Despite the potential impact on development, few studies have examined the influence of prefrontal lesions occurring prior to maturation of the central nervous system. This study investigates the effect of prefrontal lesions in general, as well as the impact of lesion laterality, with respect to attentional abilities. The sample comprised 36 children with prefrontal lesions and 40 healthy controls. Attentional function was assessed across four domains: selective, shifting and divided attention, and processing speed. Group mean performances for children with prefrontal lesions indicated global attentional deficits, with greatest difficulties for “higher-order” skills including shifting and divided attention. Children with left prefrontal lesions performed similarly to controls, with a specific deficit characterized by difficulties with on-line processing of auditory-verbal information. Right prefrontal lesions were primarily associated with impairments in day-to-day executive functions, including reduced monitoring, poor shifting attention and disinhibition. Children with bilateral prefrontal lesions performed worse than controls on tasks requiring greater cognitive resources. These results provide evidence of the important role played by prefrontal cortex in the development of attentional skills, and the particular role of the right prefrontal cortex. The pattern of attention deficits observed following early prefrontal lesions suggests some lateralization of function within the frontal lobes, even during childhood. (JINS, 2005, 11, 817–831.)Source of funding: Australian National Health and Medical Research Council, Australian Research Council, Murdoch Children's Research Institute.

The purpose of this study was to investigate whether inappropriate/excessive motor activity seen in children with Attention Deficit Hyperactivity Disorder (ADHD) could be characterized as Utilization Behavior (UB). Given evidence that the neuropathology of ADHD may involve frontal-striatal systems, we investigated the possibility that children with ADHD may demonstrate “utilization behavior.” Utilization Behavior (UB) is a neurobehavioral syndrome documented in individuals with damage or dysfunction in the frontal areas of the brain; patients exhibiting UB are often described as reaching out and utilizing objects in the environment in an automatic and inappropriate manner. The sample consisted of two group of children; children with ADHD (n = 32) and control children (n = 31). Children were assessed individually in a testing room where various objects, selected to elicit UB, were present. They completed cognitive tests and also were allowed to engage in an unsupervised activity. Testing sessions were videotaped and instances of physical activity (i.e., upper limb motor activity and utilization of objects) were counted by two raters. Results indicated high levels of object utilization in approximately one-half of the children with ADHD, whereas almost no such behavior was observed in controls. This behavior did not appear to be a result of generally heightened activity levels or due to instruction set, but differed according to object familiarity and object visibility. Levels of UB were statistically associated with the severity of hyperactivity, as reported by parents, of children with ADHD. This study suggests that inappropriate/excessive motor activity may, at least in part, be characterized as UB in some children with ADHD. (JINS, 2005, 11, 367–375.)

The objective of this study was to carry out a detailed investigation of the neurological, neuropsychological, and return-to-work status of treatment for unruptured intracranial aneurysms (UIAs). A prospective design was used to evaluate the outcome of UIA treatment in a group of 26 UIA patients. Over a 24-month period UIA patients were assessed prior to treatment, during hospitalization, at three months and at six months following treatment. Their performance was compared to a group of 20 matched controls. Neurological morbidity as a result of the UIA treatment was 5%, as assessed by the Glasgow Outcome Scale (GOS) or Rankin at 3 months. The Telephone Interview for Cognitive Status (TICS) proved to be unreliable as a measure of cognitive change. Reliability of change analysis was more sensitive than group analysis, and revealed a pattern of cognitive deficits in 10% of patients as a result of the UIA treatment. In addition, 25% of patients reported a change in work role as a result of the UIA treatment. While 10% of patients sustained mild to moderate neurological and cognitive impairments 3 to 6 months following UIA treatment, their deficits were not as wide-ranging nor as severe as those sustained by patients who survive a subarachnoid hemorrhage (SAH). (JINS, 2005, 11, 522–534.)

