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Neuropsychological and Neuropsychiatric Prediction of Cognitive Functioning and Cognitive Decline: A Cross-Cultural Perspective
Elizabeth Guerrero Berroa
Year of Dissertation:
The goal of this study was to examine whether seven neuropsychological tests and three depression measures were associated with cognitive functioning among Hispanic elderly, and to assess whether they operated differently for Hispanic and White ethnic groups. Participants were 89 community-dwelling elderly Hispanics and 89 Whites matched on clinical and demographic characteristics, all followed longitudinally at the NYU Alzheimer's Disease Center (NYUADC). Their cognitive functioning ranged from normal to moderate dementia. Although a large proportion of the measures evidenced an association with cognitive status, hierarchical regression analyses showed that the initial recall of the NYU-Paragraph Test and the Retardation measure (especially for Spanish-speaking Hispanics), as well as WAIS-Digit Symbol (especially for English-speaking Hispanics) were most strongly associated with cognitive status after controlling for demographic and other cognitive measures. Retardation (for the entire Hispanic group) and the total score of the Hamilton Depression Rating Scale (HDRS; for the entire White group) differentiated between normal cognition and Mild Cognitive Impairment (MCI). For the full range of cognitive status, the combined predictive usefulness of the 10 measures differed significantly between Hispanics and Whites; this difference was especially driven by the Retardation measure. For nondemented participants, only the depression measures predicted differently between the two ethnic groups. When the analyses examined the primary language of the participants, the predictive usefulness of neuropsychological and depression measures differed between Spanish-speaking Hispanics and their matched Whites, but no differences were found between English-speaking Hispanics and their White counterparts. Subsequent analyses showed that, for Hispanics, the usefulness of the 21-item HDRS-total score reflected the contributions of Work and Activities and Retardation, but not the other 19 items. The WAIS-Digit Symbol lacked specificity for Spanish-speaking Hispanics. Preliminary longitudinal analysis showed that the delayed recall of the NYU-Paragraph Test predicted cognitive decline among Spanish-speaking Hispanics. These results suggest that the NYU-Paragraph Test and Retardation may improve diagnostic accuracy and prediction of decline among Spanish-speaking Hispanics.
Repetition: From Compulsion to Structure
Year of Dissertation:
This work studied the different functions of repetition in the course of a long-term psychoanalysis. In empirical psychoanalytic research, repetition has been viewed as a maladaptive behavioral structure or speech disfluency. However, it was argued that repetition is a unique function of the mind that has various uses. Repetition can manifest as dominance of inertia; it can also be associated with traumatic anxiety and help develop a structure to alleviate the impact of trauma. In addition, some repetitions are in the service of difference where they modify and enrich the psyche. In an effort to study the linguistic expressions of these different kinds of repetitive phenomena, this study identified the patient's use of fixed repetitions, where the same words were used over and over again to narrate an experience. It was proposed that an increase in the use of such fixed repetitions would point to an inability to create new meaning. In contrast, when the patient is able to reach an evocative, vivid and specific representation, the use of fixed repetitions was expected to decrease. A further goal of the study was to explore the relationship between repetition and defensive processes. It was expected that an increase in the use of fixed repetitions bespeaks of a failure in defensive strategies. With these multiple objectives in mind, the transcripts of ten audio-taped psychoanalytic sessions were coded for the exact repetition of verbs. The language of verbs was expected to capture repetitions used with intention. Computerized linguistic measures of referential activity, which is a measure of imagistic language, as well as computerized linguistic measures of intellectualization and negation were used in order to capture patient's representational language and defensive processes. As expected, the results showed a general negative correlation between fixed repetitions and representational speech. No consistent pattern was found between repetition and the measured defensive processes. The results were discussed through a clinical qualitative analysis. The study marked repetition as a significant measure that is able differentiate between sessions in terms of their affective and symbolic qualities.
