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The current study examined the WAIS-IV and how the changes to the test may impact the measure's usefulness in neuropsychological evaluations. It was hypothesized that the WAIS-IV would be a significantly better predictor of performance on the neuropsychological measures of the Category Test, Finger Tapping Test, Trail Making Test, and Wisconsin Card Sorting Test over the WAIS-III. The mixed clinical sample came from an archival database of volunteer research participants and individuals clinically referred to a university outpatient facility. A total of 91 participants were administered the WAIS-III and WAIS-IV as part of a larger neuropsychological battery. The results of the current study found that both the WAIS-III and the WAIS-IV were able to account for a significant amount of the variance in performance on the neuropsychological measures, with the exception of the FTT dominant and non-dominant hands, where only the WAIS-IV was able to significantly account for the variance in performance on the measures. Using the Alf and Graf (1999) model, there were no significant R2 differences between the WAIS-III subtests and WAIS-IV at the .01 significance level. Thus, the WAIS-IV did not provide a better model for predicting performance on any of the neuropsychological measures. It should be noted that the small sample size of the current study may have inflated the R2, particularly in the WAIS-III models, which could have masked greater R2 differences between the two models. While the publishers endeavored to make the WAIS-IV a better measure of processing speed, working memory, and fluid reasoning, these goals were largely unmet. The analyses of the WAIS-IV working memory subtests, showed that the sequencing component added to the Digit Span subtest did not add to the relationship with neuropsychological measures with working memory components. The analyses of the WAIS-IV processing speed subtests showed that the Coding subtest of the WAIS-IV was a better measure of processing speed than the WAIS-III version, but this was not found for the PSI as a whole. Changes to Symbol Search did not show any improvement in the relationship to neuropsychological measures. One interesting finding was that the new subtest of Visual Puzzles does appear to add to the relationship with neuropsychological measures over the other subtests of the WAIS-IV. Visual Puzzles was consistently the highest correlated PRI subtest with the neuropsychological measures, with the exception of the WCST. The subtest appears to assess a wide range of abilities outside of the spatial reasoning skills purported by the test publishers. Specifically, the subtest was correlated with measures of processing speed, executive skills, and motor speed/reaction time. Thus, clinicians should use caution and examine all possible options when evaluating poor performance on this new subtest. Since none of the WAIS-IV models were able to significantly predict performance on any of the neuropsychological measures over the WAIS-III models, it would appear that the WAIS-IV as a whole is not a better neuropsychological measure than its predecessor. Despite being the gold standard for intellectual assessment, the WAIS-IV appears to add little to clinical utility over the WAIS-III outside of shorter administrative time. Clinicians are advised to continue using neuropsychological measures to assess processing speed, working memory, and higher order cognitive skills in conjunction with the WAIS.

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This study used an archival data set of 26 healthy adult immigrants from a sub-Saharan African country to the United States (Mage 39.0, SD = 11.36; Meducation 16.33, SD = 2.88; 40.7% male). Additional archival data was used for 32 healthy African American adults (Mage 34.06, SD = 11.18; Meducation 16.16, SD = 2.49; 53.1% male). A bivariate correlation indicated that acculturation to African culture, as measured by the mBIQ (M 49.29, SD = 8.66), was significantly positively correlated with ethnicity, r = .632, p = .000, ηp2 = 0.399. Two-way ANOVAs revealed that African Americans were able to name more animals than African immigrants (F(1, 54) = 4.82, p = 0.32, ηp2 = 0.82) and exhibited greater organizational skills during a task of cognitive set shifting and problem solving than African immigrants, regardless of level of acculturation (F(1, 54) = 4.47, p =.039, ηp2 = 0.078). In contrast, African immigrants scored higher than African Americans on indigenous fruit (F(1, 54) = 7.60, p =.008, ηp2 = 0.123) and object naming (F(1, 54) = 5.59, p =.022, ηp2 = 0.094). Results of the study concluded that there are small variance effects in language tasks as well as strategy-based approaches to tasks of novel problem solving. Implications of these findings are discussed relative to future research as well as clinical practice in the assessment of culturally dissimilar people across a racially homogenous population by pushing the field forward with diversified approaches to neuropsychological testing.

