In this study, we tested the hypothesis that action planning is impaired in children with neurofibromatosis type 1 (NF1). Thirty-six children with NF1 were pair-matched to 36 healthy controls (HC) on age (range, 7–12 years), sex, and parental education level, and both groups were administered three action-planning tasks. To examine the relation of task performance to attention deficit hyperactivity disorder (ADHD), the NF1 group was divided into subsets of children who met or did not meet criteria for ADHD. Children with NF1 performed less well than HC on all planning tasks, and differences remained when controlling for IQ or a measure of visuospatial skill. Both the NF1 with ADHD subset and NF1 without ADHD subset performed more poorly than HC on two of the tasks, whereas only the NF1 with ADHD subset performed worse than HC on the third planning task. The results underscore the importance of evaluating executive function in children with NF1 and suggest that deficits in this domain may be only partially related to ADHD. Planning deficits in children with NF1 may be part of their cognitive phenotype. Identifying these deficits is relevant in determining factors contributing to learning problems and in developing appropriate interventions. (JINS, 2010, 16, 1056–1063.)

Explosive blast is a frequent cause of traumatic brain injury (TBI) among personnel deployed to Afghanistan and Iraq. Functional magnetic resonance imaging (fMRI) with an event-related stimulus-response compatibility task was used to compare 15 subjects with mild, chronic blast-related TBI with 15 subjects who had not experienced a TBI or blast exposure during deployment. Six TBI subjects reported multiple injuries. Relative to the control group, TBI subjects had slightly slower responses during fMRI and increased somatic complaints and symptoms of post-traumatic stress disorder (PTSD) and depression. A between-group analysis indicated greater activation during stimulus-response incompatibility in TBI subjects within the anterior cingulate gyrus, medial frontal cortex, and posterior cerebral areas involved in visual and visual-spatial functions. This activation pattern was more extensive after statistically controlling for reaction time and symptoms of PTSD and depression. There was also a negative relationship between symptoms of PTSD and activation within posterior brain regions. These results provide evidence for increased task-related activation following mild, blast-related TBI and additional changes associated with emotional symptoms. Limitations of this study include no matching for combat exposure and different recruitment strategies so that the control group was largely a community-based sample, while many TBI subjects were seeking services. (JINS, 2012, 18, 89–100)

Complaints on cognitive functioning are often reported in patients suffering from whiplash syndrome, although objective neuropsychological test results do not always support these. In addition, radiological abnormalities and anatomical lesions are found only in a minority of these patients. This has led to a controversy about its existence in the literature. In this systematic review, the results of 22 neuropsychological studies on whiplash were quantitatively analyzed, focusing on working memory, attention, immediate and delayed recall, visuomotor tracking, and cognitive flexibility. Our findings suggest that a consistent overall pattern of cognitive dysfunction can be demonstrated after whiplash injury through neuropsychological testing, both compared to healthy and to asymptomatic controls. Six months after the accident, improvement is found in working memory, attention, immediate recall, and visuomotor tracking. The results are discussed in the light of recent findings on the effect of cerebral dysfunction, malingering, pain-related factors, and the role of coping strategies and posttraumatic stress on neuropsychological test performance. (JINS, 2000, 6, 271–278.)

Hepatitis C virus (HCV) can be detected in the brain (Radkowski et al., 2002) and investigators speculate that HCV has neuroinvasive properties (Forton et al., 2003) with direct effects on cerebral function. MRS studies show that the basal ganglia and white matter of individuals with HCV have abnormal choline/creatine ratios, indicating CNS inflammation or infection (Forton et al., 2003). Patients with HCV show defects in working memory and information processing speed (Forton et al., 2003; Hilsabeck et al., 2002), similar to patients with basal ganglia disorders and HIV (e.g., Heaton et al., 1995).

The development of antiretroviral therapy (ART) has dramatically improved survival for those living with human immunodeficiency virus (HIV), but whether ART improves cognitive functioning remains unclear. The aim of the present review was to examine systematically the extent to which ART improves cognition among individuals with HIV using meta-analytic methods. Twenty-three studies were included in the quantitative review. ART was associated with modest improvements in attention (mean d = .17; p < .001; 95% confidence interval [CI], .09/.25), executive function (mean d = .18; p < .001; 95% CI, .10/.26), and motor function (mean d = .24; p < .001; 95% CI, .16/.32). ART did not improve language, verbal memory, visual memory or visuospatial function. The extent to which cognition improved was correlated with the change in CD4 cell count following ART, suggesting a link between cognitive outcome and immune system integrity. Together, the present findings indicate that the neuropsychological test performance of most HIV patients taking ART is comparable to those not taking ART. Development of pharmaceutical treatments and rehabilitation strategies that target the cognitive effects of HIV infection is needed. (JINS, 2011, 17, 956–969)

