The clock drawing test (CDT) is a widely used cognitive screening test. It is useful in identifying focal lesions and cognitive deficits in dementia groups. Lately, several studies attempted its use to differentiate between dementia subtypes. Although many studies have examined the CDT in dementia populations, research into the use of clock drawing in frontotemporal dementia (FTD) is limited. We examined quantitative (global) and qualitative (specific error type) differences on the CDT between FTD (n = 36) and Alzheimer's disease (AD; n = 25) patients and controls without dementia (n = 25). Results showed significantly lower overall scores in the dementia groups compared to the control group, whereas FTD patients scored significantly higher than the AD group. On qualitative analysis, the FTD group had fewer stimulus bound responses, conceptual deficits, and spatial or planning errors compared to the AD group. In conclusion, both global and error analysis of the CDT helped discriminate the FTD group from controls and AD patients. (JINS, 2006, 12, 159–165.)

Amnestic mild cognitive impairment (MCI) has been defined as a precursor to Alzheimer's disease (AD), although it is sometimes difficult to identify which persons with MCI will eventually convert to AD. We sought to predict MCI conversion to AD over a two-year follow-up period using baseline demographic and neuropsychological test data from 49 MCI patients. Using a stepwise discriminant function analysis with Dementia Rating Scale (DRS) Initiation/Perseveration and Wechsler Memory Scale, third edition (WMS-III) Visual Reproduction Percent Retention scores, we correctly classified 85.7% of the sample as either AD converters or MCI nonconverters, with 76.9% sensitivity and 88.9% specificity. Adding race, the presence of vascular risk factors, or cholinesterase inhibitor use to the analysis did not greatly change the classification rates obtained with neuropsychological test data. Examining neuropsychological test cutoff scores revealed that DRS Initiation/Perseveration scores below 37 and Visual Reproduction Percent Retention scores below 26% correctly identified AD converters with 76.9% sensitivity and 91.7% specificity. These results demonstrate that commonly administered neuropsychological tests identify persons with MCI at baseline who are at risk for conversion to AD within 1–2 years. Such methods could aid in identifying MCI patients who might benefit from early treatment, in providing prognostic information to patients, and identifying potential clinical trial participants. (JINS, 2006, 12, 166–175.)

To elucidate the role of visual and nonvisual attribute knowledge on visual object identification, we present data from three patients, each with visual object identification impairments as a result of different etiologies. Patients were shown novel computer-generated shapes paired with different labels referencing known entities. On test trials they were shown the novel shapes alone and had to identify them by generating the label with which they were formerly paired. In all conditions the same triad of computer-generated shapes were used. In one condition, the labels (banjo, guitar, violin) referenced entities that were both visually similar and similar in terms of their nonvisual attributes within semantics. In separate conditions we used labels (e.g., spike, straw, pencil or snorkel, cane, crowbar) that referenced entities that were similar in terms of their visual attributes but were dissimilar in terms of their nonvisual attributes. The results revealed that nonvisual attribute information profoundly influenced visual object identification. Our patients performed significantly better when attempting to identify shape triads whose labels referenced objects with distinct nonvisual attributes versus shape triads whose labels referenced objects with similar nonvisual attributes. We conclude that the nonvisual aspects of meaning must be taken into consideration when assessing visual object identification impairments. (JINS, 2006, 12, 176–183.)

Recent investigations have emphasized the importance of the prefrontal cortex for humor processing. Although the prefrontal cortex is thought to be affected by normal aging, relatively little work has been carried out to investigate the effects of aging on humor processing. In the present investigation participants in three age groups were assessed on a humor comprehension task. They then answered mentalistic and nonmentalistic questions. Executive tasks were also administered. The older group selected significantly fewer correct punchlines from alternatives than the other groups. They were also poorer at answering mentalistic questions, but did not differ significantly for nonmentalistic questions. The findings of the present investigation showed altered in humor processing in normal aging, and this appeared to be related to mentalizing ability. (JINS, 2006, 12, 184–191.)

Frontal functions, or impairments, have achieved the status of pornography: everyone knows them when they see them, but there is little agreement on their exact defining properties. Patients with frontal lobe lesions have impairments in planning, monitoring, sequencing, and inhibiting responses. They cannot organize complex behaviors. They are somehow simultaneously unaware and distractible, irritable and apathetic, violent and passive, impulsive and perseverative. They lack empathy, self-awareness, and emotional regulation. Patients often are incapacitated by frontal impairments that paradoxically are not at all obvious to most observers. To understand the effects of frontal lesions, science has sacrificed countless rats and nonhuman primates. Neuropsychology and Neurology have sanctified a few tests as the tests of frontal function, and then spent money, time, and the mental health of countless graduate students and research assistants trying to tease out of those tests some basic knowledge of frontal functions. Experimental Psychology has brought novel constructs to the problem of defining frontal functions, and modern neuroimaging has merged the traditional clinical and the novel experimental with imaging technology. (A quick PubMed search of “fMRI and frontal lobes” on October 12, 2005 retrieved 4,646 articles, the most recent, “An fMRI study of the Trail Making Test”.) Yet, confronted with a patient with a large right prefrontal lesion who cannot hold a job or even be relied upon to buy the groceries he set out to buy, we have precious few tools to define his problem and almost nothing to offer to fix it.

