The number of adults in the United States who are age 65 or older is rapidly increasing. With longer lifespan comes an increase in chronic diseases such as dementia, diabetes, and depression. This study used archival data from a larger study conducted at the Memory Clinic at John Peter Smith County Hospital in Ft. Worth, Texas to examine several hypotheses and research questions related to the influence of type of dementia, presence of Type II diabetes, and presence of depression on neuropsychological test performance. First, this study attempted to identify specific patterns of performance on neuropsychological measures for those with Alzheimer's dementia (AD), vascular dementia (VaD), or mild cognitive impairment (MCI). The results indicated that those with MCI perform better than those with AD or VaD on all neuropsychological measures, and that those with VaD perform better than those with AD on a measure of verbal memory. Another purpose of the study was to determine how the presence of Type II diabetes affects this pattern of functioning; the overall finding in this study was that the presence or absence of diabetes did not affect performance on measures of cognitive functioning. Additionally, the study attempted to add to literature examining the influence of depression on older adults with diabetes and/or dementia; no significant differences emerged.

Performance on the Spatial Span subtest of the Wechsler Memory Scale has been viewed as an indicator of working memory and visuospatial processing. A number of factors including age and gender have been posited to effect performance on Spatial Span by older adults. The current study examined the impact of various forms of cognitive impairment and severity of impairment on Spatial Span performance. Five hundred thirty-eight individuals between the ages of 65 and 89 were evaluated in a university memory disorders clinic using a battery of neuropsychological tests that included Spatial Span. Participants were grouped by consensus diagnosis into type of cognitive impairment (Alzheimer's disease, vascular disease, amnestic mild cognitive impairment or non-amnestic mild cognitive impairment) or cognitively normal. As expected, an increase in severity of impairment results in a decrease in Spatial Span Total Score. Other findings included a weak relationship between age and Spatial Span Total Score. Gender, as well as age, did not fully account for the decline in Spatial Span Total Score. Spatial Span Forward score was not as good a predictor of severity in that reduction in score for Spatial Span Forward remains relatively stable regardless of level of impairment. Spatial Span Backward performance was found to be more sensitive to severity. No significant differences were found between performance of Alzheimer's disease and vascular disease suggesting they share similar deficit patterns with regard to the cognitive abilities measured by the Spatial Span subtest. A comparison between those diagnosed with mild cognitive impairment and individuals without such a diagnosis showed no significant difference suggesting that visuospatial processes are not affected early in the dementing process.

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Cognitive impairment is common in multiple sclerosis (MS), with as many as 70% of patients with MS affected. Individuals with MS who experience cognitive deficits are less likely to be employed, and may have more difficulty performing independent activities of daily living. Most commonly, deficits are observed in processing speed, complex attention, and memory. Because lesion location varies widely among individuals, no clear pattern of cognitive dysfunction in MS has emerged. However, a number of risk and protective factors may influence the likelihood of individuals to develop and/or express dysfunction, though the contribution of each to specific domains of cognition has not been fully explored. Recently, support for the cognitive reserve hypothesis (i.e., enriching life experiences protect against cognitive decline despite disease burden) has emerged in the MS literature. The current study investigated the contributions of cognitive reserve to learning and memory functioning in MS and the interaction of cognitive reserve variables and risk factors known to impact cognitive functioning in individuals with MS. Finding revealed cognitive reserve protects against decline in the domains of processing speed and complex attention. Furthermore, indirect protective effects of cognitive reserve through these domains were observed for verbal learning and memory. Finally, in line with previous literature, cognitive dysfunction predicted employment status of the current sample. Clinical implications and future directions for intervention efforts are discussed.

Indiana University-Purdue University Indianapolis (IUPUI) / Dementia studies often collect multiple longitudinal neuropsychological measures in order to examine patients' decline across a number of cognitive domains. Dementia patients have shown considerable heterogeneities in individual trajectories of cognitive decline, with some patients showing rapid decline following diagnoses while others exhibiting slower decline or remain stable for several years. In the first part of this dissertation, a multivariate finite mixture latent trajectory model was proposed to identify longitudinal patterns of cognitive decline in multiple cognitive domains with multiple tests within each domain. The expectation-maximization (EM) algorithm was implemented for parameter estimation and posterior probabilities were estimated based on the model to predict latent class membership. Simulation studies demonstrated satisfactory performance of the proposed approach. In the second part, a simulation study was performed to compare the performance of information-based criteria on the selection of the number of latent classes. Commonly used model selection criteria including the Akaike information criterion (AIC), Bayesian information criterion (BIC), as well as consistent AIC (CAIC), sample adjusted BIC (SABIC) and the integrated classification likelihood criteria (ICLBIC) were included in the comparison. SABIC performed uniformly better in all simulation scenarios and hence was the preferred criterion for our proposed model. In the third part of the dissertation, the multivariate finite mixture latent trajectory model was extended to situations where the true latent class membership was known for a subset of patients. The proposed models were used to analyze data from the Uniform Data Set (UDS) collected from Alzheimer's Disease Centers across the country to identify various cognitive decline patterns among patients with dementia.

