You are here

Raynor, Renee Dunn

Overview:

Dr. Raynor performs neuropsychological evaluations for adult patients to identify cognitive deficits and personality changes related to their brain tumor or treatment. Her intervention work includes cognitive retraining, pharmacologic treatment of cognitive and behavioral dysfunction, and supportive psychotherapy. Her research interests are related to quality of life in brain tumor patients, particularly behavioral and pharmacologic treatment of cognitive deficits and mood/behavioral disturbances.

Positions:

Assistant Professor in Psychiatry and Behavioral Sciences

Psychiatry & Behavioral Sciences, General Psychiatry
School of Medicine

Assistant Professor in Surgery

Surgery
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

Ph.D. 1998

Ph.D. — University of Southern Mississippi

Grants:

Multimodality Word-Finding in Neurosurgical Language Mapping

Administered By
Neurosurgery
AwardedBy
National Institutes of Health
Role
Clinical Neuropsychologist
Start Date
May 01, 2007
End Date
April 30, 2011

Phase II Study of 44Gy from 131I-81C6 for CNS Tumors

Administered By
Neurosurgery, Neuro-Oncology
AwardedBy
National Institutes of Health
Role
Neuropsychologist
Start Date
September 29, 2003
End Date
August 31, 2006

Publications:

Dose-dependent effects of radiation therapy on cerebral blood flow, metabolism, and neurocognitive dysfunction.

PURPOSE: A prospective study was performed to formally relate dose-dependent radiologically defined changes in normal brain induced by radiotherapy (RT) to neurocognitive dysfunction in subjects with primary brain tumors. METHODS AND MATERIALS: Adult patients receiving three-dimensional RT for central nervous system (CNS) tumors were enrolled. Positron emission tomography (PET) scanning and neuropsychological testing were performed before RT and 3 weeks and 6 months after treatment. Analyses were performed for correlations between changes in 2-deoxy-2-[(18)F]-fluoro-d-glucose (FDG)-PET (metabolism), (15)O-PET (relative blood flow), regional radiation dose, follow-up time, and neuropsychological test scores. RESULTS: Eleven subjects were enrolled and 6 completed follow-up studies. The PET data showed reduced FDG uptake, with average decreases of 2-6% in regions of the brain receiving greater than 40 Gy at 3 weeks' and 6 months' follow-up. The (15)O-H(2)O PET showed increases (<10%) at 3 weeks in relative regional blood flow in brain receiving greater than 30 Gy, but less at the 6-month follow-up studies. There were significant correlations between decreases in FDG uptake and increased scores from the Symptom Checklist-90-R, with an average increase in T score of 2 (p < 0.0001). The Wisconsin Card Sorting Test showed a significant correlation of decreased FDG uptake with increased errors and perseveration in test performance, with an average decrease in T score of 11 (p = 0.037). CONCLUSIONS: A dose-dependent response of CNS tissue was detected using FDG PET in this small number of patients. Decreases in CNS metabolism correlated with decreased performance on neuropsychological tests for problem solving, cognitive flexibility, and global measures of psychopathology. Additional research is needed to verify and define these findings.

Authors
Hahn, CA; Zhou, S-M; Raynor, R; Tisch, A; Light, K; Shafman, T; Wong, T; Kirkpatrick, J; Turkington, T; Hollis, D; Marks, LB
MLA Citation
Hahn, CA, Zhou, S-M, Raynor, R, Tisch, A, Light, K, Shafman, T, Wong, T, Kirkpatrick, J, Turkington, T, Hollis, D, and Marks, LB. "Dose-dependent effects of radiation therapy on cerebral blood flow, metabolism, and neurocognitive dysfunction." Int J Radiat Oncol Biol Phys 73.4 (March 15, 2009): 1082-1087.
PMID
18755558
Source
pubmed
Published In
International Journal of Radiation: Oncology - Biology - Physics
Volume
73
Issue
4
Publish Date
2009
Start Page
1082
End Page
1087
DOI
10.1016/j.ijrobp.2008.05.061

Neuropsychological effects and attitudes in patients following electroconvulsive therapy.

