The objective of this study is to determine (a) if decision making ability is impaired in patients with anorexia nervosa (AN) and in people with good recovery from AN and (b) whether any impairment in decision making is associated with alterations in skin conductance responses (SCR). Patients with AN (n = 29), healthy controls comparable in age and IQ (HC, n = 29), and women long term recovered from AN (n = 14), completed the Iowa Gambling Task (IGT) while their SCR were measured. AN patients performed poorly in the IGT compared to the HC and to the recovered AN participants. AN patients had decreased anticipatory SCR prior to choosing cards and reduced SCR after losses compared to HC. IGT performance and the SCR of recovered AN participants did not differ from the HC. Decision making ability is impaired in AN. It is associated with a significantly attenuated SCR. Neither of these features are found in recovered AN. The association between impaired decision making ability and a decreased autonomic response is consistent with the predictions of the Somatic Marker Hypothesis. (JINS, 2007, 13, 635–641.)

This study followed 118 HIV+ individuals who had taken steps to return to work to determine facilitators or barriers in returning to work. Over the two-year study period, 52% of the participants obtained employment. Memory function served as the most potent predictor of obtaining employment. Persons who were younger, did not have a diagnosis of AIDS and who had shorter periods of unemployment prior to entering the study also had better chances of finding employment during the study. After finding employment, participants reported lower levels of depression as well, an apparent result of their obtaining employment. These findings indicate that memory is a key neuropsychiatric variable that is perhaps most relevant to HIV+ persons' quest to return to work. (JINS, 2007, 13, 80–89.)

Competing hypotheses about neuropsychological mechanisms underlying psychopathy are seldom examined in the same study. We tested the left hemisphere activation hypothesis and the response modulation hypothesis of psychopathy in 172 inmates completing a global–local processing task under local bias, global bias, and neutral conditions. Consistent with the left hemisphere activation hypothesis, planned comparisons showed that psychopathic inmates classified local targets more slowly than nonpsychopathic inmates in a local bias condition and exhibited a trend toward similar deficits for global targets in this condition. However, contrary to the response modulation hypothesis, psychopaths were no slower to respond to local targets in a global bias condition. Because psychopathic inmates were not generally slower to respond to local targets, results are also not consistent with a general left hemisphere dysfunction account. Correlational analyses also indicated deficits specific to conditions presenting most targets at the local level initially. Implications for neuropsychological conceptualizations of psychopathy are considered. (JINS, 2007, 13, 267–276.)

Recent studies of brain injured and healthy individuals have provided empirical support for the theoretical proposition that executive function and general intelligence are closely associated by demonstrating that performance on tests of executive function is correlated with general intellectual ability (g). In the present investigation, the relationship between performance on the Wechsler Adult Intelligence Scale-III (WAIS-III), as a measure of g, and performance on recently developed ecological tests of executive function [i.e., Hayling and Brixton, Zoo Map and Key Search sub-tests from the Behavioral Assessment of the Dysexecutive Syndrome (BADS) battery], was examined in a sample of 118 severely brain injured individuals. The results indicated that (a) performance on tests of executive function share significant variance, and (b) a proportion of that shared variance is associated with performance on the WAIS-III. Correlations between conventional measures of executive function (i.e. Trails B and Controlled Oral Word Association) and WAIS-III were of comparable magnitude to the correlations between new, ecologically valid executive tests and WAIS-III. The results provide some support to the notion that tests of executive function measure non-specific intellectual functions, reminiscent of g. (JINS, 2007, 13, 90–98.)

We assessed the prediction that object structural cues could benefit the learning of object–action relationships in ideomotor apraxia (IMA). A total of 15 patients with left-hemisphere stroke, 11 of whom exhibited IMA, and 10 healthy subjects were trained to match novel gestures to novel tool pictures that were either High- or Low-Afforded by their associated tools. Learning was assessed with recognition and production tests. Only IMA patients demonstrated better recognition of High- than Low-Afforded gestures, and their recognition of High-Afforded gestures was statistically comparable to the other groups. This finding suggests that apraxics may rely abnormally on object structure when learning to associate novel gestures and tools. Finally, the “affordance benefit” was associated with relative sparing of structures in the dorsal visual processing stream. These data are consistent with the proposal that two routes may mediate skilled action, one specialized for stored information, and the other responsive to object structure, and that deficient gesture learning may be compensated by “bootstrapping” intact dorsal stream coding of action. (JINS, 2007, 13, 997–1008.)