Deficits in attention are a hallmark of the effects of heavy prenatal alcohol exposure but although such deficits have been described in the literature, no attempt to use measures of attention to classify children with such exposure has been described. Thus, the current study attempted to classify children with heavy prenatal alcohol exposure (ALC) and non-exposed controls (CON), using four measures of attentional functioning: the Freedom from Distractibility index from the Wechsler Intelligence Scale for Children–Third Edition (WISC–III), the Attention Problems scale from the Child Behavior Checklist (CBCL), and omission and commission error scores from the Test of Variables of Attention (TOVA). Data from two groups of children were analyzed: children with heavy prenatal alcohol exposure and non-exposed controls. Children in the alcohol-exposed group included both children with or without fetal alcohol syndrome. Groups were matched on age, sex, ethnicity, and social class. Data were analyzed using backward logistic regression. The final model included the Freedom from Distractibility index from the WISC–III and the Attention Problems scale from the CBCL. The TOVA variables were not retained in the final model. Classification accuracy was 91.7% overall. Specifically, 93.3% of the alcohol-exposed children and 90% of the control children were accurately classified. These data indicate that children with heavy prenatal alcohol exposure can be distinguished from non-exposed controls with a high degree of accuracy using 2 commonly used measures of attention. (JINS, 2004, 10, 271–277.)

Objectives: Military deployment is associated with increased risk of adverse emotional and cognitive outcomes. Longitudinal associations involving posttraumatic stress disorder (PTSD), relatively mild traumatic brain injury (TBI), and neurocognitive compromise are poorly understood, especially with regard to long-term outcomes, and rigorous research is necessary to better understand the corresponding relationships. The objective of this study was to examine short-term and long-term (>5 years) longitudinal associations among PTSD, neurocognitive performance, and TBI following military deployment. Methods: In this prospective study, N=315 U.S. Army soldiers were assessed at military installations before (2003–2005) and after (2004–2006) an index deployment to the Iraq War, and again an average of 7.6 years later (2010–2014) as a nationally dispersed cohort of active duty soldiers, reservists, and veterans. Thus, the study design allowed for two measurement intervals over which to examine changes. All assessments included the PTSD Checklist, civilian version, and individually-administered performance-based neurocognitive tests. TBI history was derived from clinical interview. Results: Autoregressive analyses indicated that visual reproduction scores were inversely related to subsequent PTSD symptom severity at subsequent assessments. Conversely, increases in PTSD symptom severity over each measurement interval were associated with poorer verbal and/or visual recall at the end of each interval, and less efficient reaction time at post-deployment. TBI, primarily mild in this sample, was associated with adverse PTSD symptom outcomes at both post-deployment and long-term follow-up. Conclusions: These results suggest longitudinal relationships among PTSD symptoms, TBI, and neurocognitive decrements may contribute to sustained emotional and neurocognitive symptoms over time. (JINS, 2018, 24, 311–323)

The role of the human frontal lobes in episodic memory is becoming better understood, thanks mainly to focal lesion and neuroimaging studies. Here we review some recent findings from basic research on the frontal lobes in memory encoding, search, and decision-making at retrieval. For each of these processes, researchers have uncovered cases in which frontal memory impairments can be attenuated by various task manipulations. We suggest ways in which these findings may inform clinical evaluation and rehabilitation of memory problems following frontal damage. (JINS, 2006, 12, 210–223.)

In the present study a sequential tapping task was used to compare the planning and execution of finger tapping sequences in children with motor coordination problems (clumsy children) and control children. Fifteen children with significant movement problems were compared to 15 control children matched on age, sex, and Verbal IQ. The clumsy children took significantly longer to initiate the movement sequence (i.e., reaction time). During the execution of the sequence, the clumsy children left their finger on the tap plate for significantly longer for each tap than the control children. No significant differences were found between the groups for the time taken between the taps, or mean average force. Past research has indicated that the source of timing problems in clumsy children may lie in a central timing mechanism possibly the cerebellum, whereas the evidence from the present study indicates an impairment of the peripheral processes may be a more important contributor to timing deficits in clumsy children. (JINS, 1999, 5, 320–329.)

