Visuoconstructional ability is an important domain for assessment in dementia. Use of graphomotor measures dominate this area; however, participants with low education produce results that cannot be easily interpreted. Our objective was to develop and validate a nongraphomotor assessment of visuoconstructional ability for use in dementia evaluations in persons with low or no education. In a longitudinal, population-based study of dementia among Yoruba residents of Ibadan, Nigeria aged 65 years and older, participants underwent clinical assessment with a battery of cognitive tests and consensus diagnosis. Performance on two visuoconstructional tests, Constructional Praxis and Stick Design, were compared. Gender, age, and education affected performance on both tests. The Stick Design test was more acceptable than Constructional Praxis as measured by the number of participants with total test failure (3.9% vs. 15.1%). The Stick Design test was significantly more sensitive to cognitive impairment and dementia than the Constructional Praxis test. We conclude that Stick Design is a reasonable test of visuoconstructional ability in older cohorts with very limited educational exposure and literacy. (JINS, 2005, 11, 598–605.)

Ecstasy (MDMA) is a popular drug that can act as a selective serotonin neurotoxin in several species. The goal of the present study was to examine the relationship between ecstasy exposure and cognitive functioning after controlling for other drug use and demographic variables. Furthermore, we assessed whether gender was a moderator of the relationship between cognitive functioning and ecstasy use. Data were collected from 31 men and 34 women with a wide range of ecstasy use (17 marijuana users with no ecstasy use and 48 ecstasy users ranging from low to heavy use). Participants were interviewed and administered a battery of neuropsychological tests. The primary finding was that ecstasy exposure was significantly related to poorer verbal learning and memory ability in a dose-dependent manner, while no such relationship was observed between ecstasy exposure and executive functioning or attentional ability. Gender was found to significantly moderate the relationship between ecstasy consumption and design fluency. These results suggest primary memory dysfunction among abstinent recreational ecstasy users. This finding is consistent with reports of hippocampal vulnerability, particularly among heavy users. (JINS, 2005, 11, 753–765.)

Emerging evidence from recent studies using laboratory and naturalistic attention tasks suggests that individuals with traumatic brain injury (TBI) may have a deficit mainly in strategic control of attention. In the present study, we tested the hypothesis that inattentive behavior after TBI could be predicted by performance on psychometric measures of executive function. A group of 37 individuals with moderate to severe TBI were assessed with previously validated naturalistic measures of attention. A battery of neuropsychological tests was also administered to assess various aspects of executive function. Seven measures of executive function and 10 variables reflecting inattentive behavior were combined to form 1 executive and 3 inattentive behavior (IB) composite scores. Three predictors (executive composite, current disability scores, and age) were associated, at the univariate level, with one of the IB composites reflecting frequency and duration of off-task episodes. A stepwise multiple regression procedure indicated that the executive composite was the only significant predictor of the IB composite. Additional post-hoc regression analyses suggested that the relationship was not likely to be mediated by processing speed. The current study supports the hypothesis that executive function, measured by commonly used neuropsychological tests, significantly predicts certain aspects of inattentive behavior in real-world tasks after TBI. (JINS, 2005, 11, 434–445.)

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.)

Traditional neuropsychological measures of executive dysfunction (ED) are widely believed to lack adequate sensitivity and selectivity. This may indicate that existing measures are poorly designed and constructed, although an alternative explanation is that executive cognition is multifactorial, such that its assessment necessarily requires administration of multiple measures. This possibility led to the development of a test battery, the Behavioural Assessment of the Dysexecutive Syndrome (BADS). To investigate the sensitivity of the BADS to ED, it and various other measures of ED were administered to 64 persons who had sustained traumatic brain injury. The treating clinical neuropsychologist and occupational therapist for each participant also completed a behavioural rating scale, the Dysexecutive Questionnaire (DEX). Four factors were found to underlie scores on the neuropsychological measures, but few tests were sufficiently powerful to make a significant unique contribution to predicting scores on the DEX. This confirms that multiple tests, drawn from both the BADS and other sources, may be necessary to detect ED in a clinical population. (JINS, 2005, 11, 606–613.)

The Asymmetrical Brain. Kenneth Hugdahl and Richard J. Davidson (Eds.). 2003. Cambridge, MA: The MIT Press. 796 pp., $90.00.

