[pt] O Transtorno do Espectro Autista (TEA) é um distúrbio do neurodesenvolvimento caracterizado por prejuízos sociais, comportamentais e de comunicação. Um dos modelos que tentam explicar tais sintomas é o da neuropsicologia, que propõe déficit em Funções Executivas (FEs), destacando o componente de flexibilidade cognitiva. O constructo de flexibilidade cognitiva é amplo, porém é comum estar relacionado à capacidade de alternar foco atencional e pensamento, e a capacidade de adaptação às mudanças no ambiente, estando, dessa forma, na base dos sintomas de comportamento repetitivo e estereotipado no TEA. A flexibilidade cognitiva também aparece correlacionada com Teoria de Mente (ToM) e atenção compartilhada, estando, também, em algum nível associada ao funcionamento social. A literatura afirma que FEs podem melhorar com treinamento. Existem diversos modelos de intervenção para o TEA e, entre eles, a reabilitação neuropsicológica tem sido foco de estudo. A reabilitação neuropsicológica é um modelo potente para remediar e desenvolver habilidades cognitivas que se mostram prejudicadas em alguns diagnósticos infantis como TEA. Existe uma escassez de ferramentas que atuem no campo da reabilitação neuropsicológica que atenda tanto à necessidade de desenvolvimento de flexibilidade cognitiva quanto a de promover mudanças ecológicas, ou seja, instrumento que potencialize a generalização da aprendizagem para situações de vida diária. No entanto, existem tentativas nessa área e uma ferramenta comum utilizada na reabilitação infantil envolve atividade lúdica. Para atender a estas necessidades o objetivo deste trabalho foi desenvolver uma ferramenta para estimulação de flexibilidade cognitiva em crianças com TEA leve e verbais, entre 9 e 12 anos. A ferramenta desenvolvida foi um jogo de Role- Playing Game (RPG). O jogo de RPG envolve a encenação de uma história, onde os participantes devem encenar papéis, considerando as características de seus personagens. Ao longo do jogo eles se deparam com desafios, que são situações problemas que devem resolver de forma compartilhada. A dinâmica deste jogo oferece um contexto favorável a prática e experiência de comportamentos flexíveis e atende ao constructo de flexibilidade cognitiva. Para o desenvolvimento do jogo foram realizadas diversas etapas para chegar ao modelo final que foi testado em um grupo piloto para posterior revisão e adequação. O modelo final passou por uma avaliação de concordância por juízes especialista que apresentou resultado de 100 por cento para todos os itens avaliados. Este resultado confirmou a hipótese que o jogo de RPG, chamado, Fábulas e Fantasias estimula flexibilidade cognitiva, estando apto a ser usado no grupo proposto. O jogo de RPG Fábulas e Fantasias estimula flexibilidade cognitiva por meio do treino cognitivo, oferecendo oportunidade e suporte adequado para que esta habilidade seja experimentada e praticada, com a integração de estratégias metacognitivas e de instrução. Uma limitação do presente trabalho foi à ausência da realização do estudo de eficácia da ferramenta, e este objetivo compõe as perspectivas futuras. / [en] Autistic Spectrum Disorder (ASD) is a neurodevelopmental disorder mitigated by social, behavioral and communication impairments. One of the models that try to explain such symptoms is that of neuropsychology, which offers deficits in Executive Functions (EFs), highlighting the component of cognitive flexibility. The cognitive flexibility construct is broad, however it is common to be related to the ability to alternate attentional focus and thinking, and the ability to adapt to changes in the environment. Thus, linking on the basis of symptoms of repetitive and stereotyped behavior in the ASD. Cognitive flexibility also appears to be correlated with Theory of Mind (ToM) and shared attention, too, at a level associated with social functioning. Literature states that FEs can improve with training. There are several intervention models for ASD, among them neuropsychological rehabilitation has been the focus of the study. Neuropsychological rehabilitation is a powerful model to remedy and develop cognitive skills that are impaired in some childhood diagnoses such as ASD. There is a scarcity of tools that work in the field of neuropsychological rehabilitation that meet both the need to develop cognitive flexibility and ecological changes, that is, an instrument that enhances the generalization of learning to situations of daily life. However, in this area there are and a common tool used in child rehabilitation involves playful activity. To meet these needs, the objective of this work is to develop a tool for stimulating cognitive flexibility in children with mild and verbal ASD, between 9 and 12 years old. The tool developed was a Role-Playing Game (RPG). The role-playing game involves a re-enactment of a story, where participants must enact roles, considering the characteristics of their characters. Throughout the game, they are faced with challenges, which are problem situations that they must solve in a shared way. The dynamic game offers a favorable context for this flexible behavior practice and experience and meets the cognitive flexibility construct. For the development of the game, several steps were taken to reach the final model, which was tested in a pilot group for later review and adaptation. The final model underwent an agreement assessment by expert judges who presented a 100 percent result for all items obtained. This result confirmed the hypothesis that the role-playing game, called Fables and Fantasies, estimated cognitive flexibility, fit to be used in the proposed group. The Fables and Fantasies RPG game stimulates cognitive flexibility through cognitive training, offering the opportunity and adequate support for this skill to be tried and practiced, with the integration of metacognitive and instructional. of the tool, and this objective composes the future perspectives.

