Judgment of neuropsychological decline is typically made by comparing a patient's current cognitive performance to data from demographically similar normal individuals. Even within narrowly defined demographic categories, however, there is variability in level of performance, approximating the normal curve. The present study explored the degree to which oral reading scores on the American National Adult Reading Test (ANART) could more accurately predict a person's test performance relative to other demographically similar individuals. In a sample of 141 neurologically healthy participants, the ANART added modestly to the precision of WAIS–R Verbal and Full Scale IQ and Learning score predictions, beyond that achieved by demographics alone; however, ANART score did not significantly improve estimation of Performance IQ, Average Impairment Rating, or Memory score. Use of the ANART tended to improve demographic predictions primarily with “outlier” participants whose oral reading skills were relatively poor. For Verbal IQ, ANART helped with participants who had both poor ANART and relatively high education. Oral reading can be useful for estimating premorbid verbal intelligence and learning in combination with demographic variables, but it does not appear to improve estimates of other neurocognitive abilities. (JINS, 1999, 5, 247–254.)

While it has been commonly assumed that a deficit in semantic memory underlies many of the clinical and cognitive features of early Alzheimer's disease (AD), there has been little agreement on what constitutes a proper theoretical description of this impaired system. Currently, most theories of this disorder fall into two categories: those that posit degraded semantic representations, and those that posit impaired retrieval operations with relatively intact semantic representations. It is argued that each position has both empirical and logical disadvantages that have prevented the development of a consensus on how to describe the pathology of semantic memory in AD. In this paper we present the details and supportive evidence for an alternative account of the semantic memory deficit of AD: the Gain/Decay hypothesis. The core claim of the Gain/Decay hypothesis is that a reduction in the time constant of spreading activation in AD produces dynamic changes in the availability of semantic representations that depend on the time frame in which this information must be accessed. The implications of this hypothesis for a range of experimental and clinical phenomena are discussed, as are possible biological correlates of the hypothesized alterations in the modulation of activation. (JINS, 1999, 5, 641–658.)

Little is known about specific attentional sequelae following a closed head injury, their pattern of recovery or their interaction with ongoing development. The present study examined attentional abilities in a group of children who had sustained a mild, moderate, or severe head injury. Results showed that the severe head injury group exhibited greater deficits on a number of attentional measures at acute and 6 months postinjury phases, in comparison to children in the mild and moderate head injury groups. Specifically, deficits were most evident on timed tasks where speed of processing was an integral component. Difficulties persisted to at least 6 months postinjury and so may lead to cumulative deficits over time. (JINS, 1999, 5, 48–57.)

A version of the category fluency test including the categories of animal and transportation, was administered to 316 Chinese native speakers ranging in age from 7 to 95. Results indicated that the number of items generated in the category fluency test increases with age from childhood to adulthood with a peak performance in adults aged from 19 to 30, and then declines subsequently into late life. All participants, regardless of their age, generated more animal than transportation names. Educational level, but not gender, was a significant factor affecting their performance. The participants in all age groups committed very few intrusion and perseveration errors. The results of the present study were in general consistent with those reported in the western countries. Thus, it seems to be appropriate to apply the category fluency test, which was originally developed in western countries, for clinical use in Hong Kong. (JINS, 1999, 5, 525–533.)

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 investigations have reported high frequencies of reading and writing disabilities in criminal populations. The aims of the present study were to assess the frequency of dyslexia among Swedish prison inmates and to relate dyslexia to other indices of neuropsychological functions. Sixty-three prison inmates with Swedish as their native language, age 19 to 57 years, were examined by interviews, tests of academic achievement, and neuropsychological assessment. Twenty-six (41%) were diagnosed as dyslexic. As expected, the dyslexic group performed more poorly on verbal tests as compared to the normal readers among the prison inmates, but they also performed more poorly on tests measuring nonverbal abilities. The dyslexic group had higher frequencies of paranoid and avoidant personality disorders compared to the nondyslexics. They also reported higher levels of anxiety and suspicion and a lower degree of socialization. Previous studies report low IQ to be associated with criminal propensity, supporting the interpretation that a double handicap (dyslexia and low IQ) increases the risk of entering a criminal career and remaining in it. (JINS, 1999, 5, 452–461.)

