the cerebral calci~cations. Despite this thesis we This thesis is worth reading thr thctse intcrd... more the cerebral calci~cations. Despite this thesis we This thesis is worth reading thr thctse intcrdo not yet understand why the strio-pal-ested in a up-to-date review on clinicai aspects lidodentate system is the most frequent site for of strio-pallido-dentate calcinosis. calcification.
The role of assessment in rehabilitation varies from depart ment to department. In some cases pa... more The role of assessment in rehabilitation varies from depart ment to department. In some cases patients are given a series of structured tasks and on the basis of performance on these tasks a rehabilitation programme is planned and its effectiveness is monitored by repetition of the assessment tasks. In others, the assessment and treatment stages can not be clearly differentiated and abilities are assessed and treated on the basis of observations made throughout the rehabilitation programme. In the latter case monitoring the effectiveness of treatment is usually based on observation of whether the patient appears to have improved on the activities. If we are going to separate assessment techniques from intervention strategies then we need first to consider what is meant by assessment. In this chapter, assessment is con sidered as a structured programme of observations made by the rehabilitation team. These observations may be used to identify the difficulties that a person has, to measure their severity, determine the impact they have on daily life and to monitor any changes in ability that occur, either as a result of spontaneous recovery or in response to treatment. In order to decide which assessment techniques to use we need to consider four basic questions. We need to consider why assessments are being carried out, who is going to do them, when they are going to do them and what functions need to be assessed. The answers to these questions will determine the techniques that are to be used on any given occasion.
Personality change is widely reported after head injury, but rarely investigated quantitatively. ... more Personality change is widely reported after head injury, but rarely investigated quantitatively. This Paper summarises recent quantitative studies concerned with the natural history of personality change after severe head injury; its nature; its prediction; and its consequences. Reports of personality change increase with increasing time after injury, and the changes reflect a variety of phenomena including changes in affect, behaviour, maturity, and responsibility. Although there is a relationship between injury severity and personality change, other features such as premorbid personality and lifestyle are important. A severe personality change has important functional •consequences. Families become heavily burdened, and patients with severe personality change are very unlikely to return to work.
Journal of Neurology, Neurosurgery & Psychiatry, 1991
Recent advances in Alzheimer's disease imply a need for adequate clinical trials of new treatment... more Recent advances in Alzheimer's disease imply a need for adequate clinical trials of new treatments which require careful design. The disorder is progressive and shows clinical heterogeneity. While large-scale trials of elderly subjects are appropriate in relation to assessment of drugs or other treatments designed to prevent progression of the disorder, the outcome measurements in such biological treatment trials require careful planning. Studies of individual patients are relevant for answering certain specific questions. Relatively short cross-over trial designs may be appropriate to some pharmacological studies. The choice of neuropsychological instruments for measuring change is critically important, particularly in excluding test/retest artefact and in avoiding floor and ceiling effects. Test scales designed for assessment of specific neuropsychological deficits, or forming part of standard IQ assessments are unlikely to prove robust. Tests can be selected and developed for individual patients, but generalisation of the results of such experiments to the disease as a whole is not inevitable. There is a need to develop psychological instruments for measuring change that are robust and relevant to the clinical problem of progressive dementia.
The two Papers by Vogenthaler and colleagues, concerning long-term productivity and independent l... more The two Papers by Vogenthaler and colleagues, concerning long-term productivity and independent living outcomes of the brain-injured, are of considerable interest. Not only do they identify the features of late outcome in a large group of severely injured patients, but they also attempt to model the key factors which predict those outcomes. The Papers, while of interest in themselves (Who has a good outcome? Who does not fit a general trend? Is severity of injury important?), also serve as a succinct introduction to the problems and dilemmas facing anyone attempting to measure outcome after severe brain injury. The problems range from making an operational definition of outcome; to deciding on a study population; deciding on an appropriate follow-up; identifying appropriate and achievable methodologies; identifying important predictors; and judging the clinical significance and generalizability of the results.
