Background: Alcohol misuse and dependency are major health problems worldwide. Despite the availability of a number of evidence-based treatments for alcohol-dependency, a large proportion of people relapse following detoxification. The costs to society and the individual are vast, not only economically but in terms of social and interpersonal functioning also. There is a recognised need to understand the factors that contribute to poorer outcomes in this population. Cognitive impairment is one factor that has demonstrated considerable associations with poor outcomes in the wider substance-misuse population. Aims: This thesis has two sections. The first comprises a systematic review which aimed to present the objective evidence for emotional decision-making deficits in the alcohol dependent population. The second is an empirical study which aimed to establish whether or not relapse can be predicted in a severely alcohol dependent population in the early stages following inpatient detoxification. In addition, a normative dataset for this clinical population using the ACE-III is presented. Methods: For the systematic review, a structured search of the literature relating to emotional decision-making in alcohol dependent samples was conducted. Iterative application of pre-defined inclusion and exclusion criteria identified eighteen studies for critical review. Quality assessment of these studies was undertaken and validated by means of calculating inter-rater reliability. For the empirical study, two sub-samples of a cross-sectional group of patients being treated for severe alcohol-dependence were examined; one to collate normative data for the ACE-III (N=73) and one to investigate associations between the ACE-III and relapse (N=20), including covariates of age, mood, anxiety and motivation. Results: The systematic review demonstrated substantial support for a deficit in emotional decision-making ability in alcohol-dependence. Methodological quality of the reviewed papers was moderate to high. Deficits in performance on a task of emotional decision-making compared to healthy controls indicated a reduced learning curve in alcohol dependent samples. Limitations of the studies included failure to report power analyses and effect sizes, insufficient detail regarding methodology and exclusion of common comorbidities in alcohol-dependence. The empirical study demonstrated clinically significant cognitive impairment in a sample of severely alcohol dependent individuals in the early stages following detoxification. In a smaller sample, cognitive functioning was not found to be predictive of relapse at one-month post-detoxification. Associations were identified between age and ACE-III score and between age and relapse status. Age was not predictive of outcome. Conclusions: The available evidence points towards the existence of emotional decision-making deficits in alcohol dependent individuals. These are likely to impact on the ability of individuals make the health behaviour changes required to recover from alcohol dependence. Further research may be helpful in identifying factors associated with increased decision-making deficit in this specific population and investigating the processes underlying such difficulties. The clinical normative dataset presented in the empirical study points towards generalised cognitive impairment during the early stages of abstinence which may negatively impact on ability to engage meaningfully with psychosocial interventions. Performance on the ACE-III was not found to predict relapse in the current sample. Previous research would suggest that the links between cognitive functioning and relapse are less well defined in alcohol-misusing samples than in the wider substance-misuse population. Therefore future research may help to clarify this association in alcohol dependent samples. It is acknowledged that the ACE-III is yet to be validated for use in the alcohol dependent population and is limited in its ability to assess executive functions. Given the high prevalence of executive functioning deficits in the alcohol dependent population, it seems of importance to use cognitive screening tools which place appropriate emphasis on these abilities. Service providers are encouraged to incorporate routine cognitive screening into clinical practice and consider the implications of cognitive impairment at both individual and service delivery levels.

Advances in cancer treatment have led to increasing numbers of survivors left to struggle with the long-term adverse effects of disease and treatment. Many possible effects have been described including anxiety, depression, as well as physical side effects and consequences of cancer treatment. One particular adverse effect that is frequently reported but often overlooked in clinical practice is disturbances of cognitive functioning. Cancer-related cognitive impairment (CRCI) is a growing area of research with important clinical implications for current patients and survivors. Despite a huge increase in this research endeavour in the last 20 years, many important questions remain unanswered due, in large part, to methodological limitations of many of the studies. The overall goal of this dissertation is to critically examine previous CRCI research from a methodological perspective. It will explore limitations and confounds in this research and provide suggestions for improving future work. This dissertation is comprised of three manuscripts, a critical literature review and two original papers, addressing specific research questions. The first original paper addresses the disparity between the results of objective (performance-based) and subjective (self-report) measures of cognition that is typically observed in samples of cancer patients, using multilevel modeling to explore the hypothesis that this is due to failure to address measures of change over time. Despite negative findings, the methodological approach taken to this research question provided greater evidence for this subjective-objective disparity as well as methodological suggestions for future studies. The second original paper explores the sensitivity and validity of a computerized cognitive test for measuring CRCI to determine if it might be an appropriate alternative to traditional, resource-intensive neuropsychological testing. This study found that, although the computerized measure of cognitive functioning was not sensitive enough to detect changes at the individual level or within specific domains, it was sensitive to changes in cognitive functioning at the group level suggesting its usefulness as a screening tool in research settings. By addressing methodological limitations of research to date and, specifically, the two issues identified above, this dissertation aims to a) make recommendations to help improve the quality of future research, b) validate the cognitive complaints of cancer patients, and c) improve access to cognitive assessments leading to increased detection and treatment of cognitive side effects and improvement in quality of life of cancer survivors.

