While language facility was once considered to be the sole province of the “dominant” left hemisphere, clinical and experimental findings suggest the right hemisphere plays an equally important role in many language tasks. To elucidate differential hemispheric language processes, Right Hemisphere Language Battery and Western Aphasia Battery data from left (LHD) and right (RHD) hemisphere cerebral vascular accident (CVA) patients and controls were subjected to multivariate discriminant analysis. The highly significant group differences and overall 95% classification rate obtained confirms the utility of the dependent measures in differential diagnosis. Results suggest CVA patients experience disparate language deficits, with the LHD group experiencing concordant-convergent language deficits and the RHD group displaying discordant–divergent deficits that interfere with the receptive and expressive language skills necessary for successful social discourse. (JINS, 2001, 7, 655–664.)

Recent research has demonstrated deficits on effortful executive tasks involving planning in multiple sclerosis (MS) patients. Given the high prevalence of depression in MS and the commonly reported link between depression and performance on executive tasks, planning impairments in MS may be associated with depression. We compared the performance of depressed and nondepressed MS patients on a planning task (Tower of London–TOL) to evaluate this hypothesis. Compared with nondepressed MS patients, depressed MS patients made significantly (p < .05) more moves and took more time per trial on the TOL. A follow-up regression analysis was conducted that included the TOL and speeded attentional/working memory task indices found to be associated with depression in MS from the authors' prior reports. This analysis revealed that 25% of the variance in depression scores was predicted by the most sensitive speeded attentional/working memory task. Furthermore, this variance overlapped completely with variance predicted by the TOL–time/trial index. The only clearly nonspeeded task index, TOL–moves per trial, was associated with unique variance (8%) in predicting MS depression scores. These results suggest that slowed information processing speed and, secondarily, deficient nonspeeded central executive skill, may be core to the cognitive deficits characteristic of depressed MS patients. (JINS, 2001, 7, 665–674.)

This study compared the ability of clinical and ecologic simulation measures to predict performance on environment-specific criterion measures of wayfinding. Thirty-one unilateral stroke participants comprised the right and left hemisphere groups (16 patients with left sided and 15 patients with right sided strokes). Participants completed a battery of clinical tasks (e.g., traditional paper-and-pencil measures of visualization, mental rotation, visual memory and spatial orientation), ecologic simulations (e.g., slide route recall and visualization of a model town from differing perspectives) and environment specific criterion tasks (e.g., route recall and directional orientation). The groups were equivalent in age, sex, education, handedness, and weeks since stroke. Both ecologic simulation tasks were found to have fairly good internal consistency and 1 simulation task was significantly related to real world wayfinding. Of the clinical tasks, 1 visual memory test was correlated with a directional orientation criterion task, but none correlated with route navigation ability. Results are consistent with literature purporting the benefits of ecologic simulation tasks as predictors of real world functioning. (JINS, 2001, 7, 675–682.)

Attentional–inhibitory control and social–behavioral regulation are two outcome domains commonly impaired after childhood closed head injury (CHI). We compared neuropsychological tests of attentional–inhibitory control (vigilance, selective attention, response modulation) and social discourse and intentionality (inferencing, figurative language, and speech acts) with parent ratings of attention and behavioral regulation in relation to four injury- related variables: age at CHI, time since CHI, CHI injury severity, and frontal lobe injury moderated by CHI severity. Participants were 105 school-aged children in the chronic stage of CHI, divided into mild, moderate, and severe injury severity groups, and further subdivided according to frontal lobe injury. Outcome indices were imperfectly correlated in the group as a whole, although several relations between neurocognitive tests and parent ratings were observed within CHI subgroups. Different domains of cognitive function had different predictors. For attentional–inhibitory control, age at injury and time since injury were most predictive of outcome; for social discourse, predictors were injury severity and frontal lobe injury moderated by injury severity. Variability in cognitive outcome after childhood CHI is not random, but appears related to age, time, and biological features of the injury. (JINS, 2001, 7, 683–692.)

