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ABSTRACT Over the last few years Bipolar Disorder has been associated with chronic neuropsychological deficits that remain even when episodes of depression, mania or hypomania remit. Furthermore Bipolar Disorder has been associated with progressive cognitive impairment, leading to the description of the illness as chronic and deteriorating, rather than as an illness with discreet episodes from which patients can fully recover. The results of neuropsychological studies have been criticized for methodological weaknesses however. The present study attempted to address these weaknesses. The aim was primarily to establish whether neuropsychological impairment exists in euthymic patients, and secondarily, to establish if neuropsychological functioning deteriorates with illness severity. Sixteen euthymic Bipolar I disordered patients were matched for age and sex to 16 controls and subjected to a battery of neuropsychological tests. Matched pair T-tests were used to identify if significant differences in neuropsychological functioning existed between the two groups. The ANOVA technique was used to determine if neuropsychological functioning deteriorated with illness severity. Markers of illness severity utilised in this study were number of depressive episodes, number of manic episodes, number of suicide attempts and number of hospitalisations. The results indicated that neuropsychological differences between the patient and control group were minimal and not clinically significant. The present study sample was medically and psychologically well managed and enjoyed good support structures and their neuropsychological functioning did not deteriorate with illness severity. It was concluded that the sample size and the nature of the sample selected could perhaps have affected the study outcome. It was therefore hypothesized that bipolar disorder is not a homogenous group and that protective factors may exist which affect the course and outcome of the illness. These protective factors should be the subject of further investigation as they are likely to significantly impact on the natural history of this disease process.

Thesis (Ph. D.)--York University, 2000. Graduate Programme in Psychology. / Typescript. Includes bibliographical references (leaves 112-127). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://wwwlib.umi.com/cr/yorku/fullcit?pNQ59153.

Thesis (Ph. D.)--York University, 1997. Graduate Programme in Psychology. / Typescript. Includes bibliographical references (leaves 124-135). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL:http://wwwlib.umi.com/cr/yorku/fullcit?pNQ27320.

Graduate

This study investigated the relationship between the interaction of diabetes and depressive symptoms and neuropsychological functioning in a sample of adolescents. It also addressed whether disease-related variables such as age of onset of diabetes and presence of severe hypoglycemic episodes were predictive of severity of depressive symptoms. The neuropsychological domains of memory, attention, and overall cognitive abilities were assessed using a cross-battery approach with subtests from the Wide Range Assessment of Memory and Learning - Second Edition (WRAML2), the Stroop Test, and the Kaufman Brief Intelligence Test - Second Edition (KBIT-2), respectively.The total sample consisted of 62 youth between the ages of 13 and 17 years: 31 adolescents diagnosed with Type 1 diabetes and 31 adolescents without diabetes. Adolescents were recruited from an outpatient pediatric diabetes clinic and an outpatient general medicine pediatric clinic located in Tuscon, AZ . Significant findings included that the interaction effect of diabetes and depressive symptoms scores was statistically significant for verbal memory, verbal recognition, verbal memory delayed, verbal list learning, and attention/concentration. No significant differences were found for verbal working memory, visual memory, visual recognition, or attention/inhibition. Regression analyses showed that none of the diabetes-related variables included in the study variables (age of diabetes onset, duration of diabetes, presence of severe hypoglycemic episodes, type of insulin therapy) were predictive of depressive symptoms scores that adolescents reported.

An integral part of neuropsychological assessment is the measurement of sensory-motor performance. Many studies have been conducted on the effectiveness of neuropsychological batteries to assess neurological impairment, however examination of only the sensory-motor portion of those measures has been limited. Investigations of tests of sensory and motor functions have often limited their analysis to single tests. The present study assessed the ability of the Dean-Woodcock Sensory Motor Battery (DWSMB), part of a new neuropsychological measure, the Dean-Woodcock Neuropsychological Battery (DWNB), to distinguish between normal subjects and neurologically impaired individuals as diagnosed by a neurologist. Scores from the subtests of the DWSMB from an existing data set for 250 normal and 250 neurologically impaired individuals were randomly assigned to two equal groups to allow for cross validation. Results indicated that the DWSMB was able to correctly identify 92.8% of the cases, identifying 94.4% of the normal population and 91.2% of the neurologically impaired subjects. An additional discriminant analysis was conducted to establish the accuracy of the DWSMB to identify individual diagnoses within neurologically impaired and normal subjects. The DWSMB correctly identified the following cases: 44.9% cardio-vascular accidents, 66.7% multiple sclerosis, 40% seizures, 42% traumatic brain injuries, 62.7% dementia, and 54.5% Parkinson's disease. Results indicated the usefulness of the DWSMB in identifying neurological damage and specific diagnoses in a relatively quick assessment. The utility of the DWSMB and the use of standardized administration procedures, behavioral information for evaluation, and measures of subcortical functions was discussed in light of future research. The potential use of the DWSMB in clinical and educational settings was also considered. / Department of Educational Psychology

