Debate continues about the long-term neuropsychological impact of multiple mild traumatic brain injuries (MTBI). A meta-analysis of the relevant literature was conducted to determine the impact of having a history of more than one self-reported MTBI (versus just one MTBI) across seven cognitive domains, as well as symptom complaints. The analysis was based on 8 studies, all conducted with athletes, involving 614 cases of multiple MTBI and 926 control cases of a single MTBI. The overall effect of multiple MTBI on neuropsychological functioning was minimal and not significant (d = 0.06). However, follow-up analyses revealed that multiple self-reported MTBI was associated with poorer performance on measures of delayed memory and executive functioning. The implications and limitations of these findings are discussed. (JINS, 2010, 16, 262–267.)

Spontaneous confabulation involves the production of false or distorted memories, and is commonly associated with ventromedial prefrontal damage. One influential theory proposes that the critical deficit is a failure to suppress currently irrelevant memory traces that intrude into ongoing thinking (Schnider & Ptak, 1999). In this study, we report experimental investigations with three spontaneously confabulating patients aimed at exploring this account. Using Schnider and Ptak’s (1999) continuous recognition paradigm, we replicated their experimental results with our patients. However, our data suggest that the critical impairment might be more generalized than a failure to suppress currently irrelevant memories. First, a temporal source monitoring task failed to show that previous memory traces intrude into the present. Second, a reality monitoring task revealed that confabulating patients had a tendency to misidentify imagined events as real, a result that cannot be explained in terms of temporal confusion. This error was specific to confabulating patients and was not shared by non-confabulating ACoA patients. Our data therefore suggest a more generalized impairment in source monitoring, not only on the basis of temporality or current relevance, but across a range of contextual domains, including information used to distinguish real memories from imaginings. (JINS, 2010, 16, 984–994.)

Parkinson’s disease (PD) has several negative effects on speech production and communication. However, few studies have looked at how speech patterns in PD contribute to linguistic and social impressions formed about PD patients from the perspective of listeners. In this study, discourse recordings elicited from nondemented PD speakers (n = 18) and healthy controls (n = 17) were presented to 30 listeners unaware of the speakers’ disease status. In separate conditions, listeners rated the discourse samples based on their impressions of the speaker or of the linguistic content. Acoustic measures of the speech samples were analyzed for comparison with listeners’ perceptual ratings. Results showed that although listeners rated the content of Parkinsonian discourse as linguistically appropriate (e.g., coherent, well-organized, easy to follow), the PD speakers were perceived as significantly less interested, less involved, less happy, and less friendly than healthy speakers. Negative social impressions demonstrated a relationship to changes in vocal intensity (loudness) and temporal characteristics (dysfluencies) of Parkinsonian speech. Our findings emphasize important psychosocial ramifications of PD that are likely to limit opportunities for communication and social interaction for those affected, because of the negative impressions drawn by listeners based on their speaking voice. (JINS, 2010, 16, 49–57.)

Lhermitte (1983) coined the term “utilization behavior” (UB) to define a neurobehavioral syndrome in which the visuo-tactile presentation of objects compels patients to grasp and use them, despite the fact that they have not been instructed to do so. The author suggested that UB was the consequence of frontal lobe damage. Thereafter, Shallice, Burgess, Schon, and Baxter (1989) questioned Lhermitte’s (1983) procedure for eliciting UB, putting forward an alternative research methodology that led to differentiate two forms of UB: “induced” and “incidental.” To date, there has been no direct comparison between these two procedures, nor have any other methodologies been used to explore this clinical sign, which is related to fundamental concepts such as free will and human autonomy. We investigated UB in 70 subjects (25 patients with frontal lobe lesions, 10 patients with posterior brain damage and 35 control subjects) using the methodologies of Lhermitte (1983) and Shallice et al. (1989), as well as an original “verbal generation” procedure. Our results show that the verbal generation procedure reveals UB efficiently and that elicitation of this sign appears to be directly linked to the content of the task. We discuss the interpretation of UB in terms of an executive control deficit. (JINS, 2010, 16, 453–462.)

Proposals that adaptation with left-shifting prisms induces neglect-like symptoms in normal individuals rely on a dissociation between the postadaptation performance of individuals trained with left- versus right-shifting prisms (e.g., Colent, Pisella, & Rossetti, 2000). A potential problem with this evidence is that normal young adults have an a priori leftward bias (e.g., Jewell & McCourt, 2000). In Experiment 1, we compared the line bisection performance of young adults to that of aged adults, who as a group may lack a leftward bias in line bisection. Participants trained with both left- and right-shifting prisms. Consistent with our hypothesis, while young adults demonstrated aftereffects for left, but not right prisms, aged adults demonstrated reliable aftereffects for both prisms. In Experiment 2, we recruited a larger sample of young adults, some of whom were right-biased at baseline. We observed an interaction between baseline bias and prism-shift, consistent with the results of Experiment 1: Left-biased individuals showed a reduced aftereffect when training with right-shifting prisms and right-biased individuals showed a reduced aftereffect when training with left-shifting prisms. These results suggest that previous failures to find generalizable aftereffects with right-shifting prisms may be driven by participants’ baseline biases rather than specific effects of the prism itself. (JINS, 2010, 16, 795–804.)

