Download - The Abstracts of the 8th National Conference of the APS College of Clinical Neuropsychologists 3–6 October 2002 Maroochydore, QLD

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The Abstracts of the 8th National Conference of the APS College of Clinical Neuropsychologists

3-6 October 2002

Maroochydore, QLD

Abstracts Editor: Karen Sullivan Queensland University of Technology

The 8th National conference of the APS College of Clinical Neuropsychologists (CCN) will be held in Maroochydore, Queensland, at the Twin Waters Resort, October 34,2002. This is the second conference we have held on the Sunshine Coast and we are back by popular demand.

We are pleased to announce a vaned conference program that offers coverage of a wide range of issues in clinical neuropsychology pertinent to research and clinical practice. This year’s program sees the return of free papers, further expansion of the poster program, and the continuation of symposia and workshops. Contributors this year include researchers from New Zealand, the USA, and the UK.

We are pleased to announce the invited keynote speakers are: Dr James Butcher from the University of Minnesota, who is known internationally for his work on the Minnesota Multiphasic Personality Inventory, and Dr Gordon Chelune of the Cleveland Clinic Foundation, Ohio who is internationally renowned for his work in the area of the neuropsychology of epilepsy, and more recently, multiple sclerosis.

An exciting innovation in the program this year is the inaugural poster tour. The tour will be led by a discussant who will draw out common themes and issues at the end of the tour, following a brief verbal report by poster presenters of their research. This year’s program will also include test demonstrations, for the first time. Delegates will be invited to select tests that will be featured at the conference for demonstration. We look forward to a successful and stimulating conference.

ORGANISING COMMITTEE Debbie Anderson

Michael Dent Louis Salzman

Karen Sullivan (Chair, Scientific Program) Special thanks to Renata Meuter and the student volunteers,

Phillip Stacey, Cathryne Lung, Kristie Mammen, 6 Iaimi Greenslad

Australian Journal of Psychology - SUPPLEMENT 2002

68 Combined Abstracts of 2002 Psychology Conferences

The neuropsychology of neurocutaneous syndromes in a paediatric population: Sturge-Weber syndrome

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ANDERSON, D. (Brain Sciences Institute, Swinburne University). [email protected]

lthough Sturge-Weber syndrome is one of the more A common of the group of disorders known as neurocutaneous syndromes, it is a rare condition with variable cognitive findings, neurological presentation and natural history. Katie, a teenage girl with Sturge-Weber syndrome, was referred for neuropsychological assessment in order to provide a characterisation of cognitive function. This request was made with particular reference to providing a baseline of function, as her condition appeared to be deterio- rating and an opinion was sought with respect to consideration of possible neurosurgery. Seizures had started in the first year of life and remained refractory to medication. Behavioural difficulties were also of concern for her family and at school. Katie presented with the characteristic unilat- eral port-wine stain birthmark on her face. She was very shy and refused to allow her mother to leave the room. Katie was also very difficult to engage in assessment and spent much of her time hiding her face. Assessment was conse- quently protracted and conducted over several sessions but was limited and largely neurobehavioural in nature. Results indicated significant intellectual disability. Special school placement was supported and behaviour modification strategies recommended. The case of Katie will be presented as an example of the variable cognitive presentation of Sturge- Weber syndrome and to introduce a more general discussion of the syndrome, its cognitive implications and issues related to neurosurgery in patients with the syndrome.

Evaluation of the utility of the Rarely Missed Index (RMI) of the WMS-111: Are malingerers rarely missed?

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ANDERSON, D. (Independent Practice), OLM, T. (University of Southern Queensland), & PERSHOUSE, M. (Independent Practice). [email protected]

n many contexts, the identification of invalid performance I on neuropsychological tests is an important issue. This is particularly important in the medicolegal setting, where there may be significant financial incentives. Whilst there are a number of measures designed specifically to identify invalid performance, the use of commonly used tests (e.g., WAIS-R, WMS-R) to classify malingered performance is also popular (Mittenberg et al., 1993, Mittenberg et al., 1995; Rawling, 1993). With the advent of the WMS-111, especially with its inclusion of additional forced-choice items, new methods of classification have been proposed. Killgore and DellaPietra (2000) proposed the Rarely Missed Index (RMI), based on six items that they argued were rarely incorrectly answered in the Logical Memory II recognition subtest. Using a group of mixed patients, they argued that this index offered good classification of this group, compared to subjects instructed to feign. A number of concerns are raised about this study including the use of a mixed sample, the use of analogue malingerers and the fact that not all subjects were exposed to the entire test. There- fore this study used a clinical sample of individuals with a clear history of traumatic brain injury, and clinical patients who performed below the cut-off on recognised tests of dissimulation. In addition, the results of a non-neurological

sample was also compared. Preliminary analysis has not supported the previous findings of good discrimination of the RMI amongst the groups.

Ultra high-risk for psychosis: Olfactory identification and negative symptoms ~- ~~ ~~ ~~~~~~~ ~- ~ ~~~

BREWER, W. (University of Melbourne), MCGORRY, P. (MH-SKY), WOOD, 5. (Sunshine Hospital),

(University of Melbourne), VELAKOULIS, D., & PANTELIS, C. (Sunshine Hospital). [email protected]

revious investigation has shown stable olfactory identifi- P cation deficits in patients with chronic and largely neuroleptic-nafve first-episode psychosis, which are related to negative symptoms. This was extended to an ultra-high risk (UHR), neuroleptic-naive cohort, of whom 28.57% experienced the first episode of psychosis during the investigation period. Method: One hundred and twelve patients meeting inclusion criteria for entry to an ultra-high-risk for psychosis (UHR) treatment program were compared to 38 equivalent controls (CTL). Olfactory identification ability was assessed using the University of Pennsylvania Smell Identification Test (UPSIT) on 97 of the UHR patients. Premorbid and current IQ were assessed using the National Adult Reading Test (NART), and the Wechsler Adult Intel- ligence Scale-Revised (WAIS-R) on all subjects. Cannabis utilisation was also quantified. Results: Examination of the UHR subjects who later developed psychosis compared to those who did not revealed no significant impairment in UPSIT ability compared to controls, despite the group as a whole having slightly reduced scores. Conclusions: These findings suggest that olfactory identification impairment is not apparent before the onset of psychotic illness. This contrasts with previous findings of olfactory identification deficits in first-episode psychosis and in patients with chronic schizophrenia. These data may suggest that such impairments occur during the transition phase to illness.

PHILLIPS, L., YUNG, A. (MH-SKY), ANDERSON, V.

Imaging the hippocampus - An fMRl study BUNNAGE, M. (Frenchay Hospital, UK), BOWDEN, 5. (University of Melbourne), BARDENHAGEN, F., & COOK, M. (St Vincent's Hospital, Melbourne). [email protected]

our normal subjects encoded complex visual scenes F (Stem et al., 1996), arranged in a block paradigm, whilst undergoing fMRI scanning, in two separate experiments. Imaging data were collected on a 1.5T scanner, and were analysed using correlational methods (Bandetinni et a]., 1993). Experiment 1 demonstrated activation inconsistently within the hippocampus and parahippocampal gyms bilater- ally. Experiment 2 indicated that sustained responding (Kato et al., 1998) of brain regions, in response to memory encoding, after stimulus presentation, was not specific to the hippocampal or parahippocampal region. Sustained post encoding responding occurred in one subject in a variety of cortical and subcortical regions. Further analysis indicated that using a larger p-value to determine which brain areas were considered to be active had the effect of increasing the size of already active brain areas and did not improve the sensitivity of the technique for detecting activation within additional areas, specifically the hippocampal or parahippocampal region. Overall the results indicate that complex visual scene encoding is not a sensitive fh4RI protocol for eliciting reliable bilateral hippocampal activation in normal

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The Abstracts of the 8th National Conference of the APS College of Clinical Neuropsychologisu 69


subjects. In its present form this protocol does not lend itself to the quantitative analysis of hippocampal functional integrity in the preoperative assessment of patients with temporal lobe epilepsy.

Cortical circuits in compulsive and stereotypic behaviours in Fronto-Temporal Dementia (FTD)

CASEY, BJ. (CERA, Concord Hospital), FULHAM, MJ. (Royal Prince Alfred Hospital), & BROE, GA. (Prince of Wales Hospital). [email protected]

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epetitive, stereotypic and compulsive behaviours are R, elatively common in Fronto-Temporal Dementia (FTD), although there is considerable variation between patients in the nature of these behaviours. FTD is also characterised by a relatively high prevalence of degenera- tion of the head of the caudate nucleus. The caudate nucleus participates with several frontal regions in functional circuits. A number of glucose-PET studies have reported increased caudate metabolic activity in psychiatric patients with idiopathic Obsessive Compulsive Disorder (OCD). Despite differences in the nature of OCD behaviours and the compulsive behaviours seen in FI'D (notably the fact that anxiety reduction plays an important role in driving the former) we also found increased caudate metabolism in compulsive FTD patients compared with those without compulsive behaviours. According to Denny-Brown (1958) and Lhermitte ( 1983), environmentally triggered stereotypic behaviours (such as forced object utilisation) might arise as a result of an imbalance between frontal and parietal activity, with damaged frontal lobes failing to exercise their normal modulatory and inhibitory influence on environmentally responsive parietal systems, which are able to initiate automatic responding unchecked. When FTD patients exhibiting environmentally dependent behaviours were compared with those without such behaviours, we indeed found that they differed in the ratio of orbito-frontal to parietal metabolic activity on glucose-PET.

