[Show abstract][Hide abstract] ABSTRACT: Aggression after traumatic brain injury (TBI) is common but not well defined. Sixty-seven participants with first-time TBI were evaluated for aggression within 3 months of injury. The prevalence of aggression was found to be 28.4%, predominantly verbal aggression. Post-TBI aggression was associated with new-onset major depression (p=0.02), poorer social functioning (p=0.04), and increased dependency in activities of daily living (p=0.03), but not with a history of substance abuse or adult/childhood behavioral problems. Implications of the study include early screening for aggression, evaluation for depression, and consideration of psychosocial support in aggressive patients.
The Journal of neuropsychiatry and clinical neurosciences 10/2009; 21(4):420-9. DOI:10.1176/appi.neuropsych.21.4.420 · 2.82 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Sleep disturbance is common in the subacute recovery phase following brain injury. A previous study from the authors' group found 68% of patients with closed head injury (CHI) had disrupted sleep on a rehabilitation unit. In the present study, the authors investigated whether improvement in sleep efficiency correlates with duration of posttraumatic amnesia (PTA) after CHI.
Fourteen CHI patients were enrolled and followed prospectively. Mechanism of injury included motor vehicle accident, fall, and blunt assault. An actigraph was placed on each subject's wrist within 72 hours of admission to the rehabilitation unit and recorded data for the duration of their stay. A minimum of 7 days of continuous actigraphy data was obtained on all subjects. PTA was measured daily using the Orientation Log (O-LOG).
Seventy-eight percent of subjects had mean week-1 sleep efficiency scores of < or = 63%. Patients admitted having already cleared PTA had significantly better week-1 sleep efficiency scores than those with ongoing amnesia (P = .032). For those patients admitted with ongoing PTA, each 10-unit increase in sleep efficiency score correlated with 1 unit increase in O-LOG score (P = .056).
Disrupted sleep is common in the postacute stage following CHI. Improved sleep efficiency correlates with resolution of PTA. Decreased sleep efficiency may negatively affect memory return after traumatic brain injury. Actigraphy is uniquely suited to study the sleep patterns of these patients.
[Show abstract][Hide abstract] ABSTRACT: To assess the prevalence of and risk factors for sleep disturbances in the acute post-traumatic brain injury (TBI) period.
Longitudinal, observational study.
Fifty-four first time closed-head injury patients were recruited and evaluated within 3 months after injury. Pre-injury and post-injury sleep disturbances were compared on the Medical Outcome Scale for Sleep. The subjects were also assessed on anxiety, depression, medical comorbidity and severity of TBI.
Subjects were worse on most sleep measures after TBI compared to before TBI. Anxiety disorder secondary to TBI was the most consistent significant risk factor to be associated with worsening sleep status.
Anxiety is associated with sleep disturbances after TBI. Further studies need to be done to evaluate if this is a causal relationship.
[Show abstract][Hide abstract] ABSTRACT: To estimate the frequency and correlates of insomnia and daytime sleepiness among people with dementia in AL facilities.
Participants were randomly selected from 22 different assisted living facilities in Maryland. A total of 124 dementia participants were included in the analysis. All participants were rated on an 11-item sleep questionnaire regarding insomnia and daytime sleepiness.
Sleep disturbance was present in 59.2% of people with dementia. Of the total sample, 21.8% had insomnia only (IN); 21.6% had excessive daytime sleepiness only (DS); and 16.8% had both IN and DS. 40.8% had no sleep disturbance. IN and DS scores were not significantly associated with each other (r=0.07, p=0.43). Of those in the IN group, the majority had mild and moderate dementia and of those in the DS only group the majority had severe dementia. Those with IN only performed the best and DS only performed the worst on both cognitive measures (the Mini Mental State Examination) (F=3.26, p=0.014), and on physical measures (the physical subscale of the psychogeraitric dependency rating scale) (F=6.09, p<0.001). There was no significant difference between the groups on the Cornell scale for depression in dementia.
The frequency of insomnia and daytime sleepiness in dementia subjects in AL is similar to that found in nursing homes. Daytime sleepiness is associated with poorer cognitive and day-to-day functioning. Effective management of DS may lead to improved functioning in the AL residents. Insomnia is associated with the best outcomes, even better than those with no sleep disturbance. This finding needs to be replicated.