There is increasing consensus regarding the importance of operationally defining and measuring functional decline in mild cognitive impairment (MCI). However, few studies have directly examined functional abilities in MCI or its presumed subtypes and, to date, reported findings have been discrepant. Nondemented older adults (n = 120) were administered a comprehensive cognitive battery measuring multiple domains as well as a performance-based functional ability measure. Participants were characterized as either cognitively normal, amnestic MCI, or non-amnestic MCI. MCI individuals demonstrated decrements in instrumental activities of daily living (IADL) relative to their cognitively normal counterparts. Specifically, participants with amnestic MCI demonstrated significant decrements in financial management, whereas those with non-amnestic MCI showed poorer performance in abilities related to health and safety. Moreover, decreased functional abilities were associated with decrements in global cognitive functioning but not memory or executive functions in the MCI participants. Finally, logistic regression demonstrated that functional abilities accurately predicted MCI subtype. Results support the need for better delineation of functional decline in MCI. Given the implications of functional status for MCI diagnosis and treatment, the direct assessment of functional abilities is recommended. Results further suggest performance-based IADL assessment may have utility in distinguishing MCI subtypes. (JINS, 2010, 16, 630–639.)

Subjective and mild cognitive impairment (SCI and MCI) are etiologically heterogeneous conditions. This poses problems for assessment of pathophysiological mechanisms and risk of conversion to dementia. Neuropsychological, imaging, and cerebrospinal fluid (CSF) findings serve to distinguish Alzheimer’s disease (AD) and other etiological subgroups. Tau-molecules stabilize axonal microtubuli; high CSF total tau (T-tau) reflects ongoing axonal damage consistent with AD. Here, we stratify patients by CSF T-tau pathology to determine if memory network diffusion tensor imaging (DTI) predicts memory performance in the absence of elevated T-tau. We analyzed neuropsychological test results, hippocampus volume (HcV) and white matter diffusivity in 45 patients (35 with normal T-tau). The T-tau pathology group showed more hippocampus atrophy and memory impairment than the normal T-tau group. In the T-tau normal group: (1) memory was related with white matter diffusivity [fractional anisotropy (FA) and radial diffusivity (DR)], and (2) FA of the genu corpus callosum was a unique predictor of variance for verbal learning, and HcV did not contribute to this prediction. The smaller sample size in the T-tau pathology group precludes firm conclusions. In the normal T-tau group, white matter tract and memory changes may be associated with normal aging, or with non-tau related pathological mechanisms. (JINS, 2010, 16, 58–69.)

Behaviorally spontaneous confabulation is characterized by a confusion of reality evident in currently inappropriate acts that patients justify with confabulations and in disorientation. Here, we describe a 38-year-old woman lawyer hospitalized because of non-herpetic, presumably autoimmune, limbic encephalitis. For months, she considered herself at work and desperately tried to respect her falsely believed professional obligations. In contrast to a completely erroneous concept of reality, she did not confabulate about her remote personal past. In tasks proposed to test strategic retrieval monitoring, she produced no confabulations. As expected, she failed in tasks of reality filtering, previously shown to have high sensitivity and specificity for behaviorally spontaneous confabulation and disorientation: she failed to suppress the interference of currently irrelevant memories and she had deficient extinction capacity. The observation underscores the special status of behaviorally spontaneous confabulation among confabulatory phenomena and of reality filtering as a thought control mechanism. We suggest that different processes may underlie the generation of false memories and their verbal expression. We also emphasize the need to present theories of confabulation together with experimental tasks that allow one to empirically verify the theories and to explore underlying physiological mechanisms. (JINS, 2010, 16, 995–1005.)

Executive function impairments in Parkinson’s disease (PD) are well documented. However, uncertainties remain regarding the impact of these deficits on other areas of cognitive functioning. The goal of this study was to provide a comprehensive assessment of cognitive characteristics in patients with PD without dementia and to assess how any such deficits affected other areas of cognitive functioning. Forty PD patients without dementia were compared to healthy controls using measures of attention and speed of processing and a comprehensive set of executive function tests including working memory, planning, and problem solving. Measures of memory/learning and visuospatial skills were also included to examine the relationship between aspects of executive function and other areas of cognition. Patients with PD showed deficits on measures of executive function, problem solving, and visuospatial skills. However, they were unimpaired on measures of planning, attention, and memory/learning. Deficits in problem solving were only evident for tasks with a high visuospatial content and were no longer significant when visuospatial skills were controlled for. While deficits in executive function and visuospatial skills were apparent for PD patients compared to controls, many aspects of cognition remained intact. These can provide a focus for cognitive intervention strategies that can be effective in delaying decline for PD patients. (JINS, 2010, 16, 268–277.)

