To investigate the effects of very low birth weight (VLBW, <1500 g) on the development of neuropsychological skills, we assessed 67 children with birth weight <750 g, 64 with birth weight 750–1499 g, and 67 term-born controls. Growth modeling of raw scores from mean ages 7–14 years revealed persistent VLBW sequelae. Even when adjusting for IQ, the <750 g group scored more poorly than the term-born group on measures of language processing, verbal list learning, and perceptual–motor and organizational abilities. This group also made slower age-related progress than the control group on tests of perceptual-motor and executive functions. Environmental factors moderated group differences in change on other cognitive measures. These results revealed further evidence for slower skill development in both VLBW groups relative to controls, as well as“catch-up” growth in the 750–1499 g group on some measures. The findings suggest age-related changes in the cognitive sequelae of VLBW that depend on the skill assessed, the degree of VLBW, and environmental factors. (JINS, 2004, 10, 149–163.)

We assessed 300 healthy adults in Greece on measures of semantic and phonemic verbal fluency in order to develop norms for the Greek population. We also evaluated the strategies that the participants used spontaneously in order to maximize word production, namely clustering and switching techniques. Our tasks comprised three semantic and three phonemic categories. Consistent with previous investigations of English-speaking samples, we found a contribution of demographic variables to word fluency. Specifically, level of education contributed to total word production, number of switches, and number of repetitive responses on both semantic and phonemic tasks, and the average cluster size only on the phonemic task. Age contributed to total word production and cluster size on the semantic task, and to number of switches on both semantic and phonemic tasks. Sex contributed only to total word production on the semantic task. In our sample, clustering and switching strategies were related to total word production on both tasks, suggesting that these strategies were used effectively. We present tables of normative data stratified by age and level of education. We have also included detailed guidelines for scoring clusters relevant to the Greek population. (JINS, 2004, 10, 164–172.)

We examined performances on the Wechsler Memory Scale–3rd Edition (WMS–III) among patients who underwent temporal lobectomy for the control of medically intractable epilepsy. There were 51 right (RTL) and 56 left (LTL) temporal lobectomy patients. All patients were left hemisphere speech-dominant. The LTL and RTL patients were comparable in terms of general demographic, epilepsy, and intellectual/attention factors. Multivariate analyses revealed a significant crossover interaction (p < .001), with the RTL group scoring significantly lower on the visual than auditory indexes while the LTL group scored significantly lower on the auditory than visual memory indexes. Within-group pairwise analyses revealed statistically significant auditory versus visual index score comparisons (all p < .001) for both surgical groups. Discriminant analysis (p < .001) identified Verbal Paired Associates I, Faces I, and Family Pictures II to significantly discriminate RTL and LTL patients, with an overall correct classification rate of 81.3%. Our findings suggest that the WMS–III is sensitive to modality-specific memory performance associated with unilateral temporal lobectomy. (JINS, 2004, 10, 173–179.)

Children surviving treatment for malignant brain tumors commonly have problems maintaining their premorbid levels of intellectual development and academic achievement. Our group has been especially interested in the effects of treatment on normal appearing white matter (NAWM) on MRI and the influence of NAWM volumes on neurocognitive functioning. The present study assessed NAWM and attentional abilities among 37 long-term survivors of malignant brain tumors, ranging in age from 1.7 to 14.8 (Mdn = 6.5) years at diagnosis, who had been treated with cranial radiation therapy with or without chemotherapy 2.6 to 15.3 (Mdn = 5.7) years earlier. On the Conners' Continuous Performance Test, the Overall Index and 7 of the other 10 indices were significantly deficient compared to age- and gender-corrected normative values. After statistically controlling for the effects of age at diagnosis and time elapsed from treatment, 5 of the 8 indices were significantly associated with cerebral white matter volumes and/or specific regional white matter volumes of the prefrontal/frontal lobe and cingulate gyrus. No gender effects were observed. The results of the present study further support the contention that NAWM is an important substrate for treatment-induced neurocognitive problems among survivors of malignant brain tumors of childhood. (JINS, 2004, 10, 180–189.)

