HOME COMPUTERISED COGNITIVE TESTING FOR TBI IS FEASIBLE AND POPULAR

2015 ◽  
Vol 86 (11) ◽  
pp. e4.75-e4 ◽  
Author(s):  
Peter Jenkins ◽  
Jessica Fleminger ◽  
Sara De-Simoni ◽  
Amy Jolly ◽  
Nikos Gorgoraptis ◽  
...  
Keyword(s):  
Treatment Response ◽  
Neuropsychological Tests ◽  
Cognitive Rehabilitation ◽  
Neuropsychological Testing ◽  
Cognitive Testing ◽  
Clinical Psychologist ◽  
Attention And Memory ◽  
Information Processing Speed ◽  
Severe Tbi ◽  
Assess Treatment Response

Serial neuropsychological testing potentially provides a powerful tool for tracking disease progress and identifying treatment response. Formal neuropsychometric assessment by a clinical psychologist is ideal but impractical for regular testing. Remote computerised assessment resolves this difficulty by allowing frequent home assessment, but is potentially limited by patient compliance and practise effects. We study the feasibility of this approach in an on-going clinical trial investigating the effects of methylphenidate on cognition after traumatic brain injury (TBI): Dopamine's Role in Enhancing Attention and Memory (DREAM).A battery of neuropsychological tests was delivered on an iPad. 12 patients with moderate/severe TBI and on-going cognitive complaints completed 7 tasks assessing information processing speed, memory, attention and executive functions. The 25-minute-long battery was performed daily for 4 weeks, following an initial training period. Compliance was good, with over 80% of the sessions completed, and patients found it both beneficial and enjoyable. Despite optimising the battery to minimise learning effects, differing tasks showed varying degrees of practise effects.We demonstrate a proof of principle that TBI patients will enthusiastically complete regular computerised neuropsychological tests at home. This provides a potentially powerful tool to assess treatment response, but also offers the prospect of facilitating self-directed cognitive rehabilitation.

The effectiveness of computer-assisted cognitive rehabilitation in brain-damaged patients

2013 ◽  
Vol 44 (1) ◽  
pp. 31-39 ◽  
Author(s):  
Emilia Łojek ◽  
Anna Bolewska
Keyword(s):  
Quality Of Life ◽  
Neuropsychological Tests ◽  
Cognitive Rehabilitation ◽  
Computer Assisted ◽  
Attention And Memory ◽  
Neuropsychological Rehabilitation ◽  
Therapy Program ◽  
Memory Problems ◽  
Computer Tasks

AbstractThis study examined the effects of computer-assisted cognitive rehabilitation in a group of 16 brain-damaged patients. Therapeutic effectiveness was assessed by improvement on computer tasks, the results of neuropsychological tests and quality of life ratings. Participants suffered from mild to moderate attention and memory problems or aphasia. The procedure involved baseline assessment (pretest), a 15-week course of therapy conducted twice a week (30 hours in total) and posttest. Neuropsychological tests assessing attention, memory and language problems and quality of life ratings were administered twice: in pre- and posttests. Twelve healthy controls were also examined twice (with a 15-week interval) using the same battery of neuropsychological tests. The RehaCom program and the Polish computer therapy program for aphasics called Afa-System were used for rehabilitation. The computer-assisted rehabilitation tasks were selected individually for each patient. The results showed significant improvement on computer-assisted tasks in all braindamaged subjects. However, none or very little improvement was observed on neuropsychological tests and quality of life ratings. The results of the study confirm the importance of using different types of measures to estimate the effectiveness of computer-assisted neuropsychological rehabilitation as well as the necessity of applying various kinds of therapy to improve cognitive, emotional and social functioning in brain-damaged patients.

