The use of nonliteral language in clinical assessment, especially testing the patients’ ability to interpret proverbs, has a long tradition in psychiatry. However, its diagnostic sensitivity and specificity in dementias is not yet clear. The aim of this review article is to examine the current evidence on nonliteral/figurative language (proverb, metaphor, metonymy, idiom, irony, sarcasm) comprehension in Alzheimer's disease and related disorders. A comprehensive literature search identified 25 studies (16 proverb, 3 metaphor, 0 metonymy, 5 idiom, 3 sarcasm) on nonliteral language comprehension in dementia. Studies predominantly indicate a deficit. Most studies investigated Alzheimer's dementia. Applied correctly, nonliteral language is a worthwhile diagnostic tool to evaluate language and abstract thinking in dementias. During assessment, familiarity testing (e.g., by asking “are you familiar with the proverb XY”) is obligatory. Still, future research is needed in several areas: evidence on decline of nonliteral language over the course of the illness is limited. So far, almost no studies delineated proverb comprehension in high risk populations such as patients with mild cognitive impairment. Currently, there is a lack of studies addressing performance in direct comparison to relevant differential diagnosis like older-age depression, delirium, brain lesion, or other psychiatric conditions. (JINS, 2011, 17, 207–218)

Persistent cognitive complaints are common following a mild head injury (MHI), but deficits are rarely detected on neuropsychological tests. Our objective was to examine the effect of symptom expectation on self-report and cognitive performance measures in MHI individuals. Prior research suggests that when MHI participants are informed they may experience cognitive difficulties, they perform worse on neuropsychological tests compared to MHI participants who are uninformed. In this study, undergraduate students with and without a prior MHI were either informed that the study's purpose was to investigate the effects of MHI on cognitive functioning (“diagnosis threat” condition) or merely informed that their cognitive functioning was being examined, with no mention of status (“neutral” condition). “Diagnosis threat” MHIs self-reported more attention failures compared to “diagnosis threat” controls and “neutral” MHIs, and more memory failures compared to “diagnosis threat” controls. In the “neutral” condition, MHIs reported higher anxiety levels compared to controls and compared to “diagnosis threat” MHIs. Regardless of condition, MHIs performed worse on only one neuropsychological test of attention span. “Diagnosis threat” may contribute to the prevalence and persistence of cognitive complaints made by MHI individuals found in the literature, but may not have as strong of an effect on neuropsychological measures. (JINS, 2011, 17, 219–229)

The performance of 65 patients with complicated mild–severe traumatic brain injury was evaluated on the Verbal and Design Fluency subtests of the Delis-Kaplan Executive Function System (D-KEFS), and compared with that of 65 demographically matched healthy controls. There were statistically significant group differences on Letter Fluency and Category Switching but not on any of the Design Fluency tasks. Combined, these two Verbal Fluency subtests had a classification accuracy of 65.39%, associated with a likelihood ratio of 1.87. The impact of length of coma on Letter Fluency performance but not Category Switching was mediated at least in part by processing speed. The findings suggest modest criterion validity of some of the D–KEFS Verbal Fluency subtests in the assessment of patients with complicated mild–severe traumatic brain injury. (JINS, 2011, 17, 230–237)

We report the heritability of response inhibition, latency, and variability, which are potential markers of genetic risk in neuropsychiatric conditions. Genetic and environmental influences on cancellation and restraint, response latency, and variability measured in a novel variant of the stop signal task were studied in 139 eight-year-old twin pairs from a birth cohort. Cancellation (50%), restraint (27%), and response latency (41%) showed significant heritability, the balance being non-shared environmental influences and/or error. Response variability was not heritable, with 23% of the variance attributable to shared environmental influences and 77% to non-shared environmental risk or error. The phenotypic correlation between response cancellation and restraint was −.44 and between response latency and restraint was .21. These phenotypic correlations were entirely genetic in origin. The phenotypic correlation between response variability and % successful inhibition was .27, but was not genetic. Cancellation and restraint were heritable and shared genetic influences, indicating that they may be influenced by a common gene or genes. Response latency was moderately heritable and shared genetic influences with restraint, but was not correlated with cancellation. Response variability was not heritable. These results support the potential of response inhibition and latency as endophenotypes in genetic research. (JINS, 2011, 17, 238–247)