Journal of Neurology, Neurosurgery & Psychiatry, 1981
The nature of the neurological and mental disabilities resulting from severe head injuries are an... more The nature of the neurological and mental disabilities resulting from severe head injuries are analysed in 150 patients. Mental handicap contributed more significantly to overall social disability than did neurological deficits. This social handicap is readily described by the Glasgow Outcome Scale, an extended version of which is described and compared with alternatives. Comments are made about the quality oflife in disabled survivors.
This paper examines mental health consequences of the Lockerbie Disaster in 66 adults claiming co... more This paper examines mental health consequences of the Lockerbie Disaster in 66 adults claiming compensation from the insurers of the airline. Claimants were examined 10 to 14 months after the disaster by clinical interview and questionnaires. The most frequent diagnoses were post-traumatic stress disorder and depression, followed by other anxiety disorders. Many were above "caseness" levels on questionnaires, and had very high scores on intrusion and avoidance. There were no significant predictors of the presence or severity of diagnosis, but a number of predictors (age, death of friends, exposure to unpleasant sights) of questionnaire scores.
The research examined the effects of alcohol and other variables on cognitive outcome after sever... more The research examined the effects of alcohol and other variables on cognitive outcome after severe head injury. Alcohol consumption habitually and at the time of injury were strongly related, and both were related to age and educational level but not injury severity. Covariance analysis to remove the effects of age and education showed a reduction in the main effects, so that only alcohol consumption at injury was a significant predictor of memory, but not other cognitive areas late after injury. There were significant interactions between severity of injury (post-traumatic amnesia), and alcohol habitually or at time of injury, with increasing alcohol consumption increasing the size of the memory deficit. To have a short post-traumatic amnesia and have drunk heavily led to a worse memory score than that found in patients with a considerably longer post-traumatic amnesia who had drunk lightly or not at all.
Journal of Neurology, Neurosurgery & Psychiatry, 1975
Book reviews useful descriptions of the different surgical approaches to the cervical and dorsal ... more Book reviews useful descriptions of the different surgical approaches to the cervical and dorsal spines. Several papers review the current status of treatment of severe congenital abnormalities of the spine, and discuss alternatives to immediate closure of meningomyloceles. There are contributions on the blood supply of the spinal cord, the mechanism of syringomyelia and syringobulbia, and on the use of evoked potentials for prognosis in spinal cord injury. The volume ends with an important contribution on mechanisms and management of spinal cord injury. References are given after each section. Although most of the work is already published, the sections provide stimulating reading about some of the more difficult aspects of spinal surgery. The volume should be of value to orthopaedic and paediatric surgeons, as well as to neurosurgeons. R. D. ILLINGWORTH BIOCHEMICAL ASPECTS OF NERVOUS DISEASES Edited by J. N. Cumings. (Pp. 265; price not stated.) Plenum Press: London. 1972. The scope of this book is best indicated by listing its contents: metabolic aspects of some diseases of peripheral nerves (J. Wilson and R. H. S. Thompson), biochemistry of muscle diseases (R. J. T. Pennington), biochemistry of demyelination and demyelinating diseases (B. Gerstl), biochemistry of copper in man and its role in the pathogenesis of Wilson's disease (J. M. Walshe), brain amine metabolism in some neurological and psychiatric disorders (G. Curzon), biochemical neurological disease in children (L. I. Woolf). Most chapters present their material in a form suitable for the clinician, but it must be conceded that certain aspects of biochemistry cannot be simplified without loss of precision. Nevertheless, many practising neurologists will be glad to have this useful summary available for consultation. It is well edited and the production is good.
Journal of Neurology, Neurosurgery & Psychiatry, 1983
Two groups, each of 21 cases of severe blunt head injury, were compared. Patients in one group we... more Two groups, each of 21 cases of severe blunt head injury, were compared. Patients in one group were pursuing claims for financial compensation while patients in the other were not. Patients were assessed on cognitive tests, and both patients and relatives were interviewed at 3, 6 and 12 months after injury. There were few differences between claimants and non-claimants: post-concussional symptoms were common in both, cognitive performance was equal, and the reports given by relatives of changes in the patients were very similar. However, the reports given by patients themselves differed with claimants reporting slightly more symptoms than nonclaimants.
