Due to the number of multiple comparisons being made, and to reduce the likelihood of making Type I error the significance level was set at p< .01 for all independent sample t-tests. Bonferroni correction was not applied as this would have given too conservative a value (0.05/41= p<.001) due to the number of inferential statistics conducted, and therefore would have increased the likelihood of making a Type II error. The use of a significance level of p<.01 has been used by others [114, 153]
6.5.3.1 Demographic and clinical characteristics
Demographic characteristics that were recorded and used in the analyses were gender, age, years of education, level of education (school, college or university), WAIS full IQ index score, and employment status. For the continuous variables histograms were produced and skew and standard error statistics. Means and standard deviations were reported for data that met the normal distribution. If data were considered skewed from the normal distribution the median and inter-quartile ranges were reported. The latter applied to the variables age and years of education. The mean and standard deviation were reported for the WAIS IQ index score.
Clinical characteristics that were recorded and used in the analyses were age of onset, duration of epilepsy, family history, history of febrile seizure, photosensitivity, seizure type, seizure frequency, number of AEDs, and AED type. For the continuous variables histograms were produced and skew and standard error statistics. Means and standard deviations were reported for data that met the normal distribution. If data was considered skewed from the normal distribution the median and inter-quartile ranges were reported. The latter applied to the variables age of onset and duration of epilepsy.
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6.5.3.2 Neuropsychological profile
The neuropsychological assessment administered to all the participants produced an age adjusted score for each cognitive domain assessed. The spread of these scores was determined by visual analysis of histograms, and consideration of the skew and standard error statistics. Each of the index score from the WAIS and WMS were normally disturbed apart from processing speed. Therefore the means and standard deviations were used to describe central tendency for all but processing speed, for which the median and inter-quartile range was reported.
For the subtests of the WAIS and WMS the same procedure was carried out. For the variables digit-symbol coding, faces (immediate and delayed recognition), family pictures (delayed recall) and spatial span the median and inter-quartile ranges were reported. The remaining subtests were normally distributed, and thus their means and standard deviations were reported.
In order to compare the participant’s scores to a healthy population, z-scores were calculated based on the means and standard deviations given by the assessment manuals.
To control for and assess the impact of education, intellectual functioning scores were correlated with years in education using Pearson’s R correlation coefficients. Pearson’s was chosen as the scores fitted assumptions of normality. Post hoc t-tests were run for any variables that were highly correlated.
6.5.3.3 Impact of contributory factors on neuropsychological profile
In order to determine the impact of the contributory factors outlined in Table 4.2 (and described in detail in Chapter four) on the neuropsychological profile of the sample, bivariate correlation and regression analyses were conducted. Standard linear regression was chosen to assess the predictive power of the variables and to identify which factors significantly contributed to the explanation of variance in cognition. This analysis has been utilised in previous reports investigating the neuropsychological profile of JME patients.
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For each cognitive test with a z-score >1.00 SD below published norms a univariant regression was run for each clinical and mood variable (age of onset, duration of epilepsy, types of seizures, frequency of seizure types, number of AEDs, HADS depression score and HADS anxiety score). Multivariable regression with forward variable selection was then run for further investigation of any cognitive test with more than one significant predictor.
Post-hoc analyses of significant findings were assessed using independent sample t- tests.
6.5.3.4 Personality and neuropsychological functioning
To assess whether an abnormal personality is related to neuropsychological functioning, the data from the EPQ-BV was dichotomised into ‘high’ and ‘normal’ neuroticism, and ‘low’ and ‘normal’ extroversion. The neuroticism scores were split into ≥40 for females, and ≥37 males. A score of 40 or above for females and 37 or above for males is one standard deviation above the means given by Sato [137]. The extroversion score was split into ≤33 for both males and females. A score of 33 or less is one standard deviation below the means given by Sato [137].
The performance across the battery of the participants in each personality group was compared to published norms using z-scores. Their performance was then compared across groups with independent sample t-tests.
Patients were then grouped into those with high neuroticism and/or low extroversion, and those with normal levels of neuroticism and extroversion. These two groups were coded as abnormal personality and normal personality, respectively. To assess the effect of abnormal personality traits overall on neuropsychological functioning, one sample t tests were conducted between published norms and abnormal personality group, and normal personality group.
Three additional executive function tests were administered to half of the sample, namely the rule shift, key search and zoo map from the BADS. The samples mean scores were compared to manual means by one sample t-tests. A significant difference was found for the zoo map. Pearson’s correlation was conducted between zoo map score
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and personality, psychiatric characteristics, clinical characteristics and years of education. A significant correlation between neuroticism and zoo map score. Post-hoc independent t-tests were conducted to investigate the effect of neuroticism on zoo map performance.
6.5.3.5 Severity of executive dysfunction
Executive function tests were divided into six executive functions, and the z-scores of each of the tests were calculated. In concordance with previous research [154, 155] a z- score of ≤-1 (one or more standard deviations below the manual means) on at one of the tests within each of the six domains was categorised as having executive dysfunction in relation to that domain. As naming ability was measured by only one test a z-score of ≤-1 on the Boston naming test was categorised as executive dysfunction in relation to naming ability. If two domains were found to meet these criteria the patient was said to have mild executive dysfunction. If three or four domains met the criteria the patient was said to have moderate executive dysfunction. If five or more domains met the criteria the patient was said to have severe executive dysfunction.
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