One of the most fundamental questions in cognitive neuroscience relates to the biological basis of functional hemispheric specialization and the relationship of structure to function. These important and controversial concepts are reviewed in The Asymmetrical Brain. Drs. Hugdahl and Davidson have selected core topics discussed by an impressive group of internationally recognized experts. This text was originally conceived as an update to the 1995 book Brain Asymmetry edited by Hugdahl and Davidson, but this text offers a completely reorganized approach to the topic that is both timely and comprehensive within a narrow focus on specific neural systems and neural syndromes. This book will appeal to students and experts in the broader field of human cognitive neuroscience and should be required reading to anyone with an academic interest in cerebral laterality and human cognition. Indeed, the field has advanced since 1995, and this book will surely become a major impetus to future research advancement in brain laterality.

Anosognosia, disordered awareness of cognitive and behavioral deficits, is a striking and common symptom of Alzheimer's disease (AD), yet its etiology, clinical correlates, and prognostic value are unclear. Historically, disordered awareness has been a conceptually challenging phenomenon, evidenced by the numerous and diverse theories that aim to explain the manner in which this syndrome arises. We review many of these theories, focusing on the neuroanatomic substrates of awareness, and highlighting the potential roles of critical regions such as the right prefrontal and parietal cortices in enabling self-awareness. We then address methodological limitations such as use of subjective measurement tools that likely contribute to the conceptual ambiguity surrounding anosognosia. We argue that metacognitive techniques used in healthy adults, such as the Feeling of Knowing task, offer models for dissecting awareness into clear and identifiable cognitive components in patients with AD. We critique several studies that have pioneered such tasks in AD, and offer guidelines for future implementation of such methods. A final goal of this review is to advocate for a multidimensional approach to studying metacognitive skills that will facilitate the objective investigation of deficit awareness as it relates to a variety of disease variables such as prognosis, neuropsychological profile, neuropathological distribution, psychiatric symptoms, and clinical course. (JINS, 2005, 11, 910–919.)

Patients with Alzheimer's Disease (AD) who have reached a stage of moderate to severe dementia are capable of completing a restricted range of cognitive tests and performing a limited range of activities of daily living (ADL). As part of an initiative to develop instruments to evaluate AD, we analyzed data describing the performance of a large number of ADL and scores on cognitive and global assessment measures in a cohort of patients with AD with moderate to severe cognitive impairment, defined as a Mini-Mental State Examination score ranging from 0–15 (out of 30). From the large pool of ADL, 19 met criteria of applicability, reliability, good scaling, concordant validity, and sensitivity to detect change in performance over 6–12 months. A total score derived from these 19 ADL ratings, comprising a scale termed the Alzheimer Disease Cooperative Study ADL-sev, correlated strongly with measures of cognition and of global dementia severity. Patients with moderate to severe AD showed a decline on the ADL-sev and cognitive measures over 6 and 12 months, consistent with the progression of AD. Detailed evaluation of ADL may provide a useful index to evaluate patients with moderate to severe AD and may complement cognitive assessment, especially for characterizing change in interventional or therapeutic studies. (JINS, 2005, 11, 446–453.)

Human exposure to naturally occurring marine toxins has been associated with a range of neurobehavioral abnormalities. The toxins are produced by harmful algal blooms (HABs) and are typically contracted through seafood consumption. The primary target of many of the HAB toxins is the neurologic system, and the neurobehavioral symptoms associated with the HAB illnesses have influenced public health policy. The HAB-related illnesses most frequently linked to neuropsychological disturbance are Amnesic Shellfish Poisoning, Ciguatera Fish Poisoning, and Possible Estuarine Associated Syndrome, which is associated with exposure to the Pfiesteria piscicida organism. Although the neurophysiologic mechanisms underlying many of the HAB illnesses have been well delineated, the literature examining the neuropsychological impairments is unclear and needs to be defined. This review is intended to introduce an emerging area of study linking HAB illnesses with neuropsychological changes. (JINS, 2005, 11, 331–338.)