Journal of Neurology, Neurosurgery & Psychiatry, 1985
Female relatives of defined groups of consecutive male minor and severe head injury victims were ... more Female relatives of defined groups of consecutive male minor and severe head injury victims were seen at home 3 months after the injury. The relatives of the severely injured suffered significant psychiatric morbidity compared to the minor head injury relatives. They also showed poorer functioning in social roles associated with the home. There was no difference in the vulnerability of either wives or mothers of the head injury victims. It is argued that there is a need for support for the relatives of those who have suffered severe brain injury.
International Journal of Geriatric Psychiatry, 1992
The prevalence of depression in 80 well-diagnosed demented patients was examined using the Cambri... more The prevalence of depression in 80 well-diagnosed demented patients was examined using the Cambridge Mental Disorders of the Elderly Examination (CAMDEX) based on information from patients, caregivers and professionals. The overall prevalence of DSM-111-R major depressive illness was 5%, but the identification of depressed patients and the prevalence rate varied with the source of information used. The symptom profiles of the patients were examined in more detail. The significance of these findings and the use of operational diagnostic criteria in the investigation of coexistent depression and dementia are discussed. KEY woms-Depressive symptoms, dementia, CAMDEX
International Journal of Geriatric Psychiatry, 1992
Thirty-one elderly people were examined in Lockerbie and compared with 24 younger survivors of th... more Thirty-one elderly people were examined in Lockerbie and compared with 24 younger survivors of the disaster which took place in December 1988. Examination took place within one year of the disaster, but was timed to avoid the anniversary period. All subjects were in Lockerbie at the time the aeroplane exploded in mid-air. Examinations werc conducted for purposes of medico-legal assessment. The elderly had similar responses to the younger disaster victims, the majority of whom met DSM-111-R criteria for PTSD. The elderly, however, had a very high incidence of coexisting major depression, unlike the younger population. Loss or injury to friends and the witnessing of human remains was positively correlated with a diagnosis of post-traumatic stress disorder in the elderly but not in the younger subjects. Neither material nor personal loss, nor the witnessing of human remains, was associated with a diagnosis of depression in the elderly, although significant material loss was associated with depression in the younger patients.
the cerebral calci~cations. Despite this thesis we This thesis is worth reading thr thctse intcrd... more the cerebral calci~cations. Despite this thesis we This thesis is worth reading thr thctse intcrdo not yet understand why the strio-pal-ested in a up-to-date review on clinicai aspects lidodentate system is the most frequent site for of strio-pallido-dentate calcinosis. calcification.
The role of assessment in rehabilitation varies from depart ment to department. In some cases pa... more The role of assessment in rehabilitation varies from depart ment to department. In some cases patients are given a series of structured tasks and on the basis of performance on these tasks a rehabilitation programme is planned and its effectiveness is monitored by repetition of the assessment tasks. In others, the assessment and treatment stages can not be clearly differentiated and abilities are assessed and treated on the basis of observations made throughout the rehabilitation programme. In the latter case monitoring the effectiveness of treatment is usually based on observation of whether the patient appears to have improved on the activities. If we are going to separate assessment techniques from intervention strategies then we need first to consider what is meant by assessment. In this chapter, assessment is con sidered as a structured programme of observations made by the rehabilitation team. These observations may be used to identify the difficulties that a person has, to measure their severity, determine the impact they have on daily life and to monitor any changes in ability that occur, either as a result of spontaneous recovery or in response to treatment. In order to decide which assessment techniques to use we need to consider four basic questions. We need to consider why assessments are being carried out, who is going to do them, when they are going to do them and what functions need to be assessed. The answers to these questions will determine the techniques that are to be used on any given occasion.
Personality change is widely reported after head injury, but rarely investigated quantitatively. ... more Personality change is widely reported after head injury, but rarely investigated quantitatively. This Paper summarises recent quantitative studies concerned with the natural history of personality change after severe head injury; its nature; its prediction; and its consequences. Reports of personality change increase with increasing time after injury, and the changes reflect a variety of phenomena including changes in affect, behaviour, maturity, and responsibility. Although there is a relationship between injury severity and personality change, other features such as premorbid personality and lifestyle are important. A severe personality change has important functional •consequences. Families become heavily burdened, and patients with severe personality change are very unlikely to return to work.
