We document the unexpected dissociation of preserved reading skills in a patient with severely impaired semantic memory. The common co-occurrence between impairment of word meaning and surface dyslexia has not been observed. The patient (hereafter called DRN) had marked naming and word comprehension difficulties. A strong word frequency effect was observed on tests of word comprehension but was absent in a test of word reading. DRN's ability to read both regular and exception words that he failed to comprehend was remarkably well preserved. We will argue that these findings provide further support for the independence of semantic and phonological processing. (JINS, 1995, I, 104–110.)

This investigation reports the results of a pilot study concerning the application of principles of use-dependent learning developed in the motor rehabilitation literature as Constraint Induced Therapy to language rehabilitation in a group of individuals with chronic aphasia. We compared treatment that required forced use of the language modality, Constraint Induced Language Therapy, (CILT) to treatment allowing all modes of communication. Both treatments were administrated intensively in a massed practice paradigm, using the same therapeutic stimuli and tasks. Results suggest that whereas both interventions yielded positive outcomes, CILT participants showed more consistent improvement on standard aphasia measures and clinician judgments of narrative discourse. These findings suggest that CILT intervention may be a viable approach to aphasia rehabilitation. (JINS, 2006, 12, 843–852.)

Few follow-up studies of children with very low birth weight (VLBW, <1,500 g) have examined neuropsychological sequelae at later ages or neonatal risks as predictors of these outcomes. The present study assessed cognitive skills at mean age 16 years in 48 participants with <750 g birth weight, 47 with 750–1,499 g birth weight, and 52 term-born controls. Our major objectives were to delineate the long-term cognitive consequences of VLBW, and to determine if risks for periventricular brain insults accounted for variations in outcomes. Analysis revealed poorer outcomes for the <750 g group than for term-born controls on nearly all measures, with specific impairments in visual–motor skills, spatial memory, and executive function. Predictors of outcome for participants with VLBW included lower birth weight, lower weight for gestational age, and a longer period of oxygen requirement for chronic lung disease. The longer-term consequences of VLBW are consistent with expectations based on early brain pathology and suggest limitations to functional plasticity. (JINS, 2004, 10, 987–1004.)

Although the adverse consequences of changes in social behavior following traumatic brain injury (TBI) are well documented, relatively little is known about possible underlying neuropsychological deficits. Following a model originally developed for social behavior deficits in schizophrenia, we investigated whether impairments in emotion recognition, understanding of other people's intentions (“theory of mind”), and cognitive flexibility soon after first TBI or 1 year later were associated with self and proxy ratings of behavior following TBI. Each of the three functions was assessed with two separate tests, and ratings of behavior were collected on three questionnaires. Patients with TBI (n = 33) were impaired in emotion recognition, “theory of mind,” and cognitive flexibility compared with matched orthopedic controls (n = 34). Proxy ratings showed increases in behavioral problems 1 year following injury in the TBI group but not in the control group. However, test performance was not associated with questionnaire data. Severity of the impairments in emotion recognition, understanding intention, and flexibility were unrelated to the severity of behavioral problems following TBI. These findings failed to confirm the used model for social behavior deficits and may cast doubt on the alleged link between deficits in emotion recognition or theory of mind and social functioning. (JINS, 2008, 14, 318–326.)

This study examined whether distinct neuropsychological profiles could be delineated in a sample with Mild Cognitive Impairment (MCI) and whether white matter lesion (WML) burden contributed to MCI group differences. A heterogeneous, clinical sample of 70 older adults diagnosed with MCI was assessed using cognitive scores, and WML was quantified using a semi-automated, volumetric approach on T2-weighted fluid-attenuated inversion recovery (FLAIR) images. Using cluster and discriminant analyses, three distinct groups (Memory/Language, Executive/Processing Speed, and Pure Memory) were empirically derived based on cognitive scores. Results also showed a dose dependent relationship of WML burden to MCI subgroup, with the Executive/Processing Speed subgroup demonstrating significantly higher levels of WML pathology when compared to the other subgroups. In addition, there was a dissociation of lesion type by the two most impaired subgroups (Memory/Language and Executive/Processing Speed) such that the Memory/Language subgroup showed higher periventricular lesion (PVL) and lower deep white matter lesion (DWML) volumes, whereas the Executive/Processing Speed demonstrated higher DWML and lower PVL volumes. Results demonstrate that distinct MCI subgroups can be empirically derived and reliably differentiated from a heterogeneous MCI sample, and that these profiles differ according to WML burden. Overall, findings suggest different underlying pathologies within MCI and contribute to our understanding of MCI subtypes. (JINS, 2009, 15, 906–914.)