Awareness of cognitive dysfunction shown by individuals with Mild Cognitive Impairment (MCI), a condition conferring risk for Alzheimer's disease (AD), is variable. Anosognosia, or unawareness of loss of function, is beginning to be recognized as an important clinical symptom of MCI. However, little is known about the brain substrates underlying this symptom. We hypothesized that MCI participants' activation of cortical midline structures (CMS) during self-appraisal would covary with level of insight into cognitive difficulties (indexed by a discrepancy score between patient and informant ratings of cognitive decline in each MCI participant). To address this hypothesis, we first compared 16 MCI participants and 16 age-matched controls, examining brain regions showing conjoint or differential BOLD response during self-appraisal. Second, we used regression to investigate the relationship between awareness of deficit in MCI and BOLD activity during self-appraisal, controlling for extent of memory impairment. Between-group comparisons indicated that MCI participants show subtly attenuated CMS activity during self-appraisal. Regression analysis revealed a highly significant relationship between BOLD response during self-appraisal and self-awareness of deficit in MCI. This finding highlights the level of anosognosia in MCI as an important predictor of response to self-appraisal in cortical midline structures, brain regions vulnerable to changes in early AD. (JINS, 2007, 13, 450–461.)

The study investigated the nature of the effects of maternal epilepsy on cognitive performance of the offspring. One hundred fifty-four children of mothers with epilepsy aged 5 to 11 years (study group), along with 130 control children, comparable with respect to IQ, socio-economic status, age, and gender underwent a neuropsychological assessment using subtests from the NEPSY: A Developmental Neuropsychological Assessment, tapping attentional, auditory-verbal, visuomotor, fine motor, and memory abilities. The study group scored significantly lower than the controls on measures of attention, memory, and fine-motor function. Deficits were more marked in but not limited to the subset of the study group exposed to maternal medication in utero. Group differences on auditory attention were found only in younger children. Valproate-exposed children obtained lower scores on sentence repetition, as well as on the more demanding part of a test of auditory attention, than other children in the study group, suggesting weaknesses in working memory in the former subgroup. Confounding by maternal epilepsy type and polytherapy complicate interpretation of this finding. Differences between subsets of children not exposed to anti-epileptic drugs in utero and controls suggest that both drug exposure and genetic factors may contribute to cognitive deficits associated with maternal epilepsy. (JINS, 2007, 13, 642–652.)

Hallucinations have been found associated with false detection or false recognition of acoustic/verbal material in several studies. We investigated whether they were also linked with false recognition of pictures. Furthermore, an association between hallucinations and deficits in remembering temporal context was observed in previous research on schizophrenia. We investigated whether the association extends to deficits in remembering spatial context. Forty-one patients with schizophrenia underwent a visual memory task. Sixteen mixed black-and-white and colored pictures were presented at different locations. Participants had to recognize the pictures among distractors, then to recall the spatial context of the presentation of the target pictures. Results showed that auditory hallucinations were associated with poor recognition of the colored pictures. When recognition efficiency and negative symptoms were statistically controlled, auditory hallucinations were also associated with increased response bias toward false recognition of nontarget pictures, and with errors in remembering the spatial context. No associations with visual hallucinations emerged. Anhedonia was associated with response bias, in the direction opposite to that of hallucinations. In conclusion, the association between hallucinations and response bias extends across modalities to picture recognition. The association between hallucinations and temporal context impairment extends to spatial context. (JINS, 2007, 13, 832–838.)

The role of various types of slowing of processing speed, as well as the role of depressed mood, on each stage of verbal memory functioning in patients diagnosed with schizophrenia was investigated. Mixed lists of high- and low-frequency words were presented, and immediate and delayed free recall and recognition were required. Two levels of encoding were studied by contrasting the relatively automatic encoding of the high-frequency words and the more effortful encoding of the low-frequency words. Storage was studied by contrasting immediate and delayed recall. Retrieval was studied by contrasting free recall and recognition. Three tests of motor and cognitive processing speed were administered as well. Regression analyses involving the three processing speed measures revealed that cognitive speed was the only predictor of the recall and recognition of the low-frequency words. Furthermore, slowing in cognitive speed accounted for the deficit in recall and recognition of the low-frequency words relative to a healthy control group. Depressed mood was significantly associated with recognition of the low-frequency words. Neither processing speed nor depressed mood was associated with storage efficiency. It is concluded that both cognitive speed slowing and depressed mood impact on effortful encoding processes. (JINS, 2007, 13, 99–107.)

