A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Objective: This study was performed to provide a detailed analysis of the MoCA versus the MMSE, including an item analysis and an examination of threshold scores appropriate for use in different clinical settings. Methods: 135 subjects enrolled in a longitudinal clinicopathologic study were administered the MoCA and MMSE. Subjects were classified as cognitively impaired or cognitively normal based on neuropsychological testing and consensus conference diagnosis. Results: 89 subjects were cognitively normal, 46 cognitively impaired (20 dementia, 26 MCI). ROC analysis showed that, for any threshold value selected for the MMSE to identify cognitive impairment, a MoCA value with better sensitivity and specificity could be identified. Recall performed best among individual items on the MMSE, and Orientation performed best on the MoCA. Overall, the best discrimination was obtained using a weighted combination of four items (2*MoCA-Orientation + MMSE-Recall + MoCA-Language + 0.5* MoCA-Visuospatial/Executive; AUC 0.94). A MoCA threshold score of 26 had a sensitivity of 98% and specificity of 52% for identifying cognitive 5 impairment. A MoCA threshold score of 21 had a sensitivity of 57% and specificity of 96%. Conclusions: The MoCA was superior to the MMSE in detecting cognitive impairment. Individual domains on the MoCA and MMSE made substantially different contributions to each instrument’s sensitivity, and a weighted subset of items from both instruments performed best in detecting cognitive impairment. A lower MoCA threshold score may be appropriate in a population with a higher prevalence of cognitive impairment such as a memory clinic.

Cognitive impairment is the most frequent cause of disability in humans following traumatic brain injury (TBI), yet the behavioral tasks used to assess cognitive behavior in rodent models of brain injury are underrepresented in the field. Additionally, few of these tasks have been used to assess behavior across degrees of injury severity. The goal of the present study was to compare four behavioral tasks commonly used in the field in frontally-injured rats with both mild and moderate-to-severe brain injuries. At the start of the study, rats were assigned to two of the following behavioral tasks: Dig scent discrimination (Dig) task, novel object recognition (NOR) task, Morris water maze (MWM), and passive avoidance (PA) task. Four days prior to injury, Dig rats were trained to dig in unscented sand and MWM rats were trained to locate a hidden platform positioned in the northeast quadrant of the MWM. Following training, bilateral controlled cortical impact injuries were induced (mild bilateral frontal TBI, moderate-to-severe bilateral frontal TBI, or non-injured, sham). Following a seven day recovery period, rats were tested on the two assigned behavioral tasks. Following testing, linear mixed effects modeling was performed assessing performance differences on the four tasks as a function of injury (injured vs. non-injured), injury severity (mild TBI vs. moderate-to-severe TBI), and task interaction. The results indicated that, while all four behavioral tasks were effective at assessing injury, some of the tasks were more effective at differentiating between injury severities than others. Specifically, the Dig task and MWM were effective at differentiating between rats with mild TBIs and rats with moderate-to-severe TBIs. Interactions between tasks also occurred such that Dig rats also assigned to the NOR task had significantly higher learning curves on the scent discriminations. The results from the current study indicate that all four behavioral tasks have the potential to assess cognitive impairment after TBI. However, these results are only a beginning. More work is needed before we can fully understand the efficacy of each of these tasks as behavioral assessment measures for cognitive functioning after TBI.

This doctoral project presents an example of the integration occupational therapy (OT) into primary care to improve access to OT services that will address occupational performance challenges of veterans within the Eastern Colorado Veterans Affairs (VA) Health Care system. Informed by the Person Environment Occupation model of occupation and substantial evidence supporting the necessity of assessing functional cognition to better understand occupational performance, this doctoral project focuses upon the provision of OT services in a primary care setting, which included assessments of functional cognition and ADL/IADL performance and interventions addressing functional cognitive deficits, home safety, and activities of daily living/instrumental activities of daily living (ADL/IADL) performance. Satisfaction of primary care providers with inclusion of OT services as well as data on client factors of typical veterans referred to OT and assessments and interventions utilized were collected through survey and observation. Results of this project indicate that the inclusion of occupational therapy services in primary care can reduce the wait time from referral to evaluation for some veterans from 1–2 months to 15 minutes while increasing primary care provider (PCP) knowledge of the scope of OT services. However, several factors must be considered for the successful continued presence of OT in primary care. To improve OT productivity, follow-up appointments should be scheduled at the primary care office and group programing should address health and wellness and chronic disease management. Care must be taken to balance availability for “warm hand-offs” from PCPs and prescheduled appointment times. Furthermore, continued education of PCPs on scope of OT practice will be imperative for continuing to increase numbers of appropriate referrals.

