Neuropsychological and Related Clinical Features Associated with Complex Regional Pain Syndrome: A Latent Class Analysis
David J. Libon *
Department of Neurology, Drexel University College of Medicine, 254 North 15th Street, Philadelphia, PA 19102, USA and Department of Geriatrics and Gerontology, New Jersey Institute for Successful Aging, Rowan University-School of Osteopathic Medicine, Stratford, NJ, 08084, USA.
Joel Eppig
Department of Neurology, Drexel University College of Medicine, 254 North 15th Street, Philadelphia, PA 19102, USA.
Deborah A. G. Drabick
Department of Psychology, Temple University, Philadelphia, PA, USA.
Kirsten Erwin
Department of Neurology, Drexel University College of Medicine, 254 North 15th Street, Philadelphia, PA 19102, USA.
Christine Annibali
Robert Wood Johnson Medical School, Rutgers University, Piscataway, NJ, USA.
Lynn Durmala
Department of Neurology, Drexel University College of Medicine, 254 North 15th Street, Philadelphia, PA 19102, USA.
Aaron Bloch
Department of Neurology, Drexel University College of Medicine, 254 North 15th Street, Philadelphia, PA 19102, USA.
Jacqueline Donohue
Department of Neurology, Drexel University College of Medicine, 254 North 15th Street, Philadelphia, PA 19102, USA.
Rodney Swenson
Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine, Fargo, North Dakota, USA.
Guillermo M. Alexander
Department of Neurology, Drexel University College of Medicine, 254 North 15th Street, Philadelphia, PA 19102, USA.
Enrique Aradillas
Department of Neurology, Drexel University College of Medicine, 254 North 15th Street, Philadelphia, PA 19102, USA.
B. Lee Peterlin
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Robert J. Schwartzman
Department of Neurology, Drexel University College of Medicine, 254 North 15th Street, Philadelphia, PA 19102, USA.
*Author to whom correspondence should be addressed.
Abstract
Aim: The current research examined neuropsychological and key features related to Geschwind-Behan-Galaburda (GBG) model (i.e., non-right handedness, learning problems, autoimmune disease) in patients with Chronic Regional Pain Syndrome (CRPS).
Methods: A large sample of patients with CRPS (n=509) were evaluated with a neuropsychological protocol that assessed executive control, language/ lexical retrieval, and declarative memory. A portion of our sample was assessed with the modified Oldfield-Edinburgh questionnaire (n= 262) surveyed handedness, learning problems, and autoimmune disease was obtained on a portion of patients.
Results: Latent Class Analysis identified four neuropsychological classes: patients with moderate cognitive impairment (n= 44), patients with elements of an amnestic syndrome (n= 93), patients with intact but low average/ average neuropsychological test performance (n= 191), and patients with average/ high average neuropsychological test performance (n= 181). Elements of dysexecutive impairment were obtained in some groups. A minority, but statistically significant number of patients presented with mixed/ non-right handedness (26.30%); learning disabilities/ related problems (18.40%); and autoimmune disease (23.50; P< .001, all analyses). While intact neuropsychological performance was generally found in this large sample of patients with CRPS patients, elements of mild dysexecutive and amnestic impairment were observed in a portion of patients.
Conclusion: Neuropsychological impairment is present in a minority number of patients. The statistically significant incidence of non-right handedness, learning problems, and autoimmune medical disorders among a subset of patients is consistent with elements of the GBG model.
Summary: These data suggest the presence of mild neuropsychological deficits in some patients along with the possibility for anomalous brain development, suggesting a possible predisposition for CRPS in some patients.
Keywords: Complex regional pain syndrome, reflex sympathetic dystrophy, personality, neuropsychological functioning, neuropathic pain, Geschwind-Behan-Galaburda model.