Many people who sustain traumatic brain injuries (TBI) have poor psychosocial outcomes that have been related to the use of avoidant coping. A major obstacle to understanding the mechanisms of this relationship are the self-report measures by which coping has been traditionally evaluated. The purpose of the present study was to compare coping behavior during a simulated real-world stress test with self-reported coping. People with moderate-to-severe TBI and matched controls completed the Baycrest Psychosocial Stress Test (BPST) where coping behavior was evaluated, and also completed the Ways of Coping Questionnaire (WOC). While there were no group differences in self- or significant-other-reported behavior on the WOC, the TBI group engaged in more avoidant than planful behavior on the BPST, while the control group displayed the opposite pattern of behavior. Moreover, in the control group there were positive relations between behavior on the BPST and self-reported coping on the WOC, but no such relation within the TBI group. Secondary analyses allowed for TBI participants to be characterized as “planners” or “avoiders.” This is the first study, to our knowledge, to report behavioral differences in coping post-TBI. Future work investigating the moderators of these differences may have significant implications for rehabilitative intervention. (JINS, 2011, 17, 248–255)

This study investigated the specific patient factors that predict responsiveness to a cognitive rehabilitation program. The program has previously been demonstrated to be successful at the group level in patients with gliomas, but it is unclear which patient characteristics optimized the effect of the intervention at the individual level. Four categories of possible predictors of improvement were selected for evaluation: sociodemographic and clinical variables, self-reported cognitive symptoms, and objective neuropsychological test performance. Hierarchical logistic regression analyses were conducted, beginning with the most accessible (sociodemographic) variables and ending with the most difficult (baseline neuropsychological) to identify in clinical practice. Nearly 60% of the participants of the intervention were classified as reliably improved. Reliable improvement was predicted by age (p = .003) and education (p = .011). Additional results suggested that younger patients were more likely to benefit specifically from the cognitive rehabilitation program (p = .001), and that higher education was also associated with improvement in the control group (p = .024). The findings are discussed in light of brain reserve theory. A practical implication is that cognitive rehabilitation programs should take the patients’ age into account and, if possible, adapt programs to increase the likelihood of improvement among older participants. (JINS, 2011, 17, 256–266)

Early stages of affective or psychotic disorders may be accompanied by neuropsychological changes that help to predict risk of developing more severe disorders. A comprehensive set of neuropsychological measures was collected in 109 help-seeking young people (16 to 30 years; 54 females), recently diagnosed with an affective or psychotic disorder and presenting with current depression. Hierarchical cluster analysis determined three clusters: one deemed to have a “poor memory” profile (n = 40); another with a “poor mental flexibility” profile (n = 38) and a third with widespread difficulties plus “impaired attention and memory” (n = 31). In general, the three clusters were comparable in demographic, functional and clinical factors suggesting some unique role for neurocognitive impairments. A discriminant function analysis confirmed that the clusters were best characterized by performance in “attentional” versus “learning/memory” measures. Furthermore, profiles of independent neuropsychological variables validated the original solution for two of the clusters, distinguishing all cluster-groups on an attentional measure. The findings of this study suggest that despite presenting with very similar levels of current depressive symptomatology, young help-seeking individuals in the early stages of illness have underlying neuropsychological heterogeneity. Distinct neuropsychological profiling may help to predict later psychiatric outcomes and enhance individually-tailored early intervention strategies. (JINS, 2011, 17, 267–276)

Impairments in executive cognition (EC) may be predictive of incident dementia in patients with mild cognitive impairment (MCI). The present study examined whether specific EC tests could predict which MCI individuals progress from a Clinical Dementia Rating (CDR) score of 0.5 to a score ≥1 over a 2-year period. Eighteen clinical and experimental EC measures were administered at baseline to 104 MCI patients (amnestic and non-amnestic, single- and multiple-domain) recruited from clinical and research settings. Demographic characteristics, screening cognitive measures and measures of everyday functioning at baseline were also considered as potential predictors. Over the 2-year period, 18% of the MCI individuals progressed to CDR ≥ 1, 73.1% remained stable (CDR = 0.5), and 4.5% reverted to normal (CDR = 0). Multiple-domain MCI participants had higher rates of progression to dementia than single-domain, but amnestic and non-amnestic MCIs had similar rates of conversion. Only three EC measures were predictive of subsequent cognitive and functional decline at the univariate level, but they failed to independently predict progression to dementia after adjusting for demographic, other cognitive characteristics, and measures of everyday functioning. Decline over 2 years was best predicted by informant ratings of subtle functional impairments and lower baseline scores on memory, category fluency, and constructional praxis. (JINS, 2011, 17, 277–288)

In recent work, we showed that the judgment of affective stimuli is influenced by the degree of congruence between apparently innate hemispheric dispositions (left hemisphere positive and approach, right hemisphere negative and avoidance), and the type of movement produced by the contralateral arm (flexion-approach; extension-avoidance). Incongruent movements (e.g., right arm extension) were associated with attenuation of affective valuations. In the present study, we replicated these results. We also assessed confidence in judgments as a function of stimulus valence and congruence and determined that confidence is maximal with congruent movements and highly positive or negative stimuli, suggesting that congruence effects on affective valuation could be mediated by confidence effects. However, in a second experiment, involving judgments regarding segmented lines, congruence effects were observed only for bisected lines, for which confidence was lowest. Thus, confidence does not provide a unifying explanation for congruence effects in the performance of these two tasks. (JINS, 2011, 17, 289–294)