This article considers the scientific process whereby new and better clinical tests of executive function might be developed, and what form they might take. We argue that many of the traditional tests of executive function most commonly in use (e.g., the Wisconsin Card Sorting Test; Stroop) are adaptations of procedures that emerged almost coincidentally from conceptual and experimental frameworks far removed from those currently in favour, and that the prolongation of their use has been encouraged by a sustained period of concentration on “construct-driven” experimentation in neuropsychology. This resulted from the special theoretical demands made by the field of executive function, but was not a necessary consequence, and may not even have been a useful one. Whilst useful, these tests may not therefore be optimal for their purpose. We consider as an alternative approach a function-led development programme which in principle could yield tasks better suited to the concerns of the clinician because of the transparency afforded by increased “representativeness” and “generalisability.” We further argue that the requirement of such a programme to represent the interaction between the individual and situational context might also provide useful constraints for purely experimental investigations. We provide an example of such a programme with reference to the Multiple Errands and Six Element tests. (JINS, 2006, 12, 194–209.)

The role of the human frontal lobes in episodic memory is becoming better understood, thanks mainly to focal lesion and neuroimaging studies. Here we review some recent findings from basic research on the frontal lobes in memory encoding, search, and decision-making at retrieval. For each of these processes, researchers have uncovered cases in which frontal memory impairments can be attenuated by various task manipulations. We suggest ways in which these findings may inform clinical evaluation and rehabilitation of memory problems following frontal damage. (JINS, 2006, 12, 210–223.)

The behavioral syndrome resulting from damage to the ventromedial prefrontal (VM) region presents major challenges for clinical assessment and management, stemming from the absence of reliable neurologic or psychometric markers, coupled with often debilitating impairments of decision-making and behavior regulation. Damage to this region disrupts neural circuitry critical for emotion, which in turn may contribute to impairments in real-world competencies. Here we present findings from patients with focal lesions in the VM region acquired either in childhood or adulthood, and show that there is a relationship between emotional dysfunction and impairments in real-world behavioral competencies. Emotion was rated by participants' relatives on dimensions including frustration tolerance, lability, anxiety, and blunted affect. Real-world competencies were rated by the relatives on dimensions including judgment, planning, and initiation, and were evaluated by clinician ratings in areas including social, financial, and occupational function. VM damage resulted in severe disruption of emotion, and this emotional dysfunction accounted for a significant portion of impaired real-world competencies. The long-term impairments associated with childhood-onset lesions were at least as severe as those resulting from adult-onset damage. Greater focus on the contribution of emotional dysfunction to the real-world competencies of patients with damage in the VM region may sharpen their neuropsychological assessment and facilitate rehabilitation efforts. (JINS, 2006, 12, 224–235.)

Production of complex discourse—lengthy, open-ended utterances and narratives—requires intact basic language operations, but it also requires a series of learned procedures for construction of complex, goal-directed communications. The progression of clinical disorders from transcortical motor aphasia to dynamic aphasia to discourse impairments represents a progression of procedural deficits from basic morpho-syntax to complex grammatical structures to narrative and a progression of lesions from posterior frontal to polar and/or lateral frontal to medial frontal. Two cases of impaired utilization of language exemplify the range of impairments from clearly aphasic agrammatic, nonfluency to less and less “aphasic” and more and more executive impairments from transcortical motor aphasia to dynamic aphasia to narrative discourse disorder. The clinical phenomenology of these disorders gradually comes to be more accurately defined in the terminology of executive deficits than that of aphasia. The executive deficits are, in turn, based on impairments in various components of attention. Specific impairments in energizing attention and setting response criteria associated, respectively, with lesions in superior medial and left ventrolateral frontal regions may cause defective recruitment of the procedures of complex language assembly. (JINS, 2006, 12, 236–247.)

Although the prefrontal cortex (PFC) is consistently found to be associated with various working memory processes, the necessity of the PFC for such processes remains unclear. To elucidate PFC contributions to storage and rehearsal/maintenance processes engaged during verbal working memory function, we assessed behavior of patients with lesions to the left or right lateral PFC, and neural activity of healthy young subjects during fMRI scanning, during performance of working memory tasks. We found that PFC lesions did not affect storage processes—which is consistent with the notion that posterior cortical networks can support simple retention of information. We also found that PFC lesions did not affect rehearsal/maintenance processes, which was in contrast to our finding that healthy subjects performing a verbal delayed recognition task showed bilateral PFC activation. These combined imaging and behavioral data suggest that working memory rehearsal/maintenance processes may depend on both hemispheres, which may have implications for recovery of function and development of rehabilitation therapies after frontal injury. (JINS, 2006, 12, 248–260.)

