Chang, Jianfang. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 183-217). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

The biological energy concepts used by Freud to account for unconscious mental processes in psychoanalysis are discredited by modem biological findings. As a result, different psychoanalytic schools developed new foundational theories in order to verify unconscious mentation. The present study argues that these theories are unsuccessful for two main reasons. Firstly, replacing Freud's drive energy theory with other equally hypothetical foundational constructs does not solve the problem of finding proof for the existence of unconscious mentation. Secondly, the clinical psychoanalytic definition of unconscious mentation as imaginary, internally generated processes, autonomous from the external world is misguided. External sensory data may play a formative role in producing unconscious mentation. In particular, neurobiological findings on sensory data encoding and storage in human infants may throw light on the nature of unconscious processes. The present study therefore compares ideas derived from Lacanian psychoanalysis with neuropsychological memory and infant research findings to ascertain whether unconscious mentation is linked to the memory encoding of sensory data in infants. This analysis is in tum contrasted with a more contemporary psychoanalytic synthesis of findings on infant memory and unconscious mentation (Lichtenberg, 1989, Lichtenberg, Lachmann, and Fosshage, 1992). The latter theory identifies connections between unconscious mentation and the encoding of sensory memories in infancy, but does not connect the episodic and procedural memory constructs used in this account to specific neurolo·gical mechanisms in the brain. The present study's original contributions therefore involve firstly connecting the development of aversive episodic and procedural memories to neurological mechanisms in the brain during the period between birth and 28 months of age. Secondly, this memory model suggests that the storage of aversive memories in infancy has lasting unconscious motivational significance for subjects. Presymbolic memories may unconsciously manipulate conscious attention and memory retrieval in verbal subjects, inviting comparison with the psychoanalytic concept of dynamic unconscious mentation. Thirdly, the presymbolic memory model contributes towards a novel understanding of false memories of childhood sex abuse, and the dissociation of real traumatic memories that occur in many cases of Post Traumatic Stress Disorder. / Psychology / D.Litt. et Phil. (Psychology)

The present study was designed to empirically validate six theoretically derived cognitive domains (verbal memory, visual memory, working memory, attention-concentration, executive functions, and visuospatial abilities) assessed by a comprehensive battery of neuropsychological tests used in the Geriatric Memory Clinic at the University of North Texas Health Science Center in Fort Worth, Texas. The study examined the extent to which various cognitive dimensions are tapped by this battery in a heterogeneous geriatric sample of 114 patients with cognitive impairments. The proposed six-factor model of cognitive functioning has not been supported. Further exploratory factor analysis arrived at a five-factor solution. Factor pattern of the 23 tests supported the following five dimensions: memory, executive control, attention, visuospatial abilities, and cognitive flexibility.

The clinical utility of the Intermediate Category Test, a measure of executive functioning in children 9 to 14 years of age, is currently limited by the availability of only a Total Error score for normative interpretation. The Process Scoring System (PSS) was developed to provide a standardized method of assessing specific processing patterns and problem-solving errors. The purpose of this study was to determine the ability of the PSS scores to discriminate between children with and without suspected executive deficits, thereby providing evidence of criterion-related validity.

Accurate, early diagnosis of Alzheimer's Disease is becoming increasingly important in light of its growing prevalence among the expanding older-aged adult population. Due to its ability to assess multiple domains of cognitive functioning and provide a profile of impairment rather than a simple global score, the Neurobehavioral Cognitive Status Examination (NCSE) is suggested to better assess such patterns of cognitive deficit for the purpose of diagnosis. The performance of the NCSE was compared with that of the Mini-Mental State Examination (MMSE) for diagnostic sensitivity in a sample of patients diagnosed as having probable Alzheimer's Disease. The strength of correlation between severity of cognitive impairment on these tests and report of behavior problems on the Memory and Behavior Problems Checklist (MBPC) was also explored, as was performance on the NCSE and report of behavior problems using the MBPC in predicting Single Photon Emission Computed Tomography (SPECT) scan results. The NCSE was found to exhibit greater sensitivity to physician diagnosis of probable Alzheimer's Disease relative to two versions (Serial 7's or WORLD) of the MMSE (.90, .77 and .68, respectively). While both measures were found to correlate significantly with the report of behavior problems, only a moderate proportion (NCSE = .22 and MMSE = .33) of the explained variance was accounted for by either test. Severity of cognitive impairment on the NCSE was found to be significant, though small in estimate of its effect size, for predicting the absence/presence of pathognomic findings on SPECT scans. In contrast, the report of behavior problems on the MBPC did not significantly predict SPECT scan outcomes. The NCSE would appear to be a sensitive tool for the identification of the extent and severity of cognitive impairment found among demented individuals; however, it may be "over"-sensitive to such diagnosis. Although relationships between cognitive impairment and behavior problems and/or neuroradiological findings are observed, their meaningfulness remains with the need for further, more detailed, study using standardized criteria for comparison purposes.

