As new and more effective treatments for Alzheimer's disease (AD) emerge, the development of efficient screening strategies in educationally and racially diverse primary care settings has increased in importance. A set of candidate screening tests and an independent diagnostic assessment were administered to a sample of 318 patients treated at a geriatric primary care center. Fifty-six subjects met criteria for dementia. Exploratory analysis led to the development of three two-stage screening strategies that differed in the composition of the first stage or Rapid Dementia Screen, which is applied to all patients over the age of 65. The second stage, applied to those patients who screen positively for dementia, is accomplished with the Free and Cued Selective Reminding Test to detect memory impairment. Using clinical diagnosis as a gold standard, the strategies had high sensitivity and specificity for identifying dementia and performed better for identifying AD than non-AD dementias. Sensitivity and specificity did not differ by race or education. The strategies provide an efficient approach to screening for early dementia. (JINS, 2008, 14, 130–142.)

Parkinson's disease (PD) patients may experience fluctuations in executive performance after oral levodopa (LD). Their relationship with the pharmacokinetic profile of LD and with distinct cognitive processes associated with frontal-basal ganglia circuits is not well understood. In this randomized, double-blind, crossover study we plotted acute cognitive changes in 14 PD patients challenged with faster (immediate-release, IR) versus slower (controlled-release, CR) increases in LD plasma concentrations. We monitored motor status, LD plasma levels, and performance on four tasks of executive function (Wisconsin Card Sorting Test—WCST, Sternberg test, Stroop and Tower of Hanoi), 1 hr before and over +6 hr after IR and CR-LD dose. Analysis of variance demonstrated significant but divergent changes in the Sternberg (6-digit but not 2- and 4-digit) test: improvement after CR-LD and worsening after IR-LD. Marginal improvement (p = .085) was observed with CR-LD in the WCST, while no significant differences were seen for the Stroop or Tower of Hanoi tests. Executive-related performance after LD challenge may differ depending on the LD time-to-peak plasma concentration and specific task demands. A slower rise in LD levels appears to have a more favorable impact on more difficult working memory tests. These results require replication to determine their generalization. (JINS, 2008, 14, 832–841.)

Adult readers with developmental phonological dyslexia exhibit significant difficulty comparing pseudowords and pure tones in auditory working memory (AWM). This suggests deficient AWM skills for adults diagnosed with dyslexia. Despite behavioral differences, it is unknown whether neural substrates of AWM differ between adults diagnosed with dyslexia and normal readers. Prior neuroimaging of adults diagnosed with dyslexia and normal readers, and post-mortem findings of neural structural anomalies in adults diagnosed with dyslexia support the hypothesis of atypical neural activity in temporoparietal and inferior frontal regions during AWM tasks in adults diagnosed with dyslexia. We used fMRI during two binaural AWM tasks (pseudowords or pure tones comparisons) in adults diagnosed with dyslexia (n = 11) and normal readers (n = 11). For both AWM tasks, adults diagnosed with dyslexia exhibited greater activity in left posterior superior temporal (BA 22) and inferior parietal regions (BA 40) than normal readers. Comparing neural activity between groups and between stimuli contrasts (pseudowords vs. tones), adults diagnosed with dyslexia showed greater primary auditory cortex activity (BA 42; tones > pseudowords) than normal readers. Thus, greater activity in primary auditory, posterior superior temporal, and inferior parietal cortices during linguistic and non-linguistic AWM tasks for adults diagnosed with dyslexia compared to normal readers indicate differences in neural substrates of AWM comparison tasks. (JINS, 2008, 14, 629–639.)

Clinical, experimental, and functional imaging studies suggest overlapping neuronal networks and functional interactions of alertness and visuospatial attention within the right hemisphere of the brain. To examine the interaction of arousal and visuospatial attention in peripersonal and extrapersonal virtual space, we tested 20 healthy male adults during 24 hr of sleep deprivation at four points during the night (9 p.m., 1 a.m., 5 a.m., and 9 a.m.). The main finding concerning covert orienting in a virtual environment is a highly significant slowing of reorientation toward the left visual hemifield in extrapersonal space due to decreased arousal. The results provide additional evidence for the proposed anatomical and functional overlap of the two attentional systems and indicate a modulation of visuospatial attention by the level of arousal in extrapersonal space. (JINS, 2008, 14, 309–317.)