Impaired insight for deficits (anosognosia) is common in Alzheimer’s disease (AD). However, it has not yet been determined clearly (a) whether different methods for assessing insight are comparable, and (b) whether anosognosia affects different domains to different degrees (domain-specificity). Impaired insight was investigated in 32 patients with AD, who were each accompanied by a caregiver. Anosognosia was assessed by a global clinical rating, questionnaire discrepancies (patient vs. caregiver) covering different domains, and performance discrepancies (self-assessment vs. performance) based on four neuropsychological tests which were compared with those of a healthy control sample. The results of clinical rating and questionnaire discrepancies were closely correlated, but performance discrepancies showed no association with the other methods. Anosognosia was present in the majority of the sample, and occurred across domains. The domains corresponding to core deficits in AD (recent memory, activities of daily living) appeared especially prone to anosognosia. However, results do not suggest that anosognosia itself is domain-specific. Rather, it appears that insight may be invariant, while differences in patient-caregiver discrepancies arise largely from different degrees of deficit across domains. (JINS, 2010, 16, 463–473.)

The longitudinal assessment of episodic and semantic memory was obtained from 236 patients diagnosed with Alzheimer’s disease (AD, n = 128) and with frontotemporal lobar degeneration (FTLD, n = 108), including patients with a social comportment/dysexecutive (SOC/EXEC) disorder, progressive nonfluent aphasia (PNFA), semantic dementia (SemD), and corticobasal syndrome (CBS). At the initial assessment, AD patients obtained a lower score on the delayed free recall test than other patients. Longitudinal analyses for delayed free recall found converging performance, with all patients reaching the same level of impairment as AD patients. On the initial evaluation for delayed recognition, AD patients also obtained lower scores than other groups. Longitudinal analyses for delayed recognition test performance found that AD patients consistently produced lower scores than other groups and no convergence between AD and other dementia groups was seen. For semantic memory, there were no initial between-group differences. However, longitudinal analyses for semantic memory revealed group differences over illness duration, with worse performance for SemD versus AD, PNFA, SOC/EXEC, and CBS patients. These data suggest the presence of specific longitudinal patterns of impairment for episodic and semantic memory in AD and FTLD patients suggesting that all forms of dementia do not necessarily converge into a single phenotype. (JINS, 2010, 16, 278–286.)

This study examined the contribution of executive functions to arrangement problem-solving performance in Parkinson’s disease (PD), with a particular focus on self-directed cognitive flexibility. PD patients and healthy age-matched adults completed a battery of neuropsychological measures of executive function and a series of anagram puzzles, some of which were modified to include graphemic cues designed to prime potential solutions. PD patients were less successful than healthy controls (HC) at resolving the anagram puzzles, but when a cue accompanied the anagram stimulus, PD patients performed normally. Anagram performance was associated with measures of verbal fluency and inhibition; no association emerged with working memory or set shifting ability. These data suggest that subjects with PD may have difficulty sufficiently inhibiting their automatic response to the experimental stimulus in order to generate the novel arrangements required to produce a successful response. Such deficits might be remediated through the use of environmental cues designed to support strategy generation. (JINS, 2010, 16, 70–76.)

Facial emotion recognition deficits have been widely investigated in individuals with schizophrenia; however, it remains unclear whether these deficits reflect a trait-like vulnerability to schizophrenia pathology present in individuals at risk for the disorder. Although some studies have investigated emotion recognition in this population, findings have been mixed. The current study uses a well-validated emotion recognition task, a relatively large sample, and examines the relationship between emotion recognition, symptoms, and overall life quality. Eighty-nine individuals with psychometrically defined schizotypy and 27 controls completed the Schizotypal Personality Questionnaire, Penn Emotion Recognition Test, and a brief version of Lehman’s Quality of Life Interview. In addition to labeling facial emotions, participants rated the valence of faces using a Likert rating scale. Individuals with schizotypy were significantly less accurate than controls when labeling emotional faces, particularly neutral faces. Within the schizotypy sample, both disorganization symptoms and lower quality of life were associated with a bias toward perceiving facial expressions as more negative. Our results support previous research suggesting that poor emotion recognition is associated with vulnerability to psychosis. Although emotion recognition appears unrelated to symptoms, it probably operates by means of different processes in those with particular types of symptoms. (JINS, 2010, 16, 474–483.)

