Sex differences in neuropsychological performance for children with reading deficits

This study examined sex differences in neuropsychological functioning for a large sample of public school children with reading deficits. Specifically, scores on the Weschsler Intelligence Scale for Children--Revised (Wechsler, 1974), the Halstead-Reitan Neuropsychological Battery for older children (Reitan, 1969) and the Wide Range Achievement Test (Jastak and Jastak, 1978) were compared for males and females in a multivariate fashion. Significant sex differences were found in motor, verbal and nonverbal functioning. Females seemed to be more aberrant than males in expected neuropsychological performance.     

Unawareness of deficits in neuropsychological syndromes

Damage to different regions of the brain can cause a variety of neuropsychological deficits, including specific disturbances of language, memory, perception and motor function. A significant number of brain-damaged patients are unaware of their deficits, even when they are profound and have debilitating effects on patients' performance. This article reviews clinical observations and experimental investigations concerning unawareness of deficits, considers methodological issues, and critically evaluates different interpretations of the phenomenon. An integrative theoretical framework is proposed to account for unawareness of deficits in diverse neuropsychological syndromes. Possible directions for future research are outlined.     

Age-related neuropsychological deficits in Down's syndrome

Down's syndrome (DS) has been suggested as a high-risk condition for Dementia Alzheimer's type (DAT). In the present study, neuropsychological variables were assessed in 165 DS subjects and 163 matched mentally retarded controls. Overall, DS subjects had lower scores for orientation, digit span, visual memory, object-naming, and general knowledge, as well as more "released" reflexes. Impairments were most evident in DS subjects greater than 50 years old. These findings provide further support for an association between aging and DAT in Down's syndrome. Methodological issues and areas for future research are discussed.     

Pattern of neuropsychological deficits in patients with treated Wilson's disease

The study aimed to describe the neuropsychological profiles in patients with treated Wilson's disease (WD). The series included 19 symptomatic and 2 asymptomatic patients with a mean age of 35.3 ± 9.2 years. They were tested with the Automated Psychological Test system (APT), a comprehensive computerised neuropsychological test battery. APT comprised eleven separate tests and assessed five essential types of neuropsychological functions: motor functions, basic neuropsychological functions, specific cognitive functions, memory, and executive functions. The results were compared to current norms of the test battery. The symptomatic WD patients had significantly lower performance than the norms on all finger tapping tasks, the simple reaction time, the simultaneous capacity background task, the short-term memory test, the index of word decoding speed, the grammatical reasoning test, and the perceptual maze test. They were significantly higher on the index of impulsive errors, and used a significantly more global processing mode in the test of selective attention. The female symptomatic patients displayed more pronounced neuropsychological deficits than the males in the complex tasks. WD patients displayed a specific profile of moderate neuropsychological impairment. The results are theoretically interesting and have practical implications for the management of WD patients, e. g. some patients confronted with the results have had increased compliance. Received: 24 April 2001 / Accepted: 24 September 2001     

Development of neuropsychological deficits in Huntington's disease

Patients with more recently diagnosed Huntington's disease (RHD) were compared on a neuropsychological test battery with patients who had had the disease one to eight years (moderate HD) and with asymptomatic offspring. Though the patients with HD showed deficits in motor and motor-independent abilities, the patients with RHD were less impaired on factors assessing visuospatial ability, cognitive flexibility, and motor steadiness. Of particular interest was the finding that some asymptomatic offspring showed deficits in visuospatial ability and auditory memory that resembled the deficits of patients with RHD. The findings suggest that deficits in HD do not develop at a uniform rate; deficits in cognitive flexibility occur in later stages of the disease; and visuospatial and auditory memory deficits are very early signs and are present in some asymptomatic offspring.     

Contribution of traumatic head injury to neuropsychological deficits in alcoholics.

The contribution of head injuries to neuropsychological deficits was studied in 157 recently detoxified alcoholics and 400 control subjects consisting of age-stratified randomly selected men and women from the same geographical area as the alcoholics. Head injuries had occurred in 41% and 22% of the male and female alcoholics, but only in 15% and 6% of the male and female control subjects. One third of the injured subjects in both groups had been admitted to hospital for treatment of the acute injury. The neuropsychological test results of alcoholics were significantly inferior to those of control subjects. Unexpectedly, alcoholics with head injuries not identified at hospital were significantly inferior in several Halstead-Reitan subtests when compared with uninjured alcoholics with a similar duration of alcoholism and abstinence. By contrast, control subjects who had sustained a head injury not identified at hospital did not show signs of intellectual impairment when compared with uninjured controls. We conclude that traumatic brain injuries that may cause significant intellectual impairment may easily remain unrecognised in alcoholics.     