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.

Thirty-six myelomeningocele children with hydrocephalus (between 9-16 years of age) were evaluated on a battery of neuropsychological tests and behavioural measures. The children obtained a FSIQ on the WISC-R of greater than 60 and all were attending school on a regular basis. Results showed that the myelomeningocele children, as a group, performed as well as the normative sample on measures of auditory comprehension, fine motor speed, accuracy on a visuomotor speeded task, stereognosis, and single-word reading. Although there was substantial variability within the myelomeningocele sample in terms of level of cognitive performance, as a group, with the exception of the above mentioned measures, they performed below the level expected for their age on the remaining measures in the neuropsychological test battery (83.63% of tests administered). / Graduate

Three studies investigated patterns of performance as demonstrated by the serial position on the Rey Auditory Verbal Leaning Test (RAVLT). Patterns of performance were explored in a sample of genuine traumatic brain injured subjects who were litigating (TBI-LIT; N = 22) and compared to a sample of genuine traumatic brain injured subjects who were not in litigation (TBI-NONLIT; N = 22). Comparisons were also made to a sample of subjects who were depressed but not neurologically compromised (PSY-DEP; N = 24). Results demonstrated that when time for loss of consciousness was controlled for, no difference existed between the litigating and non-litigating groups on any serial position. With this in mind the TBILIT and TBI NON-LIT groups were collapsed to form one traumatic brain injured group (TBI; N = 44). Patterns of performance were then compared between the TBI group, the PSY-DEP group and a normal control (NC; N = 68) group. No differences were demonstrated between the TBI and PSY-DEP groups on any serial position however, the NC group demonstrated significantly different primacy effects than the TBI group and significantly different recency effects than both the TBI and PSY-DEP groups (Study 1). Patterns of performance relative to the serial position were also compared in a group of Alzheimers Disease (AD; N=20) and dementia(DEM; N=20) subjects. Results indicated that the DEM group demonstrated a greater primacy effect than the AD group with both groups demonstrating a greater recency effect when compared to the primacy effect but no significantly so. Patterns of performance was also explored in a group of Huntington's Disease subjects (HD; =14) with this group demonstrating a significantly reduced primacy effect as compared to a recency effect (Study 2). In the third study patterns of performance were compared in a group of subjects having sustained fiontal lobe (FL; N=21) and posterior lobe (PL; N=21) lesions to the brain. Subjects with PL lesions demonstrated a signifckntly greater primacy effect as compared to the FL group with both groups demonstrating a reduced recency effect. Comparisons were also made between the PL and FL groups with normal control groups (FL-NC; N = 21: PL-NC; N = 21) and results indicated that the FL group demonstrated a significantly reduced primacy and recency effect when compared to the normal control group. When comparisons were made between the PL and a normal control group, the PL group demonstrated a significantly reduced recency effect as compared to normal controls. Pattern of performance were also explored in a small sample of subjects with diffuse DIFF; N=6) damage to the brain and results demonstrated that this group displayed a reduced recency effect as compared to the primacy effect (Study 3). Overall, when examining the serial position effects across all experimental groups, subjects who had sustained a traumatic injury to the brain or who were depressed all demonstrated a greater primacy effect as compared to the recency effect by recalling more words on that position. This contrasted the pattern of performance which emerged with various dementing processes where more words were recalled in the recency position as compared to the primacy position. Results for all studies were analyzed using MANOVA followed by the Sheffe procedure.