Cognitive and behavioral outcomes among seizure-controlled children with partial epilepsy on antiepileptic drug monotherapy.

The objective of this study was to assess cognitive performance and behavioral symptoms in a sample of children diagnosed with partial epilepsy who were seizure controlled on AED monotherapy for one year. Ninety-eight seizure-controlled children on AED monotherapy were included in this study. Specific AEDs examined included topiramate, divalproex sodium, lamotrigine, levetiracetam, and oxcarbazepine. Groups did not differ on age, region of focal epilepsy, or Full-Scale IQ. Direct measures included the WISC-IV and selected tests from the DKEFS (Verbal Fluency and Trail Making Test). Parent report measures included the BRIEF and the BASC-PRS. A series of ANOVAs revealed significant differences across the AED cohorts within many domains of cognitive functioning and behavioral presentation. Children prescribed divalproex sodium or topiramate demonstrated weaker working memory and verbal fluency, when compared with children prescribed other AEDs. Additionally, parents of children prescribed topiramate reported greater executive functioning and adaptive skills deficits. The pattern of findings suggests that children prescribed divalproex sodium or topiramate generally demonstrated a higher risk of cognitive and behavioral impairments compared to the other AEDs. Future prospective studies are required in order to better understand the relationship between AED type and these outcomes to inform clinical practice.

Concurrent Validity of New Subscale Scores for the Booklet Category Test.

The Booklet Category Test (BCT) is a neuropsychological test of cognitive dysfunction that provides only one overall error score indicative of global impairment. It does not, however, delineate specific domains that might be impaired. The aim of this study is to concurrently validate 13 new BCT subscales using legacy instruments in patients with nonpenetrating traumatic brain injury (TBI). Eighty-nine patients with mild, moderate, and severe TBI completed a battery of neuropsychology tests. Partial correlations controlling for age were performed and there were significant correlations between the a priori selected scores from legacy measures of major cognitive domains and both BCT total errors and subscale scores. Additional analysis showed that several subscales were able to differentiate between performance levels on the legacy measures. Overall, our results showed that the subscales measured cognitive skills beyond global impairment, supporting the use of the BCT subscales in a population with TBI.

Reliability of the Clinical Dementia Rating with a traumatic brain injury population: a preliminary study.

This study examined the inter-rater reliability (IRR) of the Clinical Dementia Rating (CDR) for patients with traumatic brain injury (TBI). The CDR is a commonly used rating of impairment, but there has been no research examining its utility in patients with TBI. It was hypothesized that the CDR would have good IRR when used with patients with TBI. Two hundred and fifty U.S. neuropsychologists were randomly selected from the National Academy of Neuropsychology's membership list and were mailed packets of information (e.g., CDR, patient vignette, mental status, neuropsychological test information, and history). Professionals were asked to complete the CDR for the described patient and return the information. IRR was calculated for the Global CDR score and each of the six CDR domains. Of those packets mailed, 53 were returned and completed as instructed (21.2% response rate). Clinician experience varied from 0 to 31 years. Global CDR score IRR was 73.6%. Domain IRRs were as follows: Orientation, 79.2%; Home and Hobbies, 71.7%; Personal Care, 71.7%; Memory, 56.6%; Judgment and Problem Solving, 49.1%; and Community Affairs, 54.7%. Results suggest the CDR Global score has acceptable IRR (>.70). Overall concordance (W = .527) among raters was significant with moderate-to-strong agreement. Further research to improve the utility of this instrument is discussed.

Frontal lobe epilepsy in children and adolescents: a preliminary neuropsychological assessment of executive function.

Although research on adults with frontal lobe epilepsy (FLE) has increased in recent years, delays in frontal lobe development preclude the generalization of these findings to children. This study compared children with FLE with typically developing children on cognitive and executive tests. Additionally, the differences between children with early and late seizure onset were explored. Results indicated comparable intelligence among all groups; however, the FLE cohort performed worse than controls on executive tests. The age of seizure onset differentially affected executive performance, such that early FLE onset resulted in greater executive dysfunction. The implications of these findings are discussed.

Are the indices of the RBANS sufficient for differentiating Alzheimer's disease and subcortical vascular dementia?

Alzheimer's disease (AD) and subcortical vascular dementia (SVaD) are among the most prevalent dementias and they often show specific patterns of cognitive dysfunction. This study examined whether differences exist between groups on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) that could assist with differential diagnosis. The examiners utilized the NINCDS-ADRDA and the NINDS-AIREN criteria to identify 39 probable AD and 29 probable SVaD patients. A battery of neuropsychological tests was performed and neuroimaging was reviewed for all subjects. Analyses revealed that the SVaD group performed significantly better on the Delayed Memory Index (DMI) and its subtests measuring Recognition, Contextual Memory, and Figure Recall. In contrast to previous research, there were no differences between groups on immediate memory tasks, and post hoc analyses revealed no differences on any other index or subtest. The results also suggested that the DMI and its subtests and the Story Memory subtest of the Immediate Memory Index have better sensitivity to AD, better specificity to SVaD, and roughly equivalent positive predictive power compared with other components of the RBANS. Overall, findings suggest that the indices and subtests of the RBANS may be limited in differentiating AD versus SVaD, except for the DMI and its subtests.

The neurometric-quantitative electroencephalogram as a predictor for psychopharmacological treatment: an investigation of clinical utility.

A retrospective validation study of the Neurometric method of the Quantitative Electroencephalogram (QEEG) in predicting response to psychotropic medication was conducted. The clinical outcomes of 2 groups of patients were compared: those patients prescribed medication regimens that were concordant with the QEEG predictors vs. those whose medication regimens were discordant with the QEEG predictors. Participants included 70 adolescent inpatients who were administered the QEEG upon admission. The results indicated no significant difference in clinical outcome between the 2 groups. The failure of this study to find significant differences in patient outcomes brings into question this particular use of the QEEG. The existing literature and future directions for research and clinical use of this method are discussed.

The category test perseveration, loss of set, and memory scales: three new scales and their relationship to executive functioning measures.

The Category Test (CT) is a neuropsychological measure that taps into multiple domains of complex reasoning but yields a single error score, limiting the use of the test. In this study, three new CT scales were developed to assess specific aspects of executive dysfunction: Perseveration, Failure to Maintain Cognitive Set, and Inability to Recall and Re-Initiate Past Behavior. The relationship of these scales to well-established neuropsychological measures was examined in head-injured individuals and schizophrenia patients. The CT Perseveration score was correlated with the Wisconsin Card Sorting Test (WCST) Perseverative Responses score, but also with measures from the Wechsler Memory Scale-Revised and the California Verbal Learning Test. The CT Memory score correlated with other memory measures, but also with the WCST Perseveration measure. Although future studies designed to test discriminant and convergent validity are warranted, these scales may be useful in determining specific aspects of impaired CT performance.