The contribution of neurologic, genetic, and demographic variables to decline in cognition was examined in 70 early- to mid-stage patients with Huntington's disease (HD) using random effects modeling. Study participants were followed prospectively at baseline and at four annual reevaluations. Only modest decline was noted on most neuropsychological variables. Neurologic dysfunction, assessed using the Quantified Neurologic Examination (QNE), proved to be the strongest predictor of cognitive decline. While significantly predictive of more rapid decline in neurologic functioning, CAG repeat length was not generally related to cognitive decline after adjusting for QNE, with the exception of performance on a single test of visual scanning and psychomotor speed (i.e., Trail Making Test, Part A). We propose that CAG repeat length is more closely linked with changes in basal ganglia that predominate in early- to mid-stage HD than with cortical degeneration seen later in disease progression. Such a relationship would explain the predictive value that CAG repeat length plays in changes associated with automatic motor response programs (e.g., QNE and Trail Making Test, Part A) but not in dysfunction on tasks requiring higher-order processing. (JINS, 2006, 12, 445–454.)

Trajectories of saccadic eye movements can be modulated by the presence of a competing visual distractor. It is proposed that the superior colliculus (SC) controls the initial deviation through competitive lateral interactions. Given the ramifications of connections between basal ganglia (BG) thalamo-cortical circuitry and the SC, it was anticipated that this modulation would be differentially effected in those with Huntington's disease, which in its early stages is primarily a disorder of the BG. Horizontal deviation was determined for exogenously driven and endogenously driven vertical saccades in the presence of peripheral distractors. For neurologically healthy participants, the initial trajectories of both saccade types curved away from distractor locations, as predicted. However, for HD participants exogenous saccades consistently deviated leftwards, irrespective of distractor location. Endogenous saccades also revealed anomalous horizontal deviation, with significant leftward deviation evident for saccades directed upward and significant rightward deviation for saccades directed downward. Further, both groups generated a comparable proportion of erroneous responses to distractor stimuli, but only neurologically healthy participants demonstrated a response time advantage for compatible target/distractor presentation. These results suggest anomalous regulation of distractor-related activity in HD. (JINS, 2006, 12, 455–464.)

Children with specific language impairment (LI) have deficits on some nonverbal tasks, but it is not clear if these are related to specific visuospatial deficits or to more general deficits in processing strategies. Children with LI were given two visuospatial tasks that we have shown to be sensitive to strategy use as well as specific processing deficits. In Study 1, children with LI (N = 29, ages 6 to 12 years) performed significantly worse than typically developing children (N = 26) on the Hierarchical Forms Memory task. In Study 2, children with LI (N = 15; ages 9 to 12 years) performed significantly worse than typically developing children (N = 40) on the Rey-Osterrieth Complex Figure task. Children with LI were less accurate and tended to use a fairly piecemeal (immature) strategy when copying the figure and were less likely to draw the core rectangle in a more integrated fashion during the immediate memory condition. These results suggest children with LI have subtle deficits on visuospatial tasks that may be more indicative of limitations associated with processing load and planning than of specific visuospatial processing deficits (JINS, 2006, 12, 465–474.)

The current project examined the impact of differential motivation on baseline versus post-mild traumatic brain injury (MTBI) neuropsychological measures in athletes. Collegiate athletes were administered a neuropsychological battery prior to and post-MTBI. High Motivation at Baseline (HMB) and Suspect Motivation at Baseline (SMB) groups were established for each measure based on whether baseline performance fell +/− one or more standard deviations from the mean of the given measure. Greater improvement was expected in the SMB group than the HMB group given hypothesized differences in baseline motivation. In repeated measures analysis of covariance (ANCOVA) that removed achievement performance, the SMB groups demonstrated greater improvement than the HMB groups for the Trail Making Test A & B (TMT-A & B), Digit Span, and Stroop-Color Word (Stroop-CW) tests. Also, the percentage of participants who improved according to reliable change indices was greater for the SMB groups on the TMT-A & B, Stroop-CW, and the Vigil. These findings are likely due to lower motivation in the SMB group for each test. However, results also suggest that some tests may be relatively unaffected by motivation. These data may have clinical implications and point to the need for better methods of identifying athletes with suspect motivation at baseline. (JINS, 2006, 12, 475–484.)

