Delaying assessment until emergence from post-traumatic amnesia increases completion rates, but this practice causes variable time delays from the date of injury to testing, which can complicate the interpretation of research findings. In the current study, the performance of 105 head injury survivors on simple tests of language comprehension and attention was used to predict global outcome. It was hypothesized that 1 month performance on these measures would aid in the prediction of Disability Rating Scale (DRS) and Glasgow Outcome Scale (GOS) scores collected at 6 months post injury. Only raw scores on the modified Test of Complex Ideational Material accounted for a significant amount of the variance in DRS scores (4.4%) above that accounted for by age, education, Glasgow Coma Scale score, and pupil response. However, testability at 1 month post injury on all four tests consistently accounted for a larger portion of the variance in DRS scores (10.1–13.2%) and significantly improved prediction of GOS scores. Galveston Orientation and Amnesia Test scores collected at 1 month post injury accounted for substantially less variance in DRS scores (7.7–8.4%). Neuropsychological data, including the testability of patients, collected uniformly at 1 month following injury can contribute to the prediction of global outcome. (JINS, 2004, 10, 807–817.)

Researchers of cognitive processing in illiteracy have proposed that the acquisition of literacy modifies the functional organization of the brain. They have suggested that, while illiterate individuals have access only to innate semantic processing skills, those who have learned the correspondence between graphemes and phonemes have several mechanisms available to them through which to process oral language. We conducted 2 experiments to verify that suggestion with respect to language processing, and to elucidate further the differences between literate and illiterate individuals in the cognitive strategies used to process oral language, as well as hemispheric specialization for these processes. Our findings suggest that semantic processing strategies are qualitatively the same in literates and illiterates, despite the fact that overall performance is augmented by increased education. In contrast, explicit processing of oral information based on phonological characteristics appears to be qualitatively different between literates and illiterates: effective strategies in the processing of phonological information depend upon having had a formal education, regardless of the level of education. We also confirmed the differential abilities needed for the processing of semantic and phonological information and related them to hemisphere-specific processing. (JINS, 2004, 10, 818–827.)

Repeated neuropsychological assessments are common with older adults, and the determination of clinically significant change across time is an important issue. Regression-based prediction formulas have been utilized with other patient and healthy control samples to predict follow-up test performance based on initial performance and demographic variables. Comparisons between predicted and observed follow-up performances can assist clinicians in determining the significance of change in the individual patient. In the current study, multiple regression-based prediction equations for the 5 Indexes and Total Score of the RBANS were developed for a sample of 223 community dwelling older adults. These algorithms were then validated on a separate elderly sample (N = 222). Minimal differences were present between observed and predicted follow-up scores in the validation sample, suggesting that the prediction formulas are clinically useful for practitioners who assess older adults. A case example is presented that illustrates how the algorithms can be used clinically. (JINS, 2004, 10, 828–834.)

Recognition and remote memory for odors, faces, and symbols were assessed in patients with pathologically confirmed Lewy body variant of Alzheimer's disease (LBV), patients with pathologically confirmed Alzheimer's disease (AD), and healthy elderly controls. On recognition memory tasks, LBV and AD patients showed significantly lower discriminability (d′) than controls, particularly for olfactory stimuli. However no significant differences were found in the bias measure (c). When participants rated familiarity (a proposed measure of remote memory) of olfactory stimuli LBV and AD patients reported significantly lower familiarity than controls. Familiarity ratings were significantly lower in LBV patients than in AD patients for olfactory, but not for visual stimuli. Consistent with prior reports, the LBV patients showed significantly poorer odor thresholds than AD patients. The results suggest that recognition memory for olfactory stimuli is impaired in LBV and AD. However, patients with LBV are more impaired than patients with AD on tasks requiring remote memory for olfactory but not visual stimuli. The findings suggest that odor memory tasks may be useful in the assessment of LBV and AD. (JINS, 2004, 10, 835–842.)