Indiana University-Purdue University Indianapolis (IUPUI) / Although cancer and treatment-associated cognitive dysfunction has been well-documented in the literature, much work remains to elucidate the biological mechanisms driving this effect, hampering current therapeutic efforts. To address this gap, we first reviewed studies utilizing neuroimaging to characterize cognitive dysfunction in cancer, as studies of neurodegenerative diseases point to neuroimaging as a sensitive measure of cognitive dysfunction. This review highlighted the need for longitudinal imaging studies of cancer and treatment-related changes in cerebral structure and function. Subsequently, we utilized multimodal neuroimaging techniques in a female breast cancer cohort to investigate the longitudinal impact of cancer and chemotherapy treatment on cerebral perfusion and gray matter. Our findings indicate that chemotherapy is associated with elevated perfusion, primarily in posterior brain regions, as well as depressed frontal perfusion associated with decreased frontal gray matter density. This pattern of results suggests the involvement of multiple mechanisms of chemotherapy-induced cognitive dysfunction. We also investigated the relationship of cognitive dysfunction and chemotherapy-induced peripheral neuropathy (CIPN), another type of chemotherapy-related nervous system sequelae, again utilizing multimodal, longitudinal neuroimaging, and found that peripheral neuropathy symptoms following chemotherapy were associated with changes in cerebral perfusion and gray matter density. Together, these findings support the hypothesis that multiple biological mechanisms drive cancer and treatment-related cognitive dysfunction. Interestingly, although cancer is associated with cognitive dysfunction, epidemiological studies have shown that cancer and Alzheimer's disease (AD) are inversely correlated. To extend our imaging analysis beyond breast cancer, we leveraged the Alzheimer's Disease Neuroimaging Initiative (ADNI) cohort to investigate the inverse relationship of cancer and AD and investigate the impact of both of these diseases on gray matter density. We found that though the inverse relationship of these diseases was replicated in the ADNI cohort, cancer history was associated with lower gray matter density, similar to findings from breast cancer studies, independent of AD diagnostic group. Finally, we reviewed microRNA studies, as microRNAs are important regulators of many cell signaling pathways and have been actively investigated in relation to both diseases. This review suggests several pathways that may be driving the inverse association and may contribute to cognitive dysfunction.

A research project submitted in fulfilment of the requirements for the degree of Master of Arts in Psychology through the Faculty of Humanities, University of the Witwatersrand, Johannesburg, 2016 / Background Chronic Kidney Disease (CKD) is a reality faced by many around the world. There has been much physiological study around factors associated with CKD, as well as many studies surrounding the psychosocial impacts of the disease, with relatively less attention given to neuropsychological effects the disease can have on sufferers. This paper investigates the cognitive impacts as well as psychological impacts simultaneously, impacting on sufferers of End Stage Kidney Disease (ESKD). Methods Sixteen medically stable patients aged (M = 40.56, SD = 12.52) years with ESKD, were investigated. Eight of the patients were evaluated before and after six months of successful kidney transplant, using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), which assessed immediate memory, visuospatial / constructional, language, and attention. They were also tested on a brief symptom inventory (BSI 18) to assess depression and anxiety in these patients. A further eight who remained on dialysis, and had not undergone renal transplant were evaluated in the same manner for comparative purposes. Results Between-group comparisons showed a statistically significant improvement in overall cognitive functioning, as well as in the specific cognitive domains of visuospatial / constructional, language and attention for participants who had undergone renal transplant surgery compared to their counterparts who had not. Results also found that there were no statistically significant differences between the levels of anxiety experienced between patients in the two groups. When assessing the differences in cognitive improvement within the transplant patient group before and after transplant, improvement in the delayed memory function of renal transplant patients post-transplant was found. Conclusion These data show improvements in delayed memory function of patients having undergone renal transplant therapy, while also highlighting a continued decline of overall cognitive functioning in patients remaining on hemodialysis therapy. / GR2017

