Dissertations / Theses on the topic 'Memory disorders – Diagnosis'

[Truncated abstract] Background: Dementia, largely due to Alzheimer's disease (AD), is a major public health problem. The early identification of disease is an important challenge for clinicians because treatment of AD is now available. A simple and accurate means of stratifying risk for AD and identifying early disease is needed so that risk factor modification and treatment can occur optimally. To date, despite many attempts, an accurate means of standardising an approach to the assessment of subtle cognitive symptoms has not been developed. A subjective complaint of poor memory has been identified as a possible marker for underlying brain disease. This study examines the utility of neuropsychological scores, homocysteine levels, APOE genotyping and brain imaging as predictors of cognitive decline in individuals with subjective memory complaint (SMC). Method Eighty subjects with SMC were recruited from memory clinics and the community (MC: 1). Forty-two control subjects were also examined (MC: 0). CAMDEX was used to describe baseline clinical features. The CAMCOG was used as a global test of cognition and was administered annually for four years. At baseline, neuropsychological testing was administered. Cranial CT scanning, measurement of plasma homocysteine and APOE genotyping were completed. Categorical variables were analysed using chi-square according to Pearson's method. Continuous data was analysed using Student's t-tests and Mann-Whitney tests. A logistic regression model was used to identify independent contributors to the presence of memory complaint. Participants were then matched for age, gender and time to follow-up (up for three years) to determine longitudinal predictors of cognitive decline. ... Baseline CAMCOG scores were greater in the control group (MC:0 = 98.3 ? 2.8, MC:1 94.2 ? 5.5, Z ?4.46, p 0.000). There were no differences in neuropsychological scores, concentration of total plasma homocysteine, APOE genotype or brain scan measurements. Using the Wald stepwise selection method, logistic regression could not be established due to non-convergence regardless of whether or not the continuous variables were re-coded into dichotomous variables. A matching process that created 32 pairs of controls/subjects allowed follow-up analysis. The controls showed significant improvement with time on the CAMCOG unlike subjects (mean ? SD, controls 1.5 ?-3.0, Z - 2.61, p 0.01, subjects 0.2 ? 3.2, Z ? 0.24, p 0.81). The logistic regression analysis showed that group membership could not be defined by any single independent variable. When group membership was abandoned and those with stable scores were compared to those who declined no clear meaningful independent predictors of decline apart from age were identified. Conclusions: Methodological issues such as small sample size and inadequate follow up duration were identified that may have precluded identification of predictive factors for cognitive decline. The results indicate that complaints of memory problems are not associated with established risk factors for Alzheimer's disease and fail to predict objective cognitive decline over three years. Future studies should continue trying to identify robust predictors of cognitive decline in later life.

