We hypothesized that patients with bipolar disorder would demonstrate verbal recognition performance deficits consistent with processing efficiency theory, a theory about how emotional states modulate performance by interfering with working memory resources or increasing cognitive arousal/effort. We predicted that (1) a manic group (n = 26) would demonstrate slow reaction time (RT) and low accuracy, (2) a euthymic group (n = 23) would demonstrate slow RT to maintain high accuracy; and (3) a healthy comparison group (n = 25) would demonstrate fast RT and high accuracy. The groups were administered symptom-rating scales and compared on a computerized, trial-by-trial, directed forgetting in recognition task. This task requires participants to comply with an overt instruction to forget irrelevant studied words, and it places a relatively high demand on working memory. The manic group was impaired on directed-forgetting sensitivity; however, when RT was statistically controlled, the groups demonstrated similar directed-forgetting effects. These findings are consistent with processing efficiency theory. They suggest that bipolar patients perform directed forgetting in recognition by increasing effortful control at encoding at the expense of processing efficiency, although acute mania reduces the capacity for control, thereby impairing recognition performance. Problems with processing efficiency are viewed as trait characteristics of bipolar disorder that may be overlooked by traditional error-based assessments. (JINS, 2005, 11, 871–880.)

Two experiments were carried out to examine memory in persons with amnesia using self-performed tasks. In Experiment 1, persons with Korsakoff's syndrome and nonamnesic participants with alcoholism learned action phrases not involving real objects by either self-performed tasks or verbal tasks. As indexed by free recall and recognition tests, a memory advantage favoring self-performed tasks was confirmed in both participant groups. In Experiment 2, persons with Korsakoff's syndrome, nonamnesic alcoholic participants, and young control participants learned object names under three different study conditions that differed from one another as to whether actions for each name were verbally generated and whether actions actually were performed. Verbal generation with or without performing the action facilitated recognition, whereas recall advantage was found only in the verbal generation-plus performance condition. These findings confirm a comparable memory advantage of self-performed tasks for a group with Korsakoff's syndrome and a group of nonamnesic comparison participants. Action memory therefore has potential therapeutic implications for memory rehabilitation. (JINS, 2005, 11, 545–553.)

The findings reported in the Letter to the Editor authored by Bungener and Jouvent are consistent with results we have presented here (Castellon et al., 2000) and again underscore the importance of considering the potentially multifactorial nature of depression in many neurologic diseases/disorders. We have suggested, although the idea is hardly a new one, that depression in HIV/AIDS can be secondary to any of multiple potential etiologies. For example, it may be a direct central nervous system (CNS) consequence of infection (i.e., neurochemical and/or neuropathological changes), a result of increased exposure to social, medical, and financial stressors secondary to living with HIV, a reaction to multiple losses (e.g., bereavement, loss of instrumental capacity), or be an admixture of multiple etiological factors. The phenomenology of this disruption of mood, motivation, and affect may differ as a function of etiology/pathophysiology. We believe that a prominent amotivation/apathy syndrome may be a more pure manifestation of the CNS effects of HIV-1 infection than is the more heterogeneous construct of depression and therefore more closely associated with other putative measures of CNS integrity (e.g., neurocognitive performance).

The following is a correction for an error that occurred in the Journal of the International Neuropsychological Society, Vol. 6, No. 3. The error occurred in the article titled “Personality change disorder in children and adolescents following traumatic brain injury,” pp. 279–289, by Max et al. On page 285, under the subheading “Injury Factors,” beginning with the second sentence in the first paragraph, the statement should read:

Visual inspection of the distribution of PC relative to lowest post-resuscitation GCS scores revealed that a cut-off of lowest post-resuscitation GCS score of 4 or less versus more than 4 yielded a sensitivity for a diagnosis of persistent PC of 9/14 (64.3%), specificity of 18/23 (78.3%), and a positive predictive value of 0.64 (9.14).

A cut-off of duration of impaired consciousness of 100 hr or less versus more than 100 hr yielded a sensitivity for a diagnosis of persistent PC of 11/14 (78.6%), specificity of 20/23 (87.0%), and a positive predictive value (PPV) of 0.79 (11/14).

Ipsative approaches to neuropsychological assessment typically involve interpreting difference scores between individual test scores. The utility of these methods is limited by the reliability of neuropsychological difference scores and the number of comparisons between scores. The present study evaluated the utility of difference scores using factor analytic methods, including reliable components analysis (RCA), equally weighted composites and individual neuropsychological measures. Data from 1,364 individuals referred for neuropsychological assessment were factor analyzed and the resulting solutions were used to compute composite scores. Reliabilities and confidence intervals were derived for each method. Results indicated that RCA outperformed other factor analytic methods, but produced a slightly different factor structure. Difference scores derived using orthogonal solutions were slightly more reliable than oblique methods, and both were more reliable than those from equally weighted composites and individual measures. Confidence intervals for difference scores were considerably smaller for factor methods relative to those for individual test comparisons, due to the greater reliability of factor based difference scores and the smaller number of comparisons required. These findings suggest that difference scores derived from orthogonal factor solutions, particularly RCA solutions, may improve reliability for clinical assessment purposes. (JINS, 2004, 10, 578–589.)