Cerebellar contributions to gait and cognition in very old community dwellers

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CRAMSIE, JE. (Macquarie University), PIGUET, O., BENNETT, HP. (Centre for Education & Research on Ageing at Concord Repatriation General Hospital & Prince of Wales Medical Research Institute), KRIL, JJ., CREASEY, H., LYE, TC. (Centre for Education & Research on Ageing at Concord Repatriation General Hospital), & BROE, GA., (Prince of Wales Medical Research Institute). [email protected]

ait ataxia is commonly diagnosed in people aged 75 and G over living in the community. Although the cerebellum is known to play a major role in the coordination of movement, no research has investigated the possible relationship between cerebellar function and gait disturbance in elderly people. Cognitive decline is also very common in this age group, and increasing empirical support has been put forth to suggest that the cerebellum may contribute to various aspects of cognition. The current study aimed to investigate the relationship between cerebellar size and indices of motor and cognitive functioning, as well as sociodemographic variables in elderly community dwellers. Measures of motor and cognitive functioning were administered to 113 community dwellers, aged 81 and over (range 81-97 years), selected from the Sydney Older Persons Study 6-year review. Indices of total cerebellar volume and vermal

area were also obtained. Associations between these variables as well as sociodemographic factors were investigated. No significant associations were revealed between cerebellar variables and any of the motor or cognitive measures. There was a mild but significant negative association between current average daily alcohol consumption and vermal area, even after controlling for cerebrum size. This was found despite the low levels of alcohol consumption reported (< 1 drinWday on average). Thus, there was no evidence to suggest a cerebellar contribution to motor disturbance or cognitive decline in relatively healthy elderly people. However, the results indicate that the cerebellum may be particularly susceptible to alcohol-related shrinkage in the elderly.

The effects of mild Traumatic Brain Injury (mTBI) on verbaVmotor dual task performance

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DE MONTE, V., & GEFFEN, G. (The University of Queensland). comerf @psy.uq.edu.au

he sensitivity of simultaneous speech and alternate T sequential finger tapping to mild Traumatic Brain Injury (mTBI) was investigated. The number of correctly sequenced taps was measured alone or during the repetition of a 3-syllable word, in 10-second (study 1) and 30-second (study 2) intervals, within 24 hours of injury. In the first study, 73 male patients with mTBI produced fewer correct taps and repeated fewer words than 42 male patients with orthopaedic injuries. In the second study, 29 male patients with mTBI repeated fewer words while also tapping than 17 male patients with orthopaedic injuries. There was no difference between the groups on word repetition alone. Patients with mTBI completed fewer correct taps, while also speaking, in the first ten seconds than orthopaedic patients. There was no difference between the groups in the second and third 10-second blocks. Both groups completed fewer correct taps and repeated fewer words from the first 10- seconds to the second 10-seconds, and then from the second 10-seconds to the third 10-seconds in both the single and dual task conditions. In both studies, right hand performance of all participants was superior to that of the left, however, in line with previous studies, concurrent speaking interfered more with right hand performance than left, reflecting competition for left hemisphere control of skilled right hand movements and speech. These results indicate that while the speed and accuracy of finger movements and speech was diminished by mTBI, there was no alteration of normal laterality effects of dual task interference.

Cognitive decline after a single stroke: A two-year prospective and community-based study

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DIDUS, E. (University of Melbourne), SALING, MM. (University of Melbourne and Austin & Repatriation Medical Centre), SRIKANTH, V. (Austin & Repatriation Medical Centre), ANDERSON, JF. (University of Melbourne), & DONNAN, GA. (Austin & Repatriation Medical Centre). [email protected]

ecent research into dementia following stroke has R proposed that a single stroke may set in train progressive cognitive decline. Methodological and conceptual inadequa- cies with these studies to date, however, suggest that this hypothesis has not been genuinely tested. This study aimed to investigate prospectively cognitive function in a cohort of


first-ever stroke and stroke-free community-residing individuals. Consistent with the single stroke mechanism of dementia, it was hypothesised that a greater proportion of first-ever stroke patients will show cognitive decline in the 24 months after the stroke event, as compared to age and sex matched controls. Of those stroke patients who show poststroke cognitive decline, it was hypothesised that none will have had evidence of pre-stroke cognitive decline. Ninety-nine first-ever stroke patients and 99 controls participated in the study. A broad array of neuropsychological tests were administered to all subjects at 3-, 12- and 24- month intervals. Results showed that first-ever stroke survivors did not show significantly greater cognitive decline in the 24 months after their stroke, when compared with the control sample. Exploratory analyses found that stroke cases experienced some difficulties with tasks tapping visuo-spatial ability in the earlier poststroke months but this improved at 12 months and stabilised at 24 months. Repeated neuropsychological assessment showed practice effects in the visuo-spatial domain for the control sample across all times; this was not seen in the stroke sample. It was concluded that the single- stroke theory of dementia is not viable.

neuropsychological assessment of personal injury claimants. Along with the increase in the usage of these tests, a growing concern has emerged that many of the hypotheses critical to these forensic assessments may not be as adequately addressed by these new revisions as their predecessors. Ultimately, any psychological assessment must be able to address the relevant issues in each case including differentiating the effects of demographic variables, separating real change from statistical artefact, and recognising the scope of normal range variation in test scores. While these concerns are certainly not restricted to the Wechsler batteries, the inability to currently address the influence of some of these variables on these tests limits the degree to which alternative explanations can be examined. This paper will address those variables that empirically have the greatest influence on Wechsler scale performance and propose strategies for accommodating or reducing their effects upon clinical decision making. Recent Australian research findings will be presented and their implications for the clinical utility of the WAIS-III and WMS-111 will be discussed.

Neuropsychotherapy in the community

The neuropsychology of neurocutaneous syndromes in a paediatric population: Tuberous sclerosis

DODDS, B. (Learning Difficulties Centre, Royal Children’s Hospital). [email protected]

ohn is a 7-year-old boy who was referred to the Learning J Difficulties at the Royal Children’s Hospital Centre for assessment in the context of learning difficulties. His medical history includes epilepsy secondary to tuberous sclerosis, diagnosed at 6 months of age with complex partial seizures that are well controlled with Tegretol; and hydro- cephalus secondary to a giant cell astrocytoma at the foramen of Munroe (right frontal horn of the right lateral ventricle of the brain). John underwent neurosurgical removal of the tumour in May 1998, and a second radical resection in November 1999. A review consultation in November 2000 was suggestive of no further recurrence. John’s mother reports that his behaviour is very poorly regulated, with impulsivity and abrupt changes in his demeanour. She reports that John is frustrated with learning and is not happy going to school. She reports that since John’s surgery he has had more trouble remembering things and staying on track, and has been more emotionally unsta- ble. John’s mother reports that John tends to play alongside other children rather than collaboratively. She reports that he can’t understand social rules, doesn’t empathise with others, and is very egocentric. She reports that John prefers routine and doesn’t cope well when change is unexpected. John’s neuropsychological results will be discussed with consideration of lesion location/MRI results and a more general discussion regarding tuberous sclerosis and associated neurological/cognitive/leaming difficulties.

Issues that effect the utility of the WAIS-Ill and WMS-Ill in forensic assessment ~~ ~ ~ ~ _ ~ _ _ ~ ~ ~ ~ -~ - ~~ ~ ~ ~ ~

DOUGLAS, L. (Medical Consultants Australia, Brisbane), & SENIOR, G. (University of Southern Queensland). [email protected]

ince their publication in the late 1990’s the WAIS-I11 and S WMS-I11 have been increasingly employed in the

GATES, N. (Independent Practice). nicolagates@bigpond

sychosocial adjustment problems following traumatic P brain injury (TBI) frequently present a major barrier for rehabilitation (Kendal et al., 2001). Neuropsychotherapy applies neuropsychological knowledge with psychotherapy models to assist persons with brain disorders. Neuropsy- chotherapy has been adopted to facilitate psychosocial adjustment, reduce anxiety and depression, and improve return to work and study. A working definition of neuropsychotherapy is presented and supported through the qualita- tive review of seventeen acquired brain injury cases treated within the community. Therapy sessions are summarised with consideration being given to the efficacy of CBT and Solution Focused models adapted for persons with acquired brain injury. A general discussion examines future require- ments in this developing field of clinical practice.