Anxiety disorders are among the most commonly diagnosed class of mental illness in the United States, and often involve abnormally high levels of stress and social fear. Despite high lifetime prevalence rates, social anxiety disorder (SAD) has remarkably low diagnosis and treatment rates. Furthermore, while individuals with other specific psychiatric disorders tend to exhibit significant neuropsychological deficits, neuropsychological functioning in individuals with SAD remains largely untested. A majority of the few existing studies concerning neuropsychological performance in SAD samples focus on specific functions, and their limited results are highly mixed. The primary objective of this investigation was to provide a more thorough, broad assessment of both auditory and visual working memory as related to psychometrically-defined social anxiety disorder. In addition, this study aimed to help clarify as to whether such deficits are related to the construct of social anxiety, or whether any potential deficits are better explained by generalized state and/or trait (in-the-moment) anxiety. The implications of a deficit in the visual and/or auditory working memory domains are multifaceted. For example, such a deficit may lead to the inability to detect visual cues in social situations. The inability to process these social cues has the potential to exacerbate some SAD- related symptoms, such as fear of humiliation and judgment. Twenty-nine college students completed both phases of this study, including an assessment of state and trait anxiety as well as social phobia and a four-part working memory battery. An analysis of the Phase II data indicates that individual scores on the four measures of both visual and auditory working memory did not relate to trait and/or state anxiety or psychometrically-defined social anxiety.; Thus, it appears that social, generalized trait, and generalized state anxiety do not relate to a neuropsychological deficit in either type of working memory in this sample population. However, we did find a statistical trend suggesting that as social anxiety increased, there was a relative decrease in visual vs. auditory working memory. This statistical trend remained after covarying for state and trait anxiety respectively. Therefore, future research in this area should examine the discrepancy in performance between the auditory and visual working memory domains as it relates to both diagnosed social phobia and psychometrically-defined social anxiety.

OBJECTIVE: Metamemory is integral for strategizing about memory intentions. This study investigated the prospective memory (PM) deficit in Parkinson's disease (PD) from a metamemory viewpoint, with the aim of examining whether metamemory deficits might contribute to PM deficits in PD. METHOD: Sixteen patients with PD and 16 healthy older adult controls completed a time-based PM task (initiating a key press at two specified times during an ongoing task), and an event-based PM task (initiating a key press in response to animal words during an ongoing task). To measure metamemory participants were asked to predict and postdict their memory performance before and after completing the tasks, as well as complete a self-report questionnaire regarding their everyday memory function. RESULTS: The PD group had no impairment, relative to controls, on the event-based task, but had prospective (initiating the key press) and retrospective (recalling the instructions) impairments on the time-based task. The PD group also had metamemory impairments on the time-based task; they were inaccurate at predicting their performance before doing the task but, became accurate when making postdictions. This suggests impaired metamemory knowledge but preserved metamemory monitoring. There were no group differences regarding PD patients' self-reported PM performance on the questionnaire. CONCLUSIONS: These results reinforce previous findings that PM impairments in PD are dependent on task type. Several accounts of PM failures in time-based tasks are presented, in particular, ways in which mnemonic and metacognitive deficits may contribute to the difficulties observed on the time-based task.

Die vorliegende Arbeit untersucht die aktuelle wissenschaftliche Evidenz zur Diagnostik und Therapie neuropsychologischer Störungen nach Hirnschädigung, wie sie bis 2020 in Leitlinien publiziert wurde. Deren Umsetzung ist nur möglich, wenn die institutionellen Rahmenbedingungen dies erlauben. Unter Einbezug der klinischen Erfahrung wurden daher auf Basis der Leitlinien Standards für eine wissenschaftlich fundierte neuropsychologische Diagnostik und Therapie erarbeitet. Es entstanden Best-Practice-Empfehlungen zu Strukturund Prozessqualität, insbesondere zu Intensität und Häufigkeit der Interventionen. Diese werden für die wichtigsten neuropsychologischen Funktionsbereiche vorgestellt. Sowohl die Deutsche Gesellschaft für Neuropsychologie e. V. (GNP) als auch die Deutsche Gesellschaft für Neurologie e. V. (DGN) unterstützen diese Empfehlungen. Sie richten sich an Neuropsycholog_innen sowie an Einrichtungsleitende und Sozialversicherungsträger und definieren die Rahmenbedingungen für eine auf den individuellen Fall angepasste leitliniengerechte neuropsychologische Behandlung. / Recent years have seen the establishment of evidence-based guidelines for neuropsychological diagnostics and therapy; however, implementing these guidelines depends on structures and processes necessary to enable essential aspects like therapy frequency and intensity. The present work examines the current scientific evidence for the neuropsychological treatment of traumatic and nontraumatic brain injury, as published in guidelines up to 2020. Standards for evidence-based neuropsychological diagnostics and therapy were developed on this basis, including clinical experience and additional literature research. Best-practice recommendations on both general and specific structural and process quality emerged, especially on the intensity and frequency of interventions. These are presented for the most important neuropsychological functional areas. The German Neuropsychological Society (GNP) and the German Society for Neurology (DGN) support these recommendations. They are aimed at neuropsychologists as well as facility managers and social insurance providers, and they define the framework for guideline-based neuropsychological treatment adapted to individual cases.

