No abstract

Considerable heterogeneity exists in the criteria used for the establishment of stages of impairment for patients with dementia. The valid distinction of stages is important both for clinical interpretation and the study of dementia. This study reports on the use of the Mattis Dementia Rating Scale (DRS) in staging dementia. Using a sample of 42 patients diagnosed with Alzheimer-type dementia, DRS performance and a rating of Instrumental Activities of Daily Living (IADL) were compared with clinical ratings of dementia severity. Total DRS score provides a clinically valid measure of stage of impairment and appeared to provide a better distinction among stages than IADL score. However, use of the IADL score in conjunction with total DRS may improve correspondence with clinical staging over use of the total DRS score alone. Normative data for the DRS are also provided.

No abstract

As part of a standard evaluation of neuropsychological sequelae, the Wechsler Memory Scale-Revised (WMS-R) was administered to 107 patients with a history of traumatic brain injury. Confirmatory factor analyses were conducted on the 12 subtests of the WMS-R to examine the fit of various hypothesized factor patterns, including patterns identified in previous exploratory factor analytic studies. Because part of the correlation between immediate and delayed recall trials of the same material is attributable to a common measurement procedure, this correlation due to measurement commonality was partialled out of the conceptual factor structure. The results suggested the presence of 3 distinct but highly correlated factors: attention/concentration, immediate memory, and delayed recall. Models that posited separate verbal and nonverbal memory processes failed to improve fit over more parsimonious models. Comparisons with previous factor analytic studies and implications for clinical assessment are discussed.

Intervention with patients who have sustained mild, neurologically mediated cognitive changes due to closed head trauma (CHT) depends upon several factors. Adequate assessment is required, lest deficits be missed or complaints dismissed as "emotional." The time course, recovery curve, and secondary symptoms are also important. Knowledge represents the core of the treatment approach, through direct education efforts, involvement of family members, and other sources of support. The goal is primarily prevention of further impairment. Coping is emphasized where remediation is not feasible and where natural recovery can be utilized as part of the therapeutic regimen.Rehabilitation and neuropsychology, traditionally separate disciplines, have recently come together in the care of closed head trauma (CHT) patients. The earliest applications of neuropsychological services to CHT patients in the rehabilitation setting were understandably aimed at the more severely impaired patients, whose cognitive and motor functions were clearly and permanently compromised. The more recent trend toward the application of neuropsychology in the care of mild CHT patients is partly the result of the realization that, of the nearly 8 million recorded head injuries annually in the United States, the vast majority are mild to moderate in severity, with many more mild injuries going unreported. THE NEEDS OF THE MILD CHT PATIENTIt would be an understatement to say that clinical neuropsychology has been of tremendous value to the victims of severe CHT, affording these patients the benefits of better documentation of the nature and extent of

CATHETERIZATION. Lois Campbel I , Stanley E. K i r k p a t r i c k The purpose of t h e study was t o determine i f mottr e r s can learn t o reduce t h e i r a n x i e t y and f u n c t i o n a s therapeutic a l l i e s in t h e h o s p i t a l t o reduce t h e s t r e s s experienced by t h e i r preschool c h i l d r e n undergoing c a r d i a c c a t h e t e r i z a t i o n . I t was designed t o compare, s i n g l y and in combination t h r e e models of p a t i e n t p r e p a r a t i o n : 1 ) d i r e c t e d a t t e n t i o n and'information about h o s p i t a l i z a t i o n and c a t h e t e r i z a t i o n , 2) s u p p o r t i v e counseling, and3) s t r e s s management t r a i n i n g . F i f t y mothers and t h e i r children were randomly assigned t o 1 of 5 experimental groups. Group E served a s t h e c o n t r o l group and received t h e c u r r e n t r o u t i n e p r e p a r a t i o n f o r c a t h e t e r i z a t i o n . Group D received t h e informat i o n model only. Group C received both t h e information and couns e l i n g models. Group B received both t h e information and s t r e s s management models. Group A received a l l t h r e e models. Assessment of treatment e f f e c t s f o r both mothers and c h i l d r e n included s e l f -r e p o r t measures completed by t h e mothers, behavioral observ a t i o n s recorded a t key s t r e s s p o i n t s by b l i n d r a t e r s and physiol o g i c responses recorded by a computerized biofeedback system. R e s u l t s i n d i c a t e d s i g n i f i c a n t treatment e f f e c t s f o r a l l intervent i o n models. The s t r e s s management model had :he g r e a t e s t e f f e c t a s measured by p o s i t i v e changes in t h e mothers s e l f -r e p o r t e d a n x i e t y s c o r e s , electromyographic readings and electrodermal responses. Both c h i l d r e n and t h e i r mothers who received t h e s t r e s s management model demonstrated more a d a p t i v e behavior in t h e h o s p i t a l and a f t e r d i s c h a r g e than those who d i d n o t . The study would suggest t h a t although information and counseling reduce s t r e s s and a n x i e t y r e l a t e d t o h o s p i t a l i z a t i o n , s t r e s s management t r a i n i n g can provide a d d i t i o n a l b e n e f i t s . Dept. of pediatrics, Phila., PA. In recent efforts directed t o t h e analysis of sensory processing in t h e newborn, neonates and adults were exposed to various reflex modification procedures. Previous work with adults had indicated that when a tone precedes a reflex eliciting stimulus by an appropriate interval the amplitude of t h e reflex is inhibited. If t h e tone is presented simultaneously with t h e reflex-eliciting event, response t o amplitude is augmented. The eye-blink eliciting device consisted of a miniature solenoid with a teflon striker which could deliver a controlled tap; a miniature photo reflective densiometer attached t o a TDH 39 earphone assessed the e y e blinks.For each experiment, 15 healthy term appropriate...

No abstract

Congenital cytomegalovirus infection occurs in about 1% of live births. Although symptomatic congenital infection often results in severe developmental deficits and mental retardation, about 90% have asymtomatic infection. Previous studies of the intellectual development in children with asymptomatic congenital cytomegalovirus have resulted in mixed findings. To control for the effects of hearing impairment (which occurs in about 15% of asymptomatic children) on intelligence scores, we tested 18 prospectively followed, normally hearing, school-aged children with asymptomatic congenital cytomegalovirus (15 black, ten male) and 18 controls matched for age, sex, race, school grade, and socioecnomic status. Children were tested via the Wechsler Intelligence Scale for Children-Revised, the Kaufman Assessment Battery for Children, and the Wide Range Achievement Test. Multivariate analysis revealed no differences between groups on intelligence scores or subscales, achievement scores, or incidence of learning disabilities (defined as significant discrepancy between intelligence and achievement), and mean scores for both groups were very close to national norms. It is concluded that the 25,000 children born in the United States each year with asymptomatic congenital cytomegalovirus and normal hearing are not likely to be at increased risk of mental impairment.