Category: News

Chronic Traumatic Encephalopathy (CTE) is a brain condition usually associated with boxers and football players.  Recent American Medical Association Journal (JAMA Neurology) revealed surprising evidence:  Of 152 brain examinations from contact sports athletes under the age of 30, more than 40% had evidence of CTE, suggesting that it can start much earlier than expected.

What happens in the brain?  When the head receives a blow or a sudden stop and acceleration as happens with a football tackle, the brain moves inside the skull, creating shearing forces that could damage tiny blood vessels (microhemorrhages), and nerve connections (axonal injuries).

As the brain bounces back and forth, the damage causes an abnormal protein called Tau to build up inside the folds of the brain surface called the cerebral cortex sulci.  Tau protein eventually builds up in the sulci and is diagnostic for CTE.  The cortex is the part of your brain responsible for thinking, memory, reasoning, emotions, and learning.

Who is at risk?  There are 4 million sports-related concussions occurring in the US each year, and about 70% of people with repeated concussions may develop CTE.  A big question is why some people develop it and others do not.  It may be that some athletes are at higher risk genetically.

Diagnosis

Researchers are developing guidelines for before-death diagnosis based on history and symptoms called Trauma Encephalopathy Syndrome (TES).  To diagnose TES, an athlete must have:

• A history of repeated head trauma.
• CTE symptoms, at least 12 months.
• A history of symptoms getting worse.
• No other diagnosis that could cause the symptoms.

CTE develops in stages.  The earliest symptoms are subtle cognitive, emotional, and behavioral changes.  These stages include:

• Mood symptoms – Depression, anxiety, and paranoia.
• Behavioral symptoms – Impulsive or aggressive, and anger.
• Cognitive systems include confusion, short-term memory, and poor judgment.
• Motor signs walking and balance problems, and trouble speaking.

There is no cure for CTE, but symptoms can be treated.  Here at NRS|LS, we are one of the seven original programs treating concussion and traumatic brain injury, extending back to 1978.  The following are the stages that need to be applied in order to help the individual:

1.     Consultation.  The athlete needs to understand the nature of his/her changed profile.

2.     A neuropsychological examination.  This is a “blueprint” that describes the functional expression of the physical changes that have occurred in the brain in the form of thinking changes, and behavior.  It enables a rehabilitative program to help the athlete understand what they have, what the adjustment strategies are, an understanding of the functional expression of these problems in daily functioning, and what they can do about it.

3.     Biofeedback.  Many of the athletes develop significant adjustment reactions in the form of depression, as well as agitation.

4.     Cognitive rehabilitation.  These are cognitive exercises enabling the athlete to develop compensatory strategies adjusting to their thinking problems.

5.     Medication.  There are medications for mood changes, depression, and anxiety.  Some medications used for Parkinson’s and Alzheimer’s may help memory and movement problems.

In closing, untreated CTE may increase the risk of accidental death or suicide.  Life expectancy for people with CTE is about 70 years old.  Education and intervention is critically needed for this population.

If you have a history of repeated head traumas, be it sports, accidents, etc., please call us and we will certainly be able to help you understand your situation and what you can do about it.

______________________________
Robert B. Sica, Ph.D., ABN
Board-Certified in Neuropsychology
Director, Neuropsychological Rehabilitation Services|LifeSpan
Director, Post-Doctoral Fellowship Supervisor
Jersey Shore University Medical Center, Neuroscience Division
Department of Neurology and Psychiatry
Clinical Assistant Professor, Rutgers-Robert Wood Johnson Medical School
Clinical Assistant Professor, Hackensack Meridian School of Medicine

Some Facts About Concussion

Concussion, also called mild traumatic brain injury, can occur due to motor vehicle accidents, hitting the head during a fall, or playing contact sports. Symptoms following the event depend on the severity of the injury and vary from mild confusion and disorientation to a complete brief loss of consciousness. These symptoms occur due to an abnormal movement of the brain inside a skull, which disrupts the functioning of the brain cells at the molecular level. These changes are often undetectable during the neuroimaging studies. Neuropsychological testing is method that is sensitive in identifying neurocognitive changes after a concussion such as problems with attention, information processing, memory, reasoning, etc.