There is increasing evidence of neurocognitive dysfunction among child molesters, supporting the notion of brain anomalies among pedophiles. However, approximately half of child molesters are not pedophilic (i.e., are not primarily attracted to children), and neurocognitive differences between pedophilic (PED) and nonpedophilic (NPED) child molesters are not well understood. The purpose of this study was to assess neurocognition, specifically executive functioning (EF), among phallometrically defined PED and NPED child molesters, relative to nonsexual offenders (NSO). Participants (N = 89) were compared on seven EF domains. Results revealed that (a) child molesters exhibited an overall executive profile that was different from that of NSOs, with PEDs differing from NSOs but not from NPEDs; (b) child molesters on the whole performed better than NSOs on abstract reasoning and more poorly on inhibition; and (c) PEDs performed better than NPEDs on planning and exhibited better overall performance accuracy relative to NPEDs. These results suggest that PEDs exhibit a more deliberate, planful response style characterized by greater self-monitoring; whereas NPEDs appear to respond more impulsively. The current report further elucidates neurocognition among child molesters and highlights the need for future research examining subtypes of child molesters. (JINS, 2011, 17, 295–307)

Traumatic brain injury (TBI) results in a variable degree of cerebral atrophy that is not always related to cognitive measures across studies. However, the use of different methods for examining atrophy may be a reason why differences exist. The purpose of this manuscript was to examine the predictive utility of seven magnetic resonance imaging (MRI) -derived brain volume or indices of atrophy for a large cohort of TBI patients (n = 65). The seven quantitative MRI (qMRI) measures included uncorrected whole brain volume, brain volume corrected by total intracranial volume, brain volume corrected by the ratio of the individual TICV by group TICV, a ventricle to brain ratio, total ventricular volume, ventricular volume corrected by TICV, and a direct measure of parenchymal volume loss. Results demonstrated that the various qMRI measures were highly interrelated and that corrected measures proved to be the most robust measures related to neuropsychological performance. Similar to an earlier study that examined cerebral atrophy in aging and dementia, these results suggest that a single corrected brain volume measure is all that is necessary in studies examining global MRI indicators of cerebral atrophy in relationship to cognitive function making additional measures of global atrophy redundant and unnecessary. (JINS, 2011, 17, 308–316)

This study examined whether children's coping strategies are related to post-concussive symptoms following mild traumatic brain injury (TBI) versus orthopedic injury (OI). Participants were 8- to 15-year-old children with mild TBI (n = 167) or OI (n = 84). They rated their current preferred coping strategies and post-injury symptoms at 2 weeks (baseline) and 1, 3, and 12 months post-injury. Children's reported use of coping strategies did not vary significantly over time, so their baseline coping ratings were examined as predictors of post-concussive symptoms across time. Self-ratings of symptoms were positively related to emotion-focused strategies and negatively related to problem-focused engagement after both mild TBI and OI. Higher problem-focused disengagement predicted larger group differences in children's ratings of symptoms, suggesting that problem-focused disengagement moderates the effects of mild TBI. Coping strategies collectively accounted for approximately 10–15% of the variance in children's post-concussive symptoms over time. The findings suggest that coping may play an important role in accounting for children's perceptions of post-concussive symptoms after mild TBI. (JINS, 2011, 17, 317–326)

Deficits in executive functioning are closely related to the level of everyday functioning in patients with schizophrenia. However, many existing neuropsychological measures are limited in their ability to predict functional outcome. To contribute towards closing this gap, we developed a computer-based test of planning ability (“Plan-a-Day”) that requires participants to create daily activity schedules in a simulated work setting. Eighty patients diagnosed with schizophrenia were tested with Plan-a-Day and a battery of cognitive ability tests. Plan-a-Day showed satisfactory psychometric properties in terms of consistency, reliability, and construct validity. Compared to other neuropsychological tests used in this study, it also demonstrated incremental validity with regard to the Global Assessment of Functioning. The Plan-a-Day approach, therefore, seems to represent a valid alternative for measuring planning ability in patients with executive function deficits, occupying a middle ground between traditional neuropsychological tests and real-life assessments. (JINS, 2011, 17, 327–335)