This study tested the hypothesis that carbon monoxide poisoning would produce a deficit of attentional control, the supervisory attention system, as indexed by attention switching and attentional scheduling, and that routine attentional orienting would be unaffected. Seventy-three cases of carbon monoxide poisoning were assessed at 3 days and 1 month post poisoning on tasks of attentional orienting, and tasks of the supervisory attention system. The results were compared to a group of 53 healthy community participants. A deficit of the supervisory attentional system was documented on a task of attention switching in survivors of both deliberate and accidental CO poisoning, leaving attentional scheduling intact. There was no deficit of attentional orienting in the current study. Alteration of consciousness was found to predict subsequent supervisory attention system impairment in correlation analyses, and the deficit was persistent for a 1 month follow-up period. (JINS, 2004, 10, 843–850.)

We explored the relation between neuropsychological (attention tests involving time constraints) and neurophysiological (N2 and P3 event-related potential (ERP) latencies) indices of slowness of information processing after closed head injury (CHI). A group of 44 CHI patients performed worse than healthy controls on most neuropsychological indices, and had significantly longer ERP latencies. Significant correlations between neuropsychological measures and ERP latencies were found only for the 3 subtasks of the Stroop test. In additional multiple regression analyses P3 latency appeared the best predictor in Stroop Color only. A possible explanation is that stimulus evaluation processes comprise a relatively large part of performance on this subtask. In Stroop Color-Word, response related processes are supposed to play a greater role, reducing the role of the preceding input related processes. The absence of significant correlations between P3 latency and scores on the other attention tests suggests a relatively small role of stimulus evaluation processes in these tasks, implying that these tasks are not sensitive to slowness of these processes. The Stroop test appears to be the only attention test administered in which slowness in stimulus evaluation processes requiring selective attention contributes significantly to the delay in final performance on the task. (JINS, 2004, 10, 851–861.)

Important claims have been made regarding the contrasting profiles of linguistic and cognitive performance observed in two genetically based syndromes, Williams syndrome (WS) and Down syndrome (DS). Earlier studies suggested a double dissociation, with language better preserved than nonverbal cognition in children and adults with WS, and an opposite profile in children and adults with DS. More recent studies show that this initial characterization was too simple, and that qualitatively different patterns of deficit observed within both language and visual–spatial cognition, in both groups. In the present study, large samples of children and adolescents with WS and age-matched DS are compared with typically developing (TD) controls matched to WS in mental age, on receptive and expressive lexical and grammatical abilities, semantic and phonological fluency, digit span and nonverbal visual–spatial span, and on 2 visual–spatial construction tasks. Study 1 confirmed distinct profiles of sparing and impairment for the 2 groups, within as well as between language and nonlinguistic domains, even after IQ variations were controlled. In Study 2 we compared performance of the children, adolescents and young adults with DS and WS included in the first study, divided on the basis of the chronological age of the participants (under 8 years; over 12 years). Although it is important to stress that these are cross-sectional rather than longitudinal data, the results demonstrated that the profile of younger children is different in respect to those of the older children; initial states of the system cannot be inferred by the final state. Possible neural substrates for these profiles and trajectories are discussed. (JINS, 2004, 10, 862–876.)

The cerebellum is part of a neural circuit involved in procedural motor learning. We examined how congenital cerebellar malformations affect mirror drawing performance, a procedural learning task that involves learning to trace the outline of a star while looking at the reflection of the star in a mirror. Participants were 88 children with spina bifida myelomeningocele, a neural tube defect that results in lesions of the spinal cord, dysmorphology of the cerebellum, and requires shunt treatment for hydrocephalus, and 35 typically developing controls. Participants completed 10 trials in the morning and 10 trials following a 3-hr delay. Although children with spina bifida myelomeningocele were initially slower at tracing and made more errors than controls, all participants improved their performance of the task, as demonstrated by increased speed and accuracy across trials. Moreover, degree of cerebellar dysmorphology was not correlated with level of performance, rate of acquisition, or retention of mirror drawing. The results suggest that congenital cerebellar dysmorphology in spina bifida does not impair motor skill learning as measured by acquisition and retention of the mirror drawing task. (JINS, 2004, 10, 877–887.)

