Karen Drysdale

Translating the Use of An Enriched Environment Poststroke from Bench to Bedside: Study Design and Protocol Used to Test the Feasibility of Environmental Enrichment on Stroke Patients in Rehabilitation:

Rationale Environmental enrichment, a paradigm investigated extensively in animal models, is an intervention, which by design facilitates motor, sensory, social, and cognitive activity. It has been shown to improve poststroke motor and cognitive function in animal models of stroke. This is the first study to attempt to translate this intervention from the laboratory to the clinical setting. Aims The overall aim of this pilot study is to test the feasibility of using environmental enrichment with stroke patients in a rehabilitation setting. The aim is to enrich the environment of stroke survivors in a rehabilitation ward and measure changes in their activity (physical, cognitive, and social activity). Design Prospective nonrandomized block design intervention study. Study In the control phase we will determine the change in activity levels of patients treated in a usual rehabilitation environment over time. In the intervention phase structured observational techniques (behavioural mapping) will be used to quantify the change in activity levels of patients exposed to environmental enrichment. Outcomes The primary outcome is change in activity level. Additional data collected on entry to and exit from the study will include: cognitive function using a battery of cognitive tests, general function using the Functional Independence Measure, mood using the Patient Health Questionnaire 9 and boredom using the Stroke Rehabilitation Boredom Survey. Quality of life will be assessed using the Assessment of Quality of Life 1 month postdischarge from rehabilitation. Australian New Zealand Clinical Trials Registry#*** ACTRN12611000629932.

Use of the Everyday Memory Questionnaire With Children

The Everyday Memory Questionnaire (EMQ; Sunderland, Harris, & Baddeley, 1983) was examined for its suitability to assess childrens memory. The parents of 226 school children (6-12 years) completed the EMQ in relation to their own children. A subset of these children (N=101), in 6, 8 and 10 years age groups, completed subtests of the Wide Range Assessment of Memory and Learning (WRAML; Sheslow & Adams, 1990). Comparison of EMQ and WRAML data found aspects of verbal memory correlated moderately with the EMQ in the 10 years age group. There were no meaningful correlations in the 8 years age group. In the 6 years age group aspects of visual memory correlated moderately with the EMQ. The diagnostic utility of the EMQ for children was assessed by comparing the school group to children diagnosed with ADHD and/or learning disorders. Diagnostic indicators revealed the EMQ to have high sensitivity (89%) but poor positive predictive power, identifying 40% of the school group as having memory deficits. Negative predictive power (confirming a negative diagnosis) was high. Validity data suggested that the EMQ could be useful with children at least as young as 10 years and further research needs to be conducted to establish the utility of the EMQ in clinical groups with primary memory deficits.

The Effects of Psychotherapy on Reducing Depression in Residential Aged Care: A Meta-Analytic Review

Published and unpublished randomized controlled trials of psychotherapeutic treatments for depression in residential aged care were systematically reviewed. A medium effect size was found to favor psychotherapy for reducing symptoms of depression in residents (average age, 79.8 years) based on 17 trials. The effect was maintained at follow-up, but was weaker and not statistically significant when interventions were compared with active control conditions in 6 trials. There was heterogeneity across studies; however, potential moderating factors were difficult to identify due to large within-study variance. A sensitivity analysis revealed that the Geriatric Depression Scale (GDS) 15-item version produced a larger effect size than did the GDS-30, and an integrated care approach was more effective than providing psychological interventions independent of aged care staff.

Event-related potential response to attended and unattended locations in an interference task

Event-related potentials were measured in response to an interference task in which unattended stimulus items were compatible, incompatible a neutral with regard to the attended stimulus items. Two stimulus items were presented simultaneously and bilaterally--one in each visual field. This allowed examination of the event-related potential waveform according to whether recording sites were contralateral to the attended or unattended location. The first experiment used sustained cueing with 3.5 degrees separation between attended and unattended locations. Attentional modulation of the N1 was observed but not for the P1. In the second experiment, separation between attended and unattended locations was increased to 11.5 degrees. In both experiments, the hemisphere contralateral to the unattended material (unattended hemisphere) showed a greater negativity in the N2 latency range in the temporal regions to compatible and incompatible conditions compared to a neutral condition. These data are inconsistent with findings suggesting the filtering of material early in visual processing.

Microstructural white matter changes mediate age-related cognitive decline on the Montreal Cognitive Assessment (MoCA).

Although the relationship between aging and cognitive decline is well established, there is substantial individual variability in the degree of cognitive decline in older adults. The present study investigates whether variability in cognitive performance in community-dwelling older adults is related to the presence of whole brain or tract-specific changes in white matter microstructure. Specifically, we examine whether age-related decline in performance on the Montreal Cognitive Assessment (MoCA), a cognitive screening tool, is mediated by the white matter microstructural decline. We also examine if this relationship is driven by the presence of cardiovascular risk factors or variability in cerebral arterial pulsatility, an index of cardiovascular risk. Sixty-nine participants (aged 43-87) completed behavioral and MRI testing including T1 structural, T2-weighted FLAIR, and diffusion-weighted imaging (DWI) sequences. Measures of white matter microstructure were calculated using diffusion tensor imaging analyses on the DWI sequence. Multiple linear regression revealed that MoCA scores were predicted by radial diffusivity (RaD) of white matter beyond age or other cerebral measures. While increasing age and arterial pulsatility were associated with increasing RaD, these factors did not mediate the relationship between total white matter RaD and MoCA. Further, the relationship between MoCA and RaD was specific to participants who reported at least one cardiovascular risk factor. These findings highlight the importance of cardiovascular risk factors in the presentation of cognitive decline in old age. Further work is needed to establish whether medical or lifestyle management of these risk factors can prevent or reverse cognitive decline in old age.

Generalization of cognitive training in an Australian sample of schizophrenia patients

OBJECTIVE The present study was undertaken to evaluate the effect of cognitive training in improving trained and untrained cognitive processes in schizophrenia. METHODS A simple pre- and post experimental study with a three month follow-up was conducted to determine the efficacy of cognitive training in speed of processing and executive functions improving cognition in 22 schizophrenia patients. RESULTS Significant improvement was found in those cognitive domains specifically targeted in the training protocol, but also to a limited extent on verbal memory and social cognition. There was also evidence of improvements in symptoms and social functioning. The training effects failed to transfer to community functioning skills however. Except for social cognition, these improvements were maintained at 3month follow-up. CONCLUSION The study highlights the importance of understanding the mechanisms that contribute to the transfer of skills as well as the maintenance of cognitive changes in individuals with schizophrenia.