The diagnosis of lifetime major depressive disorders (MDDs) and of current major depressive episodes (MDEs) are relatively common in HIV-infected individuals, and often are assumed to influence neuropsychological (NP) performance. Although cross-sectional studies of HIV-infected individuals generally have found no systematic link between current MDE or depressive symptoms and NP performance, longitudinal studies are needed to clarify whether incident MDE may impact NP functioning in at least some cases. Two hundred twenty-seven human immunodeficiency virus (HIV)-infected adult men, who did not meet criteria for a current MDE at baseline, participated in a longitudinal NP study for an average of two years. Participants received repeated NP assessments, as well as structured psychiatric interviews to ascertain presence or absence of both lifetime MDD and current MDE. Ninety-eight participants had a lifetime history of MDD, and 23 participants met criteria for incident MDE at one of their follow-up evaluations. Groups with and without lifetime MDD and/or incident MDE had comparable demographics, HIV disease status and treatment histories at baseline, and numbers of intervening assessments between baseline and the final follow-up. Lifetime MDD was associated with greater complaints of cognitive difficulties in everyday life, and such complaints were increased at the times of incident MDE. However, detailed group comparisons revealed no NP performance differences in association with either lifetime or incident major depression. Finally, NP data from consistently nondepressed participants were used to develop “norms for change” and these findings failed to show any increased rates of NP worsening among individuals with incident MDE. Our results suggest that neurocognitive impairment and major depression should be considered as two independent processes. (JINS, 2007, 13, 1–11.)

The objective of this study is to determine if distinct cognitive phenotypes could be identified in temporal lobe epilepsy. Epilepsy patients (n = 96) and healthy controls (n = 82) underwent comprehensive neuropsychological assessment. Adjusted (age, gender, and education) test scores for epilepsy subjects were grouped into cognitive domains (intelligence, language, visuoperception, immediate and delayed memory, executive function, and cognitive/psychomotor speed). Cluster analysis revealed three distinct cognitive profiles types: (1) minimally impaired (47% of subjects); (2) memory impaired (24%); and (3) memory, executive, and speed impaired (29%). The three cluster groups exhibited different patterns of results on demographic, clinical epilepsy, brain volumetrics, and cognitive course over a 4-year interval. The specific profile characteristics of the identified cognitive phenotypes are presented and their implications for the investigation of the neurobehavioral complications of epilepsy are discussed. (JINS, 2007, 13, 12–20.)

Chronically elevated levels of cortisol have been associated with changes in cognitive functioning and brain morphology. Using Cushing's disease as a model to assess the effects of high levels of cortisol on cognitive functioning, 27 patients with Cushing's disease were examined at baseline and three successive follow-up periods up to 18 months after successful surgical treatment. At all follow-up periods, patients were administered cognitive tests as well as measures of plasma and urinary free cortisol. Structural MRIs and a depression measure were taken at baseline and one-year follow-up. Results showed that there is a specific pattern of significant cognitive and morphological improvement following successful treatment. Verbal fluency and recall showed recovery, although brief attention did not. Age of participants was a significant factor as to when recovery of function occurred; younger patients regained and sustained their improvement in cognitive functioning more quickly than older participants. Improvement in verbal recall also was associated with a decrease in cortisol levels as well as an increase in hippocampal formation volume one year after treatment. Overall, these findings suggest that at least some of the deleterious effects of prolonged hypercortisolemia on cognitive functioning are potentially reversible, up to at least 18 months post treatment. (JINS, 2007, 13, 21–29.)

In this study, we assess the neuropsychological profiles of both early and late symptom-onset obsessive-compulsive disorder (OCD) patients. The early and late-onset OCD patients are compared to the control group with a series of neuropsychological measurements. The late-onset OCD patients exhibited impaired performance on the immediate and the delayed recall conditions of the Rey-Osterrieth Complex Figure Test (RCFT) and the letter and category fluency of the Controlled Oral Word Association Test (COWA), compared to the normal controls and the early-onset OCD patients. The controls and early-onset OCD patients did not differ on any of the neuropsychological measurements taken in this study. These results suggest that different neurophysiological mechanisms are in play in early and late-onset OCD patients, and age of onset can serve as a potential marker for the subtyping of OCD. (JINS, 2007, 13, 30–37.)

