Executive functions in their broadest sense may be impaired in patients with frontal lobe lesions. The Wisconsin Card Sorting Test, perhaps the most robust test sensitive to frontal lobe dysfunction, requires the flexibility to switch a response pattern to meet the change in task demands. However this task has only two category switches and normal respondents tend to score at ceiling. Verbal fluency tasks also incorporate a switching component and it was hypothesized that a word generation task that maximized a switching requirement might provide a more satisfactory verbal measure of frontal lobe dysfunction. A new test of homophone meaning generation that requires multiple switches between verbal concepts (e.g., tick = insect, correct, etc.) was devised. Normative data was obtained from a sample of 170 control participants. Seventy-one patients with unilateral anterior or posterior cerebral lesions were also tested. A normal distribution of scores was obtained in the standardization sample. The anterior lesion groups were more impaired than the posterior groups. There were no significant differences due to laterality. This homophone meaning generation task is a measure of frontal lobe dysfunction that has the advantage of psychometric properties that permit measurement of the degree of impairment. (JINS, 2000, 6, 643–648.)

To evaluate the clinical and ecological validity of affect recognition (AR) measures in a sample of community-dwelling schizophrenic outpatients (N = 40), we analyzed the relation of facial and vocal AR to intellectual, symptomatic, and quality-of-life criteria. Facial and vocal AR showed virtually identical patterns of association with these criteria, suggesting that both modalities of AR draw on the same underlying heteromodal capacity. Specifically, AR was correlated with a subset of intellectual abilities (verbal–semantic, executive–attentional), but was unrelated to age, education, or neuroleptic dose. In terms of clinical and ecological criteria, AR errors correlated with more severe psychotic symptoms (positive and disorganized) and with lower quality of life (relationships, community participation, and richness of intrapsychic experience). Even after controlling for subjects' intellectual abilities and illness severity, inaccurate AR was associated with bizarre behaviors (involving sociosexual interactions, clothing, appearance) and with impoverished interpersonal relations. Thus, while difficulty identifying basic affective cues is related to general cognitive and illness-severity factors, it appears to have specific functional implications that do not depend on generalized impairment. Assessment of AR may identify a subgroup of schizophrenic patients who have a central defect in the heteromodal monitoring of emotional-social displays, associated with dysregulation of social behaviors and disruption of interpersonal relations. (JINS, 2000, 6, 649–658.)

Emotional reactions are sometimes observed during the intracarotid sodium amobarbital test. For instance, euphoric/indifference reactions can be seen during right hemisphere inactivation and catastrophic reactions may accompany left hemisphere inactivation. Less dramatic changes can also be detected in affective self-report during left and right hemisphere amobarbital tests, with more negative affect reported during left hemisphere inactivation and either neutral or mildly positive affective states reported during right hemisphere inactivation. The current study not only replicated this effect, but in addition, found significant group differences. The first group (right way) showed a pattern of affective self-report during left and right amobarbital tests entirely consistent with prior findings, while a second group (wrong way) showed results that behaved in a diametrically opposite fashion. A third group (no change) showed little, if any, difference in affective self-report during left and right amobarbital tests. The major factor distinguishing the wrong way group from the other two appeared to be an asymmetrical distribution of left and right temporal lobe lesions in the former group. In contrast, the factor differentiating the right way group from the no change group appeared to be the relative degree of left hemisphere inactivation during the left hemisphere amobarbital test. The results are discussed not only in terms of their impact on theories of cerebral lateralization for emotion, but also in terms of methodological issues in this field. (JINS, 2000, 6, 659–667.)

Since constructional apraxia is often concomitant with brain lesions, the study of constructional tasks in the non-brain-damaged population might be useful in helping to disentangle other causal factors. This paper explores the performance of illiterate individuals (N = 29) as compared to that of semiliterates (N = 21) and literates (N = 23) in order to see the effect of reading and writing abilities on constructional tasks. Each participant was asked to construct 4 figures based upon models having varying degrees of complexity. A global criterion of lack of fidelity and several analytic criteria (related to distortion, rotation, and disarticulation errors) were used to evaluate performance. Although illiterates generally made more errors than semiliterates and semiliterates more than literates, only some of these differences were statistically significant. Significant differences were found for lack of global fidelity and disarticulation errors when all 4 figures were considered together. Subtler data emerged with respect to single figures. (JINS, 2000, 6, 668–672.)

Although body dysmorphic disorder (BDD) is receiving increasing empirical attention, very little is known about neuropsychological deficits in this disorder. The current study investigated the nature of memory dysfunction in BDD, including the relationship between encoding strategies and verbal and nonverbal memory performance. We evaluated 17 patients with BDD and 17 healthy controls using the Rey–Osterrieth Complex Figure Test (RCFT) and the California Verbal Learning Test (CVLT). BDD patients differed significantly from healthy controls on verbal and nonverbal learning and memory indices. Multiple regression analyses revealed that group differences in free recall were statistically mediated by deficits in organizational strategies in the BDD cohort. These findings are similar to patterns previously observed in obsessive–compulsive disorder (OCD), suggesting a potential relationship between OCD and BDD. Studies in both groups have shown that verbal and nonverbal memory deficits are affected by impaired strategic processing. (JINS, 2000, 6, 673–681.)