Doctor of Philosophy(PhD)
In recent years there has been a substantial increase in research examining the role of subjective memory complaints (SMC) in cognitive function and Alzheimer’s disease. These studies have related SMC to many different cognitive outcomes, such as retaining normal cognitive function, a fluctuating cognitive performance and the development of Alzheimer’s disease. Most of these studies have focused on older populations and have employed a limited assessment of cognitive function. This limits the available evidence regarding the clinical utility of SMC. The literature on the role of SMC in younger subjects is scarce. It is not known whether memory complaints are useful in predicting future cases of Alzheimer’s disease in younger community-based subjects. Aims: The main aim of the present study was to determine whether SMC predict the development of cognitive impairment in a younger cohort of subjects, many of whom were under the age of 70 years (73%), based on their risk profile and neuropsychological assessment. A further aim was to ascertain whether the DRS or 7MS are sensitive screening tools for MCI and examine whether the presence of SMC affects the 3-year cognitive outcome of subjects. To address these aims, this study consisted of two parts: a cross-sectional design and a longitudinal follow-up component. Methods: This study was carried out with 86 community-dwelling subjects recruited via advertisement within the catchment area of Central Sydney Area Health Service. The mean age of the subjects was 63.1 years (SD=8.4). Subjective memory complaints were assessed using a single question. Cognitive function was assessed using a comprehensive battery of tests, selected on the basis of their sensitivity to identifying cognitive impairment typically associated with Alzheimer’s disease. After the initial analysis between those with SMC and without SMC, subjects were further classified according to their performance on an episodic memory task (i.e., delayed verbal recall, Rey, 1964) as having normal memory function, SMC or aMCI. Results: Part 1 - Subjective memory complaints (SMC) were reported by 63% of the sample. The initial analysis between subjects with SMC (n=54) and without SMC (n=32) suggested an initial relationship between SMC and cognitive functioning. Subjects with SMC had impaired global cognitive functioning on two brief screening tests (7MS and DRS), working memory, verbal recall and visuomotor speed. However, subsequent screening with the delayed verbal recall test showed that 12 of the 54 subjects with SMC demonstrated significant cognitive impairment, scoring 2 SD below the control group mean. After these subjects were removed to form the aMCI group, the cognitive differences between subjects with SMC and without SMC were no longer apparent. Subjects with aMCI showed evidence of multiple cognitive deficits (below 1 SD of control group mean) with a high percentage of subjects demonstrating impairment on tests of verbal learning, verbal recall, verbal ability and visuomotor speed. Further analysis showed a significant association between age and subjects identified as having SMC (r=-.581, p<.001) and aMCI (r=.692, p<.001). From the age of 60 onwards, both the SMC and aMCI groups demonstrated a more rapid cognitive decline with increasing age in several cognitive domains. Part 2 - After a mean interval of 3.2 years, 43 subjects were followed up. Subjects with aMCI showed evidence of greater decline on both screening tests (7MS; DRS), whilst the SMC group had significantly higher scores. This trend was also apparent with other neuropsychological testing. The analysis of change over time in cognitive function showed that the majority of subjects (both SMC aMCI) either remained stable or improved their cognitive performance. It is likely that the small sample size and short follow-up interval of the present study contributed to the present observation of no change in cognitive function over time. Discussion: The present findings suggest that subjective memory complaints are a poor predictor of cognitive function. In isolation, SMC are unlikely to be useful for identifying cases with significant cognitive impairment. This is particularly relevant for subjects under the age of 70 years. However, for subjects over the age of 70 years, SMC are likely to identify significant cases with neuropsychological assessment (such as animal fluency and delayed recall). Conclusion: The present study showed that SMC are a poor predictor of cognitive function in subjects under the age of 70 years. This study provided evidence that selected and relatively quick to administer formal neuropsychological tests of cognitive function (in particular tests of animal fluency and delayed recall) are better able to identify those at risk of developing cognitive impairment associated with Alzheimer’s disease, at an earlier age. This would thus allow exposure to earlier treatment options, such as donepezil, aricept, vitamin E, and memantine”.