The Attention Network Test (ANT) uses visual stimuli to separately assess the attentional skills of alerting (improved performance following a warning cue), spatial orienting (an additional benefit when the warning cue also cues target location), and executive control (impaired performance when a target stimulus contains conflicting information). This study contrasted performance on auditory and visual versions of the ANT to determine whether the measures it obtains are influenced by presentation modality. Forty healthy volunteers completed both auditory and visual tests. Reaction-time measures of executive control were of a similar magnitude and significantly correlated, suggesting that executive control might be a supramodal resource. Measures of alerting were also comparable across tasks. In contrast, spatial-orienting benefits were obtained only in the visual task. Auditory spatial cues did not improve response times to auditory targets presented at the cued location. The different spatial-orienting measures could reflect either separate orienting resources for each perceptual modality, or an interaction between a supramodal orienting resource and modality-specific perceptual processing (JINS, 2006, 12, 485–492.)

Subject-performed tasks (SPTs) may facilitate the deficit in associative learning among individuals with amnestic mild cognitive impairment (aMCI) by inducing episodic integration of object-action associations. To test this hypothesis, we examined free recall and recognition memory following enactment and verbal encoding in healthy elderly controls and individuals with aMCI. Study lists contained either semantically integrated (“Bounce the ball”) or crossed object-action commands, in which episodic and semantic associations were placed in opposition (“Pet the compass”). Associative learning was indeed better after SPT than verbal encoding and with integrated relative to crossed lists for the aMCI group, as it was for controls. Moreover, the degree to which SPTs reduced the semantic interference inherent in the crossed conditions was equivalent for the two groups. The results showed that enactment facilitates formation of episodic associations, even when not supported by preexisting semantic knowledge, and even among individuals who have particular difficulty forming new associations (JINS, 2006, 12, 493–501.)

Sex differences in executive speech tasks, favoring women, have been noted in behavioral studies and functional imaging studies. In the present study, the clustering and switching components of semantic and phonemic verbal fluency tests were examined in 40 healthy men and 40 healthy women. Possible sex differences in the influence of cognitive factors such as speed of information processing, word knowledge, and/or verbal long-term memory on these verbal fluency factors were also assessed. The results showed that women switched more often between categories in the phonemic fluency test, whereas men showed a trend toward a larger cluster size leading to a smaller total number of words generated. Additionally, higher performance on the Digit Symbol test was associated with better performance on the semantic and phonemic verbal fluency test in men, whereas in women, better memory performance was associated with better performance on these verbal fluency tests. Our data indicate that men and women are using different processing strategies for phonemic verbal fluency tests to optimize verbal fluency task performance. In the current study, women adopted a more successful strategy of balancing clustering and switching in the phonemic fluency task. (JINS, 2006, 12, 502–509.)

Patients with schizophrenia exhibit normal memory for separate objects or locations but are disproportionately impaired when the items must be bound for later recognition in a working memory (WM) setting (Burglen et al., 2004). This study aimed at further evaluating the contribution of each WM component to the patients' binding deficit, using selective articulatory, visuospatial, and executive suppression tasks. In the object–location binding task used, a trial comprised the successive presentation of three drawings of familiar objects and of three spatial locations in a grid, either separately (i.e., objects alone or locations alone) or bound (i.e., object+location), and required a recognition test following an 8-s delay. In the suppression modalities, suppression was continuous from presentation to test. A total of 22 patients with schizophrenia and 24 healthy controls participated. The results confirmed the binding deficit in patients' performance in the baseline modality where no suppression was required. They also showed that patients were particularly disrupted when suppression was visuospatial. This last finding extends the specific visuospatial vulnerability in schizophrenia to the operations of binding. (JINS, 2006, 12, 510–518.)Note: The data provided in this study have been partly matter of a university thesis presented by Franck Burglen.

