Recent studies have reported abnormal implicit learning of sequential patterns in patients with schizophrenia. Because these studies were based on visuospatial cues, the question remained whether patients were impaired simply due to the demands of spatial processing. This study examined implicit sequence learning in 24 patients with schizophrenia and 24 healthy controls using a non-spatial variation of the serial reaction time test (SRT) in which pattern stimuli alternated with random stimuli on every other trial. Both groups showed learning by responding faster and more accurately to pattern trials than to random trials. Patients, however, showed a smaller magnitude of sequence learning. Both groups were unable to demonstrate explicit knowledge of the nature of the pattern, confirming that learning occurred without awareness. Clinical variables were not correlated with the patients' learning deficits. Patients with schizophrenia have a decreased ability to develop sensitivity to regularly occurring sequences of events within their environment. This type of deficit may affect an array of cognitive and motor functions that rely on the perception of event regularity. (JINS, 2005, 11, 659–667.)

Previous research has provided evidence of metamemory impairments in patients with frontal lobe damage on verbal episodic memory tasks. In the present study, we employed metamemory paradigms to investigate whether patients with frontal lesions show monitoring deficits on semantic memory tasks involving facial stimuli. Patients with frontal lobe damage and healthy control subjects made memory decisions to famous faces in a retrospective confidence judgment task and in a prospective feeling-of-knowing (FOK) task. Results indicated that frontal patients performed worse than controls on the retrospective confidence task, but there were no differences between the groups on the FOK task. These findings suggest that metamemory deficits in frontal patients are not confined to specific stimulus domains (words vs. faces) or memory systems (episodic vs. semantic). In addition, the dissociation between retrospective confidence judgments and FOK accuracy documented in this study and also in a recent report by Schnyer et al. suggesting that metamemory should not be considered a unitary function with a single neuroanatomic substrate. (JINS, 2005, 11, 668–676.)

Past research has shown that lesions in the left cerebral hemisphere often result in aphasia, while lesions in the right hemisphere frequently impair the production of emotional prosody and facial expression. At least 3 processing deficits might account for these affective symptoms: (1) failure to understand the conditions that evoke emotional response; (2) inability to experience emotions; (3) disruption in the capacity to encode non-verbal signals. To better understand these disorders and their underlying mechanisms, we investigated spontaneous affective communication in right hemisphere damaged (RHD) stroke patients with aprosody and left hemisphere damaged (LHD) stroke patients with aphasia. Nine aprosodic RHD patients and 14 aphasic LHD patients participated in a videotaped interview within a larger treatment protocol. Two naïve raters viewed segments of videotape and rated facial expressivity. Verbal affect production was tabulated using specialized software. Results indicated that RHD patients smiled and laughed significantly less than LHD patients. In contrast, RHD patients produced a greater percentage of emotion words relative to total words than did LHD patients. These findings suggest that impairments in emotional prosodic production and facial expressivity associated with RHD are not induced by affective–conceptual deficits or an inability to experience emotions. Rather, they likely represent channel-specific nonverbal encoding abnormalities. (JINS, 2005, 11, 677–685.)

Traumatic brain injury (TBI) frequently results in memory problems, and the degree of memory impairment is related to injury severity and is commonly associated with lesions in frontal and temporal brain areas. This study examined the relationship among injury severity, brain lesions, and memory in children with moderate to severe TBI using Donders' (1999) 5-factor model of performance on the California Verbal Learning Test–Children's Version (CVLT–C). Seventy-six children underwent magnetic resonance imaging (MRI) scans 3 months post-TBI and testing 1 year post-TBI. Results showed injury severity (Glasgow Coma Scale) was not predictive of performance on 4 of the 5 factors. Volume of frontal and/or temporal brain lesions was significantly predictive of performance on 3 of the 5 factors. Unexpectedly, lesion volume outside these areas (extra-frontotemporal) was predictive of performance on all 5 factors. In contrast, Verbal IQ at 1 year was most strongly associated with preinjury factors (socioeconomic status and special education involvement), although extra-frontotemporal lesions also contributed to the variability in this measure. Results suggest that in children with moderate to severe TBI, extra-frontal/temporal lesions are predictive of memory outcome 1 year postinjury above and beyond initial severity or frontal/temporal contusions. This finding may relate to widespread diffuse axonal injury, which potentially disconnects brain circuits mediating memory following moderate to severe TBI. (JINS, 2005, 11, 686–696.)

