Predictors and indicators of quality of life in patients with closed-head injury

This study examined predictors and indicators of quality of life in 71 patients with closed-head injury (CHI), 2-4 years postinjury. Predictors included premorbid characteristics and acute injury-related data. Indicators included follow-up data, e.g., neuropsychological functioning. Exploratory canonical correlation analyses demonstrated that the combination of the predictor variable, initial Glasgow Coma Scale score, and indicator variables of neuropsychological data in the areas of motor functioning, memory, and constructional ability were related most strongly to quality of life as reported by the patients. Severity of head injury and motor disability also related strongly to quality of life, based on reports by relatives (n = 68) on the Katz Adjustment Scale (Relatives' Form). These findings suggest that quality of life is adversely affected by increased severity of head injury and greater residual motor deficits. Implications of these findings for treatment and recovery are discussed.     

Assessment of Psychosocial Functioning in a Large Cohort of Patients with Schizophrenia

Background

This study addresses the question of whether psychosocial functioning measured by the Personal and Social Performance (PSP) Scale is related to various psychopathological measures in a cohort of patients with schizophrenia.

Methods

The ‘Neuroleptic Strategy Study’ (NeSSy) performed at 14 German hospitals between 2010 and 2013 compared two treatment strategies instead of individual drugs. Secondary end-points were the two PSP scales as well as measures of quality of life (SF-36) and the Positive and Negative Syndrome Scale (PANSS).

Results

149 patients were randomised. There was no difference between the two treatment strategies (first-generation versus second-generation antipsychotics) with regard to the PSP. There were differences in doctors’ assessments regarding psychosocial functioning compared with patients’ own assessments. Furthermore, there were relationships between the PSP and quality of life, level of skills (ICF), and severity of disease (PANSS), level of sexual activities and poor well-being under antipsychotic medication but not with cognitive changes.

Conclusions

The findings on psychosocial functioning of patients with schizophrenia related to severity and skill level could be confirmed. Further findings were the correlation between psychosocial functioning and quality of life, well-being under treatment, and sexuality what emphasizes the substantial importance of a reduced psychosocial functioning.

     

The cognitive aspect of formal thought disorder and its relationship with global social functioning and the quality of life in schizophrenia

Purpose

It was expected that using a comprehensive scale like the Thought and Language Disorder Scale (TALD) for measurement of FTD would enable assessing its heterogeneity and its associations with cognitive impairment and functionality. This study has aimed to analyze the relationship between formal thought disorder (FTD) and cognitive functions, functionality, and quality of life in schizophrenia.

Methods

This cross-sectional exploratory study included 46 clinical participants meeting the DSM-5 diagnostic criteria for schizophrenia and 35 healthy individuals as the control groups. Data were acquired by means of the Turkish language version of the TALD, the Positive and Negative Syndrome Scale, the Clinical Global Impression Scale, the Functioning Assessment Short Test, the Social Functioning Scale, the World Health Organization Quality of Life Instrument-Short Form, and a neuropsychological test battery on executive functions, working memory, verbal fluency, abstract thinking, and response inhibition. Correlation analyses were conducted to detect significant relationships.

Results

The clinical group scored failures in all cognitive tests. The objective positive FTD was associated with deficits in executive functions and social functioning. The objective negative FTD was associated with poor performance in all cognitive domains, physical quality of life, and social and global functioning. The subjective negative FTD was negatively correlated with psychological quality of life.

Conclusion

This study demonstrated that objective FTD factors reflect different underlying cognitive deficits and correlate with different functioning domains. Significant correlation was determined between subjective negative FTD and psychological quality of life. Given the close relationship of FTD with functioning and quality of life, the FTD-related cognitive deficits should be the key treatment goal in schizophrenia.