Malingering is the deliberate production of feigned symptoms by a person seeking external gain such as: financial compensation, exemption from duty, or leniency from the criminal justice system. The Test Translation and Adaptation Guidelines developed by the International Test Commission (ITC) specify that only tests which have been formally translated into another language and validated should be available for use in clinical practice. Thus, the current study evaluated the psychometric properties of a Spanish translation of the Structured Interview of Reported Symptoms (SIRS). Using a simulation design with 80 Spanish-speaking Hispanic American outpatients, the Spanish SIRS was produced reliable results with small standard errors of measurement (SEM). Regarding discriminant validity, very large effect sizes (mean Cohen's d = 2.00) were observed between feigners and honest responders for the SIRS primary scales. Research limitations and directions for future research are also discussed.

INTRODUÇÃO: A Mini-Addenbrooke\'s Cognitive Examination (M-ACE) consiste em um teste de avaliação cognitiva breve composta de cinco itens que visam avaliar quatro domínios cognitivos principais (orientação, memória, linguagem e função viso-espacial) com pontuação máxima de 30 pontos e um tempo de administração de cinco minutos. OBJETIVO: Avaliar o desempenho de idosos cognitivamente saudáveis, com CCL e DA leve na versão brasileira da M-ACE. MÉTODOS: o teste foi aplicado um grupo de 23 pacientes com DA provável leve, 36 CCL e 25 idosos cognitivamente saudáveis. Todos os participantes incluídos tinham idade >= 60 anos. Foram excluídos pacientes com demência de intensidade moderada ou grave, demência de outra etiologia, comorbidades graves com potencial de comprometer a cognição e uso de medicação psicotrópica. A acurácia do teste foi avaliada por meio da análise das curvas ROC. Para analisar a relação entre os escores da M-ACE e os demais testes cognitivos aplicados foram utilizados os coeficientes de correlação de Spearman. Para analisar a consistência interna da M-ACE e suas três versões foi utilizado o coeficiente alfa de Cronbach. RESULTADOS: Houve um predomínio do gênero feminino, a média de idade foi de 73 anos, com faixa etária predominante de 60-69 anos. A média de escolaridade obtida foi de 11 anos. A M-ACE apresentou alta consistência interna (alfa de Cronbach > 0,8; IC 95% 0,776 a 0,869) e mostrou ser extremamente capaz de diferenciar o grupo DA dos demais participantes, com uma acurácia superior ao MEEM. O ponto de corte de 20 foi o de maior sensibilidade e especificidade (95,6% e 90,16% respectivamente), com área sob a curva considerada alta (ASC = 0,805; IC 95% 0,705 -0,904). A M-ACE apresentou melhor precisão em diferenciar os três grupos quando comparado com o MEEM (71,43 versus 60,71). Observou-se ainda uma precisão mais robusta em diferenciar DA de CCL com a M-ACE (63,89 versus 30,56 no MEEM). O escore total da M-ACE não sofreu considerável influência da idade e escolaridade. A M-ACE apresentou forte correlação com MEEM (cor = 0,78), bem como todos os itens (exceto percepção) da BBRC e QAF (cor = -0,76). CONCLUSÃO: A M-ACE pode ser considerada um teste rápido de rastreio com elevada acurácia no diagnóstico de DA. O ponto de corte sugerido neste estudo é de 20 para DA e 27 para CCL / INTRODUCTION: The Mini-Addenbrooke\'s Cognitive Examination (M-ACE) consists of a brief cognitive assessment test composed of five items that aim to evaluate four main cognitive domains (orientation, memory, language and visuospatial function) with a maximum score of 30 points and a time of administration of five minutes. OBJECTIVE: Evaluate the performance of cognitively healthy elderly, MCI and mild AD in the Brazilian version of M-ACE. METHODS: The test was applied to a group of 23 patients with mild probable AD, 36 MCI and 25 cognitively healthy elderly. All included participants were aged >= 60 years. Patients with moderate or severe dementia, dementia of another etiology, severe comorbidities with potential to compromise cognition and use of psychotropic medication were excluded. The accuracy of the test was evaluated by analyzing the ROC curves. Spearman\'s correlation coefficients were used to analyze the relationship between the M-ACE scores and the other cognitive tests applied. In order to analyze the internal consistency of the M-ACE, the Cronbach\'s alpha coefficient was used. RESULTS: There was a predominance of females, mean age was 73 years, with a predominant age range of 60-69 years. The average level of schooling was 11 years. MACE presented high internal consistency (Cronbach\'s alpha > 0.8, 95% CI 0.776 to 0.869) and showed to be extremely capable of differentiating the AD group from the other participants, with a higher accuracy than the MMSE. The cutoff point of 20 was the one with the highest sensitivity and specificity (95.6% and 90.16%, respectively), with an AUC considered to be high (AUC = 0.805, 95% CI 0.705-0.904). The M-ACE presented better accuracy in differentiating the three groups when compared to the MMSE (71.43 versus 60.71). It was also observed a more robust precision in differentiating DA of MCI with M-ACE (63.89 versus 30.56 in MMSE). The total M-ACE score was not very influenced by age and schooling. M-ACE showed a strong correlation with MMSE (spearman = 0.78), as well as all items (except perception) of BBRC and QAF (spearman = -0.76). CONCLUSIONS: M-ACE can be considered a brief screening tool with high accuracy in the diagnosis of AD. The cutoff point suggested in this study is 20 for AD and 27 for MCI