Cognitive impairments in schizophrenia are well documented and correlated with functional disability. Although some patients demonstrate normal neuropsychological (NP) functioning, little is known about their functional disability. We examined the cross-sectional functional implications of NP normality and symptomatic remission in older outpatients diagnosed with schizophrenia or schizoaffective disorder, who were administered a NP battery and performance-based measures of functional and social competence, with their real-world functioning rated by case managers. NP status was classified by the General Deficit Score (GDS) and remission status was based on the Positive and Negative Syndrome Scale (PANSS), yielding four subsamples of patients: NP normal-remitted (n = 21), NP normal-symptomatic (n = 22), NP impaired-remitted (n = 90), and NP impaired-symptomatic (n = 97). NP normal patients demonstrated better functional and social competence and better ratings of real world functioning, after controlling for premorbid abilities. However, compared to normative date, NP normal patients manifested disability in several real-world domains, including residential status. These results suggest that NP status is a better predictor of functional outcome then symptom status or the interaction of the two factors. The disability seen in NP normal cases indicates that factors other than cognitive impairments may determine aspects of everyday outcomes in schizophrenia. (JINS, 2008, 14, 479–488.)

Two hundred-thirteen children in grades 1 through 8 were asked to rapidly generate as many names of animals as they could in 60 seconds. These children were age appropriate for their grade level in school, did not receive any form of special education services, and as a group showed (estimated) average intellectual ability. They were primarily from minority (particularly Hispanic) backgrounds and came from families with low socioeconomic status. Normative data are presented. Hierarchical multiple regression analysis revealed that the age range/grade level score accounted for 21.5% of the variability in fluency scores and the Vocabulary level of the child accounted for an additional 5.7%. Level of performance on this animal fluency task was not lower than what has been reported in primarily white children from middle socioeconomic backgrounds. (JINS, 2008, 14, 143–147.)

Although neurocognitive deficits have been identified in obsessive-compulsive disorder (OCD), little research has focused on whether these deficits are generalized or specific to a given cognitive domain. We assessed the relative strengths and weaknesses of 26 adult patients with OCD compared to 38 age- and sex-matched healthy volunteers in domains of motor, verbal memory, visual memory, reasoning/problem solving, processing speed processing, and language. Profile analysis revealed an overall neurocognitive deficit of ½ standard deviation in OCD patients versus healthy volunteers, with relative weaknesses in motor and processing speed domains. In contrast, relative strengths were observed in language, verbal memory, and reasoning/problem solving. Our findings demonstrate neurocognitive impairment in OCD that may relate to functional outcome in this population. Findings of specific abnormalities on tasks of motor and processing speed are consistent with a hypothesized role of thalamocortical and basal ganglia regions in the pathogenesis of OCD. (JINS, 2008, 14, 640–645.)

Neuropsychologists routinely rely on response validity measures to evaluate the authenticity of test performances. However, the relationship between cognitive and psychological response validity measures is not clearly understood. It remains to be seen whether psychological test results can predict the outcome of response validity testing in clinical and civil forensic samples. The present analysis applied a unique statistical approach, classification tree methodology (Optimal Data Analysis: ODA), in a sample of 307 individuals who had completed the MMPI-2 and a variety of cognitive effort measures. One hundred ninety-eight participants were evaluated in a secondary gain context, and 109 had no identifiable secondary gain. Through recurrent dichotomous discriminations, ODA provided optimized linear decision trees to classify either sufficient effort (SE) or insufficient effort (IE) according to various MMPI-2 scale cutoffs. After “pruning” of an initial, complex classification tree, the Response Bias Scale (RBS) took precedence in classifying cognitive effort. After removing RBS from the model, Hy took precedence in classifying IE. The present findings provide MMPI-2 scores that may be associated with SE and IE among civil litigants and claimants, in addition to illustrating the complexity with which MMPI-2 scores and effort test results are associated in the litigation context. (JINS, 2008, 14, 842–852.)

Some researchers have suggested that general self-report depression scales may be inadequate for assessing depression among individuals with Multiple Sclerosis (MS), because many of such items represent MS disease symptoms. However, research has been mixed on this issue: whereas some studies provide support for symptom overlap, others have found opposing evidence. We investigated this issue in two different MS samples with three different strategies. We (1) examined reliable change in depression symptom categories at two time points over three years, (2) assessed the relationship between variables associated with depression and different depression symptom subscales, and (3) assessed the relationship between symptom subscales and physical disability. In each instance we found significant evidence that items meant to assess vegetative symptoms of depression may be influenced by presence of MS disease symptoms or were not associated with other core elements or central correlates of depression. (JINS, 2008, 14, 1057–1062.)

