Thesis (Ph. D.)--Washington State University. / Includes bibliographical references.

Thesis (M.S.)--Uniformed Services University of the Health Sciences, 2006 / Typescript (photocopy)

Introdução: As tarefas de decisão lexical possibilitam estimar o funcionamento cognitivo ou QI pré-mórbido e através desta estimativa, podese estabelecer se houve estabilidade ou declínio em relação ao funcionamento pregresso do sujeito. Considerando o rápido envelhecimento da população idosa e as doenças neurodegenerativas associadas, fazer o diagnóstico precoce destas se torna cada vez mais imperioso. Embora a avaliação do QI pré-mórbido seja fundamental para o mapeamento do funcionamento cognitivo global prévio, não há estudos na população brasileira que utilizaram tarefas de decisão lexical para se obter esta medida. Objetivo: Avaliar o desempenho de idosos saudáveis, Comprometimento Cognitivo Leve (CCL) e Doença de Alzheimer (DA) em um teste de decisão lexical (TDL). Métodos: Cento e vinte e cinco indivíduos, sendo 38 idosos saudáveis, 61 CCL e 26 DA, com diagnóstico previamente estabelecido por equipe médica, recrutados no Setor de Neurologia do Hospital das Clínicas (GNCC) e no Centro de Referência em distúrbios cognitivos do Hospital das Clínicas (CEREDIC). O desempenho dos pacientes no TDL foi comparado ao de outras provas já validadas para população brasileira. Resultados: as médias dos grupos no TDL não diferiram significativamente (p=0,091). A escolaridade e o TDL, em conjunto, explicaram 66,3% da variabilidade do QI estimado do grupo-controle. Foi encontrada uma correlação moderada entre o subteste Vocabulário da Escala Wechsler para Adultos e do TDL (ambos medidas de inteligência cristalizada), com r=0,56 e p < 0,001. Estudos futuros com diferentes amostras da população brasileira poderiam corroborar ou expandir os resultados obtidos. Conclusão: Os resultados preliminares do TDL mostraram que a decisão lexical pode ser uma medida de QI prémórbido nos indivíduos de uma amostra da população brasileira / Introduction: Lexical decision tasks make it possible to estimate previous cognitive functioning or pre morbid IQ. Through this estimate we can establish whether there was a cognitive decline or maintenance in comparison to the previous functioning. If we take into account the rapid aging of the elderly population and the associated neurodegenerative diseases, early diagnosis of these these desease is crucial. Although the assessment of pre morbid IQ is fundamental for mapping the previous global cognitive functioning, there are no studies involving Brazilian population that used lexical decision task to obtain this measurement. Objective: To evaluate the performance of healthy elderly, Mild Cognitive Impairment (MCI) and Alzheimer\'s disease (AD) participants using a lexical decision test (LDT). Methods: One hundred and twenty-five individuals, 38 healthy elderly subjects, 61 MCI and 26 AD, with diagnosis previously established by medical staff, were recruited from the Cognitive and Behaviour Neurology Group (GNCC) of the Hospital das Clinicas and from the Reference Center for Cognitive Disorders of the Hospital das Clinicas (CEREDIC. The performance of patients in the LDT was compared to that of other tests already validated for the Brazilian population. Results: Group means in the LDT did not differ significantly (p = 0.091). Education and LDT together accounted for 66.3% of the variability in the control group estimated IQ. It was found a moderate correlation between vocabulary subtest of the Wechsler Scale for Adults and LDT scores (both are measures of crystallized intelligence), with r = 0.56 and p < 0.001. Future studies with different samples of the Brazilian population might support or expand the obtained results. Conclusion: Preliminary results of the LDT showed that lexical decision may be a measure of pre morbid IQ in individuals from a sample from the Brazilian population

Introdução: As tarefas de decisão lexical possibilitam estimar o funcionamento cognitivo ou QI pré-mórbido e através desta estimativa, podese estabelecer se houve estabilidade ou declínio em relação ao funcionamento pregresso do sujeito. Considerando o rápido envelhecimento da população idosa e as doenças neurodegenerativas associadas, fazer o diagnóstico precoce destas se torna cada vez mais imperioso. Embora a avaliação do QI pré-mórbido seja fundamental para o mapeamento do funcionamento cognitivo global prévio, não há estudos na população brasileira que utilizaram tarefas de decisão lexical para se obter esta medida. Objetivo: Avaliar o desempenho de idosos saudáveis, Comprometimento Cognitivo Leve (CCL) e Doença de Alzheimer (DA) em um teste de decisão lexical (TDL). Métodos: Cento e vinte e cinco indivíduos, sendo 38 idosos saudáveis, 61 CCL e 26 DA, com diagnóstico previamente estabelecido por equipe médica, recrutados no Setor de Neurologia do Hospital das Clínicas (GNCC) e no Centro de Referência em distúrbios cognitivos do Hospital das Clínicas (CEREDIC). O desempenho dos pacientes no TDL foi comparado ao de outras provas já