General Conclusions regarding Studies of Brain Damage in .NET

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General Conclusions regarding Studies of Brain Damage
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Three general conclusions seem warranted based on the numerous WAIS and WAIS-R studies of
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INTEGRATION AND APPLICATION OF WAIS-III RESEARCH
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patients having left-, right-, and bilateral hemisphere disease, and the small number of WAIS-III studies on bilateral/diffuse brain damage: 1. Patients with damage to the right hemisphere, whether the damage is unilateral or accompanied by damage to the left hemisphere as well, are very likely to manifest a substantial V > P profile. 2. Patients with unilateral damage to the left hemisphere may show a slight P > V profile, but not of a magnitude that is large enough or displayed consistently enough to be of much diagnostic benefit; indeed, they are almost as likely to show V > P or no V P discrepancy. 3. Patients with bilateral or diffuse brain injury may show a V > P profile on the W-B, WAIS, and WAIS-R. However, on the WAIS-III such a pattern will likely not be as pronounced, and, instead, the most evident pattern will be in the factor indexes with the Processing Speed index being the most depressed, especially in comparison to the Perceptual Organization index. For the present, concerning lateralized brain damage, let s ignore the subtleties of the study-tostudy differences in the brain-damaged samples, or in the neuropsychological procedure employed, and combine data from all relevant investigations. In the absence of ideal, well-controlled studies using large numbers of patients with unilateral brain damage, a compilation of data from the existing literature with the Wechsler-Bellevue, WAIS, and WAIS-R provides the best guess at the relationship between V P IQ difference and lateralized brain lesions. This overview of 2,695 adult patients (combining data from Tables 8.1, 8.2, and 8.3) is as follows: Left Lesion (N = 1,336) P > V = 3.6 Right Lesion (N = 1,359) V > P = 8.9
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and location of a brain lesion, for example, of acuteness versus chronicity of lesion, age of onset, gender, race, and the role played by each separate subtest, are discussed later in this chapter.
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THE NATURE OF BRAIN DAMAGE
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When Smith (1966a, 1966b) reported the first major negative findings regarding left- versus right-brain damage and direction of V P IQ discrepancy, he also speculated on the intervening variables that may have led to the contradictory findings. He pointed to methodological problems in most studies, including his own, stressing that lumping together younger and older patients with different types of lesions in various parts of the two hemispheres obscures possible significant differences in effects as a function of the nature, age, extent, dynamics, and specific locus of the lesion within arbitrarily defined cortical and subcortical gross structures (Smith, 1966a, p. 121). Bornstein and Matarazzo (1984) also tried to reconcile McGlone s (1977, 1978) negative findings for females with the bulk of positive findings for other patient samples by focusing on the nature of the brain damage in her samples. They note: [R]eview by us of McGlone s actual data in her published studies reveals that right lesion females did demonstrate the expected pattern of VIQ greater than PIQ; and that, among the left lesion women, patients ...vascular symptoms did demonstrate the expected pattern of VIQ less than PIQ, but women patients with tumor did not (p. 707). Bornstein and Matarazzo (1984) went one step further in this sub-analysis to emphasize that [a]mong the left tumor females..., more than 50 per cent had meningiomas...which tend to be slowly progressive [and] may allow the brain to compensate (pp. 707 708). Herring and Reitan (1986) further noted that the males in
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The interacting effects of other variables on the relationship between V P IQ discrepancy
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V P IQ DISCREPANCIES: A NEUROPSYCHOLOGICAL APPROACH
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McGlone s (1977) samples of tumor patients had more intrinsic tumors than did the females (who had more extrinsic tumors), at least raising to Herring and Reitan (1986) the possibility that the men had more malignant, destructive, and extensive lesions (p. 537). The issue of whether V P discrepancies and side of lesion are more or less related for different types of brain lesion is crucial and is commonly discussed; we have not, however, seen a systematic treatment of this topic in the literature. Most investigators have combined a variety of etiologies to form their left-lesion and rightlesion samples, and even then they usually come up with groups that are small by research standards. It is impractical to expect researchers to identify samples whose lesions are due to tumors or stroke and are restricted to the anterior left or right parietal lobes. Such control would be useful, because much clinical experience by neuropsychologists like Reitan has led to detailed understanding of brain behavior relationships. For example, Reitan (1974) states that, Block Design is especially sensitive to posterior right hemisphere involvement and especially to right parietal and occipital damage whereas Picture Arrangement is more sensitive to anterior right temporal lesions (p. 45); other researchers have verified these findings (e.g., Long & Brown, 1979). But that degree of control is not feasible in research. Even if it were, other variables would impinge on the interpretation of the findings of a very specific type of brain damage: severity of the lesion, cause of the brain damage, acuteness or chronicity of the lesion, age at onset, education of patient, and so forth. In the absence of the ideal, we have accumulated findings from the available studies that used reasonably homogeneous samples. Table 8.6 summarizes the results of 27 studies, comprising eight samples of stroke victims, six patient groups with generalized or posterior tumors, twelve samples with temporal lobe epilepsy, three groups with head injuries, one with missile wounds, and three
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