The purpose of this study was to determine if the Glasgow Coma Scale (GCS) provides a valid indication of severity after closed head injury. A second purpose was to determine the nature of the deficits seen with head injured persons shortly after injury.The subjects were 69 patients ages 13 through 26 selected from consecutive closed head injury admissions to a large acute care hospital. The subjects received comprehensive neuropsychological testing after having passed the Galveston Orientation and Amnesia Test.Two a priori hypotheses were specified for each of eight neuropsychological test groupings (i.e., motor, memory, visuographic, achievement, abstraction and concept formation, language, problem solving, and psychometric intelligence). For each of the eight test groupings two, one-way multivariate analyses of covariance (MANCOVA) were used to determine statistical significance. Premorbid IQ was used as a covariate in all of the analyses. Specifically, these a priori contrasts were GCS group (8 compared with GCS group 9-15 and GCS group 9-12 compared with GCS group 13-15. Each of the significant MANCOVA tests was followed with discriminant analysis.The results revealed that 15 out of the 16 null hypotheses were rejected (p<.05 or less) thus providing clear evidence for the usefulness of the GCS as an indicator of the severity of injury. Most notable of the results is that the GCS group comparison of 9-12 and 13-15 reached significance in seven of the eight comparisons. Given this finding, there seems justification for the GCS division of 9-12 denoting a moderately injured group and 13-15 denoting a mildly injured group as was proposed in previous research. Redundancy indexes of 6% to 25% were obtained which indicated small to relatively large effect sizes for the various criterion variates.With discriminant analysis it was determined that accurate classification into GCS groups could be achieved in 64% to 94% of the cases based upon a combination of premorbid IQ and the criterion variates. This represented an increase in classification accuracy of from 13% to 51%to be over what could be accomplished with knowledge of the premorbid IQ alone. The motor test composite, problem solving test composite and abstraction and concept formation composite revealed the highest rates of reclassification.

The purpose of the current study was to determine if the Nova Multilingual Neuropsychological Battery (NMNB) can detect neurological deficits in the traumatic brained injured (TBI) Hispanic sample by comparing subtest mean scores to the normal group mean scores. The NMNB is comprised of 39 subtests and was developed to account for language and cultural factors thought to influence neuropsychological test results. It was hypothesized that significant differences would be found in NMNB measures sensitive to brain damage. A sample size of 100 English-Spanish speaking bilinguals (50 TBI and 50 cognitively intact participants) was tested in Spanish in order to compare cognitive performance across the various NMNB measures. Due to the number of comparisons, the alpha level for this study was set to .01 to reduce Type I error. Results of the ANCOVA's partially supported the hypothesis after controlling for age and education. Findings show that the NMNB measures were able to successfully detect the TBI Spanish group from the normal Spanish group. Significant differences were displayed in the tests measuring nonverbal abilities, memory and learning, visual spatial skills, and executive functioning. More specifically, no significant differences were displayed in the tests measuring crystallized premorbid abilities, while tests measuring more fluid abilities detected problems with abstract thinking and information processing in the TBI sample. A similar deficit pattern was displayed across all measures of higher functioning systems. Deficits were detected in the nonverbal measures that involved complex attention (selective, divided, and alternating forms of attention) and concentration for visuospatial tasks, pattern synthesis and manipulation, but not for simple visuospatial attentional activities. Significant differences were found in motor speed, but not in the number of errors. These findings support previous research indicating that Hispanics tend to favor accuracy over speed. Additionally, results reveal significant differences across all memory measures. Using Cohen's d, large effect sizes were displayed between the groups ranging from 1.5 to 2.3 in the verbal and visual memory measures. Similar effect sizes were also displayed in tests of executive functioning. Preliminary data of this study suggests that the NMNB may be a sound assessment tool for detecting neurological impairments in TBIs. Collectively, the NMNB displayed significant differences in motor and processing speed, memory, visuospatial tasks, and executive functioning commonly documented in non-Hispanic TBIs. This study concluded that culturally sensitive neuropsychological tests that also control for demographic variables such as age and education can provide accurate results for Hispanics with TBI. However, these results should be interpreted with caution as this study was limited to a small sample size with an unequal proportion of TBI severity levels and educational experiences beyond educational levels. Future studies should focus on obtaining larger samples with varying TBI severity levels. Samples should also include bilingual Hispanics tested in English as well as monolingual Spanish speakers in order to develop profiles that may be useful in differential diagnosis.

