We investigated the frequency and neurocognitive correlates of attention deficit hyperactivity disorder and traits of this disorder (ADHD/Traits) after childhood stroke and orthopedic diagnosis in medical controls. Twenty-nine children with focal stroke lesions and individually matched children with clubfoot or scoliosis were studied with standardized psychiatric, intellectual, academic, adaptive, executive, and motivation function assessments. Lifetime ADHD/Traits were significantly more common in stroke participants with no prestroke ADHD than in orthopedic controls (16/28 vs. 7/29; Fisher's Exact p < .02). Lifetime ADHD/Traits in the orthopedic controls occurred exclusively in males with clubfoot (7/13; 54%). Participants with current ADHD/Traits functioned significantly worse (p < .005) than participants without current ADHD/Traits on all outcome measures. Within the stroke group, current ADHD/Traits was associated with significantly lower verbal IQ and arithmetic achievement (p < .04), more nonperseverative errors (p < .005), and lower motivation (p < .004). A principal components analysis of selected outcome variables significantly associated with current ADHD/Traits revealed “impaired neurocognition” and “inattention-apathy” factors. The latter factor was a more consistent predictor of current ADHD/Traits in regression analyses. These findings suggest that inattention and apathy are core features of ADHD/Traits after childhood stroke. This association may provide clues towards the understanding of mechanisms underlying the syndrome. (JINS, 2003, 9, 815–829.)

There is debate regarding the integrity of semantic memory in dementia of the Alzheimer type (DAT). One view argues that DAT is associated with a breakdown in semantic memory; the other argues that DAT is associated with predominantly preserved semantic memory and a breakdown in retrieval. The classic release from proactive interference (RPI) paradigm was used to shed light on this debate. Individuals with early-stage DAT (n = 36) and healthy older adult controls (n = 45) participated in an RPI paradigm. Each trial was a Brown–Peterson task in which participants read three-word lists, counted (for 0, 3, 6, or 9 s), and recalled the words. Both groups showed significant proactive interference (PI), but the size of the PI was significantly smaller in the DAT group. The group difference in PI may be due to the faster forgetting rate in the DAT group. Both groups showed significant RPI and there was no group difference in size when RPI was considered in terms of PI levels. Both groups showed PI and RPI in prior list intrusions. The DAT group's significant buildup and release of PI based on semantic categories suggest predominantly preserved semantic memory activity, at least, in early-stage DAT individuals. (JINS, 2003, 9, 830–838.)

Klinefelter syndrome (KS) is a sex chromosome abnormality associated with male infertility and mild cognitive deficits. Individuals with KS have been reported to have impaired verbal ability, as well as deficits in executive function. To further understand the nature of their deficits, we assessed specific elements of frontal lobe function such as working memory and relational reasoning. Men with KS exhibited a deficit in a transitive inference task in which participants ordered a set of names based on a list of propositions about the relative heights of the people named. This deficit was present even for items in which the propositions were given in order, so a chaining strategy could be used. Men with KS are also impaired on the n-back task, which uses letters as stimuli. In contrast, these men performed as well as controls in nonverbal reasoning (Raven's Progressive Matrices). These results suggest that men with KS have intact nonverbal reasoning abilities, but that a difficulty in encoding verbal information into working memory may underlie their executive and linguistic impairments. (JINS, 2003, 9, 839–846.)

Hepatitis C virus (HCV) infection is a major public-health-care problem, with over 170 million infected worldwide. Patients with chronic HCV infection often complain of various cognitive problems as well as symptoms of depression, anxiety, and fatigue. Relatively little is known, however, about the specific cognitive deficits that are common among HCV patients, and the influence of psychiatric symptomatology on cognitive functioning. In the current study of 21 chronically infected HCV patients, we assessed subjective cognitive dysfunction, depression, anxiety, and fatigue and compared these symptom areas to cognitive tests assessing visuoconstruction, learning, memory, visual attention, psychomotor speed, and mental flexibility. Results revealed that cognitive impairment ranged from 9% of patients on a visuoconstruction task to 38% of patients on a measure of complex attention, visual scanning and tracking, and psychomotor speed, and greater HCV disease severity as indicated by liver fibrosis was associated with greater cognitive dysfunction. Objective cognitive impairment was not related to subjective cognitive complaints or psychiatric symptomatology. These findings suggest that a significant portion of patients with chronic HCV experience cognitive difficulties that may interfere with activities of daily living and quality of life. Future research using cognitive measures with HCV-infected patients may assist researchers in identifying if there is a direct effect of HCV infection on the brain and which patients may be more likely to progress to cirrhosis and hepatic encephalopathy. (JINS, 2003, 9, 847–854.)