Several recent reviews have suggested that cognitive rehabilitation may hold promise in the treatment of memory deficits experienced by patients with mild cognitive impairment. In contrast to the previous reviews that mainly focused on outcome, the current review examines key methodological challenges that are critical for designing and interpreting research studies and translating results into clinical practice. Using methodological details from 36 studies, we first examine diagnostic variability and how the use of cutoffs may bias samples toward more severely impaired patients. Second, the strengths and limitations of several common rehabilitative techniques are discussed. Half of the reviewed studies used a multi-technique approach that precludes the causal attribution between any specific technique and subsequent improvement. Third, there is a clear need to examine the dose-response relationship since this information was strikingly absent from most studies. Fourth, outcome measures varied widely and frequently depended on neuropsychological tests with little theoretical justification or ecological relevance. Fifth, we discuss how the variability in each of these other four areas complicates efforts to examine training generalization. Overall, future studies should place greater emphasis on ecologically relevant treatment approaches and outcome measures and we propose a hierarchical model that may aid in this pursuit. (JINS, 2014, 19, 1–17)

A recent discussion in this journal illustrates some recurrent misunderstandings about the role of covariates in randomized controlled trials (RCTs). This letter aims at clarifying this role and at pointing out a pitfall in SPSS repeated measures ANOVA. We hope that our commentary will contribute to a further improvement in the use of advanced statistics in neuropsychology.

Background: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a recently described life-threatening autoimmune disorder associated with a characteristic multi-stage neuropsychiatric syndrome. Although it is known that the majority of patients experience neuropsychological disturbance post-treatment, some aspects of the cognitive profile remain unclear. Methods: This study sought to investigate patterns of cognitive functioning in a sample of anti-NMDAR encephalitis patients. Seven (6F:1M; mean age, 26.4 years; range, 16–37 years) treated patients completed a comprehensive set of neurocognitive and social functioning measures. Performance was analyzed using normative data (where available), and comparison with matched controls (10F:4M; mean age, 25.8 years; range, 16–38 years). Results: Individual cognitive profiles ranged from within normal limits to extensive dysfunction. Relative to controls, the patient group’s performance was affected in the domains of verbal/ visual memory, working memory, attention, processing speed, executive functioning, and social cognition. The patient group also reported significantly higher levels of anxiety compared to controls. Conclusions: These results add to the accumulating evidence that neurocognitive deficits, consistent with the distribution and functions of the NMDAR system can persist during recovery from anti-NMDAR encephalitis. This is the first study to provide evidence of performance decrements on measures of social cognition, including some involving theory of mind. (JINS, 2016, 22, 828–838)

There is increasing need for early, pro-active programs that can delay dementia diagnosis and enhance well-being of individuals with mild cognitive impairment (MCI) and their care-partners (i.e., care-dyads). This randomized controlled trial evaluated the efficacy of a combined cognitive rehabilitation and multi-family group treatment (CR-MFG) that was designed to facilitate adoption of newly learned cognitive strategies into the care-dyads everyday lives. Analyzed data included 23 care-dyads who participated in CR-MFG treatment and 23 care-dyads in standard care (SC). The 3-month intervention consisted of individual joining sessions, an educational workshop, and 20/twice weekly multifamily memory strategy training and problem-solving sessions. Everyday functioning, memory, and psychological functioning (i.e., quality-of-life, depression, coping) were assessed. The CR-MFG intervention was associated with significant post-test group differences and improved post-test performances by the MCI participants on performance-based measures of everyday functioning and neuropsychological tests of memory. There was also some suggestion that CR-MFG care-partners perceived positive change in the everyday functioning of the MCI participants. In contrast, no post-test group differences were found for either care-dyad member on the self-report psychological measures; care-partners in the treatment group did self-report improved coping behaviors at post-test. These 3-month results are preliminary but suggestive that CR-MFG may produce modest, practical everyday functional benefits for persons with MCI. (JINS, 2014, 20, 1–12)

We compared motor imagery performance of normally limbed individuals with that of individuals with one or both hands missing since birth (i.e., hand amelia). To this aim, 14 unilaterally and 2 bilaterally amelic participants performed a task requiring the classification of hands depicted in different degrees of rotation as either a left or a right hand. On the same task, 24 normally limbed participants recapitulated previously reported effects; that is, that the hand motor dominance and, more generally, a lifelong use of hands are important determinants of left–right decisions. Unilaterally amelic participants responded slower to hands corresponding to their absent, compared with their existing, hand. Moreover, left and right hand amelic participants showed prolonged reaction times to hands (whether left or right) depicted in unnatural orientations compared with natural orientations. Among the bilateral amelics, the individual with phantom sensations, but not the one without, showed similar differentiation. These findings demonstrate that the visual recognition of a hand never physically developed is prolonged, but still modulated by different rotation angles. They are further compatible with the view that phantom limbs in hand amelia may constrain motor imagery as much as do amputation phantoms. (JINS, 2008, 14, 81–89.)

