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Neuropsychological deficits associated with Complex Regional Pain Syndrome

Published online by Cambridge University Press:  19 March 2010

DAVID J. LIBON ,
ROBERT J. SCHWARTZMAN ,
JOEL EPPIG ,
DENENE WAMBACH ,
ERIC BRAHIN ,
B. LEE PETERLIN ,
GUILLERMO ALEXANDER  and
ATUL KALANURIA
DAVID J. LIBON*
Affiliation:
Department of Neurology, Drexel University, College of Medicine, Philadelphia, PA
ROBERT J. SCHWARTZMAN
Affiliation:
Department of Neurology, Drexel University, College of Medicine, Philadelphia, PA
JOEL EPPIG
Affiliation:
Department of Neurology, Drexel University, College of Medicine, Philadelphia, PA
DENENE WAMBACH
Affiliation:
Department of Neurology, Drexel University, College of Medicine, Philadelphia, PA
ERIC BRAHIN
Affiliation:
Department of Neurology, Drexel University, College of Medicine, Philadelphia, PA
B. LEE PETERLIN
Affiliation:
Department of Neurology, Drexel University, College of Medicine, Philadelphia, PA
GUILLERMO ALEXANDER
Affiliation:
Department of Neurology, Drexel University, College of Medicine, Philadelphia, PA
ATUL KALANURIA
Affiliation:
Department of Neurology, Drexel University, College of Medicine, Philadelphia, PA
*
*Correspondence and reprint requests to: David J. Libon, Ph.D., Department of Neurology, Drexel University College of Medicine, New College Building, 245 North 15th Street, Philadelphia, PA 19102. E-mail: dlibon@Drexelmed.edu
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Abstract

We sought to elucidate the existence of neuropsychological subtypes in Complex Regional Pain Syndrome (CRPS). One hundred thirty seven patients with CRPS were administered tests that assess executive control, naming/lexical retrieval, and declarative memory. A 2-step cluster analysis that does not require any a priori specification regarding the number of clusters, classified patients into three groups. Group 1 obtained scores that were in the average range on all tests (n = 48; normal CRSP group). Group 2 (n = 58; dysexecutive CRSP group) presented with mild impairment or statistically low average test performance on working memory/verbal fluency tests. Group 3 (n = 31; global CRSP group) produced scores in the statistically low average/borderline range on all tests with particularly reduced scores on naming/declarative memory tests. Between-group analyses found that the CRPS group 1 obtained higher scores than CRPS groups 2 and 3 on all tests. However, groups 2 and 3 were equally impaired on executive tests. CRPS group 3 was impaired on tests of naming/memory tests compared to the other groups. Significant neuropsychological deficits are present in 65% of patients, with many patients presenting with elements of a dysexecutive syndrome and some patients presenting with global cognitive impairment. (JINS, 2010, 16, 566–573.)

Keywords

Complex Regional Pain SyndromeReflex Sympathetic DystrophyNeuropsychological functioningExecutive functioningDeclarative memoryNeuropathic pain
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 16 , Issue 3 , May 2010 , pp. 566 - 573
Copyright
Copyright © The International Neuropsychological Society 2010

