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Betto G Deelman - One of the best experts on this subject based on the ideXlab platform.
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psychosocial and cognitive rehabilitation of patients with solvent induced chronic Toxic Encephalopathy a randomised controlled study
Psychotherapy and Psychosomatics, 2008Co-Authors: Moniek S E Van Hout, Ellie M Wekking, Ina J Berg, Betto G DeelmanAbstract:Background: There is little experience with the (neuro) psychological treatment of patients with solvent-induced chronic Toxic Encephalopathy (CSE). In this randomised controlled tr
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cognitive functioning in patients with suspected chronic Toxic Encephalopathy evidence for neuropsychological disturbances after controlling for insufficient effort
Journal of Neurology Neurosurgery and Psychiatry, 2005Co-Authors: M S E Van Hout, Ellie M Wekking, Ben Schmand, Betto G DeelmanAbstract:Objectives: Chronic Toxic Encephalopathy (CTE) caused by long term occupational exposure to organic solvents is still a controversial disorder. Neuropsychological testing is the cornerstone for diagnosing the syndrome, but can be negatively influenced by motivational problems. In this nationwide study, we investigated the neuropsychological functioning and psychological symptoms of a large group of patients with suspected CTE, and ruled out alternative explanations for their complaints, including suboptimal performance due to insufficient effort. Methods: We studied participants with suspected CTE (n = 386) who were referred for further diagnosis to the Netherlands Centre of Occupational Diseases in the period 1998–2003 and who had completed the entire diagnostic protocol. Patients were excluded if there was the slightest suspicion that test performance had been negatively influenced by insufficient effort (n = 221), or if comprehensive assessment identified an alternative diagnosis (n = 80). Insufficient effort was defined by a combination of three indices. The neuropsychological test scores of the patient group (n = 85) were compared with those of a control group of building trade workers matched for sex, age, and educational level (n = 35). Results: The patient group had significantly more psychological complaints and performed significantly worse than the control group on tests of speed of information processing and memory and learning. However, only a small percentage of the patients had clearly abnormal scores for cognitive speed (9%) or memory (8%). Attention, verbal abilities, and constructional functions were not disturbed. Exposure duration and cognitive complaints were significantly correlated, whereas the correlation between exposure duration and neuropsychological domain scores was not significant. Conclusions: Insufficient effort was present in a substantial part of the patient group. After minimising the likelihood that insufficient effort negatively influenced neuropsychological scores, we still found neuropsychological deficits in speed of cognitive processing and memory; however, these scores were clearly abnormal only in a minority of patients with suspected CTE. Screening instruments should focus on these domains.
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psychological treatment of patients with chronic Toxic Encephalopathy lessons from studies of chronic fatigue and whiplash
Psychotherapy and Psychosomatics, 2003Co-Authors: Moniek S E Van Hout, Ellie M Wekking, Ina J Berg, Betto G DeelmanAbstract:Background: Chronic Toxic Encephalopathy (CTE), which can result from long-term exposure to organic solvents, is characterized by problems of attention and memory, fatigue and affec
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suboptimal performance on neuropsychological tests in patients with suspected chronic Toxic Encephalopathy
Neurotoxicology, 2003Co-Authors: Moniek S E Van Hout, Ellie M Wekking, Ben Schmand, Gerard Hageman, Betto G DeelmanAbstract:Suboptimal performance during neuropsychological testing can seriously complicate assessment in behavioral neuroToxicology. We present data on the prevalence of suboptimal performance in a group of Dutch patients with suspected chronic Toxic Encephalopathy (CTE) after long-term occupational exposure to solvents. One hundred and forty-five subjects referred to one of two Dutch national assessment centers for CTE were administered the Amsterdam Short-Term Memory Test (ASTM) and the Test of Memory Malingering (TOMM), two tests specifically developed for the detection of suboptimal performance. For both tests, very cautious cut-off scores were chosen with a specificity of 99%. Results indicated that suboptimal performance appears to be a substantial problem in this group of patients with suspected CTE after long-term exposure to organic solvents. Only 54% of our subjects obtained normal scores on both tests of malingering, i.e. at or above cut-off score. The two tests seemed to measure the same concept in that nearly all the subjects with low TOMM scores also had low ASTM scores. However, a higher proportion of subjects scored below the cut-off on the ASTM than on the TOMM.
