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The Role of Neuropsychological Profiles in Adult ADHD and Ischemic Stroke: Implications for Clinical Practice

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The Role of Neuropsychological Profiles in Adult ADHD and Ischemic Stroke: Implications for Clinical Practice The role of neuropsychological profiles in adult ADHD and ischemic stroke: Implications for clinical practice A cumulative dissertation Doctorate in Psychology (Dr. rer. nat.) Submitted to the University of Bremen, Faculty 11 by Johanna Theiling Bremen, October 2014 Supervisor: Prof. Dr. Franz Petermann 1. Reviewer: Prof. Dr. Wolf-Dieter Gerber 2. Reviewer: Prof. Dr. Canan Basar-Eroglu Acknowledgements Acknowledgements First and foremost, I wish to thank the head of the Centre of Clinical Psychology and Re- habilitation and my advisor Professor Franz Petermann. He gave me the opportunity to accom- plish the present thesis and supported this research with his knowledge, painstaking effort in proof reading the drafts, and patience. I would particularly like to thank Monika Daseking, who mainly supervised the current research. I am thankful for your advice and insight throughout my work, for the non-stop availa- bility for help with questions and thoughts. Thank you for the positive vibes and for creating a relaxed yet productive atmosphere in the weekly PhD College meetings. I have been blessed with a friendly and cheerful group of fellow PhD students. It has been a great pleasure to work with Franziska Korsch and Walter, Franz Pauls, Angelika Kullik, Lina Werpub, Hanna Weber, Nicole Gust, and Esmahan Belhadj. As this work can sometimes be a bit lonely, I thank you all for the lunch- and coffee breaks, for the in-depth and fruitful discussions on various topical issues, for many laughs and moments together that enrich every day anew. Special acknowledgements to Philipp Seegers for your continuous love, your patience, un- derstanding, and the unconditional and unselfish support for the billions of things I have wished for. Thank you! Table of Contents Table of Contents ABSTRACT .............................................................................................................................................. I ZUSAMMENFASSUNG ............................................................................................................................II ABBREVIATIONS ................................................................................................................................ IV LIST OF TABLES ....................................................................................................................................V LIST OF FIGURES ................................................................................................................................. VI INTRODUCTION ..............................................................................................................................1 The originating project of the present thesis ............................................................................. 4 Publications ................................................................................................................................. 5 Thesis outline ............................................................................................................................... 5 THEORETICAL FOUNDATION 1 TOWARDS A CONCEPTUAL FRAMEWORK ........................................................................................... 7 1.1 Attention ................................................................................................................................... 7 1.2 Cognitive functions ................................................................................................................... 8 1.3 Intelligence .............................................................................................................................. 10 2 DISORDERS RELATED TO ATTENTION DEFICITS ................................................................................ 14 2.1 Psychiatric neuro-developmental disorder of attention (ADHD) ........................................ 14 2.1.1 Definition of ADHD in adults .......................................................................................... 15 2.1.2 Current state of research: Neuropsychological functions in adult ADHD .................... 20 2.1.3 The assessment process in adults with ADHD ................................................................ 26 2.2 Neurological disorder with central deficits of attention (stroke) ......................................... 30 2.2.1 Definition of stroke .......................................................................................................... 31 2.2.2 Current state of research: Neuropsychological functions post-stroke ........................... 36 2.2.3 The assessment process in stroke rehabilitation ............................................................. 42 3 THE PRESENT EMPIRICAL INVESTIGATION ....................................................................................... 46 3.1 Rationale and aims of the studies on adults with ADHD ..................................................... 46 3.2 Rationale and aims of the study on stroke ............................................................................. 48 Table of Contents EMPIRICAL RESEARCH 4 METHODS ........................................................................................................................................ 50 4.1 Target population and sample composition ........................................................................... 50 4.1.1 Demographic characteristics ............................................................................................ 50 4.1.2 Sample of adults with ADHD .......................................................................................... 51 4.1.3 Sample of ischemic stroke patients .................................................................................. 54 4.1.4 Control group ................................................................................................................... 58 4.2 Assessment ............................................................................................................................... 58 4.2.1 Wechsler Adult Intelligence Scale- IV ............................................................................ 58 4.2.2 Self-reports ........................................................................................................................ 61 4.3 Data management and statistical analyses ............................................................................. 63 5 RESULTS ........................................................................................................................................... 66 5.1 Cognitive profiles in adults with ADHD or stroke................................................................ 66 5.2 Additional influences of confounding variables .................................................................... 74 5.3 The status of self-evaluation in the assessment of ADHD in adults ..................................... 77 6 DISCUSSION ..................................................................................................................................... 79 6.1 ADHD in adulthood ................................................................................................................ 79 6.2 Ischemic stroke patients ......................................................................................................... 95 6.3 General limitations................................................................................................................ 105 7 MAIN CONCLUSION ....................................................................................................................... 108 REFERENCES ................................................................................................................................ 109 APPENDICES APPENDIX A - CONTENTS OF THE WAIS-IV APPENDIX B - STUDY I APPENDIX C - STUDY II APPENDIX D - STUDY III APPENDIX E - STATEMENT OF THE AUTHOR‟S CONTRIBUTION TO EACH PUBLICATION APPENDIX F - DECLARATION OF ORIGINALITY Abstract Abstract By quantifying behavioural outcomes that are related to cognitive functioning, neuropsy- chological assessments allow to predict the manifestations of intellectual ability. Thereby, they take an important role in the clinical management of patients with mental illnesses and neurologi- cal conditions. The literature increasingly discusses the role of neuropsychological assess- ments for diagnosis and treatment in adults with ADHD or a stroke. However, inconsistent neuro- psychological profiles in both groups lead to a lack of clarity regarding the role of neuropsycholog- ical assessments in clinical care. The aim of the present thesis was to assess intellectual functions and cognitive profiles by means of the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS- IV) in adults with ADHD and in patients with a first-ever unilateral, ischemic stroke in inpatient rehabilitation facilities in comparison to a control group. The purpose was to determine whether cognitive impairments vary as a function of clinical characteristics, including comorbidity and medication in adults with ADHD (study I) and language impairment, neglect, hemianopsia, and post-stroke depression in patients with a stroke (study II). In addition, the present thesis evaluated the contribution of self-reports for predicting cognitive functioning in adults with ADHD (study III). The results of the studies on adults with ADHD revealed deficits in intellectual and cognitive functions when compared to a randomly matched control group.
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