The current study examined the effects of electroconvulsive therapy (ECT) on neuropsychological test performance. Forty-six patients completed brief neuropsychological and psychological testing before and after receiving ECT for the treatment of recalcitrant and severe depression. Neuropsychological testing consisted of the Levin Selective Reminding Test (Levin) and Wechsler Memory Scale-Revised Edition (WMS-R). Self-report measures included the Beck Depression Inventory (BDI), the Short-Term Memory Questionnaire (STMQ), and several other measures of emotional functioning and patient attitudes toward ECT. The mean number of days between pre-ECT and post-ECT testing was 24. T-test revealed a significant decrease in subjective ratings of depression as rated by the BDI, t(45) = 9.82, P < 0.0001 (Pre-BDI = 27.9 +/- 20.2; post-BDI = 13.5 +/- 9.7). Objective ratings of memory appeared impaired following treatment, and patients' self-report measures of memory confirmed this decline. More specifically, repeated measures MANOVA [Wilks Lambda F(11,30) = 4.3, p < 0.001] indicated significant decreases for measures of immediate recognition memory (p < 0.005), long-term storage (p < 0.05), delayed prose passage recall (p < 0.0001), percent retained of prose passages (p < 0.0001), and percent retained of visual designs (p < 0.0001). In addition, the number of double mentions on the Levin increased (p < 0.02). This study suggests that there may be a greater need to discuss the intermittent cognitive risks associated with ECT when obtaining informed consent prior to treatment. Further that self-reports of cognitive difficulties may persist even when depression has remitted. However, patients may not acknowledge or be aware of changes in their memory functioning, and post-ECT self-reports may not be reliable.

Authors
Feliu, M; Edwards, CL; Sudhakar, S; McDougald, C; Raynor, R; Johnson, S; Byrd, G; Whitfield, K; Jonassaint, C; Romero, H; Edwards, L; Wellington, C; Hill, LK; Sollers, J; Logue, PE
MLA Citation
Feliu, M, Edwards, CL, Sudhakar, S, McDougald, C, Raynor, R, Johnson, S, Byrd, G, Whitfield, K, Jonassaint, C, Romero, H, Edwards, L, Wellington, C, Hill, LK, Sollers, J, and Logue, PE. "Neuropsychological effects and attitudes in patients following electroconvulsive therapy." Neuropsychiatr Dis Treat 4.3 (June 2008): 613-617.
PMID
18830401
Source
pubmed
Published In
Neuropsychiatric disease and treatment
Volume
4
Issue
3
Publish Date
2008
Start Page
613
End Page
617

Evaluation and characterization of generalized anxiety and depression in patients with primary brain tumors.

To determine clinical and sociodemographic factors that are associated with major neuropsychiatric illnesses among brain tumor patients, we administered a modified version of the Brief Patient Health Questionnaire and a demographic data form to 363 adult neuro-oncology patients. Responses were analyzed to assess for associations between demographic variables, clinical variables, and symptoms consistent with diagnoses of generalized anxiety disorder and/or depression. Multivariate logistic regression analyses showed that female gender was associated with the presence of symptoms of anxiety, depression, and combined anxiety and depression. Lower WHO tumor grade classifications, lower education level, and a history of psychiatric illness also emerged as important predictors of symptoms consistent with anxiety and/or depression. Marital status and presence of past/current medical illness trended toward being significantly associated with depression alone. Patient use of psychiatric medication was not associated with any study variables. Results of the present study suggest several hypotheses to test with neuro-oncology patients in further longitudinal analyses, which would benefit from the inclusion of a wider range of neuropsychiatric symptoms in conjunction with neurocognitive and functional impairment variables.

Authors
Arnold, SD; Forman, LM; Brigidi, BD; Carter, KE; Schweitzer, HA; Quinn, HE; Guill, AB; Herndon, JE; Raynor, RH
MLA Citation
Arnold, SD, Forman, LM, Brigidi, BD, Carter, KE, Schweitzer, HA, Quinn, HE, Guill, AB, Herndon, JE, and Raynor, RH. "Evaluation and characterization of generalized anxiety and depression in patients with primary brain tumors." Neuro Oncol 10.2 (April 2008): 171-181.
PMID
18314416
Source
pubmed
Published In
Neuro-Oncology
Volume
10
Issue
2
Publish Date
2008
Start Page
171
End Page
181
DOI
10.1215/15228517-2007-057

A pilot study: 131I-antitenascin monoclonal antibody 81c6 to deliver a 44-Gy resection cavity boost.