The aim of this study was to compare the accuracy of performance predictions in experimental tasks with patients' awareness of activity limitations. Participants were 24 patients with brain injuries (i.e., traumatic brain injury and cerebrovascular disorders) and 22 patients with orthopedic disorders. Prediction of performance was examined in a memory task (word list learning) and a motor task (finger tapping). Awareness of activity limitations was measured by comparing patients' self-ratings and staff ratings in the Patient Competency Rating Scale (PCRS). Results for the PCRS showed that patients with orthopedic disorders underestimated and patients with brain injuries (i.e., patients with TBI) overestimated their level of functioning in the total scale and the social/emotional subscale in comparison to staff ratings. Both patient groups agreed with staff ratings in physical/basic self-care items. In the predicted performance tasks a similar pattern could be observed: None of the groups showed an overestimation of performance in the motor task, whereas patients with brain injuries overestimated their competency in the memory task. However, the agreement between both awareness measures (PCRS, predicted performance) was only low, which indicates that they might measure different aspects or levels of self-awareness. (JINS, 2004, 10, 190–199.)

We investigated the sensitivity of the P300 event-related brain potential (ERP) recorded during a memory-demanding task to memory function in subjects with dementia of the Alzheimer's type (DAT), those with mild cognitive impairment (MCI), and normal elderly controls. We also explored the ability of neuropsychological (delayed verbal memory), neuroanatomical (MRI-based hippocampal volume), and electrophysiological (memory search P300 amplitude) memory measures to distinguish between the three subject groups using discriminant function analyses. Fourteen patients with DAT, 16 with MCI, and 15 age- and education-matched controls were tested. P300 amplitude was reduced in DAT subjects at all levels of memory load; however, it did not differ between MCI and control subjects. Delayed verbal memory performance best discriminated DAT from MCI and control subjects, while delayed verbal memory and hippocampal volume best discriminated MCI subjects from controls. These results support the utility of neuropsychological and neuroanatomical measures in diagnosing dementia and do not support the notion that P300 amplitude is sensitive to mild memory dysfunction when measured using the current task. (JINS, 2004, 10, 200–210.)

The effect of cranial radiation therapy (CRT) on visual attention was examined in long-term survivors of childhood acute lymphoblastic leukemia (ALL) compared to peers with no history of ALL (n = 24) using a cued orienting task and a global–local task. ALL participants treated with CRT (n = 13) demonstrated an increased cost in response time with invalid spatial orienting cues and inefficient shifts of attention across hierarchical levels. ALL participants treated only with chemotherapy (n = 8) showed performance similar to the non-ALL comparison group. Participants with exposure to CRT early in life appeared to largely account for the attention deficits, and showed particular difficulties with shifting attention from the local level of stimuli to the global level. The data are consistent with prior reports emphasizing attention deficits following CRT, and suggest that attention shifting may be particularly affected by CRT early in life. (JINS, 2004, 10, 211–220.)

The retrograde amnesia of patients with memory loss related to rupture and surgical repair of anterior communicating artery (ACoA) aneurysms is compared with the retrograde amnesia of temporal amnesic patients and nonamnesic control participants. Two tests which focus on popular culture but which differ according to extent of news exposure and the cognitive processes necessary for task performance were used to measure retrograde memory. ACoA patients demonstrated more significant retrograde memory problems than did nonamnesic controls; however, the severity and pattern of their memory loss was less severe than that seen in association with temporal amnesia. Different factors influenced the remote memory loss of respective groups: ACoA patients' problems were related to impaired lexical retrieval whereas temporal amnesic patients had problems secondary to both retrieval and storage deficits. (JINS, 2004, 10, 221–229.)