Poor awareness of deficit is common after brain injury. Recent literature has examined various tools for measurement of this phenomenon; the most widely used being self–other rating scales. Although self–other scale measures have face validity, their criterion-related validity has not been adequately demonstrated, and there is little information as to whether and how they relate to other neuropsychological measures. The present study compared measurement of awareness by the Dysexecutive (DEX) Questionnaire self–other rating scale with the Self-Awareness of Deficits Interview (SADI), a semistructured interview measure. Evaluation of awareness by these measures was compared to tests of executive functioning and IQ. Results indicated significant, albeit marginal relationships between the two measures, and better correlation of the SADI with measures of frontal lobe functioning. The SADI also predicted injury severity. (JINS, 2003, 9, 450–458.)

Decline in executive function has been noted in the prodromal stage of Alzheimer's disease (AD) and may presage more global cognitive declines. In this prospective longitudinal study, five measures of executive function were used to predict subsequent global cognitive decline in initially nondemented older adults. Of 71 participants, 15 demonstrated significant decline over a 1-year period on the Dementia Rating Scale (Mattis, 1988) and the remaining participants remained stable. In the year before decline, the decline group performed significantly worse than the no-decline group on two measures of executive function: the Color-Word Interference Test (CWIT; inhibition/switching condition) and Verbal Fluency (VF; switching condition). In contrast, decliners and non-decliners performed similarly on measures of spatial fluency (Design Fluency switching condition), spatial planning (Tower Test), and number-letter switching (Trail Making Test switching condition). Furthermore, the CWIT inhibition-switching measure significantly improved the prediction of decline and no-decline group classification beyond that of learning and memory measures. These findings suggest that some executive function measures requiring inhibition and switching provide predictive utility of subsequent global cognitive decline independent of episodic memory and may further facilitate early detection of dementia. (JINS, 2012, 18, 118–127)

We examined the relationship between nocturnal respiratory disturbance and learning and compared learning in children with and without nocturnal respiratory disturbance. Subjects were 149 participants in a prospective cohort study examining sleep in children ages 6–12: The Tucson Children's Assessment of Sleep Apnea study (TuCASA). Sleep was assessed via home polysomnography. Intelligence, learning and memory, and academic achievement were assessed. Parents rated attention. Group comparisons were used to test the hypothesis that the group with an apnea/hypopnea index (AHI) of 5 or more (n = 77) would have weaker performance than the group with AHI less than 5 (n = 72). The group with AHI of 5 or more had weaker learning and memory though differences between groups decreased when arousals were taken into account. There was a greater percentage of Stage 1 sleep in the AHI 5 or more group, and Stage 1 percentage was negatively related to learning and memory in the sample (n = 149). There were negative relationships between AHI and immediate recall, Full Scale IQ, Performance IQ, and math achievement. Hypoxemia was associated with lower Performance IQ. Thus, findings suggest that nocturnal respiratory disturbance is associated with decreased learning in otherwise healthy children, that sleep fragmentation adversely impacts learning and memory, and that hypoxemia adversely influences nonverbal skills. (JINS, 2003, 9, 1016–1026.)

Apathy is a common behavioral disturbance in patients with Alzheimer's disease (AD). Recent studies have linked the presence of apathy to alterations in frontal lobe functions, but few studies have explored the relationship using standard neuropsychological measures in patients with AD. We administered a comprehensive battery of neuropsychological tests and a behavior rating scale to 80 patients with AD. We explored the relationship of apathy to executive dysfunction. AD patients with apathy performed significantly worse on tests of executive function (WAIS–R Digit Symbol, Trail-Making, Stroop Color Interference Test) than AD patients without apathy. The presence of dysphoria did not modify these results and no significant relationships were found between tests of executive functions and dysphoria. Performance on executive measures as a group were effective in correctly classifying patients as apathetic or nonapathetic with 75% accuracy. Neuropsychological measures not dependent on executive functions were unrelated to apathy. Apathy is associated with executive dysfunction and not with other neuropsychological deficits. Apathy is distinct from dysphoria. (JINS, 2002, 8, 373–381.)