Treatment with interferon-alpha (IFN-α) has been shown to adversely affect cognitive functioning in patients with a variety of medical disorders, but information about the effects of IFN-α on cognitive functioning in patients with chronic hepatitis C (CHC) is limited. The purpose of this study was to examine the effects of IFN-α on neuropsychological test performance in CHC patients. Participants were 30 patients with CHC, 11 who underwent IFN-α therapy and 19 who did not. All participants were tested at baseline (i.e., pretreatment) and approximately 6 months later with the Symbol Digit Modalities Test and Trail Making Test. Results revealed that the treatment group performed significantly worse than untreated CHC patients on Part B of the Trail Making Test after approximately 6 months of treatment. No significant group differences were found on Part A of the Trail Making Test or Symbol Digit Modalities Test. Findings suggest that CHC patients undergoing treatment with IFN-α may experience reduced abilities to benefit from practice but suffer no decrements in performance after 6 months of treatment. Additional research is needed to replicate these findings and to explore risk factors for susceptibility to IFN-α-induced effects. (JINS, 2005, 11, 16–22.)

There is evidence that the prevention of errors during learning might be helpful in improving an impaired memory performance, both in amnesia as well as in normal age-related memory decline. Although errorless learning is a promising technique for use in rehabilitation practice, the underlying mechanisms are unclear. That is, it has been suggested that the beneficial effects of errorless learning operate through implicit memory, whereas others implicate that it is explicit memory that is responsible for the enhanced memory performance after errorless learning. The current study examined the contribution of implicit and explicit memory function to the memory performance after errorless and errorful learning using the process-dissociation procedure. A group of young adults (N = 40) was compared to a matched group of older individuals (N = 40) on a spatial memory task (i.e., learning the locations of everyday objects in a room). The results clearly show age-related decline in explicit spatial memory, while implicit spatial memory was unaffected. Furthermore, the young group benefited from errorless learning compared to errorful learning, while the older group did not show a difference between the two learning conditions. Also, it was found that the effects of errorful learning were related to explicit memory function, and not implicit processing, corroborating and extending recent findings. (JINS, 2005, 11, 144–151.)

Arithmetic skills and their cognitive correlates were studied in 24 children with myelomeningocele and shunted hydrocephalus (MM), 27 children with severe traumatic brain injuries (TBI), and 26 children with orthopedic injuries (OI). Their average age was 11.56 years (SD = 2.36). They completed the WRAT–3 Arithmetic subtest and a subtraction task consisting of 20 problems of varying difficulty, as well as measures of working memory, declarative memory, processing speed, planning skills, and visuospatial abilities. The MM group performed more poorly on the WRAT–3 Arithmetic subtest and the subtraction task than the other two groups, which did not differ from each other on either measure. The groups did not differ in the number of math fact errors or visual-spatial errors on the subtraction task, but the MM group made more procedural errors than the OI group. The five cognitive abilities explained substantial variance in performance on both arithmetic tests; processing speed, working memory, declarative memory, and planning accounted for unique variance. Exploratory analyses showed that the cognitive correlates of arithmetic skills varied across groups and ages. Congenital and acquired brain disorders are associated with distinct patterns of arithmetic skills, which are related to specific cognitive abilities. (JINS, 2005, 11, 249–262.)

It is recognized that existing neuropsychological measures of executive dysfunction lack adequate sensitivity and selectivity. While attempts have been made to develop improved measures, these have not yet been of great value to those who need to accurately identify executive deficits in a clinical setting. Several behavioral rating scales have been developed for this reason, including the 20-item Dysexecutive Questionnaire (DEX), which forms part of the Behavioral Assessment of the Dysexecutive Syndrome (BADS) test battery. To investigate the ability of the DEX to identify executive dysfunction in an acute rehabilitation setting, the BADS was administered to 64 persons who had sustained traumatic brain injury. It was found to be almost as sensitive to executive dysfunction, as measured by the total score obtained on the BADS battery, as an extended 65-item version of the scale, when completed by either the occupational therapist or clinical neuropsychologist working with each patient. Family members and the patient themselves provided, as expected, less accurate information. Our results indicate that the DEX can be used with some confidence as a screening instrument to identify executive dysfunction in an acute rehabilitation setting, provided it is completed by professional personnel, trained to be sensitive to the cognitive and behavioral concomitants of this disorder. (JINS, 2005, 11, 376–385.)

