychological testing batteries are discussed, with utilization of the WAIS-R/7 SF offered as a means to reduce intelligence testing time while maintaining the ability to detect subtle information processing abnormalities with appropriate supplemental tasks.

The comparability of the WRAT-R reading test and NAART as estimates of premorbid intelligence in neurologically impaired patients.

A study by Wiens, Bryan, and Crossen (1993) suggests the Wide Range Achievement Test-Revised (WRAT-R) Reading subtest and North American Adult Reading Test (NAART) are adequate predictors of Wechsler Adult Intelligence Scale-Revised (WAIS-R) IQ scores for a normal population. Although it is common practice to use reading scores to estimate premorbid IQ in clinical populations, the WRAT-R and NAART have not been compared using individuals with brain dysfunction. The current study cross-validated the Wiens et al. (1993) study using neurologically impaired populations: traumatic brain injury (n = 118), dementia (n = 37), and other neurologic impairments (n = 77). The results were generally consistent across all three groups: (a) the WRAT-R and NAART were equivalent and accurate estimates of average VIQ levels; (b) the WRAT-R and NAART were equivalent but underestimates of higher intelligence ranges; and (c) the WRAT-R is a more accurate estimate for lower VIQ ranges, although both are overestimates. This third finding is in contrast to Wiens et al.'s (1993) results that suggest the WRAT-R is an accurate estimate of lower IQ ranges for normals. It is concluded that the WRAT-R is the preferred measure of premorbid verbal intelligence for psychometric and clinical reasons.

Utility of a seven-subtest version of the WAIS-R among an Alzheimer's disease sample.

Recent health care sector changes have created a need for shorter, more focused neuropsychological assessments. The WAIS-R provides useful information on patients' general cognitive abilities, but poses problems in that it is time-consuming and may contribute to fatigue, especially among geriatric patients with dementia. This study evaluated Ward's (1990) 7-subtest version of the WAIS-R among 32 patients with presumptive Alzheimer's disease. Among all patients, the abbreviated test underestimated full WAIS-R scores by an average of 2.0, 0.2, and 1.8 points for the Verbal Intelligence Quotient (VIQ), Performance Intelligent Quotient (PIQ), and Full-Scale Intelligence Quotient (FSIQ). This general finding held true regardless of whether scores were generated using the standard WAIS-R method (for patients age 75 and younger) or using age corrections (i.e., Mayo Older Americans' Normative Studies [MOANS]) for older patients. Most patients scored within the mean standard errors of measurement defined in the WAIS-R manual for VIQ, PIQ, and FSIQ. In general, the 7-subtest and full versions of the WAIS-R yielded similar findings among this closely screened sample, but further testing among a more typical sample of patients with multiple risk factors for dementing conditions is needed.

The peer advisor experience providing social support.

Research shows a link between increased social support and decreased complications after myocardial infarction (MI). In a current randomized controlled trial (RCT), a social support intervention administered by nurse and peer advisors is being examined to determine its influence on the health outcomes of unpartnered, post-MI elders. This qualitative study (as part of the larger RCT) sought a better understanding regarding the experience of the peer advisor. Data sources included peer advisor logs, a focus group, and telephone interviews with peer advisors. Findings revealed that helping, mutual sharing, committing, and benefiting are characteristics of peer experiences. Primarily because of their personal experience of recovery from MI, peer advisors had a remarkable ability to relate to assigned post-MI elders, offering a unique form of social support complementary to current health practices.

Neuropsychological significance of anosmia following traumatic brain injury.