Researchers and clinicians using Jacobson and Truax's index to assess the reliability of change in patients, or its counterpart by Chelune et al., which takes practice effects into account, are confused by the different ways of calculating the standard error encountered in the literature (see the discussion started in this journal by Hinton-Bayre). This article compares the characteristics of (1) the standard error used by Jacobson and Truax, (2) the standard error of difference scores used by Temkin et al. and (3) an adaptation of Jacobson and Truax's approach that accounts for difference between initial and final variance. It is theoretically demonstrated that the last variant is preferable, which is corroborated by real data. (JINS, 2004, 10, 888–893.)

It is important to preface this piece by advising the reader that the author is not writing from the point of view of a statistician, but rather that of a user of reliable change. The author was invited to comment following the publication of an original inquiry concerning Reliable Change Index (RCI) formulae (Hinton-Bayre, 2000) and after acting as a reviewer for the current Maassen paper (this issue, pp. 888–893). Having been a bystander in the development of various RCI methods, this comment serves to represent the struggle of a non-statistician to understand the relevant statistical issues and apply them to clinical decisions. When I first stumbled across the ‘classical’ RCI attributed to Jacobson and Truax (1991) (Maassen, this issue, Equation 4), I was quite excited and immediately applied the formula to my own data (Hinton-Bayre et al., 1999). Later, upon reading the Temkin et al. (1999) paper I commented on what seemed to be an inconsistency in their calculation of the error term (Hinton-Bayre, 2000). My “confusion” as Maassen suggests was derived from the fact that I noted the error term used was based on the standard deviation of the difference scores (Maassen, Expression 5*) rather than the Jacobson and Truax formula (Maassen, Expression 4). This apparent anomaly was subsequently addressed when Temkin et al. (2000) explained they had employed the error term proposed by Christensen and Mendoza (1986) (Maassen, Expression 5). My concern with the Maassen manuscript was that it initially appeared two separate values could be derived through using expressions 5 and 5* using the Temkin et al. (1999) data. This suggested there might be four (expressions 4, 5, 5*, and 6), rather than three, ways to calculate the reliable change error term based on a null hypothesis model. Once again I was confused. Only very recently did I discover that expressions 5 and 5* yield identical results when applied to the same data set (N.R. Temkin, personal communication) and when estimated variances are used (G. Maassen, personal communication). The reason for expressions 5 and 5* yielding slightly different error term values using the Temkin et al. (1999) data was due to use of nonidentical samples for parameter estimation. The use of non-identical samples came to light in the review process of the present Maassen paper—which Maassen now indicates in an author's note. Thus there were indeed only three approaches to consider (Expressions 4, 5, & 6). Nonetheless, Maassen maintains (personal communication) that Expression 5, as elaborated by Christensen and Mendoza (1986), represents random errors comprising the error distribution of a given person, whereas Expression 5* refers to the error distribution of a given sample. While it seems clear on the surface that the expressions represent separate statistical entities, it remains unclear to the present author how these expressions can then yield identical values when applied to test–retest data derived from a single normative group. Unfortunately however, my confusion does not stop there.

Different authors have used different estimates of variability in the denominator of the Reliable Change Index (RCI). Maassen attempts to clarify some of the differences and the assumptions underlying them. In particular he compares the ‘classical’ approach using an estimate SEd supposedly based on measurement error alone with an estimate SDiff based on the variability of observed differences in a population that should have no true change. Maassen concludes that not only is SEd based on classical theory, but it properly estimates variability due to measurement error and practice effect while SDiff overestimates variability by accounting twice for the variability due to practice. Simulations show Maassen to be wrong on both accounts. With an error rate nominally set to 10%, RCI estimates using SDiff wrongly declare change in 10.4% and 9.4% of simulated cases without true change while estimates using SEd wrongly declare change in 17.5% and 12.3% of the simulated cases (p < .000000001 and p < .008, respectively). In the simulation that separates measurement error and practice effects, SEd estimates the variability of change due to measurement error to be .34, when the true variability due to measurement error was .014. Neuropsychologists should not use SEd in the denominator of the RCI. (JINS, 2004, 10, 899–901.)

