Background There appears to be clear evidence of cognitive impairment in schizophrenia which is wide ranging and relatively stable throughout the illness. Both cognitive impairment and treatment response have been argued to be highly relevant in risk assessment and management of offenders. However, there does not appear to be any research in this area on mentally disordered offenders. It is on this basis that this study attempts to determine the impact of cognitive impairment on treatment responsivity in mentally disordered offenders. Method A cohort quantitative research design was used and the data were obtained via the administration of neuropsychological assessments and self-report measures. Neuropsychological data on attention, executive functioning, memory and IQ were matched with treatment gain scores for 114 male mentally disordered offenders. The participants were further matched according to the group treatments they had participated in resulting in five different groups. Results Univariate and bivariate analyses were used to explore the relationship between cognitive predictor variables and treatment gain scores. Variables that were significantly associated with treatment gain scores were further investigated using multiple regression analyses. Results indicated that for each group, cognitive variables such as attention and memory were significantly predictive of treatment gain scores. Conclusion The results indicate the need to consider cognitive impairment constructs such as attention, executive functioning, memory and IQ when determining appropriate interventions for mentally disorders offenders. Doing so may improve treatment responsivity and have a consequent impact on risk management and recidivism. The research limitations are discussed in relation to the methodology used, and clinical implications and directions for future research are explored.

Background: Elderly people who demonstrate memory impairment that falls short of dementia, are referred to as having amnestic Mild Cognitive Impairment (aMCI). AMCI patients have an elevated risk of developing dementia, although not all will do so. Clinical criteria for Alzheimer's Disease (AD) and aMCI do not specify how impairment of a cognitive nature should be defined. The process of differentially diagnosing these conditions can be improved, if knowledge of neuropsychological measures that best discriminate between neurodegenerative and non-neurodegenerative cognitive impairment is used to implement diagnostic criteria for aMCI and AD. Aims: We sought to 1) determine the frequency of aMCI referrals to our specialist memory clinic, 2) characterise the detailed neuropsychology of a group of patients with aMCI, 3) determine the utility in differential diagnosis and test-retest reliability of these neuropsychological measures, and 4) establish a subset of neuropsychological measures that were of prognostic utility in aMCI. Methods: The case notes of 187 consecutive referrals received by our Royal Edinburgh Hospital memory assessment service across an 18-month period were reviewed retrospectively and numbers of patients fulfilling aMCI criteria were recorded. The baseline neuropsychological performances of 46 patients with aMCI, 20 patients with very early stage AD, 20 elderly patients with depressive symptoms and 24 healthy elderly participants were compared in order to determine their usefulness in differential diagnosis. AMCI participants were followed-up across an average of 4 years. Baseline neuropsychological performances of the aMCI dementia converters and aMCI non-converters were compared. Logistic regression analysis was applied to ascertain the predictive accuracy of a combination of these. Results: One quarter of referrals received by our memory assessment service met criteria for aMCI, most of whom displayed additional neuropsychological impairments of a non-memory nature, all the while performing above the highest cut off points on even the most comprehensive dementia screening measures. A number of neuropsychological measures were highly sensitive and specific to early AD however, similar combinations of both high sensitivity and specificity to aMCI were not achieved. Forty one percent of patients presenting to our service who fulfilled criteria for aMCI, received a clinical diagnosis of dementia across an average 4-year period. Performances on a comprehensive cognitive screening measure and a measure of delayed word recognition accuracy at baseline, classified 74% of aMCI patients comprising our clinic sample in accordance with their prognostic fate. Conclusion: A significant proportion of patients presenting to specialist memory clinics display episodic and semantic memory or executive impairment that falls short of dementia and that is not detectable using traditional bedside screening measures. The vast majority of such patients (i.e. 72%) experience persisting or progressive cognitive impairment, and a significant proportion (41%) go on to receive a clinical diagnosis of dementia. The baseline neuropsychological performance of aMCI patients who do and do not develop dementia differs, and contributes over and above clinical information to the prediction of long-term diagnostic outcome. The high frequency with which aMCI is encountered in clinical practice, coupled with the minority of aMCI patients who experience resolution of their cognitive impairment, and the sensitivity and prognostic utility of several neuropsychological tasks, has implications for the clinical management of patients with aMCI.

No description available.