Attentional impairments in children occur in the context of both developmental and acquired disorders involving the central nervous system (CNS) and may have implications for ongoing development, potentially impeding cognitive, educational, and behavioral functions. Using a continuous performance paradigm (CPT), this study compared attentional profiles of children with developmental and acquired conditions impacting on the CNS: (i) attention deficit–hyperactivity disorder (ADHD: n = 27); (ii) moderate traumatic brain injury (TBI: n = 41); (iii) acute lymphoblastic leukemia (n = 31); and (iv) insulin-dependent diabetes mellitus (n = 39). A healthy control group (n = 46) was also examined. Groups were compared on measures of sustained attention, selective attention, and response inhibition. In addition, measures of performance variability and deterioration and processing speed were examined. Results showed that children with ADHD exhibited global and severe attentional impairments in contrast to all other groups. Children with moderate TBI displayed mild attentional difficulties, restricted to selective and sustained attention domains. In conclusion, although CPT parameters differentiated the ADHD group from all others, a disorder-specific profile was not observed. (JINS, 2006, 12, 519–531.)

The spatial allocation of attention influences estimates of stimulus magnitude, including line length and the line bisection task has been used to assess the asymmetrical allocation of spatial attention. The purpose of this study is to learn if normal subjects' allocation of attention changes as a function of the trunk–head centered spatial position of the line stimuli. Normal subjects were asked to bisect lines placed in five different head–trunk centered special positions (central, right up–distal, left up–distal, right down–proximal, left down–proximal). When compared with the central condition, deviations in the right or left lateral conditions were only significant in the down–proximal conditions, such that the bisection bias significantly shifted direction to the left of the objective midline in left hemispace and to the right of the objective midline in right hemispace, suggesting that stimuli presented in lateral hemispace primarily activate the contralateral hemisphere's attentional systems. The finding that the lines presented in down–proximal lateral hemispace induce a greater spatial bias than lines in up–distal lateral space suggests that the portion of the brain's dorsal visual system, which processes stimuli in down–proximal space, influences the horizontal (right–left) spatial allocation of attention more than does the brain's ventral visual system. (JINS, 2006, 12, 532–537.)

Three hypotheses for cognitive deficits among psychopaths were tested: executive dysfunction, left hemisphere activation, and an interaction between the two. Twenty-one psychopathic and 23 nonpsychopathic criminal offenders identified with the Hare Psychopathy Checklist-Revised participated in verbal and visual-spatial tasks during which the level of executive processing demands was manipulated. Consistent with prior research, psychopathic offenders made more errors than controls, but only during the verbal task and only on trials with high executive demand. Within those trials, most errors occurred when set-maintenance demands were the highest. No response latency differences between groups were found. (JINS, 2006, 12, 538–548.)This article is a replication and extension of our previous study that was published in the JINS, volume 11, 2005. The article appeared as “State-dependent Executive Deficits Among Psychopathic Offenders,” by Suchy & Kosson, 2005, JINS, 11:3, pp. 311–321. There was no overlap in participants between the two studies.

Cognitive impairment occurs in roughly 50% of patients with multiple sclerosis (MS). It is well known that processing speed and episodic memory deficits are the most common neuropsychological (NP) sequelae in this illness. Consensus has emerged about the specific tests that prove most helpful for routine monitoring of MS associated cognitive impairment. The purpose of this study was to examine the validity of the Minimal Assessment of Cognitive Function in MS (MACFIMS), a recommended battery based on the findings of an international conference held in 2001. We tested 291 MS patients and 56 healthy controls. Frequencies of impairment paralleled those reported in previous work for both individual cognitive domains and general impairment. All tests were impaired in the MS group, and distinguished relapsing-remitting (RR) from secondary progressive (SP) course. Principle components analysis showed a distinct episodic memory component. Most of the MACFIMS tests discriminated disabled from employed patients. However, in regression models accounting for all NP tests, those emphasizing verbal memory and executive function were most predictive of vocational status. We conclude that the MACFIMS is a valid approach to routine NP assessment of MS patients. Future work is planned to determine its psychometric properties in a longitudinal study. (JINS, 2006, 12, 549–558.)