Although the adverse consequences of changes in social behavior following traumatic brain injury (TBI) are well documented, relatively little is known about possible underlying neuropsychological deficits. Following a model originally developed for social behavior deficits in schizophrenia, we investigated whether impairments in emotion recognition, understanding of other people's intentions (“theory of mind”), and cognitive flexibility soon after first TBI or 1 year later were associated with self and proxy ratings of behavior following TBI. Each of the three functions was assessed with two separate tests, and ratings of behavior were collected on three questionnaires. Patients with TBI (n = 33) were impaired in emotion recognition, “theory of mind,” and cognitive flexibility compared with matched orthopedic controls (n = 34). Proxy ratings showed increases in behavioral problems 1 year following injury in the TBI group but not in the control group. However, test performance was not associated with questionnaire data. Severity of the impairments in emotion recognition, understanding intention, and flexibility were unrelated to the severity of behavioral problems following TBI. These findings failed to confirm the used model for social behavior deficits and may cast doubt on the alleged link between deficits in emotion recognition or theory of mind and social functioning. (JINS, 2008, 14, 318–326.)

The present study examined whether patients with obsessive-compulsive disorder (OCD) focus on details at the expense of global aspects. A recent study of our group using Navon letters (e.g., the letter “S” composed out of “A” letters) did not yield differences between OCD patients and controls on local processing. However, the task used may have lacked sensitivity, because it did not involve a response conflict condition (i.e., global and local level associated with different responses). In the current study, we gradually varied between-level conflict. Twenty-eight OCD patients and 30 healthy controls had to attend to the global and the local level of each item. OCD patients displayed comparable performance: Patients neither displayed a preference to respond to the local level nor enhanced interference from the local level. In conclusion, the present study does not support the idea that a generalized bias to “miss the forest for the trees” forms part of the vulnerability to OCD. (JINS, 2008, 14, 489–493.)

This study compared speed of information processing in patients with relapsing–remitting or secondary progressive multiple sclerosis (MS) and healthy controls using the Stroop Test and a Picture Naming Test (PNT). While both tests evaluated processing speed within a format calling for rapid serial processing of stimulus information, the PNT included trials designed to impose greater verbal–motor and ocular–motor challenges by using novel rather than repeated pictures and by presenting the pictures in distributed locations rather than always centered on the screen. The results confirmed that a decrease in the speed of information processing is a key feature of the cognitive impairment occurring in conjunction with MS. When this feature is evaluated with tests requiring rapid serial processing of stimulus information, the contribution of peripheral motor deficits appears to be modest. (JINS, 2008, 14, 646–650.)

The goal of the current investigation was to examine adaptive behavior and cognitive skills in young children with Duchenne muscular dystrophy (DMD), a genetic disorder that causes progressive muscular weakness and concomitant cognitive deficits. Previous studies have documented specific language deficits in older children with DMD, but there are limited data on younger children. Twenty children with DMD who were between 3 and 6 years old and 20 unaffected family control children were recruited. Parents completed questionnaires relating to development and adaptive functioning, while children completed neuropsychological testing. Results of paired t tests indicate that children with DMD are rated as delayed relative to familial controls on measures of adaptive functioning, as assessed by the Vineland Adaptive Behavior Scales. Furthermore, children with DMD exhibit impairments on multiple measures of cognition, including measures of receptive language, expressive language, visuo-spatial skills, fine-motor skills, attention, and memory skills. Across all domains examined, the young children with DMD performed more poorly than their familial controls. These deficits appear to be more generalized than those reported in older children with this disorder. Dystrophin, a missing protein product, is hypothesized to be responsible for these cognitive and behavioral impairments. (JINS, 2008, 14, 853–861.)

The Iowa Gambling Task (IGT) is the major plank of behavioral support for the Somatic Marker Hypothesis—a prominent theory of emotionally-based decision making. Despite its widespread use, some have questioned the ecological and discriminative validity of the IGT because a substantial proportion of neurologically-normal adults display a response pattern indistinguishable from those with ventromedial prefrontal cortical brain lesions. In a large sample of healthy adults, we examined the statistical influence of several demographic variables on two versions of the IGT, with the specific prediction that educational attainment would moderate learning across trials. Results confirmed a highly significant effect of education. On the commonly used original version of the IGT, performance tended to improve more rapidly, and reach a higher eventual positive score, as the level of education increased. Age and gender were nonsignificant effects in the model, and Caucasians had slightly better IGT performance than their non-Caucasian counterparts. Conclusions are that education level, among neurologically-normal adults, should be treated as a stratification or matching variable in case-control research using this task. (JINS, 2008, 14, 1063–1068.)