We compared 7 mildly affected Huntington's disease (HD) patients to 7 age- and education-matched healthy controls (NC) on an odor detection test, the California Odor Learning Test, and the California Verbal Learning Test. Results demonstrated that odor detection sensitivity, but not group membership, accounted for significant variance in total olfactory learning. Both groups learned fewer items in the olfactory modality compared to the verbal modality, but retained a similar amount following a delay. No group differences were demonstrated for verbal recognition discriminability, but the HD group demonstrated significantly impaired odor recognition discriminability. Finally, odor detection provided excellent classification sensitivity and specificity between the patients and controls, suggesting that olfactory testing may provide a sensitive measure of the early disease process in HD. (JINS, 1999, 5, 609–615.)

Intense language training has been found to be more efficient in the rehabilitation of chronic aphasia than treatment spread across time. Intense treatment, however, challenges personnel and financial resources of the health care system. The present study examined, whether laypersons can be trained to apply standardized language training for chronic aphasia with effects comparable to training by experts. Twenty individuals with chronic aphasia participated in the training, Constraint-Induced Aphasia Therapy (CIAT), which comprises communicative language games with increasing level of difficulty in a motivating context for 3 hr/day on 10 consecutive days. Following a random-control design, training was applied either by experienced therapists (n = 10) or trained laypersons (n = 10). Standardized language assessments revealed significant within-group improvements, however, between-group differences were not present. We conclude that a standardized training program, such as CIAT, can be efficiently accomplished by trained laypersons with results comparable to that of experienced therapists. (JINS, 2007, 13, 846–853.)

We examined the capacity of patients with multiple sclerosis (MS) to attribute mental states to others and to identify cognitive abilities that subserve theory of mind (ToM). In this article, we report findings on 41 out-patients with diagnosed MS who underwent detailed neuropsychological and social-cognitive assessment. They were subdivided into a cognitively intact (n=15) and cognitively impaired (n=26) group according to their neuropsychological test results. Their results were compared with those of 20 age- and education-matched controls. MS patients with cognitive impairments were found to have more difficulties attributing mental states to others than did cognitively intact MS patients and normal controls on two ToM measures; short stories (Happé, Winner, & Brownell, 1998) and video clips (Ouellet, Bédirian, Charbonneau, & Scherzer, 2009). When attention, memory, and working memory were controlled, performance on the WAIS-III Picture Arrangement task accounted for 17.3% of the variance in performance on the video clips task. Performance on a WAIS-III index composed of Similarities and Comprehension subtests, accounted for 7.0% of the variance in performance on the short stories task. These results provide some preliminary information on the effect of MS-related cognitive deficits on the ability to attribute mental states to others. (JINS, 2010, 16, 287–296.)

While longitudinal studies of children treated for brain tumors have consistently revealed declines on measures of intellectual functioning, greater specification of cognitive changes following treatment is imperative for isolating vulnerable neural systems and developing targeted interventions. Accordingly, this cross-sectional study evaluated the performance of childhood brain tumor survivors (n = 50) treated with conformal radiation therapy, solid tumor survivors (n = 40) who had not received central nervous system (CNS) -directed therapy, and healthy sibling controls (n = 40) on measures of working memory [Digit Span and computerized self-ordered search (SOS) tasks]. Findings revealed childhood brain tumor survivors were impaired on both traditional [Digit Span Backward- F(2,127)= 5.98; p < .01] and experimental [SOS-Verbal- F(2,124)= 4.18; p < .05; SOS-Object- F(2,126)= 5.29; p < .01] measures of working memory, and performance on working memory measures correlated with intellectual functioning (Digit Span Backward- r = .45; p < .0001; SOS- r = −.32 to −.26; p < .01). Comparison of performance on working memory tasks to recognition memory tasks (computerized delayed match-to-sample) offered some support for greater working memory impairment. This pattern of findings is consistent with vulnerability in functional networks that include prefrontal brain regions and has implications for the clinical management of children with brain tumors. (JINS, 2012, 18, 1–10)

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)

This study examined the impact of childhood traumatic brain injury (TBI) on self-regulation and social and behavioral functioning, and the role of self-regulation as a predictor of children's social and behavioral functioning. Participants included 65 children with moderate to severe TBI and 65 children without TBI, all between 6 and 11 years of age. Self-regulation and social and behavioral functioning were assessed 2 to 5 years following injury. Children with TBI displayed deficits in self-regulation and social and behavioral functioning, after controlling for socioeconomic status (SES), although the magnitude of the deficits was not related to injury severity. Self-regulation accounted for significant variance in children's social and behavioral functioning, after controlling for SES and group membership. Self-regulation may be an important determinant of children's social and behavioral functioning following TBI. (JINS, 2006, 12, 609–621.)