We used a rational-empirical approach in the construction and validation of a cognitive activity scale for use with elderly populations. The scale development effort produced a 25-item scale with a reasonably high level of internal consistency in a sample of 200 elderly individuals. Scale scores were positively correlated with years of education and measures of various domains of cognitive ability. In a separate cross-validation sample, a similar pattern of reliability and validity coefficients was obtained. The full scale score was found to contribute significantly to the prediction of cognitive ability after controlling for the effects of age, education, and gender. Two subscales (Higher Cognitive Abilities and Frequent Cognitive Abilities) and a measure of self-reported maintenance of cognitive activity were also developed. In a separate study, the maintenance score was found to differ significantly between the validation sample and a sample of individuals with a history of neurological disorder, with a moderate effect size (d approximately = .7). Further cross-validation studies in minority groups and groups of varying socioeconomic status will be critical in establishing the research and clinical value of the scale and subscales. (JINS, 2005, 11, 108–116.)

Mental and Behavioral Dysfunction in Movement Disorders. Marc-André Bédard, Yves Agid, Sylvain Chouinard, Stanley Fahn, Amos D. Korczyn, and Paul Lespérance (Eds.). 2003. Totowa, NH: Humana Press, Inc. 561 pp., $185.00 (HB).

Disorders having an impact on subcortical brain structures, such as Parkinson's disease, Huntington's disease, and progressive supranuclear palsy (to name a few), have long been known to disrupt basic motor functions. We have also come to understand, however, that these diseases result in cognitive and psychiatric alterations. Many of these cognitive and psychiatric changes are often unrelated to the motor abnormalities seen in these diseases, highlighting the multi-faceted processes mediated by different subcortical structures. In addition, these cognitive and behavioral changes can be more debilitating than the movement deficits experienced by these patients. Thus, it is imperative that clinicians further understand the characteristics of, and treatment options for, these types of symptoms. Further, our understanding of the mental and behavioral changes in these diseases has also informed us about the role of the subcortical brain structures (and their connections) in cognition and psychiatric functioning. From this work, it has become increasingly clear that frontal-subcortical pathways play an important (if not central) role in directing human activity.

This study investigates response inhibition deficits in obsessive-compulsive disorder (OCD) by using the Hayling task. Sixteen OCD washers, 16 OCD checkers, 16 social phobic patients and 16 nonanxious controls were asked to complete sentences with either the expected word (section A: “initiation”) or an unrelated word (section B: “inhibition”). The groups did not differ in terms of section B minus section A latencies. However, OCD washers and checkers made significantly more errors (sentence-related responses) in section B than social phobic patients and controls. In the OCD patients, the frequency of these errors correlates with the total OCD severity score and the compulsion subscore, but not with the depression and anxiety scores. These findings suggest that OCD patients might present a specific deficit affecting the inhibition of a prepotent response. (JINS, 2005, 11, 776–783.)

The relation between self-reported cognitive dysfunction and neuropsychological performance over 24 weeks was assessed in a sample of 53 multiple sclerosis patients. Subjects were assessed at Weeks Zero and 24 as part of a clinical trial to enhance cognition. At baseline, subjects had at least mild cognitive impairment on the Rey Auditory Verbal Learning Test and an absence of depression. Neuropsychological performance was assessed with a modification of the well standardized Brief Repeatable Battery. The 5-item Perceived Deficits Questionnaire and a 2-item memory and attention/concentration questionnaire assessed self-perceived cognitive impairment. Self-assessed cognition did not correlate with neuropsychological performance at either baseline or 24 weeks. However, changes in the self-assessment measures did correlate with changes in neuropsychological performance. Patients accurately perceived some changes in their level of cognitive dysfunction, though they were insensitive to the degree of their current dysfunction. Possible explanations of this pattern of results are discussed. (JINS, 2005, 11, 614–619.)

The Essential Handbook of Memory Disorders for Clinicians. Alan D. Baddeley, Michael D. Kopelman, and Barbara A. Wilson (Eds.). (2004). Chichester: John Wiley & Sons. 381 pp., $45.00, £26.99/€40.50 (PB).

In the preface to this book, the editors reflect that the original Handbook of Memory Disorders (Baddeley et al., 1995) was aimed at a clinically oriented readership. Following publication of the original text, it was noted that neuroscientists expressed enthusiasm for the work, thus the second edition of the handbook (Baddeley et al., 2002) expanded significantly on scientific issues that were perhaps of less immediate clinical relevance. The current text, which the editors have titled The Essential Handbook of Memory Disorders for Clinicians is composed of a series of chapters from the 2002 text. Similar to the 1995 first edition, the goal of this new book is to provide an accessible text aimed at clinicians. Core clinical issues of assessment, nomenclature, phenomenology, etiology, and management are examined as they relate to disorders of memory and associated underlying diseases.