As the global burden of dementia continues to plague our healthcare system, efficient, objective, and sensitive tools to characterize cognition and detect underlying neurodegenerative disease increasingly are needed. Digital phenotyping relies on passive, continuous collection of smartphone sensor data during everyday life to measure activities, behaviors, and mood. The present study explored the feasibility, acceptability, and validity of a digital phenotyping protocol as a novel method for characterizing cognition and function among a heterogeneous group of older adults. Validation analyses were based on a recently proposed conceptual model explaining activity level and variability as a function of cognitive ability level. Exploratory analyses aimed to examine and account for a range of participant and environmental factors that may be associated with digital phenotyping data. A total of 22 participants ages 65 - 81 years with either healthy cognition or mild cognitive impairment (MCI) used their own personal smartphones naturally during a four-week study period while a secure software application unobtrusively and continuously obtained Global Positioning System (GPS)-based movement trajectories. Participants completed gold-standard neuropsychological measures and questionnaires of everyday function, mood, and mobility habits at a baseline visit intended to evaluate construct validity. In-depth informed consent and a comprehension of consent quiz also were administered at baseline to inform feasibility of explaining digital phenotyping study procedures to older adults. Debriefing questionnaires were completed at the end of the study period, including questions pertaining to acceptability. Correlation analyses showed that measures of GPS activity and variability were positively associated with validators of cognition, everyday function, mood, and mobility habits. Potential confounding factors included season of study participation, unexpected health changes, and highest lifetime household annual income, whereas participant demographics such as education, sex, and race were not significantly associated with GPS features. Metrics on study withdrawal, comprehension of consent, and satisfaction ratings at study completion revealed good feasibility and acceptability. In sum, digital phenotyping shows promise as a feasible, acceptable, and potentially valid method to efficiently and objectively assess cognition, function, and mood in a cohort of older adults. Future studies will benefit from incorporating these preliminary findings and testing predictions in larger, more diverse cohorts both cross-sectionally and over time in longitudinal designs. / Psychology

No description available.

Posttraumatic stress disorder (PTSD) is associated with significant functional impairments and disruptions in cognitive functioning. Functional recovery and remediation of cognitive difficulties are oft over-looked treatment targets in this population, despite their significant contribution to the burden of PTSD to the individual and to society. Existing literature suggests that functional impairment and cognitive dysfunction may not respond to first-line treatments for PTSD. Thus, the focus of this thesis was to examine symptom dimensions associated with cognitive dysfunction and functional impairment among individuals with PTSD, and to investigate a novel approach to cognitive remediation, Goal Management Training (GMT), in this population. Study one in this thesis is a review in which we identified a strong relation between dissociative symptoms and neuropsychological functioning, transdiagnostically and among individuals with PTSD. The hypothesis that dissociative symptoms would be strongly related to functional impairment among individuals with PTSD was explored in study two. We found that dissociative symptoms mediated the relation between PTSD symptoms and functional impairment among a sample of military members, veterans, and first responders with PTSD. Study three identified that emotion regulation difficulties and dissociative symptoms most strongly predicted functional impairment among civilians with PTSD and high rates of exposure to childhood abuse and neglect. In study four we investigated the effectiveness of a cognitive training program, Goal Management Training (GMT), in improving cognitive functioning, clinical symptoms, and functional impairment among inpatients with PTSD. Participation in GMT was associated with improved cognitive functioning and increased ability to engage in goal directed behaviours when highly emotional. This thesis highlights the importance of assessing emotion regulation difficulties and dissociative symptoms in order to target functional impairment and cognitive dysfunction among individuals with PTSD. Moreover, it provides evidence for a potential treatment approach to ameliorate these difficulties. / Thesis / Doctor of Philosophy (PhD) / Posttraumatic stress disorder (PTSD) is a mental health condition that develops after exposure to a traumatic event. It is associated with reduced functioning in important areas of life, including social relationships, work performance, and self-care. PTSD is also associated with reduced cognitive functioning in areas such as memory, planning, and organization. This thesis focuses on examining variables that may be related to these difficulties, including specific symptoms such as difficulty managing emotions and difficulties remaining in the present moment (dissociation). We also investigate a treatment program, Goal Management Training (GMT), aimed at teaching skills to improve cognitive and daily functioning. By understanding what contributes to cognitive functioning and functional difficulties in individuals with PTSD and by providing evidence for a treatment that can improve these difficulties, we hope to improve the lives of individuals with PTSD.