The present study investigated the usability of whole and partial report of briefly displayed letter arrays as a diagnostic tool for the assessment of attentional functions. The tool is based on Bundesen's (1990, 1998, 2002; Bundesen et al., 2005) theory of visual attention (TVA), which assumes four separable attentional components: processing speed, working memory storage capacity, spatial distribution of attention, and top-down control. A number of studies (Duncan et al., 1999; Habekost & Bundesen, 2003; Peers et al., 2005) have already demonstrated the clinical relevance of these parameters. The present study was designed to examine whether (a) a shortened procedure bears sufficient accuracy and reliability, (b) whether the procedures reveal attentional constructs with clinical relevance, and (c) whether the mathematically independent parameters are also empirically independent. In a sample of 35 young healthy subjects, we found high intraparameter correlations between full- and short-length tests and sufficient internal consistencies as measured via a bootstrapping method. The clinical relevance of the TVA parameters was demonstrated by significant correlations with established clinical tests measuring similar constructs. The empirical independence of the four TVA parameters is suggested by nonsignificant or, in the case of processing speed and working memory storage capacity, only modest correlations between the parameter values. (JINS, 2005, 11, 832–842.)

Background: Divergences in cognitive disturbances in hypothyroidism reported in the literature are a result of a methodological bias. Methods: By using a precise methodology, we examined attention and executive functions in hypothyroidism, verified the presence of anxiety and depressive symptoms in hypothyroidism, and examined the possible link between these symptoms and the cognitive disturbances (searching for attentional bias for words with a negative emotional valence). We administered a battery of cognitive tests to 23 participants who had undergone thyroidectomy for thyroid carcinoma: for the first time in an euthyroid state, then 3 weeks later (still in the euthyroid state) to assess the test/retest effect, and finally 4 weeks later in an hypothyroid state. We compared their performance with that of a group of 26 control participants who were also administered the same cognitive tests, also 3 times. Results: In hypothyroidism, the thyroid participants were more anxious and depressed than the controls and presented attentional and executive disturbances that reflected general slowing and difficulties in using their capacities of inhibition. However, they did not exhibit an attentional bias for words with a negative emotional valence. Conclusions: Contrary to what was expected, symptoms of anxiety and not symptoms of depression interfered with the cognitive performance of participants in hypothyroidism. (JINS, 2005, 11, 535–544.)

Traumatic brain injury (TBI) frequently results in memory problems, and the degree of memory impairment is related to injury severity and is commonly associated with lesions in frontal and temporal brain areas. This study examined the relationship among injury severity, brain lesions, and memory in children with moderate to severe TBI using Donders' (1999) 5-factor model of performance on the California Verbal Learning Test–Children's Version (CVLT–C). Seventy-six children underwent magnetic resonance imaging (MRI) scans 3 months post-TBI and testing 1 year post-TBI. Results showed injury severity (Glasgow Coma Scale) was not predictive of performance on 4 of the 5 factors. Volume of frontal and/or temporal brain lesions was significantly predictive of performance on 3 of the 5 factors. Unexpectedly, lesion volume outside these areas (extra-frontotemporal) was predictive of performance on all 5 factors. In contrast, Verbal IQ at 1 year was most strongly associated with preinjury factors (socioeconomic status and special education involvement), although extra-frontotemporal lesions also contributed to the variability in this measure. Results suggest that in children with moderate to severe TBI, extra-frontal/temporal lesions are predictive of memory outcome 1 year postinjury above and beyond initial severity or frontal/temporal contusions. This finding may relate to widespread diffuse axonal injury, which potentially disconnects brain circuits mediating memory following moderate to severe TBI. (JINS, 2005, 11, 686–696.)