Conduct Disorder is a disruptive behavior disorder listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision (DSM-IV-TR). Considering the prevalence and severity of Conduct Disorder and the social and economic impact, research is needed to address subtype and comorbidity. The purpose of the present study is to investigate the impact of Conduct Disorder age of onset by comparing neuropsychological functioning between adolescents diagnosed with Conduct Disorder, childhood-onset and adolescents diagnosed with the adolescent onset subtype of Conduct Disorder. In addition, the study will investigate the impact of a comorbid Attention-Deficit/Hyperactivity Disorder (ADHD) diagnosis. Exploration into the neuropsychological functioning of Conduct Disorder while considering comorbidity with ADHD is needed to clarify cognitive functioning profiles of children and adolescents diagnosed with Conduct Disorder. / text

The Neuropsychological Symptom Inventory (Dean, 1982) was developed to examine the neuropsychological symptomology presented by patients. It consists of 17 items that assess family/medical history that are responded to on a true/false format. In addition, there are 100 items which assess cognitive, emotional-social, sensory-perceptual, and behavioral symptomology, which are to be responded to on a Likert scale from 1 to 4.The present study investigated the validation of the Neuropsychological Symptom Inventory (NSI) (Dean, 1982). In a series of investigations the construct validity, internal consistency, and test-retest reliability of the NSI were examined. Such procedures were considered essential to investigate the utility of the NSI.The subjects numbered 826, for the factor analysis study and the internal consistency analysis, which consisted of college students from introductory psychology classes, and patients seen in both outpatient and inpatient settings. Additionally, there were 132 subjects who participated in the study for test-retest.Utilizing a varimax rotation, a four factor solution was obtained for the NSI, accounting for 47.9 % of the total variance. The results demonstrated high internal consistency for the NSI, with an overall Alpha coefficient of .967. In addition, moderate test-retest estimates were found, ranging from .3365 for Factor 3 to .6223 for Factor 4.These results showed strong psychometric properties for the NSI and suggest its use as a viable alternative to currently available measures. Results are discussed in terms of a need for further refinement of the NSI. / Department of Educational Psychology

No description available.

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.

The present study investigated deaf children's performance on several modified tests of the original Halstead Reitan Neuropsychological Battery for Older Children (HRNB-C). Specifically, performance of 42 deaf children (mean age = 13.3 years, SD = 0.7 yrs.) and a matched sample of 42 hearing peers was examined on the HRNB-C Category, Tactual Performance, and Trail Making tests.In Study 1, a computerized version of the Category Test was administered. Step-down F tests were used to examine differences in total errors and the unique contribution of response time. In Study 2, the Tactual Performance and Trail Making scores were dependent variables. Logistic regression analysis was used to explore multivariate intergroup differences.The major finding of this research was that neuropsychological abilities of deaf children who have no additional handicapping conditions or impairments are, in general, similar to matched hearing controls. Few clinically relevant differences were found. No quantitative differences were found on Trail Making Part A or the total number of Category Test errors. Noteworthy, from a qualitative stance, was the role of response time and its unique contribution within the Category Test. Deaf subjects had significantly greater response times to individual items regardless of correctness of answer. Deaf children were also found to take longer on Trails B, although they performed within normals limits. With respect to the Tactual Performance Test (TPT), deaf children did slightly better than their matched hearing peers on TPT total time and location. In addition, Trails B and TPT location scores were the best multivariate composite of discriminators of deaf versus hearing performance. Notwithstanding, overinterpretation of statistical differences found in both studies was cautioned and the similarities of performance between deaf and hearing children emphasized.These findings offered information of deaf children's neuropsychological functioning compared to hearing controls in the clinical setting. Moreover, the results of the present study should be generalizable to other "non-impaired", 12-14 year old deaf children within a residential academic environment. / Department of Educational Psychology

Yes / We report that performance on neuropsychological tests used in the diagnosis of dementia can be influenced by external factors such as time of day (TOD) and caffeine. This study investigates TOD effects on cognitive performance in the elderly. The optimal TOD at which an individual is at their maximal arousal alters with age and in the elderly typically occurs in the morning. Neuropsychological test scores from healthy elderly participants were analysed to determine whether TOD affected performance. Interactions between caffeine and TOD were also investigated. Across two data sets that were analysed, significant TOD effects were noted for Pattern Comparison Speed (PCS), Letter Comparison Speed (LCS), Trail Making Test Part A, Mini Mental State Examination (MMSE) and the Graded Naming Test (GNT), revealing a decline in test scores as TOD increases. Significant interactions between TOD, age and the PCS, LCS and Trail Making part A were noted in data set one. In data set two, where caffeine intake had been controlled for, significant interactions between caffeine, TOD and scores on the MMSE and GNT were found. The TOD and caffeine effects highlight the need to control for these external factors when scoring the assessments. This conclusion has implications for the clinical procedure of diagnosis and treatment of dementia and Alzheimer’s.