Stability and course of neuropsychological deficits in schizophrenia

BACKGROUND: Neuropsychological deficits in schizophrenia appear to predate clinical symptoms of the disease and become more pronounced at illness onset, but controversy exists about whether and when further neuropsychological progression may occur. OBJECTIVE: To identify and characterize any subset of patients who evidenced progressive neuropsychological impairment, we compared the longitudinal stability of neuropsychological functioning in schizophrenic outpatients and normal comparison subjects. METHODS: One hundred forty-two schizophrenic outpatients and 206 normal comparison subjects were given annually scheduled comprehensive neuropsychological evaluations during an average of 3 years (range, 6 months to 10 years). Clinically and demographically defined subgroups were compared, and test-retest norms were used to identify individual patients who showed unusual worsening over time. RESULTS: The schizophrenic group was neuropsychologically more impaired than the normal comparison subjects but showed comparable test-retest reliability and comparable neuropsychological stability over both short (mean, 1.6 years) and long (mean, 5 years) follow-up periods. No significant differences in neuropsychological change were found between schizophrenic subgroups defined by current age, age at onset of illness, baseline level of neuropsychological impairment, improvement or worsening of clinical symptoms, and occurrence of incident tardive dyskinesia. Norms for change also failed to show neuropsychological progression in individuals with schizophrenia. CONCLUSIONS: Neuropsychological impairment in ambulatory persons with schizophrenia appears to remain stable, regardless of baseline characteristics and changes in clinical state. Our results may not be generalizable to the minority of institutionalized poor-outcome patients.     

MRI features in children with desmoplastic medulloblastoma

Desmoplastic medulloblastoma (DMB) is a variant that has a more favorable prognosis compared to classical medulloblastoma, but its MRI features have not been as well described. We retrospectively reviewed the MRI features in children with pathologically proven DMB, including T2-weighted, fluid-attenuated inversion recovery (FLAIR) and contrast enhanced images, with isotropic diffusion-weighted (DW) MRI also performed in some patients. There were 16 tumors in 12 patients; one patient had five discrete lesions. In all patients, the tumor involved the cerebellar vermis, with nine lesions showing multiple peripheral small cysts. In nine of 16 tumors, there were focal areas of isointensity or hypointensity on T2-weighted or FLAIR images; seven of these showed corresponding focal enhancement. There was also one patient with radiating star-shaped enhancement in two lesions, and a multi-nodular enhancing pattern was observed in another patient. Low apparent diffusion coefficient (ADC) values were found in the lesions studied by DW MRI in five patients. DMB may have a typical imaging appearance of peripheral cysts, decreased ADC and focal enhancing areas corresponding to focal isointense or hypointense signal on T2-weighted and FLAIR images. Although these MRI features may distinguish this variant of medulloblastoma, multinodular or star-shaped radiating enhancement may also be detected in some patients.     

The association of specific neuropsychological deficits with capacity to consent to research or treatment.

Informed consent is key to ethical clinical research and treatment, but partially rests on the ability of individual patients or research participants to use disclosed information to make a meaningful choice. Although the construct of decisional capacity emerged from legal and philosophical traditions, several investigators have begun examining the relationship of specific neuropsychological abilities to decisional capacity. This line of research may foster development of better consent procedures, as well as aid in refining the construct of decisional capacity toward a form that better reflects the underlying neurocognitive processes. We conducted a systematic search of the published literature and thereby identified and reviewed 16 published reports of empirical studies that examined the relationship between specific neuropsychological abilities and capacity to consent to research or treatment. Significant relationships between neuropsychological scores and decisional capacity were present across all the reviewed studies. The degree to which specific neuropsychological abilities have particular relevance to decisional capacity remains uncertain, but the existing studies provide a solid basis for a priori hypotheses for future investigations. These ongoing efforts represent an important conceptual and empirical bridge between bioethical, legal, and neuropsychological approaches to understanding meaningful decision-making processes.     