Journal of Neurology, Neurosurgery & Psychiatry, 1991
Recent advances in Alzheimer's disease imply a need for adequate clinical trials of new treatment... more Recent advances in Alzheimer's disease imply a need for adequate clinical trials of new treatments which require careful design. The disorder is progressive and shows clinical heterogeneity. While large-scale trials of elderly subjects are appropriate in relation to assessment of drugs or other treatments designed to prevent progression of the disorder, the outcome measurements in such biological treatment trials require careful planning. Studies of individual patients are relevant for answering certain specific questions. Relatively short cross-over trial designs may be appropriate to some pharmacological studies. The choice of neuropsychological instruments for measuring change is critically important, particularly in excluding test/retest artefact and in avoiding floor and ceiling effects. Test scales designed for assessment of specific neuropsychological deficits, or forming part of standard IQ assessments are unlikely to prove robust. Tests can be selected and developed for individual patients, but generalisation of the results of such experiments to the disease as a whole is not inevitable. There is a need to develop psychological instruments for measuring change that are robust and relevant to the clinical problem of progressive dementia.
The two Papers by Vogenthaler and colleagues, concerning long-term productivity and independent l... more The two Papers by Vogenthaler and colleagues, concerning long-term productivity and independent living outcomes of the brain-injured, are of considerable interest. Not only do they identify the features of late outcome in a large group of severely injured patients, but they also attempt to model the key factors which predict those outcomes. The Papers, while of interest in themselves (Who has a good outcome? Who does not fit a general trend? Is severity of injury important?), also serve as a succinct introduction to the problems and dilemmas facing anyone attempting to measure outcome after severe brain injury. The problems range from making an operational definition of outcome; to deciding on a study population; deciding on an appropriate follow-up; identifying appropriate and achievable methodologies; identifying important predictors; and judging the clinical significance and generalizability of the results.
Journal of Neurology, Neurosurgery & Psychiatry, 1981
The nature of the neurological and mental disabilities resulting from severe head injuries are an... more The nature of the neurological and mental disabilities resulting from severe head injuries are analysed in 150 patients. Mental handicap contributed more significantly to overall social disability than did neurological deficits. This social handicap is readily described by the Glasgow Outcome Scale, an extended version of which is described and compared with alternatives. Comments are made about the quality oflife in disabled survivors.
This paper examines mental health consequences of the Lockerbie Disaster in 66 adults claiming co... more This paper examines mental health consequences of the Lockerbie Disaster in 66 adults claiming compensation from the insurers of the airline. Claimants were examined 10 to 14 months after the disaster by clinical interview and questionnaires. The most frequent diagnoses were post-traumatic stress disorder and depression, followed by other anxiety disorders. Many were above "caseness" levels on questionnaires, and had very high scores on intrusion and avoidance. There were no significant predictors of the presence or severity of diagnosis, but a number of predictors (age, death of friends, exposure to unpleasant sights) of questionnaire scores.
The research examined the effects of alcohol and other variables on cognitive outcome after sever... more The research examined the effects of alcohol and other variables on cognitive outcome after severe head injury. Alcohol consumption habitually and at the time of injury were strongly related, and both were related to age and educational level but not injury severity. Covariance analysis to remove the effects of age and education showed a reduction in the main effects, so that only alcohol consumption at injury was a significant predictor of memory, but not other cognitive areas late after injury. There were significant interactions between severity of injury (post-traumatic amnesia), and alcohol habitually or at time of injury, with increasing alcohol consumption increasing the size of the memory deficit. To have a short post-traumatic amnesia and have drunk heavily led to a worse memory score than that found in patients with a considerably longer post-traumatic amnesia who had drunk lightly or not at all.