Neuropsychological and motor deficits in Parkinson's disease that may contribute to driving impairment were examined in a cohort study comparing patients with Parkinson's disease (PD) to patients with Alzheimer's disease (AD) and to healthy elderly controls. Nondemented individuals with Parkinson's disease [Hoehn & Yahr (H&Y) stage I–III], patients with Alzheimer's disease [Clinical Demetia Rating scale (CDR) range 0–1], and elderly controls, who were actively driving, completed a neuropsychological battery and a standardized road test administered by a professional driving instructor. On-road driving ability was rated on number of driving errors and a global rating of safe, marginal, or unsafe. Overall, Alzheimer's patients were more impaired drivers than Parkinson's patients. Parkinson's patients distinguished themselves from other drivers by a head-turning deficiency. Drivers with neuropsychological impairment were more likely to be unsafe drivers in both disease groups compared to controls. Compared to controls, unsafe drivers with Alzheimer's disease were impaired across all neuropsychological measures except finger tapping. Driving performance in Parkinson's patients was related to disease severity (H&Y), neuropsychological measures [Rey Osterreith Complex Figure (ROCF), Trails B, Hopkins Verbal List Learning Test (HVLT)-delay], and specific motor symptoms (axial rigidity, postural instability), but not to the Unified Parkinson Disease Rating Scale (UPDRS) motor score. Multifactorial measures (ROCF, Trails B) were useful in distinguishing safe from unsafe drivers in both patient groups. (JINS, 2005, 11, 766–775.)

Sex differences in executive speech tasks, favoring women, have been noted in behavioral studies and functional imaging studies. In the present study, the clustering and switching components of semantic and phonemic verbal fluency tests were examined in 40 healthy men and 40 healthy women. Possible sex differences in the influence of cognitive factors such as speed of information processing, word knowledge, and/or verbal long-term memory on these verbal fluency factors were also assessed. The results showed that women switched more often between categories in the phonemic fluency test, whereas men showed a trend toward a larger cluster size leading to a smaller total number of words generated. Additionally, higher performance on the Digit Symbol test was associated with better performance on the semantic and phonemic verbal fluency test in men, whereas in women, better memory performance was associated with better performance on these verbal fluency tests. Our data indicate that men and women are using different processing strategies for phonemic verbal fluency tests to optimize verbal fluency task performance. In the current study, women adopted a more successful strategy of balancing clustering and switching in the phonemic fluency task. (JINS, 2006, 12, 502–509.)

The pathological eating behaviors in Anorexia Nervosa (AN), Bulimia Nervosa (BN), and obesity are characterized by a preference for high immediate reward, despite higher future losses in terms of both physical and psychological outcomes. The present study compared the decision making profile of females with a diagnosis of AN (n = 22), BN (n = 17), obesity (n = 18), and a healthy weight comparison group (n = 20) using a standardized neuropsychological test, the Iowa Gambling Task (IGT). The three clinical groups (AN, BN, obesity) were significantly impaired on the IGT compared with the comparison group on both overall task performance and task learning; however, the three clinical groups were not significantly different from each other. Sixty-one percent to 77% of the clinical groups reached the threshold for impairment on the IGT, compared with 15% of the comparison group. The potential basis for this shared decision making profile is discussed. (JINS, 2010, 16, 711–715.)

Moderate declines in prospective memory (PM) are common among older adults, but whether such decrements are associated with everyday functioning problems is not well established. To examine this issue, we administered the Memory for Intentions Screening Test (MIST), Prospective and Retrospective Memory Questionnaire (PRMQ), and Activities of Daily Living Questionnaire (ADLQ) to 50 healthy older Australian adults as part of a broader neuropsychological battery. In a series of hierarchical regressions controlling for demographics, medical/psychiatric factors, and other neurocognitive functions, the MIST event-based PM score and PRMQ PM scale were significantly associated with the total number of instrumental ADL (IADL) domains in which participants reported needing assistance. Extending prior findings in clinical populations, results indicate that lower PM functioning is uniquely associated with mild, concurrent IADL problems in healthy older adults. Future investigation of the potentially moderating effects of cognitive and behavioral compensatory strategies may be beneficial. (JINS, 2012, 18, 134–138)

Although the majority of research in theory of mind (TOM) has focused on young children or individuals with autism, recent investigations have begun to look at TOM throughout the lifespan and in other neurological and psychiatric populations. Some have suggested that TOM may represent a dissociable, modular brain system that is related to, but separable, from other brain functions including executive functions (EF). Recently, studies have shown that TOM performance can be compromised following an acquired brain insult (e.g, damage to the right hemisphere). However, the relationship of such impaired TOM performance to other brain functions in these cases has not been explored. This study investigated the effects of both normal human aging and Parkinson's disease on TOM. The relationship of TOM performance and EF in these groups was also examined. The results suggested that although TOM performance appeared compromised in the group of individuals with Parkinson's disease, the elderly control participants were relatively unimpaired relative to younger individuals. Significant relationships between several measures of TOM and EF were also found. The implications of these findings, and also the finding that failure on one measure of TOM did not necessarily predict failure on all measures of TOM, are discussed. (JINS, 2000, 6, 781–788.)