     

Influence of cerebral oxygenation following severe head injury on neuropsychological testing

Abstract

Despite recent advances in the management of severe head injury the mortality and morbidity remains high. Intracranial pressure (ICP) and cerebral perfusion pressure (CPP) are crucial parameters for the correct management at the intensive care unit, due to their therapeutic and prognostic importance. In addition, regional brain tissue oxygenation (p_tiO₂) seems to be of importance. While different studies demonstrated the impact of cerebral hypoxia on outcome (mortality), no data are available focusing on morbidity (neuropsychological deficits). Therefore, our study is carried out to demonstrate a possible relationship between amount of cerebral oxygenation during acute stage after severe head injury and neuropsychological outcome. Besides ICP and CPP, p_tiO₂ was monitored in 40 severely head injured patients during the ICU stay from the day of admission until day 10. Monitoring data were stored and amount of hypoxic episodes were calculated. Besides outcome using the Glasgow Outcome Scale neuropsychological testing was performed 2–3 years after injury. Analysing the quality of brain tissue oxygenation, a relationship to the performance in neuropsychological tests could be found. Patients with low brain tissue oxygenation had a worse outcome in neuropsychological testing, especially concerning intelligence and memory. Associated with these deficits patients showed a reduced performance in their profession. Our data suggest a possible predictive value of brain tissue oxygen on morbidity analysing neurocognitive function after head injury. This may implicate monitoring and treatment of cerebral hypoxia.     

Associations of Clozapine Use With Psychosocial Functioning and Quality of Life in Patients With Schizophrenia: A Community-Based Cross-Sectional Study

ObjectiveMore attempts have been made recently to improve psychosocial functioning and quality of life in patients with schizophrenia, due to their crucial role in long-term outcomes. Previous studies on the effects of clozapine on psychosocial functioning have been limited in terms of generalizability and application to clinical practice. This study examined the relationship of clozapine use with psychosocial functioning and quality of life in patients with schizophrenia in a real-world setting. MethodsData were obtained from a survey targeting community-dwelling patients with schizophrenia. The Behavior and Symptom Identification Scale (BASIS) and Satisfaction with Life Scale (SWLS) were administered to evaluate psychosocial functioning and quality of life, and patients were classified into Clozapine and Non-clozapine groups. Group differences were assessed using ANCOVA, with additional sensitivity analyses for participants on atypical antipsychotic medications only. ResultsOf 292 patients, the Clozapine group (n=34) had significantly better psychosocial functioning and quality of life than the Nonclozapine group (n=258), as demonstrated by their low BASIS score (F=4.651, df=1, 290, p=0.032) and high SWLS score (F=14.637, df=1, 290, p<0.001). Similar findings for psychosocial outcomes were observed in the analyses of the atypical antipsychotic subgroup (n=195). ConclusionFor optimal recovery in schizophrenia, restoration of impaired social functioning and enhanced satisfaction with life are essential. In this study, clozapine use was related to high levels of psychosocial functioning and quality of life in real-world settings. Further research on the causal relationship between clozapine use and psychosocial functioning is needed.     

Cognitive complaints after mild traumatic brain injury: Things are not always what they seem

ObjectiveTo compare nonreferred, emergency department (ED)-admitted mild traumatic brain injury (MTBI) patients with and without self-reported cognitive complaints on (1) demographic variables and injury characteristics; (2) neuropsychological test performance; (3) 12-day self-monitoring of perceived cognitive problems; and (4) emotional distress, physical functioning, and personality.Methods(Neuro)psychological assessment was carried out 6 months post-injury in 79 patients out of a cohort of 618 consecutive MTBI patients aged 18–60, who attended the ED of our level I trauma centre. Cognitive complaints were assessed with the Rivermead Postconcussional Symptoms Questionnaire (RPSQ). In addition, patients monitored concentration problems and forgetfulness during 12 consecutive days.ResultsSelf-reported cognitive complaints were reported by 39% of the patients. These complaints were strongly related to lower educational levels, emotional distress, personality, and poorer physical functioning (especially fatigue) but not to injury characteristics. Severity of self-reported cognitive complaints was neither associated with the patients' daily observations of cognitive problems nor with outcome on a range of neuropsychological tests.ConclusionSelf-reported cognitive complaints were more strongly related to premorbid traits and physical and emotional state factors than to actual cognitive impairments. In line with previous work, this suggests that treatment of emotional distress and fatigue may also reduce cognitive complaints. Cognitive outcome assessment of symptomatic MTBI patients should not be restricted to checklist ratings only, but also include a (neuro)psychological screening. In addition, daily monitoring of complaints is a useful method to gather information about the frequency and pattern of cognitive problems in daily life.     

