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Research has suggested that sustaining a traumatic brain injury (TBI) may increase one's risk of developing Dementia of the Alzheimer's Type (DAT) later in life. Several neuropathological models have been proposed to explain the association between TBI and DAT and studies using a neuropsychological deficit profile methodology suggest that the pattern and extent of cognitive decline associated with these conditions are similar. This paper presents a new conceptual model, derived from deficit profile methodology, regarding the relationship between TBI and DAT. This model proposes that, for some individuals, TBI may not lead to true DAT neuropathology, but rather produces a profile of neuropsychological deficits similar to DAT, which increasingly mimics the symptoms of true DAT as the TBI survivor ages. Understanding how TBI may contribute to the development of DAT has important social and medical implications, influencing the direction of prevention efforts and contributing to one's understanding of DAT. [ABSTRACT FROM AUTHOR]

PRIMARY OBJECTIVE: To determine if short forms (i.e. 15 item) of the Judgment of Line Orientation (JOLO) test are equivalent to the full JOLO (i.e. 30 item). RESEARCH DESIGN: Retrospective analysis of JOLO test performance. Methods and procedures: Seventy-two persons with TBI evaluated at a Midwestern University neuropsychology laboratory were administered the JOLO test, Form V, as part of a larger battery of neuropsychological tests. Short forms (i.e. odd and even number short forms) were correlated with the 30 item to determine equivalency of forms. The Statistical Package for the Social Sciences (version 10) was used for the data analyses (SPSS). MAIN OUTCOMES AND RESULTS: Pearson's correlations indicate that the JOLO odd and even short forms are significantly correlated with the full JOLO score (r = 0.90 and 0.93, respectively), and that 100% of the participants' estimated JOLO full score fell within 2 points of the actual full JOLO score. CONCLUSIONS: The results confirm the validity of the short forms of the JOLO for persons with TBI and that gender effects were not significant. [ABSTRACT FROM AUTHOR]

Background: Neuropsychological deficits are generally assessed in terms of absolute level of functioning, e.g. high average, average, low average, although there is increased interest in calculating indices of relative degree of decline, e.g. mild, moderate, severe., Objective: To examine differences in demographic, psychiatric, and military-specific characteristics for relative degree of decline in neuropsychological profiles attributed to traumatic brain injuries (TBIs) among service members (SMs)., Methods: Data were drawn from an existing clinical database of 269 SMs who received neuropsychological evaluations for TBI (Wechsler Test of Adult Reading, Wechsler Adult Intelligence Scale, California Verbal Learning Test, Delis-Kaplan Executive Function System) at a military treatment facility between 2013 and 2018. Independent sample t-tests and one-way ANOVA tests with pairwise comparisons were performed., Results: Memory and problem-solving abilities were the most and least affected domains, respectively. Greater relative decline was observed among male and White SMs and those with post-traumatic stress disorder (PTSD). By contrast, there were no differences in relative decline according to military rank or work status., Conclusion: Relative degree of decline after TBI among SMs is differentially impacted according to neuropsychological domain, with greater impairment among male and White SMs as well as those with PTSD.

Primary Objective: To identify the factor structure of the Personality Assessment Inventory (PAI) clinical scales for military service members with traumatic brain injury (TBI)., Research Design: Retrospective analysis of existing data base., Methods and Procedures: The sample included 210 service members with TBI who completed the PAI as part of a neuropsychological evaluation at a military TBI clinic. Statistical analysis included exploratory factor analysis of 214 items of the 11 PAI clinical scales., Main Outcomes and Results: Exploratory factor analysis indicated a four-factor solution accounting for 30.4% of the variance in scores. A review of the face validity of the items from each factor generated the following factor labels: Somatic/Psychiatric/Cognitive Distress, Social Distress, Substance Misuse, and Depression., Conclusions: The PAI appears to assess general distress (i.e., somatic/psychiatric/cognitive) and substance misuse constructs for both psychiatric and TBI populations, but it also appears to assess a "social distress" construct (i.e., difficulties socializing in both military and civilian populations) that is unique to military populations. Suggestions are offered to re-conceptualize PAI clinical scales specific to psychopathology (i.e., schizophrenia, paranoia, mania, borderline, antisocial) and personality disorders (i.e., borderline, antisocial) in terms of neurologic and military specific issues for service members with TBI.