The manuscript by Stefanatos, Gershkoff, and Madigan is the inaugural contribution to the new Neurobehavioral Grand Rounds feature of JINS. Case reports have been published in JINS in the past, but the goal of this new feature is to highlight the importance of case reports that are theoretically driven and have the potential to influence future research in the area. You will see that this case fits that description very well. In order to emphasize the larger context of the case, for each Grand Rounds an expert in the area will be asked to provide a short introduction. Dr. Jeffrey Binder, a neurologist at the Medical College of Wisconsin and an expert in the neural basis of language, has written an introduction that emphasizes the value of this case in terms of its utilization of a careful perceptual analysis combined with anatomical data to better characterize this classic syndrome.

Review of The Central Nervous System. Structure and Function (3rd ed.), by Per Brodal. 2004. New York: Oxford University Press. 515 pp., $79.95.

Executive control of learning and memory was examined in children with bilateral spastic cerebral palsy (SCP). We hypothesized that SCP-related brain damage would disrupt executive but not associative aspects of learning and memory. To test this hypothesis, the California Verbal Learning Test–Children's Version was administered to 16 children with bilateral SCP and 19 control children ranging from 6 to 18 years of age. Controlling for general verbal ability, the groups did not differ in initial learning and retention of information over time, suggesting that associative learning and memory processes subserved by medial temporal brain regions were relatively intact in children with SCP. In contrast, impairments in learning over repeated trials, strategic processing, and inhibition in the SCP group pointed to disruptions in prefrontally-mediated executive aspects of learning and memory. The inhibitory deficit was more pronounced in younger children with SCP, suggesting a developmental delay in this ability. (JINS, 2005, 11, 920–924.)

Perception of speech is effortless under most circumstances; this may explain why the complexity of this cognitive process is so often unappreciated. While most other sounds in the environment are acoustically very distinctive, the 30 or 40 speech sounds people make are discriminable only by rapid analysis of rather subtle acoustic cues. Given the importance of language, it seems plausible not only that our auditory system evolved a degree of specialization for handling such analyses, but also that this specialization should assimilate substantial neural resources. Recent work in comparative physiology and human brain imaging suggests, in fact, that much of the superior temporal gyrus in humans is devoted to this perceptual feat.

The remediative effect of galvanic vestibular stimulation (GVS) was investigated in a patient who, following right hemisphere damage, is profoundly unable to recognize faces. We administered a two-alternative forced choice match-to-sample task in which the patient had to choose which of two faces matched a sample face presented directly above, while bipolar, transcutaneous current was applied to the left and right vestibular nerves at a level below the patient's sensory threshold. Performance improved beyond the chance-level observed prestimulation, and relied on reversing the electrode polarity across two separate blocks of trials, such that each mastoid received positive current for one block and then negative charge for the next. Although our study involved only a single case, the data provide preliminary evidence that a deficit in perceptual face matching can be reduced by GVS. This raises the intriguing possibility that other unilateral visual disorders may also respond in such a manner. (JINS, 2005, 11, 925–929.)

Diagnostic neuropsychological assessment requires the clinician to estimate a patient's premorbid abilities. Word reading tests, such as the National Adult Reading Test–Revised (NART–R), provide reasonably accurate estimates of premorbid IQ, but their capacity to benchmark other premorbid cognitive abilities remains unclear. In this extension of an earlier report, we administered the NART–R, an abbreviated Wechsler Adult Intelligence Scale (WAIS–R or WAIS–III), and 26 other cognitive measures to 322 reasonably healthy adults. While NART–R performance correlated robustly (rs ≥ .72) with concurrent Verbal and Full Scale IQ, its correlation with all other cognitive measures was significantly lower. Thus, while it is appealing to use word reading as a proxy for premorbid functioning in other cognitive domains, the NART–R has limited utility for this because it does not predict current performance on other cognitive tests as well as it predicts IQ in healthy adults. (JINS, 2005, 11, 784–787.)