Atlanta Comprehensive Neuropsychology

04/07/2022

Bruce Willis' family revealed on social media Wednesday that he has been diagnosed with aphasia and would be retiring from acting

09/22/2021

People who get more deep sleep appear less likely to develop Alzheimer's. That may be because this phase of sleep allows the brain to clear out waste products.

02/14/2021

A woman in Colombia with a rare genetic mutation recently made the ultimate donation to science.

07/08/2020

Parkinson patients play ping pong to combat disease symptoms

07/03/2020

Neuropsychological Sequelae of SARS-CoV-2 Infection

Andrew Levine, PhD, ABPP

The neuropsychological sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the associated syndrome, coronavirus disease 2019 (COVID-19) are uncertain. Thus far, neurologic-focused case studies suggest that a minority of COVID-19 cases have symptoms ranging in severity from very mild (e.g., headache and loss of smell/taste) to severe (e.g., encephalitis, large vessel stroke).

However, the meaning of these observations is unclear, as the studies thus far have not included control groups consisting of uninfected patients with similarly severe symptoms (respiratory or otherwise) or those who have undergone similar medical procedures (e.g., ventilation and sedation) for other conditions.

Additionally, there are large discrepancies in case series findings, likely due to differences in data collection methods, and it is often unclear whether the patients described were tested for other potentially neuroinvasive viruses that can lead to similar neurological conditions as those reported for COVID-19.

There have been no studies on the neuropsychological outcomes of individuals infected with SARS-CoV-2 or survivors of COVID-19. However, there is good reason to anticipate cognitive sequelae due to direct and indirect mechanisms.

Concerning direct mechanism, previously identified human coronaviruses (HCoV), including SARS-CoV-1 and MERS-CoV, are both neuroinvasive and neurovirulent. During the 2002-2003 SARS outbreak, a variety of neurological conditions appeared 3-4 weeks into the course of the illness in a small number of patients, including polyneuropathy, encephalitis, and aortic ischemic stroke. MERS-CoV has been associated with reports of psychosis and seizures, altered mental status, paralysis, ischemic stroke, Guillain-Barré syndrome, and neuropathy, all of which appeared several weeks after the primary respiratory symptoms.

Assuming SARS-CoV-2, like other HCoVs, can have a lasting presence in the central nervous system (CNS), its potential to provoke a chronic neuroinflammatory immune response should be considered as a potential cause of neuropsychological deficits. Such chronic inflammation in the brain could conceivably result in neuropsychological deficits in the long-term, similar to HIV. Furthermore, chronic CNS viral infection may be associated with increased risk of neurodegenerative illness, such as dementia, as indicated by studies of human herpes viruses, Influenza A, and other HCoVs.

Concerning indirect mechanisms, cerebral strokes have been observed with greater frequency in relatively young COVID-19 patients. Furthermore, COVID-19 patients who develop acute respiratory distress syndrome (ARDS) are at risk of lowered levels of oxygen reaching the brain. Many of those with ARDS are intubated and treated with mechanical ventilators, a procedure with substantial neurologic risks, likely due to loss of oxygen to the brain. In addition, the “cytokine storms” reported in severe COVID-19 cases can cause multiple organ damage, leading to liver, kidney, or heart dysfunction, all of which can have adverse effects of cognitive functioning.

This acute inflammatory state can also be the result of more direct i CNS damage. Finally, some have proposed that CNS-related autoimmune disorders could arise post-SARS-CoV-2 infection, as has been reported in SARS-CoV-1 and MERS-CoV infection.

The psychological impact of COVID-19 illness is also relevant. Considering the relatively high fatality rate among individuals who become infected with SARS-CoV-2, as well as the emotional and financial devastation caused by the pandemic, psychological disorders such as posttraumatic stress disorder and depression will also need to be considered as primary diagnoses and factors that could potentially contribute to neurocognitive impairment. Indeed, there are now several reports of lasting psychological trauma among COVID-19 survivors.

As suggested thus far, the direct and indirect causes for neuropsychological deficits in COVID-19 survivors are varied and multifactorial. Therefore, in order to characterize the long-term neuropsychological sequelae of SARS-CoV-2 infection and/or COVID-19, large cohort studies that include both infected (historically or actively) and never-infected individuals will be required.