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References

REFERENCES

Aldenderfer, M.S., & Blashfield, R.K. (1984). Cluster analysis. Beverly Hills, CA: Sage Publications.CrossRefGoogle Scholar
Alexander, M.P., Stuss, D.T., & Fansabedian, N. (2003). California Verbal Learning Test: Performance by patients with focal frontal and non-frontal lesions. Brain, 126, 1493–1503.CrossRefGoogle ScholarPubMed
Apkarian, A.V., Sosa, Y., Sonty, S., Levy, R.E., Harden, R., Parrish, T., & Gitelman, D. (2004). Chronic back pain is associated with decreased prefrontal and thalamic gray matter density. Journal of Neuroscience, 24, 10410–10415.CrossRefGoogle ScholarPubMed
Apkarian, A.V., Thomas, P., Krauss, B.R., & Szeverenyi, N.M. (2001). Prefrontal cortical hyperactivity in patients with sympathetically mediated chronic pain. Neuroscience Letters, 311, 193–197.CrossRefGoogle ScholarPubMed
Becerra, L., Schwartzman, R.J., Kiefer, R.T., Rohr, P., Moulton, E.A., Wallin, D., et al. . (2009). CNS measures of pain responses pre- and post-anesthetic ketamine in a patient with Complex Regional Pain Syndrome. Pain Medicine. DOI: 19254342.CrossRefGoogle Scholar
Beck, A.T., & Steer, R.A. (1993). Manual for the Beck Anxiety Inventory. San Antonio, TX: The Psychological Corporation.Google Scholar
Birklein, F., Schmelz, M., Schifter, S., & Weber, M. (2001). The important role for neuropeptides in Complex Regional Pain Syndrome. Neurology, 57, 2179–2184.CrossRefGoogle ScholarPubMed
Bruehl, S., Harden, R.N., Galer, B.S., Saltz, S., Bertram, M., Backonja, M., Gayles, R., et al. . (1999). External validation of IASP diagnostic criteria for Complex Regional Pain Syndrome and proposed research diagnostic criteria. Pain, 81, 147–154.CrossRefGoogle ScholarPubMed
Burgmer, M., Gaubitz, M., Konrad, C., Wrenger, M., Hilgart, S., Heuft, G., & Pfleiderer, B. (2009). Decreased gray matter volumes in the cingulo-frontal cortex and the amygdala in patients with fibromyalgia. Psychosomatic Medicine, 71, 566–573.CrossRefGoogle ScholarPubMed
Catani, M., Jones, D.K., Donato, R., & Ffytche, D.H. (2003). Occipito-temporal connections in the human brain. Brain, 126, 2093–2107.CrossRefGoogle ScholarPubMed
DeLeo, J.A., & Yezierski, R.P. (2001). The role of neuroinflammation and neuroimmune activation in persistent pain. Pain, 90, 1–6.CrossRefGoogle ScholarPubMed
Delis, D.C., Kramer, J.H., Kaplan, E., & Ober, B.A. (1987). The California Verbal Learning Test. New York: The Psychological Corporation.Google Scholar
Delis, D.C., Kramer, J.H., Kaplan, E., & Ober, B.A. (2000). The California Verbal Learning Test. New York: The Psychological Corporation.Google Scholar
Dick, B.D., & Rashiq, S. (2007). Disruption of attention and working memory traces in individuals with chronic pain. Anesthesia and Analgesia, 104, 1223–1229.CrossRefGoogle ScholarPubMed
Eadie, W.T., Drijard, D., James, F.E., Roos, M., & Sadoulet, B. (1971). Statistical methods in experimental physics. Amsterdam: North-Holland.Google Scholar
Geha, P.B., Baliki, M.N., Harden, N., Bauer, W.R., Parrish, T.B., & Apkarian, A.V. (2008). The brain in chronic CRPS pain: Abnormal gray–white matter interactions in emotional and autonomic regions. Neuron, 60, 570–581.CrossRefGoogle ScholarPubMed
Gieteling, E.W., Van Rijn, M.A., De Jong, B.M., Hoogduin, J.M., Renken, R., Van Hilten, J.J., & Leenders, K.L. (2008). Cerebral activation during motor imagery in Complex Regional Pain Syndrome type 1 with dystonia. Pain, 134, 302–309.CrossRefGoogle ScholarPubMed
Gladsjo, J.A., Miller, S.W., & Heaton, R.W. (1999). Norms for letter and category fluency: Demographic correction for age, education, and ethnicity. Lutz, FL: Psychological Assessment Resources.Google ScholarPubMed
Gourovitch, M.L., Kirkby, B.S., Goldberg, D.E., Weinberger, D.R., Gold, J.M., Esposito, G., et al. . (2000). A comparison of rCBF patterns during letter and semantic fluency. Neuropsychology, 14, 353–360.CrossRefGoogle ScholarPubMed
