Background: Recent literature on traumatic brain injury (TBI), though mixed when reporting outcom... more Background: Recent literature on traumatic brain injury (TBI), though mixed when reporting outcomes, seems collectively to suggest possible gender advantage for women in postinjury recovery, especially in executive functions. Hormonal neuroprotection, through female reproductive hormones, is often proposed as an underlying factor in these results. We explored potential gender differences in an aspect of executive functions, selfawareness (SA), which is often impaired after TBI, limits patient effort in critical rehabilitation, and increases caregiver burden. Methods: Within a prospective survey, repeated-measures design, 121 patients with moderate or severe TBI undergoing acute rehabilitation in a Level 1 trauma center, a family member or caregiver informant, and a treating clinician were asked to complete the Patient Competency Rating Scale (PCRS) and the Frontal Systems Behavior Scale (FrSBe) at admission and discharge. Results: Although overall, women and men with TBI showed generally similar levels of SA, women had significantly better awareness of their injury-related deficits at acute rehabilitation discharge, even when controlling for age, education, and injury severity. Conclusions: Mixed findings in this study mirror the pattern of results that dominate the published literature on gender and TBI. Gender differences in executive dysfunction may not be as large or robust as some researchers argue. In addition, complex interplays of socialization, gender-role expectations, naturally occurring male and female ability differences, and differences in access to postinjury rehabilitation are understudied potential moderators.
A clinical sample of 20 sexual harassment victims who were successful in obtaining damage awards ... more A clinical sample of 20 sexual harassment victims who were successful in obtaining damage awards for trauma through the judicial system were sources of this descriptive study. Ratings of physical coercion of the harassment, MMPI–2 scores, and ratings on DSM–IV symptoms were analyzed. The majority of subjects met the DSM–IV criteria of Post-Traumatic Stress Disorder. A cluster analysis identified four clusters of harassment victims, described as older-mature, younger-mature, anxious-guilty, and expressive-adaptive based on MMPI–2 scores and symptoms.
This study investigated the psychometric properties of the Frontal Systems Behavior Scale (FrSBe)... more This study investigated the psychometric properties of the Frontal Systems Behavior Scale (FrSBe) in an acute traumatic brain injury (TBI) population across indices of factor structure, reliability, and validity. Method: Data were collected from 101 individuals undergoing acute rehabilitation for moderate and severe TBI both upon emergence from posttraumatic amnesia and at hospital discharge, as well as from their family members or caregivers. Results: Four separate confirmatory factor analyses (CFAs) suggested that the FrSBe's three-factor/three-subscale solution did not fit the data well, and follow-up CFAs employing a one-factor structure similarly yielded poor fit indices. Four exploratory factor analyses (EFAs) failed to produce factor solutions consistent with each other or that resembled the factor solution retained in the EFA during the FrSBe's initial construction. The FrSBe had sufficiently high internal consistency at the total-score and subscale-score levels, good convergent validity with other indices of TBI functioning, and good test-retest reliability in the family administration of the measure, but not in the patient administration. Conclusions: The FrSBe is an appropriate measure for use in an inpatient TBI population when using the total score and the family administration, though its subscales and patient administration warrant more rigorous examination.
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 2011
Much controversy exists and many questions remain unanswered about the effects of hormone therapy... more Much controversy exists and many questions remain unanswered about the effects of hormone therapy (HT) on cognition in postmenopausal women. There is growing evidence suggesting that HT compounds containing conjugated equine estrogen (CEE) have negative effects on cognition whereas 17β-estradiol (17β-E) either has positive or neutral effects. The present study sought to further examine this issue in a sample of postmenopausal women with risk factors for Alzheimer's disease (AD). Cross-sectional neuropsychological evaluation. Academic research clinic. 68 healthy postmenopausal women (aged 49-68) receiving either 17β-E or CEE for at least one year with increased risk for AD. Neuropsychological test battery of the cognitive domains of attention/working memory/processing speed, verbal memory, visual memory, and executive functioning. Multivariate analyses of variance (MANOVA) showed significantly better verbal memory performance in women receiving 17β-E compared to women receiving C...
