Both HIV infection and methamphetamine dependence can be associated with brain dysfunction. Little is known, however, about the cognitive effects of concurrent HIV infection and methamphetamine dependence. The present study included 200 participants in 4 groups: HIV infected/methamphetamine dependent (HIV+/METH+), HIV negative/methamphetamine dependent (HIV−/METH+), HIV infected/methamphetamine nondependent (HIV+/METH−), and HIV negative/methamphetamine nondependent (HIV−/METH−). Study groups were comparable for age, education, and ethnicity, although the HIV−/METH− group had significantly more females. A comprehensive, demographically corrected neuropsychological battery was administered yielding a global performance score and scores for seven neurobehavioral domains. Rates of neuropsychological impairment were determined by cutoff scores derived from performances of a separate control group and validated with larger samples of HIV+ and HIV− participants from an independent cohort. Rates of global neuropsychological impairment were higher in the HIV+/METH+ (58%), HIV−/METH+ (40%) and HIV+/METH− (38%) groups compared to the HIV−/METH− (18%) group. Nonparametric analyses revealed a significant monotonic trend for global cognitive status across groups, with least impairment in the control group and highest prevalence of impairment in the group with concurrent HIV infection and methamphetamine dependence. The results indicate that HIV infection and methamphetamine dependence are each associated with neuropsychological deficits, and suggest that these factors in combination are associated with additive deleterious cognitive effects. This additivity may reflect common pathways to neural injury involving both cytotoxic and apoptotic mechanisms. (JINS, 2004, 10, 1–14.)Note: Dr. Erin D. Bigler served as action editor during the course of this review.

To investigate the effects of dopamine on the dynamics of semantic activation, 39 healthy volunteers were randomly assigned to ingest either a placebo (n = 24) or a levodopa (n = 16) capsule. Participants then performed a lexical decision task that implemented a masked priming paradigm. Direct and indirect semantic priming was measured across stimulus onset asynchronies (SOAs) of 250, 500 and 1200 ms. The results revealed significant direct and indirect semantic priming effects for the placebo group at SOAs of 250 ms and 500 ms, but no significant direct or indirect priming effects at the 1200 ms SOA. In contrast, the levodopa group showed significant direct and indirect semantic priming effects at the 250 ms SOA, while no significant direct or indirect priming effects were evident at the SOAs of 500 ms or 1200 ms. These results suggest that dopamine has a role in modulating both automatic and attentional aspects of semantic activation according to a specific time course. The implications of these results for current theories of dopaminergic modulation of semantic activation are discussed. (JINS, 2004, 10, 15–25.)

The paced auditory serial addition task (PASAT), in which subjects hear a number-string and add the two most-recently heard numbers, is a neuropsychological test sensitive to cerebral dysfunction. We mapped the brain regions activated by the PASAT using positron emission tomography (PET) and 15O-water to measure cerebral blood flow. We parsed the PASAT by mapping sites activated by immediate repetition of numbers and by repetition of the prior number after the presentation of the next number in the series. The PASAT activated dispersed non-contiguous foci in the superior temporal gyri, bifrontal and biparietal sites, the anterior cingulate and bilateral cerebellar sites. These sites are consistent with the elements of the task that include auditory perception and processing, speech production, working memory, and attention. Sites mediating addition were not identified. The extent of the sites activated during the performance of the PASAT accounts for the sensitivity of this test and justifies its use in a variety of seemingly disparate conditions. (JINS, 2004, 10, 26–34.)

As many as 66% of systemic lupus erythematosus (SLE) patients have been reported to have cognitive deficits. These deficits are often associated with information processing speed and working memory. Similarly, processing speed and working memory impairments are the hallmark of cognitive dysfunction in multiple sclerosis (MS). The Paced Auditory Serial Addition Test (PASAT) places high demands on processing speed and working memory. Fisk and Archibald, however, demonstrated that the total score of the PASAT does not accurately reflect impairments in these cognitive processes. They found that MS patients used a chunking strategy to obtain correct responses and reduce the cognitive demands of the task. In the present study, PASAT performance was examined for 45 SLE patients and 27 controls using alternative scoring procedures. Although the total number of correct responses did not differ between SLE and controls at the 2.4 or 2.0 s presentation rates, SLE patients had fewer dyads (correct consecutive responses) than controls at the faster rate, and more chunking responses than controls at both rates. Disease activity, disease duration, depression, fatigue, and corticosteroids could not account for these differences. The findings suggest that SLE patients, like MS patients, chunk responses more often than controls, and that this scoring procedure may better reflect the working memory and processing speed deficits present in SLE. (JINS, 2004, 10, 35–45.)

