Emotion processing deficits may have an important effect on the quality of life of Alzheimer's disease (AD) patients and their families, yet there are few studies in this area and little is known about the cause of such deficits in AD. This study sought to determine if some AD patients have a disruption in a specific right hemisphere emotion processing system, and to determine if the processing of emotional facial expression is more vulnerable to the pathology of AD than is the perception of emotional prosody. It was specifically hypothesized that patients with greater right hemisphere dysfunction (low spatial AD patients) would be impaired on emotion processing tasks relative to those with predominantly left hemisphere dysfunction (low verbal AD patients). Both groups showed impairment on emotion processing tasks but for different reasons. The low verbal patients performed poorly on the affect processing measures because they had difficulty comprehending and/or remembering the task instructions. In contrast, low spatial AD patients have emotion processing deficits that are independent of language and/or memory and may be due to a more general visuoperceptual deficit that affects the perception of static but not dynamic affective stimuli. (JINS, 1997, 3, 411–419.)

The incidence of clinically apparent asymmetric profiles of neuropsychological deficits in Alzheimer's disease (AD) patients similar to those reported in the PET literature is currently unclear. This study investigated lateral neuropsychological asymmetry using principal component factor analysis in a sample of 153 patients diagnosed with probable AD. Using factor scores, patients were classified into groups exhibiting asymmetric or symmetric profiles of neuropsychological deficits. In the analysis of lateral asymmetry, 27.5% of patients were classified as asymmetric (10% verbally and 17% visuospatially). Consistent with reports of continued asymmetry beyond the mild dementia stage, asymmetry was exhibited in the mild, moderate, and severely demented groups. These findings of neuropsychological asymmetry across stages of dementia are consistent with the picture of significant neuropsychological heterogeneity in AD that has been emerging in the decade. (JINS, 1997, 3, 420–427.)

In a descriptive analysis of 158 patients with temporal lobe epilepsy, Taylor (1969) reported that the age of first seizure varied systematically as a function of laterality and sex. We conducted inferential analyses of Taylor's original data which (1) provided support for his proposal of disproportionate left hemisphere vulnerability to seizure onset in early life, but (2) failed to provide evidence of sex differences in age of onset of unilateral seizures. Examination of these effects in a larger sample of 844 patients drawn from the Bozeman Epilepsy Consortium provided some additional support for findings from the inferential analysis. Specifically, the left hemisphere appeared more vulnerable to seizure onset in childhood, this increased vulnerability extending to about age 5 years. Age of onset of seizures was not different when males and females were compared. Thus, reanalysis of Taylor's original data as well as examination of data from a larger, more contemporary sample suggest that seizure onset varies as a function of laterality, but not sex. (JINS, 1997, 3, 428–434.)

The construct of nonverbal memory, as assessed by figural reproduction tests, has recently been questioned by a number of investigators. The purpose of this study was to reexamine this construct and its relationship to right temporal lobe dysfunction. Figural reproduction test scores were examined in 757 epilepsy surgery candidates obtained from 8 epilepsy centers participating in the Bozeman Epilepsy Consortium. All participants exhibited unequivocal evidence of left (LTL) or right (RTL) temporal lobe epilepsy observed in ictal and interictal EEG recordings. All subjects also had IQ scores exceeding 70, right-hand preference, and left hemisphere language dominance confirmed by intracarotid sodium amytal testing. Comparisons of LTL and RTL groups showed no significant differences in scores on the Visual Reproduction subtests from the Wechsler Memory Scale (WMS) or Wechsler Memory Scale–Revised (WMS–R) or on the copy and delayed recall conditions of the Rey–Osterrieth Complex Figure Test (ROCFT). Significant differences were observed among centers on WMS and ROCFT scores, which are likely to be a result of variations in administration and/or scoring procedures. The lack of significant differences between LTL and RTL groups in this large sample raise questions about the nature of nonverbal memory and its relationship to right temporal lobe dysfunction. (JINS, 1997, 3, 435–443.)

