Driving and Self-Appraisal of Memory after Temporal Lobectomy: Correlations with Neuropsychological Tests and Hippocampal Volumes on Long-Term Follow-Up.
Abstract number :
3.059
Submission category :
Year :
2001
Submission ID :
619
Source :
www.aesnet.org
Presentation date :
12/1/2001 12:00:00 AM
Published date :
Dec 1, 2001, 06:00 AM
Authors :
M.R. Trenerry, Ph.D., Psychiatry & Psychology, Mayo Clinic, Rochester, MN; T.J. Ferman, Ph.D., Psychiatry & Psychology, Mayo Clinic, Jacksonville, FL; E.L. So, M.D., Neurology, Mayo Clinic, Rochester, MN; C.R. Jack, M.D., Diagnostic Radiology, Mayo Clinic
RATIONALE: To determine if objective memory measurement predicts changes in memory function as perceived by patients 5 years after anterior temporal lobectomy (ATL) for medically intractable epilepsy.
METHODS: A survey on driving privileges and memory was sent to 235 ATL patients an average of 5 years after ATL and 195 surveys were returned. Memory survey items were adapted with permission from Seidenberg et al. (J Clin Exp Neuropsychol 1994;16:93-104). Patients rated their current memory compared to presurgical memory on a 5-point scale: [dsquote]much better[dsquote] (1) to [dsquote]much worse[dsquote] (5). Orthogonal factor analysis of memory items produced a three factor solution. Factor 1 contained language and declarative memory items (e.g. remembering things I was told a few days ago). Factor 2 contained visual-spatial items (e.g. ability to read a map). Factor 3 contained a few remote memory items (e.g. recalling names of grade school teachers). Univariate tests were used to select independent variables from the difference in MRI hippocampal volumes (DHV), and delayed recall on the Auditory Verbal Learning Test (AVLT) and WMS-R Logical Memory (LM) and Visual Reproduction (VR) subtests given before and 4-months after ATL. Dependent variables were subjective memory (Factor 1 and Factor 2) and postoperative driving status.
RESULTS: Forward-stepping multiple regression demonstrated that postoperative LM change (post-pre) was correlated with Factor 1 (r = -.33, p[lt].005, n = 74) and Factor 2 (Spearman r = -.24, p[lt].03, n = 79) after LATL. Post-operative AVLT delayed recall (r = -.53, p[lt].002) and DHV (r = .32, p[lt].05) (n = 38) were correlated with Factor 1, and Factor 2 was correlated with preoperative AVLT delayed recall (r = -.33, p[lt].03) and DHV (r = .43, p[lt].01, n = 38) after RATL. Multiple logistic regression demonstrated that preoperative driving status and LM change (Wald [CHI]2 = 14.1, p[lt].0002, n = 77) were associated with driving after LATL. LATL patients who were not driving before surgery with a 5 point LM improvement were 12 times more likely to be licensed drivers after LATL compared to patients who had a 5 point decline. RATL patients not driving before surgery were four times more likely to be licensed drivers after RATL for every 10 points on postoperative VR(Wald [CHI]2 = 8.1, p[lt].005, n = 66).
CONCLUSIONS: Neuropsychological testing four months after surgery predicts obtaining driving privileges and self-appraisal of memory function an average of five years after ATL.
Support: R01 NS28374 (CRJ)and the Dept. of Psychiatry & Psychology, Mayo Clinic, Rochester, MN