Obsessive-compulsive disorder (OCD) has been associated with frontostriatal abnormality. This has led to the hypothesis that the disorder is characterized by abnormality of procedural memory. However, evidence for either procedural or declarative memory disturbance has been mixed, and few studies have directly assessed both of these forms of memory in the same patient group. In the present study, we assessed encoding and retrieval in declarative memory using the Rey Auditory Verbal Learning Test (RAVLT), and procedural memory using the Pursuit Rotor Task, in 27 adults with OCD and 29 matched healthy controls. Groups did not differ with respect to salient demographic characteristics or memory on the RAVLT. In contrast, patients with OCD performed significantly better than controls during the early, but not later trial blocks of the Pursuit Rotor Task. This pattern of results indicates intact encoding and retrieval in declarative memory, but abnormally enhanced procedural memory during the early course of learning in OCD. These findings may be consistent with striatal overactivation observed in neuroimaging studies of OCD, as well as the prominent role of the striatum during early stages of procedural memory. (JINS, 2004, 10, 647–654.)

Reading and writing were studied in 31 young adults with spina bifida and hydrocephalus (SBH). Like children with this condition, young adults with SBH had better word decoding than reading comprehension, and, compared to population means, had lower scores on a test of writing fluency. Reading comprehension was predicted by word decoding and listening comprehension. Writing was predicted by fine motor finger function, verbal intelligence, and short-term and working memory. These findings are consistent with cognitive models of reading and writing. Writing, but not reading, was related to highest level of education achieved and writing fluency predicted several aspects of functional independence. Reading comprehension and writing remain deficient in adults with SBH and have consequences for educational attainments and functional independence. (JINS, 2004, 10, 655–663.)

Multiple studies have explored the relationship between MRI-based volumetric measurements of the hippocampus and amygdala, the degree of volumetric asymmetry of these structures, and symptom manifestation. However, considerable variability exists with regard to the reported volumetric values of these structures. The present study employed meta-analytic procedures to provide a systematic analysis of the normal population parameters of hippocampal and amygdala volumetric asymmetry as well as the absolute intrahemispheric volumes of these structures in normal adults. A literature review of studies published between 1990 and 2002 resulted in a representative sample of 82 studies (N = 3,564 participants) providing volumetric information of the hippocampus and 51 studies (N = 2,000 participants) providing volumetric information of the amygdala. Results revealed that both the hippocampus and the amygdala are reliably asymmetrical structures in normal adults, with larger right hippocampal (D = 0.21, p < .001) and right amygdala (D = 0.09, p < .01) volumes. Additional analyses indicated that differences in MRI magnet field strength and slice thickness values might differentially contribute to volumetric asymmetry estimates. These results expand on previous volumetric normative studies and may be relevant to investigators studying the clinical correlates of hippocampal and amygdala volumes. (JINS, 2004, 10, 664–678.)

This study investigated the basic mechanisms of the impairment of memory for actions to be performed in a group of 16 chronic survivors of severe closed-head injury (CHI). The experimental paradigm allowed discrimination between the deficit in spontaneously remembering the intention at the appropriate moment (prospective component of the task) and the deficit in remembering the specific actions to perform (retrospective component). The experimental procedure also contrasted a condition in which the time expiration was marked by the ringing of a timer (event-based condition) and one in which the time expiration was not marked by any event and the patient had to monitor the passing of time and completely self-activate the recall of the intention (time-based condition). Two other experimental manipulations were concerned with the duration of the delay interval from the examiner's instructions to the time expiration (10 vs. 45 min) and the fact that the three actions to be performed could be functionally related or not. With respect to a group of 16 normal controls, the patients with CHI were impaired in both the prospective and retrospective components of the memory for actions. Although an impairment of episodic memory is a plausible explanation for the poor retrieval of specific actions to perform, it is unlikely that this deficit played a major role in the CHI patients' reduced accuracy in spontaneously recalling the intention when the event occurred or the time expired. Instead, reduced frequency and less strategic utilization of time monitoring and/or self-reminding likely played a significant role in this sense. (JINS, 2004, 10, 679–688.)

Little is known about possible differences in the memory deficits that occur in Dementia with Lewy bodies (DLB) and Alzheimer's disease (AD). We compared 24 autopsy-confirmed DLB and 24 age-, education-, and MMSE-matched autopsy-confirmed AD patients on the California Verbal Learning Test (CVLT) and the Wechsler Memory Scale-Revised Logical Memory subtest. The DLB and AD groups were similarly impaired on CVLT Total Learning (Trials 1–5) and Long Delayed Free Recall, but the DLB group demonstrated relative improvement in Savings scores and on recognition testing compared to the AD group. Likewise, the patient groups were equally impaired on Logical Memory immediate and delayed recall, but the DLB group's Saving scores were significantly better than those of the AD patients. These results indicate that while both DLB and AD patients exhibit significant memory impairment, the ability to consolidate information may be less severely impaired in DLB patients than in AD patients. (JINS, 2004, 10, 689–697.)