Background: Recent literature on traumatic brain injury (TBI), though mixed when reporting outcom... more Background: Recent literature on traumatic brain injury (TBI), though mixed when reporting outcomes, seems collectively to suggest possible gender advantage for women in postinjury recovery, especially in executive functions. Hormonal neuroprotection, through female reproductive hormones, is often proposed as an underlying factor in these results. We explored potential gender differences in an aspect of executive functions, selfawareness (SA), which is often impaired after TBI, limits patient effort in critical rehabilitation, and increases caregiver burden. Methods: Within a prospective survey, repeated-measures design, 121 patients with moderate or severe TBI undergoing acute rehabilitation in a Level 1 trauma center, a family member or caregiver informant, and a treating clinician were asked to complete the Patient Competency Rating Scale (PCRS) and the Frontal Systems Behavior Scale (FrSBe) at admission and discharge. Results: Although overall, women and men with TBI showed generally similar levels of SA, women had significantly better awareness of their injury-related deficits at acute rehabilitation discharge, even when controlling for age, education, and injury severity. Conclusions: Mixed findings in this study mirror the pattern of results that dominate the published literature on gender and TBI. Gender differences in executive dysfunction may not be as large or robust as some researchers argue. In addition, complex interplays of socialization, gender-role expectations, naturally occurring male and female ability differences, and differences in access to postinjury rehabilitation are understudied potential moderators.
This study investigated the psychometric properties of the Frontal Systems Behavior Scale (FrSBe)... more This study investigated the psychometric properties of the Frontal Systems Behavior Scale (FrSBe) in an acute traumatic brain injury (TBI) population across indices of factor structure, reliability, and validity. Method: Data were collected from 101 individuals undergoing acute rehabilitation for moderate and severe TBI both upon emergence from posttraumatic amnesia and at hospital discharge, as well as from their family members or caregivers. Results: Four separate confirmatory factor analyses (CFAs) suggested that the FrSBe's three-factor/three-subscale solution did not fit the data well, and follow-up CFAs employing a one-factor structure similarly yielded poor fit indices. Four exploratory factor analyses (EFAs) failed to produce factor solutions consistent with each other or that resembled the factor solution retained in the EFA during the FrSBe's initial construction. The FrSBe had sufficiently high internal consistency at the total-score and subscale-score levels, good convergent validity with other indices of TBI functioning, and good test-retest reliability in the family administration of the measure, but not in the patient administration. Conclusions: The FrSBe is an appropriate measure for use in an inpatient TBI population when using the total score and the family administration, though its subscales and patient administration warrant more rigorous examination.
Background -To determine the effects of memantine on cognition in a normal population of postmeno... more Background -To determine the effects of memantine on cognition in a normal population of postmenopausal women with putative risk factors for AlzheimerÕs disease (AD) using a built-in control for the genetic risk factor for AD (apoE-e4 status). Methods -A prospective, open-label, 6-month pilot medication trial with memantine and follow-up after discontinuance conducted at the Center for Neuroscience in WomenÕs Health, Stanford University School of Medicine. Neuropsychological data were collected on 22 community-dwelling postmenopausal women (11 apoE-e4 carriers and 11 apoE-e4 non-carriers) with at least one putative risk factor for AD. Results -ApoE-e4 status was not a significant predictor of change in neuropsychological performance. Changes associated with memantine treatment for entire sample included significant declines in some variables associated with verbal learning and memory that improved upon medication withdrawal. A positive medication effect was noted with executive functions and possibly category fluency. Trend-level improvements were seen in motor dexterity of the non-dominant hand and maintained even after drug discontinuance. Conclusions -Treatment with memantine appeared to have differential effects on cognitive performance in a population of women with putative risk factors for AD. ApoE-e4 carrier status did not account for observed changes in cognition.