Lateralized spatial biases after brain damage are commonly assessed using batteries of paper-and-pencil tests. These tests hardly allow quantification of performance in different locations in space, and they tend to lose sensitivity along the course of recovery. We tested the dynamic Starry Night Test (SNT), a novel computerized test measuring reaction time and detection accuracy for visual target stimuli in a dynamic background, in 32 inpatients with right hemisphere stroke (RHS), 16 patients with left hemisphere stroke (LHS), and 9 healthy controls. As a group, only the RHS patients were significantly slower to respond to contralesional targets. Individually, 21 (66%) RHS patients and 5 (31%) LHS patients showed statistically significant contralateral deficits. In a number of RHS patients the SNT was more sensitive to the ipsilesional bias of spatial attention than the Behavioral Inattention Test (BIT), a standardized paper-and-pencil test battery of unilateral spatial neglect. Two illustrative case reports show that the dynamic SNT, but not the BIT, was sensitive to the spatial deficit in recovered patients, one of whom was involved in repeated car accidents. The SNT overcomes serious shortcomings of paper-and-pencil tests of unilateral neglect. It provides a simple quantitative tool for monitoring the natural and treatment-induced recovery of patients. (JINS, 2005, 11, 697–707.)Part of the data was presented in abstract form at the EBBS EuroConference on Cognitive and Neural Bases of Spatial Neglect, September 14–17, 2000, Como, Italy.

Memory tests that are in a recall format have almost universally measured accuracy in terms of the number of target items reported by the examinee. However, this traditional scoring method can, in certain cases, result in artificially inflated memory accuracy scores. That is, just as a “yes” response bias and high false-positive rate on recognition testing can artificially inflate a patient's hit rate, so, too, a liberal response bias and high intrusion rate on recall testing can artificially inflate a patient's level of target recall. Recognition tests correct for this problem by using a discriminability measure that provides a single score of hit rate relative to false-positive rate; however, recall tests rarely provide a single score of recall accuracy that corrects for intrusion rate. In the present study, we examined the utility of a new recall discriminability measure that analyzes target recall relative to intrusion rate. Patients with Alzheimer's disease (AD) or Huntington's disease (HD) were administered the CVLT–II, which provides both the traditional measure of target recall and a new measure of recall discriminability. The results indicate that the new recall discriminability measure was superior to the traditional level of target recall measure in distinguishing the recall performance of AD and HD patients. Implications of these results for clinical practice and theories of memory disorder in dementia are discussed. (JINS, 2005, 11, 708–715.)

The longitudinal effects of age on confrontation naming using the 60-item Boston Naming Test (BNT) were studied in 541 “normal” elderly (ages 50–99). For participants with at least 4 annual assessments (n = 238), 150 were followed for ≥6 years, 81 for ≥8 years, and 43 for ≥10 years. A small practice effect (0.21 words, p = 0.06) and moderately high test-retest reliability were found when comparing the first 2 assessments, which were 9–15 months apart (r = 0.76, n = 353). Reliable change index scores indicated that an annual decline of ≥4 points on the BNT is needed for a statistically reliable decline in an individual. A gradient in the mean annual rate of change on the BNT was found with improvement in the 50s age group, no change in the 60s age group, and decline in the 70s and 80s age groups. When projected over 10 years, the magnitudes of the mean changes were relatively small, that is, a 1-word improvement for participants in their 50s and a 1.3-word decline for participants in their 70s. These findings demonstrate that lexical retrieval as measured by a visual object confrontation naming task is generally well preserved in aging with only subtle decline in the 7th and 8th decades of age. (JINS, 2005, 11, 716–726.)

Repeated neuropsychological testing gives rise to practice effects in that patients become familiar with test material as well as test-taking procedures. Using alternate forms prevents the learning of specific test stimuli, potentially mitigating practice effects. However, changing forms could diminish test-retest reliability coefficients. Our objective was to examine test-retest effects in multiple sclerosis (MS) patients randomly assigned to same- (SF) or alternate-form (AF) conditions. Thirty-four MS patients underwent neuropsychological evaluation. The battery included the California Verbal Learning Test II (CVLT-II) and the Brief Visuospatial Memory Test–Revised (BVMT-R), memory tests recommended by a recently convened consensus panel. Patients were randomly assigned to SF or AF groups and then tested at baseline and follow-up examination 1 week later. Analysis of variance tests (ANOVAs) revealed significant group × time interactions, with SF patients showing greater gain than AF patients. SF practice effects were often large, compromising test validity. Reliability coefficients were either equivalent or higher in the AF group, a finding attributed to ceiling effects and reduced variance in the SF group at retest. The generalizability of the findings may be limited to short test-retest intervals and the MS population. Nevertheless, I conclude that the use of CVLT-II and BVMT-R alternate forms likely helps preserve test validity without compromising test-retest reliability. (JINS, 2005, 11, 727–736.)