The purpose of the current study was to examine the effect of side of lesion on neuropsychological performance in childhood stroke. While laterality effects have been shown fairly consistently in adults who have experienced stroke, results from studies on children who have experienced childhood stroke are not as clear. Numerous methodological differences between previous studies on laterality effects in childhood stroke make it difficult to draw overall conclusions regarding laterality findings. The current study aimed to study a single group of children who experienced stroke in childhood across a number of cognitive domains. The participants were 13 children/adolescents with left hemisphere lesions and 16 children/adolescents with right hemisphere lesions, with a range of onset from prenatal to 13 years. All participants were administered a broad battery of neuropsychological tests including tests of intelligence, achievement, language skills, visuospatial skills, memory, and executive functioning. No significant differences were found between the groups on any of the measures and the calculated effect sizes were small for all but one of the measures examined. These results have implications for a greater understanding of the ability of the young brain to reorganize after childhood stroke. (JINS, 2004, 10, 698–708.)

The purpose of this study was to examine a behavioral index of hemispheric asymmetry (i.e., visual hierarchical attention) in posttraumatic stress disorder (PTSD), a disorder characterized by anxiety and other emotional symptoms. A reaction time based, computerized, global–local visual paradigm was administered to 26 PTSD-diagnosed and 22 psychopathology-free right-handed, male Vietnam War zone veterans. Results indicated that PTSD-diagnosed veterans displayed slower reaction times to all targets than the no-mental disorders comparison sample. However, findings also revealed a Group × Target location interaction in which the PTSD group was slower than the no-disorders comparison sample to respond to local, but not global, targets. Moreover, relative global bias was greater among PTSD-diagnosed veterans than their no-diagnosis counterparts. Findings provide partial support for the hypothesis that PTSD may be associated with a functional cerebral asymmetry favoring the right hemisphere. (JINS, 2004, 10, 709–718.)

We studied how moderate to severe childhood traumatic brain injury (TBI) affects vocational outcome with time. This is the second follow-up of patients who were injured as preschoolers in traffic accidents. In the first follow-up the mean age was 23 years and in the present study the average age of the 27-patient cohort was 40 years. Twenty-two patients were assessed clinically by a neuropsychologist, neurologist and a social worker. Five patients, although not able or willing to participate in the clinical study, were contacted by telephone and interviewed on their vocational outcome. Compared to the first follow-up, 20/27 patients in total had no change in their vocational status. Nine out of the 27 patients were working full-time, two had subsidized jobs and 16 were not working. Twenty-four of 27 patients were independent in daily living. In the neuropsychological tests of executive functions, preserved flexibility associated with full-time work status. In conclusion, 1/3 of the patients were still employed full-time over 30 years after the TBI. This suggests that favorable vocational outcome, reached by young adulthood, is maintained at least until middle age. (JINS, 2004, 10, 719–723.)

Traumatic brain injury (TBI) is often associated with enduring impairments in high-level cognitive functioning, including working memory (WM). We examined WM function in predominantly chronic patients with mild, moderate and severe TBI and healthy comparison subjects behaviorally and, in a small subset of moderate-to-severe TBI patients, with event-related functional magnetic resonance imaging (fMRI), using a visual n-back task that parametrically varied WM load. TBI patients showed severity-dependent and load-related WM deficits in performance accuracy, but not reaction time. Performance of mild TBI patients did not differ from controls; patients with moderate and severe TBI were impaired, relative to controls and mild TBI patients, but only at higher WM-load levels. fMRI results show that TBI patients exhibit altered patterns of activation in a number of WM-related brain regions, including the dorsolateral prefrontal cortex and Broca's area. Examination of the pattern of behavioral responding and the temporal course of activations suggests that WM deficits in moderate-to-severe TBI are due to associative or strategic aspects of WM, and not impairments in active maintenance of stimulus representations. Overall, results demonstrate that individuals with moderate-to-severe TBI exhibit WM deficits that are associated with dysfunction within a distributed network of brain regions that support verbally mediated WM. (JINS, 2004, 10, 724–741.)

Verbal learning and memory (VLM) following pediatric stroke was characterized in a cross-sectional neuropsychological and neuroimaging study of 26 subjects, aged 5 to 17, with a history of pediatric stroke and 26 age, SES, and gender matched orthopedic controls. Further comparisons were made between the VLM profiles of stroke subjects with right versus left hemisphere lesions and early (≤12 months) versus late (>12 months) strokes. Overall, stroke subjects scored significantly lower than control subjects on several VLM indices (California Verbal Learning Test–Children; CVLT–C), as well as on measures of intellectual functioning (IQ) and auditory attention/working memory (Digit Span). Subgroup analyses of the stroke population found no significant differences in VLM, Digit Span, Verbal IQ or Performance IQ when left-hemisphere lesion subjects were compared to right-hemisphere lesion subjects. In contrast, early strokes were associated with significantly fewer words recalled after delay, reduced discriminability (fewer correct hits relative to false positive errors on recognition testing), and relatively worse auditory attention/working memory scores (Digit Span). These findings indicate that pediatric stroke subjects demonstrated more VLM impairment than control subjects, and early strokes were associated with greater recall and recognition deficits. In stark contrast with adult-onset stroke, both left- and right-hemisphere lesions during childhood resulted in similar VLM performance. (JINS, 2004, 10, 742–752.)