Neuropsychology, with its emphasis on standardized and empirically based methods, has made a number of scientific contributions to address growing concerns about concussions resulting from sports injuries. This study employs a test–retest paradigm to determine the immediate effects of concussion in high-school and college athletes. The Standardized Assessment of Concussion (SAC) was administered to 1,313 male athletes prior to the beginning of the competitive season. Reliable change indices and multiple regression models were computed on retest scores obtained from 68 noninjured athletes who were readministered the SAC at either 60 or 120 days following baseline testing. Receiver operating characteristic (ROC) curve analyses were used to test these models with data obtained on 50 athletes tested immediately following concussion. The results indicate that a decline of 1 point on the SAC at retesting classified injured and noninjured participants with a level of 94% sensitivity and 76% specificity. The RCI and multiple regression models provided comparable levels of group classification, but provided cut-offs that are conservative for use with this population. The results support and extend previous research findings indicating that the SAC is a valid instrument for detecting the immediate effects of mild traumatic brain injury. (JINS, 2001, 7, 693–702.)

Gender specific discrepancies on psychometric examination are often interpreted to reflect static differences in cerebral hemisphere specialization, but dynamic alterations relating to circulating gonadal hormones may also be relevant after puberty. The often cited inference of a right hemisphere advantage in males and left hemisphere advantage in females derived from small but reliable differences on spatial tasks and verbal tasks, for example, may to some extent relate to gender-specific differences in circulating gonadal hormones. Performance fluctuations on other higher order cognitive tasks through the menstrual cycle tend to support a temporal association between alterations in cerebral laterality and hormone fluctuations. A potential left hemisphere advantage after menstruation when estrogen and progesterone levels are high in contrast to a right hemisphere advantage at menstruation when estrogen and progesterone levels are low has also received support from shifts in visual field perception. The present investigation continues this line of work by measurement of prospective changes in unirhinal olfactory acuity in the menstrual, ovulatory, and midluteal phases of the menstrual cycle in 11 healthy women who agreed to blood assays of estradiol and progesterone prior to completing a modified version of the Connecticut Chemosensory Perception Exam (CCPE). The CCPE detection of n-butanol showed a clear pattern of changes over the menstrual cycle marked by an asymmetry favoring the right nostril during menstruation when estradiol and progesterone levels were low, an asymmetry favoring the left nostril during ovulation when estradiol levels were high and progresterone levels were low, and an absence of asymmetry during the midluteal phase when estradiol levels decreased and progesterone levels increased. Preliminary correlation analyses revealed a potential competitive influence of estradiol and progesterone on this apparent shift in cerebral laterality. There is thus sufficient evidence to conclude that dynamic changes in relative cerebral hemisphere advantages have a temporal relation to fluctuations in circulating gonadal hormones and to suggest the value of additional investigation of more specific causal relations. (JINS, 2001, 7, 703–709.)

The contribution of the striatum to category learning was examined by having patients with Parkinson's disease (PD) and matched controls solve categorization problems in which the optimal rule was linear or nonlinear using the perceptual categorization task. Traditional accuracy-based analyses, as well as quantitative model-based analyses were performed. Unlike accuracy-based analyses, the model-based analyses allow one to quantify and separate the effects of categorization rule learning from variability in the trial-by-trial application of the participant's rule. When the categorization rule was linear, PD patients showed no accuracy, categorization rule learning, or rule application variability deficits. Categorization accuracy for the PD patients was associated with their performance on a test believed to be sensitive to frontal lobe functioning. In contrast, when the categorization rule was nonlinear, the PD patients showed accuracy, categorization rule learning, and rule application variability deficits. Furthermore, categorization accuracy was not associated with performance on the test of frontal lobe functioning. Implications for neuropsychological theories of categorization learning are discussed. (JINS, 2001, 7, 710–727.)

This study investigated the effects of type of encoding strategy (organized and disorganized) and of active versus passive encoding on memory for interrelated spatial material. Delayed recall performance for a complex, nonrepresentational two dimensional figure was measured in 120 normal young adults assigned to one of three groups that varied as to the approach used during the initial construction of the figure. Those applying self-generated strategies performed best. In addition, recall performances were significantly better for those applying a prescribed, organized strategy as compared with performances of those applying a prescribed, disorganized strategy. These effects were not attributable to differences on measures of IQ or spatial information processing. The findings indicated that, independent of memory ability, both the degree of organization and of active strategizing at encoding are determinants of recall ability for complex spatial information and suggest that these factors have implications for memory processes more generally. (JINS, 2001, 7, 728–733.)