Validation of the AUSNART as a measure of premorbid intelligence

HENNESSY, M. (James Cook University). [email protected]

here are a number of clinical, research, and medicolegal T situations where the estimation of premorbid intellectual ability is important. Current clinical practice involves the use of present ability measures, such as single word reading tests, along with demographic variables. The AUSNART is an Australian revision of the NART, a widely used single word reading test which has established reliability and validity as an estimate of premorbid intellectual ability. This research cross-validated the AUSNART’s reliability and validity against the WAIS-111, and a number of purported premorbid intelligence measures such as the Reading subtest from the WRAT-3, the Spot-the-Word test, the Cambridge Contextual Reading Test, and the PPVT-3. The influence of demographics was also examined. An Australian sample of 100 healthy individuals aged between 19 and 88 years was used. The results indicated very good split-half reliability (.92) and inter-rater reliability (.9) for the AUSNART. The AUSNART had significant correlations with FSIQ (.62), VIQ (.61) and PIQ (.49), supporting its validity as a measure of general cognitive functioning. The AUSNART also had


The Abstracts of the 8th National Conference of the APS College of Clinical Neuropsychologists 7 I significant correlations ranging from .77 to .92 with other premorbid intelligence measures. In combination with years of education the AUSNART predicted 45% of the variance in FSIQ. Future directions for research include comparison with the Contextual AUSNART, and its utility in clinical samples such as dementia.

The validity and reliability of the visuo-spatial n-back Task

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HOCKEY, A., & GEFFEN, G. (The University of Queensland). [email protected]

nformation processing theories of intelligence argue that I people have a limited capacity to store and process information in working memory. Therefore, it is assumed that the speed at which an individual can process information, or the amount of information that can be retained in working memory, will determine their level of mental abilities. This study sought to determine whether the visuo-spatial n-back working memory task is a reliable and valid measure of cognitive processes that are believed to underlie intelligence. Seventy-one participants were administered an n- back task with four levels of increasing complexity over two test occasions, separated by one week. On the second test occasion, participants completed the computerised Multidi- mensional Aptitude Battery (MAB), which correlates highly with the WAIS-R ( r ranging from 0.79 to 0.94). Moderate test-retest reliability for accuracy of performance scores was noted across the four levels of the n-back task ( r = 0.49 to 0.73), whilst reaction times were highly reliable ( r = 0.69 to 0.85). Participants’ reaction times and accuracy scores were then compared to their performance on the MAB. Intelli- gence was positively correlated with accuracy scores, and negatively correlated with reaction times. Furthermore, these associations were maximal when accuracy scores were compared to the PIQ subscale of the MAB ( r = 0.05 to 0.35), whilst reaction times with participants’ FIQ scores ( r = 0.14 to 0.45). These findings indicate that the visuo-spatial n-back task is a suitable measure to employ in research examining the cognitive bases of intelligence, and potential clinical applications are discussed.

Financial competence after brain injury: Validity of neuropsychological assessment

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HOSKIN, K., JACKSON, M., & CROWE, SF. (La Trobe University). [email protected]

he current research involves three studies investigating T the ecological validity of neuropsychological assessment to predict everyday money management and assist in determining competency in an Acquired Brain Injury (ABI) population. Study One compared the money management abilities of 30 people with ABI recruited through case management services with that of 15 controls. Basic money handling skills were measured using a performance-based survey. Case managers completed an experimenter-designed survey of their client’s everyday money management abilities. In comparison to controls, the ABI group had more difficulties with basic money handling skills and everyday money management (e.g., leaving money aside for food and rent). In Study Two, 30 people with ABI who were independently managing their money were administered a neuropsychological assessment, including measures of intellectual, attentiodexecutive, and memory abilities. While neuropsy-

chological assessment demonstrated a modest ability to predict overall money management (Rz = .19), prediction of specific money management behaviours, problematic impul- sive spending and paying bills or rent late, was more successful ( R 2 = .46 and .63 respectively). Study Three compared the neuropsychological performance of two groups with ABI; 30 managing their money independently (ABI-MF) and 15 judged incompetent to manage money and appointed an administrator (ABI-A). As expected, in comparison to the ABI-MF group, the ABI-A group performed worse on measures of executive/attentional abilities @ < .OOl) and classification success was high (83.7% correctly classified). Measures of memory were not significant discriminators. The results provide support for the ecological validity of neuropsychological assessment in assisting to determine competence to manage money in an ABI population.

Accounting for the ability to draw a person with two heads: Representational flexibility and change in young children’s drawings

HUNTLEY, W., & MEUTER, RFI. (Queensland University of Technology). [email protected]

e focused on the development of representational w flexibility in young children’s drawings, and its relation to specific verbal and non-verbal skills. Fifty-one preschoolers were asked “to draw a person with two heads”. Video analysis assessed the degree to which standard person-drawing procedures were altered when attempting the task. A series of attentional flexibility and inhibitory processing tasks, as well as the McCarthy Scales of Children’s Abilities, were completed also. As expected, age emerged as a significant predictor of success at the task. However, contrary to our predictions, the variability that the children demonstrated in drawing a novel variant of a person was not predicted by their cognitive abilities. More importantly, while representational changes might be supported by increased prefrontal cortex maturation, none of the attentional flexibility nor executive function tasks predicted performance. It is suggested that the form of representational flexibility required for the two-headed drawing task occurs via multiple domain specific routes.

Cognitive ability of elderly people: Implications for preclinical dementia

KENT, PS., & LUSZCZ, MA. (Flinders University). pat.kent@f linders.edu.au

his research explored cognitive profiles amongst a group T of community dwelling elderly people without a diagnosis of dementia. We expected to find variations in cognitive ability with patterns of normal ageing as well as patterns of cognitive deficits. Participants ranged in age from 61 to 91 years with an average of 78 years. The estimated average FSIQ was 116 and the average number of years of education was 13. Cognitive abilities examined included several aspects of memory (verbal, visual, incidental and prospective), naming, speed of information processing, attention and concentration, abstract reasoning, construction and executive functioning. Preliminary analyses on an initial small sample of participants indicated that clusters of cognitive ability could be identified, some which represent normal ageing and others which represent preclinical signs of a dementing illness.


/ L Combined Abstracts of 2002 Psychology Conferences

Attributional bias, paranoia and depression in first-episode psychosis

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LANGDON, R. (Macquarie Centre for Cognitive Science), & STILL, M. (University of Sydney). [email protected]

ecent reviews (Garety et al., 1999, 2001) suggest abnor- R, a1 attributional biases may have a primary role to play in the explanation of psychosis. Kinderman and Bentall (1999) advocate attributional therapies to augment current cognitive-behavioural treatments for psychosis. There has been a call for longitudinal and first-episode research to confirm the primacy of the role played by attributional biases. And yet, Krstev, Jackson and Maude (1999) found evidence for only a weak relationship between self-serving biases and paranoia in the only study to date investigating attributional style in early psychosis. The present study investigated attributional style, paranoia and depression in a group of young people experiencing their first psychotic episode and a healthy control group. Higher levels of suspiciousness and depression were found in the first-episode group; however, the two groups did not differ on a more general index of paranoid ideation. Across both groups, an increased tendency to attribute positive rather than negative events to self and an increased tendency to allocate negative events to other people rather than circumstances predicted higher levels of suspiciousness. In keeping with results found elsewhere for depressed individuals, higher levels of depression were associated with less of a self-serving bias and more of a self-blaming bias in the healthy controls, but not in the first-episode patients, suggesting that depression in the latter group may be secondary to the onset of psychosis. Implications concerning the primacy of the role played by attributional abnormalities in the explanation of psychosis are discussed.

The clinical utility of CAI-GMI discrepancy scores to evaluate memory impairment

LANGE, R., HOPP, G. (Riverview Hospital, Vancouver), SENIOR, G., (University of Southern Queensland), & CHELUNE, G. (Cleveland Clinic Foundation, USA). [email protected]

nalysis of the discrepancy between measures of intellec- A tual functioning and memory on the Wechsler scales has received support in the literature as being indicative of acquired memory impairment and is now included as a standard analysis in the most recent edition of these tests (i.e., WAIS-IIWMS-111). Recently, a 6-subtest General Ability Index (GAI) was developed and intended as a more efficient substitute for the 11-subtest FSIQ measure. The purpose of this investigation was to evaluate the clinical utility of GAI- GMI discrepancy scores for detecting memory impairment. Participants were 154 healthy controls and 277 patients with dementia. Base rate tables of G 41-GMI discrepancy scores were developed from the healthy controls, and served as a comparison for the performances of the dementia patients. Applying a cutoff score at the 5th percentile, only 7% of the dementia patients had unusually large GAI-GMI discrepancy scores. The ability of GAI-GMI discrepancy scores to differ- entiate between healthy controls and dementia using discrimi- nant function analysis was poor (69.5% healthy controls & 63.2% dementia). Based on the prevalence of unusually large GAI-GMI scores to detect memory impairment across binary extreme groups (i.e., normal controls + intact GMI vs. dementia + impaired GMI), low sensitivity (14.5%) was demonstrated for these scores to identify memory impair-

ment, but the specificity was very high (97.9%). The positive predictive power was high (87.0%), while the negative predictive power was in the moderate range (53.5%). The GAI-GMI does not appear to be a reliable indicator of memory impairment in this population.