To align the neuropsychological functioning of our adult euthymic patient group with that reported in previous studies on euthymic bipolar disorder (BD), we used a neuropsychological battery that examined sustained attention (Rapid Visual Information Processing Task), verbal memory (California Verbal Learning Task), executive functioning (Intradimensional-Extradimensional Shift Task, Barrett Impulsivity Task, and Framing Task), and emotion responsiveness/regulation (Positive Affect/Negative Affect Scales, Behavioral Inhibition/Behavioral Activation Scale, and Affective Lability/Affective Intensity Scales) in patients versus healthy volunteers (HV). Our results corroborated existing evidence of reduced sustained attention, impaired verbal memory and executive functioning, and abnormal emotional responsiveness and regulation in euthymic BD relative to healthy controls (Chapter 2). To investigate how abnormal development of brain function in BD leads to deficits in decision-making, motor inhibition, and response flexibility, we examined child and adult BD using a novel risky decision-making task, and used cross-sectional (age x diagnosis) functional magnetic resonance (fMRI) designs to examine neural activation associated with motor inhibition and response flexibility in BD relative to HV. During the risky decision-making task, adult euthymic BD patients were no different from healthy controls in their proportion of risky lottery choices over a range of competing lotteries. This matched behavioral performance was associated with similar prefrontal and striatal brain activation between the patient and control groups during response, anticipation, and outcome phases of decision-making (Chapter 3). These results are different from previous studies that have shown increased risk taking during decision-making in euthymic BD. Similarly, young BD patients were no different from age-matched healthy and patient controls in their pattern of decision making during the risky choice task. This was evidenced by a similar number of risky lottery selections over the range of changing expected values between the young BD group and control groups (Chapter 4). Using a cross-sectional, fMRI analytic design during the stop signal task, we found that child and adult BD showed similar behavioral performance to child and adult HV during motor inhibition. However, this matched behavioral performance was associated with abnormal neural activation in patients relative to controls. Specifically, during unsuccessful motor inhibition, there was an age group x diagnosis interaction, with BD youth showing reduced activity in left and right ACC compared to both age-matched HV and adult BD, and adult BD showing increased activation in left ACC compared to healthy adults. During successful motor inhibition there was a main effect of diagnosis, with HV showing greater activity in left VPFC and right NAc compared to BD (Chapter 5). These neuroimaging data support existing laboratory-based evidence of motor inhibition impairments in BD relative to HV, and indicate brain dysregulation during motor control is important to BD pathophysiology. A previous behavioral study showed impaired response flexibility in young BD patients relative to age-matched controls when using the change task. Here, we used the change task during fMRI to examine response flexibility in child and adult BD compared to child and adult HV. We found that patient and control groups showed similar change signal reaction times in response to change cues. However, this matched behavioral performance was associated with abnormal age group x diagnosis activations in brain regions important in signal detection, response conflict, response inhibition, and sustained attention. Specifically, during successful change trials, child BD participants showed frontal, parietal, and temporal hyperactivation relative to healthy children and adult BD, while adult BD showed hypoactivation in these regions relative to healthy adults. These novel fMRI findings during the change task indicate impaired neural activation during response flexibility may be important to the pathophysiology of BD development.