Even though early treatment of congenital hypothyroidism (CH) with newborn screening prevents the mental retardation previously seen in cretinism, affected children still exhibit subtle persisting neurocognitive deficits. One of their commonest problems is poor attention, which reflects both early disease severity and later (high) circulating thyroid hormone levels. While attention is currently regarded as multicomponential in nature, with different processing components supported by different brain regions, the specific components of attention affected by CH have not been identified. In light of animal evidence showing that neonatal thyroid hormone deficiencies impede the neurodevelopment of structures important for selective aspects of attention, we proposed a multicomponential approach to study attention in children with CH. This was accomplished via retrospective analysis of existing data on adolescents with CH whose attention was previously evaluated using multiple tests. Results showed significantly poorer overall attention in CH than controls with differences occurring mainly on focus and inhibit indices. However, performance on various indices was associated with different disease parameters. Poor encode and focus were correlated with more severe hypothyroidism and a longer period of thyroid hormone insufficiency and poor select and shift with higher thyroid hormone levels at testing. These results signify that thyroid hormone is important for the development and later regulation of brain structures supporting distinct aspects of attention. (JINS, 2001, 7, 734–744.)

Abnormalities of inflammatory and hormonal measures are common in SLE patients. Although cognitive dysfunction has been documented in SLE patients, the biological mechanism of these deficits has not been clarified. The goal of this study was to explore the relationship between inflammatory and hormonal activity and measures of learning, fluency, and attention in systemic lupus erythematosus patients without neuropsychiatric symptoms (non-CNS–SLE), patients with rheumatoid arthritis (RA), and healthy controls (HC). Fifteen non-CNS–SLE patients, 15 RA patients and 15 HC participants similar in age, education, and gender (female) were compared on tests of cognition, depression, and plasma levels of interleukin-6 (IL-6), dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEA-S) and cortisol. Non-CNS–SLE patients demonstrated lower learning and poorer attention. Furthermore, non-CNS–SLE and RA patients had significantly lower levels of DHEA and DHEA-S than HC participants. Hierarchical regression analysis demonstrates that DHEA-S and IL-6 accounts for a unique portion of the variance in subject performance on measures of learning and attention after controlling for depression and corticosteroid treatment. This data highlights the value of hierarchical analyses with covariates, and provides evidence in humans of a relationship between peripheral cytokine levels and cognitive function. (JINS, 2001, 7, 745–754.)

Child behavior problems, injury-related family burden, and parent psychological distress were assessed longitudinally over the first year post injury in 40 children with severe traumatic brain injury (TBI), 52 with moderate TBI, and 55 with orthopedic injuries not involving brain insult. Parents rated children's preinjury behavior soon after injury. Postinjury child behavior and family outcomes were assessed at 6- and 12-month follow-ups. Findings from path analysis revealed both direct and indirect effects of TBI on child behavior and family outcomes, as well as cross-lagged child-family associations. Higher parent distress at 6 months predicted more child behavior problems at 12 months, controlling for earlier behavior problems; and more behavior problems at 6 months predicted poorer family outcomes at 12 months, controlling for earlier family outcomes. Support for bidirectional influences is tentative given that limited sample size precluded use of structural equation modeling. The findings nevertheless provide impetus for considering the influences of person-environment interactions on outcomes of TBI. (JINS, 2001, 7, 755–767.)

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary brain disease with a variety of neurologic and psychiatric manifestations. We studied 3 members of a family who each had leukoencephalopathy on neuroimaging studies and a characteristic mutation for CADASIL in the notch 3 region of chromosome 19q12. In all 3 cases, neurobehavioral impairment dominated the clinical picture, and a pattern of psychiatric dysfunction heralding cognitive decline emerged. Neuropsychological evaluation revealed diverse deficits, but a profile of frontal lobe dysfunction, declarative memory impairment suggestive of a retrieval deficit, and relatively preserved language was evident. These cases provide a cross-sectional study of the evolution of CADASIL, and suggest that, as in other diseases characterized by white matter dementia, psychiatric dysfunction may occur initially, followed by pervasive cognitive dysfunction later in the course of the disease. CADASIL should be considered in young adults with unexplained leukoencephalopathy on neuroimaging studies, and in those with neurobehavioral dysfunction and a suggestive family history. (JINS, 2001, 7, 768–774.)