Abstract The prevalence of memory disorders is increasing worldwide due to an aging population. The condition affects not only those with the disorder, but also their families and the wider social network. Establishing services that meet the needs of patients and their families is a topical issue and requires knowledge produced from service user viewpoints. However there remains limited knowledge of how families manage their lives when there is a memory disorder. This study produces a substantive theory that describes the processes of managing life after disclosure of a progressive memory disorder from the viewpoint of individuals with that diagnosis and their family caregivers. A qualitative longitudinal research design informed by grounded theory methodology was undertaken. Research data were gathered for 2006–2009 using in-depth interviews (n=40) from those with the memory disorder (n=8) and their family caregivers (n=8). The data were analyzed using a constant comparative analysis. A core category ‘Accepting memory disorder as part of family life’ with related categories and subcategories was formulated from the gathered data. Family illness trajectory begins when patients or close relatives recognize the symptoms. Diagnosis of memory disorder is a turning point in that trajectory. It changes the course of lives for both individuals and their whole family and leads families to seek a new equilibrium. Altering life challenges people with the diagnosis and their family caregivers to restructure their roles and identities. Adjusting to altering self and adapting to the new role of caregiver are intertwined processes. Families strive to manage these changes by acknowledging available qualities and resources, seeking meaningful social support and living for today. Managing life with a memory disorder produces mutual processes in families that contain both positive and negative factors. Accepting memory disorder as part of family life represents a hope-fostering adjustment. The findings confirm and supplement the knowledge base in nursing science of family experiences and the means families use for managing life after diagnosis of a progressive memory disorder. These findings can be well utilized by professionals working with patients and their families who are living with newly diagnosed memory disorder while also advancing nursing education
Tiivistelmä Väestön ikääntymisen vuoksi muistisairauksien esiintyvyys on kasvussa koko maailmassa. Etenevä muistisairaus vaikuttaa sekä sairastuneiden että perheiden elämään, ja heidän tarpeisiinsa vastaavien palvelujen kehittäminen on ajankohtaista. Perheiden selviytymistä koskevaa tutkimustietoa palvelujen kehittämiseksi on kuitenkin rajallisesti. Tutkimuksen tarkoituksena oli kehittää aineistolähtöinen teoria, joka kuvaa muistisairaiden ja omaishoitajien elämänhallinnan prosesseja muistisairausdiagnoosin varmistumisen jälkeen. Tutkimus oli laadullinen pitkittäistutkimus, jossa aineisto kerättiin vuosina 2006–2009 syvähaastattelemalla (n=40) sekä sairastuneita (n=8) että heidän omaisiaan (n=8). Aineisto analysoitiin grounded theory -metodologian jatkuvan vertailun analyysimenetelmällä. Tutkimuksessa tuotetun aineistolähtöisen teorian ydinkategoriaksi muodostui ’Muistisairauden hyväksyminen osaksi perheen elämää’. Ydinkategoriaan olivat yhteydessä pää- ja alakategoriat, jotka kuvasivat vastavuoroisia elämänhallinnan prosesseja perheessä. Perheiden kehityskulku muistisairauden kanssa käynnistyi ennen diagnoosin varmistumista, kun sairastunut itse tai hänen läheisensä kiinnittivät huomiota oireisiin. Muistisairausdiagnoosi oli käännekohta, joka muutti perheiden elämänkulun suuntaa ja johti etsimään uutta tasapainoa elämässä. Muuttuva elämäntilanne haastoi sairastuneet ja heidän omaisensa rakentamaan uudelleen käsitystä itsestään ja sosiaalisista rooleistaan. Sairastuneiden kokemuksena tämä tarkoitti sopeutumista muuttuvaan itseen ja omaisten kokemuksena mukautumista uuteen omaishoitajan rooliin. Nämä kehityshaasteet kytkeytyivät toisiinsa. Perheet pyrkivät selviytymään muuttuvassa elämäntilanteessaan huomioimalla käytettävissä olevat voimavarat, hyödyntämällä merkityksellistä sosiaalista tukea ja tavoittelemalla elämää tässä ja nyt. Muistisairaiden ja omaishoitajien vastavuoroiset elämänhallinnan prosessit sisälsivät sekä myönteisiä että kielteisiä tekijöitä. Muistisairauden hyväksyminen osaksi perheen elämää merkitsi toivoa vahvistavaa sopeutumista. Tutkimustulokset täydentävät hoitotieteen tietoperustaa perheiden kokemuksista ja elämänhallinnan keinoista muistisairausdiagnoosin varmistumisen jälkeen. Tutkimustuloksia voidaan hyödyntää sekä käytännön hoitotyössä tuettaessa muistisairaita ja heidän perheitään diagnoosin jälkeen että hoitotyön koulutuksessa

Body, weight and shape related obsessions and ruminations are characteristic traits of individuals with eating disorders (ED) that are found to predate the onset of the disorder. Individuals with chronic ED display altered neural activation in response to food stimuli, and are reported to have volumetric differences compared to healthy individuals, which is likely an effect of prolonged starvation. ED individuals are also seen to dispose an attentional bias to food stimuli, even when perceived sub-consciously, which are reported to interfere with cognitive tasks, including working memory (WM). However, whether the differences in neural activation and structure are present in adolescents with a recent ED diagnosis is not known. In paper I we describe how images of high- and low-calorie foods resulted in greater responses in the prefrontal circuitry in ED adolescents compared to healthy controls (HC). Obsessive-compulsive symptoms in ED individuals were associated with prefrontal circuitry and cerebellar activation, whereas faster reaction times to the WM were associated with greater superior frontal gyrus activity. The findings indicate that ED cognitions may be linked to WM abilities, both of which are associated with frontal cortex functioning. WM performance is examined further in paper II, where we found that the presence of subliminal food images were seen to disrupt WM performance in terms of slower reaction times and less correct responses in ED but not HC. The WM interference was associated with increased activity in the parietal and superior temporal cortex. WM interference caused by subliminal food stimuli may reflect a pre-attentive bias to food in adolescents with ED, which could be a risk factor for further development of an ED. The structural differences in brain volume between adolescents with ED and HC were examined in paper III. ED symptoms were found to be associated with volume differences in insular cortex and superior temporal gyrus, whereas obsessive-compulsive symptoms were associated with reduced volumes in the putamen and cerebellum. These volumetric differences in regions implicated in restraint, obsessions and WM are likely to precede structural variations caused by starvation as seen in chronic ED’s. Connectivity from these regions, in addition to other regions believed to be implicated in ED, was studied in paper IV. Fronto-parietal regions as well as the insula showed increased connectivity in ED, whereas connectivity from the mesolimbic reward regions did not differ from HC. Regions with increased connectivity in ED are involved with self-awareness, body image and ED related ruminations, connections that could influence how one’s body is perceived. In conclusion, the studies included in this thesis describes changes in functional activity, connectivity and brain volume in regions involved with ED cognitions, eating behaviour, and body image in adolescents recently diagnosed with an ED.