Such studies should include resource-limited countries and, domestically, over-sampling (proportionally) of African Americans and Latinos due to the greater impact the virus is having on their communities. Such studies will allow for longitudinal characterization of cognitive functioning while considering comorbidities and other potential factors affecting such functioning.

Full article available at https://www.north-coast-neuropsych.com/resources

Image: Source: https://bit.ly/38mVEfh

04/28/2020

Helpful advice for these stressful times.

Our brains are adapting to acute stress, writes developmental neuropsychologist Molly Colvin. Time warps so that the present moment is elongated. Complex thinking skills, like decision-making or planning, go offline.

04/21/2020

Dr. Jennifer Katzenstein, director of Psychology and Neuropsychology and Pediatric Neuropsychologist at Johns Hopkins All Children's Hospital, gave some tips to help parents deal with the children at home and how to spot situations where stress and anxiety might require the help of a professional.

03/17/2020

COVID-19 (Coronavirus) UPDATE

As of the week of March 16, 2020, Atlanta Comprehensive Neuropsychology is remaining open for scheduled appointments. The health and well-being of our guests, employees, and families is our top priority.

Please alert our staff if you have a cough, temperature (fever), shortness of breath, or feel unwell, so we can reschedule your appointment to a later date.

Please bring no more than one family member or other person with you to a neuropsychological evaluation. Ideally, it is best if the other person does not remain in our waiting room while the patient is tested, to avoid congregating and mingling of multiple people in our waiting room.

We are taking extra infection-control precautions, including avoiding handshakes, frequent handwashing, frequent cleaning of common surfaces (e.g., doorknobs, writing utensils, and testing materials), and placement of antimicrobial wipes and hand sanitizer in all rooms and offices.

If you have a computer with Internet access or a tablet or smart phone, we may be able to offer you the option of providing certain aspects of our services to you via telehealth (i.e., videoconferencing) rather than an in-person appointment at our office.

We are closely following updates and recommendations from the Centers for Disease Control (www.cdc.gov) and other public health and government authorities, and we potentially may need to modify or reschedule upcoming appointments as conditions continue to develop rapidly. Please call our front office at 770-933-4130 to speak with our office staff.

As the nation's health protection agency, CDC saves lives and protects people from health, safety, and security threats.

02/25/2020

What is Chronic Traumatic Encephalopathy (CTE)?

What is chronic traumatic encephalopathy (CTE) and is everyone who plays contact sports at risk of getting it?

By C. Munro Cullum, PhD, ABPP and Christian LoBue, PhD

CTE is a condition involving abnormalities in the tau protein, which normally helps build and stabilize connections within the brain. Determination of CTE requires autopsy with microscopic examination of brain tissue and characterization of pathology. A diagnosis of CTE cannot be made in living individuals using brain imaging, neuropsychological testing, or other tools at present.

Media headlines have suggested that participation in contact sports and/or sustaining concussions results in CTE. However, scientists have found that such claims are not fully supported in recent studies and reviews of the literature. CTE has been detected in individuals with no known exposure to head trauma or participation in contact sports.

Along these lines, less than 6% of 300 individuals who played contact sports at any point in their lifetime were found to have CTE in a recent study. The best information suggests that CTE is a rare condition, and it is clear that most individuals who play contact sports or who sustain concussions do not develop CTE.

There have been claims that CTE is associated with a variety of behavioral changes such as depression, explosivity, substance use, cognitive impairment, and even suicidality. However, these symptoms occur in many conditions, and none are specific to CTE . To date, a causal relationship between CTE pathology and clinical symptoms has not been established, and scientists continue to debate the clinical significance of CTE abnormalities and what the risk factors may be. There have been few studies of the reliability of the pathological diagnosis of CTE, and when CTE is present, it is usually accompanied by other pathologies.

Relating specific neuropathological findings to particular behaviors earlier in life is tenuous, and this work is in its infancy. It should be kept in mind that CTE is not a clinical diagnosis and that evaluation by a qualified healthcare provider can assist with identifying treatable symptoms and conditions that may improve the lives of those who are suffering and/or concerned about CTE.

Image source: https://pixabay.com/photos/kids-football-games-tackle-sports-56952/

02/22/2020

Jones was a writer, actor, director, plus a medieval historian, children’s book author, political pundit, and more