Invited Speakers

Programme

Presidential Address

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Micheal Kopelman

Neuroscience, Memory and the Law

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Neuroscience, memory and the law

Criminal medico-legal practice is fraught with issues, some of which have been little considered by neuropsychologists, in part because the psychological literature has focused heavily upon issues in witness testimony and memory in allegations of child sexual abuse. Some less well-trodden issues will be considered in this address, including (i) the notion of automatism and the science of agency; (ii) amnesia for offences, commonly claimed in specific circumstances; (iii) false memories in the law courts (e.g. false confessions) and their relation to notions of free will; and (iv) the impact of brain pathology upon medico-legal issues, such as fitness to plead and criminal responsibility. Moreover, a burgeoning literature has focused attention upon subtle neurobiological/ neuroimaging anomalies as underlying the tendency to offend. On the other hand, philosophers of law have taken a sceptical view of the probative value of these latter findings.  Even in patients with definite neuropsychiatric/ neuropsychological disorders, there are unresolved issues, such as (i) the unsatisfactory clinical definition and status in law of ‘automatism’; (ii) the cut-off for frontal lobe pathology/ executive dysfunction (or other pathology/ impairment) in issues of criminal responsibility; (iii) the question of exaggeration or simulation; and (iv) how the courts handle people with neuropsychiatric/ neuropsychological disorders.  The lecture will be illustrated by case-examples from the author’s experience.  It will argue that there is a risk that a strongly reductionist/ biological approach can encourage the neglect of important social factors, and it will also emphasise the difficulty of defining thresholds (cut-offs) for where disease affects responsibility – a grey area in a world of legal black-and-whites.

Brief Biography: Professor Michael Kopelman is Emeritus Professor of Neuropsychiatry, King’s College London (Institute of Psychiatry, Psychology and Neuroscience), and formerly ran a Neuropsychiatry and Memory Disorders Clinic at St Thomas’s Hospital, London. He has been co-editor/co-author of The Handbook of Memory Disorders, 2002; Lishman’s Organic Psychiatry, 4th edition, 2009; and Forensic Neuropsychology in Practice, 2009. He is current President of the International Neuropsychological Society; past-President of the British Neuropsychological Society, past-President of the International Neuropsychiatric Association, and past-President of British Academy of Forensic Sciences. His research is on all aspects of memory disorders, and he was a founder member of the Memory Disorders Research Society. He was awarded a Career Achievement award by the International Neuropsychological Society in 2013.

Birch Lecture

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Donald Stuss

Personalised Medicine: The Role of Neuropsychology

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PERSONALIZED MEDICINE: THE ROLE OF NEUROPSYCHOLOGY

Birch Lecture, Cape Town, July 2017

Donald T. Stuss

Clinical trials to treat brain disorders have largely had very modest or time-limited effects; many have been outright failures – all these efforts with significant costs.   The evolving response has been a call for more effective and targeted treatments – personalized medicine, or sometimes called “precision” or “stratified” medicine.  These labels reflect a growing awareness of one major cause of these clinical failures – our labels and clinical diagnostic categories are too broad, imprecise, or even incorrect.  Even beyond clinical trials, neuroscience research is often hampered by this variability of performance among the individuals included in what seems like a well-defined supposedly homogeneous group. This review presents several examples of heterogeneity among defined clinical syndromes to illustrate how variability was explored and “harnessed” to advance the understanding of specific brain-behaviour relations.  Several examples are from the presenter’s own research in traumatic brain injury and the study of “executive functions” and frontal lobe focal dysfunction.  Other examples are related to Alzheimer’s disease.   The possible application of this more “precision” based approach to neurorehabilitation of individuals who have suffered traumatic brain injuries will be presented.  A final section summarizes how this awareness of clinical heterogeneity informed the establishment of an administrative structure that integrates different types of information (genetic to behavioural) and basic and clinical science to improve diagnoses and care, and how neuropsychology/behavioural analyses can play an important role for both diagnostic phenotyping and more sensitive outcome measures.