Dementia is a growing social problem in Australia because as the population ages, the incidence of dementia increases. While the prevalence rates are only about I% at age 65, they double every five years until by 85 years of age the rate is over 24%. It is expected that by the year 2030, the number of elderly people with dementia will increase by 200%. Dementia is easily recognized in its advanced stages but can be overlooked in the early phase. Family members, care-givers and even the treating medical practitioner may mistakenly attribute the early decline in mental function to the normal aging process. A diagnostic instrument that is easy to administer and score yet is sensitive and specific to the detection of cognitive impairment in the elderly may prove to be of significant benefit to clinicians and assist care-givers and family members in treatment decisions, accommodation requirements and the timely provision of a range of support services. This study investigates the use of the Cognitive Status Examination (CSE) for detecting brain impairment in elderly people. The Cognitive Status Examination comprises the Cognitive Difficulties Scale and a Letter Symbol Substitution Task. It was developed as a screening instrument to detect Alcohol Related Brain Impairment and has proved to be 80% sensitive and 88% specific in detecting brain impairment in that group. This study extended those results to males and females aged 65 years and over with early dementia. A sample of 58 community-dwelling, elderly people aged 65 years and above and a clinical sample of 44 in-patients who were diagnosed with early dementia completed the Cognitive Status Examination. An existing groups, quasi-experimental research design was used. The Cognitive Status Examination proved to be marginally useful as a screening instrument for detecting cognitive impairment in elderly people with early stage dementia with a sensitivity of 59% and a specificity of 93% when the original cut-off scores were used. A revised cut-off score, determined by trial and error, was developed. This resulted in a sensitivity of 86.2% and a specificity of 77.3%, but even with such ad hoc adjustments the CSE fell marginally short of the required 80% for both specifications. Use of the CSE may enable clinicians to utilize existing resources more effectively by referring elderly people in need to appropriate medical care, accommodation and community support services, but further research is required to confirm the revised cutting scores for the CSE. Regression analysis showed that a combination of the raw LST score and the BDI score gained over 90% sensitivity and specificity, and such an actuarial approach also shows promise for future development.

