Evaluating the ecological validity of neuropsychological tests has become an increasingly important topic. Previous research suggests that neuropsychological tests have a moderate level of ecological validity when predicting everyday functioning. The presence of depressive symptoms, however, may impact the relationship between neuropsychological tests and real world performance. The current study empirically tests this hypothesis in a sample of 216 participants with moderate to severe traumatic brain injury (TBI) who completed neuropsychological testing, self-report of mood symptoms, and report of everyday functioning six months post-injury. Contrary to some previous research and clinical lore, results indicated that depression was weakly related to neuropsychological test performance, although it was more strongly related to everyday functioning. Neuropsychological test performance was also significantly related to everyday functioning. The ecological validity of the neuropsychological tests together was not impacted by depressive symptoms, when predicting significant other ratings of functional status. However, patient self-report seems somewhat less related to neuropsychological performance in those with significant depressive symptoms. Neuropsychological test performance was equally related to self and other report of everyday functioning in patients without significant depressive symptoms. (JINS, 2007, 13, 377–385.)

The purpose of this study was to examine the relationships between lobar volumes and set shifting. We studied 101 subjects, including 36 normal controls, 16 patients with probable Alzheimer's disease, 30 patients with frontotemporal dementia (FTD), and 19 patients with semantic dementia (SD), using a shifting paradigm that carefully controlled for component abilities. Subjects were administered two conditions of the Delis–Kaplan Executive Function System (D-KEFS) Design Fluency Test. In the control condition (DF:Control), examinees generated as many unique designs as possible in 60 s by drawing lines connecting only unfilled dots. In the switching condition (DF:Switch), examinees generated designs by drawing lines alternating between filled and unfilled dots. We used BRAINS2 software to generate volumes of the right and left frontal, temporal, and parietal lobes. Partial correlations and multiple regressions showed that, after controlling for Mini-Mental State Examination and DF:Control, only the right and left frontal lobe volumes significantly correlated with the DF:Switch, most clearly in the FTD and SD groups. Follow-up analyses indicated that frontal contributions to shifting were not related to working memory. Results highlight the importance of carefully controlling for component cognitive processes when studying executive functioning. (JINS, 2007, 13, 386–392.)

The aim of this study was to assess cognitive effects of anticonvulsants in a way that would yield results that are most directly applicable to epilepsy populations. This was done with a placebo-controlled, prospective, randomized, double-blind, parallel group study of anticonvulsant withdrawal in a population of subjects taking a single anticonvulsant with completely controlled seizures. Outcomes of this study on cognitive measures from the California Computerized Assessment Package have recently been reported. To aid comparison with results of prior studies, we report outcomes here on several more standard measures of neuropsychological function. The major findings were that, in subjects with therapeutic drug levels at baseline, drug withdrawal was associated with significant improvement in performance on the Controlled Oral Word Association Test and the Stroop Color–Word Interference Test. Comparable results were achieved in the subgroup taking carbamazepine. (JINS, 2007, 13, 393–400.)

Although semantic memory impairment is well documented in patients with dementia of the Alzheimer's type, questions remain as to whether the deficit extends to other forms of dementia and whether it differentially affects different domains of knowledge. We examined category naming on two tasks (picture naming and naming-to-description) in patients with Alzheimer's disease (AD: n = 11), Lewy body dementia (DLB: n = 11) and healthy elderly matched controls (n = 22). The DLB and AD groups showed significantly worse naming on both tasks, although the AD patients were more impaired than the DLB patients. Like some AD patients, some DLB patients showed evidence of category-specific naming deficits, and strikingly, all 25 significant category dissociations were for living things. The latter finding accords with the preponderance of living deficits previously documented for AD patients, but extends this finding to DLB patients. The implications of this category bias is discussed in relation to relevant models of category specificity. (JINS, 2007, 13, 401–409.)