Brief Biography: Donald T. Stuss, Ph.D., FRSC, FCAHS, C. Psych., ABPP-CN, Order of Canada, Order of Ontario, is founding President and Scientific Director of the Ontario Brain Institute (2011 - 2015); University of Toronto Professor of Medicine (Neurology and Rehabilitation Science) and Psychology (1989 - ); founding Director of the Rotman Research Institute (1989 to 2008), Reva James Leeds Chair in Neuroscience and Research Leadership 2001-2009; interim Director and CEO of the Heart and Stroke Foundation Centre for Stroke Recovery 2008-2009; Senior Scientist (currently adjunct) at the Rotman Research Institute of Baycrest Centre (1989 - ); Associate Scientist, Sunnybrook Health Sciences Centre (2005 - );.  Selected Honors: Fellow of AAAS, APA (Divisions 3, 6, 20, 40), APS, American Heart and Stroke Association, CPA; Order of Ontario (2001);  University of Toronto Faculty Award (2004); University Professor status (awarded to a maximum of 2% of the tenured university academic staff), University of Toronto (2004); National Academy of Neuropsychology 2011 Lifetime Contributions to Neuropsychology Award; 3rd Annual Charles Branch Brain Health Award, University of Texas at Dallas (2012); Queen Elizabeth II Diamond Jubilee Medal (2012); International Neuropsychological Society Lifetime Achievement Award (2013); Gold Key Award American Congress of Rehabilitation Medicine (2014); Donald O. Hebb Distinguished Contribution Award, Canadian Society for Brain, Behaviour, and Cognitive Science (2016); and Officer of the Order of Canada (2017).  Personal research focuses on understanding and treating the cognitive functions and personality changes associated with the frontal lobes as they occur after stroke, normal elderly, and in those with traumatic brain injury or dementia.  Publications: over 215 peer-reviewed manuscripts, 51 chapters, 1 co-authored and 4 edited books.  Total citation count >22,000 (Scopus).

 

 Keynote Speakers

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Vicki Anderson

Predictors of Neurocognitive Outcomes Following Early Brain Injury

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Predictors of Neurocognitive Outcomes Following Early Brain Injury

The young, healthy brain is highly ‘plastic’ and able to change in the context of environmental influences. This capacity for change is likely to continue while the brain matures, throughout childhood and into late adolescence. The implications of this capacity for change in the context of brain insult or disruption remains to be determined. While some argue that ‘early plasticity’ is an advantage and will lead to minimal functional consequences, others claim that the young brain is uniquely susceptible (‘early vulnerability’) and disruption will lead to permanent and devastating effects. Neither of these views is able to fully explain the pattern of functional difficulties we observe in the context of childhood brain insult. This presentation will consider the theoretical and empirical evidence relevant to the ‘plasticity’ debate, in the context of both normal and disrupted development. Using research findings from our team and others, the influence of insult-related factors (location, laterality and extent of brain pathology, and presence of epilepsy), child characteristics (age, sex, pre-insult abilities) and environmental factors (SES, family function, parent mental health), on cognitive and behavioral outcomes will be considered. The aims of the presentation are: 1) to provide a description of brain plasticity and vulnerability theories in the context of early brain insult; 2) to examine the influence of age at insult on neurobehavioral outcomes; and 3) to propose predictors of outcome following early brain insult, based on empirical findings.

Brief Biography:  Professor Vicki Anderson BA (Hons), MA (Clin Neuropsych), PhD, FAPS, FASSA, FAAHMS, FASSBI

Dr Anderson is Director, Clinical Sciences Research, Murdoch Childrens Research Institute, Head, Psychology, The RCH, Professorial Fellow, Paediatrics & Psychology, UoM and a NHMRC Senior Practitioner Fellow. She leads the Australian Centre for Child Neuropsychology Studies.  She is a Fellow of the Academy of Social Sciences of Australia, the Aust Psychological Society and the Aust Academy of Health and Medical Sciences.

Dr Anderson has 400+ peer reviewed publications and $30M in competitive grant funding. She is an Associate Editor for Neuropsychology (APA) and the J Neuropsychology (BPS, UK). She has been a member of the NIH Common Data Elements Working groups for concussion and child TBI, the NIH National Children’s Study, the Canadian Institute for Advanced Research and the International Consensus on Concussion in Sports.

Her research and clinical interests are in disorders of childhood that impact on the brain, including both developmental and acquired disorders. Her recent work has focussed on translating her early career findings into clinical practice to optimise child outcomes from brain injury. Major translational achievements include: i) publication of the Test of Everyday Attention for Children, used by psychologists across the world; ii) development of easily accessed, low burden, e-health approaches to parent-focused psychosocial treatments as a means of maximising child outcomes and improving family function; iii) development of a novel, comprehensive iPad delivered assessment tool for social competence (PEERs: patent pending); iv) digital health tools for monitoring child post concussion symptoms (endorsed in a partnership with the Australian Football league); and v) authorship of the first-ever international paediatric sports concussion guidelines of the International Consensus on Sports Concussion.