This thesis is based on Educational Therapy (ET) practice which has found eye muscle imbalance is a key factor to be addressed in management of learning difficulties (LD). This level of oculo-motor (o-m) function is a 'hidden' handicap as individuals are unaware of the problem; it is not routinely tested; and is not generally included in learning difficulties research. O-m function is omitted in standard paediatric optometry tests, and in school vision screening. Eye exercises increase the range of binocular fields of vision by employing stereopsis glasses and red/green slides. Central vision loss was uncovered when students reported words, seen by only the right eye, "disappear" or "switch on and off". When the left eye was covered, right eye vision returned but was lost again with binocular vision, even though larger shapes on the screen remained complete. In effect, global vision was unaffected while right eye central (foveal) vision was suppressed. This is considered significant because students attending ET have learning difficulties with phonemic memory, spelling and reading deficits, which are predominantly left hemisphere processes. The aim of this three-part study, consisting of School Survey, ET Intervention study and Case studies, was to: a) determine whether o-m dysfunction was found in a girls' school population and/or was associated with LD; b) set up an Intervention study to explore the effects of vision training on the outcomes of a subsequent week-long word-skills programme in the ET practice. Two case studies we're also examined, that of matched senior school boys whose outcomes were significantly different; and c) examine more closely the common pattern of muscle imbalance in two case studies of current junior school students. This tested the therapy assumption that mal-adaptive sensory feedback was contributing to o-m dysfunction. This notion is based on the Luria (1973) Model of Levels of Neural Function which provides the framework for ET practice, and the Developmental Model of LD that has evolved in application and explanation. Part 1 School Survey. This exploratory, cross-sectional study included a randomised sample of 277 participants in a private girl's school. A 7-10 minute screening was provided by five optometrists, with an expanded protocol including o-m function. Also assessed were academic standards of reading comprehension and spelling, reasoning, visual perception, phonological skills, auditory, visual and phonemic memory, and arm dominance. Results showed visual dysfunction and mixed eye dominance in approximately equal numbers. Of the 47% girls with visual dysfunction, not all had literacy problems; however, LD students had corresponding degrees of o-m dysfunction, memory deficit and mixed hand / arm dominance. Part 2 Intervention study. The Research Question for the Intervention Study was: Does the difference in learning standards depend on which eye is disadvantaged in the case of weak binocularity? This question was answered by determining the outcomes to literacy levels once normal binocular o-m function and stable eye dominance were established. Twenty-four students (6 to 18 years) had Behavioural Optometry assessment prior to commencing therapy and were found to have o-m dysfunction, undetected by previous standard optometry tests. Eye exercise results showed 62.5% of the group had changed from left to right eye dominance. The dominance criterion was set by this group, indicated by the right eye holding fixation through full range of fusional reserves (binocular overlap), together with superior eye-tracking speed >20% by the right, compared to the left, eye. Associated significant gains in literacy and phonemic memory were also achieved by the newly established 'right-eyed' group. In spite of undergoing identical treatment, the 'left-eyed' group retained limited foveal binocularity, and made less progress in literacy outcomes. Part 3 Two current Case Studies. Present ET practice benefited from insights gained from the 36% 'unsuccessful' participants of the previous study. Better therapy outcomes are achieved from an integrative motor-sensory approach, supported by Podiatry and Cranial Osteopathy. This detailed study involved two junior school boys who exemplified a common pattern of physical anomalies. For example, RW (8-year old male) had 'minimal brain damage' and LD that co-occur with unstable feet and o-m control, postural muscle imbalance, poor balance, motor co-ordination and dyspraxia. After 18, two-hour therapy sessions over nine months, he is now reading well, his motor co-ordination, eye tracking and writing are within the ‘low normal range’, and he is interacting competently with his peers. Learning difficulties can be conceptualised as a profile of immaturities. The results of this three part study have shown that once the 'hidden' handicap of right eye suppression is overcome with balanced binocular fields of vision, learning difficulties arc ameliorated. This is affirmed by the positive gains achieved by these students, not only in literacy skills but also 'outgrowing' immaturity in motor-sensory-perceptual development.

Thesis (M.S.)--University of Florida, 2004.
Typescript. Title from title page of source document. Document formatted into pages; contains 93 pages. Includes Vita. Includes bibliographical references.