The First Attempt of Intensive Approaches in Cognitive Rehabilitation in Clients with Severe Traumatic Brain Injury

2010 ◽  
pp. 249-265
Author(s):  
Masako Fujii
Keyword(s):  
Traumatic Brain Injury ◽  
Environmental Factors ◽  
Support System ◽  
Social Life ◽  
Cognitive Rehabilitation ◽  
Attention And Memory ◽  
Large Organization ◽  
Severe Tbi ◽  
Intensive Approach ◽  
Paper Method

Cognitive rehabilitation (CR) was undertaken by two clients, A and B, using pen and paper method by an exclusive and intensive approach. Client A with very severe TBI showed improved attention and memory deficits and after undergoing a step-by-step trial, he finally landed a satisfactory job and maintained it, with the support of a large organization. Client B underwent CR with considerable effort by himself and attained a normal cognitive level but was still half way to the satisfactory social integration owing to an insufficient support system. Through the long process undergone by the two clients, it was suggested that environmental factors (support system) are extremely important for a satisfactory social life in severe TBI clients, together with the recovery of cognitive functions by CR.

scholarly journals Which Neuropsychological Tests? Predicting Cognitive Decline and Dementia in Parkinson’s Disease in the ICICLE-PD Cohort

2021 ◽  
pp. 1-12
Author(s):  
Rachael A. Lawson ◽  
Caroline H. Williams-Gray ◽  
Marta Camacho ◽  
Gordon W. Duncan ◽  
Tien K. Khoo ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Verbal Fluency ◽  
Neuropsychological Tests ◽  
Visual Memory ◽  
Attention And Memory ◽  
Memory And Attention ◽  
Global Cognition

Background: Cognitive impairment is common in Parkinson’s disease (PD), with 80% cumulatively developing dementia (PDD). Objective: We sought to identify tests that are sensitive to change over time above normal ageing so as to refine the neuropsychological tests predictive of PDD. Methods: Participants with newly diagnosed PD (n = 211) and age-matched controls (n = 99) completed a range of clinical and neuropsychological tests as part of the ICICLE-PD study at 18-month intervals over 72 months. Impairments on tests were determined using control means (<1-2SD) and median scores. Mild cognitive impairment (PD-MCI) was classified using 1-2SD below normative values. Linear mixed effects modelling assessed cognitive decline, while Cox regression identified baseline predictors of PDD. Results: At 72 months, 46 (cumulative probability 33.9%) participants had developed PDD; these participants declined at a faster rate in tests of global cognition, verbal fluency, memory and attention (p <  0.05) compared to those who remained dementia-free. Impaired baseline global cognition, visual memory and attention using median cut-offs were the best predictors of early PDD (area under the curve [AUC] = 0.88, p <  0.001) compared to control-generated cut-offs (AUC = 0.76–0.84, p <  0.001) and PD-MCI (AUC] = 0.64–0.81, p <  0.001). Impaired global cognition and semantic fluency were the most useful brief tests employable in a clinical setting (AUC = 0.79, p <  0.001). Conclusion: Verbal fluency, attention and memory were sensitive to change in early PDD and may be suitable tests to measure therapeutic response in future interventions. Impaired global cognition, attention and visual memory were the most accurate predictors for developing a PDD. Future studies could consider adopting these tests for patient clinical trial stratification.

A-14 Mechanisms and Neuropsychological Correlates of Sleep Disruption in Concussed College Athletes

2021 ◽  
Vol 36 (6) ◽  
pp. 1036-1036
Author(s):  
Kaitlin E Riegler ◽  
Erin T Guty ◽  
Garrett A Thomas ◽  
Megan Bradson ◽  
Peter A Arnett
Keyword(s):  
Memory Performance ◽  
Neuropsychological Testing ◽  
Cognitive Testing ◽  
Symptom Reporting ◽  
Sleep Disruption ◽  
Neuropsychological Battery ◽  
Symptom Scale ◽  
Concussion Management ◽  
Falling Asleep ◽  
Concussion History

