<p>The most robust neurocognitive effect of marijuana use is memory impairment. Memory deficits are also high among persons living with HIV/AIDS, and marijuana use among this population is disproportionately common. Yet research examining neurocognitive outcomes resulting from co-occurring marijuana and HIV is virtually non-existent. The primary aim of this case-controlled study was to identify patterns of neurocognitive impairment among HIV patients who used marijuana compared to HIV patients who did not use drugs by comparing the groups on domain T-scores. Participants included 32 current marijuana users and 37 non-drug users. A comprehensive battery assessed substance use and neurocognitive functioning. Among the full sample, marijuana users performed significantly worse on verbal memory tasks compared to non-drug users and significantly better on attention/working memory tasks. A secondary aim of this study was to test whether the effect of marijuana use on memory was moderated by HIV disease progression, but these models were not significant. This study also examined whether the effect of marijuana use was differentially affected by marijuana use characteristics, finding that earlier age of initiation was associated with worse memory performance. These findings have important clinical implications, particularly given increased legalization of this drug to manage HIV infection.</p> / Dissertation

Cognitive impairment is a key characteristic of schizophrenia and is a clear predictor of functional outcome. This thesis explores the relationship between cognitive ability relating to social and non-social processing. Schizophrenia patients demonstrate an impaired ability to recognise, label and discriminate emotional expression within the face. The underlying mechanisms behind this social cognitive impairment are not yet fully understood. This thesis explores the notion that a basic perceptual impairment in processing facial information adversely impacts on the perception of more complex information derived from faces, such as emotional expression. Face perception relies on processing the featural characteristics of a face as well as the relationship between these features. Information pertaining to the spatial distances between features is referred to as configural information. / A group of schizophrenia patients and healthy control participants completed a battery of tasks that assessed basic neurocognition, facial emotion processing and configural face processing. A model of face processing was proposed and used to systematically pinpoint specific deficits that may contribute to impaired face processing in schizophrenia. The results indicated that schizophrenia patients show impairments on three broad constructs; basic neurocognition, facial emotion processing, and most pertinently, deficits in configural processing. It was revealed that although neurocognitive and face processing both explained a significant proportion of the variance in facial emotion processing, the effect of neurocognition was indirect and mediated by face processing. / To investigate the diagnostic specificity of these findings, a group of bipolar disorder patients was also tested on the task battery. The results indicated that bipolar disorder patients also show social and non-social cognitive impairments, however, not as severe as that demonstrated by the schizophrenia patients. Furthermore, the effect of neurocognitive performance on facial emotion processing appeared more direct for bipolar disorder patients compared to schizophrenia patients. Although deficits in face processing were observable in bipolar, they were not specific to configural processing. Thus, deficits in emotion processing were more associated to neurocognitive ability in bipolar disorder patients, and more associated to configural face processing in schizophrenia patients. The configural processing deficits in schizophrenia are discussed as a lower-order perception problem. In conclusion, the results of this thesis are discussed in terms of their implication for treatment.

Patients with schizophrenia have extremely high levels of depression and suicide (Carlborg et al., 2008), thus, a better understanding of factors associated with poor quality of life (QoL) for this population is sorely needed. A growing body of research suggests that cognitive functioning in schizophrenia may be a strong predictor of overall QoL (Green et al., 2000), but individual domains of QoL have not been examined. Indirect evidence also suggests that emotion perception may underlie the relationship between neurocognition and QoL, but this hypothesis has also yet to be tested. Using a sample of 92 clinically stable schizophrenia patients, the current study explores the relationship between neurocognition, namely attention and working memory, and the following sub domains of QoL: social, vocational, intrapsychic foundations and environmental engagement. The current study also examines whether emotion perception mediates this relationship. In partial support of hypotheses, patients with more deficits in working memory reported decreased Occupational QoL and, although only marginally significant, decreased Total QoL. There was also a trend for poorer working memory to be associated with poorer Intrapsychic Foundations QoL. Contrary to hypotheses, emotion perception was not found to mediate the relationship between working memory and QoL. Current findings suggest that interventions that specifically target working memory may also improve many other aspects of schizophrenia patients? QoL.