Many patients with multiple sclerosis (MS) show cognitive and emotional disorders. The purpose of this study is to evaluate the role of contingency learning in decision-making in young, non-depressed, highly functioning patients with MS (n = 21) and in matched healthy controls (n = 30). Executive functions, attention, short-term memory, speed of information processing, and selection and retrieval of linguistic material were also investigated. Contingency learning based on the cumulative effect of reward and punishment was assessed using the Iowa Gambling Test (IGT). In the classic ABCD version of the IGT, advantageous decks are characterized by immediate small reward but even smaller future punishment. In the modified EFGH version, advantageous decks are characterized by immediate large punishment but even larger future reward. Results revealed that patients with MS showed significant dysfunctions in both versions of the IGT. Performances on neuropsychological tests sensitive to dorsolateral prefrontal functions did not predict and did not correlate with the IGT scores. These results suggest that patients with MS show impaired performances on tasks designed to assess decision-making in a situation requiring the evaluation of long-term outcomes regardless of gain or loss, and that this deficit is not a pure consequence of executive dysfunctions (JINS, 2006, 12, 559–565.)

Research conducted with the Rey-figure task has suggested that patients with obsessive-compulsive disorder (OCD) process local aspects of a complex stimulus more efficiently than the overall gestalt. The aim of the present study was to investigate if this “local bias” is established already during early stimulus encoding or occurs only during later processing, once a percept has been formed (e.g., memory retrieval). To this end, responding to local and global targets of hierarchical letters (e.g., an “E” composed out of small “T”s) was assessed in 30 OCD patients and 28 healthy controls. OCD patients and controls performed comparably on all parameters. These results lend no support to the notion of an early perceptual bias towards local elements in OCD patients. It remains to be tested whether a bias towards local features is confined to situations where local and global features compete for selection. (JINS, 2006, 12, 566–569.)

Amnestic mild cognitive impairment (aMCI) represents a high-risk factor for Alzheimer's disease (AD) and is characterized by a selective decline in episodic memory. Although by definition aMCI is not associated with impaired verbal fluency performance, we examined relative differences between fluency tasks because AD is characterized by poorer semantic than phonemic fluency. Phonemic and semantic fluency trials were administered to 46 healthy controls, 33 patients with aMCI, and 33 patients with AD. Results revealed a progressive advantage (controls > aMCI > AD) in semantic, relative to phonemic fluency. Difference scores between tasks distinguished each group from the others with medium to large effect sizes (d) ranging from 0.49 to 1.07. Semantic fluency relies more on semantic associations between category exemplars than does phonemic fluency. This aMCI fluency pattern reflects degradation of semantic networks demonstrating that initial neuropathology may extend beyond known early changes in hippocampal regions. (JINS, 2006, 12, 570–574.)The data were collected in accordance with the guidelines of the Helsinki Declaration and approved by the Research Ethics and Scientific Review Committee of Baycrest Centre. This is an original submission. Portions of these data were presented at the annual meeting of the International Neuropsychological Society, February 2005, St. Louis, Missouri. There is no conflict of interest.

The aim of this study was to explore multitasking skills in a Chinese sample of 22 children with attention deficit–hyperactivity disorder (ADHD) compared with 22 healthy controls matched by gender, age, and IQ. All of the participants completed the children's version of the Six Elements Test (C-SET) and neuropsychological tests that captured specific domains of attention, memory, and executive function. Children with ADHD performed significantly worse than the healthy controls in all domains except the number of rules broken in the C-SET. The majority of the C-SET domain scores correlated significantly with measures of executive function. The ADHD group also demonstrated deficits in various neurocognitive test performances compared with the healthy group. This preliminary study suggests that the C-SET is sensitive to multitasking behavior in Chinese children with ADHD. The main impairments of multitasking behavior in this clinical group involve the inhibition of goal-directed planning, flexible strategy generation, and self-monitoring. (JINS, 2006, 12, 575–579.)