Primary Objective: Research is increasingly demonstrating the significant impact that non-medical factors can have on outcomes of service members (SMs) with mild traumatic brain injury (mTBI). Thus, the current study examined which demographic, TBI-related factors, and psychological variables are most predictive of functional outcomes., Research Design: Retrospective database analysis from medical chart review., Methods and Procedures: One hundred forty-one patients who received rehabilitation services at an outpatient TBI military treatment facility between 2013 and 2018. Data collected included demographic variables, time since injury, neuropsychological measures, psychological diagnoses, Personality Assessment Inventory (PAI) scores, and Walter Reed Functional Impairment Scale (FIS). Hierarchical linear regression models were used to predict functional outcomes (measured by FIS total, work, social functioning scales)., Main Outcomes and Results: Results indicated that comorbid PTSD diagnosis and PAI Negative Impression Management (NIM) score were predictive of total functional, work, and social outcomes, over and above demographic and TBI-related factors., Conclusions: Current findings confirmed the importance of evaluating and treating psychological factors, as well as exploring one's responding style (NIM), when managing chronic mTBI in SMs. Given ongoing findings of psychological underpinnings to mTBI outcome, there is further need to focus on early interventions to optimize psychological and functional outcomes for SMs.

There is increased recognition that the brain processes a "sense of self" (best understood as a sense of "mineness") in the right hemisphere association area and which can be distorted due to neurologic injury. Although there are numerous descriptions of types of disorders of the self (e.g., asomatognosia, anosognosia, mirror misidentification disorder, Capgras syndrome, schizophrenia), there are few descriptions of the subjective experiences of individuals with traumatic brain injury (TBI) who experience a reduced sense of self. This article presents a longitudinal case study of a woman in her early 40s with a primarily right hemisphere TBI and disorder of the self who had difficulties relating her experiences from the perspective of the self. Subjective interviews, neuropsychological test scores, and objective personality testing illustrate how she reported her experiences of a diminished sense of self, and how this sense of self improved over the normal course of recovery following the TBI. This case demonstrates clinically relevant information regarding how individuals with a reduced "sense of self" (i.e., "mineness") associated with a right hemisphere TBI may report their subjective experiences and perform on objective testing.

Objective: To determine relationships among spiritual beliefs, religious practises, congregational support and health for individuals with traumatic brain injury (TBI)., Design: A cross-sectional analysis of 61 individuals with TBI evaluated in an outpatient clinic using the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS) and the Medical Outcomes Scale-Short Form 36 (SF-36)., Results: For persons with TBI the BMMRS Meaning and Values/Beliefs sub-scales were significantly correlated with the SF-36 General Health Perception sub-scale and the BMMRS Religious Support sub-scale was significantly correlated with the SF-36 General Mental Health sub-scale. Hierarchical regressions indicated that the BMMRS Values/Beliefs and Forgiveness sub-scales accounted for 16% additional variance in SF-36 General Health Perception scores beyond that accounted for by demographic variables (i.e. age, income); no BMMRS sub-scales accounted for additional variance in predicting the SF-36 General Mental Health sub-scale beyond that accounted for by demographic variables (i.e. age, income)., Conclusions: The physical health of individuals with TBI is associated with spiritual beliefs but not religious practises or congregational support. Better mental health is associated with increasing congregationally based social support for persons with TBI. Religious practises (i.e. praying, etc.) are not related to either physical or mental health, as some persons with TBI may increase prayer with declining health status.

Purpose: Missouri's traumatic brain injury (TBI) early referral programme connects individuals with TBI to state services in the acute stages of recovery. This study evaluated the impact of this programme on service utilization and functional outcomes., Method: Sixty-seven individuals in the Early Referral (ER) programme were compared with 31 individuals who received services later in their recovery (controls) in terms of their functioning upon programme enrollment and programme services received. Telephone surveys were then completed with 29 ER and 22 later-referred controls assessing social/emotional and vocational functioning, as well as satisfaction with programme services., Results: The ER group had greater functional limitations than controls upon enrollment. Despite this, at follow-up the ER group evidenced significantly better social integration, emotional well-being and vocational functioning than the control group. Individuals in the ER group did not require/receive more programme resources to achieve these better outcomes. Across both groups, 91% reported feeling the programme is valuable for individuals with TBI., Conclusions: Missouri's TBI early referral programme provides efficacious and cost-effective targeted support for individuals with TBI. Contact with clients and their families during or shortly after acute rehabilitation appears to be associated with better functional outcomes without an increase in the level of services rendered.

Electrical injury (EI) is on the rise in the US, with more than 2400 injuries occurring annually. Consequences of EI often include diffuse neurological damage and a myriad of emotional and behavioural sequelae. While delayed onset of cognitive dysfunction is frequently alluded to in the literature, few cases have been published that document the progressive neuropsychological manifestations of EI over time. This paper offers a case study of a 49 year-old female who suffered a high voltage EI and who underwent neuropsychological evaluations at 6 and 56 months post-injury. Comparison of test results suggested a progressive pattern of global decline in cognitive functioning, with particular impairment in memory, verbal learning, abstract reasoning and sensory-motor functions. This case study illustrates the delayed onset and progression of neuropsychological dysfunction that may occur following EI, as well as the importance of long-term follow-up with patients after high voltage EI.