The present study examined dual-task performance in elders with cognitive impairments and normal controls. The participants (N = 60; M age = 84.6) were recruited from residential facilities and the community. They were assigned to one of three groups: (1) cognitive impairment; (2) residential facility control; (3) community control. Two different dual-task conditions were comprised of simple tests that are presumably processed via separate perceptual modalities: 1 visual–manual and 1 auditory–verbal. The first condition consisted of a visual cancellation test and an auditory digit span. The second condition was comprised of an alternate form of the visual cancellation test and letter fluency. MANOVA examined the effect of cognitive status (3-level independent variable) on 3 indices of dual-task performance (letter fluency, digit span, visual cancellation). Analyses controlled for age, education and performance on each test when performed alone. The results revealed that the cognitive impairment group incurred significantly greater dual-task costs compared to both control groups. Furthermore, as was evident from discriminant function analyses, the dual-task measures were very accurate and better than the traditional neuropsychological measures at discriminating elders with cognitive impairments from normal controls. (JINS, 2004, 10, 230–238.)

We examined the possible role of autonomic activity in Huntington's disease (HD) during a risky decision making task. Skin conductance responses (SCRs) of 15 HD participants and 16 healthy controls were measured while they performed a computerized version of the Simulated Gambling Task (SGT). The results replicated our previous finding of a performance decrement in HD, and showed that HD was associated with an altered pattern of SCRs during the risky decision task. Specifically, the healthy controls produced increased SCRs following selections from the disadvantageous decks and following losing selections. In contrast, the SCRs of the HD group did not differentiate between wins and losses. These findings indicate a reduced impact of loss on decision-making processes under risky conditions in HD. (JINS, 2004, 10, 239–245.)

The ability to measure neuropsychological outcomes in a comparable manner in different cultural groups is important if studies conducted in geographically diverse regions are to advance knowledge of disease effects and moderating influences. The purpose of this study was to evaluate the application of neuropsychological test procedures developed for use in North America and Europe to children in a rural region of Kenya. Our specific aim was to determine if these methods could be adapted to a non-Western culture in a manner that would preserve test reliability and validity. Procedural modifications yielded reliable tests that were sensitive to both the sequelae of cerebral malaria and to children's social and school backgrounds. Results suggest that adaptations of existing tests can be made in such a way as to preserve their utility in measuring the cross-cultural sequelae of childhood neurological diseases. (JINS, 2004, 10, 246–260.)

One hundred and ninety-five participants in the Cincinnati Lead Study were neuropsychologically evaluated in mid-adolescence. The neuropsychological measures yielded five factors labeled Memory, Learning/IQ, Attention, Visuoconstruction, and Fine-Motor. Prenatal, Average Childhood, and 78 month blood lead (PbB) levels were used in a series of multiple regression analyses. Following rigorous covariate pretesting and adjustment, a significant main effect of 78 month PbB on the Fine-Motor factor was found (p < .004). Significant interactions were also found between gender and lead exposure parameters for both Attention and Visuoconstruction indicating heightened risk in males. Finally, a trend toward significance was found for the PbB × SES interaction for Learning/IQ, consistent with previous evidence of increased educational and cognitive vulnerability for youth from more disadvantaged backgrounds. These results provide new evidence from the longest continuing prospective study of the remote effects of early lead exposure. They indicate the presence of selective neuropsychological effects in this population, and also that males and females are not uniformly affected. These results also underscore the complexity of models of neurobehavioral development, and the modest predictive power of any single determinant. (JINS, 2004, 10, 261–270.)