Cross-validation of a method for predicting wechsler memory scale-revised index scores

Abstract

Equations for prorating Wechsler Memory Scale-Revised General Memory (GM) and Delayed Recall (DR) index scores (Woodward & Axelrod, 1995) were confirmed in clinical samples of patients who were seen for comprehensive neuropsychological testing with (1) moderate or severe closed-head injuries (n = 53); (2) mild head injury/concussion (n = 47); and (3) patients with intractible seizures who were seen for neuropsychological testing prior to neurosurgical resection (n = 24). Fifty-one of the closed-head injury (CHI) patients were involved in litigation related to their injury at the time of this evaluation. Predicted GM and DR index scores fell within 6 points of the obtained scores for 91% and 92%, respectively, of the CHI sample, and 100% of the seizure resection sample. This is well within the standard error of measurement of these index scores. There were no significant differences in accuracy of estimated index scores between litigants and non-litigants or between levels of head injury severity. These findings confirm the earlier cross-validation results reported by Axelrod et al. (1996) in a mixed sample of traumatic brain injury and other neurological insult.     

Relationship of neuropsychological status to everyday functioning in healthy and chronically Ill persons

Abstract

Three hundred and three patients with chronic obstructive pulmonary disease and concomitant neuropsychological impairment plus 99 healthy control subjects matched on the basis of socio-demographic variables were administered an expanded version of the Halstead-Reitan Battery and a battery of instruments measuring the quality of everyday-life functioning. The results indicated that neuropsychological measures can be used to predict everyday-life functioning in impaired persons, but few significant relationships were observed in the normals. Neuropsychological status was more consistently related to activities of daily living and basic social role performance than to emotional status. Complex, multifunctional neuropsychological tasks were found to be the best overall predictors of life functioning, whereas more specific tasks served as better predictors of specific dimensions of life functioning.     

Corticospinal excitability in patients with anoxic,traumatic, and non-traumatic diffuse brain injury

BackgroundTranscranial magnetic stimulation (TMS) have been frequently used to explore changes in motor cortex excitability in stroke and traumatic brain injury, while the extent of motor cortex reorganization in patients with diffuse non-traumatic brain injury remains largely unknown.Objective/HypothesisIt was hypothesized that the motor cortex excitability would be decreased and would correlate to the severity of brain injury and level of functioning in patients with anoxic, traumatic, and non-traumatic diffuse brain injury.MethodsTMS was applied to primary motor cortices of 19 patients with brain injury (5 traumatic and 14 non-traumatic causes; on average four months after insult), and 9 healthy controls. The test parameters included resting motor threshold (RMT), short intracortical inhibition (SICI), intracortical facilitation (ICF), and short latency afferent inhibition (SAI). Excitability parameters were correlated to the severity of brain injury measured with Glasgow Coma Scale and the level of functioning assessed using the Ranchos Los Amigos Levels of Cognitive Functioning Assessment Scale and Functional Independence Measure.ResultsThe patient group revealed a significantly decreased SICI and SAI compared to healthy controls with the amount of SICI correlated significantly to the severity of brain injury. Other electrophysiological parameters did not differ between the groups and did not exhibit any significant relationship with clinical functional scores.ConclusionsThe present study demonstrated the impairment of the cortical inhibitory circuits in patients with brain injury of traumatic and non-traumatic aetiology. Moreover, the significant correlation was found between the amount of SICI and the severity of brain injury.     

Influence d’un programme d’éducation thérapeutique du patient (ETP) sur la qualité de vie de personnes souffrant d’un trouble bipolaire : premiers résultats

