There is overwhelming evidence that the presence of secondary gain is an independent predictor of both performance validity and neuropsychological test outcomes. In addition, studies have demonstrated that genuine cognitive and/or psychological conditions can influence performance validity testing, both in the presence and absence of secondary gain. However, few studies have examined these factors in a large sample of academic accommodation seeking college students. The current study examined base rates of symptom validity test failure, the possibility of a “Near-Pass” intermediate group on symptom validity tests, the influence of diagnoses on performance indicators, and whether performance validity differed for “Near-Pass” patients relative to those who pass and those who fail performance validity indicators.

Apathy, defined as a decrease in purposeful or goal-directed behavior, is common in many neurological disorders. The assessment of apathy in these disorders is important as apathy is associated with differential engagement and response to treatment and future cognitive and functional decline. Although apathy is often described as including three separate symptom dimensions, reflecting diminished interest, action, and emotional expression, investigations of the factor structure of apathy symptoms have been limited by the use of scales which do not comprehensively assess all of three of the proposed dimensions. The current study aimed to develop a novel informant report measure of apathy symptoms, investigate the factor structure of apathy symptoms, and examine the relationship of different types of apathy symptoms to several clinically relevant variables. Participants included 249 informants who reported on an individual with (n=210) or without (n=39) a neurological or psychiatric condition. Results showed the best fitting model of apathy symptoms was a bifactor model in which apathy could be represented as a global dimension with three separate, specific symptom factors reflecting diminished interest and initiative, asociality, and diminished emotional and verbal expression. In general, apathy was associated with poorer cognitive functioning, greater functional impairment, and higher caregiver distress. The specific symptom factors differed somewhat in their association with those same variables, highlighting the utility of measuring different types of symptoms in addition to overall apathy. Future work will refine the apathy measure developed in this study and test the obtained bifactor symptom model in an independent sample.

Cancer affects millions of people every year and survivorship has increased substantially recently. Two cancers that affect older adults is non-Hodgkin's lymphoma and breast cancer, yet very little research has focused on cancer and survivorship in late life. Emerging research has suggested that chemotherapy could have deleterious consequences on cognition, but few studies have considered the long-term neurocognitive sequelae of chemotherapy. Furthermore, social support and optimism have been independently examined as predictors of quality of life in cancer patients, but little research has considered the effects of these variables on other outcomes, such as cognition. The aim of this study was to gain a better understanding of the relationship between social support and optimism on cognition, specifically in non-Hodgkin's lymphoma (NHLS) and breast cancer survivors (BCS). It was hypothesized that social support and optimism would be positively related to cognition, and that social support would mediate the optimism-cognition relationship. Twenty-seven BCS (M age = 71.96), twenty-five female (M age = 69.76) and twenty-five male (M age = 65.28) NHLS groups were recruited. Each participant completed a three-hour standardized neuropsychological battery designed to evaluate a range of cognitive abilities involving attention, premorbid and current intellect, memory, language, visuospatial skills, and executive functioning, as well as self-report measures of mood, social support, and optimism. Performances on cognitive tests were within normal limits, but differences were found in aspects of executive functioning (p < .01) with the men outperforming women in the NHLS group. Women in the NHLS group performed better on a measure of executive functioning (p < .05) and visuospatial functioning (p < .01) than women in the BCS group. Women from both groups performed better than the male NHLS group on verbal learning and memory measures (all p's < .05). The groups did not differ on psychosocial variables. Correlations between psychosocial variables (i.e., social support and optimism) were variably related to cognitive measures in both groups. Social support did not mediate the optimism-cognition relationship. This is the first study to consider the relationship between social support, optimism, and cognition and early interventions to improve cognition in cancer survivors is discussed.