The importance of humor in healthy aging is being recognized. We compared elderly and young participants on their comprehension and appreciation of, and reaction to, verbal and nonverbal humor tests. Cognitive processes—working memory, cognitive flexibility, verbal abstraction, and visual scanning—were studied in relation to humor. Results indicated a relative deficit in the elderly in the cognitive comprehension of humor—selecting punch lines to jokes and in a cartoon array test. Measures of cognitive function correlated with humor comprehension. In contrast to this deficit in comprehension, the elderly showed intact affective appreciation and emotional reactiveness. Because of the hypothesis of frontal lobe degeneration as a basis for changes with aging, we compared the elderly to patients with focal frontal lesions. In this comparison, the elderly were significantly better than the patients in their comprehension of humor. They also displayed intact appreciation of humor compared to patients with frontal lesions. This preliminary study suggests that preserved affective responsiveness may underlie the success in using humor as a coping mechanism in the elderly. (JINS, 2003, 9, 855–863.)

Neuropsychologists often diagnose cerebral dysfunction based, in part, on marked variation in an individual's cognitive test performance. However, little is known about what constitutes the normal range of intraindividual variation. In this study, after excluding 54 individuals with significant health problems, we derived 32 z-transformed scores from 15 tests administered to 197 adult participants in a study of normal aging. The difference between each person's highest and lowest scores was computed to assess his or her maximum discrepancy (MD). The resulting MD values ranged from 1.6 to 6.1 meaning that the smallest MD shown by any person was 1.6 standard deviations (SDs) and the largest MD shown by any person was 6.1 SDs. Sixty-six percent of participants produced MD values that exceeded 3 SDs. Eliminating each person's highest and lowest test scores decreased their MDs, but 27% of the participants still produced MD values exceeding 3. Although MD values appeared to increase with age, adjusting test scores for age, which is standard in clinical practice, did not correct for this. These data reveal that marked intraindividual variability is very common in normal adults, and underscore the need to base diagnostic inferences on clinically recognizable patterns rather than psychometric variability alone. (JINS, 2003, 9, 864–870.)

The present study investigated everyday numerical abilities in a group of 21 patients affected by mild to moderate dementia of Alzheimer's type (DAT). Though patients did not differ from a control group in standard laboratory tests tapping transcoding, number comparison, simple calculation, and estimation, they showed significant difficulties in numerical tasks embedded in an everyday context, such as handling money, a bus schedule, or a television program. Patients' difficulties were attributed to those multiple cognitive demands which are inherent to real situations as compared to well-structured abstract paper-and-pencil tasks. Overall, the study suggests that the examination of numerical abilities in DAT patients should go beyond abstract paper-and-pencil tasks which can only partially reflect the actual numerical skills in DAT and should therefore include also tasks simulating everyday life situations. Assessment of everyday numerical skills may be crucial in planning adequate support for patients, for example in handling money, but also in designing targeted training programs. (JINS, 2003, 9, 871–878.)

Prior studies have found no adverse effects of pediatric epilepsy surgery on IQ. However, empirical techniques such as regression models, designed to account for confounding factors such as practice effects and test–retest reliability and able to provide a standardized method for evaluating outcome, have not been used in studying change after pediatric epilepsy. The goal of this study was to demonstrate the regression technique while empirically measuring the effect of epilepsy surgery on IQ in a group of pediatric patients. Predictors of retest IQ (e.g., baseline IQ, retest interval, demographics, epilepsy severity) were evaluated in a control group with intractable seizures (N = 23) assessed twice with the WISC–III. The resulting equation was used to evaluate IQ changes in a second group of children who underwent epilepsy surgery (N = 22). In controls, baseline IQ was a strong predictor of retest IQ. Number of AEDs was inversely related to retest IQ. Based on the control regression, four children (18%) in the surgical sample obtained significantly higher than expected postsurgical IQ scores and one child (5%) obtained a lower than expected IQ score. This study demonstrates that regression-based techniques yield informative estimates on outcome and may be an improvement over prior methods of measuring change after pediatric epilepsy surgery. (JINS, 2003, 9, 879–886.)

This study identified subtypes of psychosocial functioning in children who had sustained traumatic brain injury (TBI). Child Behavior Checklist (CBCL) profiles for 92 participants, aged 12 to 18 years, who had sustained a mild, moderate, or severe TBI were subjected to Q-Factor analysis. Sixty-four of the participants (75%) were classified into a four-category psychosocial typology labelled Normal (n = 32), Attention (n = 14), Delinquent (n = 10), and Withdrawn–Somatic (n = 8). This typology was found to overlap in part with previous TBI psychosocial typology (Butler et al., 1997), and with three of the clinical profile types derived by Achenbach (1993) for the CBCL. The majority of participants, including those who sustained severe TBI, were assigned to the Normal subtype and the overall level of psychosocial deviance was relatively mild in the other three subtypes. The results of this study support previous typology efforts and confirm the heterogeneous presentation of social and emotional functioning following TBI. (JINS, 2003, 9, 887–898.)

