With a growing ageing population decline in physical function has become a major public health issue, as it is associated with disability in later life. Recent evidence suggests that blockade of the renin-angiotension-aldosterone system may have a role in improving physical function in older people.We hypothesised that inhibition of the renin-angiotensin-aldosterone system with spironolactone would improve physical function in older people without heart failure. In a double-blind, randomised controlled clinical trial 120 participants, aged >65 years with functional impairment were randomized to receive 25mg spironolactone or placebo for 20 weeks. The primary outcome was the change in six-minute walking distance over 20 weeks. Secondary outcomes were change in Timed-Get-Up and Go test, Incremental Shuttle Walk Test, measures of health related quality of life (EuroQol health questionnaire and Functional Limitation Profile) and measures of psychological state (Hospital Anxiety and Depression Scale). Outcomes measures were repeated at 10 and 20 weeks.Participant mean age was 75 years (SD 6), 65/120 (54%) were male. Only 8/120 participants (6.6%) dropped out (5 from the placebo group, 3 from the spironolactone group). Of the 112 participants who completed the study 95% (106/112) remained on medication at 20 weeks. There was no significant change in six minute walking distance at 20 weeks with a -3.2 (95% CI -28.9, 22.5) metres difference between the spironolactone group related to the placebo group (p=0.81). There was however a significant improvement in quality of life at 20 weeks (a secondary outcome) with a rise in EuroQol EQ-5D score of 0.10 (95% CI 0.03, 0.18) in the spironolactone group relative to the placebo group (p=<0.01). There were no significant changes between groups in the other secondary outcomes. This trial found that spironolactone was safe and well tolerated, but did not improve physical function in older people who did not have heart failure. Quality of life improved, but the biological plausibility and possible mechanisms for this require further study.

The purpose of this thesis was to evaluate the efficacy of an intervention to increase the production of emotion words in five children with language impairment. Participants were between the ages of 5;11 (years; months) and 11;3 (at the onset of enrollment in treatment) and had been identified with language impairment. Each participant completed between three and six baseline sessions, 20 twenty-minute intervention sessions, and three follow-up sessions. Tasks included story reading, story enactment, and journaling. Each session was recorded and then coded for emotion category (sadness, anger, fear, and surprise), errors made, type of production, and valence agreement. Total emotion word production per category is reported along with percentage of non-overlapping data calculations to determine the effectiveness of treatment for each participant for each emotion word category. Based on percentage of non-overlapping data calculations, treatment was moderately effective for four of the five participants in at least one or more emotion word category. Treatment was mildly effective for all five participants in at least one emotion category. Each participant was observed to make between one and five valence errors throughout the intervention. The errors made by participants often involved the substitution of a simple emotion word category for a more complex emotion word category. Participants were more successful with intervention tasks when provided increased support from the clinician, as seen by most productions being made in response to a question or in response to a cue. While results from this intervention were variable, participants generally made improvements from their participation in this intervention. Utilization of a similar intervention framework with a few alterations based on the limitations observed would be beneficial in future research.

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No description available.

The primary objective of this study was to assess cognitive functioning in participants with relapsing remitting multiple sclerosis (RRMS) using the MicroCog and to compare their performance to that of a demographically matched, healthy control group. It was hypothesized that as a group, participants with RRMS would have worse cognitive function than healthy controls on all Level 1, 2, and 3 Index scores of the MicroCog. Twenty-six participants with RRMS and twenty-nine sex and education matched healthy controls were administered the MicroCog (Standard Form) along with measures of depression and clinical status, and paper-pencil tests of processing speed (Symbol Digit Modalities Test; SDMT and Paced Auditory Serial Addition Test; PASAT). A series of ANCOVAs with depression as a covariate was performed to determine between group differences for each MicroCog Level 3 Index score (General Cognitive Proficiency (GCP) and General Cognitive Functioning (GCF)), Level 2 Index score (Information Processing Accuracy (IPA) and Information Processing Speed (IPS)), and Level 1 Index score (Attention/Mental Control, Memory, Reasoning/Calculation, Spatial Processing, and Reaction Time). Pearson's and point biserial r correlations were calculated in order to assess the degree to which Level 2 and 3 Index scores correlated with clinical and demographic factors (sex, disease duration, depression, and clinical status) and to correlate the MicroCog IPS index score with traditional measures of processing speed. Eight RRMS and two control participants met criteria for cognitive impairment on the MicroCog. ANCOVA results indicated there were significant differences between RRMS and control performance for two MicroCog scores (GCF and IPS). There were not significant differences for GCP, IPS, and all Level 1 scores. A post-hoc analysis performed for the same hypothesis with a group of age equivalent participants suggested a significant RRMS by depression interaction for Level 3 scores. RRMS was not predictive of Level 2 scores after controlling for depression in the age equivalent sample. Correlations for clinical and demographic factors with cognitive outcomes indicated significant relationships for clinical status and depression. There was not a significant relationship detected for disease duration or sex. MicroCog and processing speed measures were significantly related. Post-hoc analyses supported that the criterion validity of the MicroCog is comparable to other cognitive screening tools in RRMS. The results and limitations of our study are discussed, in addition to recommendations for future research.