There is considerable evidence that multiple sclerosis (MS) is associated with impaired retrospective memory. However, although preliminary evidence suggests that prospective memory is also affected by the disorder, the degree and nature of the impairment remains to be clarified. Twenty participants with MS were compared with 20 matched controls on Virtual Week, a measure of prospective memory that closely represents the types of prospective memory tasks that actually occur in everyday life, and provides an opportunity to investigate the different sorts of prospective memory failures that occur. The results indicated that irrespective of the specific prospective memory task demands, MS participants' performance was significantly impaired relative to controls. MS deficits could not be attributed to problems with retrospective memory because MS participants in the present study did not differ significantly from controls on measures of long- and short-term memory, and significant impairment was observed on a prospective memory task, which imposed only minimal demands on retrospective memory. These results therefore suggest that individuals with MS may experience general difficulties with prospective memory. The practical and theoretical implications of these findings are discussed. (JINS, 2007, 13, 410–416.)

This study examined the relationship between processing speed (PS) and working memory (WM), as measured by performance on an n-back task, in relapsing-remitting multiple sclerosis (RRMS) patients. Simple PS was defined as reaction time (RT) on the 0-back task and complex PS was defined as RT on both the 1-back and 2-back tasks. Participants were administered all three n-back tasks (0-, 1-, and 2-back). Total correct responses, total dyads, and RTs were recorded. As expected, RT for all participants slowed as WM load increased. MS patients had slower RTs than controls across all tasks, and the difference between groups for RT was greatest during the 2-back task. When RT for simple PS (0-back) was parsed from the 1- and 2-back tasks, MS patients still showed impaired complex PS compared to controls. MS patients also made significantly fewer total correct responses and had fewer dyads than controls only on the 2-back task. These findings suggest that both WM and PS deficits are present in RRMS, and that as WM demand increases (from 1- to 2-back) both PS and WM deficits become more prominent. (JINS, 2007, 13, 417–423.)

The current study examines whether the Homophone Meaning Generation Test (HMGT; Warrington, 2000) is correlated with the phonemic and/or the semantic fluency tests and compares its association with the number of switches and clusters and the mean cluster size of these two tasks. One hundred healthy Hebrew speakers (18–35 years of age; mean = 24.9) generated meanings for 24 homophones and provided words beginning in three different letters, as well as words belonging to three semantic categories. Results show that the HMGT score correlated significantly and similarly with the total score of both the phonemic and the semantic fluency tests. There was a significant correlation between the HMGT and the number of phonemic switches and clusters, but not between the HMGT and the mean phonemic cluster size. The HMGT correlated with the number of semantic switches and clusters, as well as with the mean semantic cluster size. The findings suggest that the relationship between these tests is mediated by a shared executive component, attesting to the HMGT's utility in tapping into mechanisms of shifting and mental flexibility. (JINS, 2007, 13, 424–432.)

Despite the many studies examining linguistic deterioration in Alzheimer's disease (AD), very little is known about changes in verbal expression during the preclinical phase of this disease. The objective of this study was to determine whether changes in verbal expression occur in the preclinical phase of AD. The sample consisted of 40 healthy Spanish speakers from Antioquia, Colombia. A total of 19 were carriers of the E280A mutation in the Presenilin 1 gene, and 21 were noncarrier family members. The two groups were similar in age and education. All the participants were shown the Cookie Theft Picture Card from the Boston Diagnostic Aphasia Examination and were asked to describe the scene. Specific grammatical and semantic variables were evaluated. The performance of each group was compared using multivariate analyses of the variance for semantic and grammatical variables, and errors. Carriers of the mutation produced fewer semantic categories than noncarriers. In the preclinical phase of AD, changes in verbal expression are apparent and early detection of these differences may assist the early diagnosis of and intervention in this disease. (JINS, 2007, 13, 433–439.)