OBJECTIVES: To investigate the incidence of anosmia following traumatic brain injury (TBI) using a standardized instrument and to test hypotheses that post-TBI anosmics perform significantly more poorly than do post-TBI normosmics on measures of executive skills and functional outcome. DESIGN: Prospective quasi-experimental between-groups design. PARTICIPANTS: Sixty-eight adults diagnosed with TBI. SETTING: Brain injury rehabilitation program based at a Midwestern medical center. MAIN OUTCOME MEASURES: University of Pennsylvania Smell Identification Test (UPSIT), selected neuropsychological measures of executive skills, the Disability Rating Scale (DRS), and the Community Integration Questionnaire (CIQ). RESULTS: Forty-four subjects (65%) demonstrated impaired olfaction; only 13 (30%) acknowledged smell dysfunction. Anosmic and normosmic groups did not differ in demographics, IQ, chronicity, or admission Glasgow Coma Scale (GCS). Anosmics had longer coma (P =. 01), more severe deficits in complex attention (Trailmaking Test, Part B, P =.01), new learning/memory (California Verbal Learning Test Trial V [CVLT-V], P =.001), and problem solving (Wisconsin Card Sorting Test [WCST], P =.001), leading to greater functional impairment (Disability Rating Scale [DRS], P =.003). No differences emerged on the CIQ. CONCLUSIONS: Anosmia is a common sequela of TBI, although only a minority of patients are aware of this deficit. Further, anosmics demonstrated greater impairment in a variety of frontal-lobe mediated executive functions, as well as greater functional disability.

Comparing neuropsychological and psychiatric evaluation of competency in rehabilitation: a case example.

This report describes the case of a 20-year-old man who sustained a gunshot wound to the forehead, resulting in traumatic brain injury and C2 ventilator-dependent quadriplegia. Issues of personal control and autonomy typified his psychological adjustment. The question of competency to refuse medical treatment arose when he disallowed intervention for a suspected ear infection not confirmed by culture. Subsequently, the patient was alternately described as incompetent by a psychiatrist and competent by a medical ethics review panel. These decisions are interpreted within the context of existing medical-legal literature and historical precedent of competency in civil law. Central to competency evaluation is the patient's ability to recognize that a decision-making process is required, to review the pros and cons of various options, and to communicate a decision. Importantly, this decision need not be in accordance with the opinion of family or the health care team. Neuropsychological screening indicated the patient's cognitive abilities were within functional limits, and he subsequently agreed to treatment after experiencing pain and fever, and learning of a positive culture. It is concluded that a two-pronged neuropsychological evaluation of competency based on the patient's information processing capabilities is most appropriate in medical rehabilitation settings.

The clinical utility of the Rey Auditory-Verbal Learning Test in medical rehabilitation.

Recent research has reported the Rey Auditory-Verbal Learning Test Trial V (RAVLT-V) score to be a sensitive indicator of global cognitive functioning, not merely verbal learning skills. The concurrent validity of the RAVLT-V relative to other neuropsychological measures frequently utilized in medical rehabilitation was investigated in a sample of 64 outpatients diagnosed with traumatic brain injury (TBI). The sample was predominantly male (77%), white (97%), youthful (31.4±11.5 years), high school educated, and an average of 53 months postinjury. Using stepwise multiple regression analysis, a three-variable model consisting of gender, Wechsler Memory Scale-Revised Delayed Memory Index, and Trailmaking Part B (time) accounted for 61% of the variance in RAVLT-V scores. These findings suggest that in TBI patients, the RAVLT taps not only specific verbal learning and memory, but also global cognitive functions. Sensitivity to diffuse neuropsychological changes and ease/speed of administration make the RAVLT a valuable tool in medical rehabilitation settings.

Personality hardiness, anxiety, and depression as constructs of interest in the study of temporomandibular disorders.

This study examined the stress-mediating characteristics of the personality construct of hardiness within a population of dental patients diagnosed with a temporomandibular disorder (TMD). It was found that hardiness, consisting of feelings of control and commitment, was significantly lower in TMD patients when compared with a matched control group of non-TMD subjects. A third proposed factor of hardiness, challenge, was not found to differ significantly between the groups. Anxiety and depression self-ratings also did not differ significantly between the groups.