Normals (N = 42) and patients with mild memory difficulty (N = 123) were given a neuropsychological test battery, and then followed annually for 3 years to determine which individuals developed sufficient functional change that they met clinical criteria for AD. Twenty-three of the 123 participants with mild memory difficulty converted to a diagnosis of probable Alzheimer's disease (AD) within 3 years of follow-up. Four of the 20 neuropsychological measures obtained at baseline, were useful in discriminating the groups on the basis of their status 3 years after the tests were given. The 4 discriminating tests pertained to assessments of memory and executive function. When the controls were compared to the individuals with memory impairments who ultimately developed AD (the converters), the accuracy of discrimination was 89%, based on the neuropsychological measures at baseline. The discrimination of the controls from the individuals with mild memory problems who did not progress to the point where they met clinical criteria for probable AD over the 3 years of follow-up (the Questionables) was 74% and the discrimination of the questionables from the converters was 80%. The specific tests that contributed to these discriminations, in conjunction with recent neuropathological and neuroimaging data from preclinical cases, have implications for which brain regions may be affected during the prodromal phase of AD. (JINS, 2001, 7, 631–639.)

The Paced Auditory Serial Addition Test (PASAT) is a commonly used procedure that combines elements of both a working memory task and a test of information processing speed. Patients with multiple sclerosis (MS) have consistently been found to be impaired on this test and it has been recommended as a core outcome measure in clinical trials. The standard score for this task is the number of correct responses at each stimulus presentation rate but a concern has been raised that subjects may ignore some test items in order to chunk the information into manageable portions and avoid performing several cognitive tasks simultaneously. To account for this strategy, one can examine the proportion of correct responses that are consecutive (termed dyads), since such responses require that the task be performed according to the instructions. We compared a group of 35 mildly to moderately disabled MS patients and matched healthy controls on the PASAT. The MS patients made significantly fewer correct responses at the 2 slowest presentation rates (2.4, 2.0 s/digit) while their scores at faster rates (1.6, 1.2 s/digit) did not discriminate them from controls as well. Nevertheless, the MS patients' percentage of dyads was significantly lower than that of the control sample across all stimulus presentation rates. While our study supports the use of the PASAT as a test that distinguishes MS patients from healthy individuals, our results also illustrate problems that lie in the interpretation of this difference in performance. It appears that a chunking strategy may be common in the PASAT, particularly as task demands increase, and that this may mask actual performance differences. If so, the total correct response score alone is limited as a measure of working memory and information processing speed. More detailed analyses of PASAT performance, coupled with other measures of information processing, may help clarify the underlying cognitive deficits of MS patients. (JINS, 2001, 7, 363–372.)

This study explored the neurodiagnostic utility of 6 factor scores identified by recent exploratory and confirmatory factor analyses of the WAIS–III and WMS–III: Verbal Comprehension, Perceptual Organization, Processing Speed, Working Memory, Auditory Memory and Visual Memory. Factor scores were corrected for age, education, sex and ethnicity to minimize their influences on diagnostic accuracy. Cut-offs at 1, 1.5 and 2 standard deviations (SDs) below the standardization sample mean were applied to data from the overlapping test normative samples (N = 1073) and 6 clinical samples described in the WAIS–III/WMS–III Technical Manual (N = 126). The analyses suggest that a 1 SD cut-off yields the most balanced levels of sensitivity and specificity; more strict (1.5 or 2 SD) cut-offs generally result in trading modest gains in specificity for larger losses in sensitivity. Finally, using combinations of WAIS–III/WMS–III factors together as test batteries, we explored the sensitivity and specificity implications of varying diagnostic decision rules (e.g., 1 vs. 2 impaired factors = “impairment”). For most of the disorders considered here, even a small (e.g., 3 factor) WAIS–III/WMS–III battery provides quite good overall diagnostic accuracy. (JINS, 2001, 7, 867–874.)

This study assessed two relevant aspects of executive dysfunction in children with either Tourette syndrome (TS) or ADHD. Process variables derived from existing neuropsychological measures were used to clarify the executive function construct. Clustering of responses on measures of verbal fluency, figural fluency, and verbal learning was examined to assess strategic response organization. Rule breaks, intrusions, and repetition errors were recorded to assess inhibition errors. No significant differences were found among the three groups (TS, ADHD, and controls) on tasks of response organization (clustering). In our sample, both the ADHD and the TS groups were largely free from executive function impairment, and their performance on the fluency and list learning tasks was in the average range. There was a significant group difference on one of the disinhibition variables, with both TS and ADHD groups showing significantly more intrusions on verbal list learning trials than controls. When more traditional total score variables were analyzed among the three groups, there were no significant differences; however, analysis of effect size revealed medium-to-large effect sizes for Letter Word Fluency total score differences (ADHD vs. controls), and for Semantic Word Fluency total score differences (ADHD vs. TS), with the ADHD group having weaker performance in both comparisons. Results provide some support for the use and analysis of process variables—particularly those related to inhibition and intrusion errors, in addition to the total score variables when assessing executive function deficits in children with ADHD and TS. While group differences may be found, children with uncomplicated TS should not routinely be considered to have significant executive function impairments, and when deficits are found, they may be attributable to other comorbid disorders. (JINS, 2001, 7, 102–111.)