Prediction of Post-Traumatic Amnesia (PTA) duration from early Westmead PTA scale scores

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LEACH, K., & MCMAHON, G. (Cedar Court HealthSouth Rehabilitation Hospital). kathleen [email protected]

uration of Post-Traumatic Amnesia (PTA) following D traumatic brain injury is important because it has been associated with the severity of the injury and has been found to be the best predictor of prognosis. There are numerous potential benefits of being able to make early predictions of PTA duration before it has ended. Early prediction would enable an earlier prognosis of severity of injury and would provide information to enhance family adjustment. It would also assist greatly with planning of rehabilitation programs and allocation of resources, as patients do not commence active rehabilitation programs due to the cognitive and behavioural changes characteristic of PTA. To date, two studies have attempted to provide models of prediction of PTA duration from early scores on standard PTA measures, including the Orientation Group Monitoring System (Saneda & Corrigan, 1992), the Oxford PTA scale and the Galveston Orientation and Amnesia Test (Tate et al., 2001). This study is a replication of the study undertaken by Tate et al. (2000) using the Westmead PTA, scale another commonly used measure of PTA in Australia. Patient records from the Aquired Brain Injury (ABI) unit at Cedar Court HealthSouth Rehabilitation Hospital will be reviewed. Analysis of the Westmead PTA scale data will be undertaken to determine the best fit calculation for predicting ETA duration. The significance of early prediction of PTA duration will be discussed in relation to the impact on current rehabilitation practices.

The neuropsychology of neurocutaneous syndromes in a paediatric population: Linear Sebaceous Naevus Syndrome

MACCUSPIE-MOORE, C. (Learning Difficulties Centre, Royal Children’s Hospital). cressida [email protected]

red is a 6-year-old boy referred to the Learning Difficul- F ties Centre Royal Children’s Hospital, for assessment of his academic abilities, following limited academic gains in his first year of school. Fred has previously been diagnosed with Linear Sebaceous Naevus Syndrome which is characterised by extensive sebaceous nevi (a particular form of birthmark) covering much of the left hand side of his face and scalp, and extending on the inside of his mouth and gums. Fred also has a number of cafd-au-lait birthmarks and mildly abnormal pigmentation of his arms. These additional markings are common anomalies associated with the syndrome. Fred initially presented as an extremely distressed child who was reluctant to enter the Learning Difficulties Centre, even in the presence of his mother. Fred settled well, although he remained wiggly and distractible, and required constant cueing to stay on task. Fred fatigued enormously and was unwilling to attempt items that he felt were “too hard”. His language was unclear and characterised by a


The Abstracts of the 8th National Conference of the APS College of Clinical Neuropsychologists 73 number of minor speech production errors. Aside from mild delays in developmental milestones, and some difficulties coping with kindergarten, there was no evidence in Fred’s history to indicate more serious impairment. Fred’s hearing and sight have been previously assessed and no abnormalities identified. Fred is otherwise healthy. His parents expressed no concerns about his development, aside from his failure to develop reading and writing skills at school. Linear Sebaceous Naevus Syndrome is known to be associated with a number of neurological and neuroanatomical abnormalities resulting in intellectual disability and seizure disorders. The results of Fred’s assessment will be discussed with reference to the relationship between skin lesions such as sebaceous naevi and neurological abnormalities.

The use of Cognitive Behaviour Therapy (CBT) in Acquired Brain Injury (ABI) Rehabilitation: Current practices and future directions ~ _ p _ ~ ~ ~ ~ ~ ~~p ~ ~ ~ ~ ~

MCMAHON, G. (Cedar Court HealthSouth Rehabilitation Hospital). [email protected]

motional and behavioural difficulties such as depression, E adjustment to injury difficulties, anxiety, poor anger management and substance abuse are common sequelae of acquired brain injury (ABI) and present many challenges to successful rehabilitation. It has been noted that many individuals who have sustained an ABI have difficulty benefiting from traditional psychotherapy due to the impact of cognitive and language disturbances. It has been asserted by some authors (e.g., Cicerone, 1989; Ponsford, 1995) that Cognitive Behaviour Therapy (CBT) is an appropriate therapeutic approach for use in the ABI population, not only because it is applicable to the types of problems commonly presenting, but also because the CBT approach can be adapted to take cognitive limitations into account. This paper will provide a critical review of the current literature on the application and efficacy of CBT in the ABI population to determine whether the research supports this assertion. Areas for future development of the use of CBT in the ABI population will also be discussed, with case material illustrating some of the issues raised from the literature.

Predicting duration of posttraumatic amnesia ________. _ _

MCSWIGGAN, 5 . (Macquarie University & Westmead Hospital), SHORES, A. (Macquarie University), BAGULEY, I. (Brain Injury Unit, Westmead Hospital). [email protected]

he aim of this research was to examine a set of variables T that would reliably predict duration of posttraumatic amnesia (PTA) in patients with a traumatic brain injury, and to test the efficacy of this model. Two independent samples (n = 100) (n = 27) sustaining a traumatic brain injury were assessed. Linear multiple regression analysis using three predictors attainable early in the recovery period: days from injury till PTA assessment commenced, an aggregate of the first five days scores on the Westmead PTA Scale, and age at time of injury were examined (n = 100). The outcome predictor was days of PTA assessed by the Westmead PTA Scale. This scale consists of 12 items measuring orientation and return of continuous memory. Results showed that two predictors: days from injury till PTA assessment commenced, an aggregate of the first five days scores on the Westmead PTA Scale accounted for 81% of the explained variance. It also showed excellent application to the

independent validation sample (n = 27), with an intraclass coefficient between observed and predicted duration of PTA of r = 0.95. The model can be readily calculated and will provide accurate estimates of PTA duration within the first week of testing. This information will be useful in terms of family counselling, planning of rehabilitation programs and fiscal planning. Finally, investigations into the effects of pharmacotherapies for acute brain injury may be advanced by such predictions.

Executive function and theory of mind: An exploration of the related components

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MAMMEN, K., & MEUTER, RFI. (Queensland University of Technology). [email protected]

ecent research emphasises the development of executive Rf unction abilities as playing an important role in the development of a theory of mind. Claims of a relationship between theory of mind and executive function have arisen subsequent to findings highlighting their neurological proximity and similar developmental schedule, as well as evidence that both abilities may be impaired in autism. The present study examined the contribution of inhibitory and working memory components to young children’s understanding of false belief. Thirty-two kindergarten children (aged 3; 0-5; 7) were given a series of theory of mind tasks measuring false belief prediction and explanation, as well as deception. In addition they were given two working memory tasks, a task measuring response inhibition and two set- shifting tasks. A critical aspect of the study was to disentangle the task demands associated with the set-shifting tasks. It was predicted that those tasks requiring greater inhibitory control for successful completion would be more highly predictive of theory of mind ability. While hierarchical regression analyses revealed that working memory was not predictive of false belief prediction, the set-shifting task with a proposed higher requirement of inhibitory resources did predict theory of mind understanding (after controlling for age and intelligence). However, no relationship was found that would suggest that inhibitory ability per se was the critical factor. Thus, while working memory and inhibitory control do appear to play a role in children’s development of a theory of mind, more sensitive measures may be required to disentangle their relationship.

Prospective and declarative memory problems following traumatic brain injury ~ ~ ~ ~~

MATHIAS, J., & MANSFIELD, K. (University of Adelaide). [email protected]

raumatic brain injuries (TBIs) cause a variety of cogni- T tive problems, with memory problems being amongst the most common and disabling. While declarative memory problems have been researched in TBI samples, prospective memory problems have received much less attention. However, anecdotal reports from patients, carers and clinicians suggest that prospective memory problems are a serious impediment to recovery following TBI. This study compares the prospective and declarative memory performance of persons who have suffered a moderate or severe TBI (N = 25) with that of a matched control group ( N = 25). Measures of memory (time-based and event-based prospective memory, and visual and verbal declarative memory) and other cognitive functions (e.g., attention, executive functioning) were administered to both groups in order to



examine: the extent of prospective and declarative memory problems following moderate to severe TBI, the relationship between these two types of memory problems, the relationship between these memory functions and other cognitive functions, and which of these cognitive functions are most related to outcome following TBI. A number of experimen- tal and clinical measures of time- and event-based prospective memory were used in order to evaluate the merits of these different tests. Preliminary analyses indicate that time- based prospective memory tasks better discriminate between groups than event-based prospective memory tasks. The implications of the study findings for the clinical assessment of prospective memory will be examined.