Researchers have suggested there is a wide range of neuropsychological deficits individuals with anorexia nervosa (AN) possess, including impairments in nonverbal reasoning, attention and processing speed, memory, and executive functioning. While growing, examination of the neuropsychological functioning of children and adolescents with AN is quite sparse compared to the abundance of research on adults with AN, and the many conflicting findings have been attributed to inconsistent methodologies across studies. This study examined the neuropsychological functioning of children and adolescents with AN by conducting a quantitative study loosely based on Bayless et al. (2002) and Remberk, Namysłowska, Krempa-Kowalewska, Gadaś, and Skalska (2011). Results indicated verbal intellectual functioning was significantly higher than other intellectual domains, and verbal memory was almost significantly higher than nonverbal memory (p = .051). Negative correlations were found between individual subtests and clinical data (e.g., age of onset of AN and duration of AN) as well as the EDI-3 Personal Alienation scale and the BMI-for-age percentile. Clinical implications include providing treatment improving cognitive functioning and implementing a biopsychosocial model.

It is well documented in the literature that low-birth-weight (LBW) and prematurity are associated with a variety of developmental disabilities. Within this population of LBW children it is estimated that at birth, up to 45% of them experience intraventricular hemorrhage (IVH). Only recently has pediatric research begun to look at the potentially unique effects of IVH, and attempt to separate these out form the effects of LBW in general. The purpose of this study was to investigate the neuropsychological differences that may occur in children with a history of mild or sever IVH, who are now approaching school age. The main objective was to determine whether children, ages 4 and 5, who were diagnosed with a mild IVH at birth would perform differently on a neuropsychological screening from children who were diagnosed with a severe IVH. Twenty-nine 4- and 5-year-olds born at the University of Utah Medical Center and Primary Children's Medical Center constituted the sample for this study. Potential children were identified through the medical records, where documentation of incident and severity of IVH was obtained. Descriptive medical data and documentation of other common sequelae of LBW was also obtained from the medical records. Parents of potential subjects were contacted from the respective medical centers, and interested parents were then contacted by the research team and included in the study. The children were tested on a variety of neuropsychological functions by trained examiners from the Early Intervention Research Institute at Utah State University and from the Neuropsychological Consultation Services in Salt Lake City, Utah. Analysis of this data was used in determining whether or not there were residual differences in the performance of preschool-age children who have a history of IVH at birth. The results did not indicate significant difference between mild and severe IVH groups in performance on the neuropsychological assessment. Discriminant analysis showed no significant results which did not indicate that group membership could be predicted based upon test performance. Individual subtest analyses also did not indicate a significant difference in performance. Further analysis indicated significant relationships between the presence of other common sequelae of LBW/IVH such as seizure disorder and birth asphyxia, and the neuropsychological test results. Further research is needed to determine the reliability of these findings.

Graduation date: 2006

One in nine North American women will be diagnosed with breast cancer in their lifetime and most will receive chemotherapy as part of their treatment. Although advances in treatment have increased survivorship, some research suggests chemotherapy results in cognitive deficits in a subset of recipients, a condition known as chemo-fog, thereby compromising quality of life. However, inconsistencies in methodology and neuropsychological assessment have complicated comparison of findings. The first objective of this thesis was to review the methodological issues with an emphasis on the quantitative techniques typically employed. A comparison of group and individual based analyses found negligible effects for both univariate and multivariate approaches while individual based analyses identified severe declines in function in a subset of participants. A standardized-regression based (SRB) approach was recommended as the method of choice. Furthermore, it was recommended that the number of tests be limited since comprehensive batteries can complicate identification due to increased risk of misclassification. Therefore, the second goal of the thesis was to evaluate the sensitivity of a reduced battery to the declines associated with chemo-fog. A comprehensive neuropsychological battery comprising 23 tests was compared to a subset of nine tests. SRB analyses demonstrated that a more selective battery was equally useful and may be appropriate for identification of chemo-fog. Given the variability in the composition of neuropsychological test batteries, the final aim of this thesis was to compare the structure of the theoretical cognitive domains with ones identified through exploratory factor analyses (principle axis factoring) to evaluate the convergence between the two. The results demonstrated there is statistical support for the conceptual framework that underlies the composition of the domains. The contributions of this thesis include providing methodological guidelines for those conducting future research in this area to ensure that results are comparable across studies and are meaningful, and evaluating the utility of a screening battery to facilitate identification of chemo-fog. In addition, it was demonstrated that despite the lack of professional guidelines informing the selection and construction of neuropsychological test batteries, there is statistical evidence to support the practice of grouping tests into domains based on theoretical grounds.