Recent models of impaired awareness in brain injury draw a distinction between metacognitive knowledge of difficulties and online awareness of errors (emergent and anticipatory). We examined performance of 31 Traumatic Brain Injury (TBI) participants and 31 healthy controls using a three-strand approach to assessing awareness. Metacognitive knowledge was assessed with an awareness interview and discrepancy scores on three questionnaires—Patient Competency Rating Scale, Frontal Systems Behavioral Scale and the Cognitive Failures Questionnaire. Online Emergent Awareness was assessed using an online error-monitoring task while participants performed tasks of sustained attention. Online anticipatory awareness was examined using prediction performance on two cognitive tasks. Results indicated that the TBI Low Self-Awareness (SA) group and High SA group did not differ in terms of severity, chronicity or standard neuropsychological tasks but those with Low SA were more likely to exhibit disinhibition, interpersonal problems and more difficulties in total competency. Sustained attention abilities were associated with both types of online awareness (emergent and anticipatory). There was a strong relationship between online emergent and online anticipatory awareness. Metacognitive knowledge did not correlate with the other two measures. This study highlights the necessity in adopting a multidimensional approach to assessing the multifaceted phenomenon of awareness of deficits. (JINS, 2007, 13, 38–49.)

As currently defined, it is not clear whether Nonverbal Learning Disabilities (NLD) should be considered a matter of kind or magnitude (Meehl, 1995). The taxonicity of NLD, or the degree to which it is best construed as discrete versus continuous, has not been investigated using methods devised for this purpose. Latent Class Analysis (LCA) is a method for finding subtypes of latent classes from multivariate categorical data. This study represents an application of LCA on a sample of children and adolescents with spina bifida myelomeningocele (SBM) (N = 44), those presenting with features of NLD (N = 28) but no medical condition, and control volunteers (N = 44). The two-class solution provided evidence for the presence of a taxon with an estimated base-rate in the SBM group of .57. Indicator validities (the conditional probabilities of indicator endorsement in each latent class) suggest a somewhat different priority for defining NLD than is typically used by researchers investigating this disorder. A high degree of correspondence between LCA classifications and those based on a more conventional algorithm provided evidence for the validity of this approach. (JINS, 2007, 13, 50–58.)

Working memory (WM) and inhibitory control (IC) are general-purpose resources that guide cognition and behavior. In this study, the developmental relations between WM and IC were investigated in 96 typically developing children aged 6 to 17 years in an experimental task paradigm using an efficiency metric that combined speed and accuracy performance. The ability to activate and process information in WM showed protracted age-related growth. Performance involving WM and IC together was empirically distinguishable from that involving WM alone. The results indicate that developmental improvements in WM are attributable to increased processing efficiency in activation, suppression, and strategic resource deployment, and that WM and IC are best studied in novel, complex situations that elicit competition among those resources (JINS, 2007, 13, 59–67.)

Deep brain stimulation (DBS) has the potential to significantly reduce motor symptoms in advanced Parkinson's disease (PD). Controversy remains about non-motor effects of DBS and the relative advantages of treatment at two brain targets, the globus pallidus internus (GPi) and the subthalamic nucleus (STN). We investigated effects of DBS on neuropsychological functioning in 42 patients with advanced PD randomly assigned to receive staged bilateral DBS surgery of either the GPi or STN. Patients underwent neuropsychological assessment prior to and 6 months after unilateral surgery. Twenty-nine subsequently underwent surgery to the contralateral side and completed a second follow-up neuropsychological evaluation 15 months later. Unilateral treatment resulted in small but statistically significant reductions in performance on several measures, including verbal fluency and working memory. A similar pattern was observed after bilateral treatment. Reductions in verbal associative fluency were significant only after left-sided treatment. There were few significant differences related to treatment at the two surgical targets. Supplementary analyses suggested that decrements in select neuropsychological domains following DBS are unrelated to age or post-surgical reduction in dopaminergic medication dose. Findings are discussed with reference to possible causes of neuropsychological decline and the need for further controlled studies of specific neuropsychological effects of DBS. (JINS, 2007, 13, 68–79.)

This study followed 118 HIV+ individuals who had taken steps to return to work to determine facilitators or barriers in returning to work. Over the two-year study period, 52% of the participants obtained employment. Memory function served as the most potent predictor of obtaining employment. Persons who were younger, did not have a diagnosis of AIDS and who had shorter periods of unemployment prior to entering the study also had better chances of finding employment during the study. After finding employment, participants reported lower levels of depression as well, an apparent result of their obtaining employment. These findings indicate that memory is a key neuropsychiatric variable that is perhaps most relevant to HIV+ persons' quest to return to work. (JINS, 2007, 13, 80–89.)