Palle Örbaek - One of the best experts on this subject based on the ideXlab platform.
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education for men with solvent induced chronic Toxic Encephalopathy and their spouses
Patient Education and Counseling, 2005Co-Authors: Gunnel Abjornsson, Björn Karlson, Palle ÖrbaekAbstract:Abstract In this study an education, and a series of group sessions for patients with solvent-induced chronic Toxic Encephalopathy (TE) and their spouses are evaluated. Thirty-eight patients and 21 family members participated in a 1-day education scheduled with short lectures on the clinical examination of chronic Toxic Encephalopathy and the prognosis. A specialist in occupational medicine, a psychologist and a social worker gave the lectures. Small discussion groups were also arranged. Of the participants from the educational days, 16 TE patients and 14 wives attended a 10-week counselling and coping improvement program with separate group sessions once a week, for patients and spouses. Questionnaires were used to assess symptoms, social network, mastery and family climate, and the participants’ satisfaction with the education and the group sessions. The majority of the participants experienced the 1-day information as useful and relevant. The 10-week group sessions were rated as meaningful and the design, number, duration and frequency of the sessions equally good. Self-reported symptoms, social network and mastery were measured before the group sessions, and 3 and 9 months after breaking up the group sessions. In most measurements, there were no statistically significant differences between the three points in time. However, the wives improved more than did the patients but the effect was not lasting the whole follow-up period. Considering the patients’ dependence on their wives, it might be most important that the wives experienced some relief from their own symptoms.
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psychological distress and coping in women married to men with a diagnosis of solvent induced chronic Toxic Encephalopathy
Brain Injury, 2005Co-Authors: Gunnel Abjornsson, Palle Örbaek, Björn Karlson, Birgitta Palsson, Kai ÖsterbergAbstract:Background: Solvent-induced chronic Toxic Encephalopathy (TE) is a slowly developing brain disorder associated with both a direct effect on the nervous system and as indirect experienced psychological distress. It can presumably also imply negative influence on the subject's social surroundings. Methods: Seventeen women married to men diagnosed with TE (WTE) and 51 referent women of the same age married to healthy husbands were examined. Symptoms, social network and coping style were measured by questionnaires. Results: The WTE reported slightly more psychological distress and fewer social contacts than did the referents. The WTE did not report affected stress management. Retired women in the WTE group accounted for most of the deviances from the referents. Conclusions: The conclusion is that becoming a WTE does not necessarily imply more psychological distress, social isolation or poorer stress management capability if they continue with their work and social activities.
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Personality, mental distress, and risk perception in subjects with multiple chemical sensitivity and Toxic Encephalopathy.
Scandinavian Journal of Psychology, 2002Co-Authors: Kai Österberg, Björn Karlson, Palle ÖrbaekAbstract:Personality, mental distress, and risk perception were assessed in (a) cases of multiple chemical sensitivity (MCS; n = 17), (b) chemically intolerant Toxic Encephalopathy cases (TE), type 2A (n = 31) and 2B (n = 26), and (c) healthy referents (n = 200). MCS cases showed elevated mental distress scores on the Depression, Interpersonal Sensitivity, Global Severity Index, and Somatization scales in the Symptom Checklist 90 (SCL-90). In the Karolinska Scales of Personality (KSP) the MCS group showed an elevation only on the Psychasthenia scale. Both TE groups showed elevations across the KSP anxiety scales Muscular Tension, Psychasthenia, and Somatic Anxiety. TE type 2B subjects also showed elevations on the Irritability and Indirect Aggression scales. However, neither MCS nor TE groups showed deviating personality characteristics in the Meta Contrast Technique test. Similarly, none of the groups deviated from referents in a risk perception inventory.