Neuropsychological models propose qualitatively distinct planning impairments in the psychomotor poverty and disorganization syndromes in schizophrenia. It was proposed that poor plan initiation in psychomotor poverty would lead to longer initial planning times, while poor plan execution in disorganization would lead to greater inefficiency. Participants with psychomotor poverty (n = 30) and disorganization (n = 29) symptoms were contrasted with healthy controls (n = 28) to elucidate distinct planning impairments. Planning was compared in the Tower of London task versus real life analogue performance in the form of a board-game style diary planning task. The specificity of planning impairments was investigated by controlling for current IQ. The disorganization group demonstrated inefficient planning across both tasks, with poor performance on the Tower of London but not on the real life analogue task remaining after intelligence levels were taken into account. Initial planning times did not differ between groups. Previous associations between poor planning and symptoms may have been driven by poor planning with disorganization symptoms and associated lower order impairments in executive function or the semantic system. Targeting these impairments in people with disorganization symptoms may lead to a greater chance of success in promoting generalization to the real world. (JINS, 2011, 17, 474–484)

Objective: Few studies have investigated the assessment and functional impact of egocentric and allocentric neglect among stroke patients. This pilot study aimed to determine (1) whether allocentric and egocentric neglect could be dissociated among a sample of stroke patients using eye tracking; (2) the specific patterns of attention associated with each subtype; and (3) the nature of the relationship between neglect subtype and functional outcome. Method: Twenty acute stroke patients were administered neuropsychological assessment batteries, a pencil-and-paper Apples Test to measure neglect subtype, and an adaptation of the Apples Test with an eye tracking measure. To test clinical discriminability, twenty age- and education-matched control participants were administered the eye tracking measure of neglect. Results: The eye tracking measure identified a greater number of individuals as having egocentric and/or allocentric neglect than the pencil-and-paper Apples Test. Classification of neglect subtype based on eye tracking performance was a significant predictor of functional outcome beyond that accounted for by the neuropsychological test performance and Apples Test neglect classification. Preliminary evidence suggests that patients with no neglect symptoms had superior functional outcomes compared with patients with neglect. Patients with combined egocentric and allocentric neglect had poorer functional outcomes than those with either subtype. Functional outcomes of patients with either allocentric or egocentric neglect did not differ significantly. The applications of our findings, to improve neglect detection, are discussed. Conclusion: Results highlight the potential clinical utility of eye tracking for the assessment and identification of neglect subtype among stroke patients to predict functional outcomes. (JINS, 2019, 25, 479–489)

A strong tendency toward left hemisphere (LH) language dominance has been well established, as evidenced by the high prevalence of language impairment following sudden onset lesions in the LH. In the presence of progressive LH pathology, such as epilepsy, substantial deviations in language organization can occur. However, the question regarding whether reorganization involves both expressive and receptive language functions or only the one directly affected by the primary location of pathology has not been settled. Using Wada testing scores from 296 epilepsy patients and estimated rates of typical dominance in the normal population, we assessed the frequency with which left frontal and temporal pathology resulted in reorganization of only the expressive or receptive language function or both. The comparisons revealed: (1) a significantly higher prevalence of atypical organization (i.e., deviations from LH dominance) among the LH patients compared to normal population estimates and right hemisphere patients, and (2) that regardless of pathology location within the LH, the rates of atypical reorganization for both expressive and receptive language were essentially equal. These results constitute evidence that the two language functions are intimately yoked and that when disruption to the system results in reorganization, it usually yields functional changes throughout the system. (JINS, 2010, 17, 000–000)

A veritable explosion of research in neuropsychology has occurred over the past decade in the search for cognitive and brain changes during a so-called “preclinical” phase of dementia that precedes its overt clinical manifestations. Fueling this explosion, in part, has been the revolution in the genetic bases of disease formulated from the international work of decoding the human genome (International Human Genome Sequencing Consortium, 2001; see also Patenaude et al., 2002, for discussion). The discovery of preclinical cognitive, brain, and genetic markers of dementia is helping to push back the point at which diseases can be reliably identified. Very early detection of dementia is extremely important now that a variety of investigational treatments that might prevent or delay disease progression (e.g., amyloid vaccine, anti-oxidants, nonsteroidal anti-inflammatory agents, cholinesterase inhibitors, estrogens, and others in the case of Alzheimer's disease) are on the horizon.

Several factors have been linked to severity of postconcussive-type (neurobehavioral) symptoms. In this study, predictors of neurobehavioral symptoms were examined using multivariate methods to determine the relative importance of each. Data regarding demographics, symptoms, current alcohol use, history of traumatic brain injury (TBI), orthopedic injuries, and psychiatric/developmental diagnoses were collected via questionnaire from 3027 university students. The most prominent predictors of symptoms were gender, history of depression or anxiety, history of attention-deficit/hyperactivity disorder or learning disability diagnosis, and frequency of alcohol use. Prior mild TBI was significantly related to overall symptoms, but this effect was small in comparison to other predictors. These results provide further evidence that neurobehavioral symptoms are multi-determined phenomena, and highlight the importance of psychiatric comorbidity, demographic factors, and health behaviors to neurobehavioral symptom presentation after mild TBI. (JINS, 2013, 19, 1–9)