Since memory performance expectations may be IQ-based, unidirectional base rate data for IQ-Memory Score discrepancies are provided in the WAIS–III/WMS–III Technical Manual. The utility of these data partially rests on the assumption that discrepancy base rates do not vary across ability levels. FSIQ stratified base rate data generated from the standardization sample, however, demonstrate substantial variability across the IQ spectrum. A superiority of memory score over FSIQ is typical at lower IQ levels, whereas the converse is true at higher IQ levels. These data indicate that the use of IQ–memory score unstratified “simple difference” tables could lead to erroneous conclusions for clients with low or high IQ. IQ stratified standardization base rate data are provided as a complement to the “predicted difference” method detailed in the Technical Manual. (JINS, 2001, 7, 875–880.)

Global and widespread cognitive and behavioral dysfunctions have been documented in children with heavy prenatal alcohol exposure (CHPAE). In addition to further exploring explicit-memory functioning in this population, recent investigations have creatively looked into implicit-memory functions by testing the ability of CHPAE to perform priming (Mattson & Riley, 1999) or skill-learning (Carmichael Olson et al., 1998; Sampson et al., 1997) tasks. These empirical efforts have been supported by recent studies which have linked prenatal alcohol exposure to disproportionate volumetric reductions in subcortical structures such as the basal ganglia (Mattson et al., 1994) and cerebellum (Cavanagh et al., 1997), two structures that have been shown to be actively involved in implicit memory (Doyon et al., 1997, 1998; Heindel et al., 1989; Rauch et al., 1997). In each case, a profile of preserved implicit and impaired explicit-memory functioning has emerged. In the skill-learning domain, for example, participants were required to complete four blocks of 100 trials of the serial reaction time (SRT) task in which participants have to press the button which corresponds to the light that is illuminated, and in which there is an embedded sequence of ten positions that is repeatedly presented throughout blocks of trials. On the latter task, both studies indicated that CHPAE children tended to have longer mean response times than controls, but that their learning profile did not differ across the four blocks of trials.

Child behavior problems, injury-related family burden, and parent psychological distress were assessed longitudinally over the first year post injury in 40 children with severe traumatic brain injury (TBI), 52 with moderate TBI, and 55 with orthopedic injuries not involving brain insult. Parents rated children's preinjury behavior soon after injury. Postinjury child behavior and family outcomes were assessed at 6- and 12-month follow-ups. Findings from path analysis revealed both direct and indirect effects of TBI on child behavior and family outcomes, as well as cross-lagged child-family associations. Higher parent distress at 6 months predicted more child behavior problems at 12 months, controlling for earlier behavior problems; and more behavior problems at 6 months predicted poorer family outcomes at 12 months, controlling for earlier family outcomes. Support for bidirectional influences is tentative given that limited sample size precluded use of structural equation modeling. The findings nevertheless provide impetus for considering the influences of person-environment interactions on outcomes of TBI. (JINS, 2001, 7, 755–767.)

This study evaluated the early cognitive and neurobehavioral outcomes of older adults with mild versus moderate traumatic brain injury (TBI). Thirty-five patients who were age 50 years and older and sustained mild or moderate TBI were prospectively recruited from acute care hospitals. Patients were administered cognitive and neurobehavioral measures up to 2 months post-injury. Demographically comparable control participants received the same measures. Patients and controls did not have previous histories of substance abuse, neuropsychiatric disturbance, dementia, or neurologic illness. Moderate TBI patients performed significantly poorer than mild TBI patients and controls on most cognitive measures, whereas the mild patients performed comparably to controls. In contrast, both mild and moderate patients exhibited significantly greater depression and anxiety/somatic concern than controls. The results indicate that the classification of TBI as mild versus moderate is prognostically meaningful as applied to older adults. The findings extend previous investigations in young adults by demonstrating a relatively good cognitive outcome on objective measures, but subjective complaints after a single, uncomplicated mild TBI in older persons. (JINS, 2001, 7, 373–383.)

