D. Roger

Characteristics of executive function impairment in Parkinson's disease patients without dementia.

Executive function impairments in Parkinsons disease (PD) are well documented. However, uncertainties remain regarding the impact of these deficits on other areas of cognitive functioning. The goal of this study was to provide a comprehensive assessment of cognitive characteristics in patients with PD without dementia and to assess how any such deficits affected other areas of cognitive functioning. Forty PD patients without dementia were compared to healthy controls using measures of attention and speed of processing and a comprehensive set of executive function tests including working memory, planning, and problem solving. Measures of memory/learning and visuospatial skills were also included to examine the relationship between aspects of executive function and other areas of cognition. Patients with PD showed deficits on measures of executive function, problem solving, and visuospatial skills. However, they were unimpaired on measures of planning, attention, and memory/learning. Deficits in problem solving were only evident for tasks with a high visuospatial content and were no longer significant when visuospatial skills were controlled for. While deficits in executive function and visuospatial skills were apparent for PD patients compared to controls, many aspects of cognition remained intact. These can provide a focus for cognitive intervention strategies that can be effective in delaying decline for PD patients.

Cognitive Characteristics Associated with Mild Cognitive Impairment in Parkinson's Disease

Background: Cognitive deficits are common in Parkinson’s disease (PD), but the range of deficits is variable. The aim of this study was to identify different cognitive subgroups associated with PD. Methods: A broad range of neuropsychological measures and cognitive domains were used in a cluster analysis to identify subgroups of patients. Results: Three subgroups of patients were identified. Compared to controls, one PD subgroup showed no or minimal cognitive impairment (PD-NCI), a second group showed a variable or uncertain pattern of mild to severe cognitive impairments (PD-UCI), and a third group had evidence of severe cognitive impairment across most cognitive domains (mild cognitive impairment; PD-MCI). The subgroups did not differ with regard to age, motor impairment, or disease duration. Conclusions: Patients with PD are heterogeneous with regard to cognitive presentation and it may be possible to identify patients in the preclinical stage of dementia. The identification of preclinical dementia in PD patients (PD-MCI) provides an opportunity to understand cognitive decline in PD and its progression to dementia.

Neuropsychiatric problems in Parkinson's disease: Comparisons between self and caregiver report

Introduction: This study examined the level of agreement between caregiver and Parkinsons disease (PD) patient reports of neuropsychiatric problems. Method: Forty-three patients and 43 informants who knew the patient well (caregivers) participated in the study. Caregivers rated patients’ behaviour, as well as their own stress, using the Neuropsychiatric Inventory (NPI). Information from patients was obtained using commonly used scales (Beck Depression Inventory, Apathy Scale, Unified Parkinsons Disease Rating Scale and the Hamilton Anxiety Depression Scale). Both the patients and the caregivers also completed the Frontal Systems Behavior Scale, which assesses behaviours associated with apathy, disinhibition and executive dysfunction. Results: The level of agreement between these self and caregiver reports was low, with only 45.8% agreement for depression, 45.0% for apathy, 28.6% for hallucinations, 26.9% for sleep problems and 6.7% for anxiety. Conclusions: Given this low level of agreement between self and other report, these two methods of assessment cannot be considered interchangeable.

Planning in Parkinson's disease: A matter of problem structure?

Although the Tower of London (TOL) has been extensively used to assess planning ability in patients with Parkinsons disease (PD), the reported presence or extent of any planning deficits has been inconsistent. This may partly be due to the heterogeneity of the TOL tasks used and a failure to consider how structural problem parameters may affect task complexity. In the present study, planning in PD patients was assessed by systematically manipulating TOL problem structure. Results clearly disprove the identity assumption of problems with an equal number of minimum moves. Instead, substantial parts of planning performance were related to more subtle aspects of problem structure, such as subgoaling patterns and goal hierarchy. Planning in PD patients was not impaired in general but was affected when the information provided by the problem states was ambiguous in terms of the sequential order of subgoals, but not by increases in search depth.

Students who self-harm: Coping style, Rumination and Alexithymia

Counsellors working with students or other young adults may encounter individuals who have self-harmed, either with suicidal or non-suicidal intent. Recent US studies reported rates of self-injury of up to 37% of the student population, but studies in the UK have focussed primarily on younger adolescents. This study examined reported self-harm incidents (scratching, cutting, poisoning, overdose etc) from a sample of 617 university students. A total of 27% reported at least one incident of self-harm, with almost 10% having harmed themselves while at university. Gender differences were not significant but psychology students reported significantly more self-harm than other students. Participants reporting self-harm scored significantly higher on maladaptive coping styles, rumination, and alexithymia (specifically difficulty in identifying emotions) and these differences were most marked for students reporting repetitive and recent self-harm. Rumination and Alexithymia factor 1 (difficulty identifying feelings) emerged as the most robust factors predicting self-harm status. Comments from students who self-harmed at university highlighted the importance of accessible services and academic staff support. The implications of these findings for counselling interventions are discussed, including challenging negative rumination tendencies and developing mindfulness skills.

