This study examines the validity of using a combination of two psychometric measures, an emotional adjustment measure, and functional assessment measures to predict vocational outcome in a traumatically brain injured population. Patients included 33 males and 11 females, with an average age of 32.3 years, and a stable work history over the past three years prior to injury. All had sustained a traumatic brain injury in the 12 months prior to initial testing, with a mean of 3.8 months since injury. Levels of severity of injury included 24 patients with severe injury, 12 patients with moderate injury, and 8 patients with mild injury. Patients completed the Logical Memory subtest (LM) of the Wechsler Memory Scale-Revised, Paced Auditory Serial Addition Test (PASAT), Beck Depression Inventory (BDI), and Personal Capacities Questionnaire (PCQ). A clinician working closely with the patient also completed the Functional Assessment Inventory (FAI) and the Behavior Checklist (BC) at the time of initial testing. Follow-up testing on available patients (n=16) was completed approximately six months after initial testing. Comparison of the functional assessment measures demonstrated that patients exhibited a decreased awareness of functional limitations relative to clinician's ratings, but identified an increased number of personal strengths. The present study demonstrates the first comparison of FAI and PCQ ratings in a TBI population, as well as the first available field research using the PCQ. Results also indicated that the only significant predictor on earned income after six months was the overall functional limitations score on the PCQ. The only significant difference in patients' test performance at six months with scores at initial testing was seen on the PASAT, which suggested that patients had a significant improvement in their speed of information processing after six months. In addition, comparison of patients from Canadian and American rehabilitation agencies, respectively, revealed no significant differences between patients at either initial testing or at follow-up. / Graduate

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No / . Early detection of cognitive decline in the elderly is important because this may precede progression to Alzheimer's disease. The aim of this study was to see whether sensitive neuropsychological tests could identify pre-clinical cognitive deficits and to characterize the cognitive profile of a subgroup with poor memory. Methods. A neuropsychological test battery was administered to a community-dwelling sample of 155 elderly volunteers who were screened with CAMCOG at enrolment (mean age 74·7 years). The battery included tests of episodic memory, semantic and working memory, language and processing speed. Results. Episodic memory test z scores below 1 S.D. from the cohort mean identified 25 subjects with `non-robust¿ memory performance. This group was compared to the remaining `robust memory¿ group with a General Linear Model controlling for age, IQ, education and gender. Test performance was significantly different in all tests for episodic and semantic memory, but not in tests for working memory, processing speed and language. CANTAB paired associates learning and spatial recognition tests identified the highest percentages of those in the `non-robust memory¿ group. Processing speed partialled out the age effect on memory performance for the whole cohort, but the `non-robust memory¿ group's performance was not associated with age or processing speed. Conclusions. Sensitive neuropsychological tests can detect performance below the norm in elderly people whose performance on MMSE and CAMCOG tests is well within the normal range. Age-related decline in memory performance in a cohort of the elderly may be largely due to inclusion within the cohort of individuals with undetected pre-clinical Alzheimer's disease or isolated memory impairment.

published_or_final_version / Psychiatry / Master / Master of Philosophy

Among the goals of the neuropsychological assessment are to detect the presence of brain damage, localize which areas of the brain may be dysfunctional and describe subsequent functional impairments. The sensitivity of neuropsychological instruments in carrying out these functions is a question of some debate. The purpose of this study is to determine the utility of lateralizing indicators from the WAIS-III, McCarron Assessment of Neuromuscular Development (MAND) and Haptic Visual Discrimination Test (HVDT), from the McCarron-Dial System Neuropsychological Assessment Battery (MDS), in ascertaining the presence or absence of brain damage as well as location of lesion. The classification accuracies of using performance level indicators from these tests and lateralizing indicators, alone and together, were compared.