The most severe symptoms are experienced within minutes and hours after the injury and gradually improve within days or weeks. Most people fully recover after 3-6 months. The length of recovery depends on many factors, such as the specifics of the injury, the person’s age, medical conditions, history of previous concussions, stress, previous psychological history, and current psychological symptoms, including anxiety and depression. Some people continue to experience headaches, sleep problems, fatigue, vision or balance abnormalities, and behavioral changes after the expected time of recovery. These symptoms, with proper treatment, can also improve.

The research indicates that it is essential for patients to receive accurate information and education about concussion and have positive, realistic expectations about the recovery process. A lack of information leads to a so-called ‘misattribution bias’ where patients think of common mild cognitive fluctuations caused by fatigue, pain, or psychological symptoms as symptoms of severe and permanent brain injury.

At NRS|LS, patients receive comprehensive care (i.e. neuropsychological and psychological testing, counseling, cognitive rehabilitation, etc.) for concussion and post-concussive symptoms. Please call our office if you have any questions or would like a consultation.

Eleonora Gallagher, Psy.D.
Clinical Psychologist #7297
Neuropsychology Post-Doctoral Fellow

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Aphasia is a language condition that affects an individual’s ability to understand and express language, as well as their ability to read and write. Aphasia most often occurs suddenly as the result of brain injury caused by a stroke, head injury, or brain tumor, but it can also present slowly in progressive neurological conditions such as Alzheimer’s or different types of dementia.

While there are multiple different types of aphasia, many of them fall into two broad categories that are referred to as fluent and non-fluent. The most common type of fluent aphasia is called Wernicke’s aphasia, and it is caused by damage to the temporal lobe. This condition is characterized by an individual who can speak fluently, but what they are saying may be confusing and lack meaning to others. In addition, people with Wernicke’s aphasia are often unaware of their spoken mistakes, which can cause a great deal of frustration.

Moving to non-fluent aphasia, the most common type is Broca’s aphasia. This is caused by damage to the left side of the frontal lobe, which is an area that is responsible for speech and motor movements. People with this kind of aphasia may speak in short, fragmented sentences that lack connecting words such as “but,” “or,” and “and.” Despite their lack of fluency, individuals with Broca’s aphasia are still able to use words in the correct context.

Neuropsychological evaluation is an excellent tool for identifying the different types of aphasia. In addition, it is always recommended to evaluate the totality of brain functions in order to best serve the patient. If you or a loved one is experiencing symptoms pertaining to a neurological condition, please call our office to schedule a consultation.

Gianna Scimemi, M.A.
Psychometrician & Doctoral Student

“Family History Is Not Useful in Screening Children for Dyslexia” Journal of Pediatric Neuropsychology, Volume 8, pages 15–21, published 2022 

New Research in Dyslexia Screening

Dyslexia is a learning disorder that involves difficulty in reading due to problems in identifying speech sounds and how they relate to letters and words. Early assessment and intervention are very important in helping children with dyslexia. This assessment usually involves looking at family history and completing tests. Recently, a study by Emilio Ferrer, Bennett A. Shaywitz, John M. Holahan, and Sally E. Shaywitz titled “Family History Is Not Useful in Screening Children for Dyslexia,” published in volume 8 of the Journal of Pediatric Neuropsychology, challenged the idea of using family history as a screening tool for dyslexia.

The study tracked 398 children from age 5 through adulthood to evaluate the effectiveness of using family history as a screening measure for dyslexia. The researchers compared the predictive value of family history against evidence-based early screening measures. The researchers looked at how sensitive family history was in predicting dyslexia. They found it was ineffective across all family member groups, with its sensitivity rates ranging from as low as 5% (for grandparents) to a maximum of 51% (for first- and second-degree relatives). These low sensitivity rates indicate that relying on family history alone would result in many dyslexic children being misclassified as typical readers. Evidence-Based Screening, however, was significantly more effective in detecting dyslexia, and even adding family history to the screening process did not improve the accuracy.