Abstract Objective First, to explore demographic/injury characteristics associated with increased sleep disruption post-concussion. Second, to examine the association between sleep disruption post-concussion and symptom reporting and cognitive variability. Method 124 athletes (M = 103, F = 21) completed neuropsychological testing within 14 days of concussion. Athletes were categorized as sleep-disrupted (n = 52) or not sleep-disrupted (n = 72). Athletes in the sleep-disrupted group endorsed one or more of the following from the Immediate Post-concussion Assessment and Cognitive Testing (ImPACT) Post-Concussion Symptom Scale (PCSS): trouble falling asleep, sleeping more than usual, and sleeping less than usual. Loss of consciousness (LOC) and concussion history were explored. Two neurocognitive variability measures were derived from the neuropsychological battery: intraindividual standard deviation (ISD) and maximum discrepancy score (MDS). Variability in memory and attention/processing speed (APS) composites were explored. Total PCSS symptom score, without sleep items, was calculated. Results A significantly greater proportion of sleep-disrupted athletes experienced LOC (30%) compared to not sleep-disrupted athletes (13%), χ2(1,N = 118) = 4.99, p &lt; 0.03, φ = 0.21. Sleep-disrupted athletes reported more symptoms, t(122) = −5.42, p &lt; 0.001, d = 0.98, and demonstrated more memory variability (memory ISD, t(122) = −2.22, p = 0.03, d = 0.40, and memory MDS, t(122) = −2.29, p = 0.02, d = 0.41) than not sleep-disrupted athletes. Groups did not differ in APS variability or concussion history. Conclusions Given the higher rate of LOC in sleep-disrupted athletes, it is possible that LOC is a mechanism leading to post-concussion sleep difficulties. Furthermore, sleep disruption following concussion results in more variable memory performance and higher symptom reporting. Symptom reporting and/or return to baseline cognitive functioning are often decision-making tools in concussion management. The difficulties experienced by sleep-disrupted athletes may complicate recovery.

scholarly journals Short Report: Adherence to Neuropsychological Recommendations in Patients with Multiple Sclerosis

2019 ◽  
Vol 21 (2) ◽  
pp. 70-75
Author(s):  
Marnina Stimmel ◽  
Shaina Shagalow ◽  
Elizabeth K. Seng ◽  
Jeffrey G. Portnoy ◽  
Roseann Archetti ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Cognitive Rehabilitation ◽  
Neuropsychological Testing ◽  
Treatment Recommendations ◽  
Phone Call ◽  
Short Report ◽  
Test Results ◽  
Adherence To Treatment ◽  
Other Information ◽  
Record Review

Abstract Background: Adherence to nonmedication recommendations is typically low, as seen in various health populations. Because literature on adherence to treatment recommendations made after neuropsychological testing in multiple sclerosis (MS) is lacking, this study evaluated adherence and reasons for nonadherence. Relationships between adherence to recommendations and various other factors in patients with MS were also evaluated. Methods: Of 66 adult patients seen for neuropsychological testing at an MS center, 55 were eligible for this study. Forty-five patients (mean age, 43.4 years; 75.6% women) were reached by phone, and all agreed to an interview involving questions regarding adherence to treatment recommendations. Other information was obtained through retrospective medical record review. Results: Overall self-reported adherence to recommendations made from neuropsychological testing was 38%. Adherence rates varied by recommendation type: psychopharmacological management had the highest rate (80%), and referrals for cognitive rehabilitation had the lowest (6.5%). Reasons for nonadherence included needing more information and wanting to speak with one's physician regarding the recommendations. Adherence was associated with patients' ability to spontaneously recall at least some of their recommendations and with receiving both a written report and a phone call with test results. Conclusions: Adherence to recommendations made after neuropsychological testing for patients with MS is low. Points of intervention may be to give directed feedback for each recommendation and to provide both a written report and a phone call with results and recommendations. Asking patients to repeat back the recommendations may be a simple and efficient way to increase understanding and improve adherence.