The purpose of this study was to determine the feasibility and assess the efficacy and toxicity, among newly diagnosed malignant glioma patients, of administering (131)I-labeled murine antitenascin monoclonal antibody 81C6 ((131)I-81C6) into a surgically created resection cavity (SCRC) to achieve a patient-specific, 44-Gy boost to the 2-cm SCRC margin. A radioactivity dose of (131)I-81C6 calculated to achieve a 44-Gy boost to the SCRC was administered, followed by conventional external beam radiotherapy (XRT) and chemotherapy. Twenty-one patients were enrolled in the study: 16 with glioblastoma multiforme (GBM) and 5 with anaplastic astrocytoma. Twenty patients received the targeted 44-Gy boost (+/-10%) to the SCRC. Attributable toxicity was mild and limited to reversible grade 3 neutropenia or thrombocytopenia (n = 3; 14%), CNS wound infections (n = 3; 14%), and headache (n = 2; 10%). With a median follow-up of 151 weeks, median overall survival times for all patients and those with GBM are 96.6 and 90.6 weeks, respectively; 87% of GBM patients are alive at 1 year. It is feasible to consistently achieve a 44-Gy boost dose to the SCRC margin with patient-specific dosing of (131)I-81C6. Our study regimen ((131)I-81C6 + XRT + temozolomide) was well tolerated and had encouraging survival. To determine if selection of good-prognosis patients affects outcome associated with this approach, the U.S. Food and Drug Administration has approved a trial randomizing newly diagnosed GBM patients to either our study regimen or standard XRT plus temozolomide.

Authors
Reardon, DA; Zalutsky, MR; Akabani, G; Coleman, RE; Friedman, AH; Herndon, JE; McLendon, RE; Pegram, CN; Quinn, JA; Rich, JN; Vredenburgh, JJ; Desjardins, A; Guruangan, S; Boulton, S; Raynor, RH; Dowell, JM; Wong, TZ; Zhao, X-G; Friedman, HS; Bigner, DD
MLA Citation
Reardon, DA, Zalutsky, MR, Akabani, G, Coleman, RE, Friedman, AH, Herndon, JE, McLendon, RE, Pegram, CN, Quinn, JA, Rich, JN, Vredenburgh, JJ, Desjardins, A, Guruangan, S, Boulton, S, Raynor, RH, Dowell, JM, Wong, TZ, Zhao, X-G, Friedman, HS, and Bigner, DD. "A pilot study: 131I-antitenascin monoclonal antibody 81c6 to deliver a 44-Gy resection cavity boost." Neuro Oncol 10.2 (April 2008): 182-189.
PMID
18287339
Source
pubmed
Published In
Neuro-Oncology
Volume
10
Issue
2
Publish Date
2008
Start Page
182
End Page
189
DOI
10.1215/15228517-2007-053

Support services

© Cambridge University Press 2008 and 2009. Introduction Whether the primary treatment approach to cognitive impairment in cancer is remediation/rehabilitation, pharmacotherapy, or a combination, one must not underestimate the importance of comprehensive support services throughout the illness continuum. Cognitive deficits related to cancer may be primary, related to the disease entity itself, or may be secondary, related to the various methods used to treat the cancer. Such deficits may also be related to direct and indirect co-morbidities of the cancer and treatments. Among the most common co-morbidities are mood disturbances (e.g., depression, anxiety) and fatigue. Fatigue is the most widely reported deleterious symptom in adult cancer patients (Valentine & Meyers, 2001). Additionally, in childhood cancer survivors, fatigue and “aches and pains” are reported as most problematic relative to other symptoms (Zebrack & Chesler, 2002). In this chapter, we will consider cognitive deficits, mood disturbances or emotional distress, and fatigue as highly inter-related symptoms of cancer and will discuss support services that may apply to one or more of these conditions in isolation or in combination. Support has many definitions, but is generally understood as strengthening the patient’s and family’s resources by providing emotional, informational, and practical assistance as needed, and by appropriately fostering a sense of hope or optimism. Here, we refer to a wide range of strategies designed to improve emotional and social adjustment and functioning, increase coping, assist with decision-making, and minimize distress.

Authors
Guill, B; Raynor, RH
MLA Citation
Guill, B, and Raynor, RH. "Support services." (January 1, 2008): 295-311. (Chapter)
Source
scopus
Publish Date
2008
Start Page
295
End Page
311
DOI
10.1017/CBO9780511545900.022

Neuropsychological assessment, neuroimaging, and neuropsychiatric evaluation in pediatric and adult patients with sickle cell disease (SCD).