Introduction-Physical activity can reduce the risk of contracting many of the 'diseases of the sedentary', such as coronary heart disease and cancer (Blair et al., 1996). Recognition of this protective effect has led to the development of many programmes designed to promote the benefit of participation in sport and physical exercise (Hillary Commission, 1993; Nicholl et aI., 1995). With participation in sport, especially contact sport, the risk for injuries increases, including injuries to the head and neck (Wilberger, 1993; Wekesa et al., 1996; Pettersen, 2002). Mild traumatic brain injuries (MTBI) or concussion as used interchangeably in the literature (Maroon et al., 2000; Wills & Leathem, 2001) are an important public health concern, due to the high incidence and frequently persisting symptomatology (Evans, 1992). Mild traumatic brain injury is defined as a complex patho-physiological process affecting the brain induced by traumatic biomechanical forces (Aubry et al., 2002; McCrory et al., 2004). A sub-concussive injury or very mild traumatic brain injury (vMTBI) may be defined as an apparent brain insult with insufficient force to cause hallmark symptoms of concussion (Jordan, 2000; Webbe & Bath, 2003). The high incidence of sport related head injuries in South Africa is alarming, although the prevalence thereof is unknown and difficult to assess, as the seemingly trivial injuries frequently remain unreported (Roux et al., 1987). This is especially applicable in sport where a milder form of head injury is common. This is cause for concern as cumulative head injuries traditionally regarded as trivial or 'minor' may result in players running the risk of increasingly negative consequences following repetitive 'minor' head injuries. In contact sport such as rugby, players are at great risk of sustaining repetitive mild traumatic brain injuries. The negative outcome following these repetitive minor head injuries has been demonstrated by numerous studies on boxers and other athletes exposed to repeated MTBI and vMTBI (McLatchie et aI., 1987). The incidence of vMTBI has not yet been researched in school rugby and this study is the first to report the incidence of vMTBI in a secondary school rugby team. Obiectives - The objectives of this study were to determine the incidence, the neuropsychological consequences and the effect on the academic performance of repeated mild (MTBI) and very mild traumatic brain injuries (vMTBI) in a secondary school rugby team during one playing season. Methods - A cohort of 35 secondary school male rugby players divided into a vMTBI (group 1) (n=26) and a MTBI (group 2) (n=9) from a local secondary school's first and second team, was followed for a full competitive season by a trained Biokineticist, who was present at all the games and contact sessions played. All vMTBI and MTBI and the severity of these injuries were documented. A control (group 3) that consisted of 10 secondary school non-rugby players were compared with the vMTBI and MTBI groups. The incidence of repeated MTBI and vMTBI in a secondary school rugby team were gathered by questionnaires and observation next to the field by a trained Biokineticist. Pre-season and post-season neuropsychological tests were conducted on the research groups and the control group. The neuropsychological tests that were conducted on the three groups were the Colour Trial Test 1 and 2 (CTT 1 + 2), the Symbol Digit Modalities Test (SDMT), the Wechsler Memory Scale-Revised (WMS-R) and the Standardised Assessment of Concussion (SAC). After each match played throughout the season the research group also completed a SAC test. The academic results of the final examination (year 1) of the year of the specific rugby season were obtained, as well as the academic results of the final examination of the preceding two years (year 2 and 3). The programme STATISTICA (version 7.0, Stat soft, Tulsa, OK) was used to analyse the data. Descriptive statistics, one-way ANOVA's, two-way repeated measures ANOVA's, Post-hoc Tuckey HSD analysis and Pearson's product moment correlation were used for all the statistical analyses. Results - This study of a secondary school rugby team has shown 726 vMTBI's and 18 MTBI's throughout one rugby season. This relates to 1951 vMTBI's per 1000 player hours and 48 MTBI's per 1000 player hours. Reductions in delayed memory (p=O.O1)from preseason to post-season in a group of players with repetitive vMTBI's during a single rugby season were found. This was the first evidence of possible neurocognitive deficits towards delayed memory in very mild traumatic brain injuries at secondary school level. Statistically significant (p<=0.05)results of the SAC test totals between both the vMTBI and MTBI groups were documented in the different games throughout the rugby season and compared with the baseline test. No statistically significant differences (p<=0.05) between the pre-season and post-season's scores of the SAC test totals were documented. A decrease in academic performance in the subject Afrikaans (year 1 compared with year 2) with a p-value of p=O.O17(group 1) and p=O.O16(group 2) respectively was found. Conclusion - The findings of this study indicate a high incidence of vMTBI in a cohort of secondary school rugby players in one season, a statistically significant reduction (p=O.O1 )in delayed memory of the vMTBI rugby players and a statistically significant decrease in academic performance p=O.O17 (group 1) and p=O.O16 (group 2) in the subject Afrikaans from year 1 to year 2 final examinations. / Thesis (Ph.D. (Human Movement Science))--North-West University, Potchefstroom Campus, 2006.