INTRODUÇÃO: O termo memória operacional (MO) refere-se a um constructo cognitivo capaz de armazenar e manter a informação acessível para uso determinado por um tempo limitado, possibilitando a manipulação de diversas informações simultâneas e sequenciais como operações matemáticas longas ou complexas, compreensão de palavras pouco frequentes, extensas ou frases complexas. A linguagem está entre as funções cognitivas que dependem do funcionamento da memória operacional e pode estar comprometida em várias condições patológicas, dentre elas o traumatismo cranioencefálico (TCE). Dados da literatura referentes a essa população ainda são restritos ou pouco consistentes. OBJETIVOS: investigar se o teste n-back é uma medida válida para identificar o déficit de memória em pacientes com TCE, estabelecer nota de corte e curva ROC do teste n-back, comparar o desempenho entre os indivíduos saudáveis e aqueles que sofreram TCE, comparar o teste n-back com os testes de linguagem e aspectos da lesão neurológica, tais como gravidade e tempo, tempo de coma e localização hemisférica da lesão nos resultados para verificar o desempenho e a relevância na separação dos casos em pacientes e controles.MÉTODOS: 53 indivíduos brasileiros (26 adultos com TCE e 30 adultos saudáveis) foram avaliados por bateria de estímulos verbais auditivos para verificar diferenças inter-grupos na capacidade de processamento da memória operacional, quanto ao numero de respostas corretas (acurácia), capacidade máxima de processamento na memória operacional (span) e também verificar a relação da memória operacional com habilidades linguísticas, através da comparação de testes. RESULTADOS: na comparação entre os pacientes e os indivíduos do grupo controle observou-se diferença estatisticamente significante entre os grupos tanto para os testes de base quanto para os resultados do n-back. Os grupos foram estatisticamente pareados em relação às variáveis sócio-demográficas (idade, escolaridade e gênero). O modelo estatístico com as variáveis do teste n-back demonstrou ótima separação dos casos em pacientes/ controle com a área sob a curva ROC de 89%. O modelo também mostrou convergência com os testes de linguagem para compreensão auditiva de sentenças, fluência verbal e aspectos discursivos-pragmáticos e com o nível cognitivo. O lado da lesão foi estatisticamente significante para o n-back, fluência verbal e discurso conversacional. CONCLUSÃO: Os resultados mostram que o n-back na maneira como foi desenhado é capaz de diferenciar os indivíduos alterados e os normais na habilidade de memória operacional. No estudo foi possível discriminar o comportamento de indivíduos com lesão encefálica adquirida e indivíduos saudáveis quanto à medida de acurácia e capacidade máxima de manipulação da informação na memória operacional. Esse comportamento reflete o funcionamento linguístico e cognitivo que se correlaciona com o mecanismo de memória operacional
INTRODUCTION: The term working memory (WM) refers to a construct cognitive capability of storing and keeping information on line to a determined use for a limited time, enabling the manipulation of diverse simultaneous and sequential information such as long or complex mathematical operations, comprehension of less frequent words, extensive or complex sentences. The language is among the cognitive functions which depends on the operational memory behavior and may be engaged in many pathological conditions, among them the TBI (traumatic brain injury). Literature dada relative to such population are still restrict or weak. AIM: investigate whether the n -back task is a valid measure for identifying memory deficits in patients with TBI; establish cutoff and ROC curve of n-back task; to compare performance between normals individuals and those who have suffered TBI; to compare n-back task with tests of language and aspects of neurological injury, such as severity, coma and hemispheric laterality of the lesion to verify the performance and relevance in the separation of cases. METHODOS: 53 individuals Brazilians (26 adults with TBI and 30 healthy adults) were assessed by a battery of auditory verbal stimuli for detecting differences between groups in the processing capacity of working memory, as the accuracy and span also check the relationship of working memory to language skills, through the comparison tests. RESULTS: in the comparison between patients and control subjects was observed statistically significant differences between groups thus to the tests as the basis tests as to results of the n -back. The groups were statistically matched in relation to socio-demographic variables (age, education and gender). The statistical model with variables of the n -back test showed good separation of cases where patients / control with the area under the ROC curve of 89 % . The model also showed convergence with language tests for auditory comprehension of sentences, verbal fluency and pragmatic - discursive aspects and the cognitive level. The side of the lesion was statistically significant for the n -back, verbal fluency and conversational discourse. CONCLUSION: the results demonstrated that the n-back on the way it was designed is able to distinguish the changed individuals and the normal on the working memory ability. On the study it was possible to discriminate the behaviors of individuals with acquired brain injury and healthy individuals regarding the accuracy and maximum capacity of manipulating information on the working memory. Such behavior reflects the linguistic and cognitive function which correlates with the working memory mechanism

The purpose of this investigation was to compare the performances on the Wide Range Assessment of Memory and Learning (WRAML; Sheslow & Adams, 1990) of children with different developmental and neurological disorders. The primary question was whether the WRAML subtests significantly differentiate among children with Developmental Reading Disorders (RD; n = 44), with Attention-Deficit/Hyperactivity Disorder (ADHD; n = 37), with Traumatic Brain Injury (TBI; n = 30), and without developmental or neurological disabilities (n = 103). Archival data from the TBI Project at James Whitcomb Riley Hospital for Children and from the Division of Psychology at Alfred I. duPont Institute was analyzed. The results of a discriminant functions analysis indicated that significant differences among the groups do exist on the WRAML and that the groups were discriminated from one another by three distinct types of tasks (i.e., functions): rote memory, verbal learning, and meaningful memory. Furthermore, based on WRAML performance alone, participants had a 63% chance of being classified into their proper diagnostic group. In addition to supporting the use of multi-dimensional tasks to assess memory, the results of this study have clinical relevance for developing diagnosis-specific recommendations for memory and learning problems.
Department of Educational Psychology