To explore verbal memory impairments associated with multiple sclerosis (MS), we compared proactive and retroactive interference effects on the California Verbal Learning Test (CVLT; Delis et al., 1987) in a sample of 83 community-residing individuals with MS and 80 healthy participants. Individuals with MS demonstrated normal accumulation of proactive interference (PI), but attenuated release from PI relative to healthy individuals. Furthermore, accumulation of retroactive interference (RI) at short-delay free recall (SDFR) was intensified for those with MS as compared to healthy participants. Interestingly, accumulation of RI predicted long-term memory (LTM) only for participants with MS. These findings suggest that individuals with MS may experience particular difficulty when required to use semantic properties of information flexibly to facilitate verbal LTM. (JINS, 2005, 11, 737–746.)

We examined, among those persons working preinjury, the risk of unemployment 1 year after traumatic brain injury (TBI) relative to expected risk of unemployment for the sample under a validated risk-adjusted econometric model of employment in the U.S. population. Results indicate that 42% of TBI cases were unemployed versus 9% expected, relative risk (RR) = 4.5, 95% confidence interval (CI) (4.12, 4.95). The relative risk for unemployment was higher among males, those with higher education, persons with more severe injuries, and more impaired early neuropsychological or functional status. Difference in unemployment rates gave similar results for gender, severity of injury, and early neuropsychological and functional status. However, for education, the excess was smaller among those more highly educated, but the unemployment rate in the more highly educated in the general population was sufficiently small to yield a larger relative risk. In conclusion, after accounting for underlying risk of unemployment in the general population, unemployment is substantially higher after TBI for people who were employed when they were injured. The differential employment status varies depending on demographics, severity of brain injury, early functional outcome, and neurobehavioral indicators. For characteristics such as education, associated with rates of unemployment in the general population, different methods used to compare the rates may yield different results. (JINS, 2005, 11, 747–752.)

Ecstasy (MDMA) is a popular drug that can act as a selective serotonin neurotoxin in several species. The goal of the present study was to examine the relationship between ecstasy exposure and cognitive functioning after controlling for other drug use and demographic variables. Furthermore, we assessed whether gender was a moderator of the relationship between cognitive functioning and ecstasy use. Data were collected from 31 men and 34 women with a wide range of ecstasy use (17 marijuana users with no ecstasy use and 48 ecstasy users ranging from low to heavy use). Participants were interviewed and administered a battery of neuropsychological tests. The primary finding was that ecstasy exposure was significantly related to poorer verbal learning and memory ability in a dose-dependent manner, while no such relationship was observed between ecstasy exposure and executive functioning or attentional ability. Gender was found to significantly moderate the relationship between ecstasy consumption and design fluency. These results suggest primary memory dysfunction among abstinent recreational ecstasy users. This finding is consistent with reports of hippocampal vulnerability, particularly among heavy users. (JINS, 2005, 11, 753–765.)

Neuropsychological and motor deficits in Parkinson's disease that may contribute to driving impairment were examined in a cohort study comparing patients with Parkinson's disease (PD) to patients with Alzheimer's disease (AD) and to healthy elderly controls. Nondemented individuals with Parkinson's disease [Hoehn & Yahr (H&Y) stage I–III], patients with Alzheimer's disease [Clinical Demetia Rating scale (CDR) range 0–1], and elderly controls, who were actively driving, completed a neuropsychological battery and a standardized road test administered by a professional driving instructor. On-road driving ability was rated on number of driving errors and a global rating of safe, marginal, or unsafe. Overall, Alzheimer's patients were more impaired drivers than Parkinson's patients. Parkinson's patients distinguished themselves from other drivers by a head-turning deficiency. Drivers with neuropsychological impairment were more likely to be unsafe drivers in both disease groups compared to controls. Compared to controls, unsafe drivers with Alzheimer's disease were impaired across all neuropsychological measures except finger tapping. Driving performance in Parkinson's patients was related to disease severity (H&Y), neuropsychological measures [Rey Osterreith Complex Figure (ROCF), Trails B, Hopkins Verbal List Learning Test (HVLT)-delay], and specific motor symptoms (axial rigidity, postural instability), but not to the Unified Parkinson Disease Rating Scale (UPDRS) motor score. Multifactorial measures (ROCF, Trails B) were useful in distinguishing safe from unsafe drivers in both patient groups. (JINS, 2005, 11, 766–775.)

This study investigates response inhibition deficits in obsessive-compulsive disorder (OCD) by using the Hayling task. Sixteen OCD washers, 16 OCD checkers, 16 social phobic patients and 16 nonanxious controls were asked to complete sentences with either the expected word (section A: “initiation”) or an unrelated word (section B: “inhibition”). The groups did not differ in terms of section B minus section A latencies. However, OCD washers and checkers made significantly more errors (sentence-related responses) in section B than social phobic patients and controls. In the OCD patients, the frequency of these errors correlates with the total OCD severity score and the compulsion subscore, but not with the depression and anxiety scores. These findings suggest that OCD patients might present a specific deficit affecting the inhibition of a prepotent response. (JINS, 2005, 11, 776–783.)