The findings suggest that using family history to identify dyslexia is not only inadequate but potentially harmful because misclassification can delay intervention for dyslexic children, negatively impacting their education. Instead, evidence-based screening tools that are specifically designed to identify early signs of dyslexia are encouraged. These tools focus on measurable skills such as letter knowledge and phonological awareness, which are more reliable indicators of dyslexia risk.

Effective early screening for dyslexia is crucial for timely intervention and support and validated, evidence-based screening measures can help to improve the accuracy of dyslexia identification and provide better outcomes to ensure that all children at risk of dyslexia are accurately identified and receive the necessary support to thrive in their educational journey.

If you are concerned about your child’s reading abilities, please call our office to schedule a consultation.

Sincerely,

______________________________
Steven P. Greco, Ph.D., ABN
Board-Certified in Neuropsychology #485
Partner, Neuropsychological Rehabilitation Services|LifeSpan
Post-Doctoral Fellowship Supervisor
Jersey Shore University Medical Center, Neuroscience Division
Department of Neurology and Psychiatry
Clinical Assistant Professor, Rutgers-Robert Wood Johnson Medical School
Clinical Assistant Professor, Hackensack Meridian School of Medicine

Supplemental Magnesium 

With social media being an ever-expanding source of information, there is always new advice about supplements and medicines. One new, viral trend has been taking magnesium supplements to improve sleep and reduce anxiety. There is always research to be done, but current work has shown that magnesium can help combat anxiety and sleep disturbances.

Magnesium is an essential mineral in the human body, and much of the United States population does not meet the recommended daily allowance (RDA) for magnesium and is at risk for possible insufficiency. Magnesium has been used to treat migraines, arrhythmias, and acute asthma exacerbations, and as a laxative. It is also used in obstetrics for the treatment of eclampsia and pre-eclampsia and in neuroprotection for premature infants.

Neurobiologically, magnesium ions function as NMDA receptor antagonists, meaning they stop the NMDA receptor from producing a response by binding to the receptor in place of calcium. The NMDA receptor is the primary excitatory neurotransmitter in the human brain, so magnesium prevents the excessive activation of the receptor. Magnesium also binds to and stimulates GABA receptors in the brain, which also relaxes the brain.

One review of many articles looking at the relationship between magnesium, sleep, and anxiety has shown that in higher doses it can help to improve sleep and reduce anxiety. Four out of the five studies using MgO reported positive results, and a study using magnesium L-aspartate also showed improvements in sleep quality. Further, five out of seven studies featuring anxiety-related outcomes reported positive results, with higher doses causing greater reductions in anxiety. Variations in the results are attributable to differences in the form of magnesium, dosage, and time period; however, overall, magnesium improved sleep quality and reduced anxiety.

Examining the Effects of Supplemental Magnesium on Self-Reported Anxiety and Sleep Quality: A Systematic Review.

Alexander Rawji, Morgan Peltier, Kelly Mourtzanakis, Samreen Awan, Junaid Rana, Nitin Pothen, & Saba Afzal (2024, Cureus).

The lead author, Dr. Alexander Rawji, is currently completing a neuropsychology rotation at NRS|LS. 

Disclaimer:  Always consult and obtain approval from your primary health care physician before taking an over-the-counter medication.

Unfortunately, many women with autism go undiagnosed. Historically, autism has been diagnosed more frequently in males than females, leading to a gender bias in research and clinical understanding. This bias stems from the fact that autism presents differently in females, often manifesting in subtler ways that may be overlooked or misinterpreted.