Relationship between handedness and placentation in an Australian twin sample

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MEDLAND, SE. (The University of Queensland, Queens- land Institute of Medical Research), WRIGHT, MJ., DUFFY, DL. (Queensland Institute of Medical Research), GEFFEN, GM. (The University of Queensland, Queensland Health), HAY, DA. (Curtin University of Technology), LEVY, F. (University of New South Wales), MARTIN, NG. (Queens- land Institute of Medical Research). [email protected]

t has been suggested that discordant handedness in I monozygotic (MZ) twin pairs may be due to mirroring, the twin developing from one side of the original embryo becoming right-handed, while the co-twin becomes left- handed. It is thought that mirroring is more common in monochorionic (MC) pairs, who share a single placenta as opposed to dichorionic (DC) pairs who have separate placentas. It has been reported that approximately 30% of spontaneous MZ twin births are DC. However, DC placentas often fuse and are commonly mistaken for MC so the number of reported placentas cannot be taken as a reliable indicator of chorionicity. As part of a continuing study examining the origins of liberalisation, we examined the relationship between placentation and concordance for handedness in 1411 M Z twins pairs born 1893-1983 (63% female, mean age, 32 years). Placentation and handedness were assessed either by self- or parental-report. Shared placentas were more commonly reported when placentation was self-reported (84.5% vs. 72.7%, p < .001). The proportion of pairs concordant for handedness did not differ between twin pairs with self-reported handedness (80.2%), and those with parental reported handedness (77.1%). No relationship was found between handedness concordance and placentation, for twin pairs with self-reported placentation x: = 1.1, or parent-reported placentation x: < l. This result was not moderated by the age of participants. Although reports of placentation are prone to error, given the strong claim made for increased prevalence of mirroring in MC pairs, these results suggest mirroring is not a valid explanation of handedness discordance in MZ twins.

The effect of practice on dual-task interference in the visuo-spatial n-back task

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MURRAY, 5.. & GEFFEN, G. (The University of Queensland). [email protected]

any theories of attention suggest that visual search is M reliant on visuo-spatial working memory (WM). However, recent studies have indicated that visual search processes may occur independently of visuo-spatial working memory resources. The current study aimed to further -

investigate the role of visuo-spatial working memory in visual search using the dual-task paradigm. Seventy-seven (39 Males 38 Females) participants completed a visuo- spatial n-back task four times, twice in two testing sessions separated by a week. Single letters were presented for 200 ms every 1.6 seconds at pseudorandomly varying positions on a computer screen. Participants were required to remem- ber either the first, second or third (n-back) most recent letter positions in a continuous sequence and to indicate whether the current item matched or did not match the remembered position. Continuous updating of the string of stimulus positions was required. In a control task, with no updating or maintenance requirement, participants matched to a predetermined stimulus position. In both testing sessions, reaction time (RT) and error rate increased with increasing WM load. An exponential slope for RTs in the first session indicated dual-task interference at the 3-back level. However, a linear slope in the second session indicated a reduction of dual-task interference. The dual- task interference found in the first session at the most complex level was reflective of competition for executive resources. Attenuation of interference in the second session suggested a reduction in executive demands with practice. The present results support the view that visual search is reliant on visuo-spatial working memory.

Paediatric head injury: Implications for psychosocial adjustment into adulthood

NEWIlT, H., ANDERSON, V. (University of Melbourne), & BROWN, 5. (Royal Children’s Hospital). heidi [email protected]

ittle is known about the long-term effect of head injury L W I ) on psychosocial outcome. The present study examined psychosocial adjustment of a group of adults (aged between 18 and 27 years) who sustained a mild (n = 24), moderate (n = 19), or severe (n = 16) HI as children (aged between 8 and 13 years). Many parents or guardians of the head-injured adults also participated. The adults were recruited from the Royal Children’s Hospital’s (Melbourne, Australia) neurosurgery ward’s admission records from 1983 to 1987. Questionnaires, assessments and interviews were completed during the year 2000, which was 10 to 15 years post-injury. Results generally indicated that those with severe injuries had more cognitive, educational/occupa- tional, behavioural, and social difficulties than those with less severe injuries. Daily living skill functioning, alterna- tively, seemed to be comparable across injury severity groups. Individual case analyses revealed an additive effect of pre-injury, injury, and post-injury variables on long-term adjustment. Injury severity alone does not account for psychosocial adjustment and, therefore, rehabilitation services need to be multidisciplinary rather than focusing on physical and cognitive sequalae. Counselling, education, and support services would be beneficial for head-injured individuals and their families for several years post-injury.


The Abstracts of the 8th National Conference of the APS College of Clinical Neuropsychologists 75 Memory correlates of hippocampal and rhinal cortex volumes in patients with mesial temporal sclerosis

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O’BRIEN, C., BOWDEN, S., BARDENHAGEN, F., (University of Melbourne), & COOK, M. (St Vincents Hospital, Melbourne). [email protected]

ranslating animal models to human memory has been T limited by the technological problems associated with characterising neural structures in vivo. Functional correlates of hippocampal and rhinal (comprising entorhinal and perirhinal) cortex volume changes were examined in a sample of 61 temporal lobe epilepsy patients with mesial temporal sclerosis (MTS 33 left, 28 right). Patients were administered the Wechsler Adult Intelligence Scale (Revised or Third Edition), Wechsler Memory Scale (Revised or Third Edition) and a spatial maze task. Neuropsychological data, together with rhinal cortex and hippocampal volumes, collected in our earlier study (unpub- lished observations, O’Brien et al.), were analysed using multiple regression. The only significant predictor of verbal memory function was the difference score between the volume of left hippocampus and the left perirhinal cortex (PrC). Spatial maze scores were predicted by the bilateral sum of entorhinal cortex (ErC) volume. The difference score between the left hippocampus and left PrC volumes was the most powerful predictor of verbal episodic memory. Right hippocampal volume was not a significant predictor of nonverbal episodic memory. Verbal and nonverbal semantic memory were not significantly predicted by any combination of rhinal cortex structures. This quantitative study demonstrates lateralised memory function for the hippocampus and PrC, in contrast to the bilateral role of the ErC. The hippocampus and PrC appear to act on memory function through an opposing relationship. Finally, a differentiation between hippocampal and subhippocampal components in terms of episodic and semantic memory, respectively, was not supported by the current data.

Educational adjustments for the WAIS-Ill

additive and therefore may be easily adjusted for with appropriate normative data analyses. These analyses will be outlined in more detail by the current study and educational adjustment regression equations for the WAIS-111 subtest and deviation scores will be suggested.

Converging neu ro psyc holog ical and ERP measures of working memory in schizophrenia

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ORAM, J., CAMERON, AM., GEFFEN, GM., & GEFFEN, LB. (The University of Queensland). [email protected] edu.au

he presence of working memory impairments in patients T with schizophrenia was investigated using neuropsychological assessment and event-related potential (ERP) record- ings. Forty-five patients with an ICD-10 diagnosis of schizophrenia (35 males, 10 females), mean age = 37.3, SD = 9.2 years, mean estimated premorbid IQ = 108, SD = 10.8 points, and thirty-nine well controls (30 males, 9 females), mean age = 38.9, SD = 8.9 years, mean estimated IQ = 112, SD = 11.0 points, completed a Delayed Response task, during which time Slow Wave ERPs were collected. Partici- pants were also administered a battery of neuropsychological measures which included the Trail Making Test. Patients with schizophrenia demonstrated a larger decrement in accuracy on Memory : Perceptual trials of the Delayed Response Task than did controls. Patients with schizophrenia also showed reduced Slow Wave difference activity relative to controls. However, the two groups did not differ in terms of Trail Making completion speed, Trails B : A. Nonetheless, both reduced Delayed Response accuracy, and diminished SW difference activity correlated with lengthier Trails B : A completion speed. This pattern of results suggests that although Trails B : A does not distinguish between patients with schizophrenia and well controls, there may be a subgroup of patients with a more severe deficit who perform poorly on this measure, and exhibit larger ERP abnormalities during the delayed response task. For this subgroup of patients, poor performance on working memory tasks may be underpinned by common cognitive and neuro- physiological profiles.