scholarly journals Lupus Nephritis: Role of Serum Complement Levels as Prognostic Marker

2020 ◽  
Vol 6 (1) ◽  
pp. 01-05
Author(s):  
Richmond Gomes
Keyword(s):  
Lupus Nephritis ◽  
Treatment Response ◽  
Lupus Erythematosus ◽  
Serum Complement ◽  
Class Iii ◽  
Proliferative Lupus Nephritis ◽  
Significant Difference ◽  
Before And After ◽  
Assess Treatment Response ◽  
Serological Biomarkers

Background: Lupus Nephritis (LN) is one of the most common and serious manifestations in Systemic Lupus Erythematosus (SLE) patients that causes significant morbidity and mortality. Certain biomarkers for LN are sometimes able to assess treatment response of lupus nephritis. Objective: To compare serum complement levels (C3 & C4) as markers of treatment response of LN and their relation to the LN class in renal biopsy. Methods: This prospective observational study was conducted in the Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from July 2018 to August 2019. Twenty seven patients who were diagnosed with lupus nephritis after kidney biopsy were included in this study. Serum complement levels (C3 & C4), 24 hours urinary total protein (24-hr UTP) and anti-double-stranded DNA (anti-ds DNA) were measured in all patients at baseline, 3 months and 6 months after treatment. These biomarker values before and after treatment were compared between the treatment response and non response groups. Results: Serum C3 levels were significantly different in patients of proliferative lupus nephritis (Class III & Class IV) than non proliferative lupus nephritis (Class V) at baseline (0.47 ± 0.32 vs0.89 ± 0.43g/l, p = 0.009) and levels changed significantly 6 months after treatment (p <0.001) and likewise for Serum C4 levels (0.10 ± 0.06 vs0.24 ± 0.26g/l, p = 0.040). Serum C3 levels were also found to correlate significantly with SLEDAI and renal SLEDAI. No significant difference was observed for 24-hr UTP levels at baseline between remission and non-remission groups. Conclusion: Serum C3 & C4 levels may be utilized as serological biomarkers to predict and monitor the treatment response of lupus nephritis.

A comparative Study Between Needling and Homologous Autoimplantation Techniques in Treatment of Multiple Plantar Warts

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Nermeen Samy Abdel Fattah ◽  
Rania Mahmoud Elhusseiny ◽  
Aml Magdy Darahem
Keyword(s):  
Treatment Response ◽  
De Novo ◽  
Response To Treatment ◽  
Clinical Appearance ◽  
Skin Contact ◽  
Common Warts ◽  
Significant Difference ◽  
Assess Treatment Response ◽  
Skin To Skin ◽  
Plantar Warts

Abstract Background Warts are a common dermatologic complaint resulting from infection with HPV which spread by direct skin-to-skin contact or by autoinoculation. The clinical appearance of warts is variable depends on the type of HPV involved and the site of infection. There are various types of viral warts including common warts, plantar warts, plane warts and genital warts, usually diagnosis of warts is made through clinical examination of the lesions and no laboratory investigations are required. Objective To compare between the therapeutic efficacy and safety of needling versus homologous autoimplantation techniques in treatment of multiple plantar warts and assess their recurrence rate. Patients and Methods Our study included 40 patients with multiple de novo planter warts(3 -10 warts) of (&gt;1 and &lt;3 years duration) divided into 2 groups, 20 patients per group, one group subjected to autoimplantation of wart tissue and the other subjected to needling procedure. Follow up of studied patients was assessed by physician after 2,8 and 12 weeks of procedure through clinical and dermoscopic examination to assess treatment response and after 16 weeks to assess recurrence Results Results of our study reported that there was high statistically significant difference between the 2 studied groups as regard response to treatment after 12 weeks being higher among autoimplantation group (p = 0.001). Moreover, there were no significant relations between treatment response of both patient groups and each of gender, age of patients, number of warts and duration of lesions. Conclusion Autoimplantation technique is more effective and less painful than needling procedure in treatment of multiple plantar warts (both manipulated and remote warts). No significant relations were found between treatment response of either techniques and demographic or clinical characteristics of studied patients.

