A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Informant‐based assessments of cognition and function are commonly used to differentiate individuals with amnestic mild cognitive impairment (aMCI) and Alzheimer’s disease (AD) from those who are cognitively normal (CN). However, determining the extent to which informant‐based measures correlate to objective neuropsychological tests is important given the widespread use of neuropsychological tests in making clinical diagnoses of aMCI and AD. The aim of the current study is to determine how well the Alzheimer’s Questionnaire (AQ) correlates with objective neuropsychological tests. Results showed that the AQ correlated strongly with the Mini Mental State Exam (r = ‐0.71) and the Mattis Dementia Rating Scale‐2 (r = ‐0.72), and moderate correlations were noted for the AQ with memory function (Rey Auditory Verbal Learning Test Delayed Recall, r = ‐0.61) and executive function (Trails B, r = 0.53). The AQ also correlated moderately with language function (Boston Naming Test 30‐Item, r = ‐0.44), but showed a weak correlation with visuospatial function (Judgment of Line Orientation, r = ‐0.28). The AQ also correlates particularly well with cognitive screens, showing the strongest correlations with the MMSE (r = ‐0.71) and the DRS‐2 (r = ‐0.72). The findings of this study suggest that the AQ correlates well with several neuropsychological tests, particularly those that assess the domains memory and executive function. These results lend further support to the validity of the AQ as a screening instrument for cognitive impairment as it correlates well with neuropsychological measures used to make clinical diagnoses of aMCI and AD.e sites become involved, thus providing significant feedback for possible course revision.

In 1976 it was proposed that senile dementia, a potential affliction of old age, be redefined as Alzheimer's disease, a rare diagnosis previously assigned to presenile dementia occurring in middle life. In response to a "public culture" generated by those caring for the afflicted, together with leaders of the biomedical reserch community, substantial financing has been allocated by the U.S. Congress to the National Institutes of Health, for investigation of senile dementia redefined as a "dread disease". This has funded studies in the neurosciences, and a range of epidemiological and high technology diagnostic investigations for which psychiatry developed a "case-finding" method. The "cognitive paradigm" for dementia was conceived by American psychiatry within a now dominant "biological" model which imputes physical causation to mental disorders and stresses "objectivity" in diagnosis. This has legitimated the use of "mental test" instruments based upon, or validated against, "intelligence tests" developed by psychologists for quantification of "intelligence" now redefined as "cognition". In a study funded by the National Institute of Mental Health, three cognitive assessment instruments were administered to a sample of individuals aged 60-93 with a broad range of educational experience across the age spectrum. Education rather than age was found to be the most significant predictor of test results for each instrument, and when the tests were repeated a marked "learning effect" was detected among those with the least education and lowest baseline scores. However, the identification of low education as a predictor, albeit less powerful than age for "cognitive impairment" indicative of dementia in other investigations has now been interpreted as a "risk factor" rather than a confounding variable and now enters into genetic mental testing models. Negative stereotyping of "old age", strongly associated with images of "senility", and "burden of ageing" economic arguments have therefore been reinforced by the dissemination of prevalence estimates from epidemiological studies conducted in communities in which there is an inverse correlation between age and education. In the meantime, basic scientists have failed to discriminate precisely between neuropathological changes indicative of "disease" and those of "normal ageing" or to establish a functional link between such changes and dementia behaviour in vivo. In consequence the legitimating rationale for public financing of the "Alzheimer's enterprise", i.e. "clinical benefit" remains elusive.

No description available.

Intelligence testing has had a relatively long and controversial history, beginning with what is generally considered the first formal measure of intelligence, the Binet-Simon Scales (1916). Questions regarding possible cultural bias in these measures arose virtually simultaneously (e.g. Burt, 1921; Stern, 1914). Over the course of the twentieth and early twenty-first centuries, an abundance of intelligence measures have been developed, with many of them having several revisions, but the issue of test bias remains an important one, both in the professional literature and in the popular press (Reynolds & Lowe, 2009). A current intelligence measure in use, the Differential Ability Scales, Second Edition (DAS-II, Elliott, 2007), is a test with growing popularity for assessment of children and youth, not only for its ease of use, but also for its appeal to young children and its nonverbal composite (among other things). Consequently, it is essential that there be empirical evidence supporting the use of the DAS-II as an appropriate measure of cognitive abilities for children of varying backgrounds. The test publishers conducted extensive research with a representative sample during test development in an effort to ensure that the measure met adequate reliability and validity criteria; however, the issue of test bias, particularly regarding cultural or racial/ethnic groups, was not explicitly addressed. This issue was raised and examined with the original DAS by Keith, Quirk, Schartzer, and Elliott (1999), but with the significant changes made from the first edition to the second, there is no guaranty that the evidence from the earlier would necessarily apply to the latter. The current study investigated whether the DAS-II demonstrates systematic construct bias toward children and youth of any of four ethnic groups: Black, Hispanic, Asian, and White. Multi-group confirmatory factor analysis using data from the DAS-II standardization sample was used to assess whether criteria for increasingly strict levels of invariance were met across groups. Outcomes of this research contribute to an existing body of literature on test bias, as well as provide evidence regarding cross-group construct validity in the DAS-II. Ultimately the results of this study can be used to evaluate the appropriateness of the DAS-II for clinical use with certain ethnic groups and will help to emphasize further the importance of exploring these issues with all standardized tests. / text

xvi, 68 p. : ill. / Approximately 1.5 million concussions occur annually in the United States, many affecting individuals between the ages of 15 and 18. Little is known about this age group's response to a concussion as they have been thought to respond differently than adults due to immature brain development. Additionally, relying on symptoms alone to determine level of brain function may lead to early return back to sport participation. Through the use of 3 computerized tests, neuropsychological and attentional deficit recovery post concussion was assessed between 12 subjects with concussions and 12 controls up to 2 months after injury. Memory tasks and symptoms resolved within a week after injury. Executive function tests showed small group differences up to two months post injury, suggesting these types of tests may be a useful tool in the evaluation of concussion recovery and provide an objective measure in evaluation. / Committee in charge: Dr. Li-Shan Chou, Chair; Dr. Lou Osternig, Member; Dr. Sierra Dawson, Member; Dr. Grace Golden, Member