We have been very interested in the article of Castellon et al. (2000) on the neuropsychiatric disturbances present in HIV-infection, which reports results very congruent with those published previously by our research group. Indeed, for many years we have studied psychopathological perturbations (depression and anxiety) as well as more specific emotional dimensions like emotional deficit and loss of control in HIV positive patients.

The findings reported in the Letter to the Editor authored by Bungener and Jouvent are consistent with results we have presented here (Castellon et al., 2000) and again underscore the importance of considering the potentially multifactorial nature of depression in many neurologic diseases/disorders. We have suggested, although the idea is hardly a new one, that depression in HIV/AIDS can be secondary to any of multiple potential etiologies. For example, it may be a direct central nervous system (CNS) consequence of infection (i.e., neurochemical and/or neuropathological changes), a result of increased exposure to social, medical, and financial stressors secondary to living with HIV, a reaction to multiple losses (e.g., bereavement, loss of instrumental capacity), or be an admixture of multiple etiological factors. The phenomenology of this disruption of mood, motivation, and affect may differ as a function of etiology/pathophysiology. We believe that a prominent amotivation/apathy syndrome may be a more pure manifestation of the CNS effects of HIV-1 infection than is the more heterogeneous construct of depression and therefore more closely associated with other putative measures of CNS integrity (e.g., neurocognitive performance).

In this ambitious and densely written volume, Glezerman and Balkoski attempt to present their theory of the neural basis for language and thought, and provide evidence from the literature to support their model. Their model is based on a neurobehavioral analysis of movement by the Russian physiologist Nicolai Bernstein. He proposed “horizontal” (intrahemispheric), “vertical” (hierarchical), and interhemispheric principles of brain organization that Glezerman and Balkoski have applied to the cerebral organization of language. Bernstein's basic model is described in detail in the first chapter of the book. The subsequent four chapters each consider a specific brain region and a related aspect of language and thought. Each of these chapters begins with a description of the relevant neuroanatomy. The authors then review the cognitive processes and knowledge that this brain area supports. Each chapter then considers the relevant form of aphasia that emerges following insult to the area under discussion. For example, the second chapter is concerned with temporal–occipital cortices and the role of this brain region in visual object perception, thought, and the meanings of individual words. After describing the regional anatomy, the authors characterize their perspective on object perception and how the breakdown of this process can lead to visual agnosia. Glezerman and Balkoski then relate this to the cerebral organization of word meaning and to disorders of naming. Chapter 3 is concerned with lateral temporal cortex and phonologic representations of words. The authors discuss the sound codes of a word, and how this coding process can break down

Neuropsychology owes much to the pioneering efforts of researchers in cognitive psychology. Theory and methods derived from the cognitive sciences have provided an important foundation for neuropsychology. The Attention and Performance series has been at the vanguard of cognitive psychology, both chronicling major developments in cognitive science that emerged over the past half century, and catalyzing new directions in cognitive theory, method, and application. Most students of psychology can probably recall some time during their undergraduate or graduate studies, pulling from university library shelves, one of the earlier volumes of this series, as they prepared a term paper, thesis, or research project. The 17th volume of Attention and Performance of this edited series was the product of the proceedings of the International Association for the Study of Attention and Performance, held in Haifa, Israel, 30 years after the first edition in 1966. Reviewing the topics covered in the earlier editions, one is struck by the extent to which this series has both mirrored current direction and anticipated shifts in the paradigms of cognitive science.

As individuals gain expertise in a chosen field they can begin to conceptualize how what they know can be applied more broadly, to new populations and situations, or to increase desirable outcomes. Judd's book does just this. It takes our current understanding of the etiology, course, and sequelae of brain injuries, combines this with established psychotherapy and rehabilitation techniques, and expands these into a cogent model of what Judd calls “neuropsychotherapy.” Simply put, neuropsychotherapy attempts to address the cognitive, emotional and behavioral changes in brain-injured persons, changes that may go undiagnosed, misdiagnosed, or untreated.

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).