A sample of 20 right-handed Aruaco Indians (12 male, 8 female; age 8–30 years) from the Sierra Nevada de Santa Marta (Colombia) participated in this study. A brief neuropsychological test battery (visuoconstructive and visuoperceptual abilities, memory, ideomotor praxis, verbal fluency, spatial abilities, concept formation) was individually administered. In addition, a handedness questionnaire was included. In some neuropsychological tests performance was virtually perfect (Recognition of Overlapped Figures and Ideomotor Praxis Ability test), whereas performance in other tests was impossible (e.g., Block Design using a time limit). It was proposed that two types of variables were significantly affecting performance: (1) educational level; and (2) cultural relevance. Some tests appeared significant and meaningful whereas others were meaningless and even impossible to understand. The appropriateness of current neuropsychological instruments for cross-cultural assessment is discussed. (JINS, 2001, 7, 510–515.)

Magnetic resonance (MR) images and neuropsychological testing data of 69 carbon monoxide (CO) poisoned patients were prospectively obtained within 1 day of CO poisoning, two weeks and six months. CO patients' Day 1 cross-sectional fornix surface area measurements, corrected for head size by using a fornix-to-brain ratio (FBR), were compared to normal age and gender-matched controls. Additionally, a within-subjects analysis was performed comparing the mean areas between CO patients' Day 1, 2 weeks and 6-month FBR. The FBR was correlated with patients' neuropsychological data. There were no significant differences between CO patients' Day 1 fornix measurements compared to normal control subjects. However, significant atrophic changes in the fornix of CO poisoned patients occurred at two weeks with no progressive atrophy at 6 months. By 6 months, CO patients showed significant decline on tests of verbal memory (when practice effects were taken into account), whereas visual memory, processing speed and attention/concentration did not decline. This study indicates that CO results in brain damage and cognitive impairments in the absence of lesions and other neuroanatomic markers. (JINS, 2001, 7, 640–646.)

The editors of this book present rehabilitation after brain injury in the context of a model labeled the “neurologic rehabilitation model”. The model is based on a careful functional diagnosis in the context of neurological syndromes, on prognosis, and on treatment planning. The importance of functional diagnosis cannot be emphasized enough. It constitutes a base of treatment planning and prognosis and I was very happy to read a textbook using functional diagnosis. Unfortunately, I got somewhat confused. From my point of view as a neuropsychologist, functional descriptions are mixed with terms of localizing value. The authors have chosen an uncommon way to present focal cognitive, emotional, or executive disturbances within the context of different etiologies, e.g., Wernicke's aphasia and neglect are presented as specific stroke syndromes. They very often are, but certainly not always. Specific neurological deficits are presented with regard to prognosis and likelihood for impairment. Treatment studies are reviewed. The neurologic rehabilitation model treats deficits in an “egalitarian way,” mixing sensory, motor, and cognitive problems.

This study examined the relationships between regional cortical and hippocampal brain volumes and components of remote memory (recall, recognition, sequencing, and photo naming of presidential candidates) in 13 individuals with Alzheimer's disease (AD). Recognition and sequencing of remote memory for public figures were associated with regional cortical volumes. Specifically, lower recognition and sequencing scores were associated with smaller parietal–occipital cortical volumes; poorer sequencing was also associated with smaller prefrontal cortical volumes. By contrast, poorer anterograde but not remote memory scores were correlated with smaller hippocampal volumes. Within the constraints of the brain regions measured, these findings highlight the importance of the posterior cortical areas for selective remote memory processes and provide support for the dissociation between cortically mediated remote memory and hippocampally mediated anterograde memory. (JINS, 2001, 7, 384–390.)

History, theories, methods and findings are characteristic of all disciplines. Also characteristic is the tendency to keep within a discipline much of what is known from discovery by scholars in other fields. While unintentional for the most part, the scant knowledge sharing across disciplines arises from deficits or uncertainties in understanding the definitions of terms, references to key constructs and features, variations in methodologies, and in interpretations of findings. Yet, as the chapters of this book reveal, much is known across several disciplines that converge on many of the same developmental disorders that are (and have been for decades) the focus of considerable research activity. The extensive interest in the study of developmental disorders exists both to understand their natures and causes as well as to reveal differences and similarities in development across normal and abnormal populations.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary brain disease with a variety of neurologic and psychiatric manifestations. We studied 3 members of a family who each had leukoencephalopathy on neuroimaging studies and a characteristic mutation for CADASIL in the notch 3 region of chromosome 19q12. In all 3 cases, neurobehavioral impairment dominated the clinical picture, and a pattern of psychiatric dysfunction heralding cognitive decline emerged. Neuropsychological evaluation revealed diverse deficits, but a profile of frontal lobe dysfunction, declarative memory impairment suggestive of a retrieval deficit, and relatively preserved language was evident. These cases provide a cross-sectional study of the evolution of CADASIL, and suggest that, as in other diseases characterized by white matter dementia, psychiatric dysfunction may occur initially, followed by pervasive cognitive dysfunction later in the course of the disease. CADASIL should be considered in young adults with unexplained leukoencephalopathy on neuroimaging studies, and in those with neurobehavioral dysfunction and a suggestive family history. (JINS, 2001, 7, 768–774.)