Background: Recent literature on traumatic brain injury (TBI), though mixed when reporting outcom... more Background: Recent literature on traumatic brain injury (TBI), though mixed when reporting outcomes, seems collectively to suggest possible gender advantage for women in postinjury recovery, especially in executive functions. Hormonal neuroprotection, through female reproductive hormones, is often proposed as an underlying factor in these results. We explored potential gender differences in an aspect of executive functions, selfawareness (SA), which is often impaired after TBI, limits patient effort in critical rehabilitation, and increases caregiver burden. Methods: Within a prospective survey, repeated-measures design, 121 patients with moderate or severe TBI undergoing acute rehabilitation in a Level 1 trauma center, a family member or caregiver informant, and a treating clinician were asked to complete the Patient Competency Rating Scale (PCRS) and the Frontal Systems Behavior Scale (FrSBe) at admission and discharge. Results: Although overall, women and men with TBI showed generally similar levels of SA, women had significantly better awareness of their injury-related deficits at acute rehabilitation discharge, even when controlling for age, education, and injury severity. Conclusions: Mixed findings in this study mirror the pattern of results that dominate the published literature on gender and TBI. Gender differences in executive dysfunction may not be as large or robust as some researchers argue. In addition, complex interplays of socialization, gender-role expectations, naturally occurring male and female ability differences, and differences in access to postinjury rehabilitation are understudied potential moderators.
A clinical sample of 20 sexual harassment victims who were successful in obtaining damage awards ... more A clinical sample of 20 sexual harassment victims who were successful in obtaining damage awards for trauma through the judicial system were sources of this descriptive study. Ratings of physical coercion of the harassment, MMPI–2 scores, and ratings on DSM–IV symptoms were analyzed. The majority of subjects met the DSM–IV criteria of Post-Traumatic Stress Disorder. A cluster analysis identified four clusters of harassment victims, described as older-mature, younger-mature, anxious-guilty, and expressive-adaptive based on MMPI–2 scores and symptoms.
This study investigated the psychometric properties of the Frontal Systems Behavior Scale (FrSBe)... more This study investigated the psychometric properties of the Frontal Systems Behavior Scale (FrSBe) in an acute traumatic brain injury (TBI) population across indices of factor structure, reliability, and validity. Method: Data were collected from 101 individuals undergoing acute rehabilitation for moderate and severe TBI both upon emergence from posttraumatic amnesia and at hospital discharge, as well as from their family members or caregivers. Results: Four separate confirmatory factor analyses (CFAs) suggested that the FrSBe's three-factor/three-subscale solution did not fit the data well, and follow-up CFAs employing a one-factor structure similarly yielded poor fit indices. Four exploratory factor analyses (EFAs) failed to produce factor solutions consistent with each other or that resembled the factor solution retained in the EFA during the FrSBe's initial construction. The FrSBe had sufficiently high internal consistency at the total-score and subscale-score levels, good convergent validity with other indices of TBI functioning, and good test-retest reliability in the family administration of the measure, but not in the patient administration. Conclusions: The FrSBe is an appropriate measure for use in an inpatient TBI population when using the total score and the family administration, though its subscales and patient administration warrant more rigorous examination.
The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 2011
Much controversy exists and many questions remain unanswered about the effects of hormone therapy... more Much controversy exists and many questions remain unanswered about the effects of hormone therapy (HT) on cognition in postmenopausal women. There is growing evidence suggesting that HT compounds containing conjugated equine estrogen (CEE) have negative effects on cognition whereas 17β-estradiol (17β-E) either has positive or neutral effects. The present study sought to further examine this issue in a sample of postmenopausal women with risk factors for Alzheimer's disease (AD). Cross-sectional neuropsychological evaluation. Academic research clinic. 68 healthy postmenopausal women (aged 49-68) receiving either 17β-E or CEE for at least one year with increased risk for AD. Neuropsychological test battery of the cognitive domains of attention/working memory/processing speed, verbal memory, visual memory, and executive functioning. Multivariate analyses of variance (MANOVA) showed significantly better verbal memory performance in women receiving 17β-E compared to women receiving C...