abstract: This body of research sought to explore relationships between cognitive function and physical activity (PA), sedentary behavior (SB), and sleep, independently and in conjunction, in mid-life to older adults with no known cognitive impairment. Aging is associated with cognitive decline, and lifestyle behaviors such as PA, SB, and sleep, may mitigate this decline. First, a systematic review and meta-analysis was conducted to examine the effect of aerobic PA interventions on memory and executive function in sedentary adults. Second, a longitudinal study was conducted to examine the association between SB and odds of incident cognitive impairment, and SB and cognitive decline in older adults. Last, a cross-sectional study was conducted to examine the joint associations between different levels of sleep with levels of PA, and sleep with levels of sedentary time on memory and executive function. This body of research provided evidence to support the association between aerobic PA and improved cognitive function, SB and incident cognitive impairment and cognitive function declines, and the joint association of sleep and different levels of PA and ST on cognitive function by hypertension status. / Dissertation/Thesis / Doctoral Dissertation Healthcare Innovation 2020

Contact and collision sports (CCS) expose athletes to countless repetitive head impacts (RHI) across a single season, potentially leading to increased risk of long-term difficulties in cognition and the development of neurodegenerative disease. There is mixed literature on whether RHI from CCS result in changes to white matter and long-term neurobehavioral outcomes, therefore this research project seeks to provide supporting evidence by comparing the total volume of fluid-attenuated inversion recovery (FLAIR) white matter lesions in individuals with a history of RHI from CCS to those without a history of RHI from the Boston University Alzheimer’s Disease Research Center (BU ADRC). The RHI participants were matched to a group of non-RHI participants based on age (+/- 5 years). Effects of RHI on white matter hyperintensities (WMHs) are evaluated, while considering hippocampal volume across RHI and non-RHI groups. When controlling for age, sex, education, and total hippocampal volume, those with a history of football were found to have a significantly greater WMH volume (p=.02) compared to those without a history of football play. Compared to the non-RHI group, the RHI group including all athletes (n=42) had a greater WMH volume, although it did not reach a level of significance (p=.91). This investigation provided preliminary evidence for a link between high RHI exposure and WMHs in football players, and a non-significant relationship between RHI and increased WMHs in those with a history of CCS compared to individuals in the non-RHI group. Future research should expand upon this investigation, by examining RHI exposure and WMH consequences in a diverse assortment of sports, follow athletes longitudinally for repeated in vivo MRIs and post-mortem neuropathological confirmation, and include more female athletes.

No description available.