Forensic neuropsychology studies usually address either cognitive effort or psychological response validity. Whether these are distinct constructs is unclear. In 122 participants evaluated in a compensation-seeking context, the present Exploratory Factor Analysis examined whether forced-choice cognitive effort measures (Victoria Symptom Validity Test, Test of Memory Malingering, Letter Memory Test) and Minnesota Multiphasic Personality Inventory, Second Edition (MMPI-2) validity scales (L, F, K, FBS, Fp, RBS, Md, Dsr2, S) load on independent factors. Regardless of factor rotation strategy (orthogonal or oblique), four response validity factors emerged by means of both Principal Components Analysis (82.7% total variance) and Principal-Axis Factor Analysis (74.1% total variance). The four factors were designated as follows: Factor I, with large loadings from L, K, and S—underreporting of psychological symptoms; Factor II, with large loadings from FBS, RBS, and Md—overreporting of neurotic symptoms; Factor III, with large loadings from VSVT, TOMM, and LMT—insufficient cognitive effort; and Factor IV, with the largest loadings from F, Fp, and Dsr2—overreporting of psychotic/rarely endorsed symptoms. Results reflect the heterogeneity of response validity in forensic samples referred for neuropsychological evaluation. Administration of both cognitive effort measures and psychological validity scales is imperative to accurate forensic neuropsychological assessment. (JINS, 2007, 13, 440–449.)

Awareness of cognitive dysfunction shown by individuals with Mild Cognitive Impairment (MCI), a condition conferring risk for Alzheimer's disease (AD), is variable. Anosognosia, or unawareness of loss of function, is beginning to be recognized as an important clinical symptom of MCI. However, little is known about the brain substrates underlying this symptom. We hypothesized that MCI participants' activation of cortical midline structures (CMS) during self-appraisal would covary with level of insight into cognitive difficulties (indexed by a discrepancy score between patient and informant ratings of cognitive decline in each MCI participant). To address this hypothesis, we first compared 16 MCI participants and 16 age-matched controls, examining brain regions showing conjoint or differential BOLD response during self-appraisal. Second, we used regression to investigate the relationship between awareness of deficit in MCI and BOLD activity during self-appraisal, controlling for extent of memory impairment. Between-group comparisons indicated that MCI participants show subtly attenuated CMS activity during self-appraisal. Regression analysis revealed a highly significant relationship between BOLD response during self-appraisal and self-awareness of deficit in MCI. This finding highlights the level of anosognosia in MCI as an important predictor of response to self-appraisal in cortical midline structures, brain regions vulnerable to changes in early AD. (JINS, 2007, 13, 450–461.)

Neuropsychological tests generally require adjustments for years of education when determining the presence of neurocognitive impairment. However, evidence indicates that educational quality, as assessed with reading tests, may be a better reflection of educational attainment among African Americans. Thus, African Americans with poor educational quality may be incorrectly classified with neurocognitive impairment based on neuropsychological tests. We compared the accuracy of neuropsychological test scores standardized using reading grade-equivalent versus years of education in predicting neurocognitive impairment among a sample of Whites and African-American adults who were HIV+. Participants were examined by a neurologist and classified with or without HIV-associated neurocognitive disorders according to accepted criteria. Participants were also classified as impaired versus not impaired based on their neuropsychological test scores standardized by 1) self-reported education or 2) WRAT-3 reading grade-level. Cross tabulation tables were used to determine agreement of the two methods in detecting impairment. Among African-Americans, standardized scores derived from reading scores had greater specificity than those derived from years of education (84.1% vs. 77.3). Among the Whites, correction based on years of education had both greater specificity and sensitivity. The results suggest that reading tests may be a useful alternative for determining NCI among African Americans. (JINS, 2007, 13, 462–470.)

Deficits in emotional recognition and perception following traumatic brain injury (TBI) have been associated with alexithymia (Henry et al., 2006; Williams et al., 2001). This study examined the prevalence of alexithymia in a TBI population, and its relationship to injury severity, neuropsychological ability and affective disorder. A total of 121 patients completed the Toronto Alexithymia Scale-20 (TAS-20), a measure that addresses 3 distinct characteristics of the alexithymia concept; difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking. Patients also completed a neuropsychological assessment and measures of depression and anxiety. Results confirm a high prevalence of alexithymia after TBI, relative to the general population and an orthopedic control group. There was no relationship between injury severity and the presence of alexithymia. A negative relationship was found between alexithymia and verbal and sequencing abilities, but there was no relationship with executive dysfunction or any other cognitive domain. Moderate correlations were obtained between alexithymia and affective disorder; regression analyses indicated that alexithymia, depression, and anxiety should be considered distinct, but overlapping constructs. The results of this study suggest that increased neuropsychological attention should be directed towards emotional change after head injury and its relationship with cognition and psychosocial outcome. (JINS, 2007, 13, 471–479.)