Mindfulness Based Stress Reduction in Couples Facing Multiple Sclerosis: Impact on Self Reported Anxiety and Uncertainty
Year of Dissertation:
Nearly 2.5 million people in the world have MS (The Multiple Sclerosis International Federation, 2007). MS is an auto-immune disorder, involving the white matter of the brain and spinal cord. Symptoms vary and can come and go, appear in any combination, and may be mild, moderate, or severe. The prognosis and time-course of the disease is often unclear. The disease can create a great deal of uncertainty, particularly in newly diagnosed patients (Noseworthy et al., 2000). Approximately 50% of patients and partners showed significant levels of either anxiety or distress (Pakenham, 1998). Additionally, patients who reported their spouses to be more encouraging have been shown to be significantly less depressed (Schwartz & Kraft, 1996). Thus, couples "react to disease as a unit" (Pakenham, 1998, p. 269). Rolland (1985) concurs that "the well spouse faces many of the same dilemmas" (p. 240). Mindfulness Based Stress Reduction (MBSR), an eight-week course incorporating yoga, meditation, and mind-body awareness, is a skills training technique which has successfully combated many physical and emotional ailments. This study evaluated the effect of MBSR on the uncertainty and resulting anxiety of each partner, as well as on the relationship. Twenty-five couples were recruited into two MBSR groups, with one couple partner diagnosed with Relapse-Remitting MS. Quantitative self report measures assess physical symptoms, anxiety, relationship satisfaction, perceived illness uncertainty, and intolerance of uncertainty. Data was collected before and immediately after the intervention. Results indicated a positive change in patient and partners levels of anxiety and uncertainty as well as in their relationship satisfaction. Results from this study contribute to the field of available interventions for couples dealing with chronic illness, and specifically MS. Additionally, it illuminates an important and yet undiscovered element of mindfulness meditation as a tool in coping with family illness.
The Relationship of Impulsive and Dysregulated Behaviors to Substance Use
Year of Dissertation:
Longitudinal studies indicate that individuals diagnosed with attention-deficit/hyperactivity disorder (ADHD) exhibit elevated rates of substance use and substance use disorders (SUDs). The development of substance use in individuals with ADHD has been found to be largely impacted by the presence of comorbid conduct disorder (CD). Several studies have shown an association between ADHD and increased substance use over the risk posed by CD whereas others have suggested that CD mediates the relationship between ADHD and later substance misuse. The diagnostic criteria for CD, ADHD, and SUD are notable for the presence of impulsive behaviors. One of the most robust predictors of maladaptive substance use is a persistent pattern of impulsive behavior. This series of studies investigated the relationship between substance use and impulsive behavior using animal models of impulsivity and longitudinal studies of youth with ADHD. Study I employed animals and measured the degree to which impulsive behavior was impacted after chronic drug (heroin) administration. Studies II and III characterized substance use outcomes as a function of impulsive and dysregulated behaviors and psychostimulant treatment in a large sample of ethnically diverse, lower SES urban youth diagnosed with ADHD. Study II examined late adolescent substance use outcomes in relation to childhood CD and psychostimulant treatment in youth diagnosed with ADHD in childhood and Study III examined the degree to which ratings of aggression, delinquency and attention are differentially related to adolescent substance use outcomes. These results further clarify the relations between impulsive behaviors and maladaptive substance use. Study I did not provide support for the idea that impulsivity is caused by drug use. Study II reported robust findings indicating that dysregulated behaviors associated with childhood diagnoses of CD, and not ADHD, portend both greater substance use severity and impairment. Further, a diagnosis of CD is characterized by both delinquent and aggressive behaviors and Study III provided evidence that delinquency is the most robust predictor of adolescent substance use outcome. These findings have important implications regarding delinquent behaviors and substance use outcomes. Identifying impulsive behaviors related to the delinquency may be a focus of continued efforts in the areas of preventative treatments.
The Psychological Impact of Racial Socialization on Identity Conceptualization and Race-Related Stress of Black College Students at a Multi-Racial Campus
Year of Dissertation:
Thirty-six male and female black college students attending a small private college in New Jersey participated in a mixed method study exploring recollections of received parental racial socialization, covering childhood through entrance into college. Recollections of racial socialization were gathered using a survey administered to all 36 students and face-to-face interviews with a small subset of six students, which generated rich material on experiences with racial socialization. Results from the survey showed an increase or decrease in reported protective, protective, and total (combined) racial socialization messages were not significantly related to an increase or decrease in reported race-related stress. A more complicated picture was derived from the interviews in that the participants did negotiate racial identity; however most endorsed a racial identity orientation within a pointedly mainstream experience, with minor focus on Black culture. Directions for future research on other sources of resilience against race-related stress, such as self-efficacy, and the limitations of the study are also discussed.
