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This report provides suggestive evidence that a prehabilitation program optimized the health of this elderly patient and may have prevented a further episode of postoperative delirium. Prehabilitation protocols should be evaluated in clinical trials to evaluate their efficacy and the target populations who may benefit and to elucidate the underlying mechanisms responsible for enhanced recovery in the perioperative setting.

The present study examined the influence of African American acculturation on the performance of neuropsychological tests following traumatic brain injury (TBI). Seventy one participants already enrolled in a larger-scale study assessing the impact of TBI (i.e., the South Eastern Michigan Traumatic Brain Injury Model Systems project) completed a self-report measure of African American acculturation (African American Acculturation Scale-Short Form; Landrine & Klonoff, 1995) in addition to a standardized battery of neuropsychological tests. Hierarchical regression analyses were conducted to evaluate the relationship between level of acculturation and test performance after controlling for injury-related (initial Glasgow Coma Scale score, time since injury) and demographic variables (age, sex, years of education, and socioeconomic status). Lower levels of acculturation were associated with significantly poorer performances on the Galveston Orientation & Amnesia Test, MAE Tokens test, WAIS-R Block Design, Rey Auditory Verbal Learning Test, and Symbol Digit Modalities Test. Decreased levels of acculturation were also significantly related to lower scores on a composite indicator of overall neuropsychological test performance. In addition, the examiner's ethnicity (Black or White) was related with scores on a few of the tests (i.e., Block Design, Trail Making Test), but was not significantly associated with the overall neuropsychological test performance. Overall, these findings suggest that differences in cultural experience may be an important factor in the neuropsychological assessment of African Americans following TBI, and provide additional support for the hypothesis that cultural factors may partially account for the differences among ethnic/cultural groups on neuropsychological tests.

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The results of the Best Evidence Synthesis conducted by the World Health Organization Collaborating Centre Task Force on Mild Traumatic Brain Injury (MTBI), published in this journal in 2004 (suppl. 43), reflect work of exceptional magnitude. The analysis of existing scientific research literature on all aspects of MTBI (diagnosis, prognosis and treatment) was greatly needed. However, the results of such a process merit strong caution as to their possible clinical applications. Thus, the following points should be considered:

Au cours des dernières décennies, une multitude de tests et d’indices ont été développés pour tenter de détecter la non-validité des résultats neuropsychologiques. Cependant, la prolifération et la popularité de ces mesures ont contribué à la perception qu’il est dorénavant possible de les utiliser pour identifier la simulation des troubles cognitifs (malingering). Dans cet article, un cadre conceptuel est présenté pour tenter de favoriser une meilleure compréhension des notions sous-jacentes et permettre une meilleure interprétation de la non-validité en expertise. Selon la présente conceptualisation, il existe deux étapes distinctes : la première consiste à discerner la non-validité des données à l’aide de méthodes psychométriques, notamment les tests de validité de performance (TVP). La deuxième requiert une décision quant à la crédibilité du tableau clinique, incluant un jugement quant à la cohérence de l’ensemble des informations cliniques. C’est seulement dans le contexte de certaines incohérences indéniables qu’il serait possible d’avancer une opinion évoquant l’amplification des problèmes cognitifs.

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