Emel Erdoğan Bakar

Neurocognitive functions in children and adolescents with subclinical hypothyroidism.

Objective: Hypothyroidism is a metabolic condition that can lead to cognitive and behavioral deficits in children and adolescents. However, there is less evidence about subclinical hypothyroidism (SH) as a risk factor for neuropsychological disorders in childhood. The aim of thisstudy was to evaluate cognitive functions like active/passive attention, maintaining attention, and response inhibition in pediatric patients with SH. Methods: Seventeen patients (between 7-17 years old) with SH were tested with the Stroop test, Verbal Fluency test and the sub-tests of the Wechsler intelligence scale for children-Revised (WISC-R). SH diagnosis was based on the mild increase of serum thyrotropin (TSH) level together with a normal serum free thyroxine level and an exaggerated TSH response to thyrotropin-releasing hormone. Results: Out of seventeen cases, 10 (59%) were girls and 7 (41%) were boys. Six cases were obese and 5 were overweight. The children in the SH group, as compared to the control group, obtained significantly lower scores on both the Digit Span subtest of the WISC-R and the Stroop subtests, which are sensitive to attention. No significant differences were found between the SH group and the healthy controls in verbal fluency and encoding tests. Conclusion: In this study, pediatric patients with SH showed poor performance in tests measuring attention. Therefore, we want to stress the importance of close collaboration between pediatric endocrinology and child and adolescent psychiatry departments. Conflict of interest:None declared.

Impaired executive functions in paediatric obsessive-compulsive disorder patients

Isık Taner Y, Erdogan Bakar E, Oner O. Impaired executive functions in paediatric obsessive-compulsive disorder patients. Objective: There are only few studies which investigated the neuropsychological performances of paediatric patients with obsessive-compulsive disorder (OCD). Previous studies show that most of adult OCD patients had an onset of their first symptoms before the age of 15. Our objective was to evaluate the neuropsychological functions in paediatric patients with OCD. Methods: We compared the executive functions and general intelligence of child and adolescent OCD patients (n = 20) with age- and gender-matched healthy controls (n = 20). To compare mentioned skills, a neuropsychological test battery including Wechsler Intelligence Scale for Children-Revised (WISC-R), Wisconsin Card Sorting Test (WCST), Stroop Test and Verbal Fluency Test was performed. Result: Performances of the OCD and control subjects on neuropsychological tests were statistically analysed by using multivariate analysis of covariance (MANCOVA), in which Full Scale Intelligence Quotient (FSIQ) results were taken into consideration as a covariate to observe FSIQs effect on test scores. Our results showed that the differences in WISC-R Picture Arrangement and Coding scores remained significant when co-analysed with FSIQ scores. In a similar manner, the OCD group exhibited worse performances on STR1-duration, STR3-duration, STR3-error, STR4-duration, STR4-error, STR5-correct response, and STR5-error as compared with the control group when FSIQ scores were taken into calculation. Some variables of the WCST (perseverative responses, percent errors, abstraction-flexibility and categories completed) also yield lower test scores in the OCD group. There was no significant difference between the groups regarding Verbal Fluency Test scores. Conclusion: Our results suggested that paediatric OCD patients had worse abstraction-flexibility, mental set-shifting, verbal comprehension and visuospatial/construction abilities.

Neuropsychological assessment of adult patients with shunted hydrocephalus.

OBJECTIVE This study is planned to determine the neurocognitive difficulties of hydrocephalic adults. METHODS THE RESEARCH GROUP CONTAINED HEALTHY ADULTS (CONTROL GROUP, N : 15), and hydrocephalic adults (n : 15). Hydrocephalic group consisted of patients with idiopathic aquaduct stenosis and post-meningitis hydrocephalus. All patients were followed with shunted hydrocephalus and not gone to shunt revision during last two years. They were chosen from either asymptomatic or had only minor symptoms without motor and sensorineural deficit. A neuropsychological test battery (Raven Standart Progressive Matrices, Bender-Gestalt Test, Cancellation Test, Clock Drawing Test, Facial Recognition Test, Line Orientation Test, Serial Digit Learning Test, Stroop Color Word Interference Test-TBAG Form, Verbal Fluency Test, Verbal Fluency Test, Visual-Aural Digit Span Test-B) was applied to all groups. RESULTS Neuropsychological assessment of hydrocephalic patients demonstrated that they had poor performance on visual, semantic and working memory, visuoconstructive and frontal functions, reading, attention, motor coordination and executive function of parietal lobe which related with complex and perseverative behaviour. Eventually, these patients had significant impairment on the neurocognitive functions of their frontal, parietal and temporal lobes. On the other hand, the statistical analyses performed on demographic data showed that the aetiology of the hydrocephalus, age, sex and localization of the shunt (frontal or posterior parietal) did not affect the test results. CONCLUSION This prospective study showed that adult patients with hydrocephalus have serious neuropsychological problems which might be directly caused by the hydrocephalus; and these problems may cause serious adaptive difficulties in their social, cultural, behavioral and academic life.

