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This study predicted that individuals diagnosed as having higher levels of stress, based upon DSM-III-R, Axis IV ratings, would also be diagnosed as having more severe forms of mental illness. Conversely, it predicted that individuals with higher premorbid health ratings, according to DSM-III-R, Axis V, would be diagnosed as having less severe forms of mental illness. Highly significant correlations were found between stress ratings and severity of disorder. Significant inverse relationships were also found between Axis V ratings and disorder severity. Additionally, several other demographic variables were significantly correlated with severity of disorder.

Background Dementia is a national priority for Scotland, and as such, fast and accurate diagnosis plus responsive and well-evidenced interventions post-diagnosis are key. Accurately estimating an individual’s level of premorbid functioning can be a crucial part of establishing that cognitive decline has taken place, enabling clinicians to be more confident and accurate in their diagnosis. Measures that assess premorbid ability should be able to 1) capture current ability in healthy controls and 2) resist the effects of cognitive decline when used in individuals with dementia. At the post-diagnostic stage, there is a growing evidence base for non-pharmacological, tailored interventions for individuals with dementia. However, the evidence base is limited, particularly so for Cognitive Rehabilitation. Objectives An empirical study was conducted in order to assess whether a newly developed measure that aims to capture lifelong cognitive reserve (the brain’s ability to withstand pathological change), the Cognitive Reserve Index Questionnaire (CRIq), can capture premorbid ability. Three research questions were addressed; 1) does the CRIq capture current ability in healthy controls? 2) is it resistant to cognitive decline when used with a patient group with dementia? and 3) how does the CRIq compare to a traditional measure of premorbid ability, the NART (National Adult Reading Test)? Another focus of development and innovation in dementia research is that of post-diagnostic interventions. A systematic review was therefore conducted in order to evaluate the effectiveness of Cognitive Rehabilitation for mild-moderate dementia (Alzheimer disease or mixed dementia) in relation to cognitive and functional outcomes. Due to the limited number of RCTs in this field precluding a clear understanding of the evidence base, the additional contribution of non-RCTs was also evaluated. Method For the empirical study N=20 healthy older controls and N=13 patients with dementia were recruited. In order to appropriately address the three research questions both groups were assessed using the NART, the CRIq and the MOCA (Montreal Cognitive Assessment). In addition, the control group were assessed on a measure of current ability, the WAIS-IV Perceptual Reasoning Index. For the systematic review of Cognitive Rehabilitation the CDCIG Specialised Register, ALOIS, was searched in order to identify relevant studies. In addition, previous reviews were searched to identify studies excluded on the basis that they were not an RCT. Results Results for the empirical study show both CRIq and NART were strongly correlated to current ability (performance on WAIS-IV PRI) in controls, although both significantly overestimated ability. CRIq performance was not affected by the presence of dementia whereas NART predicted premorbid ability was. CRIq and NART showed a different pattern of results between controls and patients, indicating that CRIq may more resistant to the effects of cognitive decline. Ten studies were identified for the systematic review; five RCT and five non-RCT. Study quality was assessed using a well-validated quality assessment tool, and indicated large variability. Eight of the ten studies reported a positive effect of Cognitive Rehabilitation. However, several studies were of poor quality and included aspects of other approaches in their intervention (e.g. Cognitive Training, Cognitive-Behaviour Therapy). Conclusions The empirical study found that CRIq over-estimated current ability in controls, but was resistant to cognitive decline in patients. The over-estimation of current ability may be accounted for by the CRIq being normed on an Italian population, thus not reflecting UK cultural norms (e.g. for length of schooling). When the NART and the CRIq were directly compared, the two measures were found to be related, but yet produced significantly different estimates of premorbid ability. This suggests that they may capture different facets of premorbid functioning, with the NART being primarily a verbal performance-based measure, and the CRIq capturing aspects of global cognitive functioning. Clinical implications include the potential utility of the CRIq for patients with language impairment. However the study conclusions are limited by a low N, and therefore have restricted generalisability. In the systematic review, the literature was exhaustively searched and evidence was found for the effectiveness of Cognitive Rehabilitation for mild-moderate Alzheimer disease and mixed dementia. Methodological limitations of the included studies are discussed, and clinical implications are identified. Both the empirical study and the systematic review highlight the need for greater research and development of methods by which dementia care is supported; through more effective methods of diagnosis, to a better evidence base for post-diagnostic interventions.