International Journal of Geriatric Psychiatry 02/2008; 23(2):199-206. DOI:10.1002/gps.1863 · 2.87 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The authors compared the severity and clinical profiles of patients with two etiologically different apathy syndromes: apathy after traumatic brain injury (TBI) and deficit schizophrenia (DSS). Patients from both groups were equally apathetic, but those with DSS had more severe anhedonia, blunted affect, and alogia, as measured by the Scale for Assessment of Negative Symptoms. These findings suggest that patients with DSS have a more complex presentation of apathy. Their differences may help to identify anatomical correlates of these apathy syndromes and aid in the design of more effective management strategies for both groups of patients.
[Show abstract][Hide abstract] ABSTRACT: Objective: To determine the metabolic status of the brain in post traumatic brain injury(TBI) depression using proton magnetic resonance spectroscopy (MRS). Design: Case-control study including 5 TBI depressed subjects and 5 age matched non-TBI non-depressed controls. Methods: Metabolic status was assessed using proton MRS. Ratios of N-acetylaspartate (NAA), choline (Cho) and total creatine (Cr) were calculated in frontal cortex, basal ganglia and thalamus. Results: NAA/Cho or NAA/Cr ratios were significantly reduced in the TBI depressed group compared to controls in frontal cortex, basal ganglia and thalamus. Conclusion: Reduced levels of NAA in frontal regions, basal ganglia and thalamus in TBI depression suggest neuronal damage or dysfunction which may be a associated with the primary brain injury or with depressed mood.
European Journal of Psychiatry 04/2006; 20(2). DOI:10.4321/S0213-61632006000200002 · 0.46 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Depression is a frequent neuropsychiatric complication of Alzheimer's Disease.
This study investigated the safety and effectiveness of escitalopram (LEXAPRO) for depression in AD (dAD) as defined by the NIMH consensus criteria in an 8-week, open-label treatment study.
Escitalopram was efficacious and safe for the treatment of dAD in this study. Larger, controlled studies are warranted to further assess the efficacy for mood and behavioral disturbances in this medically fragile population. Copyright
International Journal of Geriatric Psychiatry 03/2006; 21(3):273-4. DOI:10.1002/gps.1459 · 2.87 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A majority of the elderly suffer from some sort of sleep disturbance. Common sleep disturbances are insomnia and excessive daytime sleepiness. There are no published studies on the prevalence of sleep disturbance in the assisted living (AL) setting.
To estimate the prevalence, types, and associations of sleep disturbance in a stratified random sample of AL residents, and to explore the effect of sleep disturbance on cognitive and physical functioning, as assessed by the Mini- Mental State Exam (MMSE) and the Psychogeriatric Dependency Rating Scale (PGDRS).
Participants were 198 randomly selected assisted living residents in 22 Maryland facilities. Participants were rated on an 11-item sleep questionnaire regarding insomnia and daytime sleepiness.
Sleep disturbance was present in 69% of residents, insomnia (IN) in 42% and excessive daytime sleepiness (DS) in 34.6%. IN and DS scores were not significantly correlated(r = 0.10, p = 0.19). Use of hypnotics, sedating antidepressants, and depression were associated with insomnia. Depression and poor general medical health were associated with daytime sleepiness. On a cognitive task (Mini Mental State Examination) participants with insomnia only out-performed participants with no sleep disturbance and daytime sleepiness; on a measure of physical function (PsychoGeriatric Dependency Rating Scale- physical domain), participants with insomnia fared better than those with daytime sleepiness only and those with both insomnia and daytime sleepiness. Participants with DS only performed worse on both measures compared to those with no sleep disturbance, those with insomnia only, and those with both insomnia and daytime sleepiness.
The prevalence of sleep disturbance in AL is similar to that reported in nursing homes. Daytime sleepiness is associated with poorer cognitive and day-to-day functioning, while insomnia is associated with better outcomes. Effective management of DS may lead to improved functioning in the AL residents.
International Journal of Geriatric Psychiatry 10/2005; 20(10):956-66. DOI:10.1002/gps.1380 · 2.87 Impact Factor