Journal of Neurology, Neurosurgery & Psychiatry, 1975
Book reviews useful descriptions of the different surgical approaches to the cervical and dorsal ... more Book reviews useful descriptions of the different surgical approaches to the cervical and dorsal spines. Several papers review the current status of treatment of severe congenital abnormalities of the spine, and discuss alternatives to immediate closure of meningomyloceles. There are contributions on the blood supply of the spinal cord, the mechanism of syringomyelia and syringobulbia, and on the use of evoked potentials for prognosis in spinal cord injury. The volume ends with an important contribution on mechanisms and management of spinal cord injury. References are given after each section. Although most of the work is already published, the sections provide stimulating reading about some of the more difficult aspects of spinal surgery. The volume should be of value to orthopaedic and paediatric surgeons, as well as to neurosurgeons. R. D. ILLINGWORTH BIOCHEMICAL ASPECTS OF NERVOUS DISEASES Edited by J. N. Cumings. (Pp. 265; price not stated.) Plenum Press: London. 1972. The scope of this book is best indicated by listing its contents: metabolic aspects of some diseases of peripheral nerves (J. Wilson and R. H. S. Thompson), biochemistry of muscle diseases (R. J. T. Pennington), biochemistry of demyelination and demyelinating diseases (B. Gerstl), biochemistry of copper in man and its role in the pathogenesis of Wilson's disease (J. M. Walshe), brain amine metabolism in some neurological and psychiatric disorders (G. Curzon), biochemical neurological disease in children (L. I. Woolf). Most chapters present their material in a form suitable for the clinician, but it must be conceded that certain aspects of biochemistry cannot be simplified without loss of precision. Nevertheless, many practising neurologists will be glad to have this useful summary available for consultation. It is well edited and the production is good.
Journal of Neurology, Neurosurgery & Psychiatry, 1983
Two groups, each of 21 cases of severe blunt head injury, were compared. Patients in one group we... more Two groups, each of 21 cases of severe blunt head injury, were compared. Patients in one group were pursuing claims for financial compensation while patients in the other were not. Patients were assessed on cognitive tests, and both patients and relatives were interviewed at 3, 6 and 12 months after injury. There were few differences between claimants and non-claimants: post-concussional symptoms were common in both, cognitive performance was equal, and the reports given by relatives of changes in the patients were very similar. However, the reports given by patients themselves differed with claimants reporting slightly more symptoms than nonclaimants.
Journal of Neurology, Neurosurgery & Psychiatry, 1985
Female relatives of defined groups of consecutive male minor and severe head injury victims were ... more Female relatives of defined groups of consecutive male minor and severe head injury victims were seen at home 3 months after the injury. The relatives of the severely injured suffered significant psychiatric morbidity compared to the minor head injury relatives. They also showed poorer functioning in social roles associated with the home. There was no difference in the vulnerability of either wives or mothers of the head injury victims. It is argued that there is a need for support for the relatives of those who have suffered severe brain injury.
International Journal of Geriatric Psychiatry, 1992
The prevalence of depression in 80 well-diagnosed demented patients was examined using the Cambri... more The prevalence of depression in 80 well-diagnosed demented patients was examined using the Cambridge Mental Disorders of the Elderly Examination (CAMDEX) based on information from patients, caregivers and professionals. The overall prevalence of DSM-111-R major depressive illness was 5%, but the identification of depressed patients and the prevalence rate varied with the source of information used. The symptom profiles of the patients were examined in more detail. The significance of these findings and the use of operational diagnostic criteria in the investigation of coexistent depression and dementia are discussed. KEY woms-Depressive symptoms, dementia, CAMDEX
International Journal of Geriatric Psychiatry, 1992
Thirty-one elderly people were examined in Lockerbie and compared with 24 younger survivors of th... more Thirty-one elderly people were examined in Lockerbie and compared with 24 younger survivors of the disaster which took place in December 1988. Examination took place within one year of the disaster, but was timed to avoid the anniversary period. All subjects were in Lockerbie at the time the aeroplane exploded in mid-air. Examinations werc conducted for purposes of medico-legal assessment. The elderly had similar responses to the younger disaster victims, the majority of whom met DSM-111-R criteria for PTSD. The elderly, however, had a very high incidence of coexisting major depression, unlike the younger population. Loss or injury to friends and the witnessing of human remains was positively correlated with a diagnosis of post-traumatic stress disorder in the elderly but not in the younger subjects. Neither material nor personal loss, nor the witnessing of human remains, was associated with a diagnosis of depression in the elderly, although significant material loss was associated with depression in the younger patients.
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Papers by Neil Brooks