Due to space limitations I have chosen to confine my reply to the comments by Temkin (this issue, pp. 899–901) that touch most directly the concepts of practice effects and reliable change. Temkin seems to portray my adherence to the classic approach as a private affair. However, Temkin herself (Temkin et al., 1999) reported to utilize the most widely applied procedures of Jacobson and Truax and of Chelune et al., which are based on the classic approach. For unexplained reasons they had substituted a different standard error. The unsatisfactory justification later given in their reply to Hinton-Bayre's (2000) letter revealed the presumably actual reason: unfamiliarity with psychometrics including the classical test theory (CTT). Not surprisingly, Temkin ignores this historical aspect in her comment. Nevertheless, the new post-hoc arguments she brings up deserve, of course, a fair evaluation.

The purpose of this study was to examine the relation between the subjective report of feeling foggy at one-week post concussion and acute neuropsychological outcome. The outcome variables were derived from a computerized neuropsychological screening battery, Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT). Participants were 110 high school students who sustained a sports-related concussion and were evaluated 5–10 days post injury (M = 6.8 days). Athletes were divided into two groups on the basis of self-reported fogginess. The first group reported no fogginess (n = 91), whereas the second group reported experiencing some degree of fogginess (n = 19) on a 6-point scale. The athletes with persistent fogginess experienced a large number of other post-concussion symptoms, compared to the athletes with no reported fogginess. In addition, the athletes with persistent fogginess had significantly slower reaction times, reduced memory performance, and slower processing speed. Thus, athletes with any degree of self-reported fogginess at one-week post injury are likely to have adverse effects from their concussions in multiple domains. (JINS, 2004, 10, 904–906.)

The present study investigated the differential involvement of the right and left hippocampus in various forms of spatial memory: spatial search, positional memory versus object–location binding, and coordinate versus categorical processing. Twenty-five epilepsy patients with selective amygdalohippocampectomy were examined using a sensitive computer paradigm to measure these spatial memory aspects. The patients' performance was compared to a group of thirty healthy controls. The results show that the left amygdalohippocampectomy group performed poorly on the ability to bind together object information to coordinate spatial locations. In turn, the right amygdalohippocampectomy group was impaired in coordinate positional memory. Both patient groups were unimpaired on the spatial search task. These findings are discussed focusing on the “binding device” hypothesis in combination with the cognitive map theory. (JINS, 2004, 10, 907–912.)

We investigated whether the perception or production of a given line length in normal subjects varies according to where in peripersonal space the line is perceived or produced. We also investigated the influence of the direction of movement used to make the line. In Experiment 1, blindfolded normal subjects were asked to estimate distances while the examiner moved the subject's hand in proximal (medial) or distal (lateral) space, moving centripetally or centrifugally. The subjects showed a spatial effect, perceiving the same length as shorter in proximal space than distal space. This result could be related to either a proximal spatial attentional bias or an anisometric representation of spatial distances. In Experiment 2, we attempted to dissociate these hypotheses by studying blindfolded normal subjects, who were requested to produce horizontal lines of a given length (100 or 200 mm) in proximal versus distal peripersonal space using centripetal or centrifugal movements. Centrifugal movements in proximal space were the longest; centrifugal movements in distal space were the shortest; in between were the proximal centripetal and distal centripetal movements which did not differ from each other. These results suggest that in peripersonal space the perception of length in normal subjects is most consistent with anisometric mental representation where the size of mental representations of length units decreases as a function of the distance from the subject's midsagittal plane. Length production, however, may depend on an interaction of the anisometric mental representation and the premotor/intentional factors. (JINS, 2004, 10, 913–919.)