Objective: To evaluate race differences in demographics, injury severity, and vocational outcomes for persons with TBI., Participants: Seventy-five individuals with TBI (13 African American, 62 Caucasian) who requested services from the Missouri Division of Vocational Rehabilitation (VR) over a 2-year period., Measures: Demographics (i.e. age, race, level of education), injury severity (i.e. LOC, PTA, length of hospitalization, neuropsychological test scores), VR services provided (e.g. transportation, maintenance, on-the-job training, etc.), and VR outcomes (successfully vs unsuccessfully employed; cost per case)., Procedure: All participants completed a standard neuropsychological evaluation and completed VR services (i.e. were followed from enrollment to case closure)., Hypotheses: African Americans and Caucasians would not differ in demographics or injury severity, although fewer African Americans would be successfully employed through DVR., Analyses: Chi-squares and non-parametric MANOVAs to evaluate race differences in terms of demographics, injury severity, vocational services provided and vocational outcomes., Results: As hypothesized, there were few race differences in demographics or injury severity, although African Americans received significantly more transportation services (62 vs 21%). Contrary to hypotheses, there was no difference in the number of successfully employed African Americans (23%) vs Caucasians (18%)., Conclusions: African Americans and Caucasians with TBI achieve similar vocational successes if they receive state VR services.

Emotional and behavioural difficulties are one of the most common difficulties following traumatic brain injury (TBI), although it is not clear which individuals with TBI become most distressed. Numerous factors contribute to adjustment following TBI, and the current study examined degree of cognitive decline as one potential contributor to distress following TBI. The relationship between cognitive functioning and distress may be conceptualized as being related to (a) an individual's absolute level of cognitive ability following TBI, or (b) relative degree of decline following TBI (i.e. the greater the decline, the greater the distress, regardless of absolute level of ability). The current study tested these hypotheses by comparing a measure of global emotional distress with measures of absolute level of neuropsychological functioning and indices of cognitive decline. In contrast to hypotheses, regression analyses indicated that estimated pre-morbid ability accounted for more variance in distress following TBI than either absolute level of functioning or indices of cognitive decline, with individuals with higher estimated pre-morbid abilities reporting lower levels of distress. Treatment implications are discussed.

Carbon monoxide (CO) poisoning is associated with variable neuropsychological deficits, depending on levels of CO exposure and individual differences. Studies to date have reported variable findings, as their subjects have been exposed to different levels of CO from different poisoning sources. Four unique case studies are presented, all of whom experienced the same level of CO poisoning (17-29%) in the same accident. Two of the individuals were brothers with an identical genetic disorder (i.e. syndactylism) and the other two were brother/sister. The results indicated: (1) variable neuropsychological deficits despite similar levels of CO poisoning; (2) consistent estimated decline in intelligence; (3) similar memory decline for the two brothers, but not for the brother and sister; and (4) consistent late-onset emotional-behavioural difficulties. The results also suggested that the neuropsychological and emotional-behavioural deficits had an impact on the individual's ability to work.

Increasing age is associated with greater absolute neuropsychological impairment (e.g. slower processing speed, diminished memory), although it is unclear if older individuals with traumatic brain injury (TBI) show greater relative impairment than younger individuals with TBI. The current study evaluated the effects of normal ageing on TBI by using age-based normative data to calculate indices of relative decline from pre-morbid levels (expressed as z-deficit scores) for different age groups (20-39 years, 40-59 years, 60+ years). The sample included 279 individuals with TBI between the ages of 20 and 65 who were assessed in a department of rehabilitation neuropsychology laboratory over a 4-year period. Spearman correlations and ANOVAs did not show age-related differences in relative memory, attention or speed of processing abilities, although results did indicate that increasing age is associated with relatively less impairment in intelligence. The results suggest that the greater neuropsychological impairment noted in older individuals with TBI is most likely related to normal ageing. The importance of considering both absolute and relative degrees of impairment is discussed.

Pre-injury cognitive data are rarely available for review for individuals suffering from traumatic brain injury (TBI). Although pre-injury intelligence and academic scores may be available, particularly if an individual is learning-disabled (LD), data on specific cognitive abilities are unlikely to exist. We present neuropsychological data for a 15-year-old Caucasian female with a learning disability who was administered IQ testing 2 weeks prior to a significant TBI, as well as other measures of specific cognitive abilities (e.g. memory and perceptual-motor skills) throughout her education. Comparison of pre- and post-TBI data showed: (1) global and generally consistent decline in all cognitive areas and (2) relatively stable performance on tests of academic ability, supporting the validity of such test scores as estimates of premorbid intelligence.