Harden, R.N., Bruehl, S., & Galer, B.S. (1999). Complex Regional Pain Syndrome: Are the IASP diagnostic criteria valid and sufficiently comprehensive? Pain, 83, 211–219.CrossRefGoogle ScholarPubMed
Harden, R.N., Bruehl, S., Stanton-Hicks, M., & Wilson, P.R. (2007). Proposed new diagnostic criteria for Complex Regional Pain Syndrome. Pain Medicine, 8, 326–331.CrossRefGoogle ScholarPubMed
Hart, R.P., Martelli, M.F., & Zasler, N.D. (2000). Chronic pain and neuropsychological functioning. Neuropsychology Review, 10, 131–149.CrossRefGoogle ScholarPubMed
Janig, W., & Baron, R. (2003). Complex Regional Pain Syndrome: Mystery explained? The Lancet, Neurology, 2, 687–697.CrossRefGoogle ScholarPubMed
Kaplan, E., Goodglass, H., & Weintraub, S. (1983). The Boston Naming Test. Philadelphia: Lea & Febiger.Google Scholar
Kaplan, E., Goodglass, H., & Weintraub, S. (2001). The Boston Naming Test (2nd ed.). Philadelphia: Lea & Febiger.Google Scholar
Karp, J.F., Reynolds, C.F. 3rd, Butters, M.A., Dew, M.A., Mazumdar, S., Begley, A.E., et al. . (2006). The relationship between pain and mental flexibility in older adult pain clinic patients. Pain Medicine, 7, 444–452.CrossRefGoogle ScholarPubMed
Koffler, S.P., Hampstead, B.M., Irani, F., Tinker, J., Kiefer, R.T., Rohr, P., & Schwartzman, R.J. (2007). The neurocognitive effects of 5-day anesthetic ketamine for the treatment of refractory Complex Regional Pain Syndrome. Archives of Clinical Neuropsychology, 22, 719–729.CrossRefGoogle ScholarPubMed
Kuchinad, A., Schweinhardt, P., Seminowicz, D.A., Wood, P.B., Chizh, B.A., & Bushnell, M.C. (2007). Accelerated brain gray matter loss in fibromyalgia patients: Premature aging of the brain? Journal of Neuroscience, 27, 4004–4007.CrossRefGoogle ScholarPubMed
Lamar, M., Catani, M., Heilman, K.M., & Libon, D.J. (2008). The impact of region-specific leukoaraiosis on working memory deficits in dementia. Neuropsychologia, 46, 2597–2601.CrossRefGoogle ScholarPubMed
Lamar, M., Price, C.C., Libon, D.J., Penney, D.L., Kaplan, E., Grossman, M., & Heilman, K.M. (2007). Alterations in working memory as a function of leukoaraiosis in dementia. Neuropsychologia, 45, 245–254.CrossRefGoogle ScholarPubMed
Libon, D.J., Bogdanoff, B., Cloud, B.S., Skalina, S., Giovannetti, T., Gitlin, H.L., & Bonavita, J. (1998). Declarative and procedural learning, quantitative measures of the hippocampus and subcortical white matter alterations in Alzheimer’s disease and ischaemic vascular dementia. Journal of Clinical and Experimental Neuropsychology, 20, 30–41.CrossRefGoogle ScholarPubMed
Libon, D.J., Mattson, R., Glosser, G., Kaplan, E., Malamut, B.L., Sands, L.P., et al. . (1996). A nine-word dementia version of the California Verbal Learning Test. The Clinical Neuropsychologist, 10, 237–244.CrossRefGoogle Scholar
Libon, D.J., McMilan, C., Powers, C., Massimo, L., Khan, A., Morgan, B., et al. . (2009). Neurocognitive contributions to verbal fluency deficits in Frontotemporal Lobar Degeneration. Neurology, 73, 535–542.CrossRefGoogle ScholarPubMed
Loeser, J.D. (2001). Bonica’s The Management of Pain (3rd ed., pp. 388–411). Philadelphia: Lippincott, Williams, & Wilkins.Google Scholar
Luerding, R., Weigand, T., Bogdahn, U., & Schmidt-Wilcke, T. (2008). Working memory performance is correlated with local brain morphology in the medial frontal and anterior cingulate cortex in fibromyalgia patients: Structural correlates of pain–cognition interaction. Brain, 131, 3222–3231.CrossRefGoogle ScholarPubMed
Maihofner, C., Baron, R., DeCol, R., Binder, A., Birklein, F., Deuschl, G., et al. . (2007a). The motor system shows adaptive changes in Complex Regional Pain Syndrome. Brain, 130, 2671–2687.CrossRefGoogle ScholarPubMed
