One-hundred fifty-eight elderly Spanish-speaking U.S. residents (81 patients diagnosed with Alzheimer's disease and 77 subjects without dementia) were tested with Spanish-language versions of four brief cognitive assessment instruments: the Mini-Mental State Examination (S-MMSE), the Mental Status Questionnaire (S-MSQ), the Information-Memory-Concentration test (S-IMC), and the Orientation-Memory-Conccntration test (S-OMC). Within-group performances were highly correlated for all four instruments. All tests distinguished between the demented and nondemented groups, but best discrimination was achieved with the S-IMC, which correctly classified 98% of subjects. This version was also the best predictor of functional disability, as measured by impairments in instrumental activities of daily living. Within the normal comparison group, neither gender nor a subject's monolingual/bilingual status affected test performance. These four Spanish-language cognitive screening tasks may aid in the evaluation of dementia among Spanish-speaking patients. (J1NS, 1996, 2, 286–298.)

Thirteen patients with left neglect performed line bisection under four conditions: no cue, visual cueing involving the report of a digit placed at the left end of the line, circling the left-end digit, and digit circling plus tracing of the line with the right index finger from its left end to its midpoint before bisection. Digit circling plus finger tracing was unequivocally more effective in reducing left neglect than digit circling alone, which was in turn more effective than visual cueing; indeed, digit circling with tracing completely abolished the rightward bisection bias. Thus continuously directing visuomotor control to the left side of the line (even with the right hand) until bisection is performed reduces neglect more than only requiring patients to attend to left-sided visual cues. The facilitatory effects of the cueing procedures may reflect their differential efficacy in constraining as well as attracting attention and action to the left part of the target line. These findings have implications for neglect rehabilitation. (JINS, 1996, 2, 404–411.)

Two patients with nonfluent progressive aphasia, who have been studied longitudinally, are contrasted with a group of 5 patients with fluent progressive aphasia or semantic dementia. The most prominent feature of the nonfluent syndrome is the severe distortion of speech output with phonological errors and agrammatic sentence structure. This contrasts with the fluent, well articulated and syntactically correct, but empty, anomic speech found in semantic dementia. Performance on tests of comprehension separates the patient groups: The nonfluent patients show normal single-word comprehension, but marked impairment on tests of syntactic comprehension, while those with semantic dementia demonstrate the opposite pattern. Category fluency is severely defective in semantic dementia, but initial letter-based fluency is more impaired in the nonfluent syndrome. Performance on nonverbally mediated tests of semantic knowledge is impaired in semantic dementia only. The 2 forms of progressive aphasia have in common the sparing of perceptual and visuospatial skills, nonverbal problem solving abilities, and day-to-day (episodic) memory. Neuroradiological investigations have shown marked selective and striking inferolateral left temporal lobe atrophy in all 5 patients with semantic dementia. The changes in nonfluent progressive aphasia appear to be less focal and involve left perisylvian structures more diffusely. These 2 forms of progressive aphasia are, we argue, distinct in their manifestations. (JINS, 1996, 2, 511–524.)

Human immunodeficiency virus type 1 (HIV-1) seropositive AIDS free and HIV-1 seronegative intravenous drug users were tested twice with a comprehensive neuropsychological test battery. Only minor group differences were found. Memory difficulties were the most pronounced difference with lower scores in the HIV-1 seropositive group. The memory difficulties were to some degree associated with emotional difficulties, that is, anxiety. The HIV-1 seropositive subjects were tested a third time and there was no further decline in any test with memory content at this testing. The only test that showed a significant decline in the HIV-1 seropositive group was the Trail Making Test. (JINS, 1996, 2, 126–133.)

The direct and indirect effects of demographic, medical, and psychological variables on neuropsychological performance in elderly individuals were examined using a LISREL structural equation model. One-hundred fifty-six geriatric subjects were individually administered a comprehensive neuropsychological battery, an extensive medical history and demographics questionnaire, and the Neuropsychology Behavior and Affect Profile (a psychological assessment instrument). The model assessed the effects of five independent latent variables (medical history, psychological functioning, global mental status, education, and gender-related functioning) on two dependent latent variables (nonverbal and verbal neuropsychological functioning). The best fitting model revealed that three latent variables (medical history, global mental status, and gender-related functioning) had direct effects on neuropsychological functioning and that all five independent variables exhibited indirect effects. These findings suggest that the influence of demographic variables on neuropsychological functioning for geriatric persons is complex and that certain variables should not be interpreted independently of each other due to their significant moderating influences. (JINS, 1996, 2, 299–305.)

Neuropsychological functioning is reported to be impaired in patients suffering from obstructive sleep apnea syndrome (OSAS). This syndrome is characterized by nocturnal respiratory disturbances, blood oxygen desaturations, sleep fragmentation, and excessive daytime sleepiness. Opinions arc divided concerning the exact relationship between the observed cognitive deficits, nocturnal hypoxia, sleep disruption, and impaired daytime alertness. In the present study, morning neuropsychological function of 26 moderate to severe middle-aged sleep apneics is compared to that of 22 primary insomniacs. There were no performance differences on a range of neuropsychological tests among the two patient groups. In addition, the data suggest that morning alertness impairment, which is closely associated with a lack of slow wave sleep (SWS) and rapid eye movement (REM) sleep, is of major importance in inducing poorer cognitive performance in patients with moderate to severe sleep apnea. (JINS, 1996, 2,306–314.)