Esta tese descreve um estudo quase experimental que teve como objetivo: investigar a relação entre a construção do Pensamento Computacional e o desenvolvimento do raciocínio de estudantes dos últimos anos do Ensino Fundamental. A pesquisa foi realizada utilizando um curso de extensão em Desenvolvimento de Games, ofertado em 2 escolas particulares de Porto Alegre, tendo a participação de 50 alunos. A prática de ensino-aprendizagem proposta foi construída com base em pressupostos teóricos da aprendizagem significativa e aprendizagem experiencial. O Pensamento Computacional e o raciocínio dos alunos foram avaliados antes e após o término do curso, sendo utilizados para este fim o Teste de Pensamento Computacional e as provas que compõe a Bateria de Provas de Raciocínio – BPR-5. A análise estatística dos dados permitiu evidenciar um incremento do Pensamento Computacional, bem como do Raciocínio Verbal, Raciocínio Abstrato e Raciocínio Mecânico dos alunos que participaram do experimento. Comprovou-se também uma correlação positiva entre o Pensamento Computacional e os cinco tipos de raciocínio avaliados. Os resultados deste estudo demonstram como a construção do Pensamento Computacional contribuí no desenvolvimento cognitivo dos alunos e é apresentada uma proposta pedagógica que pode servir de referência para novos estudos na área. / This thesis describes a quasi-experimental study aimed to investigate a relationship between the construction of Computational Thinking and the development of students' reasoning in Middle School. A research was carried out during a course about Games Development, offered in two private schools in Porto Alegre, with 50 students. The proposed teaching-learning practice was built on the theoretical assumptions of meaningful learning and experiential learning. Both, Computational Thinking and reasoning, of the students were measured before and after the course, using a Computational Thinking Test and a set of reasoning evidence tests (BPR-5). The statistical analysis of the data showed an increase in Computational Thinking, as well as Verbal Reasoning, Abstract Reasoning and Mechanical Reasoning of the students participating in the experiment. There was also a positive observation between Computational Thinking and the five types of reasoning. The results of this study demonstrate how the construction of Computational Thinking contributes to the cognitive development of students and presents a pedagogical proposal that can serve as a reference for new studies in the area.

The primary objective of this study was to assess cognitive functioning in participants with relapsing remitting multiple sclerosis (RRMS) using the MicroCog and to compare their performance to that of a demographically matched, healthy control group. It was hypothesized that as a group, participants with RRMS would have worse cognitive function than healthy controls on all Level 1, 2, and 3 Index scores of the MicroCog. Twenty-six participants with RRMS and twenty-nine sex and education matched healthy controls were administered the MicroCog (Standard Form) along with measures of depression and clinical status, and paper-pencil tests of processing speed (Symbol Digit Modalities Test; SDMT and Paced Auditory Serial Addition Test; PASAT). A series of ANCOVAs with depression as a covariate was performed to determine between group differences for each MicroCog Level 3 Index score (General Cognitive Proficiency (GCP) and General Cognitive Functioning (GCF)), Level 2 Index score (Information Processing Accuracy (IPA) and Information Processing Speed (IPS)), and Level 1 Index score (Attention/Mental Control, Memory, Reasoning/Calculation, Spatial Processing, and Reaction Time). Pearson's and point biserial r correlations were calculated in order to assess the degree to which Level 2 and 3 Index scores correlated with clinical and demographic factors (sex, disease duration, depression, and clinical status) and to correlate the MicroCog IPS index score with traditional measures of processing speed. Eight RRMS and two control participants met criteria for cognitive impairment on the MicroCog. ANCOVA results indicated there were significant differences between RRMS and control performance for two MicroCog scores (GCF and IPS). There were not significant differences for GCP, IPS, and all Level 1 scores. A post-hoc analysis performed for the same hypothesis with a group of age equivalent participants suggested a significant RRMS by depression interaction for Level 3 scores. RRMS was not predictive of Level 2 scores after controlling for depression in the age equivalent sample. Correlations for clinical and demographic factors with cognitive outcomes indicated significant relationships for clinical status and depression. There was not a significant relationship detected for disease duration or sex. MicroCog and processing speed measures were significantly related. Post-hoc analyses supported that the criterion validity of the MicroCog is comparable to other cognitive screening tools in RRMS. The results and limitations of our study are discussed, in addition to recommendations for future research.

Thesis (Ph. D.)--Ohio State University, 2004. / Title from first page of PDF file. Document formatted into pages; contains xi, 107 p.; also includes graphics. Includes abstract and vita. Advisor: Antoinette Miranda, College of Education. Includes bibliographical references (p. 94-107).