INTRODUÇÃO: Embora o uso de cocaína seja um problema significativo de saúde pública, há uma relativa escassez de dados científicos sobre as conseqüências neurocognitivas decorrentes da exposição à substância. OBJETIVO: Este estudo avaliou a associação entre dependência de cocaína e desempenho cognitivo. MÉTODOS: Uma ampla bateria de testes neuropsicológicos, incluindo o Trail Making Test (TMT), Stroop Color Word Test (SCWT), Dígitos Diretos e Inversos (WMS-R), Memória Lógica I e II (WMS-R), Reprodução Visual I e II (WMS-R), Teste da Figura Complexa de Rey-Osterrieth (TFCRO), Buschke Selective Reminding Test (BSRT), Wisconsin Card Sorting Test (WCST), Desenhos Alternados (Luria), Códigos (WAIS-R), Cubos (WAIS-R), Vocabulário (WAIS-R), Controlled Word Association Test (COWAT), Boston Naming Test (BNT), Bateria de Avaliação Frontal (BAF) e o Iowa Gambling Task (IGT), foi aplicada a 30 dependentes de cocaína, em abstinência por duas semanas, em tratamento, e em 32 sujeitos controles, não usuários de drogas, pareados por idade, sexo, escolaridade, nível sócio-econômico, lateralidade e QI. RESULTADOS: Os resultados mostraram significação estatística (p<0,05) em testes de atenção, fluência verbal, memória visual, memória verbal, capacidade de aprendizagem, funções executivas, memória operacional, funções viso-motoras e na tomada de decisões. CONCLUSÕES: Esses dados mostram evidências de que o abuso de cocaína está associado a déficits cognitivos, semelhantes aos que ocorrem em transtornos cognitivos, possivelmente relacionados a problemas em regiões cerebrais pré-frontais e temporais. O conhecimento dos danos neuropsicológicos específicos pode ser útil no planejamento de programas de prevenção e tratamento mais efetivo para abuso de cocaína / INTRODUCTION: Although cocaine use is a significant public health problem, there is relative paucity of scientific data on long-term neurocognitive consequences of the exposure to the substance. OBJECTIVE: This study examined the association between cocaine dependence and neuropsychological performance. METHODS: An extended battery of neuropsychological tests, including Trail Making Test (TMT), Stroop Color Word Test (SCWT), Forward and Backward Digits (WMS-R), Logical Memory I and II (WMS-R), Visual Reproduction I and II (WMS-R), Rey-Osterrieth Complex Figure Test (ROCFT), Buschke Selective Reminding Test (BSRT), Wisconsin Card Sorting Test (WCST), Alternate Designs (Luria), Symbol-Digit (WAIS-R), Block Design (WAIS-R), Vocabulary (WAIS-R), Controlled Word Association Test (COWAT), Boston Naming Test (BNT), Frontal Assessment Battery (FAB) and Iowa Gambling Task (IGT), was administered to 30 abstinent cocaine abusers, inpatients in abstinence for two weeks, and 32 non-drug-using control subjects matched for age, gender, education, socio-economic status, handedness and IQ. RESULTS: The findings showed statistical significance (p<0,05) on differences of performance in attention, verbal fluency, verbal memory, visual memory, learning ability, executive functions, working memory, visuomotor functioning and decision-making. CONCLUSIONS: These results represent evidences that cocaine abuse is associated with decrements in cognitive functioning, similar to cognitive disorders associated to prefrontal and temporal brain impairments. Knowledge of specific cognitive deficits in cocaine abusers may be useful for designing more effective substance abuse prevention and treatment programs