Syftet med den här litteraturstudien var att granska effekten av fysisk aktivitet och träning på motoriska och kognitiva förmågor hos barn med autismspektrumtillstånd (AST) samt att undersöka vilken tillförlitlighet som finns för fysisk aktivitet och träning som behandlingsmetod hos denna patientgrupp. Strukturerade sökningar utfördes i databaserna PubMed och CINAHL. Nio randomiserade kontrollerade studier identifierades. Insamlade data bearbetades sedan genom att alla artiklar som inkluderas i studien granskades enligt PEDro-skalan och resultatens tillförlitlighet klassificerades enligt SBU GRADE. Effekten av interventionerna presenteras i en narrativ sammanställning av kvantitativa data. Kvalitén och bevisvärdet på ingående artiklar är låg till medelgod, men enskilda artiklar visar signifikanta resultat som indikerar att fysisk aktivet och träning kan bidra till positiva effekter vad gäller både kognitiv och motorisk förmåga hos barn med AST. Tillförlitligheten bedöms enligt SBU GRADE som mycket låg för fysisk aktivitet och träning i form av styrka och koordination, bollsporter, ridning och cykling. Resultatet i den aktuella studien ger vissa indikationer, trots stor variation av interventioner, att fysisk aktivet och träning kan bidra till positiva kognitiva effekter hos barn med AST. Även gällande motoriska effekter hos barn med AST kan positiva indikationer skönjas, men här är effekten dock ännu mindre tydlig. Det sammanvägda resultatet har mycket låg tillförlitlighet bedömt med SBU GRADE. Ytterligare studier efterfrågas.

This chapter begins by describing the appearance of motor abilities, social and play behavior, sexual maturity, and sensory function in laboratory rats. It then discusses cognitive function, the development of simple stimulus associations made in conditioned taste aversion, and complex associations necessitated in spatial memory. The development of brain structures and their possible role in these behaviors are also discussed.

Public libraries belong to the so-called public library system and must ensure that people with functional variations have access to literature in various formats but also technical solutions that enable the person to assimilate the literature (SFS, 2013: 801). What opportunities do public libraries have to keep up with the development of technology for people with reading disabilities? The technological development has in recent years gone very fast and the public libraries financial resources has not increased in the same way as the technology development instead has the financial resource decreased (Hansson and Linder, 2019).  The purpose of the study is to gain an increased understanding of inclusive activities within library activities for people with reading and writing difficulties. The question: What services and aids do public libraries offer on their websites for people with reading disabilities?  The study is a qualitative content analysis and an empirical inductive approach and where the collected material forms a pattern which in turn can be divided into categories (Patel and Davidson, 2011).  The results show that there is a big difference between the aids that public libraries advertise on their websites. Most of the public libraries advertise on their websites that they have E-books, E-textbooks and Daisy-books. There are some public libraries who advertise having several formats of books, for example cd-books, tactile books and braille-books.