Recent studies of brain injured and healthy individuals have provided empirical support for the theoretical proposition that executive function and general intelligence are closely associated by demonstrating that performance on tests of executive function is correlated with general intellectual ability (g). In the present investigation, the relationship between performance on the Wechsler Adult Intelligence Scale-III (WAIS-III), as a measure of g, and performance on recently developed ecological tests of executive function [i.e., Hayling and Brixton, Zoo Map and Key Search sub-tests from the Behavioral Assessment of the Dysexecutive Syndrome (BADS) battery], was examined in a sample of 118 severely brain injured individuals. The results indicated that (a) performance on tests of executive function share significant variance, and (b) a proportion of that shared variance is associated with performance on the WAIS-III. Correlations between conventional measures of executive function (i.e. Trails B and Controlled Oral Word Association) and WAIS-III were of comparable magnitude to the correlations between new, ecologically valid executive tests and WAIS-III. The results provide some support to the notion that tests of executive function measure non-specific intellectual functions, reminiscent of g. (JINS, 2007, 13, 90–98.)

The role of various types of slowing of processing speed, as well as the role of depressed mood, on each stage of verbal memory functioning in patients diagnosed with schizophrenia was investigated. Mixed lists of high- and low-frequency words were presented, and immediate and delayed free recall and recognition were required. Two levels of encoding were studied by contrasting the relatively automatic encoding of the high-frequency words and the more effortful encoding of the low-frequency words. Storage was studied by contrasting immediate and delayed recall. Retrieval was studied by contrasting free recall and recognition. Three tests of motor and cognitive processing speed were administered as well. Regression analyses involving the three processing speed measures revealed that cognitive speed was the only predictor of the recall and recognition of the low-frequency words. Furthermore, slowing in cognitive speed accounted for the deficit in recall and recognition of the low-frequency words relative to a healthy control group. Depressed mood was significantly associated with recognition of the low-frequency words. Neither processing speed nor depressed mood was associated with storage efficiency. It is concluded that both cognitive speed slowing and depressed mood impact on effortful encoding processes. (JINS, 2007, 13, 99–107.)

Based on his seminal contributions in 1891 and 1892, Dejerine is widely credited for initiating the investigation of acquired dyslexia. In the first contribution (1891) he described a patient who developed an inability to read and write after suffering an infarction of the left hemisphere. Dejerine designated the disorder “Alexia with Agraphia”; he attributed it to a loss of the “optical images” of words that were presumed to be supported by the angular gyrus. In 1892, Dejerine described a patient who was able to write but could not read what he (and others) had written (Dejerine, 1892). This disorder, variously known as Alexia without Agraphia, Pure Alexia or Agnosic Alexia, has been reported with regularity since the original account. Although subsequent reports have noted aspects of the disorder not emphasized in Dejerine's index case—pure alexia may be associated with surface (Patterson & Kay, 1982) or deep (Buxbaum & Coslett, 1996) dyslexia—the essential features of the disorder were well documented by Dejerine and the syndrome remains quite consistent with respect to its core phenomenology. Similarly, the pathologic substrate of the disorder has proven to be remarkably constant: the vast majority of patients with pure alexia have lesions involving the occipital lobe of the dominant hemisphere and either the forceps major or, less commonly, the splenium of the corpus callosum. The latter component of the lesion interrupts the white matter tracts connecting the visual association cortices of the right and left hemispheres.

Theories of the cognitive impairment underlying letter-by-letter reading vary widely, including prelexical and lexical level deficits. One prominent prelexical account proposes that the disorder results from difficulty in processing multiple letters simultaneously. We investigated whether this deficit extends to letters presented in rapid temporal succession. A letter-by-letter reader, G.M., was administered a rapid serial visual presentation task that has been used widely to study the temporal processing characteristics of the normal visual system. Comparisons were made to a control group of 6 brain-damaged individuals without reading deficits. Two target letters were embedded at varying temporal positions in a stream of rapidly presented single digits. After each stream, the identities of the two letters were reported. G.M. required an extended period of time after he had processed one letter before he was able to reliably identify a second letter, relative to the controls. In addition, G.M.'s report of the second letter was most impaired when it immediately followed the first letter, a pattern not seen in the controls, indicating that G.M. had difficulty processing the two items together. These data suggest that a letter-by-letter reading strategy may be adopted to help compensate for a deficit in the temporal processing of letters (JINS, 2007, 13, 110–119.)

This study provides an introduction to, and overview of, several papers that resulted from a randomized control trial that evaluated a new cognitive rehabilitation protocol. The program was designed to improve general strategic abilities in ways that would be expressed in a broad range of functional domains. The trial, which was conducted on a sample of older adults who had experienced normal age-related cognitive decline, assessed performance in the following domains: memory, goal management, and psychosocial status. The general rationale for the trial, the overall experimental design, and the approach to statistical analyses that are relevant to each paper are described here. The results for each functional domain are reported in separate papers in this series (JINS, 2007, 13, 120–131.)

