Faculty Bibliography

This study provides preliminary norms and test-retest indices on a brief battery of neuropsychological tests administered to a sample of 60 male and 40 female high school athletes. Forty-eight subjects completed retesting 8 weeks later. Analyses of baseline scores indicate that girls outperform boys on selected measures of processing speed and executive functions [Wechsler Adult Intelligence Scale-III (WAIS-III) Digit Symbol, Trails B, and Controlled Oral Word Association Test (COWAT)]. Test-retest reliability was low and varied widely among the tests. There were no gender differences in test-retest reliability. Reliable Change Indices (RCIs) were computed on the test-retest data for use in clinical interpretation. These preliminary results indicate that caution should be used in interpreting neuropsychological test data from high school athletes. The current findings indicate that separate norms for boys and girls are warranted. Caution should be used in interpreting discrepancies from baseline scores as a result of what may turn out to be poor test-retest reliability in this population

OBJECTIVE: To prospectively examine recovery of cognitive function within one month following subconcussive sports related head trauma. DESIGN: A prospective study of New York State licensed professional boxers who underwent testing of cognitive functioning before and after (within days, one week, and one month) a professional bout. SETTING: Male professional athletes recruited from the New York State Athletic Commission and local boxing gyms. PARTICIPANTS: Twenty-six licensed professional boxers were enrolled in the protocol. Data is presented on the 18 participants who completed testing on at least three of the four time points. INTERVENTIONS: Serial neuropsychological assessment before and after the athletes engaged in competition. MAIN OUTCOME MEASURES: Neuropsychological measures of cognitive functioning, including new learning and memory, information processing speed, and mental flexibility. RESULTS: A series of repeated measures MANOVAS revealed significant within subject differences across testing on complex information processing and verbal fluency. Post hoc analyses indicated significant differences between time 1 (baseline) and time 4 (one month post), with scores one month following the bout indicating significantly improved performance. Memory scores did not change significantly across testing; however, prior boxing exposure measured by total number of professional bouts was associated with poorer memory performance. CONCLUSIONS: Cognitive testing one month following participation in a professional boxing bout yielded scores suggestive of recovery to a level above the baseline. We conclude that baseline assessment taken during periods of intense training are likely confounded by other pre-bout conditions (i.e., sparring, rapid weight loss, pre-bout anxiety) and do not represent true baseline abilities. Instability of performance associated with mild head injury may complicate the interpretation of post-injury assessments. Practice effects may also confound the interpretation of serial assessments, leading to underestimation of the effects of sports related head trauma. Poorer cognitive performance was evident during the presumed recovery period in boxers with greater exposure to the sport (>12 professional bouts). This finding is consistent with reports of a cumulative effect of repetitive head trauma and the subsequent development of chronic traumatic brain injury. These data have implications for assessing recovery of function following head injury in players of other contact sports as well as determination of return-to-play following an injury.

Impaired memory is a common and often debilitating complaint in patients with epilepsy. Overlapping variables such as seizure control, attentional dysfunction, and mood disorders further complicate diagnosis and management. Direct therapy for memory deficits associated with epilepsy is rarely attempted. The varied pharmacological (AED selection, cholinesterase inhibitors, stimulants, antidepressants, and herbal supplements) and nonpharmacological approaches to cognitive remediation in epilepsy patients are reviewed

