Browsing by Subject "Neuropsykologia"

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  • Vedenkannas, Ulla (2019)
    Introduction: Attention deficits affect about 7% of adolescents and increase the risk of psychiatric disorders and poor educational/occupational adjustment. Adolescence is important for the development of executive functions (EF), but the association between EF as measured with neuropsychological (NP) tests and behavioral observations of impulsivity and inattention has received less interest than the same phenomena in childhood and adulthood. Evaluating attentional problems in school setting has specific importance, but not much is known about the associations between NP tests and teacher ratings of attention and impulsivity. Attentional problems may co-occur with depression and anxiety, so including these measures of internalizing behavior can inform about the specificity of attentional problem-EF associations. Methods: We used a population- based sample (N=708, 47% girls) of 14-year -old twins. Participants performed two commonly used NP tests of EF: 1) Trail Making Test (TMT) Children’s version (A and B parts with an and additional C–part consisting of alphabets), and 2) California Stroop with four parts: color naming, word reading, color word interference and an additional set-shifting condition (either reading of words or naming the color of the word). Time (in seconds) to complete each part and TMT B-A difference score or the number of errors (o vs. 1 or more) were used as dependent variables in separate analyses. Teacher rated impulsivity, inattention, depression and anxiety as measured with Multidimensional Peer Nomination Inventory (MPNI) were used as independent variables (each scale ranging from 0 to 3). T-tests were used to investigate sex differences and regression analyses to investigate the associations between teacher rated behaviors and EF controlling for age, sex and clustered twin data. Results: We found significant sex effects on TMT-B and TMT B-A, all four Stroop subtests and MPNI. Boys had more inattention and impulsivity whereas girls had more anxiety and depression. Correlations between NP tests (TMT-B, TMT B-A, Stroop color-word, set shifting) and impulsivity/inattention were small but significant. In regression analyses, inattention was significantly associated with slower performance in TMT-B, TMT B-A and in all Stroop subtests. Making more errors in Stroop color word task was related to higher impulsivity whereas no other significant associations between MPNI and number of errors were evident. Discussion: Based on these results, teacher ratings of attentional problems, particularly inattention, are significantly related to EF as measured with NP tests Inhibition and shifting were specifically associated with inattention but not with impulsivity or internalizing behaviors. NP assessment is typically one-to-one assessment situation measuring optimal performance whereas teachers rate everyday concentration skills based on the group-setting affected by several emotional and motivational factors. Although teacher ratings and NP measures capture different aspects of EF, our results implicated significant association especially regard to inattention and EF measures. These findings also indicate that impulsivity and inattention should be assessed separately when finding neural or genetic correlates of attentional problems. Our results have important clinical implications, e.g. for ADHD diagnosis but also stress the importance of evaluating attentional problems with different instruments. Also sex specific norms could be useful in future.
  • Kosmidis, Mary H.; Lettner, Sandra; Hokkanen, Laura; Barbosa, Fernando; Persson, Bengt A.; Baker, Gus; Kasten, Erich; Ponchel, Amelie; Mondini, Sara; Varako, Nataliya; Nikolai, Tomas; Jonsdottir, Maria K.; Pranckeviciene, Aiste; Hessen, Erik; Constantinou, Marios (2022)
    The multitude of training models and curricula for the specialty of clinical neuropsychology around the world has led to organized activities to develop a framework of core competencies to ensure sufficient expertise among entry-level professionals in the field. The Standing Committee on Clinical Neuropsychology of the European Federation of Psychologists' Associations is currently working toward developing a specialty certification in clinical neuropsychology to establish a cross-national standard against which to measure levels of equivalency and uniformity in competence and service provision among professionals in the field. Through structured interviews with experts from 28 European countries, we explored potential areas of core competency. Specifically, questions pertained to the perceived importance of a series of foundational, functional, and other competencies, as well as current training standards and practices, and optimal standards. Our findings revealed considerable agreement (about three quarters and above) on academic and clinical training, despite varied actual training requirements currently, with fewer respondents relegating importance to training in teaching, supervision, and research (a little over half), and even fewer to skills related to management, administration, and advocacy (fewer than half). European expert clinical neuropsychologists were in agreement with previous studies (including those conducted in the United States, Australia, and other countries) regarding the importance of sound theoretical and clinical training but management, administrative, and advocacy skills were not central to their perspective of a competent specialist in clinical neuropsychology. Establishing a specialty certificate in clinical neuropsychology based on core competencies may enable mobility of clinical neuropsychologists across Europe, and, perhaps, provide an impetus for countries with limited criteria to reconsider their training requirements and harmonize their standards with others.