A nomeação constitui uma das tarefas mais importantes no processamento da linguagem. A nomeação de diferentes categorias semânticas e gramaticais diverge em suas propriedades lexicais e possui substratos neuroanatômicos distintos. Esta pesquisa tem como objetivos caracterizar as alterações de nomeação de sujeitos com afasia, comparando-os aos sujeitos sem alteração de linguagem e estabelecer relações da tipologia de resposta na tarefa de nomeação de verbos e de substantivos em afásicos. A amostra foi composta por indivíduos divididos em dois grupos: GC e GP. O GC foi constituído de 95 sujeitos sem alteração de linguagem, com média de idade de 56,7 anos (15,4) e escolaridade de 9,3 anos (4,4). O GP foi constituído por 33 afásicos, subdividido em não fluentes (GNF) e fluentes (GF). No GNF foram avaliados 17 sujeitos com média de idade de 65,5 anos (14) e escolaridade de 8,2 anos (6,4). No GF foram avaliados 16 sujeitos com média de idade de 60,5 anos (16,7) e escolaridade de 11,5 anos (7,6). O teste utilizado foi a bateria inglesa An Object and Action Naming Battery (Bateria de Nomeação de Objetos e Verbos - BNOV). Houve diferenças estatisticamente significativas entre os grupos de afásicos no número de acertos para substantivos e verbos (p<0,001). O número de acertos para a nomeação de substantivos é maior do que para verbos no GNF enquanto o número de acertos para a nomeação de verbos é maior no GF. Os sujeitos do GNF apresentaram como tipo de resposta desviante mais frequente a \"complementação por gesto\", seguido dos tipos xiii \"hiperônimo\" e \"componente\" na nomeação de substantivos e \"erros de associação\", \"co-hipônimo\", e \"substantivo relacionado\", na nomeação de verbos. Os sujeitos do GF apresentaram como tipo de resposta desviante mais frequente o \"neologismo\", seguido de \"parafasia fonêmica\" e \"circunlóquios\" para a nomeação de substantivos e \"neologismo\", \"erros fonológicos\" e \"circunlóquios\" para verbos. / Naming is one of the most important functions in language processing. The naming of different semantic and grammatical categories diverge in their lexical properties and possess distinct neuroanatomical substrates. This study aims at characterizing the naming alterations and types of errors of aphasic individuals in a verbs and nouns naming. The sample was composed of subjects divided into two groups: GC and GP. The GC consisted of 95 subjects with no language impairment, with the mean age of 56.7 years (15.4) and schooling of 9.3 years (4.4). The GP comprised 33 aphasic patients, subdivided into non fluent (GNF) and fluent (GF). In the GNF, 17 subjects with the mean age of 65.5 years (14) and schooling of 8.2 years (6.4) were evaluated. In the GF, 16 subjects with the mean age of 60.5 years (16.7) and 11.5 years of schooling (7.6) were evaluated. The test used was the English battery An Object and Action Naming Battery. There were statistically significant differences between the aphasic groups as to the number of correct answers for nouns and verbs (p <0.001). The number of correct answers in the naming task for nouns was higher than for verbs in the GNF, while the number of correct answers in the naming of verbs was higher in the GF. The most frequent type of error presented by the GNF presented \"complementation by gesture\", followed by \"hyperonym\" and \"component\" in the naming of nouns and \"association errors\", \"hyponym\", and \"related noun\" in the naming of verbs. The most frequent type of error presented by the GF was \"neologism\", followed by \"phonemic paraphasia\" and \"circumlocutions\" in the naming of nouns and \"neologism\", \"phonological errors\" and \"circumlocutions\" for verbs.

