Anne D. Baird

Adult Chronic Kidney Disease: Neurocognition in Chronic Renal Failure

In recent years there has been a keen interest in the neurocognitive sequelae of renal failure and subsequent end-stage renal disease given its increasing prevalence and incidence. This review article summarizes the relevant information on cognitive functioning in chronic kidney disease in adults before the initiation of dialysis, after the initiation of dialysis, and after renal transplantation. In general, compared to pre-dialysis, there is an improvement in cognitive function after the institution of dialysis and further improvement after renal transplantation. Throughout the paper an attempt is made to highlight the importance of considering disease related variables in the neuropsychological assessment of individuals with chronic kidney disease. The paper concludes with a discussion of future avenues of research.

Complex Real-World Functioning and Neuropsychological Test Performance in Older Adults

In stepwise regression analyses with Independent Living Scales (ILS) summary and subscale scores as the dependent variables, 8 of 10 psychometric measures from our battery for older adults emerged as important predictors for 69 patients referred for clinical assessment. The Dementia Rating Scale (DRS) score entered first for 6/8 analyses. However, measures of confrontation naming, oral reading, verbal fluency, paragraph recall, visual perception, complex attention, and depression also added explanatory power. Multiple R s ranged from .66 to .88 except for the Social Adjustment subscale, which correlated only with the depression scale.

Early cognitive outcome after neonatal stroke.

The purpose of this study was to assess the cognitive development of 27 children with nonhemorrhagic neonatal stroke (occurring within the first 28 days of life). The cognitive evaluation consisted of the Bayley Scales of Infant Development, administered at 12 and/or 24 months poststroke. Compared with the normative sample, children with neonatal stroke obtained significantly lower scores on the Bayley Psychomotor Development Index at 12 months poststroke and on the Bayley Mental and Psychomotor Development Indices at 24 months poststroke. Outcome did not differ based on stroke type or laterality of infarct. However, there was a trend toward higher scores on the Bayley Psychomotor Development Index at 24 months in the left hemisphere group compared to the right hemisphere group. Overall, children with neonatal stroke evidenced significant impairment within the first 2 years poststroke. Further research is required to confirm whether cognitive impairments in these children resolve, remain in the low-average range, or increase with development as more complex skills are learned.

Fine Tuning Recommendations for Older Adults with Memory Complaints: Using the Independent Living Scales with the Dementia Rating Scale

The purpose of this study was to describe how functional test performance changed as global cognitive functioning dropped, as well as to examine the relationship of demographic variables and depression with functional test results. We found that level of performance on the Independent Living Scales (ILS) correlated highly with Dementia Rating Scale (DRS) scores in 83 older adults presenting for clinical neuropsychological assessment, while correlations with demographic factors and depression were nonsignificant or modest. Based on DRS scores, we divided our sample into four groups: normal cognitive status, borderline cognitive impairment, likely mild dementia, and likely moderate dementia. ILS profiles of the borderline impairment and mild dementia groups were similar and reflected particularly poor performance on subscales tapping financial management and everyday memory. Individuals with likely moderate dementia were markedly impaired on all subscales.

Gender role, life satisfaction, and wellness: Androgyny in a Southwestern Ontario sample.