  • Kauhanen, Lina-Lotta (Helsingin yliopisto, 2021)
    Objective: The coronavirus disease COVID-19 causes neuropsychological problems to a proportion of patients having contracted the illness in the months following the illness and on a more long-term basis. Currently there is little knowledge about how the required level of care in the acute phase affects the presence of symptoms and their change over time. The objective of this study was to investigate the neuropsychological effects of COVID-19 from a patient self-reported symptoms and cognitive screening perspective. The study examines the effects of the required level of care in the acute phase and time since contracting the illness on self-reported symptoms and cognitive screening results three and six months after the acute phase. Furthermore, the aim was to illustrate the relationship between these two assessments. Methods: The data was collected within the RECOVID-20 project (Helsinki and Uusimaa Hospital District and University of Helsinki). Subjects (N = 164, of which 96 women, mean age 54.1 years) contracted COVID-19 in the spring of 2020. The data was collected from three different levels of care as required by the acute phase: intensive care unit patients, regular inpatient wards and patients who were ill at home. Self-reported symptoms were assessed with the A-B Neuropsychological Assessment Schedule and cognitive performance was measured by the Montreal Cognitive Assessment-Blind screening tool three and six months after the acute phase. Group differences and change over time was analysed using multivariate variance analyses and linear mixed models. Results and conclusions: About a third of all patients reported neuropsychological symptoms regardless of the level of care required in the acute phase both three and six months after the acute phase. Symptoms consisted mainly of fatigue, slowing and concentration problems. In the cognitive screening patients having received ICU and inpatient ward care performed worse compared to patients having been ill at home, but a statistically significant result was not detected when controlling for age. A statistically significant relationship between self-reported symptoms and cognitive performance was observed only in ICU patients at three months. Although the majority of COVID-19 patients do not have significant symptoms after the acute phase, there are patients that show preliminary signs of more chronic symptoms based on both self-reported symptoms and cognitive screening. More research is needed to investigate the causes of these symptoms.
  • Kallio, Eeva-Liisa (Helsingin yliopisto, 2019)
    Dementia is an age-related, progressive and chronic syndrome, which is characterized by cognitive decline from a person’s prior performance level, neuropsychiatric symptoms, and severe inability to manage everyday activities. The most common late-life cause of dementia is Alzheimer’s disease, followed by vascular dementia, Lewy body dementia, and mixed dementia. The limited efficacy of current pharmacological treatments has directed research increasingly to various non-pharmacological therapies, such as cognitive training (CT). The findings so far are inconsistent and conflicting. The two aims of this thesis were (1) to systematically evaluate the current evidence on the effects of CT in dementia; and (2) to explore the feasibility and effectiveness of a systematic CT program for patients with established dementia in a randomized controlled trial (RCT). The effects of CT on participants’ cognition, psychological well-being, and health-related quality of life (HRQoL) were investigated in a Finnish Cognitive Intervention (FINCOG) trial among older home-dwelling patients with mild to moderate dementia who participated in regular adult day care. The systematic review focused on 35 eligible RCTs including participants with dementia, using restorative or compensatory CT programs, and concerning the effects of CT on cognition, functional abilities, psychological well-being, and quality of life of patients. Beneficial effects of CT were primarily reported on global cognition, training-specific functioning, and occasionally on mood, however, several limitations in research methodology decrease the current grade of evidence. Low methodological quality of a trial resulted predominantly from low statistical power, poorly described randomization methods, and non-robust statistical methodology. Furthermore, CT interventions were highly heterogeneous, trial drop-outs inadequately described, and intention-to-treat analysis as well as long-term follow-up infrequently used. The FINCOG participants (n = 147) were randomized in two arms: CT intervention (n = 76), and control groups (n = 71). Measures of cognition, psychological well-being, and HRQoL were assessed before the intervention, and three and nine months after baseline assessment. A systematic 12-week CT program was conducted in adult day-care centers twice a week for 45 minutes. Regular CT was found to be feasible, and subjective gain was achieved by 76 % of the feedback responders. However, CT did not improve or stabilize cognition in older adults with dementia. Moreover, the participants did not benefit from CT either in terms of their HRQoL, or psychological well-being. In conclusion, the findings of this thesis do not support the effectiveness of CT among older patients with established dementia.