OLM, T. & SENIOR, G. (University of Southern Queensland). [email protected]

ducational level is well recognised as a possible E confound with figard to the interpretation of test scores on most of the Wechsler Intelligence Scales. Despite the provision of appropriate adjustments for education levels on previous Wechsler scales, no such adjustments are currently available for the third edition of the Wechsler Adult Intelli- gence Scale (WAIS-111). Despite this lack of educational adjustments for the WAIS-III, significant effects for education were clearly demonstrated using the statistical methodology of analysis of variance. The subtests of Vocabulary, Similarities, Comprehension, Matrix Reasoning, Informa- tion, Symbol Search, and Letter-Number Sequencing all exhibited significant main effects for education, indicating that educational adjustments for these scores would be advantageous to users of the WAIS-III. In addition, similar analyses revealed significant main effects for education on all deviation scores for the WAIS-III. These results indicate that performance on much of the WAIS-111 is significantly affected by skills or knowledge acquired in the course of formal education. A lack of significant interactions with any other demographic variables is encouraging, however, suggesting that the influence of education is essentially

Normal ageing is not necessarily synonymous with impaired executive functions

PIGUET, 0. (Concord Repatriation General Hospital &Prince of Wales Medical Research Institute), GRAYSON, DA. (University of Sydney), BROE, GA. (Prince of Wales Medical Research Institute), TATE, RL. (Rehabilitation Studies Unit, University of Sydney), BENNETT, HP. (Concord Repatriation General Hospital & Prince of Wales Medical Research Institute), LYE, TC., CREASEY, H., 81 RIDLEY, L. (Concord Repatriation General Hospital). [email protected]

n non-demented elderly individuals, executive functions I (EF) are generally reported to show earlier and greater decline compared to other cognitive domains. Interestingly, EF deficits are typically present in vascular dementia (VaD) and extrapyramidal (EP) related dementia, and are not uncommon in Alzheimer’s disease (AD). These disorders are the most common neurodegenerative disorders associated with ageing accounting for up to 90% of all cases of dementia in the elderly and have a prodromal period of many years. The aim of this study was to identify the specific contribution of chronological age to EF performance in the elderly. Nine EF tests were administered to 123 randomly selected community dwellers, aged 81 years and over. The impact of



neurological and cognitive markers of AD, VaD and EP related dementia, as well as sociodemographic and psychological variables on EF performance was investigated. Analyses revealed the greatest contribution to EF scores from the markers of AD and estimated IQ, but not from age or from the markers of VaD and EP related dementia. These findings suggest that chronological age acts as a proxy variable mediating the impact of other factors (e.g., subclini- cal signs of neurodegenerative disorders), and makes little independent contribution to EF scores. Results also indicate the importance of cognitive abilities supported by posterior neural networks in EF problem resolution. This study demonstrates that cognitive decline is not an ineluctable process that is associated with “normal” ageing but rather represents, in many cases, a by-product of neurodegenerative disorders, albeit themselves highly age-related.

Developmental neuropsychology and genetics ~~

PORTER, M., COLTHEART, M., & LANGDON, R. (Macquarie Centre for Cognitive Science). [email protected]

wenty-five people with Williams syndrome aged 5 to 45 T years were administered the Woodcock Johnson Test of Cognitive Ability - Revised and were read 13 stories that included non-literal remarks (sarcasm, metaphors and similes). Subjects with Williams syndrome varied in their neuropsychological profiles on both these tests. In contrast to past literature it is asserted that people with Williams syndrome are not a homogeneous group. This heterogeneity will be explored along with the possibility that cognitive processes may map directly onto the numerous genes potentially mutated in Williams syndrome.

Action Disorganisation Syndrome and the role of working memory in configured movement

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RAMSDEN, C., & KINSELLA, G. (La Trobe University). [email protected]

ction Disorganisation Syndrome (ADS) has been A defined as an impairment of the performance of routine everyday tasks, such as making a cup of tea. ADS has been associated with disorders of executive function and with impaired semantic memory skills. An extended version of Baddeley’s working memory model (Baddeley & Hitch, 1974) was proposed which included a subsystem for configured movement that allowed representation, comprehension, retention, formulating and achieving goal-oriented tasks, and problem solving of movement information. ADS may be conceived of as an impairment to the configured movement subsystem of working memory. In this study an interference-task methodology was used to attempt to elicit ADS-like behaviour from normal participants when performing routine, everyday tasks. Results are discussed in the context of the proposed expanded working memory model, specifically in terms of a configured movement subsystem, and the implications for the understanding of ADS and possible underlying mechanisms of the disorder.

Limitations in the clinical applications of the WAIS-Ill and WMS-Ill

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RAWLING, P. (St. Vincent‘s Clinic, Sydney). [email protected]

he WAISNMS-111 has enjoyed a high take-up rate in T Australia. This appears to be predicated on the increased statistical power of these scales. Discrepancies between the WAIS-111 IQ and Factor Scores and WMS-111 Index scores can be tested for statistical significance and abnormality and by virtue of the co-norming procedure employed in the standardisation of these scales, testing for the abnormality of discrepancies between obtained Memory Index Scores and those predicted on the basis of IQ is now possible. This paper begins by drawing attention to a number of caveats that need to be considered in undertaking this kind of discrepancy analysis. In comparing differences between WAISNMS-111 scores, clinicians need to consider whether a one-tailed or two-tailed test of abnormality is appropriate. In testing for a specific impairment in memory functioning (relative to intelligence), clinicians need to consider regression to the mean effects and to bear in mind that traumatic brain injury can lead to a decline in WAIS-TI1 IQ and Factor scores. In addition, it needs to be understood that recent factor analytic studies indicate that the WMS-111 does not yield a separate measure of delayed recall. The paper concludes with a review of recent studies examining the sensitivity and specificity of these discrepancy scores, particularly in the case of traumatic brain injury. In many respects, the results of these studies have been disappointing and suggest that use of the WAISNMS-111 in screening for the cognitive impairment associated with TBI is premature.

Long term changes in neuropsychological functioning in Parkinson’s disease

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REID, WGJ., HELY, MA., MORRIS, JGL. westmead Hospital), HALLIDAY, GM. (Prince of Wales Medical Research Unit), & TURNER, K. (Liverpool Hospital).

he aim of the present study was to examine in detail the T changes in neuropsychological functioning in a group of 20 Parkinson’s disease (PD) patients over 15 years. The patients were survivors from the Sydney Multicentric Study of PD that began in 1984 and was completed in 2002. The test battery included tests of vocabulary store, auditory verbal comprehension, writing, naming, auditory verbal learning, visual memory, visuospatial problem solving, nonverbal reasoning, verbal fluency, animal category fluency, simple and choice reaction time, depression and Mini Mental State (MMSE) score. Our results show that the greatest area of cognitive decline is in auditory verbal learning 74%, simple and choice reaction time, 54 & 52%, nonverbal reasoning 47%, visual memory 43%, vocabulary 23%, animal category fluency 17%, verbal fluency 15% and recognition memory 12%. We have called this syndrome Dementia of the Parkinson’s Type (DPT). It is characterised by progressive memory impairment, slowing of information processing and reduced executive adaptive skills affecting nonverbal reasoning and visuospatial problem solving.


The Abstracts of the 8th National Conference of the APS College of Clinical Neuropsychologists 77

Practice effects for working memory and executive tasks completed by children

The WAIS-IIVWMS-Ill in forensic assessment: Caveats, concerns, and corrections

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SAFLEKAS, S., & TUCKER, A. (Victoria University). [email protected]

SENIOR, G. (University of Southern Queensland), LANGE, R. (Riverview Hospital, Vancouver), & DOUGLAS, L.

easures of working memory have been increasingly M utilised in clinical and research studies of neuropsychological developmental disorders. However few studies have examined the extent of any practice effects. Kuntsi et al. (2001) reported on the performance of children (aged 7 to 15 years), on a number of executive and working memory tasks, performed twice, over a 2-week period. They found that most of the test measures showed small but noteworthy increases in performance over 2 weeks. A longer test-retest interval is important from a clinical viewpoint. The purpose of the present study was to investigate the extent of any practice effect on a range of working memory and executive tasks, administered twice over 5 months. Participants were 50 healthy children (40 boys and 10 girls) aged 6 to 12 years (mean = 9.2 years). As a group these children showed no significant improvement on measures of working memory and executive function (dual-task p = .72; Sentence Span p = .29; Trail Making part B p = .26), except for the Semantic Association Task where second performance was better (p = .OO). By way of contrast and internal control these children were also given tests of other cognitive functions. These showed significantly better second performances on immediate and delayed spoken Story Recall (p = .OO), Trail Making part A, and WISC-I11 Block Design and Vocabulary (for all, p = .OO). These findings raise important issues for normal cognitive development as well as clinical assessments where repeated measures are required.

Measuring meaningful change in WAIS-Ill & WMS-Ill scores over time

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SENIOR, G., & DAWES, 5. (University of Southern Queensland). [email protected]

he detection of change in psychological test scores over T time is important in many areas of neuropsychology including measuring recovery of cognitive functioning and differentiating it from seemingly ubiquitous practice effects. This is particularly critical in the assessment of personal injury claimants where the misattribution of practice effects to recovery of function would result in a reduction in the level of compensation the litigant receives. A number of methods have been proposed in recent years to detect meaningful change in Wechsler scores that attempt to correct for practice effects. This paper will review these methods and highlight their strengths and weaknesses. A recently developed alternative approach will be described that first detects meaningful change in test scores over time and then seeks to determine the likelihood that these changes are attributable to practice as opposed to other systematic influences. The clinical utility of each of the methods discussed will be examined in terms of their ability to detect changes in scores and correctly infer the source of that change.