Impairments to either perceptual or word-retrieval processes have been hypothesized to explain confrontation naming impairments in patients with Alzheimer's disease (AD). This study measured the effects of structural similarity, which affects perceptual processing, and name frequency, which affects word retrieval, on naming latency and accuracy in 16 AD patients and 16 age-matched controls. AD patients named pictures more slowly and made more errors than control participants. Their naming accuracy was disproportionately affected by name frequency, but not by structural similarity. The findings indicate that the processing of structural properties of objects is unaffected in early-stage AD, and suggest that word-retrieval impairments underlie the naming deficit in AD. (JINS, 1999, 5, 659–667.)

Prenatal alcohol exposure is associated with widespread and devastating neurodevelopmental deficits. Numerous reports have suggested memory deficits in both humans and animals exposed prenatally to alcohol. However, the nature of these memory deficits remains to be characterized. Recently children with fetal alcohol syndrome were shown to have learning and memory deficits on a verbal learning and memory measure that involved free recall and recognition memory. The current study seeks to further characterize memory functioning in children with heavy prenatal alcohol exposure by evaluating priming performance. The choice of task is also relevant given previous studies of memory performance in patient groups with and without involvement of the basal ganglia, a group of structures known to be affected in fetal alcohol syndrome. Three groups were evaluated for lexical priming, free recall, recognition memory, and verbal fluency: (1) children with heavy prenatal alcohol exposure; (2) children with Down syndrome; and (3) nonexposed controls. The children with Down syndrome showed significantly less priming than alcohol-exposed children, who did not differ from controls. In addition, the alcohol-exposed children were impaired on the free recall task but not on the recognition memory task, whereas the children with Down syndrome performed significantly worse than the alcohol-exposed group on both tasks. Finally, on the verbal fluency task, children with heavy prenatal alcohol exposure were impaired on both category and letter fluency, but the degree of impairment was greater for letter fluency. These results further characterize the memory deficits in children with heavy prenatal alcohol exposure suggesting that in spite of learning and memory deficits, they are able to benefit from priming of verbal information. (JINS, 1999, 5, 462–471.)

Previous studies of childhood traumatic brain injury (TBI) have emphasized injury-related variables rather than psychiatric or psychosocial factors as correlates of cognitive outcomes. We addressed this concern by recruiting a consecutive series (N = 24) of children age 5 through 14 years who suffered a severe TBI, a matched group who sustained a mild TBI, and a second matched group who sustained an orthopedic injury. Standardized intellectual, memory, psychiatric, family functioning, family psychiatric history, neurological, and neuroimaging assessments were conducted at an average of 2 years following injury. Severe TBI, when compared to mild TBI and orthopedic injury, was associated with significant decrements in intellectual and memory function. A principal components analysis of independent variables that showed significant (p < .05) bivariate correlations with the outcome measures yielded a neuropsychiatric factor encompassing severity of TBI indices and postinjury psychiatric disorders and a psychosocial disadvantage factor. Both factors were independently and significantly related to intellectual and memory function outcome. Postinjury psychiatric disorders added significantly to severity indices and family functioning and family psychiatric history added significantly to socioeconomic status in explaining several specific cognitive outcomes. These results may help to define subgroups of children who will require more intensive services following their injuries. (JINS, 1999, 5, 58–68.)

Information on the clinical utility of neuropsychological tests in non-North-American samples is limited. We examined the diagnostic efficacy of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) neuropsychological battery in Jamaican men and women age 65 and older. A total of 72 elders were diagnosed as normal and 12 were demented based on history, physical, and neurological examination. Independent of this medical examination, participants were tested with the CERAD battery. Normal controls scored significantly better than dementia patients on all tests in the CERAD battery. A discriminant function found that a combination of Word List Learning Sum Recall and Boston Naming Test correctly classified a total of 81% of the cases (83% of the dements and 81% of the normal controls). This study is the first to demonstrate the clinical utility of the CERAD neuropsychological battery in the differential diagnosis of memory disorders of the aged in a non-North-American sample. (JINS, 1999, 5, 255–259.)