Ph.D (Industrial Psychology) / Brain injuries often occur suddenly and without warning, and from that instant, a normal life can be changed. Traumatic Brain Injury (TBI) may result in significant impairment of an individual’s physical, cognitive and psychosocial functioning. Although there is a fair amount of research on the concept of brain damage and the consequent effects on the family and return to work (RTW) prospects, there is far less information available on the actual assessment of workplace capability or workplace potential following the head injury incident. This is important, since the concept of work or job value has been well documented. Employment is far more than just a job; it not only provides for basic sustenance needs and decent living conditions, but also allows someone to fit into the world, create relationships, use talents and skills, learn, grow and build, and develop a sense of identity and belonging. While the value of work is well-documented, the statistics regarding unemployment following a head injury are concerning. It is estimated that approximately 1.5 million Americans sustain head injuries each year, with the majority of these people being under the age of 35 and in their prime years of vocational productivity. A baseline figure of 2% of the American population is currently living with disabilities as a result of head injuries. In South Africa, the rate of occurrence seems to be even more alarming, with published rates of 89,000 cases for 2009. In 2001, this was a baseline figure of 5% of the population living with disabilities resulting from head injuries. Various sources put the occurrence of head injuries in South Africa at 1.5 to 3.5 times higher than the estimated global rate. The negative impact of this on the individual, the family, community and economy is clear.

To date, no research exists examining criterion-related validity of alternate, computerized forms of the Category Test. The intent of this study was to address criterion-related validity of three full forms of the Category Test. In that, the goal was to examine equivalency of each version in their ability to differentiate brain-injured from non-brain-injured individuals. Forty-nine (N = 49) healthy adults and 45 (N = 45) brain-injured adults were tested using three versions of the Category Test, the BDI, and the WAIS-R NI. ANOVA indicated no significant differences between versions of the Category Test or an interaction between Category Test version and group membership on the total error score. MANOVA performed between versions of the Category Test and Subtest error scores indicated significant differences between versions on Subtest 3 and Subtest 6. Group membership (brain-injured v. non-brain-injured) produced a significant main effect on all subtests of the Category Test except Subtest 2. Several exploratory analyses were performed examining the relationship between neuropsychological impairment, group membership based on Category Test error scores, and the WAIS-R NI. Clinical applications, such as the use of serial testing to index neurorehabilitation gains, were discussed.

A avaliação neuropsicológica de portadores de doença de Parkinson (DP) tem sido de fundamental importância para definição de resultados em procedimentos clínicos, cirúrgicos experimentais ou para diagnóstico de demência nestes doentes. No entanto, ainda não existe consenso quanto aos testes neuropsicológicos necessários e padrões de comprometimento esperados. Este estudo objetivou comparar a produtividade das funções neuropsicológicas entre portadores da Doença de Parkinson, em diferentes estágios da doença, em relação aos indivíduos normais. Foram analisados 60 sujeitos (32 homens e 28 mulheres), emparelhados em relação à idade (média de 65,6 +-9,2) e instrução (média de 5,9 =- 4,0), distribuídos entre normais (n=20) e portadores de DP ambulatoriais, nos estágios leve a moderado (n=20) ou moderado a grave (n=20), de acordo com a escala Hoehn & Yahr. A bateria utilizou 24 testes neuropsicológicos abrangendo as funções de raciocínio, percepção visuoespacial, visuoconstrução, linguagem, memória, atenção e função executiva. Os resultados apontaram diferenças significantes (p < 0,01) entre vários testes e em todas as funções, exceto linguagem. Alguns instrumentos se mostraram mais adequados e outros se mostraram pouco indicados para avaliar estes doentes. Diferenças entre os estágios da doença só se evidenciaram nos testes que exigiam destreza motora. Este trabalho estabelece a adequação dos instrumentos e propõe uma bateria específica para avaliação destes doentes. A investigação de estados situacionais (nível cultural, sintoma afetivo e/ou limitações funcionais), manifestos na avaliação, permitiu estabelecer parâmetros para discriminar o modo como estas variáveis interferem na produção dos doentes de Parkinson. E conclui-se apresentando um método inovador de classificação para subsidiar com objetividade o diagnóstico neuropsicológico diferencial na DP. / The neuropsychological assessment of patients with Parkinson disease (PD) has been very important to define the results in clinical, experimental surgeries procedures or in the diagnostic of dementia of these patients. However, there is no consensus about the necessary neuropsychological tests and about the expected commitment patterns. This study aimed to compare the productivity of the neuropsychological functions among patients with Parkinson Disease, in different stages of the disease, in relation to normal people. Sixty subjects were assessed (32 men and 28 women), pared in relation to the age (average of 65.6 +- 9.2) and age of study (average of 5.9 +- 4.0), distributed among normal (n=20) and outpatients with PD, in the mild to moderate stages (n=20) or moderate to severe (n=20), according to Hoehn & Yahr Scale. The battery used 24 neuropsychological tests comprising the thinking, visuospatial perception, visuoconstruction, language, memory, attention and executive function. The results showed significant differences (p < 0.01) among many tests and in all the functions, except language. Some instruments were more suitable and others proved to be less indicated to assess these patients. Differences in the stages of the disease were highlighted in the tests that required motor ability. This work establishes the adequacy of the instruments and proposes a specific battery to assess these patients. The investigation of the situational state (cultural level, affective symptom and/or functional limitations), that appeared in the assessment, allowed to establish parameters to find out the way that these variables interfered in the Parkinson patients’ production. The work concludes presenting an innovative classification method to objectively subside the neuropsychological differential diagnosis for PD.