Learning to read and write generates new rules within the language processing systems. These new rules significantly change the manner in which some operations are performed. This finding was studied, by comparing the performance of literate and illiterate persons in several tasks. It was found that illiterate individuals (1) had difficulties in repeating pseudowords, (2) were worse at memorizing pairs of phonologically related words compared to pairs of semantically related words, and (3) were unable to generate words according to a formal criterion. Illiterate persons use strategies that are good for semantic processing, but inadequate for phonological analysis, while literate individuals are able to use several parallel running strategies. (JINS, 1997, 3, 444–450.)

We studied the integrity of working memory operations in 38 HIV-seropositive and 20 seronegative drug users, using a modified version of the Tower of London task. This new task, the Tower of London–Working Memory version (TOL–WM), includes a delayed-response component in addition to the planning required for successful performance of the standard TOL. Symptomatic HIV-seropositive participants solved significantly fewer TOL–WM problems compared to matched seronegative controls. However, seropositive and seronegative subjects showed similar overall levels of planning efficiency, suggesting that the TOL–WM deficit may be associated primarily with failure to encode or maintain an adequate online memory representation. The results of this study confirm our previous report of a possible working memory deficit in HIV-1 infection and suggest that measures of working memory have particular utility in the evaluation of HIV-related cognitive deficits. (JINS, 1997, 3, 451–456.)

This study sought to determine if human immunodeficiency virus–type 1 (HIV-1) infected depressed men were more likely to be neuropsychologically impaired than their nondepressed counterparts. Subjects were 47 HIV-1 infected men who met DSM–III–R criteria for current major depressive disorder (MDD) and 47 HIV-1 infected nondepressed male controls (M age = 34.2 years) equated on HIV-1 disease severity, demographics, and drug use. The psychiatric interview included the Structured Clinical Inventory for the DSM–III–R, and Hamilton Rating Scale for Depression. The neuropsychological battery included tests covering 8 functional domains based on an expanded Halstead-Reitan Battery. The medical assessment included a history and physical examination, immunologic staging, and evaluation of prescription and recreational drug use. Prevalence of global neuropsychological impairment in the two groups (depressed vs. control) did not differ [53% vs. 38% respectively; χ2(1, N = 94) = 2.11, p > .05]. While syndromically depressed patients performed less well than nondepressed individuals on memory tests [delayed retention portions of the Story Memory Test: F(1,91) = 5.34, p < .05; and Figure Memory Test: F(1,90) = 4.16, p < .05], the majority of depressed participants (64%) did not have clinically impaired memory. No relationship between neuropsychological impairment and severity of depression was observed. The results suggest that, while HIV-1 infected men with major depression may perform more poorly than nondepressed men on some aspects of memory tasks, they are not more likely to evidence clinically significant neurocognitive impairment. (JINS, 1997, 3, 457–463.)

A traumatic spinal cord injury (SCI) is accompanied by a documented moderate to severe head injury in significant numbers of SCI patients. In a previous study (Dowler et al., 1995), cognitive deficits were found in 41% of the SCI individuals who were studied with a chronic injury from a traumatic event. The present study investigated whether clinically useful subtypes of normal and impaired cognition could be identified in a chronic (M = 17 years postinjury) SCI sample using a cluster analysis of neuropsychological test performance. A battery of 16 neuropsychological tests was administered to 91 SCI patients and 75 control participants. Composite scores, reflecting performance in different cognitive domains, were derived from a factor analysis of the battery, and these scores were then used in the cluster analysis. A six-cluster solution generated the most distinct and clinically relevant SCI group profiles. Two of the cognitive profiles were characterized by normal functioning in all cognitive domains, but they were distinguished by differences in performance levels. The remaining four SCI groups (60% of the sample) showed clinically significant deficits in one or more cognitive domains, with different groups showing moderate attention and processing speed deficits, mild deficits in processing speed, executive processing difficulties, or moderate memory impairments. Though age and premorbid intellectual ability were strong predictors of the cognitive profiles of some SCI groups, when these factors were controlled, the findings suggested that the patterns of cognitive impairment were likely due to a potential concomitant head injury. (JINS, 1997, 3, 464–472.)

