OBJECTIVES. It has been illustrated in numerous studies that children with Bipolar Disorder (BD) consistently show deficits in declarative memory. There are a number of regions within the brain that have been inferred to correspond to these deficits. Currently, there are a limited number of studies that have analyzed the direct relationship between neuropsychological tests and anatomical brain regions. The purpose of this study was to establish a relationship between structural neuroanatomical measurements and cognitive tasks measurements in Pediatric Bipolar Patients. METHODS. We administered the California Verbal Learning Test-II (CVLT-II) to 46 children and adolescents with BD and compared their scores 35 age-matched healthy controls. A MANCOVA between PBD and Healthy was performed and Long-Delay Free Recall (LDFR) and Long-Delay Cued Recall (LDQR) were significantly different. A multiple linear regression between LDFR and LDQC cognitive variables and anatomical volume and cortical thickness was performed in SPM and FreeSurfer libraries. RESULTS. There was overall significance in CVLT-II Trial 1 (p=0.042), Long Delay Free Recall (LDFR) (p=0.047), and Long Delay Cued Recall (LDQC) scores (0.038), amongst the diagnostic groups (BD-I, BD-II, BD-NOS, Other, Healthy). Within Bipolar subjects, LDFR scores were positive correlated to the gray matter volume of the cingulate gyrus, Brodmann's area 6, parrahippocampal gyrus and the thickness of the lateralorbitofrontal region. LDQC scores were positive correlated to the gray matter volume of the cingulate gyrus, Brodmann's area 7 and middle temporal gyrus. LDQC was also correlated to the volume of the superior frontal, pars triangularis, insula and the thickness of the rostral middle frontal region. CONCLUSION. These results reaffirm previous reports of the cognitive deficits present in children with bipolar disorder. This study also revealed a positive correlation between gray matter density of structures within the limbic system and performance on cognitive variables of the California Verbal Learning Test-II Children's version.

abstract: Differentiating bilingual children with primary language impairment (PLI) from those with typical development in the process of learning a second language has been a challenge. Studies have focused on improving the diagnostic accuracy of language measures for bilinguals. However, researchers are faced with two main challenges when estimating the diagnostic accuracy of new measures: (a) using an a priori diagnosis of children (children with and without PLI), as a reference may introduce error given there is no gold standard for the a priori classification; and (b) classifying children into only two groups may be another source of error given evidence that there may be more than two language ability groups with different strengths and weaknesses or, alternatively, a single group characterized by a continuum of language performance. The current study tested for the number of distinct language ability groups and their characteristics in predominately Spanish-speaking children in the U.S. without using an a priori classification as a reference. In addition, the study examined to what extent the latent groups differed on each measure, and the stability of language ability groups across three assessment methods in Spanish (standardized tests, language sample analyses, and comprehensive assessment), taking in to account English and non-verbal cognitive skills. The study included 431 bilingual children attending English-only education. Three latent profile analyses were conducted, one for each method of assessment. Results suggested more than two distinct language ability groups in the population with the method of assessment influencing the number and characteristics of the groups. Specifically, four groups were estimated based on the comprehensive assessment, and three based on standardized assessment or language sample analysis in Spanish. The stability of the groups was high on average, particularly between the comprehensive assessment and the standardized measures. Results indicate that an a priori classification of children into two groups, those with and without PLI, could lead to misclassification, depending on the measures used. / Dissertation/Thesis / Ph.D. Speech and Hearing Science 2012