The effect of attentional set-shifting, working memory, and processing speed on pragmatic language functioning in Parkinson's disease

Parkinsons disease (PD) is traditionally associated with motor symptoms. However, impairments in language functioning may also accompany this disorder. The present study investigated pragmatic language deficits in PD and their relationship to cognitive functioning. Forty patients with PD were compared to age- and IQ-matched controls on measures of pragmatic language functioning using the Test of Language Competence–Expanded (TLC-E), and measures of attentional set-shifting, working memory, and processing speed. Overall, PD patients were impaired on aspects of language, working memory, and processing speed. Measures of cognition were significantly correlated with pragmatic language functioning. Path analyses revealed that deficits in pragmatic language functioning were mediated by verbal working memory and processing speed, but not attentional set-shifting. Regression analyses found that processing speed was a stronger determiner of pragmatic language performance than verbal working memory. Results suggest that pragmatic language deficits may be explained in terms of deficits in processing speed associated with the disease.

Assessing cognitive impairment in Parkinson's disease: a comparison of two tower tasks.

This study examined whether two tower tasks—the Cambridge Automated Neuropsychological Test Battery “Stockings of Cambridge” (CANTAB-TOL) and the Delis-Kaplan Executive Function System (D-KEFS-TOH), are interchangeable for detecting cognitive deficits in Parkinsons disease (PD) patients. Forty PD patients who met the criteria for this study were assessed with both tasks. The relative contribution of working memory and inhibition was also examined. Relative to controls, PD patients were impaired on the CANTAB-TOL but not the D-KEFS-TOH. Regression analysis which showed that whereas performance on the CANTAB-TOL task was dependent on inhibition and spatial working memory, performance on the D-KEFS-TOH was dependent on spatial working memory only. Only 7% to 24% of the variance between the two tasks was shared. These findings suggest that these tower tasks from two well-established neuropsychological test batteries are not interchangeable.

Predicting adult offending behavior for individuals who experienced a traumatic brain injury during childhood

Objectives:To examine whether individuals who experienced a childhood traumatic brain injury (TBI) are at increased risk for subsequent offending behavior, to identify the emotional characteristics of adults who experienced childhood TBI, and to examine whether these predict offending behavior. Participants:Individuals from the Canterbury region who had experienced a childhood (<18 years of age) injury event and were now 18 years or older and more than 5 years postinjury (between 18 and 30 years of age). Three groups were formed: (1) moderate/severe TBI (n = 62); (2) mild TBI (n = 58); and (3) fracture control group (n = 38). Setting:University of Canterbury. Main Measures:A semistructured interview assessed lifetime involvement in offending behavior; the Emotional Behavior Scale measured internalizing and externalizing behaviors, including malevolent aggression, social anxiety, and social self-esteem. Results:Compared with controls, there was an increased risk of offending behavior (mild TBI: odds ratio = 8.7; moderate/severe TBI odds ratio = 20.4). Binary logistic regression analysis revealed that the strongest predictors of offending behavior were TBI status, higher levels of malevolent aggression, and age at injury. Conclusions:Individuals who experienced childhood TBI are at increased risk of offending behavior. Emotional behavior measures were useful predictors of offending behavior, offering opportunity for intervention.

Individual differences in young offender emotional behaviour

Purpose. Recent research into adolescent emotional behaviour has confirmed a three-factor structure for emotional style in samples of children and adolescents, ranging in age from nine to nineteen years (Clarbour & Roger, 2004). This study was aimed at replicating the factor structure for the Emotional Behaviour Scale (EBS) amongst young offenders, and investigating the role of the factors in offender behaviour. n n n nMethod. Both exploratory and confirmatory factor analyses were used to compare the responses of 307 male young offenders to those of 294 schoolchildren. A subsample of 264 offenders additionally completed indices of offending behaviour that were used for further validation of the EBS amongst young offenders. n n n nResults and conclusions. The three emotional style factors obtained for schoolchildren – social anxiety, malevolent aggression and social self-esteem – were confirmed in the young offender sample. Lower scores on malevolent aggression, and higher scores on social anxiety and social self-esteem, were significantly associated with later first police contact. High malevolent aggression and lower social anxiety were also significantly associated with placement on Governors report, and high malevolent aggression was associated with violent offence types. The three scales were also found to relate systematically and predictably to a range of other personality and emotional style scales.