Females with autism often exhibit different behavioral patterns and coping mechanisms compared to males. They may display stronger social skills, as they tend to have a larger emotional vocabulary, greater awareness and desire for social interaction, and an ability to mimic others in social situations. They also tend to have intact symbolic and imaginary play and may develop a few close friendships. Their restricted interests may be more related to people and animals rather than inanimate objects, which is often seen in males.

Often, women will go undiagnosed because their behaviors may be mistakenly attributed to shyness, anxiety, or other conditions. Autism in females is a complex phenomenon, but by recognizing the distinctive characteristics, more women can get the support they need.

Camouflaging in ASD

Some people with Autism Spectrum Disorder may hide or camouflage their symptoms, making it harder to recognize and diagnose. Research points to this being a protective effect, more common in females. This “Camouflaging Effect” is because females are more likely to hide behaviors associated with Autism Spectrum Disorder likely because of social pressures, leading to higher rates of internalizing disorders like anxiety, depression, and eating disorders.

There are three categories of camouflaging. The first one is compensation, which is how an individual compensates for social challenges. This is often in the form of copying the behaviors of other people. The second category is masking, which is how an individual attempts to hide autistic characteristics. This can be done by forcing eye contact and tolerating overwhelming situations even when in distress. The third category is assimilation which is how an individual fits in with others in social contexts like forcing interactions with others. Camouflaging in Autism Spectrum disorder is a complex trait that can make identification harder.  Hence, comprehensive neurodevelopmental assessment is recommended in order to provide a thorough understanding of the child or adolescent.

If you have any concerns about a social emotional developmental condition, please call our office to schedule a consultation.

A frequent referral to our practice is to diagnosis and differentiate complex neuropsychological presentations. A common example is to differentiate different types of conditions, such as, Bipolar Disorder, Oppositional Defiance, Disruptive Mood Dysregulation Disorder, Conduct Disorder, ADHD, OCD, etc.  This blog post focuses on mood related conditions.

Bipolar disorder, intermittent explosive disorder, and disruptive mood dysregulation disorder (DMDD) are three main mood disorders that may be difficult to differentiate between.

In bipolar disorder, children present with symptoms of both major depressive disorder and mania. In children, depressive episodes may present as a decrease in interest in life, agitation, inconsistent sleep (too much or too little), appetite changes, lower energy and activity levels, inability to concentrate, sadness, feelings of worthlessness or guilt, and thoughts of self-harm, etc. Manic episodes would include an elevated, euphoric mood inflated self-esteem, increased energy levels, decreased need for sleep, increased talkativeness, racing thoughts, distractibility, and increased impulsivity. Children can cycle through these states significantly faster than adults with bipolar disorder, but they still have distinct depressive and manic episodes.

Intermittent explosive disorder is classified by repeated, sudden episodes of impulsive, aggressive, violent behavior or angry verbal outbursts, which are too extreme for the situation. The outbursts are short and not premeditated, examples of this can include road rage with adults. The onset of recurrent, problematic, impulsive aggressive behavior is most common in late childhood or adolescence and rarely begins for the first time after age 40 years. This condition cannot be diagnosed before 6 years of age.

If the child’s irritability is persistent and particularly severe, they may, instead be disruptive mood dysregulation disorder (DMDD). Outbursts characteristic of DMDD are more frequent, and the child’s mood between the outbursts is persistently irritable or angry most of the day, nearly every day. The outbursts start before the age of 10 and can be diagnosed only between the ages of 6 and 18 years old.

Children experiencing sudden outbursts or irritability and aggression may have intermittent explosive disorder rather than bipolar disorder.  Sudden outbursts of irritability and aggression could be mistaken for Bipolar Disorder; however they are more consistent with Intermittent condition.  As a result, a thorough assessment of the child including collateral information is necessary.

At NRS|LS we employ a comprehensive approach to assessing mood disorders. Our data is collected from parents, teachers, other significant family members, medical team providers of the child’s care, objective data pertaining to the child, etc. Treatment recommendations will vary depending upon accurate diagnostic procedures and outcomes.

Please call our office if you have any questions or would like a consultation with our neuropsychologist.