No description available.

Vocabulary tests have long been used for estimating premorbid intelligence level in the neuropsychological assessment of dementia. However, doubts exist about the validity of such intelligence tests. The present study examines whether the Multiple-Choice Vocabulary Test – Version A (Mehrfachwahl-Wortschatz-Test – Version A, MWT-A) is valid for assessing premorbid intelligence level. Data from a total of 821 patients in a specialized outpatient clinic for dementia (memory clinic), covering the whole spectrum of cognitive impairment, were evaluated using analysis of variance with the dependent variable premorbid intelligence level (MWT-A) and the independent variable extent of global cognitive impairment (Mini-Mental-State Examination, MMSE: mean = 25.2, SD = 3.9). The latter was divided into six MMSE ranges or groups, respectively (29–30, 28–28, 27–27, 25–26, 22–24, 05–21). In the case of a pathologically relevant global cognitive impairment (24–26 MMSE points), the MWT-A underestimates the premorbid intelligence level. This effect is moderated neither by age nor education. Results indicate that the MWT-A is unsuitable for estimating premorbid intelligence level in neuropsychological assessments of cognitively impaired patients or demented patients.

Introduction: Previous epidemiologic studies suggest that the personality of Parkinson's disease (PD) patients differs from that of controls, and laboratory evidence supports a potential common pathophysiology of personality traits and PD. One nested case-control study found that PD cases were significantly more anxious than controls before the clinical onset of the disease, and additional data suggest that certain occupations may be risk factors for the disease. Additionally, the latent period that precedes the onset of motor symptoms of PD is unknown. Objectives: The objectives of this study were to evaluate the association of PD with objective indicators of current and pre-morbid personality, to determine the correlation of early-adult life personality indicators with current personality characteristics and to evaluate the role of personality as indicated by occupational choice and employment patterns in the risk for PD using the Dictionary of Occupational Titles job classification system. Methods: Eighty-nine cases and 99 controls completed in-person structured interviews. Assessments included measures of current personality characteristics and indicators of early-adult (ages 20-35 years) personality, such as activities and lifestyle patterns. Associations between these latent personality variables and current personality characteristics were studied using correlation, partialling out the effects of age, sex and education. Multiple logistic regression was used to evaluate the associations of early-adult personality and occupational characteristics and the risk for Parkinson's disease. Results: Cases with Parkinson's disease reported higher levels of neuroticism (OR=1.05 (95% CI 1.00-1.11)) and harm-avoidance (OR = 1.07 (95% CI 1.00-1.15)) compared with controls on measures of current personality. A stable association among many traits, particularly traits such as novelty-seeking, which are driven by dopaminergic function, was present not only among controls with presumably normal dopaminergic function throughout their lives, but also among cases. Early-adult life routinization was correlated with current levels of neuroticism (cases: r=0.33, p=0.01; controls: r=0.26, p=0.04), extraversion (cases: r=-0.33, p=0.01; controls: r=-0.33, p=0.04), novelty-seeking (cases: r=-0.33, p=0.015; controls: r=-0.34, p=0.007) and harm-avoidance (cases: r=0.47, p=0.0003; controls: r=0.45, p=0.0002) and for the association of early-adult life activity risks with harm-avoidance (cases: r=-0.47, p=0.0004; controls: r=-0.42, p=0.0006). Taking or wanting to take "activity risks," such as riding on roller coasters as a young adult was found to reduce the odds of Parkinson's disease (OR = 0.78 (95% CI 0.63-0.97)) in the entire sample, while higher levels of early-adult routinization were associated with a greater risk for Parkinson's disease among women (OR=1.63 (95% CI 1.05-2.53)). Parkinson's disease was inversely associated with the total number of jobs held (OR=0.87 (95% CI 0.75-0.99)) but not with the number of job categories or duration of the primary occupation. Increased complexity of work with people was associated with PD among women (OR=0.69 (95% CI 0.53-0.89), as was less complex work with things (OR=1.45 (95% CI 1.11-1.88). The complexity of work with data, people or things was not associated with the risk for PD among men or in the sample as a whole. Men with PD whose work involved greater complexity with data took fewer activity risks (r=0.32, p=0.02) and reported greater routinization (r=-0.34, p=0.01) as a young adult. Conclusions: This evaluation of early-adult risk factors advances current knowledge about the premorbid period of PD and supports the hypothesis that a long period of subclinical disease precedes the onset of motor symptoms. These findings validate the association of these early-adult personality traits and PD and support the idea that behaviors associated with PD personality exist many years before the presentation of motor symptoms. Dopaminergic aspects of personality were related to occupational choices and future consideration of this hypothesis is warranted. Since PD is a degenerative disorder, determining the age of onset of this illness is important in the search for modifiable risk factors and neuroprotective strategies.