This study tested the hypotheses that older adults make less advantageous decisions than younger adults on the Iowa Gambling Task (IGT). Less advantageous decisions, as measured by the IGT, are characterized by choices that favor larger versus smaller immediate rewards, even though such choices may result in long-term negative consequences. The IGT and measures of neuropsychological function, personality, and psychopathology were administered to 164 healthy adults 18–85 years of age. Older adults performed less advantageously on the IGT compared with younger adults. Additionally, a greater number of older adults' IGT performances was classified as “impaired” when compared with those of younger adults. Less advantageous decisions were associated with obsessive symptoms in older adults and with antisocial symptoms in younger adults. Performance on the IGT was positively associated with auditory working memory and psychomotor function in young adults, and in immediate memory in older adults. (JINS, 2007, 13, 480–489.)

When assessing older adults for mild cognitive impairment (MCI) or dementia, it is important to understand how often low memory scores are obtained in healthy people in order to minimize false positive diagnoses. This study examines the base rates of low memory scores in older adults across a battery of memory tests. Participants included older adults (55–79 years; N = 742) from the Neuropsychological Assessment Battery (NAB; Stern & White, 2003a) standardization sample. The NAB Memory Module consists of four co-normed memory tests (i.e., List Learning, Shape Learning, Story Learning, and Daily Living Memory) yielding 10 demographically corrected T-scores. When all 10 T-scores were examined simultaneously, 55.5% of older adults had one or more scores one standard deviation (SD) below the mean. At <1.5 SDs, 30.8% of healthy older adults obtained one or more low memory scores. Obtaining low memory scores occurs more often with lesser intellectual abilities. For example, 56.5% of older adults with low average intellectual abilities obtained one or more low memory scores (<1.5 SDs) compared to 21.1% with high average intellectual abilities. Understanding the base rates of low scores can reduce over-interpretation of isolated low memory scores and minimize false positive diagnoses of MCI. (JINS, 2007, 13, 490–500.)The data in Tables 3, 4, 5, 6, and 7 are original data produced by special permission of the Publisher, Psychological Assessment Resources, Inc., 16204 North Florida Avenue, Lutz, Florida 33549, from the standardization data presented in the Neuropsychological Assessment Battery Psychometric and Technical Manual by Travis White, Ph.D. and Robert A. Stern, Ph.D. Copyright 2001, 2003 by PAR, Inc. Further reproduction is prohibited without permission from PAR, Inc.

The defining role of language for communicating and forming social bonds has captured the imagination of scientists and scholars throughout the ages, and scientific inquiry into the neural correlates of language is now centuries old. Theories of linguistic structure and function occupy center stage in fields as diverse as neuroscience, embryology, anthropology and evolution. This should come as no surprise as the neural basis of linguistic function holds promise for understanding how the mind works and what makes us uniquely human.

We investigated language representation in nine children (six male, three female; 5.6–17.7 years of age) who underwent surgical treatment of medically intractable epilepsy of the left hemisphere. Although interhemispheric reorganization has been previously documented in similar groups, this is the first study to systematically evaluate possible intrahemispheric effects of early insult. All cases had left hemisphere seizure foci and underwent extraoperative stimulation mapping (ESM) for language localization prior to receiving cortical resections. To compare ESM findings across subjects and to assess intrahemispheric reorganization, we developed a novel coregistration technique whereby independent raters plotted two-dimensional (2D) ESM findings in 3D standard space. Expressive language sites identified with ESM were compared with a structural probability map of pars opercularis, or Broca's area. The average difference between independent raters' estimates of 28 language sites was 3.9 mm (SD = 2.0), indicating excellent agreement; the coregistration procedure permitted assessment of 2D ESM findings in 3D standard space. We observed language sites in regions substantially anterior and superior to canonical Broca's area, possibly reflecting intrahemispheric reorganization. Findings suggest that left hemisphere insult in young children may result in anterior displacement of language within the frontal cortex. (JINS, 2007, 13, 505–516.)This study was drawn from a thesis submitted by D.S.K. in partial fulfillment of requirements of the MA degree through the Graduate Program in Psychology and the Collaborative Program in Neuroscience at the University of Toronto (Ontario, Canada).