One in nine North American women will be diagnosed with breast cancer in their lifetime and most will receive chemotherapy as part of their treatment. Although advances in treatment have increased survivorship, some research suggests chemotherapy results in cognitive deficits in a subset of recipients, a condition known as chemo-fog, thereby compromising quality of life. However, inconsistencies in methodology and neuropsychological assessment have complicated comparison of findings. The first objective of this thesis was to review the methodological issues with an emphasis on the quantitative techniques typically employed. A comparison of group and individual based analyses found negligible effects for both univariate and multivariate approaches while individual based analyses identified severe declines in function in a subset of participants. A standardized-regression based (SRB) approach was recommended as the method of choice. Furthermore, it was recommended that the number of tests be limited since comprehensive batteries can complicate identification due to increased risk of misclassification. Therefore, the second goal of the thesis was to evaluate the sensitivity of a reduced battery to the declines associated with chemo-fog. A comprehensive neuropsychological battery comprising 23 tests was compared to a subset of nine tests. SRB analyses demonstrated that a more selective battery was equally useful and may be appropriate for identification of chemo-fog. Given the variability in the composition of neuropsychological test batteries, the final aim of this thesis was to compare the structure of the theoretical cognitive domains with ones identified through exploratory factor analyses (principle axis factoring) to evaluate the convergence between the two. The results demonstrated there is statistical support for the conceptual framework that underlies the composition of the domains. The contributions of this thesis include providing methodological guidelines for those conducting future research in this area to ensure that results are comparable across studies and are meaningful, and evaluating the utility of a screening battery to facilitate identification of chemo-fog. In addition, it was demonstrated that despite the lack of professional guidelines informing the selection and construction of neuropsychological test batteries, there is statistical evidence to support the practice of grouping tests into domains based on theoretical grounds.

Epilepsy is one of the most common neurological disorders in children, with both seizures and their medical treatment associated with increased risk of neuropsychological impairments. Adaptive functioning in children with epilepsy is poorly understood. This study sought to identify the neuropsychological and medical predictors of optimal adaptive functioning in pediatric epilepsy. Forty-six children with epilepsy and 16 typically developing children and their parents participated in this study at two time points. Overall, adaptive functioning was found to be in the average to low average range in children with epilepsy. A composite measure assessing cumulative seizure history was able to significantly predict Adaptive Behavior Assessment System-II (ABAS-II) scores. Whether a child had experienced one or more seizures in the last year was the only individual seizure and treatment variable able to significantly predict adaptive functioning as measured by the ABAS-II. Verbal learning, executive functioning, and internalizing and externalizing behavior problems assessed at Time 1 predicted performance on the ABAS-II at Time 2. Verbal memory and attention, however, were not significant predictors of adaptive functioning. Consistent with what was hypothesized, executive functioning was found to mediate the relationship between seizure history and adaptive functioning when controlling for behavior problems at both Times 1 and 2. When behavior problems were the mediator and executive functioning was controlled for, mediation was not found. Executive functioning also mediated the relationship between group membership (monotherapy, polytherapy, and typically developing) and ABAS-II scores at Time 1, but not at Time 2 when a post-surgical group also was represented. Secondary analyses showed that the relationship between executive and adaptive functioning at Time 2 was moderated by whether or not a child had ever experienced seizures, such that children diagnosed with epilepsy evidenced greater correlations between these constructs than typically developing children. The results of this study suggest that a subset of children with epilepsy, those with active seizures and/or executive dysfunction, are at increased risk of adaptive deficits. These findings highlight the risk factors for suboptimal adaptive functioning in this population, and also suggest potential avenues for remediation.

Thesis (Ph. D.)--Ball State University, 2009. / Title from PDF t.p. (viewed on Nov. 12, 2009). Includes bibliographical references (p. 73-82).