Are All Relational Judgments the Same? An Investigation of Two Decision Models Using Event-Related Potentials
Year of Dissertation:
Two neurocognitive models of decision-making, Iterative Reprocessing (IR) and Accumulator models have been proposed to explain subjective conceptual and objective perceptual judgments, respectively. To date, there is little evidence from humans in support of the central tenet of both models that there is a direct relation between duration of evaluative processing and judgment difficulty. Further, it is not known if a single model can explain all types of judgments. To compare the timing and location of neural activations underlying decision-making, event-related potentials (ERPs) were recorded while participants completed judgments in a 2-by-2 factorial design with factors of Judgment Type (Objective, Subjective) and Domain (Semantic, Perceptual). To assess the effect of difficulty on evaluative processing, difficulty was manipulated for Objective judgments. Confirming the finding of Johnson and colleagues (2011) both Early and Late LPCs were elicited by all judgments creating an evaluative processing interval. The duration of ERPs reflecting evaluative processing (i.e., accumulation, working memory, selection, monitoring) increased as a function of judgment difficulty for Objective Semantic and Perceptual judgments, providing some of the first direct evidence that duration of this processing is related to difficulty. A comparison of the judgments examined here revealed two networks underlying decision-making; however, these networks did not divide based on judgment type or domain. Instead, judgments differed on whether the details on which the decision was based were analyzed based on global or local properties. The division between networks involve whether judgments can be decided by fitting things together into a whole (e.g., global) (Objective Perceptual, Subjective Perceptual, Subjective Semantic) or can be decided based on only a few details (e.g., local) (Objective Semantic). Processing in the local network is consistent with the IR model, while the global network is consistent with Accumulator models. Results indicate the IR model does not account for explicit subjective conceptual judgments, but can account for Objective Semantic judgments. Further, the study validates that Accumulator models' account for Objective Perceptual judgments and expands this model to both Subjective Perceptual and Semantic judgments, suggesting that these models may provide accurate accounts of most types of decisions that humans make every day.
Electrophysiological Identification of Malingered Executive Dysfunction
Year of Dissertation:
Traditional evaluation of cognitive functioning is based on the assumption that the individual being assessed is responding to the best of his or her abilities. However, when individuals have external incentives to appear more impaired, such as those involved in civil or criminal litigation, the results of these evaluations may be questionable. Therefore, measures designed to assess malingering have become an integral part of many neuropsychological evaluations, particularly in forensic settings. However, these malingering measures have been demonstrated to be vulnerable to both manipulation and coaching. Consequently, recent research has attempted to identify physiological indices of cognitive functioning that are less susceptible to overt manipulation. Previous physiological studies have focused on assessing the validity of an individual's memory impairment, however, this study evaluates the effectiveness of a physiological measure of frontal lobe executive functioning. This study used EEG recording in conjunction with a three stimulus oddball design to compare differences in neural responses in simulated malingerers and controls. The experimental group was tasked with simulating the cognitive deficits associated with traumatic brain injury (TBI). Specifically, the study was designed to compare an event-related potential (ERP) known as the P3a, which is elicited by irrelevant distracter stimuli, and to investigate its resilience to intentional manipulation. The P3a is believed to be an index of frontal lobe executive processes, specifically the attentional orienting response. The results of this study demonstrated that simulated malingerers did not produce a physiological P3a response that was significantly different from control participants. Furthermore, the P3a in simulated malingerers did not demonstrate any of the physiological indicators demonstrated to be present in prior studies with mTBI patients. Not only were malingerers unable to produce a significant change in their basic orienting response, but the very process of attempting to employ additional strategies to appear impaired produced other physiological markers of deceptive responses. Therefore, the P3a component appeared to be unaffected by an individual's motivation or overt performance, thus making it an excellent candidate for measures differentiating between malingerers and patients with genuine TBI. The results are discussed in comparison to traditional behavioral measures of malingered executive deficits, and serve as a pilot study for future development of physiological measures of cognitive functioning that span multiple cognitive domains.
