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Depression is frequently a comorbid symptom in patients suffering from neurological or psychiatric illnesses, and this presents a challenge for the differential diagnosis of neuropsychological functioning, especially in the assessment of concentration. The 2 & 7 test was administered to 27 patients with major depression without other neurological or psychiatric illnesses. The average percentile rankings fell within the unimpaired range, with 42.7% for speed, 36.3% for accuracy, and 44.9% for processing. Only three patients were significantly slowed in performance speed, of whom two also showed deficient motor speed on eye-hand coordination performances. None demonstrated deficient accuracy rates, yet four patients were impaired in parallel processing. Thus, major depression did not for the majority of these patients impair 2 & 7 test performance, particularly if no concurrent motor slowing was present. Four guidelines for differential diagnosis are discussed.

The neuropsychological application of the Ruff 2 and 7 Selective Attention Test as a measure of visual selective attention was investigated. The instrument was constructed as a paper-and-pencil approach to evaluate sustained attention utilizing different distractor conditions in the study of voluntary or intentional aspects of attention. Four patient groups with cerebral lesions confined to either the right or left anterior or left or right posterior region (ns = 8, 8, 8, 6) were studied. Patients with right-hemispheric lesions showed a greater over-all reduction in processing speed independent of the serial or parallel processing mode in comparison to individuals with left-sided lesions. Furthermore, as predicted, the two groups with anterior brain damage showed a larger discrepancy between serial and parallel processing modes than patients with posterior lesions. Specifically, the right frontal cases showed the greatest differential of accuracy on the serial and parallel tasks.

Patients suffering from severe head injury may fall into a persistent vegetative state or PVS. While the eyes of PVS patients may open and might even follow objects around the room, PVS patients make no adaptive responses to their surroundings. They make no purposeful movements and can not obey any commands. It is generally difficult, if not impossible, to predict the outcome of a PVS case. Some patients die, some remain vegetative, and others recover. It should be emphasized, however, that recovery in this context means only regaining consciousness; the 'recovered' patients remain severely impaired and only a minority recover any ability to communicate. A review of case records was conducted to estimate the likelihood of recovery of such patients and to determine which factors, if any, might provide insight into the prognosis for an individual PVS patient. Of 650 patients with closed-head injuries (that is, without penetrating wounds), 93 patients were discharged to rehabilitation hospital in a vegetative state. Follow-up data could be obtained on 84 of these patients. Within 6 months, 41 percent of the patients regained consciousness and, by the end of one year, 52 percent had become conscious. Of the 84 patients, 58 percent regained consciousness during the three-year study period. These observations clearly indicate that the majority of recoveries occur within the first six months. Furthermore, if recovery has not occurred within the first year, the chances of recovering fall to about one in eight. A tabulation of the findings of the present patients failed to reveal any significant factor to distinguish the patients who recovered from those who failed to regain consciousness. During the period of the study, 20 of the 84 patients died, and it was possible to identify factors that distinguished these patients. The most important among these was the presence of a mass lesion that had been evacuated (drained). For example, a head injury often produces a hemorrhage; a pool of blood, called a hematoma, may collect and put pressure on the brain. Such a lesion was present in half the patients who died, but in only one-quarter of the patients who survived. (Consumer Summary produced by Reliance Medical Information, Inc.)

The efficacy of a computer-assisted attention retraining program was evaluated with 29 outpatients suffering from moderate to severe traumatic brain injury. Ss who were at least 12 months postinjury were randomly assigned either to the attention training program or a memory training program that served as a control condition. Training lasted 9 weeks with two 2-hr sessions per week for both groups. The experimental design evaluated outcome by juxtaposing a multiple baseline procedure for a 1st set of measures of attention and memory with a pre and post group comparison that relied on a 2nd set of neuropsychological tests. The experimental group improved significantly in comparison with the control group on measures of attention. The reversed pattern for the memory measures was not observed. None of the treatment effects generalized to the 2nd set of dependent variables.