In this study we investigated sexual functioning in 52 outpatients with a history of traumatic brain injury to determine: (1) the prevalence of reported sexual dysfunction; and (2) the relationship between sexual functioning and age, severity and locus of injury, time since injury, and physical and cognitive function. Reports of sexual functioning indicated a reduction below levels within non-injured populations, but only to statistically significant levels on two scales of the Derogatis Interview of Sexual Function (DISF): Orgasm and Drive/Desire. Location of injury was related to sexuality in that patients with frontal lobe lesions reported an overall higher level of sexual satisfaction and functioning than those individuals without frontal lobe lesions. Time since injury was inversely related to reports of levels of sexual arousal; that is, patients with more recent injuries reported greater levels of arousal than those not recently injured. Right hemisphere injuries also correlated with higher scores on reports of sexual arousal and sexual experiences.
To detect malingering during memory assessment, we evaluated item response biases to the Logical Memory Delayed Recognition (LMDR) subtest of the WMS-III. In a sample of 50 healthy volunteers who were completely naïve to the content of the Logical Memory stories, 6 LMDR items were correctly endorsed above chance probabilities. These 6 rarely missed items significantly discriminated 51 patients with neurological impairment from 36 volunteers who attempted to feign head injury and poor cognitive performance. A weighted combination of the 6 items was summed to form a single Rarely Missed Index (RMI). The RMI accurately classified over 98% of participants and demonstrated high sensitivity (97%) and specificity (100%) in discriminating between analog malingerers and patients. Because the RMI is calculated directly from the LMDR items, it has the advantage of requiring no additional administration time or materials, and thus may serve as a quick screen for dissimulation that can be obtained without additional testing.
Material-specific memory dysfunction was assessed using a nonverbal, visuospatial, supraspan learning test, the Biber Figure Learning Test-Extended (BFLT-E), in 71 left-hemisphere language-dominant epilepsy patients prior to anterior temporal lobectomy (ATL) and in 48 age-matched healthy subjects. Two matched forms of the BFLT-E yielded comparable scores, indicating that this task may be used to track memory performance over time in individual patients. Right temporal lobe epilepsy (RTLE) and left temporal lobe epilepsy (LTLE) patients performed below healthy subjects on all free-recall measures. RTLE, but not LTLE, patients also differed from healthy subjects in recognition memory discrimination. Furthermore, the RTLE patients performed below LTLE patients on measures specific to long-term memory abilities. The BFLT-E appears to be a useful clinical tool for assessing different components of visuospatial memory in patients with lateralized mesial temporal lobe (MTL) dysfunction. The test is sensitive to visuoconstructional problems associated with various types of brain damage, but it also distinguishes material-specific, nonverbal, visuospatial memory impairments in patients with neurological dysfunction in the non language-dominant right temporal lobe.
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