A job-related social skills program for high school students with mild cognitive impairments, using a range of media materials has been implemented in several school districts in Virginia. The program, developed under the auspices of the U.S. Office of Special Education Programs, will be examined in this study for issues of implementation and adoption in public high schools. The use of traditional experimental designs in program evaluation is seriously questioned when complex issues of implementation are involved. These issues are magnified in special education settings where subject assignment, sample size, individualized instruction, and teacher choice of materials are uniquely present. Consequently, a case study approach of four classrooms following the techniques of Miles and Huberman and Yin was used to examine the implementation process. Three major factors were used to organize data collection: teacher understanding of existing curriculum and goals and teaching style, congruence between the existing and new content and decision making related to implementation, and instructional delivery and the way program use actually looked. While all teachers appeared to like and accept the program, they did not want it to alter their existing classroom plans, teaching styles, and personal interaction approaches. Each teacher showed a unique defense of his or her existing educational style, and the new program was adapted to the ongoing classroom situation, rather than vice versa. If faced with decisions between using the new program and fulfilling existing requirements, these teachers chose to reject the program. The great variation in implementation and modification of the program across these sites supports the need for more careful descriptive site by site studies that allow for differences that cannot easily be identified in quasi-experimental designs. / Ph. D.

Thesis (MA)--Stellenbosch University, 2005. / ENGLISH ABSTRACT: Acknowledgement of the right to equal work opportunities for people with disabilities is widely supported in South Africa. Several policy documents and laws have been published since July 1993 and provide clear guidelines regarding equal opportunities for people with disabilities. A state subsidy scheme for protective workshops was introduced for the first time on 1 April 1997 (Operational Manual for Protective Workshops, 2001: 1). The purpose of this subsidy scheme was to provide work opportunities for people who cannot enter the sheltered or open labour market due to the effect of their disabilities on their daily functioning. In March 2001, the Department of Social Development and Poverty Alleviation in the Western Cape introduced a draft document, Operational Manual for Protective Workshops. The aim of the manual focused on the development of the worker role and economic empowerment of people with disabilities who work in protective workshops. Due to ignorance, fear and stereotyping, persons with intellectual impairment are being unfairly discriminated against in society and at the workplace. With reasonable accommodation, persons with intellectual impairment are able to demonstrate their work ability and contribute equally in the workplace. Persons with intellectual impairment contribute to the economy and society by means of their service in protective workshops. The aim of the study was to investigate whether the structured activity programme implemented in a protective workshop in the Western Cape brought a change to the level of cognitive functioning of workers with intellectual impairment as assessed by the Allen Cognitive Level Screen (ACLS), with the purpose of making recommendations regarding the sustainability and extension of the structured activity programme. Pre- and post-tests of the workers' cognitive functioning were done to determine whether the implemented structured activity programme had an effect on the cognitive functioning level of the workers. The ACLS was used as measurement instrument and a hypothesis was stated: HO - There is no change in the level of cognitive functioning of the workers after participation in a structured activity programme. H1 - There is a change in the level of cognitive functioning of the workers after participation in a structured activity programme. The Functional Information Processing Model (FIPM) was used as a frame of reference in the development of the structured activity programme for the occupational group. The structured activity programme was implemented and after one year and six months a post-test was done on the workers in the occupational group. The null hypothesis was accepted as p=O.28.A 95% confidence interval was indicated. The post-test indicated that there was no significant change in the cognitive levels of the workers in the occupational group after implementation of a structured activity programme. This could have resulted from the study sample being too small. Although the change was not statistically significant. it indicated that learning did occur on an Allen Cognitive Level (ACL) 3. It is recommended that the study to be replicated at other protective workshops that may provide a bigger sample to confirm the amount of learning that takes place. / AFRIKAANSE OPSOMMING: Erkenning van persone met gestremdhede se gelyke reg tot indiensneming word sterk in Suid-Afrika ondersteun. Verskeie beleidsdokumente en werkstukke is sedert Julie 1993 gepubliseer wat duidelike riglyne aangaande hierdie standpunt stel. 'n Staatsubsidieskema vir beskermde werkwinkels is vanaf 1 April 1997 vir die eerste keer beskikbaar gestel (Operational Manual for Protective Workshops, 2001: 1). Die doel van hierdie skema is om werksgeleenthede te verskaf aan persone wat as gevolg van hul graad van gestremdheid nie die beskutte arbeids- of ope arbeidsmark kan betree nie. In Maart 2001 het die Departement van Sosiale Dienste, Wes-Kaap, 'n voorlopige dokument, Operational Manual for Protective Workshops, bekendgestel, wat fokus op die ontwikkeling van werksvaardighede en die ekonomiese bemagtiging van persone met gestremdhede in beskermde werkwinkels. Weens onkunde, vrees en stereotipering word daar onregverdig gediskrimineer teen persone met intellektuele gestremdheid in die samelewing, asook in die werksplek. lndien persone met intellektuele gestremdheid billik geakkommodeer word, sal hulle hul werkvermoëns demonstreer en sal hulle 'n gelyke bydrae kan lewer in die werksplek. Persone met intellektuele gestremdheid lewer 'n bydrae tot die ekonomie en die samelewing deur hul diens in beskermde werkwinkels. Die doel van die studie was om ondersoek in te stelof die gestruktureerde aktiwiteitsprogram, soos aangebied in 'n beskermde werkswinkel in die Wes-Kaap, 'n verandering in die kognitiewe funksioneringsvlakke van werkers met intellektuele gestremdheid, soos bepaal deur die Allen Cognitive Level Screen (ACLS), teweeggebring het ten einde aanbevelings te maak oor die uitbreiding en volhoubaarheid van die program. Voor- en na-toetse van die werkers se kognitiewe funksioneringsvlakke is gedoen om te bepaal of die gestruktureerde aktiwiteitsprogram enige verskil in hul kognitiewe funksionering gemaak het. Die Allen Cognitive Level Screen- (ACLS-)toets is as 'n meetinstrument gebruik en 'n hipotese is gestel: HO - Daar is geen verandering in die werkers se kognitiewe funksioneringsvlak na deelname aan 'n gestruktureerde aktiwiteitsprogram nie. H1 - Daar is 'n verandering in die werkers se kognitiewe funksioneringsvlak na deelname aan 'n gestruktureerde aktiwiteitsprogram. Die Functional Information Processing Model (FIPM) is gebruik as 'n verwysingsraamwerk vir die ontwikkeling van die gestruktureerde aktiwiteitsprogram. Die gestruktureerde aktiwiteitsprogram is geïmplementeer en 'n na-toets is na 'n jaar en ses maande op die werkers in die gestruktureerde aktiwiteitsprogram gedoen. Die nulhipotese is aanvaar aangesien p=O.28. 'n Sekerheidsinterval van 95% is aangetoon. Die na-toets het getoon dat daar geen statisties beduidende verskil was in die verandering van die kognitiewe vlakke van die werkers in die aktiwiteitsgroep na implementering van 'n gestruktureerde aktiwiteitsprogram nie. Die resultaat kan die gevolg wees van 'n te klein steekproef. Alhoewel die verandering in kognitiewe vlak nie statisties beduidend was nie, het daar tog 'n mate van leer op 'n Allen Cognitive Level (ACL) 3 by die werkers plaasgevind. Dit word voorgestel dat hierdie studie herhaal word by ander beskermde werkswinkels wat 'n groter steekproef kan lewer om die mate van leer wat plaasvind, te bevestig.