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a comparison of neuropsychological tests for the assessment of chronic Toxic Encephalopathy
American Journal of Industrial Medicine, 2000Co-Authors: Kai Österberg, Palle Örbaek, Björn Karlson, Ulf Bergendorf, Lena SegerAbstract:BACKGROUND: From the viewpoint of the clinical neuropsychologist, it is not evident if the detection of solvent induced Toxic Encephalopathy (TE) could be optimized by a modification of the traditional test batteries, adding tests covering new dimensions or monitoring further functional domains. METHODS: To clarify this issue, TE patients were re-examined with (a) the tests traditionally used in screening for TE and (b) some tests hitherto less utilized within neuroToxicology, involving complex attention and frontal lobe functioning. RESULTS: The results do not indicate that tests of the latter category would be more sensitive to TE than the tests traditionally used. Using an optimized core battery, compiled of tests from both categories, the sensitivity and specificity levels reached a maximum of around 0.7 when using as criterion the reproduction of a subnormal test profile (TE type 2B). CONCLUSIONS: A combination of several traditional and a few newer tests is suggested to optimize the detection of TE. Repeated assessments over time are also recommended. (Less)
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influence of personality traits on neuropsychological test performance in Toxic Encephalopathy cases and healthy referent subjects
Neurotoxicology, 2000Co-Authors: Roger Persson, Björn Karlson, Kai Österberg, Palle ÖrbaekAbstract:The relationship between personality traits and cognitive performance was studied in two groups: men with symptoms and neuropsychological test results compatible with Toxic Encephalopathy (TE) and demographically similar healthy men (N=57 per group). Personality traits were assessed with the Karolinska Scales of Personality (KSP). The neuropsychological examination included 13 tests covering various functional domains. The TE group displayed elevated scores on all three KSP anxiety scales as well as an elevated impulsiveness score. Furthermore, the TE group had a lower score on the socialization scale than did the referent group. Different relationships between personality dispositions and cognitive functioning emerged in the two groups. Within the referent group the highest correlations were observed between KSP anxiety and socialization scale scores and reaction times measures. This pattern did not appear in the TE group; instead, divergent and a few weak relationships emerged. These relationships involved correlations between the KSP monotony avoidance score and some motor speed scores. By dividing the referent group into low anxiety and high anxiety subgroups on the basis of the multi-component anxiety scale score, it was shown that the test scores in the high anxiety subgroup mostly were indistinguishable from the scores in the TE group. In contrast, the low anxiety group had higher test scores than the TE group in 8 of the 13 tests. In conclusion, the expected relationship between anxiety and cognitive vigilance is absent in TE cases. This indicates that the neuropsychological performance decrement in TE cases is not primarily related to elevated mental distress, but is probably dominated by the effects of organic brain impairment. Thus, in TE cases low neuropsychological test scores should not be regarded as a consequence of emotional symptoms. Furthermore, personality traits may be considered as potential confounders even if traditional matching by demographic criteria has been successfully implemented.
P Arliensoborg - One of the best experts on this subject based on the ideXlab platform.