Diagnostic neuropsychological assessment requires the clinician to estimate a patient's premorbid abilities. Word reading tests, such as the National Adult Reading Test–Revised (NART–R), provide reasonably accurate estimates of premorbid IQ, but their capacity to benchmark other premorbid cognitive abilities remains unclear. In this extension of an earlier report, we administered the NART–R, an abbreviated Wechsler Adult Intelligence Scale (WAIS–R or WAIS–III), and 26 other cognitive measures to 322 reasonably healthy adults. While NART–R performance correlated robustly (rs ≥ .72) with concurrent Verbal and Full Scale IQ, its correlation with all other cognitive measures was significantly lower. Thus, while it is appealing to use word reading as a proxy for premorbid functioning in other cognitive domains, the NART–R has limited utility for this because it does not predict current performance on other cognitive tests as well as it predicts IQ in healthy adults. (JINS, 2005, 11, 784–787.)

McCrea and colleagues (2005) sought to evaluate the efficacy of a multidimensional assessment approach to the management of concussion in contact sport in their article entitled “Standard regression-based methods for measuring recovery after sport-related concussion.” They used the Standardized Regression-Based (SRB) method to determine when an athlete was recovered. Though not in the above article, the SRB is often presented alongside the Reliable Change Index adjusted for practice (RCIp) and the clinician must choose which to use with limited direction. This letter seeks to further elaborate on why the SRB may be preferred and how tighter methodology is perhaps even more important.

Forensic Neuropsychology: A Scientific Approach. Glenn Larrabee (Ed.). 2005. New York: Oxford University Press, 479 pp., $68.50.

As a practitioner of the art and as an instructor for a course in “neuropsychology and the law,” I can assure you that all of my students will be assigned Larrabee's Forensic Neuropsychology in coming semesters. The editor and his co-authors have assembled a thoughtful and comprehensive introduction to a rapidly evolving area of science and practice. The unique contributions that neuropsychological assessment and an understanding of brain-behavior relationships can provide are fast becoming the rule, rather than the exception, in civil, criminal, and, sometimes, even probate litigation.

Event Related Potentials: A Methods Handbook. Todd C. Handy (Ed.). 2005. Cambridge, MA: Bradford/MIT Press, 404 pp., $60.00.

The dramatic increase in interest in functional magnetic resonance imaging in recent years has been accompanied by a wealth of literature on the scientific foundations of the procedure and the highly complex methodological issues that must be considered during experimental design and data analysis. To some extent, progress in this exciting area has eclipsed significant developments in other areas of neuroimaging, particularly the “neuromagnetic” approaches that study time-locked brain electrical potentials or magnetic field changes produced in the course of processing perceptual, cognitive, and motor events. However, there has been increasing recognition that the study of event-related electrical potentials and neuromagnetic responses remains a critical complement to “hemodynamic” approaches because of their exquisite temporal resolution and because they provide a more direct index of neural activity related to stimulus events than procedures dependent on the coupling of brain activity with cerebral blood flow. In this context, Event Related Potentials: A Methods Handbook, edited by Todd C. Handy, represents an important and long overdue handbook. It provides practical and concise information on ERP methods that is comparable to literature available for fMRI techniques.

Essays in Social Neuroscience. John T. Cacioppo and Gary G. Berntson (Eds.). 2004. Cambridge, MA: The MIT Press, 168 pp., $32.00/£20.95.

Essays in Social Neuroscience, edited by John T. Cacioppo and Gary G. Berntson, is a slim collection of highly engaging and—for the overextended neuropsychologist—enjoyably brief essays surveying current research and theory in the emerging field of social neuroscience. Each contributor attests to the variety of examples of research bridging the historic divide between neuroscience and social psychology. For neuropsychologists, this volume offers enlightening demonstrations of the potential for traditional methods in neuroscience to speak to the complex and reciprocal interplay between neural systems and the social world. From Sue Carter's essay “Oxytocin and the Prairie Vole: A Love Story” to Shelley E. Taylor's contribution “The Accidental Neuroscientist: Positive Resources, Stress Responses, and Course of Illness,” these essays speak to such diverse issues as interpersonal attraction, loyalty, emotional reactivity, and environmental contributions to autoimmune disease. Some essays speak more to the potential for bridging the gap than to demonstrated success in this effort, but those essays remain pleasurable, rewarding reads. The large majority of essays, four of which are described in more detail below, beautifully exemplify the fruitfulness of this area of inquiry.