We examined short duration perception (400 ms), long duration estimation (30 and 60 min), and spatiotemporal estimation in long-term survivors of childhood cerebellar tumors with a mean time since diagnosis of 14.2 years. Groups of individuals with tumors treated with surgery only (astrocytoma, N = 20) were compared to those with tumors treated with surgery, focal radiation, and craniospinal radiation (medulloblastoma, N = 20), and to age- matched controls (N = 40). Childhood lesions of the cerebellum produced enduring deficits in short-duration perception, but spared the ability to functionally estimate long durations, regardless of the pathology or treatment of the tumor. Evidence did not support any functional recovery over time of the cerebellar system that underlies short-duration perception. Younger age at treatment was not a protective factor. Although no group differences were present in the functional measures of long-duration estimation, tumor-related prospective memory deficits interfered with the ability to produce long-duration prospective estimates. The utilization of sensory and somatomotor information to refine real-world spatiotemporal estimates was compromised in the medulloblastoma group only. (JINS, 2000, 6, 682–692.)

This study was designed to examine the patterns of apraxic disturbances and the relationships between action knowledge and other measures of semantic knowledge about objects in 10 well-characterized Alzheimer's disease (AD) patients. Five tasks were used to assess components of action knowledge (action–tool relationships, pantomime recognition, and sequential organization of action) and praxis execution (actual use, pantomiming) according to the cognitive model of praxis. Three tasks (verbal comprehension, naming, and a visual semantic matching task) were used to assess verbal–visual semantics. Considering patterns of apraxia first, conceptual apraxia was found in 9 out of the 10 AD patients, suggesting that it is a common feature even in the early stages of AD. Second, we found partly parallel deficits in tests of action-semantic and verbal–visual semantic knowledge in 9 AD patients. Impaired action knowledge was found only in patients with a semantic language deficit. These findings provide no evidence that “action semantics” may be separated from other semantic information. Our results support the view of a unitary semantic system, given that the representations of action-semantic and other semantic knowledge of objects are often simultaneously disrupted in AD. (JINS, 2000, 6, 693–703.)

Although a U.S. Presidential Proclamation designated the 1990s “The Decade of the Brain,” not all cerebral constituents shared equally in the limelight. By anyone's accounting, the prefrontal cortex was the darling of clinicians and neuroscientists throughout the '90s, with everything from schizophrenia and anorexia nervosa to pathological gambling and the emergence of artistic skill attributed to “frontal lobe dysfunction” (David, 1992; Miller et al., 1998; Rugle & Melamed, 1993). It should come as no surprise, then, that that most universal of cognitive afflictions, aging, should be linked to changes in frontal cortex.

That the human frontal lobes are particularly vulnerable to age-related deterioration has been frequently invoked as an explanation of functional decline in aging. This “frontal aging hypothesis” is evaluated in this review by examining evidence of selectively reduced frontal lobe function in aging. The frontal aging hypothesis predicts that functions largely dependent on frontal regions would decline in aging, while functions largely independent of frontal lobes would remain relatively spared. The hypothesis further predicts that age-related brain change would selectively impact frontal regions. The literatures on working memory, visuospatial attention, face recognition, and implicit memory were reviewed as exemplars of functions dependent on prefrontal, parietal, temporal and occipitotemporal cortices, respectively, with a view to establishing mediating structures and effects of aging. Age sensitivity was seen both in functions dependent on frontal integrity as well as in functions apparently independent of frontal integrity. Further, although prefrontal areas exhibit age-related decreases in regional volume, blood flow and metabolism, nonfrontal cortical regions undergo similar declines. It is concluded that while the frontal lobes are subject to age-related changes reflected in both behavior and pathology, there is only weak and conflicting evidence that frontal regions are selectively and differentially affected by aging. It is argued that a network-based theory of cognitive aging has advantages over the localizationist approach inherent in the frontal aging hypothesis. (JINS, 2000, 6, 705–726.)

Over the past decade a number of reviewers have argued that the pattern of spared and impaired cognitive functions observed in the cognitive aging literature can be understood within the context of a neuropsychologically constrained model that proposes that the prefrontal cortex is more vulnerable to the effects of normal aging than other cortical regions (Dempster, 1992; Hartley, 1993; Moscovitch & Winocur, 1992; West, 1996). While this model has served as a valuable heuristic in my own thinking about cognitive aging, the current review of Greenwood and theoretical work emerging from other laboratories argues that the “frontal lobe hypothesis” (FLH) no longer provides a useful or accurate framework within which to understand brain behavior relationships in cognitive aging. While I agree with several of the ideas developed in the review of Greenwood (this issue) I believe the continued utility of the FLH can be demonstrated by considering two questions: (1) What does the FLH predict about cognitive aging and is there support for these predictions? and (2) Has the time come to move beyond a general specification of the FLH? In answering these questions I will provide one or two findings from the empirical literature. These are intended to be illustrative, not exhaustive.