Age-dependent neuropsychological deficits and effects of methylphenidate in children with attention-deficit/hyperactivity disorder: a comparison of pre- and grade-school children

Summary. Objective: Pre-school and grade-school children diagnosed with attention-deficit/hyperactivity disorder (ADHD) were compared in their performance on computerized attention tasks. Depending on the nature of the specified attention deficit, subjects were assigned to groups of cognitive subtypes. The effects of methylphenidate (MPH) were analysed depending on age and cognitive subtype. Method: The preschool group comprised 45 children aged 5–7 years; the grade-school group comprised 54 children aged 8–12 years. Children were tested on placebo and on MPH (mean dose: 0.25–0.3mg/kg body weight) employing tasks of alertness, sustained attention, focused attention, divided attention, and a cognitive conflict task. Results: Both groups showed measurable attention deficits. While preschoolers were especially impaired in supervisory attention functions, grade-schoolers most frequently exhibited deficits in attention intensity and selectivity. Positive MPH effects were documented for sustained attention in both age-groups. Analysis of MPH effects in dependence on the type of attention impairment (supervisory functions vs. attention intensity/selectivity) revealed a positive relation between deficits in a specific attention domain and MPH effects. Conclusions: Age-dependent differences in attention dysfunctions might be due to brain maturational processes. Performance on computerized attention tasks was particularly improved by MPH in children with objectified attention deficits suggesting that neuropsychological diagnostics can be useful to optimise treatment outcome.     

Melanotic medulloblastoma in children

Purpose

We report a case of melanotic medulloblastoma in a child. Reviewing the literature, we discuss the characteristics, therapeutic method, and prognosis of melanotic medulloblastoma in children.

Materials and methods

A 2-year-old girl was admitted with a mass located in the pineal region and presented obstructive hydrocephalus. The mass was subtotally resected through a slit-corpus?Cfornix approach. Thereafter, intraoperative direct third ventriculostomy was performed. The histopathological diagnosis of the mass suggested melanotic medulloblastoma.

Results

The MRI done at 4?days after surgery showed that the lateral ventricle normalized and the hydrocephalus was resolved. Thereafter, the patient underwent a Gamma Knife. The patient recovered well during the 8-month follow-up.

Conclusions

Melanotic medulloblastoma is a malignant tumor of childhood. It usually occurs at young age and might involve the vermis cerebelli, the fourth ventricle, and the pineal region. Surgery combined with radiotherapy and chemotherapy is recommended for children. But, it still requires observation to determine their long-term prognosis.     

Extrapyramidal symptoms and neuropsychological deficits in schizophrenia.

BACKGROUND: Extrapyramidal (EP) symptoms and neuropsychological (NP) deficits are both frequently present among schizophrenia patients. EP symptoms, such as motor slowing, could hinder performance on NP tests, yet little is known about the relationship between EP symptoms and NP functioning among schizophrenia patients. METHODS: Using a comprehensive NP test battery and standard ratings of EP symptoms and other psychiatric characteristics, we conducted a cross-sectional exploration of the association between EP symptoms and NP functioning among 96 middle-aged and elderly outpatients with schizophrenia. RESULTS: Severity of EP symptoms was associated with worse NP performance, particularly the areas of learning and motor skills. Regression analyses indicated that the relationship between EP symptoms and NP deficits was not accounted for by slowed motor or mental processing, demographic characteristics, severity of psychopathology, dyskinesia, or medication status. CONCLUSIONS: The pathophysiological mechanisms underlying EP symptoms and some NP deficits in schizophrenia may overlap.     

Neurocognitive deficits in medulloblastoma survivors and white matter loss

Although previous studies have documented a significant risk of intellectual loss after treatment for childhood medulloblastoma (MED), the pathophysiology underlying this process is poorly understood. The purpose of this study was to test the hypotheses that (1) patients treated for MED in childhood have reduced volumes of normal white matter (NWM) related to their treatment with craniospinal irradiation with or without chemotherapy, and (2) deficits in NWM among patients surviving MED can at least partially explain deficits in their intellectual performance. Eighteen pediatric patients previously treated for MED were matched on the basis of age at the time of evaluation to 18 patients previously treated for low-grade posterior fossa tumors with surgery alone (mean difference, 3.7 months). Evaluations were conducted with age-appropriate neurocognitive testing and quantitative magnetic resonance imaging by using a novel automated segmentation and classification algorithm constructed from a hybrid neural network. Patients treated for MED had significantly less NWM (p < 0.01) and significantly lower Full-Scale IQ values than those treated for low-grade tumors (mean, 82.1 vs 92.9). In addition, NWM had a positive and statistically significant association with Full-Scale IQ among the patients treated for MED. We conclude that irradiation- or chemotherapy-induced destruction of NWM can at least partially explain intellectual and academic achievement deficits among MED survivors.     

