An evaluation of executive functioning is a critical component of a comprehensive assessment of higher cerebral functioning. The Tinker Toy Test (TTT) was introduced in 1982. This test allows an individual to demonstrate the extent of their executive capacities by permitting them to initiate, plan, and structure a potentially complex activity and carry it out independently in an unstructured fashion and administration is simple. This is a departure from more complex and structured tests of executive function. There is a dearth of research on the TTT and this study seeks to examine some of the psychometric properties of this instrument; i.e., working time minimum, gender effects, convergent and divergent validity, and potential intellectual correlates. Participants included 10 male and 30 female student volunteers from a large university in Central Florida. Participants had no history of neurologic disease/trauma or conditions that would affect motor functioning of the upper extremities. Participants completed a demographic questionnaire, the WASI-II, and the TTT. A two-way mixed-design ANOVA examining TTT scores as a function of work time and gender revealed a non-significant gender main effect, F(1, 21) = .09, p = .767. The work time main effect was not significant, , F(1, 21) = .324, p = .575. A significant work time x gender interaction was observed, F(1, 21) = 4.983, p = .037. Convergent validity was assessed by comparing the TTT scores with the Matrix Reasoning subtest, r(38) = .32, p = .044, and the Similarities, r(38) = .34, p = .03, subtest on the WASI-II. Divergent validity was assessed by comparing TTT scores to the Block Design subtest of the WASI-II, r(38) = .245, p = .127. No significant correlation was found between intelligence and TTT (VCI, r(38) = -.16, p = .335; PRI, r(38) = .15, p = .344; and FSIQ, r(38) = -.02, p = .928). The data supports the continued use of the 5-minute working time minimum presented by Lezak, as this temporal index was a more accurate representation of executive functioning. This study demonstrated no association between TTT scores and intellectual functioning. The findings of this study support the validity of this underutilized test of executive functioning and its inclusion in neuropsychological test batteries.

Regardless of the reason, many patients/clients do not have access to face-to-face medical, neuropsychological, or mental health consultation, assessment, or treatment (Cowain, 2001). The term Remote Neuropsychological Assessment (RNA) has been proposed by Browndyke to denote the general use of telecommunication and Internet-based technologies in neuropsychological assessment and practice (as cited in Schatz & Browndyke, 2002). RNA (Telemedicine) offers a plausible, potentially cost-effective solution to individuals in need of medical, neuropsychological, or mental health consultation, assessment, or treatment that are located in geographical areas away from the specialist (Armstrong, 2006; Berman, 2005; Cowain, 2001; Jacobsen, Sprenger, Andersson, & Krogstad, 2003). The purpose of this study was to examine if test performance for RNA administration of the Cognistat is comparable to test performance for the pencil-paper administration. A one-way repeated measures multivariate analysis of variance (MANOVA) was used to analyze the data. The main effect for administration modality was not significant, F(9, 126) = .375, p = .945. The present study demonstrated the utility of a widely used neurobehavioral screening test that provides a differentiated profile of cognitive status can now reliably be used through a video-conferencing administration. The importance of this finding is that a more comprehensive detection of deficits in multiple domains of cognitive functioning for screening purposes is now possible remotely.

The purpose of the current study was to clarify the neurocognitive mechanisms underlying social phobia. Previous research has identified some specific group differences in neurocognitive functioning between individuals diagnosed with social phobia and nonpsychiatric controls, but has failed to administer a comprehensive neuropsychological battery to a social phobia patient group, resulting in a piecemeal understanding of the neurocognitive functioning of this population and an incomplete picture of the neuropsychological profile inherent to this group. The present research utilized a broader collection of neuropsychological tests to assess nine cognitive domains: Verbal Learning, Verbal Delayed Memory, Visual Immediate Memory, Visual Delayed Memory, Visual-Spatial Processing, Verbal Working Memory, Visual Working Memory, Executive Functioning, and Attention. A mixed analysis of variance (ANOVA) did not reveal a significant group by cognitive domain interaction, nor a significant main effect of group. As this was the first study to examine multiple cognitive domains in a single sample of individuals with generalized social phobia, exploratory univariate analyses were performed to examine group differences for the specific cognitive domains. This revealed significant group differences specific to the Visual Working Memory domain, with the social phobia group scoring significantly lower than the nonpsychiatric control group. Implications of these findings and directions for future research are discussed.