This thesis is an inquiry into the creative processes of poetry and poetic expression in documentary. The practice-based element is a 60 minute video about a poet living in Exeter, UK, called James Turner. The documentary is entitled, The Knotweed Factor. This written element of the thesis contextualises the investigation as a discourse on blindness and visual impairment. There are few representations of blindness and/or visual impairment (VI) in The Knotweed Factor. Rather, the documentary is concerned with how visual information (e.g., filming a poet) is translated non-visually (e.g., the sound of the poem being recited). It also addresses the issue of how the non-visual is translated into the visual. I argue in this text that blindness/VI is marginalised in visual studies/culture. This is unfortunate because blindness/VI studies provides valuable context for understanding the dynamics of sound and vision in creative media, which is a central concern of The Knotweed Factor. The rationale for taking this approach is as follows: During the editing, it was noticed that Turner (who is sighted) provides a kind of unprompted audio description (AD) of events in his environment to the audience, as if he is participating in a radio documentary. This raised questions, not only about the ekphrastic possibilities of his technique, but also about the potential to contextualise such scenes as a disquisition on blindness/VI. Blindness/VI is an important and under-theorised element of visual studies/culture (VS/C). Many films, plays, animations, documentaries, and television programmes are audio described. AD enables the blind/visually impaired (also VI) to comprehend and enjoy visual action. It is suggested here that AD theory is an insufficient model for critically reflecting on the creative processes in The Knotweed Factor. This is because the field is presently more concerned with practicability than with aesthetics. It seemed more helpful to address the broader question of how blindness/VI is positioned in VS/C. Doing so has highlighted instances of exclusion and marginalisation in VS/C. In the course of the video production, it was discovered that the interaction of dreams, memories, and ideas (the mindscape) informs the temporal creative process. Most analytical models within VS/C (e.g., Deleuze) offer a dialectical approach to understanding creativity. Henri Bergson, however, proposes a theory of multiplicity, which considers the interplay of phenomenological creativity of the mindscape as a homogenous, multifaceted process, in place of a dialectical one. Martha Blassnigg interrogates Bergson’s responses to audiovisual media and argues that Bergson’s multiplicity formula is more useful for understanding these processes, both for artist and audience. Blassnigg interprets Bergson’s theory as a universality of idea communication. This thesis considers what the universality of audiovisual experience implies for blindness/VI studies. It does so by contextualising the written research as a discourse on VS/C. In The Knotweed Factor, the emotions, sounds, and visual ideas, memories, and dreams which inform James Turner’s creativity are conveyed to the audience in two ways: 1) By sound (Turner’s recitations, interviews, and conversations), and 2) by the documentary’s abstracted audiovisualisations of Turner’s poetry and mindscape. For Turner, the ‘image’ is a personalised, innate phenomenon. It is ephemeral, intangible imagination. Turner’s experience (audiovisualised in The Knotweed Factor) is compared in this written part of the thesis to pre-Socratic ideations of image-making. It is argued that for many cultures, the image was (and for some remains) an emanation of spirit or idea. In other words, the image was considered a transcendent force, and the ‘soul’ of the image eternal and universal. This transcendence is considered in this written element of the thesis as a bridge between the present academic gap in the fields of blindness/VI studies and visual studies/culture. In this text, The Knotweed Factor serves as a case-study to test how non- and minimal-visual elements of audiovisual art and media are positioned in VS/C. Constructed here is a history of the interpretation of blindness and the image, from pre-Socratic aesthetics to the Enlightenment, where ideas concerning the phenomenology of blindness and visual impairment were transformed into epistemological inquiries. This approach enables the researcher to reflect critically on the aesthetics of The Knotweed Factor, using the framework of the non-visual (in this case recited poetry) to test and interrogate the visual (i.e., ‘poetically’ visualised poetry).

Today accessibility is an important and well known factor in the construction of new houses and locations. This development is furthermore shaped by regulations and laws set by government. Nevertheless, accessibility is also a subject that isn’t always as prioritized as other issues which puts it at a disadvantage. With this essay I researched and analyzed how accessibility is created in public buildings. I’ve done this by interviewing seven different people that in one way or another works in the building sector or gets affected by the shaping of places. Three observations have also been performed by me in order to research how various locations are constructed. I’ve found that there is an overall will to make all places accessible for all people. However accessibility is foremost constructed after the normate and after the beliefs of it’s functions. Accessibility for other types of bodies and minds become deviant and seen as an extra cost. This results in a distorted view of what accessibility can mean and limits the possibilitys of accessibility.