Deficits in attention are a hallmark of the effects of heavy prenatal alcohol exposure but although such deficits have been described in the literature, no attempt to use measures of attention to classify children with such exposure has been described. Thus, the current study attempted to classify children with heavy prenatal alcohol exposure (ALC) and non-exposed controls (CON), using four measures of attentional functioning: the Freedom from Distractibility index from the Wechsler Intelligence Scale for Children–Third Edition (WISC–III), the Attention Problems scale from the Child Behavior Checklist (CBCL), and omission and commission error scores from the Test of Variables of Attention (TOVA). Data from two groups of children were analyzed: children with heavy prenatal alcohol exposure and non-exposed controls. Children in the alcohol-exposed group included both children with or without fetal alcohol syndrome. Groups were matched on age, sex, ethnicity, and social class. Data were analyzed using backward logistic regression. The final model included the Freedom from Distractibility index from the WISC–III and the Attention Problems scale from the CBCL. The TOVA variables were not retained in the final model. Classification accuracy was 91.7% overall. Specifically, 93.3% of the alcohol-exposed children and 90% of the control children were accurately classified. These data indicate that children with heavy prenatal alcohol exposure can be distinguished from non-exposed controls with a high degree of accuracy using 2 commonly used measures of attention. (JINS, 2004, 10, 271–277.)

The degree of neuropsychological dysfunction across multiple domains was examined in individuals suffering from chronic fatigue syndrome (CFS). In this descriptive study, a similar series of neuropsychological tests was administered to a group of CFS patients and healthy participants. More specifically, CFS patients (n = 141) who met the 1994 Case Definition criteria were compared to 76 healthy control participants on tests of memory, attention (concentration), speed of information processing, motor speed, and executive functioning. On the 18 measures administered, CFS patients scored 1 standard deviation below the healthy mean on nine measures and scored 2 standard deviations below the healthy mean on four of the measures. Moreover, results indicated that CFS patients were more likely than healthy controls to fail (1.6 SD below the healthy mean) at least one test in each of the following domains: attention, speed of information processing, and motor speed, but not on measures of memory and executive functioning. Finally, CFS patients demonstrated a greater total number of tests failed across domains. (JINS, 2004, 10, 278–285.)

Neuroradiological and neuropathological investigations have found evidence of diffuse brain damage in the frontal and temporal lobes, corpus callosum, and fornices in patients who have sustained a mild traumatic brain injury (TBI). However, neuropsychological assessments of these patients do not typically target many of the subtle information processing deficits that may arise from diffuse damage involving the frontotemporal regions of the brain as well as white matter pathology, including the corpus callosum. Consequently, we have a limited understanding of the deficits that may be attributable to temporary or permanent disruptions to these functional pathways. This study assessed a group of mild TBI patients (N = 40) and a matched control group (N = 40) on a number of standard neuropsychological tests of selective and sustained attention, verbal and non-verbal fluency, and verbal memory. In addition, reaction time (RT) tasks, requiring both the inter- and intra-hemispheric processing of visual and tactile information, were used to assess the functional integrity of the tracts that are likely to be affected by diffuse damage. In the 1st month after sustaining their injury, the mild TBI group demonstrated deficits in attention, non-verbal fluency, and verbal memory. They also demonstrated slower visual and tactile RTs, with the visual RTs of mild TBI patients being more affected by increased task difficulty and the need to transfer information across the corpus callosum, than did their matched controls. (JINS, 2004, 10, 286–297.)

Hepatitis C virus (HCV) can be detected in the brain (Radkowski et al., 2002) and investigators speculate that HCV has neuroinvasive properties (Forton et al., 2003) with direct effects on cerebral function. MRS studies show that the basal ganglia and white matter of individuals with HCV have abnormal choline/creatine ratios, indicating CNS inflammation or infection (Forton et al., 2003). Patients with HCV show defects in working memory and information processing speed (Forton et al., 2003; Hilsabeck et al., 2002), similar to patients with basal ganglia disorders and HIV (e.g., Heaton et al., 1995).

A critical endeavor in every health-related field is the continued development of new technologies and instrumentation for improving diagnosis and treatment. For example, the field of neuroimaging has made astonishing advances with procedures such as functional MRI, MR spectroscopy, and MR diffusion tensor imaging. The field of neuropsychology has also recognized the importance of continually striving to develop new, more sensitive clinical measures. At the same time, the development of new tests or procedures does not guarantee that the instruments represent improvements in diagnosis or treatment. For this reason, ongoing studies of reliability and validity of new diagnostic instruments are also an important part of research in all health-related fields.