Identification deficits in dementia of the Alzheimer Type (DAT) often target specific classes of objects, sparing others. Using line drawings to uncover the etiology of such category-specific deficits may be untenable because the underlying shape primitives used to differentiate one line drawing from another are unspecified, and object form is yoked to object meaning. We used computer generated stimuli with empirically specifiable properties in a paradigm that decoupled form and meaning. In Experiment 1 visually similar or distinct blobs were paired with semantically close or disparate labels, and participants attempted to learn these pairings. By having the same blobs stand for semantically close and disparate objects and looking at shape–label confusion rates for each type of set, form and meaning were independently assessed. Overall, visual similarity of shapes and semantic similarity of labels each exacerbated object confusions. For controls, the effects were small but significant. For DAT patients more substantial visual and semantic proximity effects were obtained. Experiment 2 demonstrated that even small changes in semantic proximity could effect significant changes in DAT task performance. Labeling 3 blobs with “lion,” “tiger,” and “leopard” significantly elevated DAT confusion rates compared to exactly the same blobs labeled with “lion,” “tiger,” and “zebra.” In conclusion both visual similarity and semantic proximity contributed to the identification errors of DAT patients. (JINS, 1999, 5, 330–345.)

The relationship between neurocognitive impairment and employment in a cohort of 130 predominantly symptomatic individuals with HIV–1 infection was examined. Participants were classified as employed (full or part-time for pay) or unemployed (N = 64) and administered a neuropsychological test battery. When covarying for CD4 count, age, and physical limitations, the results revealed that unemployed men performed below that of employed participants on tasks of memory, set shifting–cognitive flexibility, and psychomotor speed. The results are discussed within the context of similar findings in other illnesses. (JINS, 1999, 5, 534–539.)

Citicoline is an investigational new drug in this country that was provided on a compassionate use basis in two cases of traumatic brain injury after horseback riding accidents. While this report is primarily anecdotal, the behavioral observations in both cases suggested atypical patterns of improvement and perhaps greater recovery than might otherwise have been predicted. The side effect profile of this drug is negligible and previous experimental research has yielded positive findings for treatment after stroke and head trauma, as well as memory loss in aging. Consequently, Citicoline may potentially be very helpful for patients suffering traumatic brain injuries and should, in our opinion, be made available and studied further in this clinical population. (JINS, 1999, 5, 260–264.)

This concise volume contains a wealth of information on scoring and interpreting the WISC–III. There are chapters on gifted children, mental retardation, attention deficit hyperactivity disorder, language impairment, hearing impairment, minority and culturally diverse children, and also emotionally disturbed children. The text also addresses the use of the WISC–III with achievement tests, accurately recording and interpreting behavioral observations over the course of administering a WISC–III, and also the neuropsychological basis of intelligence and the WISC–III.

Sixty individuals with probable Alzheimer's disease (AD) and 48 normal elders were given a task in which they had to judge the relatedness of concepts as a means of evaluating semantic memory. Very mild AD patients performed similarly to normal elders. Mild AD patients were significantly inferior in performance to normals but the pattern of their performance did not suggest a loss of conceptual knowledge. Moderate AD patients were significantly inferior in performance to mild AD patients, and 8 moderate AD patients (compared to 1 mild AD patient) were unable to do the task. The pattern of performance of moderate patients suggests that conceptual knowledge may degrade and ultimately be lost. (JINS, 1999, 5, 668–675.)