Yes / Cognitive ability is used in numerous everyday situations (for example, in the classroom, workplace and home) and can be measured using cognitive tests designed to target specific cognitive domains. Cognition can be influenced by external factors (for example, age, education, caffeine intake and time of day) which if not controlled for or noted could influence performance. Prior food intake has not received a direct focus in the cognition literature, and therefore, this study aims to investigate the time elapsed since the last food item was consumed as a factor which may affect cognitive performance. Fifty-two healthy adults with no reported cognitive impairment or diagnosis of any eating or metabolic disorder took part in the study. Participants completed a self-rated hunger scale and stated the time that they last consumed a food item. The time of day that the assessments were completed was also noted. All participants completed a brief cognitive battery consisting of a semantic recall assessment, digit span and parts A and B of the Trail Making Test. Results revealed a significant main effect of minutes since the last food item was consumed on semantic recall and both Trails A and B whereby performance was significantly worse as the time since the last food item was consumed increased. These results suggest that information about when the participant consumed food prior to assessment should be gathered to check for any such effects. This could have implications for cognitive performance in educational settings and clinical environments, where scores often determine academic progression and further interventions.

No / . Early detection of cognitive decline in the elderly is important because this may precede progression to Alzheimer's disease. The aim of this study was to see whether sensitive neuropsychological tests could identify pre-clinical cognitive deficits and to characterize the cognitive profile of a subgroup with poor memory. Methods. A neuropsychological test battery was administered to a community-dwelling sample of 155 elderly volunteers who were screened with CAMCOG at enrolment (mean age 74·7 years). The battery included tests of episodic memory, semantic and working memory, language and processing speed. Results. Episodic memory test z scores below 1 S.D. from the cohort mean identified 25 subjects with `non-robust¿ memory performance. This group was compared to the remaining `robust memory¿ group with a General Linear Model controlling for age, IQ, education and gender. Test performance was significantly different in all tests for episodic and semantic memory, but not in tests for working memory, processing speed and language. CANTAB paired associates learning and spatial recognition tests identified the highest percentages of those in the `non-robust memory¿ group. Processing speed partialled out the age effect on memory performance for the whole cohort, but the `non-robust memory¿ group's performance was not associated with age or processing speed. Conclusions. Sensitive neuropsychological tests can detect performance below the norm in elderly people whose performance on MMSE and CAMCOG tests is well within the normal range. Age-related decline in memory performance in a cohort of the elderly may be largely due to inclusion within the cohort of individuals with undetected pre-clinical Alzheimer's disease or isolated memory impairment.