The Neuropsychological Evaluation of the Child. Ida Sue Baron. 2004. New York: Oxford University Press. 454 pp., $79.95 (HB).

It is with extreme pleasure that I write a review of this outstanding text, and also pride that I was selected to be the reviewer. When Dr. Lezak mailed me the book with a request to write a review for JINS, I literally called her and thanked her for this opportunity. I should note, this was not because I would receive a complimentary copy of The Neuropsychological Evaluation of the Child, as I had already purchased and read the text, and ordered an additional copy for my clinic and trainees' access. Dr. Baron has provided those of us in the field of child/pediatric neuropsychology with has long been needed: a general background on clinical issues in conducting neurocognitive assessments with children and adolescents, along with practical matters and concerns, such as how to cope with the varying needs of different referral sources, and providing feedback to parents. Moreover, and most essential, the text comprehensively reviews neuropsychological measures under all cognitive domains, and presents exhaustively researched historical and current normative data for the developmental population. This compilation is an excellently written book that is comprehensive, detailed, current, thoughtful, and an invaluable reference for every child and pediatric neuropsychologist. Indeed, our colleagues who specialize in adult neuropsychological evaluations would well benefit from reading the text because the clinical insights are germane to all ages, and the normative data will enrich their understanding of brain function and progression throughout the development years.

Pathways to Prominence in Neuropsychology: Reflections of Twentieth-Century Pioneers. Anthony Y. Stringer, Eileen L. Cooley, and Anne-Lise Christensen, 2002. New York: Psychology Press. 324 pp., $64.95.

Pathways to Prominence in Neuropsychology discusses the origin and development of research and clinical neuropsychology in the 20th century. This is an important first book to help us better understand where we have been, where we are, where we are going and who we are, but be forewarned that the writer of this review is extremely biased, believing that history is both interesting and potentially useful to enlighten our individual and collective journeys. The writing of history, its facts and interpretations, is fraught with challenges and pitfalls, especially when looking at ourselves. As the American humorist Herb Shiner once said, “Nothing has changed the course of history as much as the historian.

Clinical Neuropsychology. Fourth Edition. Kenneth M. Heilman and Edward Valenstein (Eds.). 2003. New York: Oxford University Press. 744 pp., $78.00 (HB).

As a 1st-year graduate student and new convert to clinical neuropsychology, the second book I purchased in this exciting area was the first edition of Heilman and Valenstein's “Clinical Neuropsychology” published in 1979. It will come as no surprise to most readers that the first book I purchased was Lezak's first edition of “Neuropsychological Assessment,” published 3 years earlier, and of course a required text for our graduate course. As a teacher of that very same course over the past 18 years, I have recommended the various editions of both these texts to my students as the “standard” texts, a practice I imagine is shared world-wide. Thus, at one level it seems almost unnecessary to write a review of such a classic text, and at the same time to do it justice is a humbling task which I have no hope of fulfilling. All I can do is give a small taste of this latest offering edited by two of the great neurologists (and neuropsychologists) of modern times.

Mild Cognitive Impairment Aging to Alzheimer's Disease. R.C. Petersen (Ed.), 2003, New York: Oxford University Press. 269 pp., $55.00.

People are living longer and along with this phenomenon emerges the concern about the quality of life as the person ages. While dementia is by no means a natural consequence of aging, both its incidence and prevalence increase dramatically with age, from 0.5 percent per year at the age of 65 years to nearly 8%/year after the age of 85 years (Evans et al. 1989). Alzheimer's disease (AD) is the most common cause of dementia. Although the goals of treatment in patients with AD have been to improve or, at least, to slow the deterioration of memory and cognition and to maintain independent function, research is moving from controlling symptoms to early identification and prevention of age-related cognitive disabilities.