The influence of action knowledge associated with novel objects was investigated using functional magnetic resonance imaging. Participants were trained on complex actions associated with novel objects (“tools”) and had experience manipulating other visually similar novel objects (“shapes”). During scanning, participants viewed, imagined grasping, and imagined using the objects. Based on previous neuroimaging and neuropsychological findings, our primary goal was to examine frontal and parietal regions subserving action representations associated with visual objects, namely the left inferior parietal lobule (IPL), the left ventral premotor cortex (VPM) and the presupplementary motor cortex (pre-SMA). We predicted differences between the tool and shape stimuli, modulated also by task demands. In viewing, we found greater effect sizes in the left VPM and IPL for tools versus shapes. In grasping, there was similar activation with both object types. The largest differences existed in using, in which greater effect sizes were found for tools versus shapes in left IPL and pre-SMA, and marginally in the left VPM. We suggest that representations of tools extend beyond classically defined affordances and recruit processing about both graspability and known action plans in tasks involving visual memory, motor imagery, and motor execution. (JINS, 2007, 13, 1009–1020.)

We examined the ability of 23 schizophrenia patients and 24 healthy controls to exert intentional inhibition of prepotent responses in the Think-No-Think (TNT) paired-associate learning paradigm (Anderson & Green, 2001). TNT manipulates the frequency (1, 8, 16 times) of intentional attempts to suppress (inhibit) some target words and to respond to most cue words. Following a TNT practice-phase, recall of suppressed words was tested in two ways, using the same cue words initially learned, and the category name plus letter-stem of the target words. Inhibition of prepotent responses was also examined in a random number generation (RNG) task. In TNT, speed results showed longer reaction times after 16 suppress attempts in patients, not in controls, reflecting increased difficulty with retrieving the memory traces of the overridden items. In accuracy, no between-groups differences were evidenced, and overall patterns replicated those of Anderson & Green. In RNG, patients produced more stereotyped responses and ascending and descending counting than controls, pointing to on-line failures to inhibit prepotent responses. These findings suggest that schizophrenia patients' difficulties to inhibit prepotent responses appear specific, not widespread, the intentional inhibition addressed in TNT being preserved, and on-line inhibition in RNG being impaired. (JINS, 2007, 13, 277–287.)This paper was presented at the 4th International Conference on Memory, July 16–21, 2006, in Sydney, Australia.

A hallmark of schizophrenia is impaired proverb interpretation, which could be due to: (1) aberrant activation of disorganized semantic associations, or (2) working memory (WM) deficits. We assessed 18 schizophrenia patients and 18 normal control participants on proverb interpretation, and evaluated these two hypotheses by examining within patients the correlations of proverb interpretation with disorganized symptoms and auditory WM, respectively. Secondarily, we also explored the relationships between proverb interpretation and a spectrum of cognitive functions including auditory sensory-memory encoding (as indexed by the mismatch negativity (MMN) event-related brain potential (ERP)); executive function; and social/occupational function. As expected, schizophrenia patients produced less accurate and less abstract descriptions of proverbs than did controls. These proverb interpretation difficulties in patients were not significantly correlated with disorganization or other symptom factors, but were significantly correlated (p < .05) with WM impairment, as well as with impairments in sensory-memory encoding, executive function, and social/occupational function. These results offer no support for disorganized associations in abnormal proverb interpretation in schizophrenia, but implicate WM deficits, perhaps as a part of a syndrome related to generalized frontal cortical dysfunction. (JINS, 2007, 13, 653–663.)

