The second edition of Clinician's Guide to Neuropsychological Assessment is intended to be a graduate level textbook dealing with the practice of neuropsychology. The number of chapters has been expanded considerably, compared to the first edition of this book. Most of the new contributions are fairly up to date with the recent literature and pertain to areas of applied neuropsychology that have shown considerable growth over the past few years. In contrast, many of the purportedly revised chapters that were also present in the first edition are disappointing. For example, the chapter on “Principles of Neuropsychological Interpretation” appears to be an almost verbatim reprint of its 1994 counterpart and fails to review any of the literature that has since then developed with regard to issues such as reliability of change in test scores (Sawrie et al., 1996), effects of financial incentives (Binder & Rohling, 1996), or construct validity of commonly used tests (Goldman et al., 1996).

Objectives: The aim of this study was to assess the association between personality factors and age-related longitudinal cognitive performance, and explore interactions of stress-proneness with apolipoprotein E (APOE) ɛ4, a prevalent risk factor for Alzheimer’s disease (AD). Methods: A total of 510 neuropsychiatrically healthy residents of Maricopa County recruited through media ads (mean age 57.6±10.6 years; 70% women; mean education 15.8±2.4 years; 213 APOE ɛ4 carriers) had neuropsychological testing every 2 years (mean duration follow-up 9.1±4.4 years), and the complete Neuroticism Extraversion Openness Personality Inventory-Revised. Several tests were administered within each of the following cognitive domains: memory, executive skills, language, visuospatial skills, and general cognition. Primary effects on cognitive trajectories and APOE ɛ4 interactions were ascertained with quadratic models. Results: With personality factors treated as continuous variables, Neuroticism was associated with greater decline, and Conscientiousness associated with reduced decline consistently across tests in memory and executive domains. With personality factors trichotomized, the associations of Neuroticism and Conscientiousness were again highly consistent across tests within memory and to a lesser degree executive domains. While age-related memory decline was greater in APOE ɛ4 carriers as a group than ɛ4 noncarriers, verbal memory decline was mitigated in ɛ4 carriers with higher Conscientiousness, and visuospatial perception and memory decline was mitigated in ɛ4 carriers with higher Openness. Conclusions: Neuroticism and Conscientiousness were associated with changes in longitudinal performances on tests sensitive to memory and executive skills. APOE interactions were less consistent. Our findings are consistent with previous studies that have suggested that personality factors, particularly Neuroticism and Conscientiousness are associated with cognitive aging patterns. (JINS, 2016, 22, 765–776)

Objectives: It is widely believed that phonemic fluency is more difficult than naming exemplars from a semantic category. Normative data in this regard are scarce, and there is considerable disagreement in the literature regarding the pattern in normal ageing and neurodegenerative conditions. Our objective was to provide normative data for semantic phonemic discrepancy scores from a large sample of older adults. Methods: A total of 5780 community-dwelling older adults were included in this prospective, longitudinal study. Discrepancy scores were calculated by subtracting phonemic fluency score from semantic fluency score for each participant. Quantile regression was used to estimate normative values stratified for age. Results: Subjects did better on testing of semantic fluency. The average discrepancy score was 9.18±6.89 words, (range, −20 to 37; n=5780). At the fiftieth percentile, those in their fifth decade produced 10 more “animals” than “letter F” words. Subjects scored one word less per decade, with an average of seven more “animal” words produced by those in their eighth decade. Conclusions: Our study is the first to provide normative data and confirms that, for animal versus letter F fluency, the semantic advantage persists into later life in a population-based sample of community-dwelling older adults. Given that a majority of clinical samples have confirmed a reverse of this pattern in Alzheimer’s dementia (i.e., loss of semantic advantage in Alzheimer’s disease, yielding a phonemic advantage), our findings support the clinical utility of brief fluency tests and encourage further research into their use in diagnosis and prediction of progression to dementia. (JINS, 2016, 22, 1–7)

We examined differences in response latencies obtained during a validated video-based hazard perception driving test between three healthy, community-dwelling groups: 22 mid-aged (35–55 years), 34 young–old (65–74 years), and 23 old-old (75–84 years) current drivers, matched for gender, education level, and vocabulary. We found no significant difference in performance between mid-aged and young-old groups, but the old-old group was significantly slower than the other two groups. The differences between the old-old group and the other groups combined were independently mediated by useful field of view (UFOV), contrast sensitivity, and simple reaction time measures. Given that hazard perception latency has been linked with increased crash risk, these results are consistent with the idea that increased crash risk in older adults could be a function of poorer hazard perception, though this decline does not appear to manifest until age 75+ in healthy drivers. (JINS, 2009, 15, 799–802.)