RE-LOCATING RECYCLING: A CONTEXTUAL ANALYSIS OF RECYCLING BEHAVIOR IN THE USA AND GERMANY
Year of Dissertation:
While recycling remains a common research topic within environmentally responsible behavior studies, it is little known how contextual factors such as physical environments, social interactions, and cultural backgrounds influence people's attitudes and behavior. This research adopts an ecological framework and conducts a mixed-method qualitative inquiry of whether and how relocation has impacts on people's ecological thinking and behavior in their everyday life. Semi-structured interviews were conducted within two groups of people: Americans who moved to Munich and Germans who moved to New York City. Interviews were conducted in participants' homes or workplaces. Pictures were taken inside the apartments, in common areas in the buildings, and recycling areas in public spaces to record recycling accessibility. This dissertation describes and analyzes people's recycling behavior in three interrelated aspects. First, it challenges the traditional dichotomous categorization of recyclers versus non-recyclers by presenting a model of recycling orientations in multiple dimensions: material, spatial, and temporal. Second, it investigates various contextual factors including physical, political, and social environments that influence pro-environmental attitudes and recycling behavior. The findings show that different contextual factors are connected to each other and collaboratively influence how people perceive and perform recycling as well as other pro-environmental behavior. Finally, this research examines the effects of relocation and how people change their pro-environmental attitudes and behavior over time. The results demonstrated how changes in physical, social, political, and cultural contexts altered the way people think and act towards the environment. This study explores and confirms the importance of contextual factors in people's recycling attitudinal and behavioral changes and suggests that a consistent and comprehensive environmentally friendly environment is essential to help people build and maintain a greener lifestyle.
Place Connections: A Study of the Dynamics and Planning Process of Remigration in Trinidadians and Tobagonians
Year of Dissertation:
The purpose of this dissertation is to study migration and remigration of Trinidadians and Tobagonians as it relates to the meaning, experiences, and attachment these individuals have with the different places they have lived. The research questions focus specifically on remigrants who have the choice to return to Trinidad and Tobago or not after long-term residence abroad and why they make the decision to return. Interviews and surveys were used to understand the roles of place identity, place attachment, and place dependence in choosing whether or not to remigrate to Trinidad and Tobago. Participants were asked about their understanding of dominant narratives of immigrants and how these narratives do or do not reflect their own perceptions and experiences of an immigrant's life, thus showing the network of social and geographical connections these immigrants form and the value immigrants bring to the host countries. A key finding is that remigration is not solely an economic decision, but instead infused with the meaning of the Place Attachments, Place Identity and Place Dependence created in the home country. People's migration experiences do not tell the whole story about their decision making process for remigrating. The findings suggest that remigration happens because of the social and cultural connections and place attachment individuals maintain through transnationalism.
The geographical imagination of youth: Transformation through political participation and community engagement
Year of Dissertation:
The period of adolescence is strongly associated with explorations of one's identity, values and surroundings. Youth organizations can offer a platform for young people to work collectively on community organizing and campaigns for social justice. Through the process of participating in social conflict and contestation, youth are often engaged in spatial conflict and contestation. The concept of the geographical imagination or critical consciousness about space makes this connection between the social and the spatial explicit. The geographical imagination includes the knowledge and meaning one ascribes to different places, along with an awareness of the social, spatial, political and economic forces that help to produce and maintain these spaces. There is little research that considers the contexts in which the geographical imagination develops in young people and how this relates to their emergent identities as political actors and activists. Interviews, participant observation and a participatory mapping project were conducted over the course of a yearlong case study at a Harlem-based organization. The findings articulate: 1) how young people learn about the social and material aspects of their neighborhood and the world in an `education for liberation' context, 2) how they apply `dimensions' of this spatial lens to trace root causes of issues, analyze the current context and gather perspectives about places, 3) how they enact their geographical imagination using specific `modes' of engaging the environment and 4) the ways in which the goals of social justice youth programs could be furthered by fostering the geographical imagination. This interdisciplinary research clarifies the geographical imagination as a critical construct to analyze the role of space and place in one's biography and as a critical capacity to experience and intervene in the built and natural environment. As young people collectively work to address uneven development, they are learning about the social and spatial relations that affect their lives and taking on new roles as political actors in their community. By extending the concept of the geographical imagination to community engagement, this work contributes to understanding and establishing conditions for young people to not only see things as they are, but how they could be.