The present study further explored the phenomenon of “diagnosis threat” (Suhr & Gunstad, 2002), by examining the potential explanatory roles of anxiety, effort, and depression. Individuals with mild head injury history were randomly assigned to receive either neutral instructions (controls, N = 25) or to have attention called to their head injury history as a reason for invitation into the study (diagnosis threat, N = 28). Depression was measured at baseline. Following the neuropsychological battery, ratings of effort, test pressure, and state anxiety were completed. The diagnosis threat group performed worse than controls on attention/working memory, psychomotor speed, and memory tasks, but not on measures of executive functioning, post-test anxiety, or effort. Effort, anxiety and depression were not related to cognitive performance, nor did depression interact with expectations in explaining group differences in performance. Results provide further support for the “diagnosis threat” effect, but offer no support for effort, anxiety, or depression explanations for diminished performance. (JINS, 2005, 11, 23–29.)

It is unclear if the commonly observed “subcortical” verbal memory profile in schizophrenic patients is present at the onset of the disease. Therefore, the performance of 43 first-episode patients with schizophrenia or schizophreniform disorder on the Dutch version of the California Verbal Learning Test (VLGT) was compared to that of 43 normal comparison participants. We hypothesized that the first-episode patients would exhibit a “subcortical” memory profile, that is, they would show a primary retrieval deficit. This hypothesis was not confirmed: the patients displayed a profile suggestive of a prominent storage deficit, that is, a “cortical” memory profile. Subsequently, patients' VLGT performance was cluster analyzed to determine whether subgroups could be identified exhibiting a cortical, subcortical, and normal profile, respectively. Two subgroups (N = 22; N = 13) exhibited memory impairments, while one subgroup (N = 8) was unimpaired. The memory profiles of the two impaired subgroups differed both qualitatively and quantitatively, but did not conform neatly to a cortical and a subcortical profile. Demographic and verbal fluency data provided limited validation of the subgroup classification. Our results may suggest that combining the verbal memory performance of first-episode patients obscures meaningful heterogeneity. Alternatively, the cluster solution could merely reflect a continuum of severity. (JINS, 2005, 11, 152–162.)

Based on a ‘Theory of Visual Attention’ (TVA), whole and partial report of brief letter arrays is presented as a diagnostic tool to estimate four clinically significant attentional components: perceptual processing speed, visual working memory storage capacity, efficiency of top-down control, and spatial distribution of attention. The procedure used was short enough to be applicable within a standard clinical setting. Two brain-damaged patients, selected based on lesion location and neuropsychological test profile, were compared to a control group of 22 healthy subjects. One patient with a right inferior parietal lesion showed a pattern of non-spatially and spatially lateralized attention deficits that is typically found in neglect patients. Results from the second patient supported the decisive role of superior frontal brain structures for top-down control of visual attention. This double dissociation supports the hypothesis that, even with a short version of whole and partial report, valid and meaningful results can be obtained in the neuropsychological assessment of attention deficits. The potential and constraints of TVA-based parameter estimation for the clinical application are discussed. (JINS, 2005, 11, 843–854.)

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 ability to spatially rotate a mental image was compared in patients with Alzheimer's disease (AD; n = 18) and patients with Huntington's disease (HD; n = 18). Compared to their respective age-matched normal control (NC) group, the speed, but not the accuracy, of mental rotation abnormally decreased with increasing angle of orientation for patients with HD. In contrast, the accuracy, but not the speed, of rotation abnormally decreased with increasing angle of orientation for patients with AD. Additional analyses showed that these unique patterns of performance were not attributable to different speed/accuracy trade-off sensitivities. This double dissociation suggests that the distinct brain regions affected in the two diseases differentially contribute to speed and accuracy of mental rotation. Specifically, the slowing exhibited by HD patients may be mediated by damage to the basal ganglia, whereas the spatial manipulation deficit of AD patients may reflect pathology in parietal and temporal lobe association cortices important for visuospatial processing. (JINS, 2005, 11, 30–39.)