Subjective memory complaints (SMCs) are part of the diagnostic criteria for Mild Cognitive Impairment (MCI), yet little is known about their etiology. In some previous studies, no direct relation has been found between SMCs and objective memory performance, yet significant correlations have been identified between SMCs and psychological factors such as depression and anxiety. In the current study, we examined whether negative affect moderated the relation between objective memory functioning and SMCs in a sample of healthy, non-demented participants aged 65 and older. As predicted, several negative affect measures moderated the relationship between objective cognitive functioning and SMCs. In the absence of objective memory impairment as indexed by the Rey Auditory Verbal Learning Test (RAVLT) and the Dementia Rating Scale-2nd Edition (DRS-2), higher levels of negative affect were associated with increased levels of SMCs. Moreover, a lower order negative affect factor, anxiety sensitivity, significantly moderated the relation between objective memory functioning and SMCs, after controlling for higher order measures of general negative affectivity. Findings suggest that negative affect, particularly anxiety sensitivity, distorts the subjective appraisal of one's own memory, such that people high on negative affect factors report more episodes of forgetting, even in the absence of objective cognitive impairments. (JINS, 2008, 14, 327–336.)

The potential influence of recruitment context in neuropsychological (NP) research is seldom addressed in the literature. Our experience with a previous large-scale study of MS cognitive impairment led us to speculate that referral questions and motivation bias significantly impact conclusions drawn from NP testing. We re-analyzed data from Benedict et al. (2006) and compared the results obtained across three groups of patients: paid research volunteers, clinical patients undergoing evaluation for routine monitoring of cognitive status, and clinical patients referred for diagnostic clarification, determination of disability benefits, and other more complex issues. Research volunteers were significantly younger and less frequently cognitively impaired compared to the clinical groups, greatly affecting prevalence estimates (45.6 to 65.6%). Significant correlations between depression and cognitive impairment were present only among the research volunteers. NP testing significantly predicted vocational outcomes in all groups. These results suggest that greater attention should be paid to the reasons patients agree to participate in NP testing. (JINS, 2008, 14, 494–498.)

The objective of this study is to obtain preliminary normative data on the performance the Pyramids and Palm Trees Test (PPT) for a Spanish-speaking population. The effects of age, gender, and educational level on the PPT test were also analyzed. A total of 234 healthy participants, with a broad range of age (18–80 years) and education (1–20 years) performed the three-picture version of the PPT. The mean performance was 51.1 out of 52 possible points (SD = 1.3). PPT performance did not vary with age or gender. However, subjects with less than 6 years of formal education scored significantly lower than those with more than 6 years of education though this effect was confounded with age because the group with lower education was also older. Given the ceiling effects of the PPT, further investigation is needed to determine if the visual PPT is sensitive to mild semantic memory impairment. (JINS, 2008, 14, 148–151.)

Pediatric Neuropsychological Intervention. Scott J. Hunter and Jacobus Donders (Eds.). 2007. New York: Cambridge University Press, 493 pp., $115.00 (HB).

Pediatric neuropsychologists have a new resource to add to their growing collection of texts. Hunter and Donders have edited an invaluable resource with chapters on basic developmental and assessment issues, reviews of both common and less commonly known conditions that often result in disability, and suggestions for empirically based treatment. The editors' goal is to direct researchers toward intervention studies to demonstrate that practice is indeed based on evidence.

The performance of 40 children with complicated mild to severe traumatic brain injury on the Wechsler Intelligence Scale for Children–Fourth Edition (WISC–IV; Wechsler, 2003) was compared with that of 40 demographically matched healthy controls. Of the four WISC–IV factor index scores, only Processing Speed yielded a statistically significant group difference (p < .001) as well as a statistically significant negative correlation with length of coma (p < .01). Logistic regression, using Processing Speed to classify individual children, yielded a sensitivity of 72.50% and a specificity of 62.50%, with false positive and false negative rates both exceeding 30%. We conclude that Processing Speed has acceptable criterion validity in the evaluation of children with complicated mild to severe traumatic brain injury but that the WISC–IV should be supplemented with other measures to assure sufficient accuracy in the diagnostic process. (JINS, 2008, 14, 651–655.)

Relatively little research has focused on everyday memory function in childhood, possibly reflecting the limited number of measures available. This study introduces the Observer Memory Questionnaire—Parent Form (OMQ-PF), which assesses parental beliefs about their child's everyday memory. The OMQ-PF and a selection of neuropsychological measures were administered to a cohort of healthy children in Study 1 (n = 376; 5–16 years old) and a temporal lobe epilepsy (TLE) group in Study 2 (n = 44; 6–16 years old). Study 1 found the OMQ-PF had sound internal consistency and was significantly correlated to a learning task. Study 2 found the TLE group was impaired on the OMQ-PF relative to the healthy cohort. Everyday memory ratings were related to a wider range of neuropsychological measures in this group. Findings are encouraging in terms of the properties of the OMQ-PF and suggest further development of the scale is warranted. (JINS, 2008, 14, 337–342.)