IntroductionBipolar disorder is a mental illness that is associated with a long-term impairment in psychosocial functioning and quality of life. The objective of this study was to evaluate the influence of a therapeutic education program on the quality of life of patients with bipolar disorder (type 1 or 2).MethodThis study included 18 patients with bipolar disorder (type 1 or 2) following the therapeutic education program on bipolar disorder which includes 8 sessions of 2 hours each. The assessment of quality of life and mood, self-esteem, insight and global functioning was performed before and after the program using the following tools: World Health Organization Quality Of Life questionnaire in short version (WHOQOL-Bref), Hamilton Depression Rating Scale, Young Mania Rating Scale, Rosenberg Self-Esteem Scale, Birchwood Insight Scale and Global Assessment of Functioning Scale. The total score of WHOQOL-Bref constitutes the primary study outcome. The under-scores of WHOQOL-Bref as insight, self-esteem, functioning, depression and mania scores constitute secondary outcomes.ResultsOur results show an improvement in quality of life, regarding global and main dimension scores of WHOQOL-Bref. The mean total scores for quality of life at the beginning and the end of the program were respectively 55.47/100 (standard deviation = 14.11) and 60.03/100 (standard deviation = 12.62). However, the difference was still not significant even after statistical adjustment with depression, mania and functioning scores. Self-esteem was significantly improved (P = 0.0469). Quality of life and self-esteem evolutions were strongly related (correlation coefficient = 0.80, P = 0.0006). At the end of the program, the less depressed the patients were, the better their quality of life was (correlation coefficient = 0.67, P = 0.0090). We did not find any correlation between quality of life and mania intensity or global functioning level at the end of the program.ConclusionThis study suggests a need to focus on self-esteem perception in order to understand and ameliorate the quality of life of patients with bipolar disorders. Going further, the use of bipolar disorder specific scales to assess quality of life would be more relevant.     

Children's adaptive behavioural competence after head injury

Abstract

Eighty-six children were evaluated in a cross-sectional study 1 to 3 years after hospitalization for closed head injury in order to ascertain the effects of head injury severity, age, and chronicity of injury on the development of adaptive behavioural competence as measured by the Vineland Adaptive Behavior Scales. Twenty-three subjects had sustained moderate to severe injuries and 63 had sustained mild injuries, based on neurosurgical criteria including the Glasgow Coma Score, CT scans, and other medical variables. It was hypothesised that severity of head injury would adversely affect overall adaptive competence. It was also predicted that social competence would be less well developed in children with moderate to severe injury than in those with mild injury. Study findings provided partial support for these hypotheses. An unavoidable confounding of age and gender resulted in the decision to examine the data by gender to determine whether the data could be analysed without regard for this factor. An unexpected gender effect was observed. Severity of injury did adversely influence the adaptive competence of boys, especially in the area of social competency, but hypotheses were not upheld for girls. Discussion focuses on issues related to gender and adaptive outcome, parent report of adaptive functioning in light of gender and cultural factors, the relationship of neuropsychological functioning and adaptive competence, and the nature of social deficits following pediatric traumatic brain injury.     

Self-awareness after acquired brain injury

Abstract Objective To investigate the factors contributing to deficit in self-awareness following acquired brain injury and to study change in self-awareness during a group support program. Methods Sixty-two patients (mean age: 35.4±15.3 years) attending our Service (295±525 days after injury) were included in the study (41 of them had sustained a head injury). Thirty-six patients were admitted to a multidisciplinary rehabilitation program including a group support program designed to improve self-awareness deficits. All patients were assessed with the Patient Competency Rating Scale as a measure of self-awareness and with a broad range of neuropsychological tests, checklists of psychopathological symptoms, and several functional scales. Results Thirty patients showed high levels of self-awareness while 32 showed impaired self-awareness. Patients with appropriate perception of their deficits showed less psychopathological symptoms, better neuropsychological function and higher functional independence than those with impaired SA (Students t test, p<0.05). Both groups improved, but with different patterns, after rehabilitation (MANOVA, p<0.05). Multiple regression analysis revealed that cognitive status was predictive of level of self-awareness. Conclusion The level of self-awareness after acquired brain injury is a useful prognostic index of the neuropsychological, psychopathological and functional status of the patient. We recommend the evaluation of this symptom after acquired brain injury due to its clinical relevance.     

Long-Term Neurocognitive,Psychosocial, and Magnetic Resonance Imaging Outcomes in Pediatric-Onset Acute Disseminated Encephalomyelitis