Confrontation naming of 52 unilateral or bilateral brain-damaged Chinese patients were examined with a modified version of the Boston Naming Test (BNT). Chinese patients with left or right hemisphere lesions, contrary to studies on English speakers, demonstrated similar levels of naming impairments, supporting the notion that English and Chinese are mediated by different neuroprocessing systems. In addition, the psychometric properties of the BNT on Chinese population were examined. While the test demonstrated satisfactory internal consistency and discriminant validity, level of education was found to be a significant factor affecting participants' performance. A cut-off score of 24 in spontaneous naming yielded a sensitivity of 73.1% and specificity of 75.3% in differentiating normal from brain-damaged participants, suggesting that the modified BNT is applicable to the Chinese population. (JINS, 2004, 10, 46–53.)

Obsessive-compulsive disorder (OCD) is characterized by repetitive obsessions and/or compulsions that interfere with daily functioning. Neuropsychological studies have suggested that such perseverative behaviors may be due to underlying attentional deficits. Inhibition of return (IOR) is an adaptive mechanism that is thought to assist visual search by biasing attention after a critical, short interval to novel, previously unattended areas. Therefore, this study aimed to examine whether deficient IOR mechanisms could underlie some of the attentional, and perhaps behavioral, problems, reported in OCD patients. Using a computerized IOR paradigm, participants were required to respond to a target that appeared at either the same or different location to a precue that was presented either 100 ms or 700 ms earlier. Results indicate that patients had a reduced IOR for targets presented in the left visual field, suggesting lateralized anomalies in shifting attention. Results are consistent with lateralization anomalies previously reported in OCD. (JINS, 2004, 10, 54–59.)

Hypoxia damages multiple organ systems especially those with high oxygen utilization such as the central nervous system. The purpose of this study was to compare the neuropathological and neuropsychological effects of hypoxia in patients with either carbon monoxide poisoning or obstructive sleep apnea. Neuroimaging revealed evidence of hippocampal atrophy in both groups although a linear relationship between hippocampal volume and memory performance was found only for selected tests and only in the sleep apnea group. There were significant correlations between hippocampal volume and performance on measures related to nonverbal/information processing. Generalized brain atrophy, as measured by the ventricle-to-brain ratio, was more common in the carbon monoxide poisoning group compared to the obstructive sleep apnea group. Performance on tests of executive function improved following treatment with nasal continuous positive airway pressure treatment in the obstructive sleep apnea group but there was no associated improvement in general intellectual function. We found that hypoxia due to obstructive sleep apnea and CO poisoning resulted in neuropathological changes and neuropsychological impairments. The observed group differences provide insight into the relationship between etiology of injury, neuropathological changes, and clinical presentation. (JINS, 2004, 10, 60–71.)

This study aimed to explore the effects of age, education and gender on the performance of eight tests in the Korean version of the CERAD neuropsychological assessment battery and to provide normative information on the tests in the Korean elderly. The battery was administered to 618 healthy volunteers aged from 60 to 90. People with serious neurological, medical and psychiatric disorders, including dementia, were excluded. Multiple linear regression analyses were performed to assess the relative contribution of the demographic factors on the score of each cognitive test. Age, education, and gender were found to have significant effects on the performance of many tests in the battery. Based on these results, 4 overlapping age normative tables (60 to 74, 65 to 79, 70 to 84, and 75 to 90 years of age) with 3 educational strata (0 to 3 years, 4 to 6 years, and 7 years and more) for both genders are presented. The normative information will be useful for a clinical interpretation of the CERAD neuropsychological battery in Korean elderly as well as for comparing the performance of the battery across countries. (JINS, 2004, 10, 72–81.)

The strength and nature of the association between IQ and performance on other cognitive tests has both practical and conceptual significance for clinical neuropsychology. In this study, 28 measures derived from 16 cognitive tests were analyzed as a function of IQ in 221 adults. Participants were grouped by their IQ scores as having below average (BA), average (A), or above average (AA) intelligence. Planned comparisons revealed that A adults performed significantly better than BA adults on 25 of the 28 cognitive measures, and that AA adults performed significantly better than A adults on 19 of 28 measures. Effect sizes averaged .74 for BA–A comparisons and .41 for A–AA comparisons. Linear, quadratic, and cubic functions described the relationships between IQ and cognitive test performance equally well for most individual test measures and for a composite index of test performance, whereas quadratic and cubic functions explained the proportion of abnormal performances better than a linear function. These findings confirm that IQ predicts concurrent neuropsychological performance across the entire spectrum of intelligence, but more so among persons of average IQ or less than among those with above average IQ. (JINS, 2004, 10, 82–90.)