Recent studies on specific language impairment (SLI) have suggested that language deficits are directly associated with poor procedural learning abilities. Findings from our previous work are contrary to this hypothesis; we found that children with SLI were able to learn eight-element-long sequences as fast and as accurately as children with normal language (NL) on a serial reaction time (SRT) task. A probabilistic rather than a deterministic SRT paradigm was used in the current study to explore procedural learning in children with SLI to mimic real conditions of language learning. Fifteen children with or without SLI were compared on an SRT task including a probabilistic eight-element-long sequence. Results show that children with SLI were able to learn this sequence as fast and as accurately as children with NL, and that similar sequence-specific learning was observed in both groups. These results are novel and suggest that children with SLI do not display global procedural system deficits. (JINS, 2011, 17, 336–343)

The influence of posttraumatic stress disorder (PTSD) on cognitive control and auditory attention modulation was examined with the use of a dichotic-listening (DL) task. The participants were 45 war-exposed refugees. The PTSD group comprised 22 participants meeting the DSM-IV criteria for PTSD, and the Control group comprised 23 war-exposed participants without PTSD. Both groups were tested with a consonant–vowel syllables DL task under three different attentional instructions. The two groups did not differ in the non-forced and forced-right conditions and showed, as expected, right-ear advantages. The Control group showed, as expected, a left-ear advantage in the forced-left (FL) condition. However, the PTSD group continued to show a right-ear advantage - and only minor modulation of the performance during the FL condition. This finding suggests that PTSD is associated with a reduced capacity for top-down attentional control of a bottom-up or stimulus-driven effect. The result shows that participants with PTSD have impaired cognitive control functions when tested on information processing of neutral stimuli. (JINS, 2011, 17, 344–353)

The color word Stroop test is the most common tool used to assess selective attention in persons with traumatic brain injury (TBI). A larger Stroop effect for TBI patients, as compared to controls, is generally interpreted as reflecting a decrease in selective attention. Alternatively, it has been suggested that this increase in Stroop effects is influenced by group differences in generalized speed of processing (SOP). The current study describes an overview and meta-analysis of 10 studies, where persons with TBI (N = 324) were compared to matched controls (N = 501) on the Stroop task. The findings confirmed that Stroop interference was significantly larger for TBI groups (p = .008). However, these differences may be strongly biased by TBI-related slowdown in generalized SOP (r2 = .81 in a Brinley analysis). We also found that TBI-related changes in sensory processing may affect group differences. Mainly, a TBI-related increase in the latency difference between reading and naming the font color of a color-neutral word (r2 = .96) was linked to Stroop effects. Our results suggest that, in using Stroop, it seems prudent to control for both sensory factors and SOP to differentiate potential changes in selective attention from other changes following TBI. (JINS, 2011, 17, 354–363)

The nature of residual cognitive deficits after out of hospital cardiac arrest (OHCA) is incompletely described and has never been defined against a cardiac control (CC) group. The objective of this study is to examine neuropsychological outcomes 3 months after OHCA in patients in a “middle range” of acute severity. Thirty prospective OHCA admissions with coma >1 day and responsive but confused at 1 week, and 30 non-OHCA coronary care admissions were administered standard tests in five cognitive domains. OHCA subjects fell into two deficit profiles. One group (N = 20) had mild memory deficits and borderline psychomotor deficits compared to the CC group; 40% had returned to work. The other group (N = 10) had severe impairments in all domains. Coma duration was associated with group. Neither group had a high prevalence of depression. For most patients within the “middle range” of acute severity of OHCA, cognitive and functional outcomes at 3 months were encouraging. (JINS, 2011, 17, 364–368)

Pituitary adenomas, even after successful treatment, are associated with cognitive impairments. It is unclear whether these deficits are a consequence of unspecific factors associated with having a chronic illness and whether the cognitive dysfunctions exceed those of other chronically ill patients. Thirty-eight patients with transsphenoidal surgery for pituitary adenomas and 38 patients undergoing L-thyroxine replacement therapy after thyroid surgery were studied neuropsychologically with established tests. Executive function was examined with the Trail-Making Test A and B, working memory with the digit span test, attention with the digit symbol test, verbal memory with the German version of the Auditory Verbal Learning and Memory Test, and general verbal intelligence by a vocabulary test. Attention (p = .007), attentional speed (p = .0004), executive control (p = .04), and working memory (p = .01), were significantly reduced in patients with pituitary adenomas compared with other chronically ill patients. In contrast, no differences were found between the groups for verbal memory (all subtests: p ≥ .06). Patients with successful surgery for pituitary adenomas show also in comparison with other chronically ill patients an increased risk for deficits in certain aspects of cognitive function, including attention and working memory, supporting the relevance of the brain lesion and its treatment for these dysfunctions. (JINS, 2011, 17, 369–375)