The current study investigated the relationship between obstructive sleep apnea (OSA) and depressive symptoms on neuropsychological functioning and academic achievement in a sample of ethnically diverse school-aged children in the Southwest United States. A total of 38 participants aged 6 - 12 were studied as part of an ongoing randomized clinical trial (SleepCATS) investigating the neurocognitive impact of continuous positive airway pressure therapy (CPAP) on neurobehavioral outcomes. Children were identified as having primary snoring, mild OSA, or Moderate-Severe OSA based on in-lab nocturnal polysomnography and were assessed for depressive symptoms using the parent report of the Child Behavior Checklist (CBCL). Neuropsychological testing was conducted using the Cambridge Automated Neuropsychological Test Battery (CANTAB) to assess executive functioning, working memory, and motor control. The Grooved Pegboard Test (GPT) was used to assess fine motor speed and dexterity and academic achievement was assessed on the Woodcock-Johnson Test of Academic Achievement Third Edition (WJ-ACH III). The study identified 39% of the sample as having clinical depressive symptoms and mean depressive symptoms for the sample was nearly one standard deviation above the norms. Multivariate analysis of covariance models (MANCOVA) were used to determine differences in neuropsychological test performance by neurocognitive constructs. Results from the study found significant main effects for OSA severity on the CANTAB Spatial Span Test and a significant interaction of off clinical depressive symptoms and OSA severity on the Applied Problems test of the WJ ACH III. When groups were compared between children with primary snoring and OSA (Mild and Moderate-Severe combined) there were no longer significant effects for academic achievement or working memory, however, there was a significant main effect for motor control on the CANTAB with children with OSA exhibiting lower performance compared to those with primary snoring. The results from this study suggest children with moderate-severe OSA may exhibit increased difficulties in working memory and fine-motor control, and also have increased difficulties with academic math achievement when children with moderate-severe OSA also have depressive symptoms. These findings suggest children with higher severities of OSA may experience increased learning and academic challenges, which may be further exacerbated when accompanied by depression.

Introduction The problem at hand is understanding if pediatric acute lymphoblastic leukemia (ALL) treatment affects neurocognitive function or development. As the children battle ALL and are given treatments such as cranial radiation therapy and chemotherapy, they are having issues later on in life because the treatment regimens are very strong and are given during a crucial period of development. Purpose Statement and Question Does one pediatric treatment option affect neurocognitive development more than another later in life? Literature Review Research was conducted online via Google Scholar and East Tennessee State University Library database. Key terms used were pediatric ALL and neurocognitive effects of chemotherapy and radiation. Five studies were collected all pertaining to the question at hand. Findings The findings from the research collected was that certain demographics have a stronger effect on the development of a child post-ALL treatment. The treatment regimen and the strength of the treatment affect cognitive development. Cognitive impairment related to attention occurs with all children treated for ALL. Conclusion Nurses see first-hand the effects treatment have on children as the grow. We have to provide resources to help with attention deficits among other cognitive issues that result from treatment. The literature gave a great insight to what effects are to be expected post-treatment.