OBJECTIVE: To examine the independent contribution of executive versus semantic function to improvement in formal thought disorder after initial stabilization in a first-episode sample. BACKGROUND: Neurocognitive deficits have been suggested to predict treatment response in patients with first-episode schizophrenia. However, studies targeting putative neurocognitive mechanisms to explore improvement in positive psychotic symptoms and especially formal thought disorder are lacking. METHOD: Formal thought disorder symptoms in 81 first-episode patients with schizophrenia or schizoaffective disorder either showed significant improvement (responders > 60% change) or not (nonresponders < 60%) 6 months after initial stabilization of symptoms. These two groups were compared on neuropsychologic (n = 16), clinical (n = 15), and volumetric measures of the frontal and temporal lobes (n = 5) in univariate analyses. The variables that significantly differed between these two groups were used in a forward binary logistic regression analysis. RESULTS: As compared with nonresponders, responders were younger at time of testing, had higher verbal intelligence and reading achievement scores, higher scores on the arithmetic subtest of the Wechsler Adult Intelligence Scale-Revised, and lower number of perseverative responses on the Wisconsin Card Sort Test. Responders also had larger frontal lobe volumes than nonresponders. Only two measures (perseverative responses on the Wisconsin Card Sort Test and age at testing) entered the regression equation. Measures of semantic competency and volumetric measures of the temporal lobes were not associated with formal thought disorder improvement. CONCLUSIONS: Neurocognitive deficits are associated with treatment response in formal thought disorder in first-episode patients with schizophrenia. The improvement in formal thought disorder is more strongly linked to executive than semantic function in this sample, pointing to the salience of frontal systems in treatment response in positive psychotic symptoms.

Neuropsychological (NP) testing is now recognized as an important method for evaluating treatment effects. However, there are limitations to how these tests are currently used in most drug treatment protocols. Changes in cognition are typically defined in statistical terms, with little knowledge as to whether the observed differences are meaningful in any other sense. Methods for assessing changes in test scores need to account for test-retest reliability, practice effects, regression to the mean, and the impact of initial performance. All of these factors may vary according to the individual characteristics of the subject. This article reviews two methods from the NP literature that have attempted to account for these sources of test-retest bias. The reliable change index provides a confidence interval for predicted change by taking into account the test-retest reliability of the measure. Standardized regression-based measures use a more sophisticated statistical approach that enables them to better account for other potential sources of confound. Use of this methodology has been limited to studies of epilepsy surgery and sports-related concussion. These methods have the potential for enhancing the interpretation of NP test data in drug treatment protocols by providing an empirically based definition of clinically meaningful change

PURPOSE: To identify and define clinical and behavioral features of patients with adult-onset idiopathic generalized epilepsy (IGE). METHODS: We reviewed the charts of 313 IGE patients at the NYU Comprehensive Epilepsy Center over the past 5 years to identify patients with adult onset (18 years old or older). We excluded patients with childhood or adolescent symptoms that suggested absence, myoclonic, or tonic-clonic seizures, as well as those with a history of significant head injury or other known causes of localization-related epilepsy. RESULTS: Forty-two (13.4%) patients had a clear onset of IGE in adulthood; average age of onset was early 20s (mean, 23.8 years; range, 18-55 years). Twenty-one patients had adult myoclonic epilepsy (AME, 50%), and three had generalized tonic-clonic seizures on awakening (GTCS-A, 7%). More than two thirds (n=30) are well controlled with current antiepileptic drugs (AEDs), and almost 90% are currently employed (n=37). One third were diagnosed and treated for mental disorders, including depression (n=12), anxiety (n=7), obsessive-compulsive personality disorder (n=2), and postictal psychosis (n=1). CONCLUSIONS: Adult-onset IGE is associated with a good prognosis. An association may exist between psychological disorders, psychotropic medication, and level of seizure control in adults with IGE

Neuropsychology, with its emphasis on standardized and empirically based methods, has made a number of scientific contributions to address growing concerns about concussions resulting from sports injuries. This study employs a test-retest paradigm to determine the immediate effects of concussion in high-school and college athletes. The Standardized Assessment of Concussion (SAC) was administered to 1,313 male athletes prior to the beginning of the competitive season. Reliable change indices and multiple regression models were computed on retest scores obtained from 68 noninjured athletes who were readministered the SAC at either 60 or 120 days following baseline testing. Receiver operating characteristic (ROC) curve analyses were used to test these models with data obtained on 50 athletes tested immediately following concussion. The results indicate that a decline of I point on the SAC at retesting classified injured and noninjured participants with a level of 94% sensitivity and 76% specificity. The RCI and multiple regression models provided comparable levels of group classification, but provided cut-offs that are conservative for use with this population. The results support and extend previous research findings indicating that the SAC is a valid instrument for detecting the immediate effects of mild traumatic brain injury