Limbic system atrophy and memory dysfunction are common in patients with temporal lobe epilepsy (TLE). However, the relationship between extrahippocampal limbic structures and memory functioning within TLE has received little attention. The present study examined associations of MRI volumetric measurements of the mammillary body, fornix, amygdala, and hippocampus to measures of episodic verbal and visual memory. The Logical Memory and Visual Reproduction subtests from the Wechsler Memory Scale were administered to 47 unilateral TLE patients (25 right, 22 left). Normalized right and left MRI volumes were determined for each patient by cursor tracing 1.5 mm slices from 3D-MRI. Significant associations were found between left hippocampal volume and the immediate, delayed, and percent retention scores of the Logical Memory Test; between the left mammillary body volume and the Logical Memory Test delayed and percent retention scores; immediate Visual Reproduction performance was significantly related to the right and left amygdala volumes, and right mammillary body volume; only the right amygdala and right mammillary body volume were associated with the delayed Visual Reproduction trial. However, neither right nor left hippocampal volumes were related to visual memory performance. Multiple limbic system structural volumes were independently associated with verbal and nonverbal memory performance. Results suggest that visual memory, as measured by the Visual Reproduction Test, may be uniquely associated with extrahippocampal volumes in patients with TLE. (JINS, 1999, 5, 540–548.)

Left-to-right reorganization of verbal memory following early left hemisphere damage has been reported in patients whose expressive language is governed by the right hemisphere. We present a case in which verbal memory performance was intact, despite severe left mesial temporal damage, and despite aphasia on left internal carotid sodium amytal ablation. The distribution and degree of left mesial temporal damage was assessed visually and quantitatively on MRI. These findings raise the possibility that verbal memory may shift to the language-nondominant hemisphere as a result of early left mesial temporal damage. (JINS, 1999, 5, 69–74.)

Test–retest reliabilities and practice effects of a broad range of neuropsychological measures were examined in 384 normal or neurologically stable adults. Median test–retest interval was 11 months (range 3–16 months). The reliability estimates for most of the measures are reasonably good, ranging from .70 to low .90s. An exception is the relatively poor reliabilities of most memory measures. For all test measures, the value on initial testing is a strong determinant of the value on the second examination. Practice effects are seen on most measures. The magnitude of the practice effects, however, varies as a function of type of measure, test–retest interval, age, and overall competency level of the participant. This study provides several types of retest information that may be useful for future research and clinical work: comparative reliabilities of the various measures, estimate of error variability associated with each administration, standard deviation of the change, and comparative magnitude of practice effects on various tests. (JINS, 1999, 5, 346–356.)

The Handbook of Clinical Child Neuropsychology (2nd ed.), as is obvious from the title, is an updated edition of the editors' first book, originally published in 1989. At that time the subspecialty of child neuropsychology was just beginning to unfold its wings, and little was available in terms of a broad and encompassing handbook resource.

The book Biological and Neuropsychological Mechanisms: Life-Span Developmental Psychology is an example of how the above problems can be manifested even with a good attempt at execution. The chapters in this book cover a wide range of topics within developmental neuropsychology, including a developmental theory of behavior, mathematical modeling, electrophysiology, lateralization, and adolescent substance abuse.

A major use of neuropsychological assessment is to measure changes in functioning over time; that is, to determine whether a difference in test performance indicates a real change in the individual or just chance variation. Using 7 illustrative test measures and retest data from 384 neurologically stable adults, this paper compares different methods of predicting retest scores, and of determining whether observed changes in performance are unusual. The methods include the Reliable Change Index, with and without correction for practice effect, and models based upon simple and multiple regression. For all test variables, the most powerful predictor of follow-up performance was initial performance. Adding demographic variables and overall neuropsychological competence at baseline significantly but slightly improved prediction of all follow-up scores. The simple Reliable Change Index without correction for practice performed least well, with high error rates and large prediction intervals (confidence intervals). Overall prediction accuracy was similar for the other three methods; however, different models produce large differences in predicted scores for some individuals, especially those with extremes of initial test performance, overall competency, or demographics. All 5 measures from the Halstead–Reitan Battery had residual (observed − predicted score) variability that increased with poorer initial performance. Two variables showed significant nonnormality in the distribution of residuals. For accurate prediction with smallest prediction–confidence intervals, we recommend multiple regression models with attention to differential variability and nonnormality of residuals. (JINS, 1999, 5, 357–369.)