The accuracy of neuropsychological assessment is critical in the diagnosis of cognitive impairments in older adults. However, existing neuropsychological tests may not be suitable for minority populations. This thesis aimed to address this issue by recruiting cognitively-healthy South Asian older adults and assessing cognitive function in this group. Results showed that typically used assessments, despite being translated, were not suitable for this cohort. Furthermore, skills required for test completion such as mathematics and writing/hand dexterity (which are related to education levels) influenced test scores. Therefore, new assessments of general cognitive function and associative memory were developed to improve the accuracy of neuropsychological test scores. The new tests were not affected by education and they achieved high internal and test re-test reliability. Time of day (TOD) that testing takes place is also known to affect cognition. Interestingly, no TOD effects were observed in this cohort. It was hypothesised that engagement in the daily five Islamic prayers may have contributed to this lack of a TOD effect. However, the results did not confirm this. The thesis then looked at overall prayer engagement and cognition. Results showed that engagement in the daily five prayers and Quran recitation significantly increased scores on assessments of processing speed. This thesis demonstrates that accurately assessing cognition in South Asian older adults is challenging and that the cognitive tests used must be suitable for this cohort. Interesting findings emerged for prayer engagement which may have wider implications for the field of cognitive reserve.

No description available.

No description available.

No description available.