  • Immonen, Satu; Launes, Jyrki; Järvinen, Ilkka; Virta, Maarit; Vanninen, Ritva; Schiavone, Nella; Lehto, Eliisa; Tuulio-Henriksson, Annamari; Lipsanen, Jari; Michelsson, Katarina; Hokkanen, Laura (2020)
    The aim was to examine cross-sectional association between moderate alcohol consumption and total brain volume in a cohort of participants in early middle-age, unconfounded by age-related neuronal change. 353 participants aged 39 to 45 years reported on their alcohol consumption using the AUDIT-C measure. Participants with alcohol abuse were excluded. Brain MRI was analyzed using a fully automated method. Brain volumes were adjusted by intracranial volume expressed as adjusted total brain volume (aTBV). AUDIT-C mean of 3.92 (SD 2.04) indicated moderate consumption. In a linear regression model, alcohol consumption was associated with smaller aTBV (B=- 0.258, p
  • Peltonen, Kati; Launes, Jyrki; Koskinen, Sanna; Vartiainen, Matti; Pajunen, Sara; Pertab, Jon; Laitala, Tiina; Hokkanen, Laura (2020)
    Abstract The usefulness of on-field signs in predicting concussion outcome is under debate. We studied the prevalence of these signs and analyzed the predictive value for post-injury cognitive recovery in Finnish elite-level youth ice hockey players. Of the 570 consecutive athletes, 52 were concussed during seasons 2015-2017. After exclusion criterion analysis included 34 hockey players (14-20 years-old). Follow-up assessment was performed seven days post-injury and compared with pre-injury baseline. Cognitive performance was assessed using the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT?) battery. Hierarchical regression analyses were conducted to examine the relationship between on-field signs of concussion and the post-injury change in cognitive performance. The findings indicated that on-field loss of consciousness, amnesia, and vacant look were associated with larger decrements in cognition. Loss of consciousness accounted for 22% of the variance in verbal memory scores; amnesia accounted for 15% of the variance in verbal memory scores, and the presence of vacant look accounted for 9% of the variance in visual memory performance. The presence of loss of consciousness, amnesia, or vacant look is risk factors for longer recovery times and predict the need for extended cognitive follow-up.
  • Mansikka, Tuomas (Helsingin yliopisto, 2018)
    The relationship between cognition and functional capability is an important research topic as it concerns the ecological validity of clinical neuropsychology. The purpose of this thesis was to explore the relationship between executive functioning and functional capability in very mild to moderate Alzheimer's disease. A further goal was to investigate the effect of dementia severity on the relationship between executive functioning and functional capability. The study sample consisted of relatively aged individuals (mean age 83.53 years), which is meritable, since very few analogous studies have been conducted with as old a sample. The sample of this study consisted of Alzheimer's disease patients who participated in an intervention study involving elderly dementia patients by Helsinki University Central Hospital during 2014–2016. Baseline measurements of the study were used. The sample (n=97) was split into very mild/mild (n=55) and moderate (n=42) Alzheimer's disease using the Clinical Dementia Rating scale (CDR). Executive functioning and functional capability were measured using the Frontal Assessment Battery (FAB) and Alzheimer's Disease Cooperative Study–Activities of Daily Living (ADCS-ADL), respectively. The relationship between executive functioning and fuctional capability was measured using regression analysis. In this study the relationship between executive functioning and functional capability could not be replicated. Furthermore, dementia severity was found to have no effect on the relationship between executive functioning and functional capability. There might have been notable dementia comorbidity, physical morbidity and old age fragility within the sample which have had an impact on the results. Moreover, functional capability was conceptualized using only the total score of the ADL measure. In the future functional capability should be measured more minutely, inspecting the individual items of the selected ADL measure.