Introdução: a desorientação topográfica é um sintoma comum em pacientes com doença de Alzheimer (DA), no entanto não tem tão estudada quanto outros sintomas da DA. Objetivos: Verificar a ocorrência da desorientação topográfica em pacientes com DA e identificar quais transtornos neuropsicológicos estão relacionados com a desorientação. Métodos: Foram avaliados vinte e sete pacientes com DA provável (12 do sexo feminino, 14 com DA com demência de leve intensidade) e 30 indivíduos controles sem demência (21 do sexo feminino). Os pacientes foram submetidos a um questionário específico sobre orientação topográfica e foram submetidos aos seguintes testes: Mini Exame do Estado Mental, extensão de dígitos, fluência verbal, teste de cancelamento, teste dos blocos de Corsi, localização de pontos no espaço, julgamento de orientação de linhas, cópia de figuras em três dimensões e figuras sem sentido e testes de rotação mental. Foram realizados testes de reconhecimento de marcos topográficos, orientação pessoal, descrição de rotas, localização de cidade no mapa do Brasil. Resultados: Pacientes e controles não apresentaram diferença quanto à escolaridade e gênero. Houve diferença entre pacientes e controles no questionário sobre orientação topográfica e em todos os testes utilizados, exceto nas tarefas de funções vísuo-espaciais. O grupo de pacientes com demência de leve intensidade demonstrou diferença no questionário sobre orientação topográfica, descrição de rotas, reconhecimento de marcos topográficos, orientação espacial julgamento de orientação de linhas e localização de cidades no mapa. Apenas o reconhecimento de marcos topográficos, foi capaz de diferenciar entre pacientes com demência de leve ou de moderada intensidade. Conclusões: O questionário sobre orientação topográfica demonstrou que até mesmo os pacientes com DA com demência de leve intensidade tiveram desorientação topográfica. Os testes de reconhecimento de marcos topográficos, xi orientação pessoal egocêntrica e alocêntrica, estão alterados precocemente e podem contribuir para a desorientação topográfica, A memória operacional espacial e as funções visuo-espaciais não estão comprometidas inicialmente e provavelmente não contribuíram para a desorientação topográfica em pacientes com demência de leve intensidade. No entanto, pacientes com demência de intensidade moderada demonstraram comprometimento nas tarefas de memória operacional especial e testes de funções vísuoespaciais, o que provavelmente contribuiu para a desorientação topográfica nestes pacientes / Background: Topographical disorientation is a common symptom in patients with Alzheimer´s disease (AD) that has not been as extensively studied as other common manifestations of this disease. Objective: To verify the occurrence of topographical disorientation in patients with Alzheimer\'s disease (AD) and to identify which neuropsychological dysfunctions are causally related to the presence of this manifestation. Methods: Twenty seven patients meeting criteria for probable AD (12 female, 14 with mild dementia) and 30 subjects (21 female) without dementia were analyzed. The subjects and the caregivers were interviewed with a questionnaire on topographical orientation. The following tests were given: Mini mental state examination (MMSE), digit span, verbal fluency, cancellation task, Corsi\'s block tapping test, point localization, line orientation judgment, three dimension and nonsense figure copy and mental rotation tests. Landmarks recognition, personal orientation, recalling routes were tested in a descriptive task and geographic knowledge was evaluated with a Brazilian map. Results: Patients and control subjects were not different regarding schooling years and gender. There were differences between patients and controls in the questionnaire on topographical orientation and in all tests except in visual spatial tasks. Patients with mild dementia had difference in the questionnaire, recalling routes, landmark recognition, personal orientation, geographical knowledge and line orientation judgment. Only the landmark recognition test was found to differentiate between patients with mild or moderate dementia. Conclusions: The topographic orientation questionnaire showed that even in mild dementia, AD patients have topographical disorientation. The landmark recognition, self-centered and world-centered orientation were precociously affected and may contribute for topographical disorientation. Spatial working memory and spatial visual functions are not compromised initially and xiii probably did not contribute for topographical disorientation in the patients with mild dementia. However, patients with moderate dementia showed impairment in spatial working memory and spatial visual tests, which may have contributed to the topographic disorientation of these patients