Although many theorists have speculated that chronic pain may be linked to some sort of central neuropsychological integration deficit, a review of the current literature reveals no empirical support for this theory. This study attempts to assess the severity, if any, of neuropsychological deficits in chronic pain subjects by using a neuropsychological screen developed at the University of North Texas. Also, presented are studies of correlations between the UNT Neuropsych-screen and the MMPI. the Dallas Pain Questionnaire (DPQ), the Dallas Pain Drawing CDPD), and time since injury in order to assess any possible relationships. The subjects in this study consist of 100 volunteers. Of these subjects, 74 were patients of the Spinal and Chronic Pain Center at Medical Arts Hospital in Dallas, Texas and represented the clinical population. The remaining 26 subjects were staff volunteers from the hospital . The results of the study indicate significant differences between chronic pain subjects and non-pain subjects across many areas of neuropsychological functioning, as well as other significant correlations among many of the variables. The implications of this study are elaborated upon, in the discussion section, in detail along with limitations and future research directions.

Among the goals of neuropsychological assessment are to detect the presence of brain damage, localize which areas of the brain may be dysfunctional, and describe subsequent functional impairments. The sensitivity of neuropsychological instruments in carrying out these functions has long been a question of debate. The purpose of the present study was to determine the utility of various performance level indictors and lateralizing indicators from the McCarron-Dial System Neuropsychological Assessment Battery (MDS) in ascertaining the presence or absence of brain damage as well as location of lesion. Models used in the present study appear to provide increased classification accuracy compared to other studies utilizing the MDS. The MDS was also shown to be comparable to other well-known neuropsychological batteries, including the Halstead-Reitan Neuropsychological Test Battery (HRB) and the Luria-Nebraska Neuropsychological Battery (LNNB) with regard to distinguishing between those with brain damage and normal controls, and also localizing brain lesion. The results of this study offer clinicians parsimonious models to evaluate for presence of lesion and its location so this information may be used to make accurate, thorough diagnoses and appropriate treatment and rehabilitation recommendations.

The purpose of the current study was to determine if the Nova Multilingual Neuropsychological Battery (NMNB) can detect neurological deficits in the traumatic brained injured (TBI) Hispanic sample by comparing subtest mean scores to the normal group mean scores. The NMNB is comprised of 39 subtests and was developed to account for language and cultural factors thought to influence neuropsychological test results. It was hypothesized that significant differences would be found in NMNB measures sensitive to brain damage. A sample size of 100 English-Spanish speaking bilinguals (50 TBI and 50 cognitively intact participants) was tested in Spanish in order to compare cognitive performance across the various NMNB measures. Due to the number of comparisons, the alpha level for this study was set to .01 to reduce Type I error. Results of the ANCOVA's partially supported the hypothesis after controlling for age and education. Findings show that the NMNB measures were able to successfully detect the TBI Spanish group from the normal Spanish group. Significant differences were displayed in the tests measuring nonverbal abilities, memory and learning, visual spatial skills, and executive functioning. More specifically, no significant differences were displayed in the tests measuring crystallized premorbid abilities, while tests measuring more fluid abilities detected problems with abstract thinking and information processing in the TBI sample. A similar deficit pattern was displayed across all measures of higher functioning systems. Deficits were detected in the nonverbal measures that involved complex attention (selective, divided, and alternating forms of attention) and concentration for visuospatial tasks, pattern synthesis and manipulation, but not for simple visuospatial attentional activities. Significant differences were found in motor speed, but not in the number of errors. These findings support previous research indicating that Hispanics tend to favor accuracy over speed. Additionally, results reveal significant differences across all memory measures. Using Cohen's d, large effect sizes were displayed between the groups ranging from 1.5 to 2.3 in the verbal and visual memory measures. Similar effect sizes were also displayed in tests of executive functioning. Preliminary data of this study suggests that the NMNB may be a sound assessment tool for detecting neurological impairments in TBIs. Collectively, the NMNB displayed significant differences in motor and processing speed, memory, visuospatial tasks, and executive functioning commonly documented in non-Hispanic TBIs. This study concluded that culturally sensitive neuropsychological tests that also control for demographic variables such as age and education can provide accurate results for Hispanics with TBI. However, these results should be interpreted with caution as this study was limited to a small sample size with an unequal proportion of TBI severity levels and educational experiences beyond educational levels. Future studies should focus on obtaining larger samples with varying TBI severity levels. Samples should also include bilingual Hispanics tested in English as well as monolingual Spanish speakers in order to develop profiles that may be useful in differential diagnosis.

The present study compared the responses of a group of simulating malingerers who were offered a monetary incentive to feign symptoms of a head injury, with the responses of head injured groups both with and without litigation, a forensic parole group, and an honest-responding control group. The following six neuropsychological measures were utilized: Rey 15-Item Memory Test, Controlled Oral Word Association Test, Finger Oscillation Test, WAIS-R Neuropsychological Instrument (Vocabulary, Information, and Similarities subtests), Booklet Category Test, and Wisconsin Card Sorting Test. The statistical concepts of floor effect, performance curve, and magnitude of error were examined. Additionally, the statistical differences in the responses of the five groups were analyzed to determine cutting scores for use in distinguishing malingerers from nonmalingerers.