Background: Impairments in executive functioning and autobiographical memory (AM) are common in people with schizophrenia spectrum disorders (SSD). There is a need for greater understanding of how neurocognitive factors such as these relate to recovery. This is important because improving treatments requires better understanding of the psychological process involved in recovery from SSD. Aims: We aimed to determine the feasibility of assessing AM and metacognitive functioning in the acute phase of psychosis during inpatient admission. Relationships between neuropsychiatric measures and autobiographical memory were explored with a view to refining the use of this assessment battery with participants who are acutely psychotic. Methods: Twelve people diagnosed with a schizophrenia spectrum disorder were recruited from adult inpatient psychiatric wards shortly after admission. They completed the Autobiographical Memory Interview, Indiana Psychiatric Illness Interview, Hayling Sentence Completion Task, BMIPB Story Recall Task and the Positive and Negative Syndrome Scale (PANSS) interview in baseline assessment. Four participants were re-tested prior to discharge and rated their own recovery using the Questionnaire on the Process of Recovery. Ward clinicians also rated recovery in terms of symptom remission for eleven of the participants. Results: A moderate correlation between metacognition and semantic AM (r=.716) was identified at baseline. Correlations of moderate strength were identified between clinician ratings of recovery and metacognition (r=-.725) and PANSS (r=.877) scores at baseline assessment. Conclusions: The study faced difficulties recruiting sufficient numbers of eligible participants at baseline and retaining them to allow for follow up assessment. Hence, the results are preliminary but the data do suggest possible neuropsychological correlates of recovery from acute psychosis. If the recruitment and retention issues could be addressed, this paradigm could be applied to a larger sample to test the findings of this pilot study.

Attention deficit hyperactivity disorder (ADHD) is one of the most challenging children’s public health concerns today. Children diagnosed with ADHD struggle more academically and are at a significant risk of lower academic achievement, increased grade-level retention, and additional diagnoses of learning disabilities. Symptoms of ADHD primarily arise from deficits in specific executive function (EF) domains, one of which is working memory (WM). Children diagnosed are impaired on tasks that specifically measure WM capacity and short-term visuo-spatial memory. In this study, four fifth-grade students diagnosed with ADHD were administered a variety of assessments. WM was measured through a math vocabulary recall, visuo-spatial WM via a computerized Corsi Block Tapping Test, and WM capacity was assessed through an Operation Span Task. In addition, on-task behavior was determined using the partial interval recording process with overall mathematical skill based knowledge being evaluated through a pre and post assessment. Using the ABAB Withdrawal Single-Case Research Design, a 10-min intervention of short burst high intensity exercise was introduced. Participants were assessed each session (daily) and exhibited improvement on all measurements during the intervention conditions of the study.

The results suggest that a vigorous 10-min daily regime of short-burst-high-intensity exercise improves the working memory and on-task behavior of preadolescent children diagnosed with ADHD.

Yes
Objectives: In the UK dementia is under-diagnosed, there is limited access to specialist memory clinics, and many of the patients referred to such clinics are ultimately found to have functional (non-progressive) memory disorders (FMD), rather than a neurodegenerative disorder. Government initiatives on ‘timely diagnosis’ aim to improve the rate and quality of diagnosis for those with dementia. This study seeks to improve the screening and diagnostic process by analysing communication between clinicians and patients during initial specialist clinic visits. Establishing differential conversational profiles could help the timely differential diagnosis of memory complaints. Method: This study is based on video- and audio recordings of 25 initial consultations between neurologists and patients referred to a UK memory clinic. Conversation analysis was used to explore recurrent communicative practices associated with each diagnostic group. Results: Two discrete conversational profiles began to emerge, to help differentiate between patients with dementia and functional memory complaints, based on (1) whether the patient is able to answer questions about personal information; (2) whether they can display working memory in interaction; (3) whether they are able to respond to compound questions; (4) the time taken to respond to questions; and (5) the level of detail they offer when providing an account of their memory failure experiences. Conclusion: The distinctive conversational profiles observed in patients with functional memory complaints on the one hand and neurodegenerative memory conditions on the other suggest that conversational profiling can support the differential diagnosis of functional and neurodegenerative memory disorders.