The present study examines differences in functional cerebral asymmetries modulated by gonadal steroid hormones during the menstrual cycle in women. Twenty-one right-handed women with regular menstrual cycles performed a double-stream rapid serial visual presentation (RSVP) task, with one stream in each visual field, during the low steroid menses and the high steroid midluteal phase. They were required to detect a target item, and then a probe item, each of which could appear in either stream. If the probe item appeared 200 ms after the target, detection of the probe was impaired—a phenomenon known as the “attentional blink.” This occurred in both streams in the midluteal phase, but only in the right visual field during menses. Thus low steroid levels appeared to restrict the attentional blink to the left hemisphere, while high levels of estradiol and progesterone in the midluteal phase appeared to reduce functional asymmetries by selectively increasing the attentional blink in the right hemisphere. This effect appears to be mediated by estradiol rather than progesterone, and it is compatible with the assumption of a hormone-related suppression of right hemisphere functions during the midluteal phase. (JINS, 2005, 11, 263–272.)

Lateralized spatial biases after brain damage are commonly assessed using batteries of paper-and-pencil tests. These tests hardly allow quantification of performance in different locations in space, and they tend to lose sensitivity along the course of recovery. We tested the dynamic Starry Night Test (SNT), a novel computerized test measuring reaction time and detection accuracy for visual target stimuli in a dynamic background, in 32 inpatients with right hemisphere stroke (RHS), 16 patients with left hemisphere stroke (LHS), and 9 healthy controls. As a group, only the RHS patients were significantly slower to respond to contralesional targets. Individually, 21 (66%) RHS patients and 5 (31%) LHS patients showed statistically significant contralateral deficits. In a number of RHS patients the SNT was more sensitive to the ipsilesional bias of spatial attention than the Behavioral Inattention Test (BIT), a standardized paper-and-pencil test battery of unilateral spatial neglect. Two illustrative case reports show that the dynamic SNT, but not the BIT, was sensitive to the spatial deficit in recovered patients, one of whom was involved in repeated car accidents. The SNT overcomes serious shortcomings of paper-and-pencil tests of unilateral neglect. It provides a simple quantitative tool for monitoring the natural and treatment-induced recovery of patients. (JINS, 2005, 11, 697–707.)Part of the data was presented in abstract form at the EBBS EuroConference on Cognitive and Neural Bases of Spatial Neglect, September 14–17, 2000, Como, Italy.

Bipolar disorder (BPD) is a severe psychiatric illness that is characterized by episodes of extreme mood states. The affective components of bipolar disorder have been studied extensively, but only recently have investigators begun to systematically examine its cognitive concomitants. Although executive dysfunction has been reported in this population, especially while patients are manic, the tasks administered in many previous studies have made it difficult to determine the specific executive abilities that were compromised. The present study examined 15 patients with bipolar disorder who were manic, 18 who were euthymic, and 18 healthy participants. Tests were selected to evaluate two specific aspects of executive functioning in these participants. The Object Alternation Task was given as a measure of inhibitory control, and the Delayed Response Task was included as a measure of spatial delayed working memory. All groups performed similarly on the Delayed Response Task. On the Object Alternation Task, however, the manic and euthymic patients committed significantly more perseverative errors than healthy participants. These results indicated that patients in the present sample had relatively normal working memory abilities, but had a deficit in behavioral self-regulation, which was evident across mood states. (JINS, 2005, 11, 163–172.)Location of work: Center for Bipolar Disorders Research, Department of Psychiatry, University of Cincinnati School of Medicine, Cincinnati, Ohio.