Background: Recent literature on traumatic brain injury (TBI), though mixed when reporting outcom... more Background: Recent literature on traumatic brain injury (TBI), though mixed when reporting outcomes, seems collectively to suggest possible gender advantage for women in postinjury recovery, especially in executive functions. Hormonal neuroprotection, through female reproductive hormones, is often proposed as an underlying factor in these results. We explored potential gender differences in an aspect of executive functions, selfawareness (SA), which is often impaired after TBI, limits patient effort in critical rehabilitation, and increases caregiver burden. Methods: Within a prospective survey, repeated-measures design, 121 patients with moderate or severe TBI undergoing acute rehabilitation in a Level 1 trauma center, a family member or caregiver informant, and a treating clinician were asked to complete the Patient Competency Rating Scale (PCRS) and the Frontal Systems Behavior Scale (FrSBe) at admission and discharge. Results: Although overall, women and men with TBI showed generally similar levels of SA, women had significantly better awareness of their injury-related deficits at acute rehabilitation discharge, even when controlling for age, education, and injury severity. Conclusions: Mixed findings in this study mirror the pattern of results that dominate the published literature on gender and TBI. Gender differences in executive dysfunction may not be as large or robust as some researchers argue. In addition, complex interplays of socialization, gender-role expectations, naturally occurring male and female ability differences, and differences in access to postinjury rehabilitation are understudied potential moderators.
This study investigated the psychometric properties of the Frontal Systems Behavior Scale (FrSBe)... more This study investigated the psychometric properties of the Frontal Systems Behavior Scale (FrSBe) in an acute traumatic brain injury (TBI) population across indices of factor structure, reliability, and validity. Method: Data were collected from 101 individuals undergoing acute rehabilitation for moderate and severe TBI both upon emergence from posttraumatic amnesia and at hospital discharge, as well as from their family members or caregivers. Results: Four separate confirmatory factor analyses (CFAs) suggested that the FrSBe's three-factor/three-subscale solution did not fit the data well, and follow-up CFAs employing a one-factor structure similarly yielded poor fit indices. Four exploratory factor analyses (EFAs) failed to produce factor solutions consistent with each other or that resembled the factor solution retained in the EFA during the FrSBe's initial construction. The FrSBe had sufficiently high internal consistency at the total-score and subscale-score levels, good convergent validity with other indices of TBI functioning, and good test-retest reliability in the family administration of the measure, but not in the patient administration. Conclusions: The FrSBe is an appropriate measure for use in an inpatient TBI population when using the total score and the family administration, though its subscales and patient administration warrant more rigorous examination.
Background -To determine the effects of memantine on cognition in a normal population of postmeno... more Background -To determine the effects of memantine on cognition in a normal population of postmenopausal women with putative risk factors for AlzheimerÕs disease (AD) using a built-in control for the genetic risk factor for AD (apoE-e4 status). Methods -A prospective, open-label, 6-month pilot medication trial with memantine and follow-up after discontinuance conducted at the Center for Neuroscience in WomenÕs Health, Stanford University School of Medicine. Neuropsychological data were collected on 22 community-dwelling postmenopausal women (11 apoE-e4 carriers and 11 apoE-e4 non-carriers) with at least one putative risk factor for AD. Results -ApoE-e4 status was not a significant predictor of change in neuropsychological performance. Changes associated with memantine treatment for entire sample included significant declines in some variables associated with verbal learning and memory that improved upon medication withdrawal. A positive medication effect was noted with executive functions and possibly category fluency. Trend-level improvements were seen in motor dexterity of the non-dominant hand and maintained even after drug discontinuance. Conclusions -Treatment with memantine appeared to have differential effects on cognitive performance in a population of women with putative risk factors for AD. ApoE-e4 carrier status did not account for observed changes in cognition.
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Papers by Megan Holcomb