Traditionally, neuropsychological deficits due to Sickle Cell Disease (SCD) have been understudied in adults. We have begun to suspect, however, that symptomatic and asymptomatic Cerebrovascular Events (CVE) may account for an alarming number of deficits in this population. In the current brief review, we critically evaluated the pediatric and adult literatures on the neurocognitive effects of SCD. We highlighted the studies that have been published on this topic and posit that early detection of CVE via neurocognitive testing, neuropsychiatric evaluations, and neuroimaging may significantly reduce adult cognitive and functional morbidities.

Authors
Edwards, CL; Raynor, RD; Feliu, M; McDougald, C; Johnson, S; Schmechel, D; Wood, M; Bennett, GG; Saurona, P; Bonner, M; Wellington, C; DeCastro, LM; Whitworth, E; Abrams, M; Logue, P; Edwards, L; Martinez, S; Whitfield, KE
MLA Citation
Edwards, CL, Raynor, RD, Feliu, M, McDougald, C, Johnson, S, Schmechel, D, Wood, M, Bennett, GG, Saurona, P, Bonner, M, Wellington, C, DeCastro, LM, Whitworth, E, Abrams, M, Logue, P, Edwards, L, Martinez, S, and Whitfield, KE. "Neuropsychological assessment, neuroimaging, and neuropsychiatric evaluation in pediatric and adult patients with sickle cell disease (SCD)." Neuropsychiatr Dis Treat 3.6 (December 2007): 705-709.
PMID
19300604
Source
pubmed
Published In
Neuropsychiatric disease and treatment
Volume
3
Issue
6
Publish Date
2007
Start Page
705
End Page
709

Prospective trial of a video educational tool for radiation oncology patients.

OBJECTIVES: Prospective assessment of the informational needs of radiation oncology patients and efficacy of an educational video in meeting them. METHODS: Subjects completed baseline self-administered questionnaires and subsequently viewed the patient education video. Post-testing was performed after initiation of therapy and subjects rated their satisfaction with the video, its relevance, and their emotional response. Analyses were performed with respect to patient and disease characteristics. RESULTS: Fifty-three subjects were enrolled and completed both before and after video measures. The mean age of participants was 58 years (range, 33 to 83). Pretreatment, >90% of patients reported specific information needs. One hundred percent of patients watched the video and 77% rated it as highly relevant. High levels of satisfaction (>90%) were reported with video information describing radiation and simulation. Older subjects (58 years and older) found video information significantly more relevant than those younger (55% versus 27%, P = 0.04) and rated greater satisfaction with side effect information (78% versus 41%, P = 0.006). Subjects with breast cancer exhibited a trend towards feeling better informed by the video. CONCLUSIONS: Radiation oncology patients reported informational needs unmet by standard educational measures. High levels of satisfaction were reported with video education. It promoted better understanding of radiotherapy. Older patients found the video to be significantly more relevant and informative.

Authors
Hahn, CA; Fish, LJ; Dunn, RH; Halperin, EC
MLA Citation
Hahn, CA, Fish, LJ, Dunn, RH, and Halperin, EC. "Prospective trial of a video educational tool for radiation oncology patients." Am J Clin Oncol 28.6 (December 2005): 609-612.
PMID
16317273
Source
pubmed
Published In
American Journal of Clinical Oncology: Cancer Clinical Trials
Volume
28
Issue
6
Publish Date
2005
Start Page
609
End Page
612

Routine screening for depression in radiation oncology patients.

PURPOSE: Depression is a debilitating illness with symptoms that overlap those of cancer and radiotherapy. We sought to measure the frequency of depression in adult radiation oncology patients. METHODS AND MATERIALS: The Beck Depression Inventory-II (BDI-II) was incorporated into routine clinical evaluation of patients. Results were analyzed by univariate analysis and multivariate analysis of variance (MANOVA). RESULTS: One hundred twenty-four patients were screened and 19 (15%) endorsed significant depressive symptoms. Of these, levels of depression were: 58% mild, 32% moderate, and 10% severe. Twenty-six percent of the depressed group had a history of previous psychiatric diagnoses and 32% previously had been placed on psychotropic medications. The most frequent somatic symptoms for the entire group were loss of energy (73%) and tiredness or fatigue (69%). All depressed patients endorsed some somatic symptoms, but these alone were insufficient to score in the range of depression. CONCLUSIONS: A simple tool can be administered in the clinic by radiation oncologists to screen for depression. The frequency of depression in our patients was 15%. Somatic symptoms alone were insufficient to score as depressed.