Differing degrees of head motion have long been recognized as a potential confound in functional neuroimaging studies comparing neuropsychiatric populations to healthy normal volunteers, and studies often cite excessive head motion as a possible reason for the different patterns of functional activation frequently observed between groups. We empirically tested the degree of head motion in 16 patients with chronic schizophrenia and 16, age- and education-matched controls during the acquisition of functional magnetic resonance imaging data. We examined the degree of motion across three different indices (total motion, relative motion, task-correlated motion) during a complex attentional task and the effect of entering the motion parameters as additional regressors in a general linear model analysis. Results indicate that individuals with schizophrenia did not exhibit more task-correlated or total motion compared with controls. Moreover, the residual error term from the general linear model analysis was similar for both groups of subjects. In conclusion, current results suggest that stable patients with schizophrenia are capable of controlling head motion compared with matched normal controls. However, a direct comparison of the motion parameters is an essential step for any quality assurance protocol to determine whether additional corrective techniques need to be implemented. (JINS, 2007, 13, 839–845.)

Neuropsychological tests generally require adjustments for years of education when determining the presence of neurocognitive impairment. However, evidence indicates that educational quality, as assessed with reading tests, may be a better reflection of educational attainment among African Americans. Thus, African Americans with poor educational quality may be incorrectly classified with neurocognitive impairment based on neuropsychological tests. We compared the accuracy of neuropsychological test scores standardized using reading grade-equivalent versus years of education in predicting neurocognitive impairment among a sample of Whites and African-American adults who were HIV+. Participants were examined by a neurologist and classified with or without HIV-associated neurocognitive disorders according to accepted criteria. Participants were also classified as impaired versus not impaired based on their neuropsychological test scores standardized by 1) self-reported education or 2) WRAT-3 reading grade-level. Cross tabulation tables were used to determine agreement of the two methods in detecting impairment. Among African-Americans, standardized scores derived from reading scores had greater specificity than those derived from years of education (84.1% vs. 77.3). Among the Whites, correction based on years of education had both greater specificity and sensitivity. The results suggest that reading tests may be a useful alternative for determining NCI among African Americans. (JINS, 2007, 13, 462–470.)

Reliable neuropsychological markers of right temporal integrity have proven elusive. Specifically it is unclear whether figural and spatial aspects of visual memory are differentially affected by right temporal lobe epilepsy (TLE) and subsequent resection. To investigate this we used the modified Rey Complex Figure (RCF) scoring system devised by Brier et al. (1996) to obtain separate indices of figural and spatial memory in TLE surgery candidates. We extended on their study by examining presurgical performance and change following right and left temporal lobectomy (RATL, n = 38, LATL, n = 42) in individuals from a cross-institutional sample with and without hippocampal sclerosis (HS+/HS−). Contrary to expectation neither figural nor spatial RCF recall were differentially sensitive to RTLE, right HS, or subsequent resection. Presurgically, laterality effects on both figural and spatial memory indices were not found although HS− individuals significantly outperformed HS+ individuals on both measures. Following surgery the largest decrements in both figural and spatial recall were observed among LATL HS− participants. We concluded that RCF recall is a poor marker of right temporal lobe function and suggest it may be a “surrogate” measure of left temporal lobe function possibly due to the verbalizability of many of its components. (JINS, 2007, 13, 664–671.)

Type 2 diabetes mellitus (DM2) is a common metabolic disorder. DM2 is associated with cognitive impairments, and with depressive symptoms, which occur in about one third of patients. In the current study we compared the cognitive profile and psychological well-being of 119 patients with DM2 (mean age: 66 ± 6; mean duration: 9 ± 6 years) with 55 age and education matched-control participants. Groups were compared on cognitive performance in five major cognitive domains, psychological wellbeing [assessed by Symptom Checklist (SCL)-90-R and the Beck Depression Inventory (BDI-II)] and abnormalities on brain MRI. We hypothesized an interrelationship between cognition, MRI abnormalities, and psychological well-being. DM2 patients performed significantly worse than controls on cognitive tasks, especially on tasks that required more mental efficiency, although the differences were modest (effect sizes Cohen d < .6). We speculate that DM2 patients have a diminished ability to efficiently process unstructured information. Patients with DM2 had significantly higher scores on the SCL-90-R (p < .001) and on the BDI-II (p < .001) and worse MRI ratings than controls, but psychological distress did not correlate with cognition, MRI ratings or biomedical characteristics. Contrary to our hypothesis, cognitive disturbances and psychological distress thus seem independent symptoms of the same disease. (JINS, 2007, 13, 288–297.)