The frontal lobes (FL), are they a general adaptive global capacity processor, or a series of fractionated processes? Our lesion studies focusing on attention have demonstrated impairments in distinct processes due to pathology in different frontal regions, implying fractionation of the “supervisory system.” However, when task demands are manipulated, it becomes evident that the frontal lobes are not just a series of independent processes. Increased complexity of task demands elicits greater involvement of frontal regions along a fixed network related to a general activation process. For some task demands, one or more anatomically distinct frontal processes may be recruited. In other conditions, there is a bottom-up nonfrontal/frontal network, with impairment noted maximally for the lesser task demands in the nonfrontal automatic processing regions, and then as task demands change, increased involvement of different frontal (more “strategic”) regions, until it appears all frontal regions are involved. With other measures, the network is top-down, with impairment in the measure first noted in the frontal region and then, with changing task demands, involving a posterior region. Adaptability is not just a property of FL, it is the fluid recruitment of different processes anywhere in the brain as required by the current task. (JINS, 2006, 12, 261–271.)

Warrington and Shallice's (1984) report on patient J.B.R. [4] was the first and most influential study about the living/nonliving semantic dissociation.

The evolution of the progressive loss of semantic knowledge of a patient, VZ, with lesions mainly affecting the infero-medial temporal lobes, was followed for two years. At the beginning of the study VZ's performance was mainly characterized by a category-specific deficit for living things and a modality-specific deficit for perceptual attribute knowledge. As time went on, VZ's disorder affected all categories by changing the relationship between category and attribute knowledge. Data show that dissociations may change in the course of progressive cognitive breakdown, depending on both degeneration stage and task demands. VZ's performance is discussed in the light of the most influential theoretical accounts. Methodological suggestions regarding longitudinal studies of degenerative patients are also put forward. (JINS, 2006, 12, 275–284.)

Spina bifida myelomeningocele (SBM), a neural tube defect that is the product of a complex pattern of gene-environment interactions, is associated with naturally occurring, systematic variability in the neural phenotype and in environmental factors that lead to systematic variability in the cognitive phenotype. We characterize the basis for variability in the cognitive phenotype of children with SBM with reference to a model of key biological, cognitive, and environmental events unfolding over the course of development from infancy to middle age. The cognitive phenotype is not domain-specific, but represents manifestations of unobservable constructs involving associative and assembled processing, the latter directly reflecting the impact of the neural phenotype on core deficits involving movement, timing, and attention orienting. The expression of the cognitive phenotype is variable, being moderated by features of the neural phenotype involving secondary CNS insults (such as hydrocephalus) that impair assembled processing, as well as by environmental factors (such as poverty, parenting, and education) that impair associative processing. The preservation of strengths in associative processing depends in part on the severity of the CNS deficits in SBM and the impact of the environment. (JINS, 2006, 12, 285–296.)

The Wisdom Paradox: How Your Mind Can Grow Stronger as Your Brain Grows Older, by Elkhonon Goldberg. 2005. New York: Gotham Books. 337pp., $26.00 (HB).

Creativity and the Brain, by Kenneth M. Heilman. 2005. New York: Psychology Press. 207 pp., $55.00 (HB).

Doctors Goldberg and Heilman have both written absorbing accounts of the brain for the interested public as well as scientists that address some of the most intriguing questions in neuroscience, wisdom and creativity. Dr. Goldberg is a Clinical Professor of Neurology at New York University School of Medicine and a valuable and innovative contributor to the theoretical foundations of neuropsychology. Dr. Heilman, a Distinguished Professor of Neurology and Health Psychology at the University of Florida, is recognized for his many contributions to understanding brain mechanisms underlying behavior as well as his legacy as a teacher and mentor for many neuroscientists.

Rehabilitation for Traumatic Brain Injury. Walter M. High, Jr., Angelle M. Sander, Margaret A. Struchen, and Karen A. Hart (Eds.). 2005. New York: Oxford University Press. 368 pp., $69.50 (HB).

Rehabilitation for Traumatic Brain Injury, the final product of a 2003 conference that assembled national experts on traumatic brain injury (TBI) rehabilitation, was written to “bring into one volume a concise and authoritative account of what is currently known in the field of TBI rehabilitation.” It is intended for TBI clinicians and researchers including neuropsychologists, physiatrists, neurologists, neurosurgeons, psychiatrists, and rehabilitation therapists. The volume is impressive for the number of chapter authors who are nationally recognized experts on various aspects of TBI rehabilitation (e.g., Drs. Prigatano, Malec, Corrigan, Levin, Boake, Diller, Sohlberg, and Cicerone), as well as the broad and inclusive range of topics covered.

Forensic Neuropsychology Casebook. Robert L. Heilbronner (Ed.). 2005. New York: The Guilford Press. 370 pp., $50.00 (HB).

The chapters in Forensic Neuropsychology Casebook read like a collection of short stories. An experienced forensic neuropsychologist authors each chapter and each case is presented from a personal point of view, a viewpoint generally not found in mainstream textbooks. The case background, test results, and legal proceedings are described along with the neuropsychologist's thoughts, feelings, insights, and lessons learned. The practitioners and topics were well chosen to display the diversity of forensic neuropsychology. Included are adult, pediatric, civil, and criminal cases. Besides the more common cases such as traumatic brain injury, medical malpractice, and workers' compensation, more esoteric topics are covered such as electrical injury, sexual consent capacity in an Alzheimer's patient, and competence to confess.

The following books were received in recent months.