Dans cette étude, nous avons effectué des recherches sur les relations entre le rôle sexuel et le fonctionnement physique autodéclaré, à partir d’un échantillon d’aînés vivant dans la communauté. Cent deux participants ont été recrutés (55 femmes, 47 hommes) dans les associations pour personnes âgées de Windsor, Ontario. Nous avons mené des analyses de variance pour chacun des sexes afin de comparer l’autoévaluation du fonctionnement physique, du bien-être et de la satisfaction de vivre des participants qui diffèrent dans la classification de leur rôle sexuel. Pour ce qui est des femmes âgées classées comme androgynes, le rôle sexuel avait des effets importants sur le bien-être général et la satisfaction de vivre, mais n’avait pas d’effet sur le fonctionnement physique autodéclaré. Venant à l’appui du modèle androgénique d’ajustement optimal de Bem, les analyses a posteriori ont révélé que les femmes qui se sont autodéclarées androgynes ont un meilleur niveau global de bien-être que les autres. L’autoévaluation du fonctionnement physique et du bien-être général chez les hommes âgés n’a pas démontré de différences importantes en fonction du rôle sexuel. Les limitations et les implications font l’objet de discussions. This study investigated the relationships among gender role and self-reported health functioning in a sample of community dwelling older adults. One hundred and two (55 female, 47 male) participants were recruited through seniors’ associations in Windsor, Ontario. Analyses of variance were conducted separately by gender to compare the self-rated physical health functioning, wellness, and life satisfaction of participants differing on classification of their gender role. For older women classified as androgynous, gender role exhibited significant effects on general wellness and life satisfaction, but not on self-reported physical health functioning. In support of Bem’s androgyny model of optimal adjustment, post-hoc analyses revealed that women who rated themselves as androgynous reported better overall wellness levels than their peers. Older men’s self-reported physical health functioning and general wellness did not differ significantly by gender role. Limitations and implications are discussed.

Developing a Spatial Analogue of the Reliable Digit Span

It is recommended that performance validity be assessed in all neuropsychological cases involving external incentive. The present study sought to develop an embedded performance validity measure based on the Spatial Span task of the Wechsler Memory Scale-III in a sample of litigating persistent postconcussion complainants. The Reliable Spatial Span (RSS) calculation had specificity, sensitivity, and predictive power values within the range of other embedded measures. This finding suggests that RSS is able to distinguish between persistent postconcussion complainants demonstrating valid and invalid performance. Other calculations involving Spatial Span scores had lower classification accuracy. Reliable Digit Span (RDS) classification accuracy within the present sample was lower than that of previous research, as well as of RSS. Potential reasons for lack of RDS replication are discussed, along with the potential use of RSS as an embedded validity performance indicator.

Are cognitive outcome and recovery different in civilian penetrating versus non-penetrating brain injuries?

The present study sought to determine whether cognitive outcome and course of recovery in civilian penetrating brain injury due to gunshot can be distinguished from that of non-penetrating brain injury due to motor vehicle accident. Matched survivors of penetrating and non-penetrating brain injury were assessed with a brief neuropsychological test battery at inpatient rehabilitation, 1 year post-injury, and 2 years post-injury. The traumatic brain injury groups were found to have patterns of performance marked by reliably distinct differences in isolated areas, with different cognitive predictors of brain injury type present in early versus later recovery. The degree of recovery over the first 2 years appeared to be quite similar for penetrating and non-penetrating injuries.

Older Adults and Capacity-Related Assessment: Promise and Caution

Data from 30 cognitively intact and emotionally stable Canadian elders provided support for the construct validity of the Hopemont Capacity Assessment Instrument and the Independent Living Scales. Subscale scores in the health or financial domains on these two capacity-related instruments were moderately correlated; weaker correlations were observed between ILS and HCAI subscales tapping discrepant domains. Training in thinking aloud and responding to hypothetical questions did not affect scores on these measures, nor were scores on brief depression and anxiety scales statistically associated with standing on capacity-related measures. Reading comprehension was associated with scores on the Hopemont Capacity Assessment Instrument.

Interacting effects of age and time of day on verbal fluency performance and intraindividual variability

We explored the effects of age and time of day (TOD) on verbal fluency ability with respect to performance level and intraindividual variability (IIV). Verbal fluency, which involves complex cognitive operations, was examined in 20 older (mean age = 72.8 years) and 20 younger (mean age = 24.2 years) adults with test start time alternating between morning and evening across four days. Older adults generated more words in the morning and younger adults more in the evening, corresponding with self-report peak TOD. Age by TOD interactions were also observed across fluency tasks on the number of switches among subcategory exemplars during word generation and on the IIV observed in switching behavior. Older adults exhibited greater variability in switching in the evening than in the morning, whereas younger adults showed the opposite pattern. These findings demonstrate that processes involving energization (initiating and sustaining) and attentional control may be particularly sensitive to age differences in TOD influences on cognition.