Our memory is prone to distortions which in everyday life can lead to mistaken memories. This thesis investigates memory distortion. In addition, one might recall (e.g. an event) correctly but misremember the source of the event (e.g. place or time of the event); this particular type of memory distortion is called source amnesia. Here, an overview of cognitive theories of memory distortion as well as the neuroscience behind memory distortion is provided. In addition, the particular memory distortion of source amnesia where one is unable to acquire when or where a fact was learned is further investigated. Results indicate that an overlap of qualities related to the information being learned causes information to be linked to wrong sources, thus creating distorted memories. Misinformation is also indicated to produce impairment in memory. In memory distortions, memory impairments are representative in various areas of the brain, including the hippocampus and the amygdala in the medial temporal lobes as well as in the frontal cortex and in the visual cortex. These key areas are also closely related to brain aging in Alzheimer´s disease and in schizophrenia, depression, posttraumatic stress disorder (PTSD) and in drug and alcohol abuse. Individuals inflicted with these disease symptoms seem to be more prone to source amnesia compared to controls. The limitations and future directions of what we can study regarding memory distortion and source amnesia are also presented in this thesis.

Submitted by Cristiane de Melo Shirayama (cristiane.shirayama@unifesp.br) on 2018-04-13T20:43:40Z No. of bitstreams: 1 Dissertação Final.pdf: 1287777 bytes, checksum: 2bfe84a2c44a2de9a396ebec601efdd5 (MD5) / Approved for entry into archive by Diogo Misoguti (diogo.misoguti@gmail.com) on 2018-04-17T17:49:26Z (GMT) No. of bitstreams: 1 Dissertação Final.pdf: 1287777 bytes, checksum: 2bfe84a2c44a2de9a396ebec601efdd5 (MD5) / Made available in DSpace on 2018-04-17T17:49:26Z (GMT). No. of bitstreams: 1 Dissertação Final.pdf: 1287777 bytes, checksum: 2bfe84a2c44a2de9a396ebec601efdd5 (MD5) Previous issue date: 2012-11-22 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Esta dissertação problematiza como “sexualidade” e “deficiência visual” aparecem imbricadas no campo da pesquisa. Tomando essas noções como construções histórico-sociais, importa considerar o caráter plural que as define nos discursos, relativizando seus significados contextualmente. A fim de recompor parte do itinerário etnográfico percorrido durante a pesquisa, discute-se como a “sexualidade” vem assumindo um lugar nos discursos de “pessoas com deficiência” a partir de uma retórica de direitos humanos e políticas de saúde. Como a “perda da visão” aparece nos discursos dos interlocutores conformando a percepção de si no mundo, apreende-se, por fim, como a “sexualidade” é conformada por relações erigidas a partir da “deficiência visual”. / This dissertation deals with the issue of how “sexuality” and “visual impairment” seems to overlap in the research field. Taking these concepts as a socio - historical construction, it is relevant consider the many features that define it in the discourses, having its meaning relativized due to the context. In order to rebuild part of the ethnographic itinerary from the research phase, it is debated how the “sexuality” is taking place in the discourses of “ persons with disability” from a human rights and health politics rhetoric. Once the “loss of vision” appears in the interlocutors discourses shaping how they perceive themselves in the world, lastly it is apprehended how the “sexuality” is shaped by the relationships put up from the “visual impairment”.