The utility of the WMS–III in detecting lateralized impairment was examined in a large sample of patients with temporal lobe epilepsy. Methods of analysis included evaluation of group means on the various indexes and subtest scores, the use of ROC curves, and an examination of Auditory–Visual Index discrepancy scores. In addition, performance on immediate and delayed indexes in the auditory and the visual modality was compared within each group. Of the WMS–III scores, the Auditory–Visual Delayed Index difference score appeared most sensitive to side of temporal dysfunction, although patient classification rates were not within an acceptable range to have clinical utility. The ability to predict laterality based on statistically significant index score differences was particularly weak for those with left temporal dysfunction. The use of unusually large discrepancies led to improved prediction, however, the rarity of such scores in this population limits their usefulness. Although the utility of the WMS–III in detecting laterality may be limited in preoperative cases, the WMS–III may still hold considerable promise as a measure of memory in documenting baseline performance and in detecting those that may be at risk following surgery. (JINS, 2001, 7, 881–891.)

The ability of subject F.F., diagnosed with Down syndrome, to appreciate nonliteral (interpreting metaphors and idioms) and literal (vocabulary knowledge, including highly specific and unusual items) aspects of language was investigated. F.F. was impaired in understanding both metaphors and idioms, while her phonological, syntactic and lexical–semantic skills were largely preserved. By contrast, some aspects of F.F.'s executive functions and many visuospatial abilities were defective. The suggestion is made that the interpretation of metaphors and idioms is largely independent of that of literal language, preserved in F.F., and that some executive aspects of working memory and visuospatial and imagery processes may play a role. (JINS, 2001, 7, 516–527.)

Various factors influence the degree of leftward error (pseudoneglect) that typifies the performance of normal individuals in line bisection tasks. This experiment reveals that the eye through which stimuli are viewed also exerts a modulating influence on spatial attention, as indexed by significant alterations in the magnitude of pseudoneglect. Using a forced-choice tachistoscopic line bisection protocol, 24 participants (12 male; 12 female) bisected horizontally oriented lines (22.6° w × 0.39° h) presented to central vision in 3 conditions: left uniocular viewing (L), right uniocular viewing (R), and binocular viewing (B). Perceived line midpoint, a measure of bisection accuracy, deviated significantly leftward of veridical ( p < .05) in all viewing conditions, confirming a tonic asymmetry of visuospatial attention in normal young observers. In addition, a significant influence of viewing condition was found (p < .05) where pseudoneglect was greatest in the L condition, followed by the B and R conditions, respectively. Analysis of the slopes of the psychometric functions revealed significantly greater bisection precision in the binocular versus uniocular viewing conditions (p < .05). The results are interpreted to suggest that phasic effects on spatial attention can be produced by uniocular viewing via asymmetric retinotectal projections. The results are consistent with activation–orientation theories of attentional asymmetry. (JINS, 2001, 7, 391–395.)

We have been very interested in the article of Castellon et al. (2000) on the neuropsychiatric disturbances present in HIV-infection, which reports results very congruent with those published previously by our research group. Indeed, for many years we have studied psychopathological perturbations (depression and anxiety) as well as more specific emotional dimensions like emotional deficit and loss of control in HIV positive patients.

The stated intent of this rather hefty book is to “provide a readily available handbook for neuropsychology interns, fellows, and practicing clinicians,” with a focus on the “major differential diagnoses that neuropsychologists are routinely asked to make,” particularly in a hospital-based neuropsychological practice. These are optimistic goals that are frequently, although not always, fulfilled. The editors are to be commended for their success in organizing a knowledgeable and erudite group of contributors, who generally have conformed to the recommended stylistic and content guidelines. However, as is typical of most edited works, the stated intent(s) of the book are rather unevenly addressed in both the scope of the included topics and by the various authors. The book includes 30 chapters divided into five sections: General Issues (101 pp.), Pediatric Psychology (64 pp.), Geriatric Psychology (66 pp.), Neurological Disorders (159 pp.), and Neuropsychological Syndromes (225 pp.), and an appendix of medical abbreviations. The result is a not-so-brief handbook that is useful as a desk reference guide for students, interns, fellows, and nonneuropsychological clinicians working with neurological patients. For experienced neuropsychologists, the book is likely to be of less value due to its intentionally brief reviews of most topics.

The relatively recent advent of computer-based technologies such as information on the web and CD-ROM storage mediums have opened up a new arena for the presentation of educational materials in the sciences. While the possibilities for what can be presented are almost endless, the reality generally has been less successful. In Essential Psychopharmacology, the author has made a commendable effort at presenting materials from his fine textbook of the same name in a stimulating, graphic-intensive fashion.