The aim of this study was to investigate the relationship between noncognitive symptoms and premorbid temperament in a group with Alzheimer’s disease. The relationship between premorbid temperament and noncognitive symptoms can be used to understand symptom susceptibility and risk, caregiver burdens, as well as providing insights into the neuroanatomical substrates of temperament and noncognitive behaviour. Sixty-three primary caregivers of Alzheimer’s patients fulfilled the eligibility criteria for this study. Information regarding the noncognitive symptoms and premorbid temperament was procured from the primary caregivers. In fifty-one cases, a secondary caregiver also provided information about the premorbid temperament of the Alzheimer’s patient. The latter was obtained to enhance the reliability of retrospective data. The Behaviour Rating Scale for Dementia, the Formal Characteristics of Behaviour-Temperament Inventory, and the Blessed Dementia scale were used to elicit data on noncognitive symptomatology, premorbid temperament, and current cognitive status, respectively. ii Noncognitive symptoms were grouped into two clusters namely neuropsychiatric and neurobehavioural disturbances. The neuropsychiatric cluster included mood and psychotic symptoms and the neurobehavioural cluster included vegetative and overall behavioural dysregulatory symptoms. Results showed that there is a wide spectrum of noncognitive symptom manifestation in patients’ profiles and that the neurobehavioural dysregulatory symptoms are more common than the neuropsychiatric symptoms in this Alzheimer’s cohort. With regard to symptom manifestation and cognitive status, a Pearson product moment correlational analysis showed that a lower level of cognitive functioning is significantly associated with aggressive episodes and a higher level of cognitive functioning with manifestations of depressive symptoms. In terms of interrater concordance on premorbid temperament ratings, intraclass correlations were significant for five of the six temperament domains, thus indicating a reliable estimate of premorbid disposition. Canonical correlational analysis yielded two significant variates. The first variate indicated that Alzheimer’s disease patients with a proclivity for aggressive behaviours and general behavioural deregulation but lower depressive profiles, were premorbidly more emotionally reactive, had low sensory thresholds (high sensitivity), and greater cognitive deficit. The second variate showed that patients with Alzheimer’s disease who tended to manifest with depressive and dysregulatory behaviour appear to have been premorbidly perseverative in temperament with a low sensory threshold (high sensitivity) and the tendency to maintain and attain a low level of activity (stimulation). Taken together, the significant variates revealed a dimensional relationship between depressive symptoms, aggressive symptoms, and behavioural dysregulation; and sensory sensitivity, emotional reactivity, perseverance, and activity, with cognitive status serving as a moderating variable. In conclusion, the study indicated a dimensional relationship between specific premorbid temperament traits and noncognitive symptoms, thereby highlighting the possible predictive influence of premorbid temperament on noncognitive manifestations in Alzheimer’s disease patients. / Thesis (PhD (Psychology))--University of Pretoria, 2005. / Psychology / unrestricted