It has been well-established in the literature that a history of concussion makes individuals more susceptible to sustaining subsequent concussions. However, there is little neuropsychological evidence of how sustaining multiple lifetime concussions affects cognitive functioning in the general adult population. It is known from previous traumatic brain injury and single concussion literature that impairments in cognitive performance across domains often follow the initial injury, and exploratory studies have shown that multiple concussions can have a measurable impact on cognition. However, existing research is often limited by its reliance on archival data and abbreviated neuropsychological batteries. Therefore, the current study aimed to fill this gap in the literature to help inform clinical prognoses and treatment considerations. Analyses of attention and memory outcomes revealed significant associations between concussion history and performance, but they were directionally opposite from expectations. When discrepancy scores were used to account for participants’ estimated intellectual functioning, these associations were no longer significant. Executive functioning was also not significantly associated with concussion history, either with or without accounting for intelligence, contrary to expectations. On language and spatial measures, outcomes were unrelated to concussion history, as expected. Together, results from the present study emphasized the multifaceted nature of concussions and highlighted the many necessary considerations when investigating long-term outcomes, particularly when multiple concussions are involved. Future research would likely benefit from continuing to explore the neurocognitive impact of sustaining multiple concussions in the general adult population and expanding the current research with larger, more representative samples, neuroimaging, and baseline data, as available.

No description available.

Hemispatial neglect, is a major cause of post-stroke disability and poor functional recovery. Hence, identifying sensitive methods to assess and rehabilitate neglect is important. Chapters 3 and 4 focused on development of novel assessment techniques for representational neglect. The 'Shopping Mall' and 'Clock Cueing' tasks improved upon previous tests and were useful in identifying dissociations in representational neglect based on type of stimuli (topological, non-topological) and time of assessment (pre-stroke, post-stroke) in chronic stroke patients. Chapters 5 and 6 investigated the efficacy of offline inhibitory repetitive Transcranial Magnetic Stimulation (rTMS) in producing short (<1 month) and long term (>6 months) changes in visual neglect behaviour. Overall, the findings from these chapters were limited due to lack of sufficient power. After controlling for the effect of baseline performance, the Intervention group's Activities of Daily Living scores significantly improved in the short-term post rTMS, as compared to the Control group. The fMRI task attempted to recruit attention-based top down modulation of sensory activity. It revealed relative hypoactivation of the right occipital lobe in the four left neglect patients tested, both pre and post rTMS, when compared to elderly controls. Chapter 7 explored cognitive predictors of spatial and object neglect in the sub-acute stage after controlling for demographic and stroke related factors, using multivariate blocked logistic regressions. Cognitive performance indicative of spatial attention and selective attention to local features predicted both spatial and object neglect. In addition, coding of spatial relations between features also predicted spatial neglect. Suggestions for combining neglect rehabilitation techniques to target these cognitive processes are discussed. Overall, this thesis provides novel methods to improve representational neglect assessment and highlights the importance of ancillary cognitive domains in contributing to both representational and visual neglect. The rTMS research provides study design-related insights to incorporate in future studies with larger patient samples.

Aims: The study of cognitive functioning in large epidemiological settings is hampered by a lack of instruments for the remote assessment of cognitive performance, especially when targeting variability across the full range of adult functioning. The present study examined the practicability of such investigations using a recently developed telephone interview (Cognitive Telephone Screening Instrument, COGTEL). Methods: A subcohort of an ongoing epidemiological study in the elderly German population (ESTHER) was interviewed via telephone by trained personnel. These data were combined with sociodemographic information obtained by standardized self-administered questionnaires, and analysed by tabulation, histograms and regression models. Results: A total of 1,697 interviews could be analysed. The eligible participants had a mean age ± standard deviation of 74.0 ± 2.8 years. The COGTEL total scores closely followed a normal distribution with no evidence of a ceiling effect. In adjusted regression models, COGTEL total and subcomponent scores were negatively associated with age and strongly positively with higher education, whereas the association with sex was less consistent. Conclusions: The results suggest that the COGTEL can readily be administered to large study populations and produces plausible and informative results. Education should be considered in all investigations using this instrument and requires further in-depth analyses. Future studies will need to elucidate its associations with risk factors and its prognostic potential for cognitive decline and dementia. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

The Woodcock-Johnson 4th Edition Test Battery is the latest version of assessment battery which measures cognitive function in childhood and adulthood. This is a very large test battery and the adaptation of the Czech version of this method is in progress. However, some subtests are closely related to the language and cultural habits of a country. The aim of this diploma thesis is to examine selected verbal tests of the Woodcock-Johnson assessment battery in the Czech environment. Specifically if these subtests do not disadvantage children who are from other language environment than Czech. The theoretical part of the thesis speaks about the concept of bilingualism (definition, categorisation) and how bilingualism is reflected in the results of cognitive tests. It also introduces the theory of CHC, which was the basis for the creation of the Woodcock- Johnson assessment battery. It analyses verbal subtests of the Woodcock-Johnson test battery, fourth edition, in more details. The research study focuses on comparison of the results of two groups of children. The groups are divided according to the language environment from which the tested children come from: either Czech or Russian-Czech. The focus will be put onto (1) the extent to which the dissimilarities in the groups express cultural...