“The Lost Years: an Integrative Review of the Mental Health,
Educational, and Social Impact of the Pandemic on Children
and Adolescents From 2019 to 2022″

The following was taken from the conclusion section of the following article that was recently
published from the Journal of Pediatric Neuropsychology (2024) 10:49–90

“It is clear that the impact of the COVID-19 pandemic,
lockdown, quarantine, and extended social distancing
measures have had a deleterious effect on children and adolescents’
mental health, interpersonal relations, social
skills development, and academic achievement. Many
studies helped to elucidate these findings and provide
researchers with a pathway through which we can begin
to examine the long-term effects of the pandemic. We
now know that depending on the variable (i.e., mental
health, academic achievement, and the like), the effects
will vary depending on age during the pandemic, socioeconomic
influences, and access to mental health care. It
would behoove researchers to adopt a biopsychosocial-economic-cultural
lens while examining these variables.
Both the mental health and academic communities should
be identifying evidence-based interventions for those who
are at-risk and most impacted and begin to develop innovative ways to
deliver services and instruction at the earliest
possible time. Hopefully, should something like this occur
again, we will not only be better prepared to anticipate the
difficulties that children and adolescents face in the context of
social isolation and decreased access to academic
instruction, but also have the resources and mechanisms
in place to intervene early.”

Please call our office if you would like a consultation or have any questions regarding your child or adolescent.

NRS|LS acknowledges Dr. Steven Greco’s presentation on Brain Health on 4/12/24.  Dr. Greco presented for Wellness Day at the Academy of Allied Health and Sciences (AAHS).   Dr. Greco’s presentation focused on how the field of neuropsychology is a critical aspect in understanding and improving brain health.  Dr. Greco reviewed the recent literature about supplements and their effects on the brain, neurogenesis, case presentation, and presented on current trends improving brain health.    NRS|LS is an affiliated organization with AAHS and Dr. Greco has served as a mentor for the students at AAHS.

If you would like more information about Dr. Greco’s presentation, please call 732-988-3441.

Dr. Steven Greco is a board certified neuropsychologist serving Monmouth County for 20 years.  He specializes in clinical treatment and is a clinical professor in the department of neurology at Hackensack Meridian Health, Jersey Shore campus.

With continued research and more information published, we are learning that ADHD and autism have many overlapping characteristics, especially in children. Though the two are very different neurological disorders, there are many attributes that children present that could easily be mistaken as one of the two conditions. However, small nuances may allude to the other conditions. It is also very common for children to have both ADHD and autism together, but there are certain signs to differentiate what the child might be dealing with.

Similarities between ADHD and Autism:

• Attention difficulties – Children with ADHD have trouble paying attention or holding attention, and children with autism struggle to pay attention when they lack interest in something.
• Hyper Behavior – Children with ADHD typically struggle to sit still and are constantly moving, and children with autism are often seen stimming, or creating self-stimulation with repetitive, rapid movements.
• Impulsivity – Children with ADHD will often talk over others, interrupt, and act without thinking, and children with autism may interrupt, say inappropriate things at inappropriate times, and lack self-regulation tactics.

Characteristics more specific to ADHD:

• Fidgeting
• Hyperactivity/inability to sit still
• Difficulty following directions
• Acting/speaking without thinking
• Easily distracted by different stimuli

Characteristics more specific to Autism:

• Avoiding eye contact
• Lack of social reciprocity
• Highly fixated interests
• Sensory-seeking behavior/sensory sensitivity
• Scripting/repeating phrases, words, and/or songs on a consistent basis

Though the characteristics listed to differentiate the two are strong indicators of what a child might be dealing with, there is still high likelihood of overlap. Some of the signs might not be as prevalent as others, and it may be difficult to realize certain behaviors when they are viewed often in everyday life. If you feel your child may be presenting any of these issues, schedule a consultation with our office and let our professionals provide your child with the tools they need to excel.

Joshua Tice
Psychometrician and Behavioral Technician