Arterial spin labeling (ASL) is a magnetic resonance imaging (MRI) method that provides a highly repeatable quantitative measure of cerebral blood flow (CBF). As compared to the more commonly used blood oxygenation level dependent (BOLD) contrast-based methods, ASL techniques measure a more biologically specific correlate of neural activity, with the potential for more accurate estimation of the location and magnitude of neural function. Recent advances in acquisition and analysis methods have improved the somewhat limited sensitivity of ASL to perfusion changes associated with neural activity. In addition, ASL perfusion measures are insensitive to the low-frequency fluctuations commonly observed in BOLD experiments and can make use of imaging sequences that are less sensitive than BOLD contrast to signal loss caused by magnetic susceptibility effects. ASL measures of perfusion can aid in the interpretation of the BOLD signal change and, when combined with BOLD, can measure the change in oxygen utilization accompanying changes in behavioral state. Whether used alone to probe neural activity or in combination with BOLD techniques, ASL methods are contributing to the field's understanding of healthy and disordered brain function. (JINS, 2007, 13, 517–525.)

Arterial spin labeling (ASL) uses magnetic resonance imaging methods to measure cerebral blood flow (CBF) non-invasively. ASL CBF validly localizes brain function and may be especially useful for studies where the time frame of behavioral change is more than a few minutes, such as in longitudinal and treatment studies. ASL measures of cerebral perfusion are highly accurate in detecting lesion laterality in temporal lobe epilepsy, stenotic-occlusive disease, and brain tumors. Among lesioned patients, ASL CBF has excellent concurrent validity when correlated with CBF measured by Positron Emission Tomography or with dynamic susceptibility-weighted magnetic resonance. ASL CBF can predict tumor grading in vivo and can predict six-month response to the surgical treatment of brain tumors. ASL's capability to selectively and non-invasively tag flow in major vessels may refine the monitoring of treatment of cerebrovascular disease and brain tumors. Conclusions about the utility of ASL are limited by the small sample sizes of the studies currently in the literature and by the uncertainty caused by the effect of brain disease on transit times of the magnetic tag. As the method evolves, ASL techniques will likely become more widely used in clinical research and practice. (JINS, 2007, 13, 526–538.)

Huntington's disease (HD) is a neurodegenerative disorder diagnosed clinically with the development of choreiform movements. However, neuropsychological studies have demonstrated cognitive and psychiatric changes during the preclinical phase (pre-HD) prior to formal diagnosis. Previous studies have demonstrated the sensitivity of time reproduction tasks to basal ganglia pathology, as seen in clinical HD and Parkinson's disease. In this study, 29 pre-HD participants, ranging from 3 to 39 years from estimated onset (YEO) of HD based on genetic testing and chronological age, were administered the paced finger-tapping task using target intervals of 600 and 1200 ms. Mean inter-response interval, a measure of timing accuracy, did not systematically deviate from the target interval as a function of YEO. In contrast, timing variability increased curvilinearly as a function of YEO, but not with chronological age alone. Motor timing variability, but not accuracy, may serve as a marker to define the earliest behavioral changes in HD. The present study is among the first to examine the relationship between behavioral measures and YEO in pre-HD. (JINS, 2007, 13, 539–543.)

Because MS patients frequently report visual acuity disturbances, neuropsychologists often screen patients for severe visual acuity disturbances and tailor test batteries that minimize the need for intact vision. Less is known about how mild visual acuity disturbances may influence neuropsychological test performance. This study examined the extent to which mild visual acuity disturbances influence performance on visually-based tests of complex attention. Relapsing-remitting and secondary progressive MS patients who reported adequate vision were recruited for this study. A battery was administered that included the oral version of the Symbol Digit Modalities Test (SDMT), the Visual Elevator (VE) subtest from the Test of Everyday Attention, and a reduced near vision eye chart. Results suggested that, in addition to measuring higher order cognitive processes, visual tests of attention are sensitive to mild primary visual disturbances in MS. (JINS, 2007, 13, 544–548.)