Originally Posted by fmichael

I was putting "CRPS" into PubMed Monday night, to see what was new, and this popped up:

DJ Libon, RJ Schwartzman, J Eppig et al., Neuropsychological deficits associated with Complex Regional Pain Syndrome, Journal of the International Neuropsychological Society 2010 Epub 2010 Mar 19.

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, 1-8.).

PMID: 20298641 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/20298641

Fortunately, I got a copy of the article within a couple of hours. Reading through it carefully puts the abstract in some perspective.

The essential results are as follows:

Relying primarily on a statistical technique called "cluster analysis" of a sample of 137 patients with more or less chronic CRPS, roughly a third of them had no cognitive decline, which is good news right there.

Then, at the end of a paragraph in the middle of the "Discussion" section, the authors commit the stylistic error of "burying their lead" when they just get around to mentioning that "It is important to mention that, as far as we could determine, these patterns of neuropsychological impairment are independent of the spread of CRPS (i.e., number of limbs involved), illness duration, and medication use." (Emphasis mine.) And for what it’s worth, the group with no cognitive decline had the longest average length of illness, which is almost counterintuitive.

As to the remaining 2/3's of the patients studied, almost twice as many had problems just with organizational issues ("executory functioning"), so that of all patients sampled, only 22 - 23% of them had both executive dysfunction (which everyone apparently gets if they get anything) and memory recall issues. But in contrast to the ominous final line of the abstract, "and some patients presenting with global cognitive impairment," the text of the article merely speaks of "a more global profile of cognitive impairment involving reduced performance on tests that assess working memory/mental search (executive tests) along with problems on tests of naming and memory . . . "

And in fact, a subsequent paragraph puts even the memory recall issue into perspective:

The profile produced by CRPS group 3 on tests of memory also suggests the presence of executive (i.e., retrieval) rather than amnesic (i.e., encoding) problems. The delayed free recall for CRPS 3 was quite low, in that on average these patients could recall only 6 of 16 original target words. Superficially, such behavior might suggest a striking amnesia or an encoding problem. However, on the delayed recognition test, patients from CRPS group 3 demonstrated improvement, in that 13 of the 16 original target items were correctly identified. Such behavior suggests the presence of a source recall problem, a deficit linked to frontal systems impairment. [Emphasis added; citation omitted.]

I am reminded of one of the most difficult circumstances of my professional career. Forgive the length of this tale, but there's a point at the end. I had been looking for a new position as a bankruptcy attorney when it became clear that I wasn't going to make partner at the firm I had been at for four years. But while I didn't have any rainmaking abilities, I knew the stuff cold. And when a headhunter put me in touch with a really tony and (then) national real estate firm that was looking for a senior bankruptcy associate, the interviews went beautifully. When the senior partner asked me about a particular issue, it just so happened that I had stayed in my car an extra 2 minutes that morning to hear the end of a continuing education tape, and I pulled the names of two or three circuit court opinions out of the top of my hat. Magically, I had secured a position for which they had been interviewing over six months, and I was ensconced in a beautiful office with a floor to ceiling curved glass wall at my side, in the highest per sq. ft. rental space in all of Los Angeles, doing work I had always dreamed of. Enter the evil head of the newly formed litigation department. One of the guys who had interviewed me. But over a few weeks, he picked up on the fact that I had a slow speech syntax, and one of their biggest clients, a bunch of financial sharpies working for a couple of billionaire brothers from Texas, would eat me alive. And so he decided that I could not be introduced to them, and my fate was sealed. Not because I didn't know my stuff, but because I couldn't get it out as fast as the next guy.

So here I sit tonight. Having recently taken many of the same tests as are referred to in the article, with the same pattern of poor "delayed free recall" but with perfect "delayed recognition." That and an "extreme" 45 point spread between my verbal and non-verbal IQ sub-scores, a.k.a. executive dysfunctioning. And a head full of Leonard Cohen songs.

And yes, I have to fight my way out of a wet paper bag and my wife no longer sees me as her "equal," but I've got the now, and I'm good with it. Guess I’ll be some sort of a greeter for group 3.

Mike