In this article I critically review the concept of the central executive. I argue that the experimental evidence for a central executive lacks rigor to the point where it is an unfalsifiable construct. I examine the neuropsychological and neuroradiological evidence and demonstrate that there is no localization evidence for a central executive. What emerges instead is a pattern of extensive heterogeneity with different executive tasks associated with different neural substrates. In sum it is argued that the idea of a central executive should be abandoned, and, from a neuropsychological perspective, tests that purport to measure executive function should do so in a qualitative way rather than assume that a range of tests load on a unitary dimension of performance. (JINS, 1998, 4, 518–522.)

Confrontation naming ability entails the operation of distinct cognitive operations and the integrity of a distributed neural network. Previous research has indicated a critical role for the left temporal lobe region in naming ability, but there is less agreement about the relative role of distinct temporal lobe regions. In the current paper, we used quantitative MR volumetrics to investigate the relative contribution of the hippocampus and extrahippocampal temporal lobe (segmented gray and white matter) volumes to confrontation naming performance in 53 patients with temporal lobe epilepsy. Findings showed (1) a stronger relationship for left temporal lobe volume than right temporal lobe volume in predicting naming performance; (2) both left temporal lobe white matter volume and left hippocampus volume contributed a significant amount of unique variance to spontaneous naming performance; and (3) left temporal lobe white matter volume but not left hippocampus volume predicted recognition naming performance. (JINS, 2005, 11, 358–366.)

Apathy is a frequent syndrome in Parkinson's disease (PD) usually associated with depression, cognitive impairment (CI), and dementia. Whereas executive dysfunction seems to play a major causative role in the development of apathy in PD, recent findings pointed for the possible participation of other underlying mechanisms in the development of clinically meaningful symptoms of apathy. By means of neuropsychological testing focused over global cognitive functioning, set-shifting, decision making, and cognitive effort, we compared to a control group, a carefully selected sample of PD patients presenting apathy as the only neuropsychiatric symptom and without clinically relevant signs of cognitive impairment. In addition to the previously reported executive dysfunction, apathetic patients also exhibited significant difficulties in tasks assessing for cortical functioning, such as naming and clock drawing. Moreover, apathetic patients performed significantly better on a decision-making task, although any of these differences appeared linked to a lack of effort when performing the tasks. On the basis of our findings, we discuss the possible implication of added mechanisms rather than just executive dysfunction in the development of apathy in PD. (JINS, 2013, 19, 1–12.)

As new and more effective treatments for Alzheimer's disease (AD) emerge, the development of efficient screening strategies in educationally and racially diverse primary care settings has increased in importance. A set of candidate screening tests and an independent diagnostic assessment were administered to a sample of 318 patients treated at a geriatric primary care center. Fifty-six subjects met criteria for dementia. Exploratory analysis led to the development of three two-stage screening strategies that differed in the composition of the first stage or Rapid Dementia Screen, which is applied to all patients over the age of 65. The second stage, applied to those patients who screen positively for dementia, is accomplished with the Free and Cued Selective Reminding Test to detect memory impairment. Using clinical diagnosis as a gold standard, the strategies had high sensitivity and specificity for identifying dementia and performed better for identifying AD than non-AD dementias. Sensitivity and specificity did not differ by race or education. The strategies provide an efficient approach to screening for early dementia. (JINS, 2008, 14, 130–142.)