validadas para população brasileira. Resultados: as médias dos grupos no TDL não diferiram significativamente (p=0,091). A escolaridade e o TDL, em conjunto, explicaram 66,3% da variabilidade do QI estimado do grupo-controle. Foi encontrada uma correlação moderada entre o subteste Vocabulário da Escala Wechsler para Adultos e do TDL (ambos medidas de inteligência cristalizada), com r=0,56 e p < 0,001. Estudos futuros com diferentes amostras da população brasileira poderiam corroborar ou expandir os resultados obtidos. Conclusão: Os resultados preliminares do TDL mostraram que a decisão lexical pode ser uma medida de QI prémórbido nos indivíduos de uma amostra da população brasileira / Introduction: Lexical decision tasks make it possible to estimate previous cognitive functioning or pre morbid IQ. Through this estimate we can establish whether there was a cognitive decline or maintenance in comparison to the previous functioning. If we take into account the rapid aging of the elderly population and the associated neurodegenerative diseases, early diagnosis of these these desease is crucial. Although the assessment of pre morbid IQ is fundamental for mapping the previous global cognitive functioning, there are no studies involving Brazilian population that used lexical decision task to obtain this measurement. Objective: To evaluate the performance of healthy elderly, Mild Cognitive Impairment (MCI) and Alzheimer\'s disease (AD) participants using a lexical decision test (LDT). Methods: One hundred and twenty-five individuals, 38 healthy elderly subjects, 61 MCI and 26 AD, with diagnosis previously established by medical staff, were recruited from the Cognitive and Behaviour Neurology Group (GNCC) of the Hospital das Clinicas and from the Reference Center for Cognitive Disorders of the Hospital das Clinicas (CEREDIC. The performance of patients in the LDT was compared to that of other tests already validated for the Brazilian population. Results: Group means in the LDT did not differ significantly (p = 0.091). Education and LDT together accounted for 66.3% of the variability in the control group estimated IQ. It was found a moderate correlation between vocabulary subtest of the Wechsler Scale for Adults and LDT scores (both are measures of crystallized intelligence), with r = 0.56 and p < 0.001. Future studies with different samples of the Brazilian population might support or expand the obtained results. Conclusion: Preliminary results of the LDT showed that lexical decision may be a measure of pre morbid IQ in individuals from a sample from the Brazilian population

<p>Uvod: Traumatsko o&scaron;tećenje mozga (TOM) nastaje usled dejstva spolja&scaron;nje mehničke sile na kranijum i endokranijalni sadržaj, koje se karakteri&scaron;e privremenim ili trajnim neurolo&scaron;kim o&scaron;tećenjem, funkcionalnom onesposobljeno&scaron;ću ili psihosocijalnom neprilagođeno&scaron;ću. Blago TOM je najče&scaron;će i čini između 70% i 90% svih povređenih sa TOM. Postoji veliki broj definicija ovog kliničkog entiteta, ali gotovo sve sadrže Glazgov koma skor 13-15, poremećaj stanja svesti u različitom trajanju, te posttraumatsku amneziju kao odrednice koje defini&scaron;u blago TOM. Najveći broj povređenih sa blagim TOM ima dobru prognozu i potpunu rezoluciju tegoba u kratkom vremenskom periodu nakon povređivanja, bez medicinski relevantnih posledica. Međutim, jedna grupa povređenih koja navodi nagla&scaron;enije i dugotrajnije tegobe koje mogu imati uticaja na ukupno zdravstveno stanje i kvalitet života. U savremenom naučnoistraživačkom radu aktuelni su poku&scaron;aji da se primenom novih dijagnostičkih metoda, detaljnim praćenjem povređenih i primenom neuropsiholo&scaron;kih testova objektivizuju ove tvrdnje, kako bi se pacijenti sa povi&scaron;enim rizikom od nastanka dugotrajnih tegoba pravovremeno identifikovali i kako bi se mogao sprovesti adekvatan tretman. Cilj: Cilj ove studije je da se utvrditi da li postoji korelacija između kliničkih i radiolo&scaron;kih simptoma i znakova i rezultata neuropsiholo&scaron;kog testiranja kod povređenih sa blagim traumatskim o&scaron;tećenjem mozga, kao i da se utvrdi da li neki od od kliničkih simptoma i znakova mogu biti pouzdan prediktor pojave perzistentnih neuropsiholo&scaron;kih posledica, i koja je priroda moždanih o&scaron;tećenja koja mogu biti u njihovoj osnovi. Materijal i metode: Sprovedeno istraživanje je u celosti bilo kliničko, prospektivno, i obuhvatilo je 64 povređena sa blagim TOM koji su u periodu od 2012. do 2015. godine hospitalizovani na Klinici za neurohirurgiju Kliničkog centra Vojvodine u Novom Sadu. Pre prijema je svim ispitanicima načinjen pregled endokranijuma kompjuterizovanom tomografijom (CT) koji nije prikazivao znakove traumatskih o&scaron;tećenja kranijuma niti endokranijalnog sadržaja. U toku hospitalizacije kod povređenih su praćeni i beleženi relevantni klinički parametri. U prvih 72 sata od povređivanja je kod 37 ispitanika načinjen pregled endokranijuma magnetnom rezonancom (MRI). Kod 25 ispitanika je načinjeno neuropsiholo&scaron;ko ispitivanje