There has been accumulating scientific evidence, over the last three decades, of the role of inflammatory processes in the development of Alzheimer's disease (AD). Population based studies suggest that plasma levels of inflammatory markers are raised in peripheral blood of people with AD. People on long term use of non-steroidal anti-inflammatory drugs have a lower prevalence of AD. Moreover, both animal and human histopathology studies have reported localization of inflammation in brain areas primarily affected by AD pathology. Areas of increased inflammation can be visualized in vivo by Positron Emission Tomography (PET) scans using the PK11195 ligand that binds with the benzodiazepine receptor sites of activated microglial cells. Cognitive decline in AD has been shown to correlate with levels of microglial activation using PK11195 PET scans. People with amnestic mild cognitive impairment (MCI) are known to be at high risk of developing AD.We aimed to investigate the association between peripheral and central markers of inflammation and cognitive decline in a group of people with amnestic MCI.MCI subjects (n=70) underwent cognitive testing, IL-6 and CRP in peripheral blood were measured and repeated after 1 year. A sub group (n=15) was followed up for another year and central brain microglial activation was measured by PET using PK11195 along with cognitive and peripheral inflammatory marker measurement. The mean CRP and IL-6 levels of the cohort increased over one year but the rise was only significant for CRP. No association was detected between inflammatory markers levels and cognition as measured by a battery of cognitive instruments. Group comparisons of the PET cohort with healthy controls (n=5) showed increased PK11195 binding (mean binding potential) in frontal lobe, temporal lobe, parietal lobe, putamen, occipital lobes and significantly increased binding in posterior cingulate gyrus. This study, to our knowledge, is unique in studying makers of inflammation in amnestic MCI participants both in peripheral blood and brain. The results of this study, in the light of current literature, add to the importance of recognition of inflammatory processes in people at risk of developing AD. The results suggest that CRP levels rise significantly over time and are detectable in peripheral blood by using practically simple laboratory techniques. The results also suggest that activated microglia in amnestic MCI patients can be visualized in vivo by using PK11195 PET scans and show higher levels of activation as compared to healthy controls. These finding could be useful in identifying people with malactivated (pro-inflammatory) microglia as potential targets for prevention/early treatment strategies. Further studies with larger samples sizes and long term follow-up are needed to investigate whether these peripheral and central inflammatory markers could shed light on the aetiology of AD and be useful in monitoring disease progression.

No description available.

As Ontario faces a major shift in demographics, it is anticipated that the number of community-dwelling people living with cognitive impairment will increase significantly. Occupational therapists (OTs) may play a key role in ensuring timely diagnosis and/or informing a comprehensive plan of care for this population by assessing and reporting on functional abilities. The purpose of this study was to explore the impact of an OT home assessment on diagnosis and plan of care for persons with Mild Cognitive Impairment (MCI) in a primary care Memory Clinic setting using a before and after design. A toolkit of clinical measures was developed to assess self-perception of occupational performance, instrumental activities of daily living (IADLs), falls risk and home safety. Thirty-one participants who had been assessed by a Memory Clinic team completed a one-hour OT home assessment focused on these attributes. A change in the plan of care was proposed for 24 of 31 participants (i.e., 77%) after the assessment findings were reviewed by the lead physicians of three Memory Clinic teams. Clinical information from an OT home assessment was used by the Memory Clinic teams to change follow-up visit times, plan diagnosis and/or medication review and initiate additional community supports for persons with MCI. Women in this sample were more likely than men to experience changes to their plan of care and were also at a higher falls risk as indicated by scores on a screening tool of this attribute. Several time sensitive issues were identified during the OT home assessment including falls risk, home safety issues and participant concern with driving ability. The addition of an OT home visit to an existing Memory Clinic Model has the potential to change the overall plan of care and to identify issues that may impact overall health and wellness, and the ability to live well at home. While the context for this study was an existing Memory Clinic Model in primary care, the findings have implications for older adults in any health setting who are experiencing cognitive changes. / Thesis / Master of Science Rehabilitation Science (MSc)