(Medical Consultants Australia, Brisbane). [email protected]

he introductions of the latest editions of the Wechsler T Adult Intelligence Scale (WAIS-111) and Wechsler Memory Scale (WMS-111) have brought a number of valuable methods for analysing psychological test data to the attention of clinicians. In particular, the co-standardisation of these two batteries has permitted comparisons between memory performance and other cognitive abilities in an attempt to better detect the impact of pathology on behaviour. Recent publications have provided clinicians with further tools to aid in separating indications of impairment from statistical artefact, detect meaningful change in test scores over time, and introduced new composite scores. However, despite the many advantages of employing these new instruments, concerns still exist with regard to the appropriateness of these batteries for psychological assessment particularly in the medicolegal setting. The majority of these concerns can be divided into three related issues: the applicability of U.S. normative data to Australians; the loss of information and methods that were available for use with the second editions of these tests; and the misapplication of current methods in examining hypotheses relevant to the medicolegal setting. These issues can lead clinicians to systematically overestimate or underestimate the presence or impact of pathology upon test performance. This sympo- sium will review recent developments in methods for analysing and scoring WAIS-I11 and WMS-111 data and will discuss strategies for overcoming some of the problems with these batteries. Specific conditions under which these tests may prove less than adequate will be considered as well as those situations for which they are ideally adapted.

What is the role of families in neuropsychological rehabilitation? (Part 1)

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SHERIDAN, P. (Victorian Rehabilitation Centre). [email protected]

case study will be presented to illustrate the role of A families in neuropsychological rehabilitation. Patients who present with concrete, inflexible thinking, organisational difficulties and significant memory problems have the most difficulty in developing insight and correspondingly, using strategies independently. They are more llkely to experience difficulties in communicating and negotiating, anger management problems, and correspondingly relationship problems. This group are more likely to make progress if their partnedparent can make a commitment to the rehabilitation process. In some instances, family members who become a pseudo “member of the team” are able to increase their knowledge and insight into the cognitive, behavioural, and emotional changes, which invariably assists them in more efficacious management in the home environment. The involvement of a family member can vary from attendance at a family meeting, to attending sessions with their relative on a regular basis. Successful training of the family member in management strategies, sometimes in joint sessions with the patient, can mean the difference between the patient return- ing home or living in supported accommodation.



What is the role of families in neuropsychological rehabilitation? (Part 2)

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SHERIDAN, P. (Victorian Rehabilitation Centre). [email protected]

case study will be presented to illustrate the issues that A can arise within a relationship when a family member is recruited as a “therapist” in neuropsychological rehabilitation. A family member can work with the patient and the team in weekly monitoring of particular behaviours at home, in providing the prompts to consistently utilise strategies, and in being a reliable secondary source. For patients with cognitive difficulties, information provided by the family about “real world” situations, in which their cognitive problems were evident, can often be an integral part of cognitive rehabilitation. A shift in power can occur when a family member is taking the role of cognitive and behavioural manager. A patient with poor insight may want to present a faqade of good performance in the home environment to therapists, to justify a position that there have been no changes after a neurological event. If a family member is recruited to obtain a more accurate report on performance at home, the patient may feel undermined. Management of the implications of this change in role, on the relationship between the family member and the patient, will be detailed. The outcome for the patient and partner at discharge and one year post-discharge will also be described.

NART prediction and impairment in neurological patients

SKILBECK, CE. (University of Tasmania), ALLEN, EA., & BRECHIN, D. (University of Teesside, UK). [email protected]

he NART accurately estimates premorbid IQ in neuro- T logical patients. For patients where NART scores are not available it would be helpful if these could be generated. Crawford et al. (1990) attempted this using a demographic equation with normal participants. The current study addresses how well this equation holds for neurological patients, whether prediction can be improved using additional variables, and whether NART scores can be impaired in neurological patients. Participants were identified from a neuropsychological database of routinely referred neurological patients for whom NART, demographic and WAIS-R subtest data were available (n = 175). Their data were entered into Multiple Regression analyses to predict NART scores from demographic and subtest scores. Crawford’s equation is found to be accurate with neurological patients ( R = 0.61; SEest = 8.10), although its predictive accuracy is increased by the addition of subtest data ( R = 0.77; SEest = 6.71). Evidence of “impaired” NART scores is noted, associated with diffuse damage.

Visual working memory in subarachnoid haemorrhage: The Visual Patterns Test (VPT)

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SKILBECK, CE. (University of Tasmania), ALLEN, EA., & BRECHIN, D., (University of Teesside, UK). cliveskr [email protected]

isual working memory may fractionate into span and V spatial components. It has been suggested the VPT (Della Sala, et al., 1997) assesses the former. Available VPT clinical data are very limited. The study’s aims are to provide VPT clinical data in sub-arachnoid haemorrhage (SAH), covering side of SAH, aneurysm site, or type of

Yn


operation, to investigate the relationship between VFT and tests assessing visual perceptual, spatial, and working memory abilities, and to examine whether the VPT is an index of the span or spatial components of working memory or of both. Another aim is to provide data on age, IQ and gender effects on VPT scores in SAH patients. Participants (n = 64) were SAH patients from a UK Regional Neuro- science Centre. Follow-up points were six-, 12-, and 24- months post-SAH. Some patients (n = 55) were tested at both 6-months and 12-months follow-up, some (n = 23) at 12 months and 24 months and some (n = 16) at all three points. In addition to the VPT, assessment included the NART, WAIS-R subtests, VOSP, face processing tasks, cancellation tasks, and Complex Figure. VPT deficits are noted, with some evidence of improvement between 6 and 12 months. Scores are significantly better in SAH affecting the posterior vascular circulation. Findings relating to lesion side and operation type are non-significant. Test correlation results suggest the VPT primarily tests visual spadpattern recognition and its indices show significant relationships with NART PIQ, but not with age or gender.

Genetic influences on the relationship between EEG and intelligence

SMIT, CM., WRIGHT, MJ. (Queensland Institute of Medical Research), GEFFEN, GM. (The University of Queensland & Queensland Health), GEFFEN, LB. (The University of Queensland), MARTIN, NG. (Queensland Institute of Medical Research). [email protected]

he primary objective of this study was to investigate the T relationship between cognition and the frequency of brain oscillations (measured as individual peak frequency, or IAF) in an EEG recording which might be considered as an index to some form of cognitive processing speed and whether this relationship is influenced by genetic and environmental factors. EEG was recorded in a sample of 16- year-old identical twins (108 MZF, 103 MZM pairs) and non-identical twins (56 DZF, 55 DZM, 122 DZOS pairs) while resting with their eyes closed. Cognitive measures were collected using the Multidimensional Aptitude Battery (MAB) using 3 verbal (information, arithmetic and vocabulary) and 2 performance subtests (object and spatial assem- bly). Results show that identical twinpairs have a higher IAF correlation than non-identical twinpairs (rmz= 0.83, r&= 0.36) resulting in a heritability of 94%. The heritability of the cognitive measures ranged from 49% to 67% (Luciano, 2002). Small yet significant correlations were found between IAF and verbal IQ ( r = 0.20) and also with the subtests Information ( I = 0.18), Arithmetic ( r = 0.20) and Vocabulary ( r = 0.20) in males but no significant correlations were found in females. Further analyses are necessary to determine the genetic influences on the relationship between IAF and the cognitive measures.

The detection of thiamine in beer ~ ~~ ~.

STACEY, PS., & SULLIVAN, KA. (Queensland University of Technology). [email protected]

ernicke-Korsakoff syndrome consists of a triad of W neurological symptoms and stems from the combination of prolonged alcohol consumption and thiamine deficiency. Fortification of alcoholic beverages with thiamine has been proposed as a method of reducing the severity of the brain insults associated with WKS.

The Abstracts of the 8th National Conference of the APS College of Clinical Neuropsychologists 79 Undergraduate students volunteered to participate in a double-blind beer tasting experiment to examine the efficacy of adding thiamine to beer. Subjects were randomly assigned to one of three conditions in which thiamine (lOmg thiamine HCL) was added to none, one, or two of the three (100mi) beer samples. Subjects were asked to drink each sample and rate each beer for taste and appearance separately. Subjects were then delayed to allow the alcohol and thiamine to absorb. Later a Trail Making Test (parts A and B) was administered and BAC measurements were taken. The ability to detect thiamine in beer beyond chance, beer ratings, and the effects of thiamine on cognitive-motor performance and BAC were analysed. The results of the study are presented and their implications for alcohol manufacturers and regulating bodies are discussed.