OBJECTIVE: The goal of this research was to examine the clinical utility of the digital Clock in the Box (dCIB), a novel digitized cognitive screening test. This was accomplished by (1) creating cutoff scores for the dCIB, (2) evaluating performance on the dCIB relative to established cognitive screening and standardized neuropsychological measures, and (3) determining the efficacy of the dCIB to screen for subtle cognitive deficits associated with poor vascular health. Metabolic Syndrome (MetS; clinical syndrome of three or more cardiovascular risk factors) is a rising health epidemic associated with an increased risk for cerebrovascular disease and vascular dementia. Early detection of subtle deficits associated with MetS may assist in regulation of disease progression and prevention of future vascular dementia. METHODS: A community-based sample of adults with no self-reported history of cognitive impairment was recruited for a cross-sectional study in which they completed a metabolic assessment, blood draw, and a brief neuropsychological battery consisting of the dCIB, the Mini-Mental State Exam (MMSE), and measures of executive function, memory, and attention. For part of the analysis, participants were separated into MetS (n=21) and non-MetS (n=42) groups based on current diagnostic criteria for MetS. RESULTS: Participants (N=63) were older (62.49 ± 9.16 years), educated (16.46 ± 2.76 years), and diverse with 44.4% female (n=28) and 28.6% non-White (n=18). Receiver operating characteristic (ROC) analysis and Youden’s J statistic determined the optimal cutoff value for the dCIB as 5.5 (dCIB score ≤ 6 indicating suspected impairment; dCIB score ≤ 5 indicating probable impairment). Performance on the dCIB (6.32 ± 2.32) was significantly correlated with the MMSE (28.19 ± 2.06); (Pearson’s r = 0.437, p = 0.000). The dCIB had better sensitivity (72.7%) but poorer specificity (65.4%) compared to the MMSE (sensitivity 45.5%; specificity 94.2%). Using regression modeling, the dCIB significantly predicted performance on measures of executive function, memory, and attention. In a sample stratified by vascular risk, the dCIB successfully differentiated MetS (5.33 ± 2.75) and non-MetS (6.81 ± 1.93) groups, with lower dCIB scores in the MetS group relative to the non-MetS group (F = 8.975, p = 0.004). CONCLUSION: The dCIB is a novel digitized clock drawing task designed to screen for cognitive impairment. Clinical utility for the dCIB was established by determining its test validity and demonstrating its sensitivity to detect subtle cognitive deficits in a sample with vascular risk. Because the dCIB is simple to administer and brief to complete, it may be an ideal option for routine cognitive screening in primary care settings.

The relationship between anxiety and neuropsychological functioning has attracted much attention in the literature over the past two decades. Though significant progress has been made in understanding the cognitive correlates of anxiety disorders, many questions still remain, particularly in child and adolescent populations. The following chapters examine the relationship between youth anxiety and neuropsychological functioning in three ways: Paper 1 examines the relationship between anxiety and executive functioning difficulties in a sample of youth seeking treatment for anxiety. Specifically, the study sought to clarify which executive functioning domains were most strongly associated with anxiety, and which anxiety subtypes were most linked to executive dysfunction. Self-reported anxiety and executive functioning data from 102 youth (ages 8-18) and/or their parents were examined via bivariate Pearson correlation and stepwise regression modeling. Consistent with hypotheses, results indicated that youth with elevated anxiety experience specific difficulties with daily tasks involving the capacity to “shift,” or flexibly adapt thoughts and behaviors to meet changing task demands, compared to other executive functions. Paper 2 explores the effects of state anxiety on neuropsychological test performance, relative to a youth’s performance when not in acutely anxiety provoking circumstances. In this pilot study, we investigated the relationship between youth state anxiety, trait anxiety, and neuropsychological test performance in youth before and after an anxiety manipulation. Fourteen youth were recruited from an outpatient anxiety treatment center and from the surrounding community. After baseline neuropsychological screening, youth were randomly assigned to either an anxiety induction or a matched control condition, and then re-tested on similar neuropsychological measures. Contrary to our hypotheses, we found a positive relationship between state/trait anxiety and neuropsychological test performance in youth. Results are limited by a small sample size and little variability in state anxiety. Paper 3 is a clinically oriented commentary on how clinicians can identify and respond to test anxiety in youth undergoing neuropsychological testing using evidence-based techniques. This paper describes factors that contribute to test anxiety in children and adolescents, the signs and symptoms of elevated anxiety in testing contexts, and offers brief strategies practitioners may use to address youth anxiety during neuropsychological tests.

Neuropsychological testing is one method used in the diagnosis of Alzheimer’s disease and other cognitive disorders. However, the testing process may be affected by subtle external factors which if not controlled for may have the ability to affect the scores obtained. The primary aim of this thesis was to investigate the effects of some of these external factors, namely caffeine, non-oily fish consumption and time of day. A secondary aim was to evaluate the use of a novel virtual assessment as a possible tool for the early detection of AD. Healthy elderly participants over the age of sixty with no existing cognitive impairment or neurological condition were recruited to take part. For each external factor investigated participants were required to undertake a cognitive assessment. The results demonstrated that subtle external factors present during a typical testing session have the ability to significantly affect the scores obtained. Scores on one part of the virtual test correlated with existing tests used for the early detection of cognitive impairment and were significantly lower in participants classified as mildly impaired. With further modification this test has the potential to be used as an early detection tool. The results have implications for the interpretation of neuropsychological test scores which may be considered when classifying participants, determining treatment interventions, selecting participants for research and making a diagnosis. These findings have important considerations for psychological and cognitive research that investigates human brain function.

The cerebellar granule cell layer has inspired numerous theoretical models of neural representations that support learned behaviors, beginning with the work of David Marr and James Albus. In these models, granule cells form a sparse, combinatorial encoding of diverse sensorimotor inputs. Such sparse representations are optimal for learning to discriminate random stimuli. However, recent observations of dense, low-dimensional activity across granule cells have called into question the role of sparse coding in these neurons. In this thesis, I generalize theories of cerebellar learning to determine the optimal granule cell representation for tasks beyond random stimulus discrimination, including continuous input-output transformations as required for smooth motor control. I show that for such tasks, the optimal granule cell representation is substantially denser than predicted by classic theories. The results provide a general theory of learning in cerebellum-like systems and suggest that optimal cerebellar representations are task-dependent.

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