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prognosis in chronic Toxic Encephalopathy a two year follow up study in 26 house painters with occupational Encephalopathy
Acta Neurologica Scandinavica, 2009Co-Authors: P Bruhn, P Arliensoborg, C Gyldensted, E L ChristensenAbstract:The prognosis of chronic Toxic Encephalopathy in former house painters was examined in a prospective study with a two-year observation period. Twenty-six patients, who at the initial examination had cerebral atrophy and/or intellectual impairment, were selected for the follow-up study. No competitive etiological factors (including alcohol) to the Encephalopathy were suspected. During the two-year follow-up interval these patients were not professionally exposed to organic solvents. At the follow-up examination neurological, biochemical, neuropsychological, and neuroradiological parameters were reassessed and compared to the original findings. Generally the condition was unchanged. Slight improvements with regard to headache and dizziness were reported by some. However, the neurological status, the neuropsychological impairment, and the cerebral atrophy, did not change significantly. In three patients further deterioration was observed. It is argued that our patients suffered from a brain disorder different from presenile dementia of the Pick-Alzheimer type. Other alternative etiological entities were also excluded. Our findings indicate that long-term exposure to organic solvents may lead to a chronic brain syndrome. Once intellectual impairment and/or cerebral atrophy had developed, reversibility is not observed. Nor is further progression to be expected if exposure is stopped. Occupational exposure to organic solvents should be maximally restricted as it represents a risk of inducing invalidating brain syndromes.
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chronic painters syndrome chronic Toxic Encephalopathy in house painters
Acta Neurologica Scandinavica, 2009Co-Authors: P Arliensoborg, P Bruhn, C Gyldensted, B MelgaardAbstract:Seventy house painters were examined after being referred because organic solvent inToxication of dementia was suspected. In 50 cases no competitive etiological factors to the cerebral symptoms other than exposure to organic solvents could be disclosed. In these, neuropsychological examination showed signs of intellectual impairment in 39 patients and neuroradiological examination by PEG or CT demonstrated the presence of cerebral atrophy in 31 patients; 38 patients studied with CT were compaired to an age-matched control group regarding maximum sulcus width, and a highly significant difference was found. It is argued that long-term exposure to turpentine substitute-often through a period with acute inToxication symptoms--gradually may lead to the development of a chronic brain syndrome, which we have called the "chronic painters' syndrome".
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cerebral blood flow in chronic Toxic Encephalopathy in house painters exposed to organic solvents
Acta Neurologica Scandinavica, 2009Co-Authors: P Arliensoborg, C Gyldensted, L Henriksen, Anders Gade, Olaf B PaulsonAbstract:Cerebral blood flow (CBF) was studied in 11 controls and 9 house painters occupationally exposed to organic solvents for a mean of 22 years. They had mild to moderate intellectual impairment, and no or only minor cerebral atrophy was seen in a CT-scan of the brain. The 133Xe inhalation technique was used and the flow was calculated from the initial slope of the 133Xe wash out curve (ISI). ISI averaged 36.8 ml/100 g/min in the painters and 45.4 ml/100 g/min in the controls, representing a significant difference (P less than 0.05). The reduced CBF in these painters with slight to moderate intellectual impairment might be due to limited neuronal loss or to permanently decreased metabolism of the neurones.
Stanley Berent - One of the best experts on this subject based on the ideXlab platform.
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evaluation of blink reflex results obtained from workers previously diagnosed with solvent induced Toxic Encephalopathy
Journal of Occupational and Environmental Medicine, 2001Co-Authors: James W Albers, John J Wald, David H Garabrant, Christine L Trask, Stanley BerentAbstract:We reviewed blink reflexes recorded from 51 railroad workers with long-term occupational exposure to solvents who were diagnosed by others with solvent-induced Toxic Encephalopathy. No worker fulfilled conventional clinical criteria for dementia or trigeminal mononeuropathy. All workers had normal R1 and R2 blink reflex latencies. R1 latencies correlated significantly with several nerve conduction measures, including F wave latencies, suggesting that some intersubject variability reflected intrinsic conduction properties, not isolated brain-stem function. Although normal, the workers' R1 latencies were significantly prolonged compared with historical control groups, including gender-matched control subjects of similar mean age (11.2 ms vs 9.9 ms; P < 0.0001). Stepwise multiple regression models demonstrated significant associations of R1 latency with age and use of CNS-active prescription medications (P = 0.003), but duration of occupational solvent exposure did not enter into the models. Paradoxically, workers using CNS-active medications had significantly shorter R1 latencies compared with workers not using such medications (10.9 vs 11.7 ms; P = 0.01). Job title, another potential surrogate measure of exposure, was not significantly related to reflex latencies. The geographical site of predominant solvent exposure did influence R1 latency, and workers from one site had longer exposure duration and longer R1 latencies than remaining workers. However, an interaction between age and exposure duration (r = 0.39; P = 0.003) confounded interpretation of this observation. Disability or work status, mental status findings, or classification of Encephalopathy did not influence blink reflex latencies. The overall results do not support, but do not entirely exclude, a possible relationship between subclinical blink reflex abnormalities and occupational exposure to solvents. Nevertheless, it is clear from these results that the small group differences in R1 latency between exposed workers and control subjects are of no diagnostic importance and of uncertain physiologic importance, and they may reflect unrecognized confounders and technical factors.