BACKGROUND. Neuropathological processes affecting the left frontotemporal lobes and their connections with subcortical structures have been reported in individuals who sexually assault minors. However, these findings are not necessarily conclusive, and knowledge is limited as to how such factors influence the 'blocking' adult sexual relations, disinhibition, emotional congruence and sexual arousal to children; or indeed if functional disorders are more significant. METHOD. A combination of neuropsychological (LNNB Form II) and personality (MMPI-2) probes where used to ascertain the profiles of male subjects satisfying DSM-III criteria for paedophilia, and a comparison was made with male rapist and homicide offenders to identify a characteristic neuro-behavioural syndrome. All groups were matched for premorbid intelligence, drug/alcohol abuse, socio-economic status and incarceration period. Hypotheses of greater dysfunction localised to the lefthemisphere fronto-temporal lobe areas, and more disturbed personality and psychopathology in the paedophile offenders were tested. The Multiphasic Sex Inventory (MSI) was also used to confirm the diagnoses of the sexual offenders and to assess psychosexual functioning. RESULTS. The offender groups were undifferentiated in terms of frequency of overall neuropsychological dysfunction, yet 26.8 per cent had clinically significant cognitive impairment, and a further 23.2 per cent were diagnosed as 'Borderline.' However, pattern of expressive speech and writing deficits in the paedophile group's LNNB-11 profile was consistent with subclinical features of Transcortical Motor Aphasia-Type I syndrome (i.e. non-fluent verbal output - decreased spontaneity of expression and impoverished narrative speech, but with intact comprehension, repetition of spoken language; clumsily produced letters and hypereconomy of written content; and apathy). Damage to the left-hemisphere dorsolateral prefrontal cortex (DLPFC) is known to be associated with this type of aphasia, which in tum increases the probability of dysexecutive syndrome (i.e. limited planning and maintenance of goal-directed behaviour and behavioural flexibility). The impact of this syndrome was clearly reflected by socialdeficit type features found in the paedophile's MMPI-2 48' /84' profile which are consistent with a schizotypal personality disorder (i.e. apathy, social withdrawal, constricted affect, odd speech and behaviour). Additionally, psychosexual functioning, rationalisations and cognitive distortions relating to offence behaviours was found to be more deviant in paedophiles than rapists. CONCLUSION. From a developmental perspective, neuropathology of the circuits connecting the dorsolateral prefrontal cortex with sub-cortical areas, presenting as dysexecutive syndrome, may be significant in explaining the paedophile' s lack of adjustment to, indifference for, and alienation from the adult world; increasing the probability for emotional and sexual dependency on children. Several possibilities for future research are identified and practical uses for the findings of this study are presented.

Attention impairment is one of the most common complaints following Traumatic Brain Injury (TBI). Multiple studies have shown that performance on neuropsychological tests of attention is affected by many factors, including injury severity and effort. The aim of this study was to determine the effect of injury severity on neuropsychological tests across different domains of attention while controlling for effort. The domains of focused attention, selective attention, divided attention, sustained attention, and working memory were assessed by performance on the Digit Span Forward subtest, the Stroop Color Word Test, the Trail Making Test, the Conners' Continuous Performance Test - II, and Digit Span Backwards subtest, respectively. Effort was determined according to performance on the Portland Digit Recognition Test and the Test of Memory Malingering. Effort was found to have a greater effect on test performance (.79) than injury severity (.47). Clinical implications of the findings are discussed.

Cardiovascular disease (CVD) affects millions of people worldwide. Many of these people require treatment for their condition, and for roughly a million individuals each year, this treatment includes coronary artery bypass graft (CABG) surgery - a procedure that aims to restore proper blood flow to the arteries of the heart. Although the physical impact of CVD and CABG surgery are well-known, their cognitive impact has not been clearly established. Recent studies suggest that both CVD and CABG surgery may have a detrimental effect on neuropsychological functioning. The first goal of the present study was to cognitively assess patients with severe, chronic CVD to determine the association of heart disease with neuroopsychological functioning. The second goal was to then continue monitoring these patients once they had undergone CABG surgery to establish what cogntive effect this treatment has. CABG surgery has traditionally been performed with the aid of a cardiopulmonary bypass (CPB) machine, but in the past decade, another technique, in which the heart remains beating, has been developed. Some have argued that this beating heart surgery (BHS) may be a superior alternative to the CPB procedure. Consequently, the third goal of the present study was to compare outcomes in patients undergoing these two surgical procedures. The present study had a prospective, double blind design. Patients were randomly assigned to either CPB surgery (CPBS) or BHS. Sixty-three patients were recruited and underwent a comprehensive neuropsychological assessment preoperatively and 6 days, 6 weeks and 30 weeks postoperatively. Despite including a higher risk group than previous comparative studies, there were virtually no differences between the CPBS and BHS groups. When the groups were combined and the sample was examined as a whole, the patients were cognitively impaired even before their surgery. Given that their premorbid abilities were estimated to be in the average range, their pre-surgery deficits were likely to be the result of a long-standing history of CVD. Immediately after surgery (Day 6), the neuropsychological performance of the sample decreased further, but they had significantly improved by Week 6 and this improvement increased further by the Week 30 time-point (with many scores in the average range). This postoperative recovery suggests that the decline these patients exhibit preoperatively may be reversible and that rather than causing cognitive deficits, CABG surgery may ultimately improve both cardiac and cognitive health. Psychologically, patients in the present sample reported the highest level of anxious and depressive symptoms, and the lowest quality of life, pre-surgically, but their psychological health gradually improved over the course of the postoperative period. Compared to other samples, however, the present sample were generally psychologically healthy.