Yes
Objective This study explores whether the profile of patients’ interactional behaviour in memory clinic conversations with a doctor can contribute to the clinical differentiation between functional memory disorders (FMD) and memory problems related to neurodegenerative diseases. Methods Conversation Analysis of video recordings of neurologists’ interactions with patients attending a specialist memory clinic. “Gold standard” diagnoses were made independently of CA findings by a multi-disciplinary team based on clinical assessment, neuropsychological testing and brain imaging. Results Two discrete conversational profiles for patients with memory complaints emerged, including (i) who attends the clinic (i.e., whether or not patients are accompanied), and (ii) patients’ responses to neurologists’ questions about memory problems, such as difficulties with compound questions and providing specific and elaborated examples and frequent “I don’t know” responses. Conclusion Specific communicative difficulties are characteristic of the interaction patterns of patients with a neurodegenerative pathology. Those difficulties are manifest in memory clinic interactions with neurologists, thereby helping to differentiate patients with dementia from those with FMD. Practical implications Our findings demonstrate that conversational profiles based on patients’ contributions to memory clinic encounters have diagnostic potential to assist the screening and referral process from primary care, and the diagnostic service in secondary care.

Yes
Specialist services for dementia are seeing an increasing number of patients. We investigated whether interactional and linguistic features in the communication behaviour of patients with memory problems could help distinguish between those with problems secondary to neurological disorders (ND) and those with Functional Memory Disorder (FMD). In Part 1 of this study, a Diagnostic Scoring Aid (DSA) was developed encouraging linguists to provide quantitative ratings for 14 interactional features. An optimal cut-off differentiating ND and FMD was established by applying the DSA to 30 initial patient-doctor memory clinic encounters. In Part 2, the DSA was tested prospectively in ten additional cases analysed independently by two Conversation Analysts blinded to medical information. In part one, the median score of the DSA was +5 in ND and -5 in FMD (p<0.001). The optimal numeric DSA cut off (+1) identified patients with ND with a sensitivity of 86.7% and a specificity of 100%. In part two, DSA scores of rater one correctly predicted 10/10 and those of rater two 9/10 diagnoses. This study indicates that interactional and linguistic features can help distinguish between patients developing dementia and those with FMD and could aid the stratification of patients with memory problems.
NIHR Research for Patient Benefit (RfPB) Programme: PB-PG-0211-24079 – Using Conversation Analysis in the Differential Diagnosis of Memory Problems: a pilot study. 2013-2015

M. Tech.
Memory loss refers to the loss of ability to learn new information and the inability to retrieve information previously learnt (Karlawish & Clark, 2003). It is estimated that more than 40% of individuals over the age of 60 are affected by memory loss (Jackson, 2004). There are no recommended treatment options available for mild forms of memory loss (D‟Esposito & Weksler, 2000). The aim of the study was to determine the effects of the anthroposophical medicine, Scleron® in the treatment of memory loss associated with ageing, assessed by digit span; verbal and visual recall and recognition and a memory questionnaire. The trial was a double-blind placebo controlled study using matched pairs. Participants selected to take part in the study were between the ages of 60 and 75 and presented with subjective symptoms of memory loss. Participants were excluded from the study if they scored less than 24 out of 30 on the Mini-Mental State Exam; were previously diagnosed with memory or cognitive disorders; had a previous history of stroke, epilepsy, head injury, psychiatric disease and drug or alcohol dependence. Participants were divided into two groups in matched pairs according to age, education level, occupation and Mini-Mental State Exam scores. At the start of the study, participants completed a memory test and memory questionnaire. Participants in the experimental group received Scleron®, while participants in the placebo group received unmedicated tablets. Participants were required to take 2 tablets in the morning for a period of six weeks. The memory test and memory questionnaire was once again completed by participants at the end of the study. Thirty six participants completed the study. The results of the study were analysed and frequencies and descriptives were calculated for the sample group. The Wilcoxon test was used to compare the data within groups, while the Mann-Whitney test was used to compare the results between the two groups. iv After analysis of the results of the study, it was concluded that Scleron® did not appear to improve the symptoms of memory loss when using tests of digit span, verbal and visual recall or verbal and visual recognition. Furthermore, it did not appear to improve subjective symptoms of memory loss assessed by the use of a memory questionnaire.