Impairment in delayed recall has traditionally been considered a hallmark feature of Alzheimer's disease (AD). However, vulnerability to semantic interference may reflect early manifestations of the disorder. In this study, 26 mildly demented AD patients (mild AD), 53 patients with mild cognitive impairment without dementia (MCI), and 53 normal community-dwelling elders were first presented 10 common objects that were recalled over 3 learning trials. Subjects were then presented 10 new semantically related objects followed by recall for the original targets. After controlling for the degree of overall memory impairment, mild AD patients demonstrated greater proactive but equivalent retroactive interference relative to MCI patients. Normal elderly subjects exhibited the least amount of proactive and retroactive interference effects. Recall for targets susceptible to proactive interference correctly classified 81.3% of MCI patients and 81.3% of normal elderly subjects, outperforming measures of delayed recall and rate of forgetting. Adding recognition memory scores to the model enhanced both sensitivity (84.6%) and specificity (88.5%). A combination of proactive and retroactive interference measures yielded sensitivity of 84.6% and specificity of 96.2% in differentiating mild AD patients from normal older adults. Susceptibility to proactive semantic interference may be an early cognitive feature of MCI and AD patients presenting for clinical evaluation. (JINS, 2004, 10, 91–100.)

To examine the relative influence of speed of information processing versus working memory ability, CFS participants with psychiatric comorbidity (CFS–Psych) and CFS without a psychiatric history (CFS–noPsych) were examined on tests of visual and auditory processing speed and visual and auditory working memory. Compared to healthy controls (HC) and a group of participants with rheumatoid arthritis (RA), the CFS–noPsych group displayed significantly reduced performance on tests of information processing speed, but not on tests of working memory. No significant differences were observed between the CFS–Psych group and any other group in the study. The implications of group heterogeneity on the understanding of cognitive impairment in CFS are discussed. (JINS, 2004, 10, 101–109.)

Nearly 3,000,000 people in the United States, and over 100,000,000 people worldwide, are infected with hepatitis C virus (HCV), with an increasing trajectory for the foreseeable future (Alter et al., 1999). While hepatic encephalopathy has been long recognized as a disorder associated with cerebral structural, metabolic, and cognitive changes (e.g., Tarter et al., 1989), HCV infection itself is increasingly associated with changes in the brain, even in the absence of hyperammonemia. Specifically, HCV-infected individuals may have deficits in cognitive functions such as attention, working memory, and speed of information processing (Forton et al., 2002; Hilsabeck et al., 2002). They may also have abnormalities on magnetic resonance spectroscopy (MRS), a non-invasive method to measure cerebral metabolites. The most reliably measured compounds using a standard 1.5 Tesla MRI scanner are N-acetylaspartate (NAA), a marker of neuronal integrity; choline and choline-containing compounds (Cho), a measure of cell membrane turnover and lipid changes; myo-Inositol (Ins), a possible indicator of glial proliferation and/or osmolar changes; and creatine+phosphocreatine (Cr), an indicator of high energy stores that is often used as a relative standard for other metabolites. In the first studies of HCV using MRS, Forton et al. (2001; 2002) found elevated Cho/Cr in the frontal white matter and basal ganglia in patients with HCV. In addition patients with two or more impaired neuropsychological test performances had higher Cho/Cr compared to those with less than two impaired test performances.Dr. Erin D. Bigler served as Action Editor during the course of this review.

Thirty studies published between 1977 and 2001 that focus on outcome following unruptured intracranial aneurysm (UIA) treatment are reviewed. Although findings from these studies suggest outcome from UIA treatment is reasonably good (between 5% and 25% morbidity and between 0–7% mortality), many of the complex issues associated with the treatment of UIAs remain controversial. Most of the studies reviewed address outcome in terms of mortality and neurological morbidity. Very few studies exist which include measures of outcome such as cognitive status, psychosocial functioning and quality of life. Given that patients facing treatment tend to be healthy middle-aged adults with many years of active working and social life ahead of them, it is important to take into account the long-term consequences of either harboring an UIA, or having it treated. The small number of studies that include cognitive, psychosocial and quality of life outcomes are reviewed in some detail and suggestions made for improving future UIA outcome research. (JINS, 2004, 10, 114–134.)