Major depressive disorder (MDD) and frontotemporal dementia (FTD) are both disorders in elderly populations that involve the prefrontal cortex and appear to have similar neurocognitive deficits. This review examined whether there are testable deficits in cognition that are consistent across individuals within the same neuropathological condition that could be used to facilitate early diagnoses. Medline and PsychInfo databases were searched for cognitive studies of depressed and FTD patients that used a matched control group and reported findings with means and standard deviations (N = 312). Effect sizes for FTD patients with mild and moderately advanced disease were compared to effect sizes within subgroups of depressed patients, such as inpatients, outpatients and community volunteers. Moderately advanced FTD patients were more impaired than depressed patients over all domains, particularly in language ability, although depressed inpatients appeared similar to FTD patients in some domains. Effect sizes for FTD patients who were in the mild, or early, stage of the disease (MMSE = 28) were similar to those of depressed outpatients but slightly worse than those of community volunteers in all domains except semantic memory and executive ability. In the latter two domains, even mild FTD patients had notably large deficits. All FTD patients showed more severe deficits in some domains relative to other domains. In contrast, depressed patients tended to vary by clinical presentation or disease severity, but the magnitude of impairment for each subgroup remained relatively consistent across domains and they did not have the severe focal deficits in one or two domains demonstrated by FTD patients. (JINS, 2004, 10, 753–771.)

Obstructive sleep apnea-hypopnea syndrome (OSAHS) is a well-recognized clinical sleep disorder that results in chronically fragmented sleep and recurrent hypoxemia. The primary daytime sequelae of the disorder include patient reports of excessive daytime sleepiness, depression, and attention and concentration problems. It has been well established that OSAHS negatively impacts certain aspects of cognitive functioning. The primary goals of this article are to (1) clarify the pattern of cognitive deficits that are specific to OSAHS; (2) identify the specific cognitive domains that improve with treatment; and (3) elucidate the possible mechanisms of cognitive dysfunction in OSAHS. At the conclusion of the paper, we propose a potential neurofunctional theory to account for the etiology of cognitive deficits in OSAHS. Thirty-seven peer-reviewed articles were selected for this review. In general, findings were equivocal for most cognitive domains. Treatment, however, was noted to improve attention/vigilance in most studies and consistently did not improve constructional abilities or psychomotor functioning. The results are discussed in the context of a neurofunctional theory for the effects of OSAHS on the brain. (JINS, 2004, 10, 772–785.)

This study investigated two mechanism-based treatments for expressive aprosodia, a disturbance in emotional prosody thought to be governed by the right hemisphere. The 3 participants all suffered right CVA's resulting in expressive aprosodia. Presence of expressive aprosodia was determined by performance on two batteries of emotional communication. A single subject ABAC design was employed in which two treatments, one imitative and one cognitive linguistic, were assigned in random order. All participants in this study were randomly assigned to begin with the cognitive linguistic treatment. Probes of treated and untreated emotions were completed during baseline and therapy phases. Probe items were judged by a reliable, trained rater blind to time of testing. Visual and statistical analyses were completed. These analyses confirmed that both treatments were active. For example, effect size calculations confirmed modest to substantial treatment effects for both treatments in all 3 patients. Replication to increase confidence about treatment effect and enhance understanding of the neuromechanisms underlying aprosodia is underway. (JINS, 2004, 10, 786–793.)

Autopsy studies were undertaken in a 47-year-old college-educated male patient who, 7 months prior to an unexpected death, had sustained a mild traumatic brain injury (TBI) as manifested by brief loss of consciousness and an initial Glasgow Coma Scale score of 14. The patient died from cardiac arrest secondary to an undiagnosed and unknown arteriosclerotic cardiovascular disease as assessed by the coroner's office at the time of autopsy. Gross inspection of the brain at autopsy was normal; however, microscopic analysis demonstrated what were considered trauma findings of hemosiderin-laden macrophages in the perivascular space and macrophages in the white matter, particularly the section taken from the frontal lobe. The patient had partially returned to work at the time of death, but had encountered problems with diminished cognitive performance in his work as an appraiser. Neuropsychological studies were generally within normal limits although several tests of either speed of processing or short-term memory showed lower than expected performance. This case demonstrates the presence of subtle neuropathological changes in the brain of a patient who sustained a mild TBI and was still symptomatic for the residual effects of the injury 7 months post injury when he unexpectedly died. (JINS, 2004, 10, 794–806.)