BackgroundAcute disseminated encephalomyelitis (ADEM) is a demyelinating disorder that is usually self-limited. Recent studies have suggested ongoing neurological deficits and neurocognitive impairment in these patients. Little information on the correlation of clinical and neuroimaging markers in ADEM is available. We examined potential clinical factors (e.g., age of onset, acute symptom duration, magnetic resonance imaging [MRI] lesions) and their relation to neurocognitive and psychosocial outcomes.MethodsThis is a retrospective chart review of consecutive pediatric patients diagnosed with ADEM between 2006 and 2012. Patients were evaluated with standard neurological assessment, MRI of the brain, and neuropsychological evaluation.ResultsTwenty-three patients with ADEM with average age at neuropsychological assessment of 10.1 years (±3.50) were included. Five (22.7%) patients were impaired on three or more neurocognitive measures. Psychosocial problems were reported in 20%-40% of patients. Earlier age of onset was correlated with poorer sustained attention and psychosocial problems, whereas acute symptom duration and Expanded Disability Status Scale were not. MRI outcomes were correlated with psychosocial outcomes but not neuropsychological findings.ConclusionsOur findings suggest lingering cognitive and psychosocial deficits in children with a history of ADEM. Clinical features and MRI findings correlated more strongly with psychosocial outcomes than cognitive functioning. Further studies are needed to confirm relationships and other possible contributing factors to lingering deficits.     

Effects of intensive neuropsychological rehabilitation for acquired brain injury

The objective of the study was to examine the effects of a comprehensive neuropsychological rehabilitation programme (Intensive NeuroRehabilitation, INR) on the emotional and behavioural consequences of acquired brain injury (ABI). The participants were 75 adult patients suffering from ABI (33 traumatic brain injury, 14 stroke, 10 tumour, 6 hypoxia, 12 other), all of whom were admitted to the INR treatment programme. The main outcome measures were: general psychological well-being (Symptom-Checklist-90), depression and anxiety (Beck Depression Inventory-II, Hospital Anxiety and Depression Scale, State Trait Anxiety Inventory), and quality of life (Quality of Life in Brain Injury). The study was a non-blinded, waiting-list controlled trial. During the waiting-list period no or minimal care was provided. Multivariate analysis of the main outcome measures showed large effect sizes for psychological well-being (partial η²?=?.191, p?η²?=?.168, p?η²?=?.182, p?η²?=?.130, p?=?.001). Changes on neuropsychological tests did not differ between the groups. It was concluded that the INR programme improved general psychological well-being, depressive symptoms, anxiety, and quality of life. The programme does not affect cognitive functioning.     

Independence and cognition post-stroke and its relationship to burden and quality of life of family caregivers

Background: Stroke is a chronic disease responsible for changes in the functional capacity of the patients. Patient care is usually provided by family caregivers, but with great burden and negative impact on their quality of life.

Objectives: (1) To investigate whether a correlation existed between the levels of independence and cognition in stroke patients and the burden and quality of life of their caregivers; (2) to assess whether periods of injury, rehabilitation and care, and age of the stroke patients interfered with these correlations.

Methods: This was a cross-sectional and correlational study that included 60 participants, of which 30 were post-stroke patients and 30 were their caregivers. The data collection instruments were the Mini Mental State Examination and the Functional Independence Measure for the post-stroke participants, and the Zarit Burden Interview Scale and the World Health Organization Quality of Life-BREF, for the caregivers. The Pearson’s product-moment correlation was used for the data analysis.

Results: Independence and cognition showed no correlation with the burden and quality of life of the caregivers. We identified a strong positive correlation between independence and cognition (r = 0.882), and a moderate negative correlation between independence and rehabilitation period (r = ?0.398) and between burden and quality of life of the caregivers (r = ?0.414). Conclusions: Our data suggest the need for health interventions aimed not only at stroke patients, but also at their family caregivers, given the association between the burden and the low levels of quality of life of the caregivers.     

Predictors of health-related quality of life and participation after brain injury rehabilitation: The role of neuropsychological factors

The aims of this longitudinal study were: (1) to assess associations between neuropsychological factors and health-related quality of life (HRQoL) and participation three months after discharge from inpatient acquired brain injury (ABI) rehabilitation; and (2) to determine the best neuropsychological predictor of HRQoL and participation after controlling for demographic and injury-related factors. Patients with ABI (n?=?100) were assessed within approximately two weeks of enrolment in inpatient rehabilitation. Predictor variables included demographic and injury-related characteristics and the following neuropsychological factors: active and passive coping, attention, executive functioning, verbal memory, learning potential, depressive symptoms, motivation, extraversion, neuroticism and self-awareness. Bivariate analyses revealed that passive coping, executive functioning, depressive symptoms, extraversion, and neuroticism were significantly associated with HRQoL and/or participation. Neuropsychological factors significantly explained additional variance in HRQoL (18.1–21.6%) and participation (6.9–20.3%) after controlling for demographic and injury-related factors. However, a higher tendency towards passive coping was the only significant neuropsychological predictor (β?=??0.305 to ?0.464) of lower HRQoL and participation. This study shows that neuropsychological functioning, and in particular passive coping, plays a role in predicting HRQoL and participation after inpatient ABI rehabilitation and emphasises the importance of addressing patients’ coping styles in an early phase of ABI rehabilitation.     