A dislexia é um transtorno específico de leitura que consiste em um rendimento na leitura e na escrita inferior ao esperado para a idade cronológica, para nível de escolaridade e para o nível de inteligência, sendo a eficiência intelectual adequada (QI 80). Os principais comprometimentos envolvem habilidades de competências linguísticas como dificuldade de consciência fonológica, memória fonológica, discriminação e nomeação. Estudos apontam relação entre as dificuldades na leitura e na escrita e fatores neurobiológicos. O objetivo deste projeto foi investigar se existem diferenças entre morfometria cerebral através de segmentação automática para análise de espessura e volume e diferenças entre o desempenho cognitivo em testes neuropsicológicos do grupo de indivíduos com dislexia comparados com um grupo controle pareado. Foi realizado um estudo prospectivo no qual participaram 30 crianças, sendo 15 indivíduos com dislexia e 15 controles pareados por idade e por sexo. Foram avaliadas habilidades cognitivas tais como: eficiência intelectual, funções de atenção, habilidade visuoconstrutivas e habilidades de linguagem oral e escrita. A morfometria cerebral foi baseada em sequência T1 volumétrica de ressonância magnética e segmentação automática com medida da espessura e volume utilizando o pacote de software FreeSurfer. Na avaliação neuropsicológica, as habilidades que se mostraram mais prejudicadas foram aspectos da memória e da linguagem oral e escrita, tais como rebaixamento de span de memória operacional fonológica e dificuldade de fluência verbal, de associação e integração de ideias, de definição/conceitos, de nomeação e principalmente de consciência fonológica, de leitura e de escrita. As análises de neuroimagem sugerem alterações estruturais no cérebro do grupo clínico com redução no volume de substância cinzenta em regiões corticais, tais como lobo temporal inferior esquerdo e lobo temporal médio direito, e redução no volume de substância branca de ambos os hemisférios. Não foram identificadas alterações significativas na espessura. As alterações estruturais observadas através das técnicas de imagem podem estar relacionadas às funções cognitivas que se mostraram afetadas. / Dyslexia is a specific reading disorder that consists of a performance in reading and writing lower than expected for chronological age, educational level and for the level of intelligence, with an adequate intellectual efficiency (IQ 80 ). The main commitments involve abilities of language skills as difficulty in phonological awareness, phonological memory, discrimination and naming. Studies show link between difficulties in reading and writing and neurobiological factors. The objective of this project was to investigate whether differences in brain morphometry using automatic segmentation for the analysis of thickness and volume differences between cognitive performance on neuropsychological tests of the group of individuals with dyslexia compared with a control group. This is a prospective study in which 30 children participated, with 15 individuals with dyslexia and 15 controls matched by age and sex. Cognitive skills were evaluated as such: Intellectual efficiency, attention skill, visuo- constructive abilities and skills of oral and written language. Brain morphometry was based on sequence T1 volumetric MRI automatic segmentation and measurement of the thickness and volume using FreeSurfer software package. Neuropsychological skills that were more impaired were aspects of memory and oral and written language, such as flattening of phonological working memory span and difficulty in verbal fluency, association and integration of ideas, definitions / concepts, appointment and especially phonological awareness, reading and writing. Neuroimaging studies suggest structural changes in the brain with clinical group reduction in gray matter volume in cortical regions such as the left inferior temporal lobe and right middle temporal lobe, and a reduction in the volume of white matter of both hemispheres. No significant changes were identified in thickness. Structural changes observed through imaging techniques may be related to cognitive functions that have proven affected.

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