Memory Impairment

2014 ◽  
pp. 77-82
Author(s):  
David L Brody
Keyword(s):  
Cognitive Rehabilitation ◽  
Illicit Drugs ◽  
Speech Therapy ◽  
Memory Function ◽  
Neuropsychological Testing ◽  
Vitamin B12 Deficiency ◽  
Memory Training ◽  
Electrolyte Disorders ◽  
Cardiovascular Exercise ◽  
Bedside Testing

Many complaints of memory problems after concussion actually turn out to be attention deficit. Take a careful collateral history regarding memory function in everyday life. Consider both bedside testing and formal neuropsychological testing of memory, but treat the patient, not the test results. Reduce barriers to optimal memory function: Optimize sleep; treat chronic pain; taper or stop cognitively impairing medications; stop alcohol and illicit drugs; prescribe moderate cardiovascular exercise; test for vitamin B12 deficiency, hypothyroidism, electrolyte disorders, hypo- or hypergylcemia, renal failure, liver failure, and anemia. Refer to speech therapy and occupational therapy for memory training. Stimulants can allow more intense cognitive rehabilitation when attention or fatigue are limiting. Consider pharmacological enhancers of memory including caffeine, donepezil, or rivastigmine. These have modest benefits, and the nonpharmacological interventions are more important.

scholarly journals A-030 Sensitivity and Specificity of Measures for Dementia with Lewy Bodies

2020 ◽  
Vol 35 (6) ◽  
pp. 820-820
Author(s):  
Duarte A ◽  
Alcina J ◽  
Rodriguez M
Keyword(s):  
Sensitivity And Specificity ◽  
Lewy Body ◽  
Neuropsychological Tests ◽  
Dementia With Lewy Body ◽  
Block Design ◽  
Neuropsychological Testing ◽  
Verbal Learning ◽  
Lewy Bodies ◽  
Target Population ◽  
Specificity And Sensitivity

Abstract The present review aimed to examine sensitivity and specificity across neuropsychological tests for Dementia with Lewy Body (DLB), to enhance diagnostic utility. A systematic search of the literature was conducted. Databases used: PsycInfo, Discovery Service for Carlos Albizu University-Miami, PsycARTICLES. Data selection criteria entailed articles from 2010–2020. Search terms included: Dementia with Lewy body, sensitivity, specificity, neuropsychological assessment, neuropsychological testing. Original search yielded 27 results, from those, only 8 articles contained sensitivity and specificity regarding DLB. The target population of review were older adults 65 and older. The assessment measures analyzed were the BSID, HVLT, MMSE QSPT, SAI, MMSE, and ICS, and others. Findings of eight studies were evaluated regarding sensitivity and specificity across neuropsychological assessments for DLB. Among the most specific and sensitive measures were the Alba Screening Instrument (ASI; sensitivity 90.7%, specificity 93.6%), and a combination of the Auditory Verbal Learning Test (AVLT) percent retention, Block Design, Trail Making Test--Part A, and Benton Visual Form Discrimination (specificity 96.1% and sensitivity 88.6%). Lower specificity and sensitivity were found in Illusory contour (ICs-4; specificity and sensitivity of 37.1% and 88.6%) and the Minimental State Examination-Pentagon Test (MMSE-QSPT; specificity 78.67% and sensitivity 70.29%). Other tests and combinations were explored. Specificity ranged from 76% to 96.1%, while sensitivity ranged from 37.1% to 90.7% throughout the neuropsychological tests examined. One major limitation across the studies constituted lack of pathological, post-mortem, confirmation. Additionally, while the use of cutoff scores across assessments appeared to enhance the sensitivity and specificity, it seemed to compromise the diagnostic accuracy of AD.

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