There is limited research on the association between participation in cognitively stimulating activity and cognitive function in older Hispanics. The main purpose of the present study was to explore whether frequency of cognitive activity and its association with cognitive function in Hispanics is comparable to that of non-Hispanics. In a multiethnic cohort of 1571 non-demented older adults, we assessed past and current cognitive activity, availability of cognitive resources in the home in childhood and middle age, and five domains of cognitive function. The measures of cognitive activity and cognitive resources had adequate reliability and validity in our subset of Hispanic participants (n = 81). Hispanics reported lower levels of education, lower frequency of cognitive activity and less cognitive resources than non-Hispanic White (n = 1102) and non-Hispanic Black (n = 388) participants. Despite these differences the strength of the association between cognitive activity and cognitive function was comparable across ethnic groups. Because Hispanics have lower frequency of cognitive activity, the benefit of cognitive activity to late life cognitive function may be potentially larger in this segment of the population. Thus, interventions aimed at increasing frequency of participation in cognitively stimulating activity may offer a potential target to reduce cognitive impairment in Hispanics. (JINS, 2012, 18, 1–11)

The performance of 16 patients with Alzheimer's disease (AD) was compared to 11 patients with right-frontotemporal dementia (FTD) and 11 patients with left-FTD on a comprehensive neuropsychological battery. Standardized scores (i.e., z scores based on normal control data) were analyzed for 5 cognitive domains. The results revealed that the AD group displayed significant impairment in visual–constructional ability relative to the two FTD groups; however, no significant difference was found between the groups on memory scores (verbal and nonverbal). Patients with left-FTD scored significantly below patients with AD on the language measures (e.g., word retrieval, verbal semantic memory), and verbal executive ability (phonemic fluency); AD patients did not differ from patients with right-FTD on these measures. Patients with right-FTD exhibited significantly more perseverative behavior than AD patients; AD patients did not differ from left-FTD patients on this parameter. These results indicate that the pattern of neuropsychological performance of AD patients is distinguishable from patients with left and right frontal frontotemporal dementia. (JINS, 2001, 7, 468–480)

Structural and physiological frontal brain system deficits in patients with schizophrenia are reviewed quantitatively. We report effect sizes from studies since 1980 that used structural (CT, MRI), and functional (PET) neuroimaging methods. We found both literatures to be distinguished by heterogeneity whereby most patients show normative frontal function and structure, a minority shows diminished values and some patients demonstrate augmented function and structure rather than deficit. The average magnitude of difference between patients and controls is generally too modest to support the idea that frontal brain dysfunction is a necessary component of schizophrenia. This modesty is most apparent in average effects obtained for frontal brain volume (M = −.36), left frontal brain volume (M = −.16), frontal resting metabolism, and blood flow (M = −.64). Effect sizes of this magnitude imply that schizophrenia and control distributions overlap by as much as 88% and no less than about 60% on frontal brain measures. It is only when behavioral measures are employed as activation tasks during frontal blood flow and metabolism studies, that average effect sizes rise in magnitude to indicate patient–control distribution overlaps that are less than 50%. Overall, the findings are hard to incorporate within single disease models that propose major involvement of the frontal system, at least at the degree of resolution obtained with current imaging technology. (JINS, 1999, 5, 556–566.)

Recent research has demonstrated some beneficial effects in patients with neglect using rightward shifting prismatic lenses. Despite a great deal of research exploring this effect, we know very little about the cognitive mechanisms underlying prism adaptation in neglect. We examined the possibility that prism adaptation influences visual attention by having healthy participants complete either a reflexive or a voluntary covert visual attention cuing paradigm before and after adaptation to leftward, rightward, or sham (no shift) prisms. The results for reflexive orienting demonstrated that a subset of participants with large cuing effects before prism adaptation were faster to reorient attention away from an invalid cue on the side of space opposite the prismatic shift post adaptation. For voluntary orienting, left prisms increased the efficiency of voluntary attention in both left and right visual space in participants with a small cuing effect before prism adaptation. In contrast, right prisms decreased the efficiency of voluntary attention in both left and right space for participants with a large cuing effect before prism adaptation. No significant effects were observed in the sham prism groups. These results suggest that prism adaptation may exert a variety of influences on attentional orienting mechanisms. (JINS, 2006, 12, 337–349.)

Executive functioning is frequently impaired among people with Parkinson's disease (PD). Little is known about awareness of executive functioning, in the sense of being able to accurately appraise functioning or performance, in people with PD, or about whether awareness is particularly affected in those who have impaired executive functioning. This study explored awareness of executive functioning at the levels of evaluative judgment (comparison of self- and informant ratings of executive functioning), and performance monitoring (comparison of performance on cognitive tests and self-ratings of that performance). Awareness levels were assessed in people with PD with and without executive deficits, and in healthy controls. When the level of agreement between self- and informant ratings was considered, people with PD in both groups appeared as accurate in evaluating their overall executive functioning as healthy controls. When appraising their performance as the specific tasks were completed, people with PD who had impairments in executive functioning appeared less accurate than controls and people with PD without executive impairments. People with PD who have executive deficits may lack the ability to recognize their limitations while performing specific tasks, which may have implications for their functional abilities. (JINS, 2013, 19, 1–12.)