Calculation and number-processing abilities were studied in 49 patients with chronic single vascular brain lesions by means of a standardized multitask assessment battery (EC301), as well as through other tasks, testing functions thought to be implicated in calculation such as language, visuo-perceptive abilities, verbal and spatial working memory, planning, and attention. The results show that (1) lesions involving parietal areas—particularly left parietal lesions—are prone to alter calculation processing. A more detailed analysis showed that patients with lesions involving left parietal areas were impaired in both digital (i.e., comprehension and production of numbers written in Arabic code) and oral (i.e., comprehension and production of numbers heard or expressed orally) processing while lesions involving right parietal areas lead to an impairment in digital processing only. However, linguistically related alphanumerical processing (i.e., comprehension and production of numbers written orthographically) was not influenced by parietal lesions. (2) Semantic representations (knowledge of the magnitude related to a given number) as well as rote arithmetical knowledge are also impaired following damage to parietal and particularly left parietal lesions, suggesting that these areas are also implicated in magnitude comparisons and in the retrieval of arithmetical facts. (3) Performance in calculation is highly correlated with language. (4) Moreover, we found a highly significant correlation between performances in oral calculation and verbal working memory, and between written-digit calculation and visuospatial working memory. Performances in regard to visuo-perceptive abilities, planning, and attention were less consistently correlated with calculation. These results stress the close correlation, but relative independence between calculation and language, as well as a dissociated sensitivity of oral and digital processing to brain lesions. (JINS, 2003, 9, 899–912.)

Coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB) can produce a higher incidence of neuropsychological complications than other types of highly invasive noncardiac vascular surgery. Cognitive complications most likely arise from either embolization or hypoxia. An alternative surgical procedure has been developed that allows CABG to be performed without stopping the heart (“off-pump” CABG, or OPCABG). This study examined the neuropsychological performance of patients undergoing OPCABG, hypothesizing that patients undergoing OPCABG would show fewer cognitive deficits than patients whose hearts were stopped. A 1-hr neuropsychological battery was administered preoperatively to 43 patients before prospective randomization to either CPB CABG or OPCABG, and again to 34 of those patients 2 to 3 months postoperatively by an examiner blind to surgical condition. Neuropsychological status did not change 2.5 months postsurgically in either OPCABG or CABG groups. However, both groups showed dramatic presurgical cognitive deficits in multiple domains, particularly verbal memory and psychomotor speed. This corroborates previous research suggesting that patients requiring CABG surgery may evidence significant presurgical cognitive deficits as a result of existing vascular disease. (JINS, 2003, 9, 913–924.)

Wilson and Watson (1996) identified several factors that were associated with use of memory aids and strategies in a group of people with acquired brain injury. The present study tested these findings, with the aim of identifying the variables that best predict effective use of memory aids after brain injury. One-hundred and one people with memory problems arising from brain injury and their carers were interviewed to identify the aids/strategies used to compensate for memory impairment, and the efficacy of their use. Information relating to variables previously found, or hypothesized to predict use of memory aids, was collected. Use of memory aids correlated with level of independence. External aids such as calendars, wall charts, and notebooks were the most commonly used memory aids. Electronic organizers were not used by many participants. The variables that best predicted use of memory aids were (1) current age, (2) time since injury, (3) number of aids used premorbidly, and (4) a measure of attentional functioning. The implications for rehabilitation services are discussed. (JINS, 2003, 9, 925–935.)

For nearly a century, the primary method employed by psychologists to define and test the validity of constructs evaluated by assessment instruments has been shared-variance techniques such as intervariable correlations or factor analysis with large normative or mixed clinical samples. To illustrate the shortcomings of this approach, we conducted (1) correlational analyses of immediate- and delayed-memory measures separately in normal participants and in homogeneous samples of patients with either Alzheimer's disease or Huntington's disease; and (2) factor analysis of immediate and delayed-recall and recognition measures in a large, homogeneous sample of patients with Alzheimer's disease. The findings revealed that cognitive measures that share variance in the intact brain—thereby giving the facade of assessing a unitary construct—can dissociate and contribute to unique variance in the damaged brain, but only if the pathology occurs in brain regions known to disrupt vital cognitive processes tapped by those measures. The results illustrate that shared-variance procedures applied to normal or mixed clinical populations can mask some of the most vital cognitive constructs, such as the classic distinction between short- and long-term memory. Implications of these findings for research and clinical practice are discussed. (JINS, 2003, 9, 936–946.)

This commentary expands on issues raised by Delis, Jacobson, Bondi, Hamilton, and Salmon, in their paper on the use of shared variance techniques to establish construct validity. Significant discussion is focused on method variance, and how this can distort the results of factor analysis. Solutions are offered for the appropriate use of factor analysis in construct validation. Examples are also provided of construct validation procedures that do not rely on correlational or shared variance techniques. (JINS, 2003, 9, 947–953.)

Automatic and effortful information processing in depressed patients was investigated by a visual search paradigm, in order to examine dysfunctional effortful processing in depressed patients. Twenty-one patients with major depression, according to the DSM–IV, and with a moderate depression measured by the Hamilton Rating Scale score at >18 participated in the study. The healthy control group was matched for age, gender, and level of education. Half of the trials involved only one type of distractor, and the other half of the trials involved two types of distractors being presented. The results show that the performance of the depressed patients was equal to the control group when the target was easily recognized with only one type of distractor present. However, when target detection required a more difficult and complex attentive search strategy, effortful information processing, the depressed patients needed longer visual search time compared to the controls. Depressed patients seem to have impaired performance on effortful but not automatic information processing. (JINS, 2003, 9, 954–959.)