Alzheimer's disease (AD) is the most common form of dementia and results in progressive cognitive decline, particularly in regards to memory (National Institute on Aging, 2012). Prior research has shown sex differences in brain-atrophy rates of AD patients, with women experiencing a higher rate of progression in volume reduction (Skup et al., 2011). This suggests that there may also be differences in cognitive functioning between sexes, particularly in the rate of cognitive decline with a more rapid disease progression for dementing females compared to dementing males. The current study monitored memory function longitudinally in approximately 200 total participants, 100 with Mild Cognitive Impairment (MCI) or probable AD and 100 healthy controls enrolled in an aging study through the Arizona Alzheimer's Disease Research Consortium. Memory performance was evaluated with two memory tests, the Rey Auditory Verbal Learning Test (RAVLT; Rey, 1941) and the Brief Visuospatial Memory Test-Revised (BVMT-R; Benedict, 1997). Memory function was evaluated in participants with at least three data points over a five-year span. A multivariate regression model was used that includes controls for disease severity, age, age at disease onset, education, ethnicity, and medical comorbidities. Results indicated that females in the MCI and AD groups initially performed better than the males, but that over time, female scores had dropped significantly lower than male scores, suggesting a more rapid decline in females. Significant sex differences in cognitive decline may yield a deeper understanding of the development and progression of AD and aid in more effective and sex-specific treatment.

Studies over the past several years have shown that children with language impairment (LI) have greater difficulty in social situations than typically developing children. More specifically, studies have shown that children with LI have more difficulty with dissemblance. This study was conducted to assess whether these children are less likely to dissemble in real-life situations. Forty-four children aged 7 to 11 years (22 LI and 22 typically developing) were presented with four situations designed to elicit dissemblance. Their reactions were scored and compared. The results of this study showed subtle differences between children with LI and typically developing children. Children with LI were more likely to display emotions, and the typically developing children were more likely to have non-committal and dissembled responses. These tasks were pilots, and further research is suggested.

Children with language impairment (LI) are more likely to be socially withdrawn than their typically-developing peers. This withdrawal can lead to negative outcomes later in life. This study focuses on a subtype of withdrawal labeled as solitary-pretend play, which involves parallel play and solitary-dramatizing. The effectiveness of the Teacher Behavior Rating Scale (TBRS) to measure the construct of solitary-pretend play was considered in a group of 256 children. First, confirmatory factor analysis was used on the entire sample to assess the TBRS questions. The TBRS ratings of 128 children with LI and 128 typically developing peers were then compared, with group and gender as variables. The analyses revealed that the TBRS items intended to measure solitary-pretend play grouped together to measure a single construct. Additionally, significant differences were observed between the groups of children with LI and their typically-developing peers. There was also a significant difference between boys and girls. The interaction between these variables was not significant. These results demonstrated that the TBRS is a viable measure of solitary-pretend play in children and that children with LI are rated as demonstrating higher levels of solitary-pretend play that their typical peers. Boys were also rated as demonstrating more instances of solitary-pretend play compared to girls. This study suggests that the TBRS is an effective way to quickly identify instances of solitary-pretend play in children and that children with LI and boys are more likely to demonstrate instances of solitary-pretend play, which will lead to the needed referrals and interventions to help manage these behaviors. Further research is required to determine the extent to which the influence of group and age has on solitary-pretend play and the extent to which each of the subtypes of withdrawal relate one to another.

This study describes a series of case studies on topic management patterns of five children (ages 5 to 10 years) with language impairment. The children participated in semi-structured topic tasks that assessed conversational abilities on topics that were verbally introduced and topics that were introduced both verbally and with an object. Although there was considerable variability among participants, the children generally responded to most introductions by acknowledging and maintaining the topic. With the exception of one child, however, the children in this study demonstrated immature topic manipulation patterns that could be expected to have negative social ramifications.

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