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neurologic evaluation of workers previously diagnosed with solvent induced Toxic Encephalopathy
Journal of Occupational and Environmental Medicine, 2000Co-Authors: James W Albers, John J Wald, David H Garabrant, Christine L Trask, Stanley BerentAbstract:We examined 52 railroad workers with long-term occupational solvent exposures (average 22 years duration) who had been previously diagnosed by others as having solvent-induced Toxic Encephalopathy. All described episodes of transient inToxication associated with occupational solvent exposure. Persistent symptoms developed, an average, 16 years after exposure onset and included impaired memory (38), altered mood (21), imbalance (18), and headache (17). Thirteen workers had mild mental status abnormalities, but none fulfilled conventional clinical criteria for Encephalopathy or dementia. None had abnormal blink reflex (51) or abnormal electroencephalographic (39) studies. Eight of 47 magnetic resonance imaging studies showed evidence of scattered ischemic lesions among workers with known diabetes mellitus (2), elevated blood pressure (4), or peripheral vascular disease (2). One magnetic resonance imaging scan showed mild cortical atrophy. In stepwise multiple linear and logistic regression models, no statistically significant (P < 0.05) dose-response relationships were found between exposure duration and symptoms or signs that were suggestive of Encephalopathy. However, the number of symptoms (P < 0.001) and the number of signs (P = 0.05) were associated with current use of central nervous system-active medications. Further, lower Mini-Mental Status Examination scores were associated with a history of alcohol abuse (P = 0.01) and lower educational level (P = 0.03). The number of chief symptoms involving memory, mood, balance, or headache differed significantly among workers in different geographic sites (F(3.48) = 2.94, P = 0.04), a finding that was not explained by job title or exposure duration. There also was a significant (P = 0.0001) inverse relationship between initial exposure year (r2 = 0.60) or total years of exposure through 1987 (r2 = 0.56) and interval to major neurologic symptom onset, suggesting that factors other than solvent exposure account in part for worker complaints. We found no objective neurologic evidence supportive of Toxic Encephalopathy or any other uniform syndrome among these individuals, and most complaints were explained by neuropsychological factors or conditions unrelated to occupational solvent exposure.
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absence of polyneuropathy among workers previously diagnosed with solvent induced Toxic Encephalopathy
Journal of Occupational and Environmental Medicine, 1999Co-Authors: James W Albers, John J Wald, Robert A Werner, Alfred Franzblau, Stanley BerentAbstract:An association between polyneuropathy and occupational exposure to trichloroethylene, trichloroethane, perchloroethylene, or similar solvents alone or in combination is controversial. We sought to determine whether workers previously diagnosed with solvent-induced Toxic Encephalopathy had objective evidence of polyneuropathy. Thirty railroad workers previously diagnosed with Toxic Encephalopathy were examined in the context of litigation against their employers. All described long-term occupational solvent exposure averaging 20 years in duration (range, 10 to 29 years) and producing acute inToxication on a regular basis. The diagnosis of subclinical or clinical polyneuropathy was established using a combination of symptoms, signs, and nerve conduction study (NCS) measures, consistent with standard clinical practice. Potential confounders were identified. NCS results were compared with historical controls, including unexposed workers matched by gender, age, and body mass index. Dose-response relationships were evaluated using simple linear and stepwise regression models. Three workers fulfilled clinical polyneuropathy criteria. The only worker fulfilling NCS criteria for confirmed clinical polyneuropathy had diabetes mellitus. Mean NCS values for most measures were similar to control values, and existing differences in sensory amplitudes disappeared when compared with the matched control group. NCS measures were not significantly influenced by exposure duration or job title. Separation into groups on the basis of the presence or absence of polyneuropathy symptoms, previous diagnosis of polyneuropathy, disability status, and severity or type of Encephalopathy did not demonstrate significant NCS differences. The complaints of these workers claiming neuroToxic injury from occupational solvent exposure are not explained by peripheral nervous system dysfunction.