This study reports the effects of a 12-week multimodular cognitive rehabilitation training program on memory performance in two groups of older adults. In the Memory Training module, participants were instructed on the nature of memory and how to improve memory performance; internal and external strategies were described and practiced over the training sessions. Memory performance was assessed by four tests: Alpha Span, Brown-Peterson, Hopkins Verbal Learning Test − Revised (HVLT-R), and Logical Stories. One group received training on entry into the study (Early Training Group, ETG), the other after a 3-month delay (Late Training Group, LTG). The results showed no training-related improvement in working memory (Alpha Span), primary memory (Brown-Peterson, HVLT-R), or recognition memory (HVLT-R). While the most direct analyses of a training effect (analyses of covariance) rarely demonstrated significant effects, exploratory analyses provided some evidence for a training benefit in several measures of secondary memory (Logical Stories; HVLT-R) and strategic processing (Brown-Peterson; Logical Stories; HVLT-R). Positive results were largely restricted to the ETG, possibly because the LTG lost motivation as a consequence of their delayed training. The results need to be treated with caution, but are promising for the rehabilitation of memory functioning in older adults (JINS, 2007, 13, 132–142.)

Executive functions are highly sensitive to the effects of aging and other conditions affecting frontal lobe function. Yet there are few validated interventions specifically designed to address executive functions, and, to our knowledge, none validated in a healthy aging sample. As part of a large-scale cognitive rehabilitation randomized trial in 49 healthy older adults, a modified Goal Management Training program was included to address the real-life deficits caused by executive dysfunction. This program emphasized periodic suspension of ongoing activity to establish goal hierarchies and monitor behavioral output. Tabletop simulated real-life tasks (SRLTs) were developed to measure the processes targeted by this intervention. Participants were randomized to two groups, one of which received the intervention immediately and the other of which was wait-listed prior to rehabilitation. Results indicated improvements in SRLT performance and self-rated executive deficits coinciding with the training in both groups. These gains were maintained at long-term follow-up. Future research will assess the specificity of these effects in patient groups (JINS, 2007, 13, 143–152.)

In this study, we report changes in psychosocial function in two groups of older adults that participated in the experimental trial of our cognitive rehabilitation program. The results, based on tests that measured a range of psychosocial attributes, showed that, following training, participants improved in terms of overall well-being, as well as in specific areas that included perceived happiness, coping strategies, and quality of life. An important finding was that improvements were also observed in long-term follow-up testing. Both groups benefited from training, but the effect was greater in the group that received training before undergoing a control procedure. The results, which show that the benefits of our rehabilitation program extend into the psychosocial domain, underscore the potentially important relationship between psychosocial factors and cognitive performance in older adults. (JINS, 2007, 13, 153–165.)

This study provides an overview of the papers emanating from the experimental trial that evaluated a new cognitive rehabilitation program in older adults who were experiencing normal cognitive decline. The main features of the design are summarized, along with evidence that the training produced long-lasting improvement in memory performance, goal management, and psychosocial status. The benefits were attributed to several factors, including the program's emphasis on techniques that promoted efficient strategic processing. Limitations of the program and directions for future research are discussed (JINS, 2007, 13, 166–171.)

The current study characterizes cognitive and psychiatric status in hematopoietic stem cell transplantation (HSCT) patients shortly before and after transplant. Thirty adult patients were assessed prospectively 1–2 weeks before transplantation and 100 days posttransplantation on neuropsychological and psychiatric measures. Before transplant, participants showed mild impairments on several neuropsychological measures, with the poorest performances occurring on learning and attention. Psychiatric functioning was significantly elevated compared with normative data. Significant improvements, however, were observed on neuropsychological measures by 100 days after transplant. Depression and anxiety scores also improved. Candidates for HSCT experienced mild diffuse cognitive dysfunction and psychiatric morbidity before the procedure, but these symptoms significantly improved by 3 months following their transplant in this small sample. Education about these possible pretransplant sequelae and the potential for rebound may be helpful to patients and families as they prepare for this treatment and the recovery period (JINS, 2007, 13, 172–177.)

Speed of information processing in persons with postconcussion syndrome (PCS) was examined using word fluency tasks. Twenty patients with PCS and twenty controls matched for age, gender, and occupation were given two word fluency tasks, and the speed of word generation was measured. Response latencies were analyzed to determine whether slowed retrieval or degradation of words in semantic memory was responsible for problems with word retrieval after traumatic brain injury. The PCS group recalled fewer words, had significantly longer interresponse times, and took significantly longer to generate their first word than the controls. There was no evidence that either structure loss or slowness in word retrieval from semantic memory could account for the word fluency deficits. Rather, the findings suggest that the primary cause of word retrieval difficulties in patients with PCS is a generalized slowness of cognitive processing (JINS, 2007, 13, 178–182.)The study described was part of Maria Crawford's doctoral thesis. This research was supported by a University of Otago Research Grant awarded to Robert G. Knight and a Ph.D. scholarship awarded to Maria Crawford.