Vocabulary tests have long been used for estimating premorbid intelligence level in the neuropsychological assessment of dementia. However, doubts exist about the validity of such intelligence tests. The present study examines whether the Multiple-Choice Vocabulary Test – Version A (Mehrfachwahl-Wortschatz-Test – Version A, MWT-A) is valid for assessing premorbid intelligence level. Data from a total of 821 patients in a specialized outpatient clinic for dementia (memory clinic), covering the whole spectrum of cognitive impairment, were evaluated using analysis of variance with the dependent variable premorbid intelligence level (MWT-A) and the independent variable extent of global cognitive impairment (Mini-Mental-State Examination, MMSE: mean = 25.2, SD = 3.9). The latter was divided into six MMSE ranges or groups, respectively (29–30, 28–28, 27–27, 25–26, 22–24, 05–21). In the case of a pathologically relevant global cognitive impairment (24–26 MMSE points), the MWT-A underestimates the premorbid intelligence level. This effect is moderated neither by age nor education. Results indicate that the MWT-A is unsuitable for estimating premorbid intelligence level in neuropsychological assessments of cognitively impaired patients or demented patients.

La paralysie obstétricale du plexus brachial (POPB) est une paralysie du membre supérieur qui survient à la naissance et peut entraîner une déformation de l'articulation et un fonctionnement anormal de l'épaule. Bien que le traitement de la POPB tente de restaurer la fonction de l'épaule, la pathomécanique sous-jacente n'est pas encore clairement comprise. Les modèles computationnels sont efficaces pour fournir de telles informations, mais il n'existe aucun modèle d'articulation de l'épaule pédiatrique pour comprendre la POPB. Ainsi, ce travail de recherche a pour but de construire un framework combinant les avancées dans les domaines de la modélisation statistique de forme (MSF) et de la modélisation musculo-squelettique multi-corps (MCM). Due à l’insuffisance des données dans la cohorte pédiatrique, ce cadre a été mis en place pour l'articulation de l'épaule adulte. Pour cela, la précision de la MSF a été illustrée en prédisant 1) la forme de l'omoplate pré-morbide, et 2) les régions d'insertion musculaire sur l'omoplate et l'humérus. Cette méthode a ensuite été intégrée aux modèles MCM pour l'épaule adulte pour souligner l’importance des modèles spécifique-patient pour l’usage clinique. Pour le second objectif de cette thèse, j'ai développé un modèle MCM pédiatrique du complexe articulaire de l'épaule en utilisant le logiciel OpenSim. Grâce aux approches de cinématique et dynamique inverse, le modèle a permis de déterminer les différences de dynamique articulaires entre le côté sain et le côté pathologique. Les travaux futurs seront axés sur l’extension du travail réalisé pour la population pédiatrique afin de comprendre la pathomécanique de POPB. / Obstetrician Brachial Plexus Palsy (OBPP) is a common birth injury in children leading to shoulder joint deformity and abnormal function. While the management of OBPP disorder focuses on restoring the shoulder joint function, the underlying pathomechanics is not clearly understood yet. Computational models are effective to provide such insights, however, there is no pediatric shoulder joint model to understand the OBPP disorder. Thus, the global aim of this research work was to build a computational framework combining the advances in statistical shape modeling (SSM) and multi-body musculoskeletal modeling (MSKM) domains. Due to a lack of sufficient data in the pediatric cohort, I first developed the framework for adult shoulder joint. For this, I illustrated the accuracy of SSM in predicting 1) missing part of the scapula, and 2) muscle insertion regions on scapula and humerus bones. This method was then integrated with adult shoulder MSKMs to show the differences between generic and subject specific constructs. For the second aim of this thesis, I developed a pediatric MSKM of the shoulder joint complex using OpenSim software. Pediatric MSKM represented scapulothoracic, sternoclavicular, acromioclavicular, and glenohumeral joints with 13 degrees of freedom, and actuated by 52 musculotendon actuators representing 14 shoulder muscles. Using inverse kinematics and inverse dynamics approaches, the model was used to determine the differences in joint kinematics, and joint dynamics between healthy and unhealthy side of a single OBPP subject. Future work is focused on completing the framework on pediatric population and understanding the pathomechanics of OBPP.