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Schmitt M.M.,James ley Veterans Administration Medical Center | Goverover Y.,New York University | Goverover Y.,Kessler Foundation Research Center | DeLuca J.,Kessler Foundation Research Center | And 3 more authors.
Rehabilitation Psychology | Year: 2014

Objective: The objective of this study was to investigate whether self-efficacy is associated with physical, cognitive, and social functioning in individuals with multiple sclerosis (MS) when controlling for disease-related characteristics and depressive symptomatology. Method: Study subjects were 81 individuals between the ages of 29 and 67 with a diagnosis of clinically definite MS. Hierarchical regression analysis was used to examine the relationships between self-efficacy and self-reported physical, cognitive, and social functioning. Results: Self-efficacy is a significant predictor of self-reported physical, cognitive, and social functioning in MS after controlling for variance due to disease-related factors and depressive symptomatology. Conclusions: Self-efficacy plays a significant role in individual adjustment to MS across multiple areas of functional outcome beyond that which is accounted for by disease-related variables and symptoms of depression. © 2013 American Psychological Association.


Eichstaedt K.E.,University of South Florida | Soble J.R.,South Texas Veterans Healthcare System | Kamper J.E.,University of South Florida | Kamper J.E.,James ley Veterans Administration Medical Center | And 4 more authors.
Brain and Language | Year: 2015

When differences exist, women tend to outperform men on measures of verbal fluency, possibly due to greater bilateral language representation. Patients with temporal lobe epilepsy (TLE) have a higher rate of atypical cortical language representation than the general population, making them a population of interest for the study of language. For the current study, 78 TLE patients (51% male, 51% left temporal focus) underwent pre-surgical neuropsychological evaluations. Retrospective data analyses investigated the impact of seizure laterality and sex on letter and semantic verbal fluency. Results indicated an interaction between sex and laterality for semantic, but not letter, verbal fluency. Males with left TLE exhibited significantly worse semantic fluency than males with right TLE, whereas females' semantic fluency did not differ by seizure focus. These data indicate that females with TLE may indeed engage in more bilateral hemispheric processing of semantic verbal fluency, whereas males may be more reliant on left temporal cortical function for this task. © 2014 Elsevier Inc.


Oehler R.L.,James ley Veterans Administration Medical Center
Infectious Diseases in Clinical Practice | Year: 2015

Despite advances in the surgical and medical management of liver transplant patients, infections remain a significant cause of transplant-associated morbidity and death. Invasive fungal infections are among the leading causes of infectious complications in solid organ transplant recipients and have a comparatively much higher risk of mortality. Liver transplant recipients with invasive fungal infections have the highest mortality, a finding perhaps attributable to the acuity of their systemic illness as well as their degree of immune system compromise. Cryptococcus neoformans is the third most common fungal infection in this group.In this article, we describe our experience with a 65-year-old patient with type 2 diabetes, ethanol abuse, and hepatitis C/cirrhosis/hepatocellular carcinoma who ultimately received orthotopic (cytomegalovirus [CMV] D+/R-) hepatic transplantation. He developed posttransplant shortness of breath, but workup of this finding was negative, and his immunosuppressive doses were slowly weaned. However, his shortness of breath continued. A computed tomography of the thorax was obtained 6 months after transplantation, and he was found to have multiple bilateral irregular opacities that were suggestive of infection. Cultures were eventually positive for C. neoformans. A CMV polymerase chain reaction also demonstrated evidence of CMV viremia at 7310 copies. Further workup was negative for central nervous system or extrapulmonary disease, and the patient was started on treatment for CMV and pulmonary cryptococcosis with good response.In this article, we review some of the epidemiologic, diagnostic, prognostic, and management issues for cryptococcal disease in solid organ transplant recipients with a focus on hepatic transplantation. We also draw a distinction between C. neoformans and Cryptococcus gattii, a more recently characterized pathogen. Lastly, we discuss the treatment of isolated pulmonary cryptococcosis as well as central nervous system and extrapulmonary disease in this growing patient population. © 2014 Wolters Kluwer Health, Inc. All rights reserved.


King-Kallimanis B.,University of Amsterdam | Schonfeld L.,University of South Florida | Molinari V.A.,University of South Florida | Algase D.,University of Michigan | And 4 more authors.
International Journal of Geriatric Psychiatry | Year: 2010

Objectives: To explore the extent of and factors associated with male residents who change wandering status post nursing home admission. Design: Longitudinal design with secondary data analyses. Admissions over a 4-year period were examined using repeat assessments with the Minimum Data Set (MDS) to formulate a model understanding the development of wandering behavior. Setting: One hundred thirty-four Veterans Administration (VA) nursing homes throughout the United States. Participants: Included 6673 residents admitted to VA nursing homes between October 2000 and October 2004. Measurements: MDS variables (cognitive impairment, mood, behavior problems, activities of daily living and wandering) included ratings recorded at residents' admission to the nursing home and a minimum of two other time points at quarterly intervals. Results: The majority (86%) of the sample were classified as non-wanderers at admission and most of these (94%) remained non-wanderers until discharge or the end of the study. Fifty-one per cent of the wanderers changed status to non-wanderers with 6% of these residents fluctuating in status more than two times. Admission variables associated with an increased risk of changing status from non-wandering to wandering included older age, greater cognitive impairment, more socially inappropriate behavior, resisting care, easier distractibility, and needing less help with personal hygiene. Requiring assistance with locomotion and having three or more medical comorbidities were associated with a decreased chance of changing from non-wandering to wandering status. Conclusion: A resident's change from non-wandering to wandering status may reflect an undetected medical event that affects cognition, but spares mobility. Copyright © 2009 John Wiley & Sons, Ltd.


Mouzon B.C.,Roskamp Institute | Mouzon B.C.,James ley Veterans Administration Medical Center | Mouzon B.C.,Open University Milton Keynes | Bachmeier C.,Roskamp Institute | And 15 more authors.
Annals of Neurology | Year: 2014

Objective Traumatic brain injury (TBI) is a recognized risk factor for later development of neurodegenerative disease. However, the mechanisms contributing to neurodegeneration following TBI remain obscure. Methods In this study, we have utilized a novel mild TBI (mTBI) model to examine the chronic neurobehavioral and neuropathological outcomes following single and repetitive mTBI at time points from 6 to 18 months following injury. Results Our results reveal that at 6, 12, and 18 months after injury, animals exposed to a single mTBI have learning impairments when compared to their sham controls without exhibiting spatial memory retention deficits. In contrast, animals exposed to repetitive injury displayed persistent cognitive deficits, slower rate of learning, and progressive behavioral impairment over time. These deficits arise in parallel with a number of neuropathological abnormalities, including progressive neuroinflammation and continuing white matter degradation up to 12 months following repetitive injury. Neither single nor repetitive mTBI was associated with elevated brain levels of amyloid beta or abnormal tau phosphorylation at 6 or 12 months after injury. Interpretation Importantly, these data provide evidence that, although a single mTBI produces a clinical syndrome and pathology that remain static in the period following injury, repetitive injuries produce behavioral and pathological changes that continue to evolve many months after the initial injuries. As such, this model recapitulates many aspects described in human studies of TBI, providing a suitable platform on which to investigate the evolving pathologies following mild TBI and potential strategies for therapeutic intervention. © 2014 American Neurological Association.

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