Magister Curationis - MCur / Worldwide concerns have been raised about the presence and association of depressive symptoms, cognitive impairment, and dementia in older adults (60 years and older), which are often unrecognised and untreated in long-term care facilities (LTCF’s). The progression of cognitive impairment to dementia reduces quality of life with negative consequences of physical, mental, and psychosocial health. In many LTCF’s internationally, the standardised interRAI system is used to capture depressive symptoms and cognitive impairment. However, there is a fragmentation of systems for making evidence-based decisions to plan and manage care for residents with depressive symptoms, cognitive impairment, and dementia. This study, being the first of its kind in South Africa, addressed this gap, by describing a profile of depressive symptoms and cognitive impairment in residents, and analysing their coexistence, using the interRAI-LTCF in a LTCF in the Cape Metropole in South Africa. A quantitative, descriptive, and analytical cross-sectional secondary data analysis was conducted using the records of all 173 resident’s medical records of residents with a last interRAI-LTCF assessment from 2014 and 2016. The objectives were to determine the levels of depressive symptoms and cognitive impairment, and to assess variously associated demographics and clinical variables between depressive symptoms and cognitive impairment of the interRAI-LTCF in residents in a LTCF. Secondary data were analysed, using the IBM Statistical Package for Social Sciences (SPSS) software, version 25, to test any statistically significant relationship between the extracted variables (Significance was set as p˂0.05). The prevalence of possible depression, using the Depression Rating Scale (DRS) of the interRAI-LTCF in the residents in this study was 36.4%, of whom 54.3% had a documented clinical diagnosis of depression. The prevalence of cognitive impairment was 39.3%, using the Cognitive Performance Scale (CPS), of whom 34.1% had a documented clinical diagnosis of cognitive impairment/dementia. There were more females than males with the possibility for depression and cognitive impairment, especially in those who were older than 80 years of age, those without partners, and who had ≤12 years of education. The DRS and the CPS were able to predict the possibility for depression and CI. There is a 55.9% risk of possible depression with CI present as compared to a 23.8% risk of possible depression when CI is not present. That means that people meeting criteria for CI on the CPS are 2.3 times more likely to meet the criteria for possible depression on the DRS. Similarly, there is a 60.3% risk of CI with possible depression present as compared to a 27.3% risk of CI when possible depression is not present. That means that people meeting criteria for possible depression on the DRS are 2.2 times more likely to meet the criteria for CI on the CPS. The logistic regression confirmed the coexistence between depressive symptoms and cognitive impairment.

Thesis advisor: Elizabeth A. Kensinger / Although healthy young and older adults remember emotional information better than neutral, emotion does not confer the same benefit upon memory for those experiencing memory impairments due to Alzheimer's disease (AD). It is poorly understood at what stage of processing these deficits occur--are they due to declines in memory storage and retrieval processes, or to a decline in earlier stages of attention allocation, which then impact memory storage and retrieval? It remains an open question how attention and memory processes may interact in aging and age-related disease. The goal of this research was to examine the effects of aging on the neural mechanisms underlying selective memory for emotional information in visual scenes, and to compare memory between healthy older adults and patients with very early AD pathophysiological changes. Experiment 1 examined young and older adults' encoding-related neural activation associated with selective memory for emotional items within visual scenes and with successful memory for emotional items and the scene background. There were few regions showing significant interactions between age and memory for positive and negative scenes. In contrast, Experiment 2 showed that aging significantly affected the neural networks underlying selective emotional item memory and successful memory for emotional items and backgrounds. The results indicate that older adults require greater connectivity among prefrontal regions than young adults to encode all elements of a scene, rather than just encoding the emotional item. Experiment 3 showed that despite poorer memory overall, patients showing very early AD pathophysiological changes have relatively well preserved memory, especially for positive information. Dividing older adults' attention during encoding did not significantly alter their pattern of selective emotional item memory, suggesting that encoding of emotional items may be an easier or relatively automatic task compared to encoding of the background. In conclusion, there are significant age-related changes in the underlying neural networks, but not activation patterns, for selective memory for positive and negative scenes. Patients with early AD pathophysiological changes have impaired memory overall, however they may be able to recruit a similar neural network of prefrontal regions as healthy older adults for encoding of scenes with positive information. / Thesis (PhD) — Boston College, 2011. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Psychology.

Depression is associated with higher severity of memory disorders and has been shown to predict lower levels of cognitive functioning in those diagnosed with Mild Cognitive Impairment (MCI) or dementia. Yet, little is known about this association cross-culturally, particularly between Hispanics and European Americans. This study demonstrates that although levels of depression differed significantly across diagnostic group, Hispanics and European Americans were similar in levels of depression at each diagnosis. However, only for the European American group did depression levels predict lower scores in confrontational naming and semantic memory. Additionally, exploratory analyses of the entire sample demonstrated that lower depression predicted less likelihood of MCI or dementia diagnoses. This could indicate that there is a need for intervention and treatment of depression, in particular for later stages of MCI and dementia, that should be culturally catered to individual ethnicities. / Includes bibliography. / Thesis (M.A.)--Florida Atlantic University, 2018. / FAU Electronic Theses and Dissertations Collection

The aim of this study is to examine schoolchildren’s knowledge about malaria in Babati, Tanzania. It will also examine the impact of the disease on children’s education and if schoolchildren in Babati have the possibility to act as health change agents and be a part of combating the high malaria prevalence. The thesis is based on a qualitative method with secondary information retrieved from scientific articles and previous studies. It is also based on empirical data collected during a field study in Babati, Tanzania in 2012. Both structured and semi structured interviews were made with schoolchildren, teachers and health care personnel. The studies showed that malaria affects children’s education primarily through absence, but can also cause cognitive impairment as well as neurological damage. The interviews revealed the students to have varying knowledge about the disease and it also revealed that children only have the ability to act as health change agents if teachers with help of the government, the hospital or an NGO are willing to cooperate and provide the students with information.