baterijom neuropsiholo&scaron;kih testova mesec dana nakon povređivanja i 6-9 meseci nakon povređivanja. Rezultati su uno&scaron;eni u bazu podataka i nakon toga statistički analizirani. Rezultati: U analiziranoj grupi od 64 povređena sa blagim TOM kod 37 ispitanika (58%) je načinjen MRI pregled endokranijuma, a pozitivan nalaz u smislu postojanja traumom izazvanih o&scaron;tećenja moždanog parenhima pronađen je kod 17 ispitanika (46%). Najsenzitivnije MRI sekvence su SWI i T2* kojima se otkrivaju veoma diskretni depoziti razgradnih produkata krvi. Povređeni sa pozitivnim MRI nalazom imaju lo&scaron;ije postignuće na rekogniciji liste B Rejovog testa verbalnog učenja u odnosu na povređene iz grupe bez intrakranijalne traumatske lezije. Rezultati neuropsiholo&scaron;kih testova ukazuju na pobolj&scaron;anje rezultata između prvog i drugog testiranja u pogledu egzekutivnih i govornih funkcija u ispitivanoj grupi. U ostalim ispitivanim kognitivnim aspektima nije pronađena značajna razlika među navedenim grupama Zaključak: TOM predstavlja jedan od najvećih savremenih medicinskih izazova koji se nameće zbog svoje visoke incidence, dijagnostičkih i terapijskih problema, ali i potencijalno lo&scaron;eg ishoda i visokih tro&scaron;kova rehabilitacije i resocijalizacije povređenih. Rezultati studije se mogu iskoristiti za bolje razumevanje blagog TOM u smislu lak&scaron;eg re&scaron;avanja dijagnostičkih dilema, kreiranje efikasnijih dijagnostičkih protokola i preciznije procene ishoda nakon povređivanja ove vrste.</p> / <p>Introduction: Traumatic brain injury (TBI) is a result of the influence of external mechanical forces on scull and endocranial structures which can produce temporarily or permanent neurological impairment, functional disability or psychosocial unconformity. Mild TBI is the most frequent form of TBI and represent between 70% and 90% of all TBI cases. There are several different definitions of mild TBI, but almost all of them contain Glasgow Coma Scale score 13-15, altered state of consciousness and different forms of amnesia as criteria for mild TBI diagnosis. Largest number of patients suffered mild TBI have good prognosis and complete resolution of symptoms in short period of time after injury, with out of any kind of sequeles. However, small group of patients report various symptoms and complaints which can last longer than is usual and seriously affect quality of life of this patients. Numerous researches has been conducted applying novel imaging technologies, long follow-up periods and neuropsychological testing in order to make these non-specific self-reported complaints as much objective as possible. The other reason is necessity of timely identification of patients in risk of developing long term complaints so they can be treated in a proper manner. Objective: The aim of this study was to determine is there correlation between clinical and radiological signs and symptoms and results of neuropsychological testing in patients with mild TBI. The aim also was to determine are there some clinical signs which can be reliable predictor of appearance of neuropsychological consequences and what is the nature of cerebral lesion suspected to be a cause of this consequences. Materials and methods: The research was clinical, completely prospective and included total of 64 patients with mild TBI who were hospitalized between 2012 and 2015 at Clinic for neurosurgery, Clinical Centre of Vojvodina in Novi Sad. All patients had computed tomography scan (CT) at the admission which failed to show any signs of trauma of cranial bones or endocranial content. During the first 72 hours after injury the magnetic resonance imaging (MRI) has been performed in 37 patients. 25 patients had neuropsychological testing one month and 6-9 months after injury. We entered results in database and after completion we performed statistical analysis. Results: In 37 of 64 patients (58%) MRI examination has been performed and in 46% of patients we found trauma induced small haemorrhagic and oedematous brain lesions. The most sensitive sequences in our protocol were SWI and T2* confirmed superb sensitivity in detection of small foci of blood. Patients with detected MRI abnormalities showed poorer accomplishment at recognition of list B of Ray Auditory Verbal Learning Test in comparison with group with no intracranial lesions. The results of neuropsychological testing showed significant improvement of executive and speech functions between two periods in time when tests have been administered. We found no other significant differences between analysed cognitive functions in this period in our group of patients. Conclusion: TBI is one of the most important contemporary medical problems due to his high incidence, diagnostics and therapy related issues, but also potentially poor outcome and high costs of rehabilitation. Results of this study can be used for better understanding of mild TBI in order to solve some diagnostic dilemma, create more efficient diagnostic protocols and facilitate more precise outcome assessment after mild TBI.</p>