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Jonathan Evans

Rehabilitation of Memory and Executive Functions

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Rehabilitation of Memory and Executive Functions

Everyday life requires the ability to carry out tasks and activities with multiple steps, to maintain multiple goals or intentions over time, and to interrupt one task in order to complete another intended action. Successful task management and prospective remembering require the carefully coordinated interaction of memory and executive functions. These cognitive processes are frequently impaired after damage to the brain and are therefore a key target for neuropsychological rehabilitation.  A big question for rehabilitation is whether interventions should aim to restore lost functions or to compensate for them. The evidence to date suggests that the greatest benefits come from compensatory strategies. Technology based solutions offer significant potential in supporting prospective memory and the management of complex tasks. I will present evidence that technology based reminding systems (pagers, smartphones, smart-watches) can improve task performance in people with brain injury and dementia, although uptake of technological solutions, whilst increasing, remains low. We have explored the barriers to uptake of technology and have developed an app designed to address the limitations of standard smartphone reminding systems. I will discuss the use of alerting, or ‘non-contingent’ reminders in combination with cognitive training programmes such as Goal Management Training, and the use of a voice-based interactive technology system used to support complex sequence learning. Given the ubiquity of mobile technology, including in low and middle-income countries, technology-supported neuropsychological interventions have huge potential to improve the lives of people with cognitive impairment.

Brief Biography: Jon Evans is Professor of Applied Neuropsychology at the University of Glasgow and honorary Consultant Clinical Psychologist with NHS Greater Glasgow and Clyde. Jon was the first Clinical Director of the Oliver Zangwill Centre for Neuropsychological Rehabilitation in Ely, Cambridgeshire. He is now Programme Director for the MSc in Clinical Neuropsychology programme at the University of Glasgow. Jon has published more than 140 papers, books and book chapters in the field of cognitive neuropsychology, neuropsychological assessment and rehabilitation. He is an Executive Editor of the journal Neuropsychological Rehabilitation and is a co-author of the Behavioural Assessment of the Dysexecutive Syndrome and the Cambridge Prospective Memory Test. His research focuses on the assessment and rehabilitation of disorders of memory and executive functions, and on the treatment of mood disorders after brain injury.

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Jennifer Manly

Mechanisms of Cognitive Disparity in Older Adults: The Role of Race, Culture and Education

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Mechanisms of Cognitive Disparity in Older Adults: The Role of Race, Culture and Education

There is a rich history of empirical evidence demonstrating that race/ethnicity and socioeconomic status are fundamental causes of inequalities in health. However, research linking race, culture, and education to inequalities in neurological conditions that have their onset in later life such as dementia is relatively recent. Research in the United States shows that African Americans, Latinos, and American Indians are at elevated risk of developing Alzheimer’s disease, dementia, and cognitive impairment compared to non-Hispanic Whites and Asian Americans. These disparities were identified in epidemiological samples, but in the clinical setting, cognitive impairment and dementia are frequently underdiagnosed and undertreated among these groups. This presentation will address several methodological challenges to identification of mechanisms of racial/ethnic and educational disparities in cognitive impairment and dementia among older adults. Confounds that are frequently unmeasured such as educational quality, bias due to mortality and selection, as well as bias in measurement of memory, language, executive function, and other neuropsychological domains are among these challenges. Potential mechanisms of racial and educational disparities in dementia have been investigated and include genetics, inflammation, accelerated aging, cardiovascular and cerebrovascular disease, residential segregation, experience of discrimination, cognitive engagement, stress, and psychosocial function. The evidence to date points to early life social factors as having the enduring influences on later life cognition. These data suggest that addressing the dementia epidemic and achieving health equity in Alzheimer’s disease will require early-life social policy interventions.

Brief Biography: Jennifer Manly, Ph.D. is an Associate Professor of Neuropsychology in Neurology at the G.H. Sergievsky Center and the Taub Institute for Research in Aging and Alzheimer’s disease at Columbia University. She completed her graduate training in neuropsychology at the San Diego State University / University of California at San Diego Joint Doctoral Program in Clinical Psychology, a clinical internship at Brown University, and a postdoctoral fellowship at Columbia University. Her research on early life determinants of cognitive aging and social and biological risks for cognitive impairment among racially and ethnically diverse middle aged and older adults has been funded by the National Institute on Aging and the Alzheimer’s Association. She has authored over 175 peer-reviewed publications and 9 chapters. Dr. Manly has served the American Psychological Association Division 40 (Society for Clinical Neuropsychology) and the International Neuropsychological Society in several leadership roles. She received Early Career Awards from both Division 40 of the American Psychological Association and from the National Academy of Neuropsychology, was the 2014 recipient of the Tony Wong Diversity Award for Outstanding Mentorship, and is a Fellow of APA. She served on the US Department of Health and Human Services Advisory Council on Alzheimer's Research, Care and Services from 2011 – 2015, and is a current member of the Alzheimer’s Association Medical & Scientific Research Board.