West argues that the frontal aging hypothesis remains a useful construct, largely on the basis of evidence that cognitive functions dependent on frontal regions decline at an earlier age than those independent of frontal regions. This point was considered in my review, which found only sparse evidence in its favor. Few investigations have been aimed at determining the age at which decline begins for a set of functions. West cites one behavioral study (Shimamura & Jurica, 1994) and one PET study (Shaw et al., 1984). Given the size of the literature from which these studies are drawn, a finding of age effects in one “frontal” memory task with mean age 61 but not in one “nonfrontal” memory task can only suggest that age-related functional decline is more rapid in the frontal-dependent task. This finding must be viewed in the context of a broader range of functions. Several large scale studies aimed at this question have examined age-related declines on a broad range of functions and concluded verbal abilities are preserved until late in life while visuospatial abilities decline throughout adulthood (Arenberg, 1978; Eisdorfer et al., 1959; Koss et al., 1991). Shaw et al. (1984) must also be considered in the context of other studies of resting cerebral blood flow and metabolism which I reviewed which did not find selectively reduced prefrontal blood flow (Azari et al., 1992; Martin et al., 1991). Indeed, it is difficult either to prove or to disprove the somewhat vaguely-conceived frontal aging hypothesis using the current

Negative phenomena can occur with seizures, but some ictal negative manifestations are rare and may lead to misdiagnosis. A patient series is presented with unusual ictal negative phenomena: neglect syndrome, catastrophic depression, apraxia, aphasia, amnesia, homonomous hemianopsia, and hemiparesis. One had repeated episodes with PLEDs but no parenchymal lesions. Clinicians should consider seizures in the setting of unexplained deficits, even if there are no positive ictal phenomena. (JINS, 2000, 6, 731–733.)

Of all the symptoms associated with aphasia, anomia may be the most pervasive. Virtually all individuals with aphasia have some degree of word-finding difficulty. Even when an individual experiences significant recovery in aphasia, anomic deficits typically remain, resulting in frustration for the anomic individual, their communication partners, and the clinicians attempting to treat them. This volume in the Foundations of Neuropsychology Series, devoted entirely to naming and its disorders, provides a welcome review incorporating current clinical findings and theoretical viewpoints.

In recent years, edited books presenting unusual case studies of neuropsychological disorders have appeared in the literature with increasing frequency. In general, I have found these books to be fascinating, illustrating the seemingly endless variety of ways in which damage to the nervous system can affect the cognitive functioning and the day-to-day lives of previously normal individuals. These volumes, which focus on the uniqueness or specificity of an individual neuropsychological deficit rather than on the commonality of dysfunction across individuals, always include at least some cases that are unlike any that I have previously encountered and almost always present some real surprises—cases that seem to defy easy explanation in terms of existing theories. In these respects, Case Studies in the Neuropsychology of Memory, edited by Alan Parkin, is no exception. The descriptions of the cases reported in the 10 chapters of this book are unique and intriguing. They are presented as stand-alone case studies without any cross-referencing to other cases in the book, which highlights their uniqueness. There is little in the way of editorial intrusion. A brief introduction tells us what to expect, provides some rationale for the selection of cases that appear in the book, and includes a sentence or two of the accepted theory that may be challenged by the reported case studies.

The psychological and neuropsychological changes of aging and dementia have been a topic of study for decades, if not centuries. It is only more recently, however, that technological changes have allowed the biological processes triggering the changes of aging to be uncovered. The overlap between these two sciences, namely, the relationship between cognitive aging and the study of biological aging, is an emerging area of research. The study of aging, however, is confounded by the close association between aging and the development of particular diseases. Older people are far more likely than young people to suffer from multiple illnesses. Furthermore, older people are far more vulnerable to specific types of diseases such as heart disease, cancer, and dementia. The relationship between the onset of the aging process and the development of dementing disorders such as Alzheimer's disease is of particular interest.

It is a testimony to the genius of William James that scarce a lecture on attention passes without the speaker quoting him on the subject. This has, however, also been a cause for concern: do we really understand any more about this amorphous topic now, than we did when James wrote Principles of Psychology? It might occur to more jaundiced reviewers that the fact that James abandoned psychology completely after finishing this great book implies that he was beaten by the subject of attention, for, in many senses, the study of attention is at the very heart of the science of psychology. And if the founding genius of psychology could not crack the code of attention, is there any hope for the rest of us?

The significance of the human face in social interaction can hardly be overestimated. We rely primarily on facial appearance in discriminating between members of our species, but we also use the face to judge the age and gender of a person and to interpret his or her emotional state. We find certain faces pleasant or attractive, attribute personality characteristics to people such as intelligence or honesty based on physiognomy, and use facial cues to guess people's intentions and predict their behavior toward us. Similarly, we can gauge the effect of our words or actions on others by the feedback we receive from their faces. The face assumes a privileged role in social communication almost immediately after birth, suggesting that the neural systems underlying various facial behaviors are to a large extent innately specified and genetically determined.