Cognitive complaints in women with fibromyalgia: Are they due to depression or to objective cognitive dysfunction?

Introduction: Cognitive complaints are common in fibromyalgia, but it is unclear whether they represent an objective cognitive dysfunction or whether they could be explained by depressive symptoms. Here, we aim to elucidate the frequency of subjective cognitive complaints in a sample of women with fibromyalgia, in addition to analyzing associations between these subjective complaints and objective measures linked to the attention and executive cognitive domains. Finally, we aim to investigate the ability of demographic, clinical, and psychological variables to explain the subjective complaints observed. Method: One hundred and five women aged 30–55 years diagnosed with fibromyalgia completed a neuropsychological assessment, which included measures of attention and executive functions. They also completed self-report inventories of subjective cognitive complaints, depression, anxiety, intensity of pain, sleep quality, everyday physical functioning, and quality of life. Results: Eighty-four percent of the patients reported subjective cognitive complaints. Depression scores, everyday physical functioning, and working memory performance were most strongly associated with subjective cognitive complaints. These three variables were significant predictors for subjective cognitive complaints with a final model explaining 32% of the variance. Conclusions: Cognitive complaints are very frequent in patients with fibromyalgia, and these are related to functional and cognitive impairment as well as to depressive symptoms.     

Speech-language performance in Sjögren-Larsson syndrome

Objective: To describe speech-language pathology in patients with Sjögren-Larsson syndrome (SLS) in relation to their cognitive and motor impairment.

Design: Observational case series.

Methods: Cognitive functioning was assessed in 16 patients with SLS (nine males; seven females) using different neuropsychological tests. Speech-language pathology was studied focusing on dysarthria, oral motor functioning, speech intelligibility and language development. Potential correlations between speech-language pathology and other neurological symptoms (e.g. spasticity) were studied.

Results: The median cognitive developmental age was 5;8 (n = 13; range 3;5–8;0) years. A variable degree of mainly pseudobulbar dysarthria was found. Speech intelligibility was influenced by dysarthria, but was also related to language pathology. No correlation between motor functioning and dysarthria or cognitive development was observed.

Conclusion: Dysarthria and language problems are important factors in daily life functioning of patients with SLS. Based upon the clinical profile found, early speech-language therapy is recommended in order to optimize their speech-language development.     

Neuropsychological assessment in Niemann-Pick disease type C: a systematic review

Background

The neuropsychological profile of Niemann-Pick type C (NP-C) patients is characterized by an early deterioration in executive functions and attention. There are few studies on cognitive impairment and on neuropsychological assessment of NP-C disease. The purpose of this review is to analyze the studies on a psychological assessment for NP-C patients.

Method

This review aims to identify a neuropsychological assessment to evaluate cognitive domains and neuropsychological changes in these patients. There were a total of 73 articles. The search terms were identified as titles and abstracts. All articles were evaluated by title, abstract, and text.

Results

Only four of the 73 articles were included because they met the criteria of our review. Furthermore, in these studies, possible diagnostic protocols are proposed on NP-C subjects.

Discussion and conclusion

The cognitive impairment in NP-C has a negative impact on daily functioning and quality of life. Early diagnosis could identify cognitive deficits and promote cognitive interventions to improve the neuropsychological profile. The management of NP-C disease should be based on a multidisciplinary approach, to treating symptoms, preserving neurological functions, and guaranteeing the best possible quality of life. Early identification of neurological and psychological symptoms of the disease is necessary in order to decrease the progression of neurological disease and improve patient care and treatment outcomes. Furthermore, research should focus more on cognitive aspects, not only in the diagnostic process but also in the rehabilitation process.