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Memory screening in the community promotes early detection of memory problems, as well as Alzheimer’s disease (AD) and related illnesses, and encourages appropriate intervention. The Montreal Cognitive Assessment (MoCA) is a rapid and sensitive screening tool for cognitive impairment that can be readily employed at the clinical level, but little is known about its utility as a community screening tool. Also, little is known regarding the demographics of the population that presents for a community screen. The research aims to evaluate the demographics of the participants that attended community memory screens in the greater Phoenix metropolitan area and to evaluate the prevalence of screen positives using the MoCA. It is hypothesized that cognitive impairment will be significantly prevalent in the screened population and that age and family history of dementia will correlate with the presence of cognitive impairment. The study methods involve descriptive analysis and application of statistical tests to evaluate for significant relationships between demographic variables and MoCA scores. The population (n=346) had a mean age of 72 (SD =10.7), was primarily female (70%), primarily Caucasian (68%) and 86% had greater than a high school education. A 58% prevalence of cognitive impairment was found in the population as defined by the MoCA. Increased age, male gender, and non‐Caucasian race correlated with lower MoCA scores. Lower education correlated with lower MoCA scores despite the inherent educational correction in the MoCA. Diabetes and a family history of AD were not significant factors. Although the number of true positives following methodical diagnosis is unknown, given the validity of the MoCA in discerning cognitive impairment, the screen was likely worthwhile and supports more routine use of community memory screens. Variables identified that were associated with increased cognitive impairment better describe the population at risk and can be utilized to focus future screening efforts.

Approximately half of Multiple Sclerosis (MS) patients experience cognitive deficits. Accessing neuropsychological assessment can be challenging due to the considerable time, expense, and expertise required for test administration. Computerized cognitive testing has been proposed as an alternative. The objective was to validate a computer generated cognitive screen for MS patients. Ninety-nine MS patients and 98 healthy controls completed the computerized battery consisting of the Stroop, Symbol Digit Modalities Test (C-SDMT), Paced Auditory Serial Addition Test (PVSAT-2, PVSAT-4), and simple and choice reaction time tests. The Minimal Assessment of Cognitive Function in MS (MACFIMS) was used to define cognitive impairment in the MS sample. A combination of the C-SDMT, PVSAT-2, PVSAT-4 had a sensitivity of 83.3% and specificity of 87.7% in detecting cognitive impairment. Each measure had good test-retest reliability (p < 0.001). High sensitivity and specificity, and brevity emphasize the usefulness of the computerized cognitive screen in busy MS clinics.

Approximately half of Multiple Sclerosis (MS) patients experience cognitive deficits. Accessing neuropsychological assessment can be challenging due to the considerable time, expense, and expertise required for test administration. Computerized cognitive testing has been proposed as an alternative. The objective was to validate a computer generated cognitive screen for MS patients. Ninety-nine MS patients and 98 healthy controls completed the computerized battery consisting of the Stroop, Symbol Digit Modalities Test (C-SDMT), Paced Auditory Serial Addition Test (PVSAT-2, PVSAT-4), and simple and choice reaction time tests. The Minimal Assessment of Cognitive Function in MS (MACFIMS) was used to define cognitive impairment in the MS sample. A combination of the C-SDMT, PVSAT-2, PVSAT-4 had a sensitivity of 83.3% and specificity of 87.7% in detecting cognitive impairment. Each measure had good test-retest reliability (p < 0.001). High sensitivity and specificity, and brevity emphasize the usefulness of the computerized cognitive screen in busy MS clinics.

abstract: The Native American population is severely underrepresented in empirical test validity research despite being overrepresented in special education programs and at an increased risk for special educational evaluation. This study is the first to investigate the structural validity of the Wechsler Intelligence Scale for Children - Fourth Edition (WISC-IV) with a Native American sample. The structural validity of the WISC-IV was investigated using the core subtest scores of 176, six-to-sixteen-year-old Native American children referred for a psychoeducational evaluation. The exploratory factor analysis procedures reported in the WISC-IV technical manual were replicated with the current sample. Congruence coefficients were used to measure the similarity between the derived factor structure and the normative factor structure. The Schmid-Leiman orthogonalization procedure was used to study the role of the higher-order general ability factor. Results support the structural validity of the first-order and higher-order factors of the WISC-IV within this sample. The normative first-order factor structure was replicated in this sample, and the Schmid-Leiman procedure identified a higher-order general ability factor that accounted for the greatest amount of common variance (70%) and total variance (37%). The results support the structural validity of the WISC-IV within a referred Native American sample. The outcome also suggests that interpretation of the WISC-IV scores should focus on the global ability factor. / Dissertation/Thesis / Ph.D. Educational Psychology 2011