abstract: Research suggests that some children with primary language impairment (PLI) have difficulty with certain aspects of executive function; however, most studies examining executive function have been conducted using tasks that require children to use language to complete the task. As a result, it is unclear whether poor performance on executive function tasks was due to language impairment, to executive function deficits, or both. The purpose of this study is to evaluate whether preschoolers with PLI have deficits in executive function by comprehensively examining inhibition, updating, and mental set shifting using tasks that do and do not required language to complete the tasks. Twenty-two four and five-year-old preschoolers with PLI and 30 age-matched preschoolers with typical development (TD) completed two sets of computerized executive function tasks that measured inhibition, updating, and mental set shifting. The first set of tasks were language based and the second were visually-based. This permitted us to test the hypothesis that poor performance on executive function tasks results from poor executive function rather than language impairment. A series of one-way analyses of covariance (ANCOVAs) were completed to test whether there was a significant between-group difference on each task after controlling for attention scale scores. In each analysis the between-group factor was group and the covariate was attention scale scores. Results showed that preschoolers with PLI showed difficulties on a broad range of linguistic and visual executive function tasks even with scores on an attention measure covaried. Executive function deficits were found for linguistic inhibition, linguistic and visual updating, and linguistic and visual mental set shifting. Overall, findings add to evidence showing that the executive functioning deficits of children with PLI is not limited to the language domain, but is more general in nature. Implications for early assessment and intervention will be discussed. / Dissertation/Thesis / Doctoral Dissertation Speech and Hearing Science 2015

(AJ) Tinnitus is not seen as a separate disease, but in terms of symptoms accompanying various diseases. The emergence of tinnitus is involved in a variety of risk factors. Relationship between tinnitus and blood flow of the ear is described in a relation to impaired microcirculation, which plays a key role in the proper function of the inner ear and therefore we evaluated the relationship prothrombogenic factors for tinnitus. From the original group of 853 patients we excluded patients with organic cause problems. We excluded patients with hearing impairment, cardiovascular and other comorbidities and also patients taking ototoxic drugs or patients with laboratory abnormalities. Then we have a homogenous group of 40 patients without the evidence of an organic cause of tinnitus and without associated diseases and the effect of ototoxic medications. On this basis there has been created a control group matched by the age and sex. In our group as the main marker of protrombogenic state was used a level of 11- dehydrotromboxan B2. Patients with tinnitus have significantly higher values of 11- dehydrotromboxane-B2. The average concentration in tinnitus patients was 2.02±1.81 ng/ml compared to 1.32±1.33 ng/ml in the control group. At the same time we evaluated other coagulation parameters. We checked...

Introdução: O Questionário do Informante sobre o Declínio Cognitivo do Idoso (IQCODE) é um instrumento de rastreio que se baseia nas informações fornecidas por familiares ou cuidadores acerca de um possível declínio cognitivo do paciente. Embora tenha boa sensibilidade para a identificação de casos suspeitos de demência, poucos estudos avaliaram as propriedades diagnósticas do IQCODE no rastreio do comprometimento cognitivo leve (CCL). O CCL corresponde a uma condição de risco para o desenvolvimento de demência, sendo caracterizado pela presença de alterações cognitivas que podem ser mensuradas objetivamente, indicando um declínio em relação ao desempenho esperado para indivíduos da mesma faixa etária e nível de instrução. Tais alterações cognitivas (ou déficits) são insuficientes para o diagnóstico de demência, no caso de um funcionamento cognitivo global preservado e da capacidade de desempenhar as atividades da vida diária (Winblad, 2004). Objetivos: Examinar as propriedades diagnósticas do IQCODE no rastreio do CCL, identificando os pontos de corte do teste IQCODE que melhor separam indivíduos idosos cognitivamente normais dos indivíduos com CCL; correlacionar os resultados obtidos com outros testes de rastreio cognitivo amplamente utilizados em nosso meio, como o Mini-Exame do Estado Mental (MEEM), o Teste do Desenho do Relógio (TDR) e o Teste Cognitivo de Cambridge (CAMCOG); identificar entre os 26 itens do IQCODE os agrupamentos (clusters) que contribuem para a identificação dos casos de CCL. Métodos: Estudo de corte transversal em amostra de 167 indivíduos idosos (Controles n=51, CCL n=58 e Demência de