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Andrew Mayes

The Role of Hippocampus and Other Connected Brain Regions in Memory Functions

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The role of the hippocampus and connected structures and other connected structures in memory functions

Although organic amnesics show dissociable memory deficits, the basis of this functional heterogeneity, particularly of structures in the medial temporal lobe is still disputed. It is still disputed whether the hippocampus mediates recall memory but not item familiarity memory whereas the neocortical medial temporal lobe (MTL) structures mediate familiarity memory for different kinds of information, inputting recall-related information into the hippocampus. Consistent with the disputed view are the distinct inputs and contrasting cytoarchitectonics of MTL structures, which suggest that the hippocampus binds object-context information into memory using pattern separation to support recall memory. In contrast, the perirhinal cortex receives mainly object information and the parahippocampal cortex mainly context information, which they bind. stressing commonalities, to support familiarity memory. Relatively selective hippocampal lesions are rare and, although impaired cued recall and intact familiarity are often found, other studies have found global deficits. The full explanation for this conflict is still lacking. However, selective damage to structures in the hippocampal circuit (e.g., fornix, mammillary bodies) causes selective recall deficits. Furthermore, in a recent large study of hippocampal patients, recall was impaired and familiarity preserved even when it was as accurate as strong control recollection (with the apparent exception of word familiarity). Our fMRI studies consistently find that even strong/accurate familiarity does not activate the hippocampus for visual stimuli. The apparent exception was again words but further work indicates that the hippocampal effect relates to word abstractness, not familiarity. Data support the hypothesis but issues remain. These and future implications will be discussed.

Brief Biography: After completing a first degree and D.Phil. at Oxford University, I worked in the Department of Psychology in Leicester University between 1970 and 1977. I then lived a peripatetic academic existence, moving to the University of Manchester, Psychology Department between 1977  and 1991, the University of Liverpool, Psychology Department where I was professor and head of department between 1991 and 1993, the University of Sheffield, Department of Clinical Neurology where I was Professor of Cognitive Neuroscience for the first time between 1993 and 2000, then back to Liverpool with the same title, and finally back to Manchester again with the same title yet again. Whilst here, I acted as the editor in chief of Neuropsychologia, one of the leading international journals of neuropsychology. My recommendation is not to move as much as I have done. It is very disruptive of your research and your personal life, but I was chasing good magnetic resonance imaging facilities usually not very successfully. My research has been on the brain bases of memory using lesion and brain imaging methods since 1977 and, although I became emeritus in 2010, I am currently in the later stages of a seven year Wellcome Trust programme grant to explore the controversy about the role of the hippocampus and related structures in memory for facts and personal events. During the last 40 years, therefore, I have been mainly focused on exploring the neural bases of declarative memory and priming in humans, using a convergent lesion and neuroimaging approach. In particular, for the past 20 odd years, I have been interested in the functional role of the different medial temporal lobe structures and their connections with respect to recollection and familiarity memory.

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Michael Saling

Diagnostic Approaches in Progressive Disorders: From Subjective Symptomology to Neurobiomarkers

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Diagnostic Approaches in Progressive Disorders: From Subjective Symptomology to Neurobiomarkers

Abstract: TBC

Brief Biography: Professor Michael Saling is the Director of the Professional Program in Clinical Neuropsychology in the School of Psychological Sciences at The University of Melbourne, Australia, having been appointed in 1988 as the successor to Dr Kevin Walsh. He is also the Director of Neuropsychology at The Austin Hospital in Melbourne, and Honorary Professorial Fellow at the Florey Institute for Neuroscience and Mental Health. He has published extensively on neurocognitive aspects of dementia with an emphasis on early detection, on language and memory disorders in temporal lobe epilepsy, and stroke-related cognitive decline. He has served as a consultant in numerous medicolegal and statutory matters where complex neuropsychological diagnosis was a central focus of contention. He is the senior neuropsychological consultation to the world-renowned Comprehensive Epilepsy Program at The Austin Hospital, and has served two terms on the Diagnostic Methods Commission of the International League Against Epilepsy. He has been privileged to teach Clinical Neuropsychology in South Africa and Australia for more than three decades, and continues to derive great fulfilment from teaching. On the 26th of January 2015, he was appointed by the Governor General as a Member of the Order of Australia, for significant service to education in the field of clinical neuropsychology as an academic, researcher, and clinician.