Studies have found that infection with the Human Immunodeficiency Virus (HIV) leads to cognitive dysfunction. In fact, attention problems have been reported to be the most frequent cognitive symptom in HIV-infected adults. One question is how early in the course of information processing can attention impairment be detected? To address this issue, performance on a perceptual span task was examined in 54 HIV-infected adults and 19 seronegative controls. In this task a target had to be identified in a briefly presented (50 ms) array of 1, 4, or 12 letter-characters. Response accuracy was differentially worse in the HIV+ group relative to seronegative controls in the most difficult condition, the 12-item array, but not in the easier conditions. There was no evidence of a group difference in response strategy due to disinhibition or in psychomotor speed. These data suggest that HIV infection leads to a reduction in early visual processing capacity (or span of apprehension). The present results illustrate a new type of attentional deficit in HIV and show the impact of HIV on cognition at an earlier point in information processing than has been previously reported. (JINS, 2004, 10, 135–140.)

Cognitive Rehabilitation: A Clinical Neuropsychological Approach. W. Brouwer, E. van Zomeren, I. Berg, A. Bouma, and E. de Haan (Eds.). 2002. Amsterdam: Boom Publishers. 296 pp.

Neuropsychological Interventions: Clinical Research and Practice. P.J. Eslinger (Ed.). 2002. New York: The Guilford Press. 360 pp., $50.00.

Cognitive dysfunction is the sine qua non of brain injury. Rehabilitation of cognitive deficits is therefore central to the treatment of persons with brain injury. Nevertheless, advances in the treatment of various cognitive functions have been slow to occur. In all likelihood this slow pace reflects the complex nature of brain function and brain injury as well as the challenges that researchers encounter when they conduct research with real world populations whose condition may be evolving. Yet, brain injury treatment shows promise. After reading both of these books, the reader will have the sense that our approaches are becoming more scientific, that there are large gaps in our knowledge, with variability in knowledge across cognitive domains, and that there is still much art in the treatment of cognitive deficits. These two books provide valuable information of a complementary nature on the status of brain injury care.

In Search of Madness: Schizophrenia and Neuroscience, by Walter Heinrichs. (2001). New York: Oxford University Press. 368 pp., $19.95.

In Search of Madness: Schizophrenia and Neuroscience is a concise but thorough and even-handed review of the current status of research in schizophrenia. It is an amalgam of research studies distributed across numerous domains relevant to schizophrenia and represents a much expanded version of his 1993 review article in the American Psychologist. In particular, the book synthesizes aspects of neuropsychological functioning, genetic, behavioral and genetic markers, and the neurochemistry of schizophrenia with information on etiology and overt symptoms of the illness. One potentially controversial and central feature of this book is Heinrich's argument that schizophrenia is not one single illness but a heterogeneous syndrome. Heinrichs' rationale for conducting research on the studies is to exemplify the discrepancies between what researchers claim to be “common symptoms” of schizophrenia. For each topic covered, Heinrichs and colleagues combined all relevant research studies between 1980 and 1999 and performed a meta-analysis to better explain the overall status of such research. For example, regarding attention deficits on the Continuous Performance Test, he grouped all studies together between 1980 and 1999 and matched the studies according to patient sample (schizophrenia patients and controls) and measure used (the Identical Pairs version of the CPT). He then calculated the effect size to determine the variance attributed to the identified construct. This meticulous method was employed for each phenomenon that was examined.

The Handbook of Cognitive Neuropsychology: What Deficits Reveal About the Human Mind. Brenda Rapp (Ed.). 2001. Philadelphia: Psychology Press. 652 pp., $41.95 (PB).

Traditionally, research findings in cognitive neuropsychology have been used as theoretical bench marks for research in other areas of psychology attempting to explain brain-behavior relationships. Several branch disciplines in the behavioral sciences have used knowledge gained through studies in cognitive neuropsychology not only to help support theories developed in their respective areas, but also to advance more in-depth frameworks to better understand human behavior. However, within recent years there has tended to be greater emphasis placed on understanding what areas of the brain are involved in general cognitive functions, and researchers have tended to forget the intricacies of cognition. The explosion in the use of fMRI and other functional imaging techniques has helped to deemphasize the importance of understanding how cognitive processes can fractionate along important theoretical lines. As a result, we are often confronted with research that is devoid of theory and does little to advance our understanding of how the brain and mind work. In her edited book, The Handbook of Cognitive Neuropsychology: What Deficits Reveal About the Human Mind, Brenda Rapp has admirably assembled a collection of chapters that reminds us of the importance of how neurological patients can inform us about the mind, and, in my opinion, how such findings can and should be used to provide a theoretical road map to understanding brain-behavior relationships.