Left hemisphere damage is a frequent cause of aphasia. Analyses of deviant linguistic behaviors provide valuable information about the functional architecture of language. Correlating specific language difficulties with damage to the brain helps shed light on the relationships between language and the neural substrate. The aim of this Ph.D. thesis is to contribute to the understanding of the neural correlates of sentence comprehension, based on behavioral and neuroimaging evidence from aphasia. A substantial amount of research based on lesion-symptom mapping has been devoted to this issue, but several issues remain to be clarified. To consider just an example, lesion-symptom mapping studies have systematically linked the posterior regions of the left hemisphere to sentence comprehension. Surprisingly, however, the same studies failed to provide similarly strong evidence for prefrontal regions, contradicting the results of previous neuropsychological investigations that clearly supported the critical role of these regions in sentence processing. To date, there are enough controversial issues on sentence processing as to warrant reconsideration of available evidence. The present project focused on the neural correlates of the mechanisms involved in thematic role assignment and in the processing of morphosyntactic features. This is because both sets of mechanisms are critical for sentence interpretation both in comprehension and in production. The first step of the project consisted of a systematic literature review and meta-analysis of lesion-symptom investigations of sentence processing (study 1 – Chapter 1). The literature search yielded 43 studies eligible for review, of which 27 were used in the meta-analysis. The main goal was to identify the correlates of thematic role assignment and of morphosyntactic processing. Thematic role assignment errors correlated mainly with damage in the left temporo-parietal regions, and morphosyntactic errors mainly with damage in the prefrontal regions. However, careful consideration of the reviewed and meta-analyzed studies shows that conclusions are biased under several aspects. Data on thematic deficits are based almost exclusively on sentence comprehension, and data on morphosyntactic deficits on sentence production. Furthermore, even the very few studies that evaluated both impairments did so in distinct linguistic contexts, or in different response modalities. In addition, studies that focused on one set of mechanisms did not consider the possibility that performance on their dimension of interest was influenced by damage to the other. For example, studies focusing on thematic comprehension administered thematic foils, but not morphosyntactic foils. Therefore, the neurofunctional correlates emerging from the meta-analysis and the review may offer a biased and/or partial view. As a first attempt at overcoming these limitations, a lesion study on native speakers of Italian with post-left stroke aphasia was conducted (study 2 – Chapter 2) to clarify the neural substrates of morphosyntactic and thematic processes in comprehension. Experimental stimuli consisted of simple declarative, semantically reversible sentences presented in the active or passive voice. In an auditory sentence comprehension task, participants were asked to match a sentence spoken by the computer to the corresponding picture, that had to be distinguished from a thematic, a morphosyntactic or a lexical-semantic foil. Thirty-three left brain-damaged individuals (out of an initial sample of 70) were selected because they fared normally on lexical-semantic foils, but poorly on morphosyntactic (n=15) and/or thematic (n=18) contrasts. Voxel-based Lesion Symptom Mapping (VLSM) analyses retrieved non-overlapping substrates. Morphosyntactic difficulties were uninfluenced by sentence voice and correlated with left inferior and middle frontal damage, whereas thematic role reversals were more frequent on passives and correlated with damage to the superior and middle temporal gyrus and to the superior occipitolateral cortex. Both correlations persisted after covarying for phonological short-term memory. When response accuracy to passive vs active sentences in the presence of thematic foils was considered, portions of the angular and supramarginal gyrus were retrieved. They could provide the neural substrate for thematic reanalysis, that is critical for comprehending sentences with noncanonical word order. However interesting and strong, these results were obtained by considering just one sentence type (declaratives) and by relying on basic neuroimaging data. To go beyond these limitations, the final step of the project relied on more comprehensive behavioral analyses and more advanced neuroimaging techniques (study 3 – Chapter 3). The SCOPRO (Sentence Comprehension and PROduction) language battery was developed, that focuses on thematic and morphosyntactic processes and allows assessing these processes in a variety of reversible sentences in both comprehension and production. SCOPRO was administered to 50 neurotypical subjects (to assess applicability and establish cutoff levels) and 27 aphasic participants (native Italian speakers with left post-stroke aphasia). Of the latter, 21 were included in an MRI-based lesion-symptom mapping study. Results obtained in comprehension tasks were correlated with neuroimaging data (structural T1 and DWI). Lesion maps, disconnectome maps, tract disconnection probability and personalized deterministic tractography data demonstrated the involvement of grey and white matter. Thematic role reversals correlated to cortical damage in the left angular gyrus. They also correlated to cortical damage in the left supramarginal gyrus when controlling for single-word processing in a voxel-based disconnectome-symptom mapping analysis. Thematic errors were associated also with underlying white matter damage. Correlating the probability of tract disconnections and personalized deterministic tractography with thematic role performance involved the left arcuate fasciculus. The posterior segment was associated with thematic role reversals, even after controlling for morphosyntactic and single-word processing. The anterior segment was linked to accuracy on thematic roles when single-word processing was used as a covariate. The long segment also correlated with the level of thematic role performance, but the correlation was no longer present when morphosyntactic performance was used as a covariate. SCOPRO can be used not only to assess language processes in a broad sense (e.g., morphosyntactic vs thematic), but also to look into more detailed issues. Contrasting accuracy on declarative and comparative sentences is an interesting case in point. Both sentence types express reversible relations, but only declaratives require thematic role mapping. Hence, contrasting results between the two could help distinguish the correlates of role mapping from those of reversibility per se. The supramarginal gyrus was damaged in participants who fared poorly in both declaratives and comparatives but, interestingly, the aphasics with selective thematic difficulties had suffered damage to the posterior division of the middle temporal gyrus and to the angular gyrus, whereas those with selective difficulties on comparatives presented with lesions in the parietal and central opercular cortex. Clearly, these results are preliminary and require further investigation. It is unanimously accepted that sentence processing involves a large-scale network including frontal, temporal and parietal cortices and the underlying white matter pathways. The main contribution of the present project is that it allows articulating more detailed hypotheses on the role played by some components of the network during sentence comprehension. Results tie left frontal regions to morphosyntactic processing, posterior temporal regions to the retrieval of verb argument structure, and a posterior-superior parietal area to thematic reanalysis. Preliminary observations also suggest that different neural substrates could be involved in processing reversibility as such and when more specifically implemented in thematic roles. Further studies exploiting detailed behavioral tools like the SCOPRO battery and sophisticated neuroimaging techniques in larger samples will lead to a better understanding of language functions and their processing in the brain.

The role of executive functioning in substance dependence and addiction has received increased attention in recent years; however, the findings of empirical studies are at times contradictory and difficult to compare at face value. To address the current state of fragmentation and to delineate the current body of knowledge a systematic review of existing studies was conducted. The synthesis of the findings from these studies confirmed that lower neuropsychological performance scores of executive functioning are observed in substance dependent populations. Furthermore, the synthesis of the components of these studies provided a comprehensive overview and revealed a number of critical gaps in the current body of knowledge. The gaps include limitations concerning specific demographics of the samples studied (under-representation of females, adolescents, the elderly, individuals with limited education, and individuals from Africa, Oceania, Asia, Latin America and the Caribbean), as well as the scarce number of studies investigating specific substances; insufficient longitudinal studies; and the fragmentation of executive functioning as a theoretical construct. / Psychology / M.A. (Psychology)