The current study examined cognitive effects of unilateral subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson's disease (PD) patients. Neuropsychological evaluations were conducted at baseline and follow-up. Data was collected from 28 unilateral STN DBS patients (15 English- and 13 Spanish-speaking), and 15 English-speaking matched PD control patients. English-speaking DBS patients demonstrated significant declines in verbal fluency and attention/executive function, whereas PD control patients did not experience significant cognitive decline. Cognitive performance did not differ based on side of DBS. Spanish-speaking DBS patients experienced significant declines in verbal fluency, confrontational naming and visuospatial abilities. Among Spanish-speaking DBS patients, older age and later age of disease onset predicted verbal fluency decline, even after controlling for education.

Recent publications have urged researchers to address neuropsychological assessment issues among culturally and linguistically diverse individuals for whom current assessment measures are not typically appropriate. This dissertation examined cultural considerations in clinical neuropsychological practice with Cree-speaking Canadians residing in Saskatchewan. Four inter-related studies focused on understanding cultural perceptions of normal aging and dementia within a Canadian Aboriginal population, modifying existing screening and neuropsychological assessment instruments for use in both normal aging research and clinical practice, and investigating the role of culture in cognitive aging with Cree-speaking. Study 1 involved the qualitative analyses of a series of key informant interviews with an Aboriginal Grandmothers Group. Three related themes were identified that highlighted Aboriginal experiences of aging, caregiving, and dementia within the healthcare system. The third theme, the importance of culturally grounded healthcare, directly informed test development for Studies 2 and 3. In Study 2, two screening measures that were adapted for use with seniors from diverse cultural groups were further modified and examined for use with Canadian Aboriginal seniors. Overall, performance was consistent across the two screening measures, and the measures informed clinical diagnosis and were well-received by both the Aboriginal patients and their family members. Study 3 describes the development of the Grasshoppers and Geese Test battery (G&G), created by modifying and integrating existing instruments and paradigms for language and memory assessment for use with culturally diverse seniors. All G&G subtests demonstrated adequate preliminary psychometric properties and generated excellent sensitivity and good specificity in differentiating healthy older adults from adults with Alzheimers disease. Finally, Study 4 examined performance on the G&G and on other neuropsychological measures in groups of young-middle aged and older adults from majority culture and Cree background. Cree participants mean scores were lower on measures of confrontational naming, semantic memory, verbal fluency, prospective memory, and processing speed, and were presumed to be in keeping with the significantly fewer years of education, lower estimated reading ability, and possible health disparities in the participants of Cree background. Findings of the four studies are discussed in the context of implications for current clinical practice and with regard to future research.

Recent publications have urged researchers to address neuropsychological assessment issues among culturally and linguistically diverse individuals for whom current assessment measures are not typically appropriate. This dissertation examined cultural considerations in clinical neuropsychological practice with Cree-speaking Canadians residing in Saskatchewan. Four inter-related studies focused on understanding cultural perceptions of normal aging and dementia within a Canadian Aboriginal population, modifying existing screening and neuropsychological assessment instruments for use in both normal aging research and clinical practice, and investigating the role of culture in cognitive aging with Cree-speaking. Study 1 involved the qualitative analyses of a series of key informant interviews with an Aboriginal Grandmothers Group. Three related themes were identified that highlighted Aboriginal experiences of aging, caregiving, and dementia within the healthcare system. The third theme, the importance of culturally grounded healthcare, directly informed test development for Studies 2 and 3. In Study 2, two screening measures that were adapted for use with seniors from diverse cultural groups were further modified and examined for use with Canadian Aboriginal seniors. Overall, performance was consistent across the two screening measures, and the measures informed clinical diagnosis and were well-received by both the Aboriginal patients and their family members. Study 3 describes the development of the Grasshoppers and Geese Test battery (G&G), created by modifying and integrating existing instruments and paradigms for language and memory assessment for use with culturally diverse seniors. All G&G subtests demonstrated adequate preliminary psychometric properties and generated excellent sensitivity and good specificity in differentiating healthy older adults from adults with Alzheimers disease. Finally, Study 4 examined performance on the G&G and on other neuropsychological measures in groups of young-middle aged and older adults from majority culture and Cree background. Cree participants mean scores were lower on measures of confrontational naming, semantic memory, verbal fluency, prospective memory, and processing speed, and were presumed to be in keeping with the significantly fewer years of education, lower estimated reading ability, and possible health disparities in the participants of Cree background. Findings of the four studies are discussed in the context of implications for current clinical practice and with regard to future research.