Alzheimer’s disease (AD) is a rapidly growing public health concern causing severe challenges to the health care system. Affecting the lives of more than 5 million Americans, it is characterized by brain-related morphological changes coupled with decrements in performance on tasks involving cognitive function such as those assessing memory and problem-solving abilities. Fortunately, current scientific research provides evidence that this trend towards rapid cognitive decline in older adults is not immutable, but rather can be attenuated through a simple adjustment to regular engagement in aerobic exercise. To date, numerous studies have associated regular cardiovascular exercise to changes in brain function and structure. In particular, aerobic exercise has been shown to have a direct effect on the hippocampus (HC), one of the earliest regions of the brain to be affected in AD, which plays an important role in learning and memory. Scientific research on animal models has demonstrated increased adult hippocampal neurogenesis (AHN), or the birth of new neurons, in the dentate gyrus (DG) subregion of the hippocampus as a response to increases in aerobic exercise. Such findings have led to the hypothesis that aerobic exercise can improve cognitive performance, more specifically hippocampal-dependent learning and memory, through the formation of new hippocampal neurons. Similarly, in human studies, previous research has shown that significant improvements in cardiovascular fitness are positively correlated with increased hippocampal volume. Structural increases in hippocampal volume are thought to be mediated by increased angiogenesis, or the generation of new blood vessels, which in turn are correlated with significant improvements in spatial memory, a task determined by memory function. The benefits of aerobic exercise, nonetheless, are not limited to the hippocampus. As people age, atrophy of the brain is also inclusive of the prefrontal cortex, a region implicated in planning and decision making. Scientific literature has shown, that similar to the hippocampus, increases in aerobic exercise, directly result to increases in grey matter volume in the prefrontal lobe and increases in white matter volume in the genu of the corpus callosum. Such structural changes in the prefrontal lobe are correlated with enhanced decision making on cognitive tasks, an essential component of executive function. For the purposes of this study, an effective method of evaluating whether changes in brain structure due to higher cardiorespiratory fitness have an association with cognitive function was through the administration of the Digital Clock Drawing Test (dCDT). The dCDT is a recently developed cognitive test based on the traditional Clock Drawing Test (CDT) that uses a digital pen and allows for the measurement of several parameters such as “Ink time” and “Think time.” Recent scientific studies report that such parameters may have a potential enhanced sensitivity to detecting cognitive change as compared to the traditional CDT. Therefore, the dCDT has come forward as an advantageous approach for testing cognitive skills in aging individuals such as those assessing executive and motor function, and semantic memory, as it happens in real time. DCDT parameters such as total time to complete the clock drawing, total ink time, total think time, total ink length, and clock size have been shown to differ significantly among subjects of varying degrees of cognitive impairment such as AD, mild cognitive impairment (MCI), and healthy, non-demented controls. Patients who were clinically diagnosed as cognitively impaired spent a greater amount of time thinking and drawing on both the command and copy clocks conditions as compared to healthy, non-demented individuals. Similarly, patients affected by greater cognitive impairments, such as AD, tended to draw smaller clocks in terms of height and width of the clock face that required less total ink length to complete the clock drawing, when compared to healthy controls and MCI participants. Findings showed that AD patients appeared to be working longer (greater time of completion) though producing less output (smaller clock and shorted ink length) as compared to non-impaired individuals. Variations of graphomotor latencies in the dCDT performance, therefore, are associated with individual’s cognitive capacities. The goal of this study is to investigate the associations between cardiorespiratory fitness based on VO2 max testing and cognitive constructs such as memory, executive function, and gross motor processing speeds as measured by graphomotor latencies and drawing patterns using the dCDT in healthy, non-demented older adults. I hypothesize that greater cardiorespiratory fitness will be negatively associated with graphomotor timed latencies in various parameters of the dCDT, given that exercise has known effects on the brain regions responsible for executive function and memory. To test these hypotheses, cardiorespiratory fitness and dCDT data from 12 sedentary older adults between the ages of 55 and 85 years from a larger study in the Brain Plasticity and Neuroimaging Laboratory at Boston University were collected and analyzed. A multiple regression analysis was used to predict the dCDT measures from individual’s cardiorespiratory fitness using estimated VO2 max levels. Results showed that cardiorespiratory fitness in older adults is inversely associated with graphomotor times in both the command and copy test conditions as predicted by our hypothesis. In particular, greater cardiorespiratory fitness was associated with shorter total ink time for both clock drawing testing conditions. These results held when controlled for age, sex, and education; higher cardiorespiratory fit older adults performed better (a shorter time is needed to achieve the same outcome) on tasks requiring greater cognitive constructs such as memory, executive function, and motor processing speeds. Therefore, it can be concluded that cardiorespiratory fitness may be a neurodegenerative protector in aging adults supporting its beneficial role as a therapeutic agent for cognitive decline in older adults.

A disabling condition in old age is poor cognitive function (CF), which affects more than 16 million people in the United States. Research has correlated oxidative stress with poor CF, and antioxidants have been suggested as a means to counteract this impact, although there are inconsistencies in the literature. Guided by the oxidative stress theory of aging, the purpose of this study was to determine the relationship between blood serum antioxidant levels and CF in participants aged 60 and older. This cross-sectional study used data from the National Health and Nutrition Examination Survey from 2001 2002 (n = 291). Correlation studies were performed using Pearson's correlation coefficient. Multiple linear regression was used to determine whether blood serum antioxidant status predicted CF while controlling for age, gender, race, hypertension, smoking status, and Body Mass Index. Results of this study demonstrated that alpha-tocopherol (r = .257), retinyl palmitate (r = .248), trans-lycopene (r = .196), retinyl stearate (r = .136), age (r = -.239; p < .001), and BMI (r = .189; p = .001) were all significantly correlated with CF. After controlling for covariates, higher concentrations of alpha-tocopherol and retinyl palmitate were associated with higher CF (p < .01). The positive social change implications of this study include interventions designed to educate the elderly about the role of antioxidants in delaying or preventing poor CF or to reduce barriers to healthy eating. By implementing interventions that incorporate data from this study, healthcare professionals may be able to reduce the incidence and prevalence of poor CF in the elderly population.