The effect of race on cognitive test performance in the evaluation of Alzheimer's disease (AD) remains controversial. One factor that may contribute substantially to differences in cognitive test performance in diverse populations is education. The current study examined the extent to which quality of education, even after controlling for formal years of education, accounts for differences in cognitive performance between African Americans and White Non-Hispanics (WNHs). The retrospective cohort included 244 patients diagnosed with AD who self-identified as African Americans (n = 51) or WNHs (n = 193). The Wechsler Test of Adult Reading (WTAR) was used as an estimate of quality of education. In an analysis that controlled for traditional demographics, including age, sex, and years of formal education, African Americans scored significantly lower than WNHs on the Mini-Mental State Examination, as well as on neuropsychological tests of memory, attention, and language. However, after also adjusting for reading level, all previously observed differences were significantly attenuated. The attenuating effect remained even after controlling for disease severity, indicating that reading scores are not confounded by severity of dementia. These findings suggest that quality, and not just quantity, of education needs to be taken into account when assessing cognitive performance in African Americans with AD. (JINS, 2012, 18, 277–285)

Patients with Parkinson’s disease (PD) frequently display non-motor symptoms. In this study, we investigated intensity-dependent facial emotion recognition in patients with PD and healthy controls (HC), matched for age, gender, and education, and its relationship to individual cognitive domains. Seventy patients with PD and 70 HC were submitted to a clinical, neuropsychological, and psychopathological evaluation. Facial emotion recognition performance was assessed using the Penn Emotion Recognition Test (PERT). The patients with PD recognized fewer low- and high-intensity facial expressions of disgust than HC. This effect was selective, because their global ability to recognize emotions was intact. Both patients with PD and HC recognized high-intensity better than low-intensity emotions, except for disgust, which was recognized better at low intensity. In the patients with PD, overall facial emotion recognition and selective disgust recognition performances were related to deficits in many neuropsychological domains (verbal and visuo-spatial memory, attention, praxis, and verbal fluency). The ability to recognize emotions is a complex cognitive process requiring the integrity of several functions. Therefore, it is likely that structural or functional derangement of the discrete neural pathways involved in these cognitive functions in patients with PD makes it difficult for them to recognize emotions expressed by others. (JINS, 2010, 16, 867–876.)

A high frequency of suicide ideation (SI) has been reported following traumatic brain injury (TBI) (Simpson & Tate, 2002; Teasdale & Engberg, 2001). This study examined the frequency of SI following TBI, and its relationship to alexithymia, and depression, plus two components of depression—hopelessness and worthlessness. One hundred and five TBI patients and 74 demographically matched controls completed the Toronto Alexithymia Scale-20 (TAS-20) and the Beck Depression Inventory (BDI-II). Ratings of SI, hopelessness, and worthlessness were extracted from the BDI-II. Results confirm a high frequency of SI (33%) and alexithymia (61%) after TBI compared with healthy controls (1.4% and 6.5%, respectively). A high frequency of alexithymia was also found in a sub-group of moderate-severely depressed TBI patients (70.68%) compared with two non-TBI depressed samples (53.92% and 44.8%). A significant association was found between SI and alexithymia in the TBI group, with the SI group reporting significantly higher TAS-20 total scores. However, logistic regression analysis found that worthlessness was the strongest predictor of SI after TBI. The results of this study suggest that increased attention should be directed toward emotional change after TBI, as alexithymia may mediate the development of worthlessness and, in turn, increase the risk of SI. (JINS, 2010, 16, 1108–1114.)