Authors
Hahn, CA; Dunn, R; Halperin, EC
MLA Citation
Hahn, CA, Dunn, R, and Halperin, EC. "Routine screening for depression in radiation oncology patients." Am J Clin Oncol 27.5 (October 2004): 497-499.
PMID
15596919
Source
pubmed
Published In
American Journal of Clinical Oncology: Cancer Clinical Trials
Volume
27
Issue
5
Publish Date
2004
Start Page
497
End Page
499

Prospective study of neuropsychologic testing and quality-of-life assessment of adults with primary malignant brain tumors.

PURPOSE: To identify the characteristics of adult patients with newly diagnosed primary brain tumors associated with identifiable deficits in neuropsychologic function to target interventions to improve function and quality of life (QOL). MATERIALS AND METHODS: Adult patients with newly diagnosed primary brain tumors and their caregivers were enrolled and underwent a battery of standardized neuropsychologic tests, allowing for qualitative and quantitative assessment and sensitive to the effects of the brain tumor, QOL, or caregiver stress. RESULTS: We enrolled 68 patients with no prior radiotherapy. Patients with left hemisphere tumors reported significantly more memory problems and depressive symptoms. They also exhibited poorer attention and were more distractible, with poorer verbal fluency and poorer verbal learning. Patients with glioblastoma multiforme demonstrated poorer psychomotor speed and visual tracking than patients with non-glioblastoma multiforme histologic features. Patients and caregivers perceived QOL in a similar fashion, with significant correlation between patient and caregiver on hope testing and general QOL on the Linear Analog Self-Assessment Scale. CONCLUSIONS: Patients with left hemisphere tumors and glioblastoma multiforme histologic features demonstrated testable differences in neuropsychologic function and QOL that may be amenable to improvement with medical therapy or tailored rehabilitation programs. Caregiver assessments can predict patient QOL, which may be useful in patients with declining status.

Authors
Hahn, CA; Dunn, RH; Logue, PE; King, JH; Edwards, CL; Halperin, EC
MLA Citation
Hahn, CA, Dunn, RH, Logue, PE, King, JH, Edwards, CL, and Halperin, EC. "Prospective study of neuropsychologic testing and quality-of-life assessment of adults with primary malignant brain tumors." Int J Radiat Oncol Biol Phys 55.4 (March 15, 2003): 992-999.
PMID
12605978
Source
pubmed
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
55
Issue
4
Publish Date
2003
Start Page
992
End Page
999

Electromyographic (EMG) biofeedback in the comprehensive treatment of central pain and ataxic tremor following thalamic stroke.

Peripheral pain and ataxic tremor can appear suddenly following thalamic stroke and can significantly alter a patient's psychological, social, and physical functioning. The present paper reports the case of a 70-year-old Caucasian female who sustained an acute left posterior cerebral artery infarction involving the thalamus and left mesiotemporal regions. She subsequently developed Central Poststroke Pain and ataxic movement of her right arm and hand in addition to a significant right-side claudication. She was treated over 16 weeks (6 weeks of EMG biofeedback and 10 weeks of psychotherapy) with a combination of EMG biofeedback, progressive muscle relaxation, behavioral pain coping skills training, Forced Use Therapy, and Cognitive Behavioral Therapy 7 years after her initial cerebral accident. The case demonstrates the utility of biofeedback when combined as part of a comprehensive treatment program to address the multiple complications associated with thalamic stroke.

Authors
Edwards, CL; Sudhakar, S; Scales, MT; Applegate, KL; Webster, W; Dunn, RH
MLA Citation
Edwards, CL, Sudhakar, S, Scales, MT, Applegate, KL, Webster, W, and Dunn, RH. "Electromyographic (EMG) biofeedback in the comprehensive treatment of central pain and ataxic tremor following thalamic stroke." Appl Psychophysiol Biofeedback 25.4 (December 2000): 229-240.
PMID
11218924
Source
pubmed
Published In
Applied Psychophysiology and Biofeedback
Volume
25
Issue
4
Publish Date
2000
Start Page
229
End Page
240
Show More