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"Nature-based solutions", such as green stormwater infrastructure, take advantage of natural systems to tackle the increasing challenges facing the built environment. Green infrastructure is effective in reducing stormwater runoff for urban stormwater management using connected green space. Green infrastructure also delivers multiple benefits to the community (e.g., increased quality of life and public health) and environment (e.g., enhanced biodiversity, less energy use, and reduced urban heat island effect), which is adaptive to the changing climate. However, the pace and the scale of green infrastructure implementation are still not on track with the much-needed change in the urban built environment. Policy barriers, resources barriers, governance barriers, and cognitive barriers are limiting the practice. Cognitive barriers are cited as the most critical barrier because most of the barriers limiting green infrastructure stem from and are intensified by human cognition during the design and decision-making process for infrastructure. Stakeholders involved in the decision-making process for green infrastructure must weigh the perceived risks and benefits that green infrastructure provides. This dissertation aims to better understand how stakeholders perceive green infrastructure, how much they weigh risks and benefits, and test interventions to aid the decision-making process to promote more green infrastructure design. Both a stated preference survey with discrete choice modeling and two sets of experiments using neuroimaging to measure the change in neurocognition were used to explore preference construction and decision-making about green infrastructure. A sample of the public (N=946) across the U.S. participated in the survey and reported their perceptions of risk and benefit about green infrastructure. The result highlights that perceived higher risk of green infrastructure reduced people's preference for green infrastructure. In contrast, perceived higher benefit, age, education, and the use of a rating system to measure sustainability outcomes firstly contribute to people's preference construction for green infrastructure. Engineering students who were trained in stormwater infrastructure design (N=60) participated in a stormwater infrastructure design scenario. Change in students' neurocognition was measured when students made judgments and decisions between a green infrastructure design option and a conventional stormwater infrastructure design option. Two interventions, (1) telling students about a municipal resolution in support of green infrastructure and (2) priming students to think about sustainable design before evaluating design options, were tested to change perceptions about risk and benefit of stormwater design options. The results found that telling decision-makers about a green infrastructure resolution changed their neurocognition when processing perceived risk and reduced the perceived risk they associated with green infrastructure. The results also found that priming decision-makers to think about sustainable design with a rating system for sustainability significantly decreased their cognitive load when evaluating the benefits of green infrastructure and increased their stated benefits associated with green infrastructure. These findings demonstrate the effects of relatively simple choice modifications to promote more green infrastructure. The results provide insights for policy-makers, engineers, and other stakeholders involved in the early-phase decisions on effective practice to modify human choice when facing challenges with sustainable and resilient design. / Doctor of Philosophy / Green stormwater infrastructure uses connected green space to absorb and filter excessive stormwater runoff in the environment where humans live. Green infrastructure also brings multiple benefits, such as increased quality of life and public health, habitats to more creatures, and less energy use. However, the pace and the scale of green infrastructure implementation are still limited. Barriers in policy, resources, governance, and human cognition are preventing the implementation of green infrastructure. Cognitive barriers are believed to be the most critical barrier because they intensify all other barriers during the design and decision-making process for infrastructure. Stakeholders involved in the decision-making process for green infrastructure must weigh the perceived risks and benefits that green infrastructure provides. This dissertation aims to better understand how stakeholders perceive green infrastructure, how much they weigh risks and benefits, and test interventions to aid the decision-making process to promote more green infrastructure design. Both a survey with choice modeling and experiments using neuroimaging to measure the change in brain activity were used to explore preference construction and decision-making about green infrastructure. 946 people across the U.S. participated in the survey and reported their perceptions of risk and benefit about green infrastructure. The result highlights that perceived higher risk of green infrastructure reduced people's preference for green infrastructure. In contrast, perceived higher benefit, age, education, and the use of a rating system to measure sustainability outcomes positively contribute to their preference construction for green infrastructure. 60 Engineering students who were trained in stormwater infrastructure design participated in a stormwater infrastructure design scenario. Change in students' brain activity was measured when they made judgments and decisions between a green infrastructure design option and a conventional stormwater infrastructure design option. Two interventions, (1) telling students about a municipal resolution in support of green infrastructure and (2) priming students to think about the sustainable design before evaluating design options, were tested to change perceptions about the risk and benefit of stormwater design options. The results found that telling decision-makers about a green infrastructure resolution changed their brain activity when evaluating risk and reduced the perceived risk they associated with green infrastructure. The results also found that priming decision-makers to think about sustainable design with a rating system for sustainability significantly decreased their cognitive efforts when evaluating the benefits of green infrastructure and increased their stated benefits associated with green infrastructure. These findings demonstrate such relatively simple choice modifications are effective to promote more green infrastructure. Stakeholders who are involved in the early-phase decisions can take advantage of the findings about the effective practice to modify human choice when facing sustainable design challenges.

Many psychotic patients fail to admit they are mentally ill. The current study evaluated the associations between insight, specific symptoms, and neurocognitive impairments. Thirty-three acute inpatients with a schizophrenia, schizoaffective disorder, or psychotic disorder NOS diagnosis were rated on the SAIE, Birchwood's IS, and the BPRS. Neurocognitive assessments of attention and frontal lobe functioning were also conducted. Stepwise multiple regression analyses found composites representing delusions, disorganization, and anxiety/depression, as well as CPT-IP shapes hit rate, served as significant predictors of total insight or the specific insight dimensions. At least for acute patients, symptoms tended to have stronger relationships with and were more regularly predictive of insight than neurocognitive measures, though the attentional task associated with right hemisphere functioning, contributed significantly.

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