Alzheimer (DA) n=58) acompanhados no Ambulatório de Psicogeriatria do LIM-27, Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. O diagnóstico do estado cognitivo (padrão-ouro) estabelecido por meio de consenso multidisciplinar, levando-se em consideração as informações clínicas e o desempenho em testes neuropsicológicos: A idade média dos indivíduos de cada grupo foi, respectivamente, de 67,5 (±5,6), 70,2 (±6,1) e 75,5 (±8,4) anos, e a escolaridade média foi de 12,6 (±5,4), 9,6 (±5,7) e 8,5 (±5,5) anos. Análises de curvas ROC (Receiver Operating Characteristics) foram realizadas para avaliar a acurácia diagnóstica do IQCODE e demais testes comparativos na separação dos pacientes de cada grupo diagnóstico, comparados dois a dois (CCL versus Controles, CCL versus DA, DA versus Controles); por meio de regressão logística, avaliou-se o potencial do uso combinado do IQCODE em conjunto com os demais instrumentos de rastreio para predizer a ocorrência de CCL e DA; finalmente, por meio de análise de clusters, avaliou-se a distribuição dos diferentes itens do IQCODE nos pacientes com CCL e seus subtipos. Resultados: Os pontos de corte do IQCODE para a separação dos grupos diagnósticos foram: (a) DA versus Controles: 3,3 (AUC=0,90; sensibilidade: 84,5%; especificidade: 82,4%); (b) CCL versus Controles: 3,1 (AUC=0,73; sensibilidade: 77,6%; especificidade: 60,8%); (c) CCL versus DA: 3,4 (AUC=0,81; sensibilidade: 79,3%; especificidade: 70,7%). O IQCODE apresentou melhor correlação com o CAMCOG (=0,542; p<0,001). Com base na análise de cluster, estimou-se que o agrupamento que contém itens relacionados à memória episódica foi o mais relevante para identificar os pacientes portadores de CCL amnéstico. Conclusões: O uso do IQCODE obteve melhores resultados para diferenciar idosos cognitivamente normais de CCL quando utilizado em conjunto com o CAMCOG. A análise de cluster do IQCODE melhor prediz CCL e seus subtipos / Introduction: The Informant Questionnaire of Cognitive Decline in the Elderly is a screening diagnostic instrument which is based on given information from family members and caregivers regarding a possible patients cognitive impairment. Despite its good sensitivity for suspected dementia caseness, few studies have been carried out using the diagnosis properties of the IQCODE to screen for Mild Cognitive Impairment (MCI). MCI corresponds to a condition of a risk factor for dementia outcome and is characterized by the presence of cognitive changes measured objectively, indicating an impairment in comparison with the expected performance for individuals at the same age and years of schooling. These deficits are insufficient for dementia diagnosis in case of preserved global cognitive functioning as well as in the capacity to perform daily activities (Winblad, 2004). Objectives: Examine diagnostic properties of the IQCODE in identifying cut-off scores which best distinguish the cognitively normal elderly from those with MCI; to correlate these results with other widely used cognitive tests, such as the Mini Mental State Examination (MMSE), the Clock Drawing Test (CDT) and the Cambridge Cognitive Test (CAMCOG); to identify among the 26 items in the IQCODE those clusters which best contribute to the identification of the cases. Methods: Cross-sectional study in a sample of 167 elderly subjects (Controls: n=51, MCI: n=58 and Alzheimer Disease (AD): n=58) followed at the Psychogeriatric Clinic of the Laboratory of Neuroscience (LIM-27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo. The cognitive diagnosis was reached by consensus at expert multi-disciplinary meetings (gold standard), taking into account clinical and neuropsychological evaluation. The mean age in each group was respectively: 67.5(±5.6), 70.2 (±6.1) and 75.5 (±8.4) years, and mean of years of schooling were 12.6(±5.4), 9.6(±5.7) and 8.5(±5.5) years. ROC (Receiver Operating Characteristics) Curve analysis were carried out to determine diagnostic accuracy of the IQCODE and the comparative tests in paired sets (MCI versus Controls, MCI versus AD, AD versus Controls); by logistic regression analysis it was evaluated the prediction of MCI and AD with the IQCODE and its combined usage with the comparative tests; finally by cluster analysis it was evaluated the different distribution of the IQCODE items in MCI patients and its subtypes. Results: The IQCODE cut-off scores for diagnostic groups separation were: (a) AD versus Controls: 3.3 (AUC=0.90; sensitivity: 84.5%; specificity: 82.4 %( b) MCI versus Controls: 3.1 (AUC=0.73; sensitivity: 77.6%; specificity%: 60.8); (c) MCI versus AD: 3.4 (AUC=0.81; sensitivity: 79.3%; specificity: 70.7%). The IQCODE had the best correlation with the CAMCOG (=0.542; p<0.001). According to cluster analysis, the episodic memory grouping was the most relevant in identifying amnestic MCI. Conclusions: The IQCODE achieved best results to discriminate cognitively unimpaired elderly from MCI when combined with the CAMCOG. Cluster analysis of the IQCODE better predicts MCI and its subtypes.