Memory difficulties of adult patients with shunted hydrocephalus: a clinical study.

AIM The purpose of this prospective study was to describe memory problems of adult patients with hydrocephalus. MATERIAL AND METHODS The research group consisted of healthy adults (control group) and hydrocephlic adults (hydrocephalus group). The hydrocephalus group (n: 19) had no clinical signs or symptoms of increased intracerebral pressure. The control group (n:20) was chosen from healthy adults. Both groups were evaluated by an experienced neuro-psychologist blinded to the groups. The examiner performed a battery of three different neuropsychological tests (Raven Standart Progressive Matrices, RSPM; Rey-Osterrieth Complex Figure Test, RCFT; and Rey Auditory-Verbal Learning Test, AVLT) to all groups. RESULTS Almost all subtest scores of the AVLT and RCFT remained significant after the RSPM scores were controlled. Almost all neuropsychological test results of the hydrocephalus group were significantly worse than control group. CONCLUSION This prospective study showed that adult patients with hydrocephalus have serious problems in memory function which might be directly caused by the hydrocephalus.

Applicability Of The Bannatyne And Kaufman Classifications Of WISC-R To Turkish Children -

ABSTRACT Objective: To demonstrate the applicability of the Kaufman factors and Bannatyne categories to samples of Turkish children; and to test the validity of the Kaufman factors, which are specifically used in attention deficit hyperactivity disorder (ADHD), and Bannatyne categories, which are used in specific learning disability (SLD). Methods: Study sample consisted of an ADHD group (191 boys within 72-140 months age range), SLD group (21 boys within 76-131 months age range) and control group (117 boys within 70-143 months age range). Exclusion criteria were comorbidity, medication affecting cognitive processes, uncorrected visual and/or auditory defects, and intelligence quotient outside the 90-119 range. Trained psychologists administered Wechsler Intelligence Scale for Children- Text Revised (WISC-TR) to those volunteering children whose parents gave informed consent for participation in the study. Results: The cumulative variances (principal component analysis) for the 2-factor (Wechsler classification), 3-factor (Kaufman factors) and 4-factor (Bannatyne categories) models were low to medium. According to the fitness indexes, the concordance between the data and the model were, for all three models, below acceptable levels (confirmatory factor analysis). Discussion: The factors and categories in the Kaufman, Bannatyne and Wechsler models are not applicable to samples of Turkish children. This conclusion is also supported in the ADHD group by the disorganized nature of the scores that loaded on attention-related factors (Kaufman’s Freedom from Distractibility factor and Bannatyne’s Sequencing category).

Using neuropsychometric measurements in the differential diagnosis of specific learning disability

INTRODUCTION The aim of this study was to develop a neuropsychometric battery for the differential diagnosis of specific learning disability (SLD), with specific respect to attention deficit hyperactivity disorder (ADHD), and to help resolve the conflicting results in the literature by an integrative utilization of scores on both the Bannatyne categories and neuropsychological tests. METHODS The sample included 168 primary school boys who were assigned to SLD (n=21), ADHD (n=45), SLD and ADHD (n=57), and control groups (n=45). The exclusion criteria were a neurological or psychiatric comorbidity other than ADHD, a level of anxiety and/or depression above the cutoff score, medication affecting cognitive processes, visual and/or auditory disorders, and an intelligence level outside the IQ range of 85-129. Psychometric scores were obtained from the SLD Battery and Wechsler Intelligence Scale for Children-Revised in the form of Bannatyne category scores. Neuropsychological scores were from the Visual-Aural Digit Span Test-Form B, Serial Digit Learning Test, Judgment of Line Orientation, and Mangina Test. The battery was called the Integrative Battery of SLD. RESULTS The correctness of estimation for classifying cases into the diagnostic dyads (SLD/ADHD, SLD/SLD+ADHD, and SLD+ADHD/ADHD) by an integrative utilization of both the Bannatyne category scores (n=4) and scores from the four neuropsychological tests (n=10) was 92.4%, 81.4%, and 71.8%, respectively. These proportions were generally higher than those obtained using the Bannatyne category scores alone (86.4%, 75.5%, and 73.1%, respectively). The same trend was seen in the classification of children into diagnostic and control groups. However, the proportion of the correctness of estimation was higher than that obtained for the diagnostic dyads. CONCLUSION When conducted using appropriately chosen research designs and statistical techniques and if confounding variables are sufficiently controlled, a neuropsychometric battery that includes capacities that relate to intelligence (Bannatyne categories) and those that relate to neurocognitive processes (neuropsychological tests) can be useful in the differential diagnosis of SLD.