The complex process of cortical reorganization of language-related brain regions during recovery from aphasia and the effects of therapeutic interventions on brain systems are poorly understood. We studied two patients with chronic aphasia and compared their functional neuroanatomical responses to a younger control group on two tasks, an oral-reading task involving overt speech and a “passive” audiovisual story-comprehension task. Following identical therapy, we re-examined behavioral (language) and functional neuroanatomical changes using the same functional magnetic resonance imaging (fMRI) tasks. We hypothesized that better recovery would be associated with brain activation patterns more closely resembling healthy controls, whereas positive responses to language treatment would be associated with increased activity in undamaged left perisylvian areas and/or right-hemisphere areas homologous to the damaged regions. For the participant with a frontal lesion who was most responsive to therapy, brain activation increased in the right hemisphere during oral-reading, but decreased bilaterally in most regions on story-comprehension. The other participant with a temporal–parietal lesion showed decreased activation, particularly in the right hemisphere, during oral-reading but increased activation bilaterally on story-comprehension. Results highlight individual variability following language therapy, with brain activation changes depending on lesion site and size, language skill, type of intervention, and the nature of the fMRI task. (JINS, 2006, 12, 828–842.)

Departing from the observation that illiterates significantly underscore in some neuropsychological tests, a learning-to-read method named NEUROALFA was developed. NEUROALFA is directed to reinforce these underscored abilities during the learning-to-read process. It was administered to a sample of 21 adult illiterates in Colima (Mexico). Results were compared with 2 control groups using more traditional procedures in learning to read. The NEUROPSI neuropsychological test battery was administered to all the participants before and after completing the learning-to-read training program. All 3 groups presented some improvement in the test scores. Gains, however, were significantly higher in the experimental group in Orientation in Time, Digits Backward, Visual Detection, Verbal Memory, Copy of a Semi-Complex Figure, Language Comprehension, Phonological Verbal Fluency, Similarities, Calculation Abilities, Sequences, and all the recall subtests, excluding Recognition. Performance in standard reading tests was also significantly higher in the experimental group. Correlations between pretest NEUROPSI scores and reading ability were low. However, correlations between posttest NEUROPSI scores and reading scores were higher and significant for several subtests. Results are interpreting as supporting the assumption that reinforcement of those abilities in which illiterates significantly underscore results in a significant improvement in neuropsychological test scores and strongly facilitates the learning-to-read process. The NEUROALFA method of teaching reading to adult illiterates is beginning to be used extensively in Mexico. To our knowledge, this is the first attempt to apply neuropsychological principles to social problems. (JINS, 2000, 6, 789–801.)

Impulsive behaviors and poor inhibition performances are frequently described in patients with traumatic brain injury (TBI). However, few studies have examined impulsivity and associated inhibition impairments in these patients. Twenty-eight patients with moderate to severe TBI and 27 matched controls performed a stop-signal task designed to assess prepotent response inhibition (the ability to inhibit a dominant or automatic motor response) in a neutral or emotional context and a recent negative task to assess resistance to proactive interference (the ability to resist the intrusion into memory of information that was previously relevant but has since become irrelevant). Informants of each patient completed a short questionnaire designed to assess impulsivity. Patients showed a significant increase in current urgency, lack of premeditation, and lack of perseverance when retrospectively compared with the preinjury condition. Group comparisons revealed poorer prepotent response inhibition and resistance to proactive interference performances in patients with TBI. Finally, correlation analyses revealed a significant positive correlation between urgency (the tendency to act rashly when distressed) and prepotent response inhibition in patients with TBI. This study sheds new light on the construct of impulsivity after a TBI, its related cognitive mechanisms, and its potential role in problematic behaviors described after a TBI. (JINS, 2013, 19, 1–9)

Objectives: Children and adolescents who were born very preterm (≤32 weeks’ gestation) are vulnerable to experiencing cognitive problems, including in executive function. However, it remains to be established whether cognitive deficits are evident in adulthood and whether these exert a significant effect on an individual’s real-lifeachievement. Methods: Using a cross-sectional design, we tested a range of neurocognitive abilities, with a focus on executive function, in a sample of 122 very preterm individuals and 89 term-born controls born between 1979 and 1984. Associations between executive function and a range of achievement measures, indicative of a successful transition to adulthood, were examined. Results: Very preterm adults performed worse compared to controls on measures of intellectual ability and executive function with moderate to large effect sizes. They also demonstrated significantly lower achievement levels in terms of years spent in education, employment status, and on a measure of functioning in work and social domains. Results of regression analysis indicated a stronger positive association between executive function and real-life achievement in the very preterm group compared to controls. Conclusions: Very preterm born adults demonstrate executive function impairments compared to full-term controls, and these are associated with lower achievement in several real-life domains. (JINS, 2017, 23, 381–389)