Background: Mild Cognitive Impairment (MCI) is a clinical construct reputed to represent an intermediate stage on a continuum between normal aging and cognitive decline. Conceptual and prognostic ambiguity can lead to significant diagnostic challenges and there is a need for accurate screening tests which can assist clinicians with decision-making. A diagnosis of MCI is also associated with considerable uncertainty for patients who may be adjusting to cognitive difficulties along with an increased risk of developing dementia. Beliefs about MCI may influence psychosocial adjustment, and individual differences in ‘psychological flexibility (PF)’, as conceptualised by the Acceptance and Commitment Therapy (ACT) model, may also be involved in this process. Objectives: In order to evaluate the accuracy and clinical utility of a recently developed screening tool for MCI, the Montreal Cognitive Assessment (MoCA), a systematic review of validation and diagnostic test accuracy (DTA) studies for this measure was conducted. Psychosocial adjustment to a diagnosis of MCI was also a key focus. An empirical study was therefore carried out with the aim of evaluating the possible relationships between cognitive impairment, illness representations about MCI, psychological wellbeing and quality of life (QoL), and to assess the potential involvement of PF. Method: Following a systematic search of relevant electronic databases and reference lists, validation and DTA studies of the MoCA were identified and evaluated for methodological quality. For the empirical study, patients recently diagnosed with MCI were recruited from local NHS memory clinic services and completed the MoCA and a questionnaire pack assessing illness representations, PF, mood, anxiety and QoL. Results: The systematic review identified 18 validation and DTA studies. Few of the studies achieved high ratings for methodological quality and problems with representativeness and generalisability were identified. Nevertheless, sensitivity levels appeared robust across studies, though specificity was variable. For the present empirical study, participants reported a spectrum of positive and negative beliefs about MCI. Distress attributed to MCI was associated with anxiety, along with perceptions of more serious illness consequences, while higher PF was associated with higher perceived QoL and mood. Lived experience of MCI appeared to have more relevance to psychosocial adjustment than objective cognitive impairment. Conclusions: The results of the systematic review indicate that while the MoCA is a robust tool overall in the identification of cognitive impairment, estimates of accuracy may be exaggerated by inter-study variation and bias. More rigorous validation studies are therefore needed. Implications for clinical decision-making regarding MCI are discussed and recommendations for future accuracy studies are outlined. The empirical study supported the findings of previous studies of the relevance of illness representations to psychosocial adjustment in MCI and added to the evidence base by providing preliminary support for the possible involvement of PF. The results suggest that both cognitive content and PF may represent possible vehicles for therapeutic change in patients with adjustment difficulties, and indicate that further investigation of these factors is warranted. Conclusions are limited, however, by small sample size and low statistical power. Replication of these findings with a larger and more representative sample is therefore recommended.