Susan P Proctor - One of the best experts on this subject based on the ideXlab platform.
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magnetic resonance imaging mri neurobehavioral testing and Toxic Encephalopathy two cases1
Neurobehavioral Methods and Effects in Occupational and Environmental Health, 1994Co-Authors: Roberta F White, Robert G Feldman, Mark B Moss, Susan P ProctorAbstract:The objective of this investigation was to examine cerebral magnetic resonance imaging (MRI) pathology and functional deficits demonstrated by neuropsychological testing in cases of Toxic Encephalopathy. Two subjects, occupationally exposed to Toxic chemicals, were studied. As part of their neurological assessment, MRI was done and each underwent a neuropsychological battery for patients with Toxic exposures (White et al. Clin. Neuropharmacol.13(5), 392–412, 1990). In Case 1, who was exposed to inorganic mercury, MRI showed mild central and cortical atrophy. Punctiform foci (T2) were noted in both frontal regions underlying the precentral gyri and in the subcortical myelin. Neuropsychological testing showed problems in cognitive flexibility, cognitive tracking, inhibiting perseveration, fine manual motor coordination, visuospatial analysis and organization, memory, and affect and personality. In Case 2, who was exposed to 2,6-dimethyl-4-heptanone, MRI showed multiple small foci in the white matter and pons. Neuropsychological testing indicated affective changes, deficits in manual motor speed, verbal fluency, visuospatial organization, and short-term memory. Lack of aphasia in patients with Toxic Encephalopathy indicates that neurotoxins probably affect subcortical and mesial temporal structures more than cortical gray matter. These MRI studies show subcortical sites of pathology. © 1993 Academic Press, Inc.
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magnetic resonance imaging mri neurobehavioral testing and Toxic Encephalopathy two cases
Environmental Research, 1993Co-Authors: Roberta F White, Robert G Feldman, Mark B Moss, Susan P ProctorAbstract:The objective of this investigation was to examine cerebral magnetic resonance imaging (MRI) pathology and functional deficits demonstrated by neuropsychological testing in cases of Toxic Encephalopathy. Two subjects, occupationally exposed to Toxic chemicals, were studied. As part of their neurological assessment, MRI was done and each underwent a neuropsychological battery for patients with Toxic exposures (White et al. Clin. Neuropharmacol. 13(5), 392-412, 1990). In Case 1, who was exposed to inorganic mercury, MRI showed mild central and cortical atrophy. Punctiform foci (T2) were noted in both frontal regions underlying the precentral gyri and in the subcortical myelin. Neuropsychological testing showed problems in cognitive flexibility, cognitive tracking, inhibiting perseveration, fine manual motor coordination, visuospatial analysis and organization, memory, and affect and personality. In Case 2, who was exposed to 2.6-dimethyl-4-heptanone, MRI showed multiple small foci in the white matter and pons. Neuropsychological testing indicated affective changes, deficits in manual motor speed, verbal fluency, visuospatial organization, and short-term memory. Lack of aphasia in patients with Toxic Encephalopathy indicates that neurotoxins probably affect subcortical and mesial temporal structures more than cortical gray matter. These MRI studies show subcortical sites of pathology.