Predicting duration of posttraumatic amnesia in a rehabilitation setting

TATE, RL. (University of Sydney & Royal Rehabilitation Centre Sydney), PERDICES, M. (Royal North Shore Hospital), PFAFF, A. (Liverpool Hospital, Sydney), JURJEVIC, L. (University of Sydney & Royal Rehabilitation Centre Sydney).

t the CCN conference last year, our group presented a A paper examining patterns of emergence from posttraumatic amnesia (PTA) in patients who had prolonged PTA after traumatic brain injury. The conclusion of the paper heralded work we are presently conducting to predict duration of PTA in patients after their admission to inpatient rehabilitation. The current paper describes this work in greater detail, using the Modified Oxford PTA Scale, a 12-item test measuring orientation (8 items) and anterograde memory (4 items). Sixty-one patients were examined daily until they emerged from PTA. Regression analysis was used to predict the duration of PTA. A three- variable model accounted for 89% of the variance, and a simpler model (accounting for 88% of the variance) used two variables: the day posttrauma on which PTA testing commenced and the aggregate PTA score from the first five days of testing. The model was validated on a separate sample, with a very high intraclass correlation coefficient between observed and predicted duration of PTA. The resulting regression equation enables ready calculation of the predicted duration of PTA in individual patients within the first week of testing, thereby assisting in planning the patient’s rehabilitation program.

Insight building: How do we do it? ___ ~~~~ ~~

THOMAS, 5. (Rehabilitation & Aged Services Program, Southern Health). [email protected]

nsight in a cognitive rehabilitation setting can often be the I factor that determines the rate and amount of progress, the level of independence achieved and the type of outcome attained on discharge. Insight is regarded as more than an awareness of cognitive, behavioural and emotional changes subsequent to a neurological event, but an understanding of the implications and consequences of these changes. Active insight building in a neuropsychological rehabilitation setting should commence as soon as an assessment starts. The style of assessment must include regular feedback on performance, in some instances at the end of each subtest. Feedback needs to be tailored to the cognitive profile of a patient to maximise its success in building insight. For patients where there is a

disparity between the clinician’s assessment of their functioning and their own assessment, monitoring of cognition each week, or behavioural experiments, can provide concrete feedback on their performance “in the real world”. Weekly cognitive analysis of every day events can also assist a patient in increasing insight. Two case studies will be presented to demonstrate a range of insight building techniques and their impact on progress in rehabilitation.

Insight building: Why do we need to do it? ~ ~~ ~~

THOMAS, 5. (Rehabilitation and Aged Services Program, Southern Health). [email protected]

retrospective analysis of 120 cognitively impaired A patients admitted to Hampton Rehabilitation Hospital was conducted. Clinician, patient, and carer ratings were obtained regarding level of insight and level of independence in the use of cognitive or behavioural strategies for the first three weeks of admission, on transfer to the outpa- tient program, and on discharge. Clinician ratings for degree of impairment, and type of insight technique utilised, were also collected. Insight building techniques included providing a patient with verbal feedback, weekly cognitive analysis of daily events, behavioural experiments and daily monitoring of the impact of changes on everyday activities. The results indicated that level of insight increased over time for the majority of patients. Of those patients whose insight had not increased by discharge, the majority were dependent on a carer for management of their difficulties. The majority of patients who developed insight into all the cognitive and behavioural changes sustained, had received more intensive insight building techniques than simply verbal feedback on assessment results. The majority of severely impaired patients, who have received the most intensive level of insight building techniques, had improved their level of insight from admission to discharge. In addition, this group had improved from being dependent on their carer for management when transferred to the outpa- tient program, to independently using strategies to manage at least one area of cognitive difficulty on discharge.

Measuring challenging behaviour: Development of the Overt Behaviour Scale (OBS)

TODD, J., KELLY, G. (ABI Behaviour Consultancy), & SIMPSON, G. (Brain Injury Rehabilitation Unit, Liverpool Hospital). [email protected]

hallenging behaviour is a common outcome following C acquired brain injury (ABI) and can place at risk a client’s accommodation and social relationships, impede rehabilitation and prevent community reintegration. Despite the frequency of these problems there are few tools that (a) address the range of common behavioural difficulties after brain injury, (b) use clear descriptions of overt behaviours and (c) are specific to brain injury. Existing tools typically focus on a narrow group of behaviours (e.g., aggression) and have been developed for specific settings (e.g., hospital). This paper focuses on the development of the Overt Behaviour Scale (OBS). This scale is an extension of the Overt Aggression Scale (Yudofsky et al., 1986) which



measures frequency and severity of verbal and physical aggression. The OBS adds five new subscales: inappropriate sexual behaviour, perseveration, wandering, inappropriate social behaviour and adynamia and measures impact of behaviour in addition to frequency and severity. The OBS has three key advantages on other behavioural measures available. It encompasses most of the challenging behaviour that can follow ABI; it uses clear behavioural definitions with examples; and it establishes a common terminology for challenging behaviours following ABI that makes it possible to compare behaviour across hospital, rehabilitation and community settings. Data from a pilot study using this scale will be presented on a group of clients accessing ABI Behaviour Consultancy over a 6-month period. Details of the ongoing modification of the scale will be discussed with a more detailed example examining the development of the inappropriate sexual behaviour subscale.

Neuropsychological functioning in patients with borderline personality disorder

TRAVERS, C., & KING, R. (The University of Queensland). [email protected]

revious research has documented both a range of P neuropsychological deficits in patients with Borderline Personality Disorder (BPD) and a high incidence of organic insults. The latter include developmental neurological deficits (i.e., attention deficit hyperactivity disordernearning disability) or acquired neurological dysfunction secondary to trauma, encephalitis or epilepsy. Neuropsychological deficits have been most notable on visuospatial tests, memory tests and tests of executive functioning and there is some controversy as to whether these findings indicate a cognitive syndrome specific to BPD or whether they are simply an index of comorbidity with acquired neurological dysfunction. The present study sought to clarify the extent to which organic factors might explain the cognitive deficits observed among BPD patients. Eighty subjects (58 females and 22 males) who met the DSM-IV criteria for Borderline Personality Disorder participated in the study and completed a battery of neuropsychological tests and a comprehensive interview assessing organic status. Potentially confounding factors of current levels of depression and anxiety were also measured. This paper presents the major findings of this study and discusses reasons for these findings as well as the implications of this research for clinicians treating borderline patients. It is proposed that the efficacy of treatment will be enhanced if those patients who have cognitive deficits are identified and their difficulties addressed.

Strategic memory, metamemory and executive functioning in children with ADHD

TUCKER A., SAFLEKAS, S., & WALTERS, I . (Victoria University). [email protected]

n recent years there has been a research focus on the I integrity of executive functioning in children with Attention Deficit Hyperactivity Disorder (ADHD). Cornoldi et al.

(1999) extended this focus to assess strategic memory (involving some executive processes) and metamemory in young adolescents. They reported that strategic memory in adolescents (aged 12-14 years) with ADHD was impaired relative to matched controls but there was no difference in the metamemory score for the two groups. Metamemory help for the ADHD children lead to improved scores on their strategic memory task. The present study addresses the issue of strategic memory and metamemory, using Cornoldi’s visual memory task, in children with ADHD and also includes some other direct tests of executive functioning. Participants were 17 boys with ADHD and little or no comorbidity, and 22 non- clinical controls (all in range 6-12 years). These two groups were carefully matched on age (ADHDs mean age = 10.3 years; controls mean age = 9.6 years), IQ (ADHDs mean IQ = 97.3; controls mean IQ = 97.6), and socio-economic scale (ADHDs mean SES score = 4.96; controls mean SES score = 4.77). The ADHD boys had greater difficulty with the Continuous Performance and Animal Fluency measures of executive functioning than controls but did not differ from controls on the Comoldi strategic visual memory task. This last result was obtained with or without metamemory help on the task. Whilst our findings of deficit in executive functioning are consistent with other reports in the literature our data on strategic memory differ from those of Cornoldi et al. ( 1999). Methodological, conceptual and developmental issues arising are discussed.

The neuropsychology of neurocutaneous syndromes in a paediatric population: Neurofibromatosis

WILLIAMS, M. (Learning Difficulties Centre, Royal Children’s Hospital).

euofibromatosis Type I is a relatively common neuro- N cutaneous autosomal dominant genetic disorder. Common manifestations of the disorder include multiple pigmented skin lesions (cafi-au-lait spots) and subcutaneous tumours (neurofibromas). Clinically, it is frequently associated with learning difficulties and symptoms of attention deficit hyperactivity disorder. This paper presents the case of an 8-year-old boy (TE) diagnosed with Neurofibromato- sis Type I. He presented with a history of academic difficulties, poor attention and concentration, and behaviour and social difficulties. TE’s developmental history included a difficult birth, and uneventful attainment of his milestones. He came to medical attention when he experienced an afebrile generalised tonic clonic seizure, at which time multiple cafi au lait spots were detected, and a diagnosis of Neurofibromatosis Type I was made. Subsequent EEG investigations were normal. CT scan revealed an asymmetri- cal enlargement of the lateral ventricles with the left larger than the right. Neuropsychological assessment revealed significant discrepancies between TE’s verbal and nonverbal cognitive skills, suggestive of a language based learning difficulty. Evidence of mild executive level impairments was seen. The results of TE’s assessment will be discussed with reference to the possible aetiology of learning difficulties in Neurofibromatosis Type I .


Download - The Abstracts of the 8th National Conference of the APS College of Clinical Neuropsychologists 3–6 October 2002 Maroochydore, QLD

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