A range of tests of everyday attention is described, based on ecologically plausible activities such as searching maps, looking through telephone directories, and listening to lottery number broadcasts. An age-, sex- and IQ-stratified sample of 154 normal participants was given these tests, along with a number of existing tests of attention. The factor structure revealed by this data set matched well contemporary evidence for a set of functionally independent attentional circuits in the brain, and included factors for sustained attention, selective attention, attentional switching and auditory-verbal working memory. The Test of Everyday Attention (TEA), which was developed and standardized on the basis of these subtests, has three parallel forms, high test-retest reliability, and correlates significantly with existing measures of attention. Furthermore, selected subtests successfully discriminate among a number of brain-impaired groups, including closed head injury versus age-matched controls, minimal versus mild Alzheimer’s disease, and progressive supranuclear palsy patients versus age-matched controls. (JINS, 1996, 2, 525–534.)

Problem solving by patients with clinically definite multiple sclerosis (MS) was examined using the Wisconsin and California Card Sorting Tests (WCST and CCST). On the WCST, the MS patients achieved fewer categories and made more perseverative responses and errors than controls, confirming results of several previous studies. On the CCST, the MS patients generated and identified fewer concepts, but they performed normally when sorting was cued by the experimenter and they made no more persevcrations than controls. Although findings from the WCST indicate that the problem solving deficits by MS patients closely resemble those exhibited by patients with various conditions that produce frontal lobe dysfunction, results from the CCST indicate that the problem solving difficulties exhibited by patients with MS arc distinct and probably represent a primary deficit in concept formation. (JINS, 1996, 2, 134–140.)

We report a case of severe visuo-spatial neglect consequent upon right-hemisphere stroke. At the time of testing, the patient had no visual field cut and no significant hemiparesis. Conventional testing on cancellation tasks with the right hand revealed reliable left neglect, but performance was significantly improved when the left hand was used. Investigations of (manual) line bisection showed normal performance with the right hand but right neglect when the left hand was used. Right neglect was also observed on a purely perceptual version of the line bisection task. We argue that the attentional vectors of the cerebral hemispheres can be modulated by (perceptual) task-demands and by (motorie) response demands. (JINS, 1996, 2, 412–418.)

Recent investigations have distinguished between ophthalmokinetic and melokinetic factors of unilateral neglect. The aim of our study was to investigate the possible dissociation between melokinetic (premotor) and perceptual factors, avoiding any overt oculokinctic components. We asked four blindfolded left neglect patients to set a dichotic sound in central position, by moving a handle controlling the difference of intensity between the sounds delivered to the left and to the right cars. Two conflicting conditions were used. In the congruent condition, the sound moved in the same direction as the hand movement; in the noncongruent condition, it moved in the opposite direction. One patient performed as if suffering from melokinetic neglect, and another as if suffering from perceptual neglect. The behavior of the other two subjects did not lend itself to a clearcut interpretation. (JINS, 1996, 2, 419–425.)

This study investigated underlying mechanisms of the verbal memory disorder associated with chronic alcoholism. Previous investigations have suggested that alcoholics are more vulnerable to interference effects on verbal learning and memory tasks, both with respect to retroactive interference (RI) and proactive interference (PI); this was the hypothesis of the current study. Measures of RI and build-up and release from PI were administered to 31 abstinent male chronic alcoholics and 24 healthy male nonalcoholic control subjects. Alcoholics demonstrated more sensitivity to RI than controls. Additionally, alcoholics displayed a more rapid build-up of PI, although they showed normal release. An increased interference effect was found to be a component of chronic alcoholics’ verbal memory impairment and may differentiate chronic alcoholism from other disorders affecting verbal learning and memory. (JINS, 1996, 2, 141–145.)

The preoperative delayed memory performance on the Rey-Osterrieth Complex Figure (Lezak, 1983) of 54 patients with complex partial seizures of temporal lobe origin was analyzed using 3 different indices. One index (composite) was derived using a common scoring method that included both spatial and figural aspects of memory in its score. The other two indices were derived emphasizing either spatial or figural aspects of memory for the elements of the figure separately. All 3 indices distinguished between individuals with right-sided (RTLE) and left-sided (LTLE) seizure onset. However, spatial memory was significantly lower than figural memory in individuals with RTLE as compared to those with LTLE. Both the spatial and figural memory indices were significantly lower in the presence of magnetic resonance imaging (MRI) evidence for hippocampal selerosis in individuals with RTLE. Results suggest that while both the spatial and figural aspects of nonverbal memory are sensitive to right hippocampal dysfunction, figural memory may be less vulnerable to the effects of RTLE. (JINS, 1996, 2, 535–540.)