Based on his seminal contributions in 1891 and 1892, Dejerine is widely credited for initiating the investigation of acquired dyslexia. In the first contribution (1891) he described a patient who developed an inability to read and write after suffering an infarction of the left hemisphere. Dejerine designated the disorder “Alexia with Agraphia”; he attributed it to a loss of the “optical images” of words that were presumed to be supported by the angular gyrus. In 1892, Dejerine described a patient who was able to write but could not read what he (and others) had written (Dejerine, 1892). This disorder, variously known as Alexia without Agraphia, Pure Alexia or Agnosic Alexia, has been reported with regularity since the original account. Although subsequent reports have noted aspects of the disorder not emphasized in Dejerine's index case—pure alexia may be associated with surface (Patterson & Kay, 1982) or deep (Buxbaum & Coslett, 1996) dyslexia—the essential features of the disorder were well documented by Dejerine and the syndrome remains quite consistent with respect to its core phenomenology. Similarly, the pathologic substrate of the disorder has proven to be remarkably constant: the vast majority of patients with pure alexia have lesions involving the occipital lobe of the dominant hemisphere and either the forceps major or, less commonly, the splenium of the corpus callosum. The latter component of the lesion interrupts the white matter tracts connecting the visual association cortices of the right and left hemispheres.

Past research suggests that the similarity between the objects associated with actions impacts visual action identification and action production. Indeed, people often confuse actions that are visually similar, as well as actions that are associated with visually similar objects. However, because the action errors often involve actions that are visually similar and are associated with visually similar objects, it is difficult to disambiguate between the influences of object similarity and action similarity. In our experiments, healthy participants were asked to learn to associate nonword names and actions with novel objects. Participants were first shown each object and its action and were then asked to visually identify each object. In Experiment 1, participants were then asked to produce the action associated with each object, and in Experiment 2, they were asked to visually identify the action associated with each object. Actions were confused more often when they were associated with similar objects than when they were associated with dissimilar objects. Furthermore, following an object naming error, participants were more likely to produce the action associated with the erroneous name than any other erroneous action. The results suggest that the visual characteristics of the objects influenced action production and action identification. (JINS, 2007, 13, 1021–1034.)

Intense language training has been found to be more efficient in the rehabilitation of chronic aphasia than treatment spread across time. Intense treatment, however, challenges personnel and financial resources of the health care system. The present study examined, whether laypersons can be trained to apply standardized language training for chronic aphasia with effects comparable to training by experts. Twenty individuals with chronic aphasia participated in the training, Constraint-Induced Aphasia Therapy (CIAT), which comprises communicative language games with increasing level of difficulty in a motivating context for 3 hr/day on 10 consecutive days. Following a random-control design, training was applied either by experienced therapists (n = 10) or trained laypersons (n = 10). Standardized language assessments revealed significant within-group improvements, however, between-group differences were not present. We conclude that a standardized training program, such as CIAT, can be efficiently accomplished by trained laypersons with results comparable to that of experienced therapists. (JINS, 2007, 13, 846–853.)

Deficits in emotional recognition and perception following traumatic brain injury (TBI) have been associated with alexithymia (Henry et al., 2006; Williams et al., 2001). This study examined the prevalence of alexithymia in a TBI population, and its relationship to injury severity, neuropsychological ability and affective disorder. A total of 121 patients completed the Toronto Alexithymia Scale-20 (TAS-20), a measure that addresses 3 distinct characteristics of the alexithymia concept; difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking. Patients also completed a neuropsychological assessment and measures of depression and anxiety. Results confirm a high prevalence of alexithymia after TBI, relative to the general population and an orthopedic control group. There was no relationship between injury severity and the presence of alexithymia. A negative relationship was found between alexithymia and verbal and sequencing abilities, but there was no relationship with executive dysfunction or any other cognitive domain. Moderate correlations were obtained between alexithymia and affective disorder; regression analyses indicated that alexithymia, depression, and anxiety should be considered distinct, but overlapping constructs. The results of this study suggest that increased neuropsychological attention should be directed towards emotional change after head injury and its relationship with cognition and psychosocial outcome. (JINS, 2007, 13, 471–479.)