This study examined whether memory span was impaired during the acute and post-acute phases following mild traumatic brain injury (mTBI). Twenty-two adults with mTBI were compared with 22 controls on computerized tasks of immediate memory for verbal, spatial, and hand movement sequences under no interference (baseline) and articulatory suppression conditions. Groups were assessed within a month and followed up 3–12 months post-injury. In the acute phase, there were no group differences across tasks under either condition. At follow-up, all spatial and verbal span scores and associated practice effects were equivalent across groups. Yet for the hand movement task, baseline movement span was worse for the mTBI group suggesting that they failed to benefit from practice to the same extent as controls. Furthermore, the fact that this group difference in span scores disappeared when articulatory suppression was imposed indicates that successful hand movement task performance involves verbal recoding. (JINS, 2006, 12, 580–584.)

The Lost Self: Pathologies of the Brain and Identity. Todd E. Feinberg and Julian Paul Keenan (Eds.). 2005. New York: Oxford University Press, 275 pp., $49.95 (HB).

The recent emergence of the field of social cognitive neuroscience has been accompanied by an increasing number of studies aimed at uncovering the neurobiological basis of the self. For instance, several studies have now been published using functional neuroimaging to uncover neural responses to self-related processing in healthy subjects. Complementing this approach, important insights regarding the brain and the self can be obtained from studying neurological and psychiatric conditions that affect the self. Examples of such conditions are frontal lobe impairment, autobiographical disorders, dissociative disorders, schizophrenia, and autism. The Lost Self, edited by Todd E. Feinberg and Julian Paul Keenan, addresses both types of research endeavors. The reader gets even more: a perspective from philosophy and a first-person account.

Atypical Parkinsonian Disorders: Clinical and Research Aspects. Irene Litvan (Ed.). 2005. Totowa, NJ: Humana Press, 512 pp., $175.00 (HB).

This edited collection of perspectives on Atypical Parkinson's Disease, or Parkinson's plus as it is often called, is both a treasure and a pleasure. The editor, Irene Litvan, ably accomplishes the daunting task of bringing order to what might be considered a grab bag of diagnostic leftovers in Chapter 1. To the generalist, fair warning that Parkinson's plus may be misconstrued as Parkinson's minus, since tremor, the most commonly recognized symptom may not be a feature of at least some of these syndromes. Litvan provides us with an organizational structure for summarizing clinical features and surmising etiologies. An extensive literature review is distilled to give impressions of when to suspect these diagnoses, hints to the natural progression, and discussion of the validity of specific diagnoses within the atypical PD spectrum. Chapter 2, on historical perspectives, is one that is so tempting to skip in the rush to get to the most up to date science. Please don't, because it is one of the gems of this tome. In his readable style, Christopher Goetz reminds us that clinical skill begins with being a good observer and this will serve the field throughout time. His selection of historical anecdotes, literary passages, and classic photographs illustrates the timelessness of some of these clinical entities. The photograph from the 1925 Lhermitte et al. report so captured the syndrome of cortical basal degeneration, that I suddenly recalled several similar patients and was reassured that there was something more than idiosyncratic imposition of this diagnosis.

Treating Neurodevelopmental Disabilities: Clinical Research and Practice. Janet E. Farmer, Jacobus Donders, and Seth Warschausky (Eds.). 2006. New York: Guilford Press. 336 pp., $48.00 (HB).

Born of a “growing frustration over the lack of evidence available to guide interventions for children with disabilities” (p. xiii), this volume was undertaken to address a major gap in the literature. Its editors attempt to end the frustration both for themselves and their colleagues. Moreover, they enlist the aid of well-known figures in neuropsychology to assist them in this effort and contribute some of their own important conceptualizations. The volume is divided into three parts: (I) Overview, (II) Psychological and Social Aspects of Childhood Disability, and (III) Innovative Treatment Strategies. The text is organized well and its clarity and easy to read format makes it ideal for professionals looking for concisely written chapters that highlight current research. Each chapter smoothly transitions to the next despite the broad coverage inherent to the topic of neurodevelopmental disabilities. Excellent use of graphs and charts illustrate central research points, pertinent ideas, and core treatment elements. Although one might expect a neurodevelopmental disabilities text to focus primarily on children and the significant impact on the family system, this volume does not neglect the impact of these disabilities in adults.