Mild Traumatic Brain injury (mTBI) is one of the most common forms of acquired neurological damage. However, the term 'mild' TBI is misleading because the physical, cognitive and emotional impairments that can follow from mTBI can be significant. In order to provide objective, prognostic measures for diagnosing the severity of mTBI and identifying individuals who may be at risk for poor outcomes a battery of neuropsychological measures for detecting cognitive impairment was evaluated. The Rapid Screen of Concussion (RSC) is a collection of tests assessing verbal recall, orientation, processing speed and speed of language comprehension. Previous studies have demonstrated that the RSC has acceptable reliability, validity and sensitivity to cognitive impairment that arises during the acute stages of injury. However, no studies have investigated the predictive validity of this instrument. Moreover it is unclear what additional patient or post injury variables could assist in identifying those individuals who may be at risk of poor neuropsychological outcomes following mTBI. These were among the main issues that were addressed across the five empirical studies in this thesis. A pragmatic, prospective, longitudinal and cross-sectional study of the sequelae of mTBI in patients presenting to the Department of Emergency Medicine of the Royal Brisbane and Women's hospital was the basis of this project. The first empirical chapter (chapter 2), examined the psychometric properties of two measures of verbal learning and memory and investigated their potential for discriminating between mTBI and orthopaedic controls. The performance of 93 patients with mTBI and 68 participants with orthopaedic injuries was analysed to identify the number of individuals who performed at ceiling on the Hopkins Verbal Learning test (HVLT-R) versus a 5-word test of immediate and delayed recall. While both of these verbal recall measures were effective in separating the mTBI and orthopaedic groups, overall, the HVLT-R was shown to be a more suitable measure for screening for deficits in verbal learning and memory after mTBI. Given the superiority of the HVLT-R as a measure of verbal learning and memory, chapter 3 aimed to examine whether inclusion of this test could improve the sensitivity of the RSC in mTBI compared to orthopaedic and uninjured control samples. Results were generally within the direction predicted. Significant differences were found between groups on the majority of cognitive indices assessed. Both the orthopaedic and mTBI group performed more poorly than the uninjured group on all measures except the Hopkins delayed recognition. Additional performance decrements shown by the mTBI group compared to the orthopaedic group illustrate that factors beyond the general effects of trauma influence performance and may be related to cognitive impairment specific to sustaining mTBI. Overall it was concluded that the revised RSC is a sensitive instrument deserving investigation in assessing the more long term cognitive effects following mTBI. Chapter 4 applied this sensitive battery for investigation of group and individual recovery of neuropsychological test performance and post-concussive symptom reporting up to 3-months after mTBI. A sample of 30 mTBI participants and 30 uninjured controls were serially assessed on cognitive measures and symptom report scales immediately after injury and after 1-week, 1-month and 3-months. Symptom reporting on the Rivermead post-concussive inventory separated the mTBI and control groups after 1-week but diagnostic accuracy was no greater than chance at 1 and 3-months. In contrast the mTBI group performed more poorly than controls on measures on neuropsychological measures acutely, at 1-week and 1-month, with group differences still evident after 3-months. Nonethless, a trend of progressive recovery over time was seen in the mTBI group. In chapter 5, criteria utilising the concepts of reliable and statistically significant change were applied to the data. Overall, 73% of mTBI patients were impaired on one or more tests acutely. Significant recovery was demonstrated by 20% of mTBI participants by 3-months; however recovery remained incomplete for half of the mTBI participants by 3-months. These results highlighted the importance of an individual approach to the assessment of mTBI and support the notion that a proportion of mTBI cases may have protracted difficulties. Chapter 6 extended these findings by showing that the RSC has prognostic ability. It was found that acute neuropsychological performance on the RSC was a significant predictor of performance on an extended battery at 3-months. The final chapter provides a general discussion and synthesis of the findings. In summary, the present dissertation demonstrated that inclusion of a sensitive measure of verbal recall led to improved diagnostic validity of the RSC. Neuropsychological measures rather than symptom reporting were sensitive in detecting cognitive impairment at 3-months. Analysis of individuals showed that up to 50% of the group had failed to – demonstrate reliable recovery – that is, make improvements over and above practice effects after 3-months. Finally, acute neuropsychological performance was predictive of long term performance. Overall, the present thesis has identified a short battery of tests that is suitable for assessment of mTBI within 24 hours and may assist in identifying individuals at risk of poor cognitive outcomes after mTBI.