Executive control is a vital cognitive function that facilitates the focussing and shifting of attention, planning and working towards a goal, ignoring distractions, and flexibly responding to novel situations. Disruptions to executive control are seen in many psychiatric and neurodegenerative disorders, as well as healthy ageing, which can be profoundly detrimental. Despite having many effective and well-validated methodologies for detecting and quantifying these deficits, there are very few treatments — pharmacological or otherwise — for ameliorating executive dysfunction. This lack of progress can partly be blamed on difficulties associated with identifying drugs that enhance cognition in preclinical research. The work in this thesis aimed to expand our understanding of executive dysfunction — as well as the tasks that measure it — in rats. In results presented in chapter three, middle-aged rats demonstrated impaired reversal learning on the standard attentional set-shifting task, but this was treatable with a novel drug targeting the N-methyl-D-aspartate receptor. The age impairments seen in this experiment were similar to those previously found in young rats with orbital prefrontal cortex (OFC) lesions. The results of chapter four expanded on this similarity to show that, along with reversal deficits, young OFC-lesioned rats are impaired at forming attentional sets when tested on a modified task. In chapter five, another modified set-shifting task revealed that middle-aged rats also suffer from impaired set-formation, but their reversal learning impairments only manifest before attentional set has been formed — not after. Finally, in chapter six, the putative cognitive enhancer modafinil was found to exacerbate middle-aged rats' reversal learning deficit, but it also enhanced their subsequent ability to form attentional set. These experiments reveal that modifying the rat attentional set-shifting task can sometimes make it a more effective tool for testing cognitive enhancers in preclinical settings.