Maihofner, C., & DeCol, R. (2007b). Decreased perceptual learning ability in Complex Regional Pain Syndrome. European Journal of Pain, 11, 903–909.CrossRefGoogle ScholarPubMed
Maihofner, C., Forster, C., Birklein, F., Neundorfer, B., & Handwerker, H.O. (2005). Brain processing during mechanical hyperalgesia in Complex Regional Pain Syndrome: A functional MRI study. Pain, 114, 93–103.CrossRefGoogle ScholarPubMed
Maihofner, C., Handwerker, H.O., & Birklein, F. (2006). Functional imaging of allodynia in Complex Regional Pain Syndrome. Neurology, 66, 711–717.CrossRefGoogle ScholarPubMed
Maihofner, C., Handwerker, H.O., Neundorfer, B., & Birklein, F. (2003). Patterns of cortical reorganization in Complex Regional Pain Syndrome. Neurology, 61, 1707–1715.CrossRefGoogle ScholarPubMed
Maihofner, C., Handwerker, H.O., Neundorfer, B., & Birklein, F. (2004). Cortical reorganization during recovery from Complex Regional Pain Syndrome. Neurology, 64, 693–701.CrossRefGoogle Scholar
Melzack, R. (1987). The short-form McGill Pain Questionnaire. Pain, 30, 191–197.CrossRefGoogle ScholarPubMed
Mummery, C.J., Patterson, K., Hodges, J.R., & Wise, R.J. (1996). Generating ‘tiger’ as an animal name or a word beginning with T: Differences in brain activation. Proceedings of the Royal Academy, Biological Sciences, 263, 989–995.Google ScholarPubMed
Phelps, E.A., Hyder, F., Blamire, A.M., & Shulman, R.G. (1997). fMRI of the prefrontal cortex during overt verbal fluency. NeuroReport, 8, 561–565.CrossRefGoogle ScholarPubMed
Pleger, B., Ragert, P., Schwenkreis, P., Forster, A.F., Wilimzig, C., Dinse, H., et al. . (2006). Patterns of cortical reorganization parallel impaired tactile discrimination and pain intensity in Complex Regional Pain Syndrome. NeuroImage, 32, 503–510.CrossRefGoogle ScholarPubMed
Plewes, L.W. (1956). Sudek’s atrophy in the hands. Journal of Bone and Joint Surgery, 38, 195–203.Google Scholar
Price, C.C., Garrett, K.D., Jefferson, A.L., Cosentino, S., Tanner, J., Penney, D.L., et al. . (2009). The role of leukoaraiosis severity on learning and memory in dementia: Performance differences on a 9-word list learning test. The Clinical Neuropsychologist, 23, 1–18.CrossRefGoogle Scholar
Schinkel, C., Gaertner, A., & Zaspel, J. (2006). Inflammatory mediators are altered in the acute phase of posttraumatic Complex Regional Pain Syndrome. Clinical Journal of Pain, 22, 235–239.CrossRefGoogle ScholarPubMed
Schmidt-Wilcke, T., Luerding, R., Weigand, T., Jurgens, T., Schuierer, G., Leinisc, E., & Bogdahn, U. (2007). Striatal grey matter increase in patients suffering from fibromyalgia: A voxel-based morphometry study. Pain, 132, S109–S116.CrossRefGoogle ScholarPubMed
Schwartzman, R.J., Alexander, G.M., & Grothusen, J. (2006). Pathophysiology of Complex Regional Pain Syndrome. Expert Review of Neurotherapeutics, 6, 669–681.CrossRefGoogle ScholarPubMed
Schwartzman, R.J., Erwin, K.L., & Alexander, G.M. (2009). The natural history of Complex Regional Pain Syndrome. Clinical Journal of Pain, 25, 273–280.CrossRefGoogle ScholarPubMed
Stuss, D.T., Alexander, M.P., Palumbo, C.L., Buckle, L., Sayer, L., & Pogue, J. (1994). Organizational strategies of patients with unilateral or bilateral frontal lobe injury in word list learning tasks. Neuropsychology, 8, 355–373.CrossRefGoogle Scholar
Wambach, D.M., Lamar, M., Swenson, R., Penney, D.L., Kaplan, E., & Libon, D.J. (in press). The Digit Span Test. In Kreutzer, J., DeLuca, J., & Caplan, B. (Eds.), The encyclopedia of clinical neuropsychology. New York: Springer.Google Scholar
Wechsler, D. (1997). The Wechsler Adult Intelligence Scale–III. San Antonio, TX: The Psychological Corporation.Google Scholar
Weiner, D.K., Rudy, T.E., Morrow, L., Slaboda, J., & Lieber, S. (2006). The relationship between pain, neuropsychological performance, and physical function in community-dwelling older adults with chronic low back pain. Pain Medicine, 7, 60–70.CrossRefGoogle ScholarPubMed