Pseudomigraine with prolonged aphasia in a child with cranial irradiation for medulloblastoma

We report a 12-year-old child with episodes of migraine-like headaches with visual and motor auras a year after the surgical resection and radiation therapy for medulloblastoma The patient presented with an episode of headache, prolonged aphasia, right hemiparesis, status epilepticus, and salt wasting. There was no evidence of a structural lesion. The neurologic deficits resolved over a period of 6 weeks. Because of the progressive deterioration in neurologic deficits, the patient underwent an extensive battery of laboratory tests and multiple neuroimages, all of which were normal. The unusually prolonged neurologic deficit in this patient without demonstrable structural lesions and his eventual complete recovery were most likely caused by ischemia in the left hemisphere secondary to vasospasm. This presentation mimics migraine headache. Evidence suggesting that this represents a long-term complication of treatment of children with central nervous system neoplasia is presented.     

Improved neuropsychological outcome in children with brain tumors diagnosed during infancy and treated without cranial irradiation.

Neuropsychological outcome of 28 patients with brain tumors diagnosed before the age of 36 months (mean, 19 months) was assessed using a comprehensive battery of tests. Elapsed time between diagnosis and testing averaged 6.2 years. Half the patients had received cranial radiation therapy and surgery, with and without chemotherapy, whereas the rest had received only surgery, with or without chemotherapy. Groups were comparable with respect to tumor diagnosis and location, age at diagnosis, race, and sex. Intellectual functioning was significantly lower in children whose treatment included cranial irradiation than in those treated without cranial irradiation, and this effect was more pronounced in nonverbal than in verbal intellectual abilities. Mean scores for the radiation group were lower than for the no-radiation group in all areas assessed and were significantly below age-based normative means in five of the eight cognitive areas: intellectual, memory, attention, motor, and visual-spatial skills. Mean scores for children in the no-radiation group were generally within the average range in all cognitive areas except visual-spatial skills, which were significantly below age-based normative means. Endocrine deficiencies and growth retardation were much more prevalent in patients treated with cranial irradiation. Because the immature brain is susceptible to treatment-related pathologic changes, infants are at greater risk than older children for significant, long-term neuropsychological, endocrine, and growth sequelae. In children treated without cranial irradiation, morbidity was minimized without an increased rate of mortality.     

Risk factors associated with persistence of neuropsychological deficits in persons with organic solvent exposure

This study examined neuropsychological prognosis following organic solvent exposure. Twenty-seven persons with evidence of "mild toxic encephalopathy" were evaluated on two separate occasions with a standard neuropsychological test battery and the Minnesota Multiphasic Personality Inventory. Ratings by experienced clinicians revealed that 50% of exposed persons had improved neuropsychological performance at the second evaluation. The other 50% were rated as having no change or a decline in neuropsychological tests scores. While the majority of persons in the good-outcome group were working at the time of the follow-up evaluation, none of the persons in the poor-outcome group was actively employed. Persons rated as having shown no improvement were significantly more likely to have had a peak exposure--an episode in which they were briefly exposed to a larger than normal amount of solvent. In addition, persons in the poor outcome group reported higher levels of psychological distress, both initially and at the follow-up evaluation. Results from this study suggest that the presence of certain risk factors, namely a peak exposure and psychological distress, may be particularly detrimental for long-term neuropsychological outcome in persons with a history of organic solvent exposure.     

Multiple neuropsychological deficits due to anoxic encephalopathy: a case study

In this article we report the case of a woman who survived an out-of-hospital cardiac arrest but was left with severe neuropsychological impairments due to anoxia. The deficits included anterograde and retrograde amnesia, dysphasia, disorientation, intellectual deterioration, visual impairments, ataxia, and myoclonus. Despite this degree of impairment the patient retained some insight into her condition which, in turn, created additional emotional problems. Rehabilitation and the problems of long-term care are considered.