Humans learn skilled acts in order to effectively interact with their environment. A loss of the ability to perform skilled acts is termed apraxia. Apraxia has been thought to be of theoretical interest, but the ecological implications of apraxia are controversial and have not been fully studied. We examined ten patients with unilateral left hemisphere cerebral infarctions (eight of whom were apraxic) and compared their mealtime eating behavior to a group of neurologically normal, age-matched controls. The stroke patients were less efficient in completing the meal. They made more action errors and were less organized in the sequencing of mealtime activities. Because the patients made more errors while using tools than when performing nontool actions, their deficit could not be accounted for by an elemental motor deficit. A positive relationship was found between mealtime action errors and the severity of apraxia. These findings suggest that limb apraxia may adversely influence activities of daily living. (JINS, 1995, I, 62–66.)

In this paper different models of anosognosia are confronted and data concerning denial behaviors are presented that were collected on a selected population of right brain-damaged patients affected by motor and neglect disorders. Anosognosia for motor impairment and anosognosia for cognitive impairments were found to be dissociated, as well as anosognosia for the upper and lower limb motor impairments. These findings are then discussed in an attempt to choose the more suitable theoretical framework for interpreting the various disorders related to denial of illness. (JINS, 1996, 2, 426–440.)

Neuropsychologists often diagnose cerebral dysfunction based, in part, on marked variation in an individual's cognitive test performance. However, little is known about what constitutes the normal range of intraindividual variation. In this study, after excluding 54 individuals with significant health problems, we derived 32 z-transformed scores from 15 tests administered to 197 adult participants in a study of normal aging. The difference between each person's highest and lowest scores was computed to assess his or her maximum discrepancy (MD). The resulting MD values ranged from 1.6 to 6.1 meaning that the smallest MD shown by any person was 1.6 standard deviations (SDs) and the largest MD shown by any person was 6.1 SDs. Sixty-six percent of participants produced MD values that exceeded 3 SDs. Eliminating each person's highest and lowest test scores decreased their MDs, but 27% of the participants still produced MD values exceeding 3. Although MD values appeared to increase with age, adjusting test scores for age, which is standard in clinical practice, did not correct for this. These data reveal that marked intraindividual variability is very common in normal adults, and underscore the need to base diagnostic inferences on clinically recognizable patterns rather than psychometric variability alone. (JINS, 2003, 9, 864–870.)

Cognitive reserve is a hypothetical construct that has been used to inform models of cognitive aging and is presumed to be indicative of life experiences that may mitigate the effects of brain pathology. The purpose of this study was to evaluate the construct validity of cognitive reserve by examining both its convergent and its discriminant validity across three different samples of participants using structural equation modeling. The cognitive reserve variables were found to correlate highly with one another (thereby providing evidence of convergent validity), but demanding tests of discriminant validity indicated that, in two of the samples, the cognitive reserve construct was highly related to an executive functioning construct. (JINS, 2009, 15, 558–569.)

The List Sorting Working Memory Test was designed to assess working memory (WM) as part of the NIH Toolbox Cognition Battery. List Sorting is a sequencing task requiring children and adults to sort and sequence stimuli that are presented visually and auditorily. Validation data are presented for 268 participants ages 20 to 85 years. A subset of participants (N=89) was retested 7 to 21 days later. As expected, the List Sorting Test had moderately high correlations with other measures of working memory and executive functioning (convergent validity) but a low correlation with a test of receptive vocabulary (discriminant validity). Furthermore, List Sorting demonstrates expected changes over the age span and has excellent test–retest reliability. Collectively, these results provide initial support for the construct validity of the List Sorting Working Memory Measure as a measure of working memory. However, the relationship between the List Sorting Test and general executive function has yet to be determined. (JINS, 2014, 20, 1–12)

Patients diagnosed with bipolar disorder (BPD), by definition, have problems with emotional regulation. However, it remains uncertain whether these patients are also deficient at processing other people's emotions, particularly while manic. The present study examined the ability of 25 manic bipolar patients and 25 healthy participants on tasks of facial recognition and facial affect recognition at three different presentation durations: 500 ms, 750 ms, and 1000 ms. The groups did not differ in terms of age, education, sex, ethnicity, or estimated IQ. The groups did not differ significantly on either a novel computerized facial recognition task or the Benton Facial Recognition Test. In contrast, the bipolar group performed significantly more poorly than did the comparison group on a novel facial affect labeling task. Although the patient group had slower reaction times on all 3 computerized tasks, the presentation duration did not have an effect on performance in the patients. This study suggests that patients with bipolar disorder are able to recognize faces, but have difficulty processing facial affective cues. (JINS, 2003, 9, 623–632.)