Sixteen right-handed male students were administered a unilateral lexical decision task in 4 conditions: a baseline condition and three sound conditions. In the sound conditions, the participants listened to noise, to music with a positive emotional valence, and to music with a negative emotional valence, while performing the visual half-field task. In the baseline condition, the noise condition, and the positive music condition, lexical decision latencies were shorter to right than to left visual field presentations. In the negative music condition, there was a selective enhancement of left visual field performance, which cancelled the visual field advantage completely. None of the concurrent sounds affected autonomic arousal as measured by heart rate. The results demonstrated that music with a negative emotional valence can alter the half-field asymmetry of a verbal task. The outcome was discussed in terms of right hemisphere priming due to negative emotional experience. (JINS, 1997, 3, 473–479.)

The preoperative cognitive test performance of 77 candidates for elective open-heart surgery that did not suffer from carotid artery stenosis, was compared with the performance of 37 normal controls. Multivariate analysis of variance, with state anxiety score and depression score as covariates, showed a significantly reduced cognitive performance in the surgical candidates. Post hoc analyses using univariate F tests revealed a significantly impaired word fluency, manual dexterity, verbal learning, and psychomotor speed. A stepwise multiple regression analysis revealed that, besides the usual demographic factors, preoperative variables indicating a more precarious heart function also contributed significantly to the estimation of the proportion of variance of the results on several impaired cognitive tests. Future research should focus on the etiology of the cognitive impairment in cardiovascular disease. (JINS, 1997, 3, 480–484.)

This issue of JINS sees the merging of two of its departments: “Critical Reviews/Updates” and “Dialogues” have been combined to form “Critical Reviews & Dialogues.”

For too many members of our discipline, the practice of clinical neuropsychology is synonymous with the administration and interpretation of specialized tests of brain functioning. We have, in fact, become quite sophisticated in the assessment of brain-disordered patients. But the development of effective programs of neuropsychological treatment (which includes, but is not limited to, “cognitive rehabilitation”) remains one of the most pressing needs and awesome challenges for clinical and research neuropsychology.

This paper suggests there are, at present, four main kinds of cognitive rehabilitation programs for brain injured people. The first attempts to rehabilitate cognitive deficits through drills and exercises. The second uses theoretical models from cognitive psychology to identify deficits in order to remediate them. The third is primarily a patient-driven approach that uses a combination of learning theory, cognitive psychology, and neuropsychology to identify and remediate cognitive difficulties. The fourth is the holistic approach that has, as its basic philosophy, a belief that cognitive functions cannot be divorced from emotion, motivation, or other noncognitive functions, and consequently all aspects of functioning should be addressed in rehabilitation programs. Despite some overlap between these approaches, there are major differences. The two main arguments offered in this paper are (1) that the first two approaches do not lead to good clinical rehabilitation practice; and (2) that a synthesis of the second two approaches would result in the best cognitive rehabilitation model. (JINS, 1997, 3, 487–496.)

Barbara A. Wilson's article in this issue is a thoughtful and scholarly commentary on the present state of cognitive rehabilitation. Her review of the meaning of the term “rehabilitation,” and her reminder that we are better at treating disabilities than impairments after brain damage, set the background for her four major points. First, there are currently four basic approaches to cognitive rehabilitation. Second, two of these approaches are of little help to patients. Third, combining learning theory, cognitive psychology, and neuropsychology is helpful in dealing with the “everyday problems of brain-injured people.” Finally, this latter approach combined with the holistic approach is promising, especially given that patients' personality disturbances must be considered if neuropsychological rehabilitation is to be effective.

While readers may share my enthusiasm and gratitude for Prigatano's further explication of holistic rehabilitation, I would be disappointed if this were the only issue that remained highlighted in the debate. Other areas that I hope will promote further critical analysis are my arguments concerning the strengths and weaknesses of approaches to rehabilitation that differ according to whether impairments, disabilities, or handicaps are being treated. My critique of cognitive neuropsychological/theoretical approaches also deserves some reply.