Several prominent models of confabulation characterize the syndrome as a failure in controlled aspects of memory retrieval, such as pre-retrieval cue specification and post-retrieval monitoring. These models have been generated primarily in the context of studies of autobiographical memory retrieval. Less research has focused on the existence and mechanisms of semantic confabulation. We examined whether confabulation extends to the semantic domain, and if so, whether it could be understood as a monitoring failure. We focus on post-retrieval monitoring by using a verification task that minimizes cue specification demands. We used the semantic illusion paradigm that elicits erroneous endorsement of misleading statements (e.g., “Two animals of each kind were brought onto the Ark by Moses before the great flood”) even in controls, despite their knowing the correct answer (e.g., Noah). Monitoring demands were manipulated by varying semantic overlap between target and foils, ranging from high semantic overlap to unrelated. We found that semantic overlap modulated the magnitude of semantic illusion in all groups. Compared to controls, both confabulators and non-confabulators had greater difficulty monitoring semantically related foils; however, elevated endorsement of unrelated foils was unique to confabulators. We interpret our findings in the context of a two-process model of post-retrieval monitoring. (JINS, 2010, 16, 1006–1017.)

It has been suggested that, relative to the other basic emotions, the perception of threat-related emotion is disproportionately impaired in schizophrenia-spectrum disorders. Yet research has not assessed how schizophrenia-spectrum disorders affect the ability to make direct appraisals of threat. In the present study, participants with schizophrenia spectrum disorders were compared with controls on two danger rating tasks that involved differentiating between faces and situations normatively judged to be either high or low in threat. It was also assessed whether danger ratings were related to clinical symptoms, as well as performance on an emotion recognition measure that depicted emotions in point-light animation (biological motion). While the two groups did not differ in their ability to differentiate high- from low-danger stimuli, or overall danger attributed to faces, overall danger attributed to situations was greater for the clinical group. The clinical group also showed a selective deficit recognizing fear on the bioemotion task, but only for the control group was recognition of threat-related emotions associated with danger ratings. These data are consistent with other evidence showing that there may be a disconnect between the usual processes used to make inferences regarding potential threat in schizophrenia spectrum disorders. (JINS, 2010, 16, 805–812.)

There is increasing recognition that set-shifting, a form of cognitive control, is mediated by different neural structures. However, these regions have not yet been carefully identified as many studies do not account for the influence of component processes (e.g., motor speed). We investigated gray matter correlates of set-shifting while controlling for component processes. Using the Design Fluency (DF), Trail Making Test (TMT), and Color Word Interference (CWI) subtests from the Delis-Kaplan Executive Function System (D-KEFS), we investigated the correlation between set-shifting performance and gray matter volume in 160 subjects with neurodegenerative disease, mild cognitive impairment, and healthy older adults using voxel-based morphometry. All three set-shifting tasks correlated with multiple, widespread gray matter regions. After controlling for the component processes, set-shifting performance correlated with focal regions in prefrontal and posterior parietal cortices. We also identified bilateral prefrontal cortex and the right posterior parietal lobe as common sites for set-shifting across the three tasks. There was a high degree of multicollinearity between the set-shifting conditions and the component processes of TMT and CWI, suggesting DF may better isolate set-shifting regions. Overall, these findings highlight the neuroanatomical correlates of set-shifting and the importance of controlling for component processes when investigating complex cognitive tasks. (JINS, 2010, 16, 640–650.)

To validate the Neuropsychological Assessment Battery (NAB) List Learning test as a predictor of future multi-domain cognitive decline and conversion to Alzheimer’s disease (AD), participants from a longitudinal research registry at a national AD Center were, at baseline, assigned to one of three groups (control, mild cognitive impairment [MCI], or AD), based solely on a diagnostic algorithm for the NAB List Learning test (Gavett et al., 2009), and followed for 1–3 years. Rate of change on common neuropsychological tests and time to convert to a consensus diagnosis of AD were evaluated to test the hypothesis that these outcomes would differ between groups (AD>MCI>control). Hypotheses were tested using linear regression models (n = 251) and Cox proportional hazards models (n = 265). The AD group declined significantly more rapidly than controls on Mini-Mental Status Examination (MMSE), animal fluency, and Digit Symbol; and more rapidly than the MCI group on MMSE and Hooper Visual Organization Test. The MCI group declined more rapidly than controls on animal fluency and CERAD Trial 3. The MCI and AD groups had significantly shorter time to conversion to a consensus diagnosis of AD than controls. The predictive validity of the NAB List Learning algorithm makes it a clinically useful tool for the assessment of older adults. (JINS, 2010, 16, 651–660.)

We examined the capacity of patients with multiple sclerosis (MS) to attribute mental states to others and to identify cognitive abilities that subserve theory of mind (ToM). In this article, we report findings on 41 out-patients with diagnosed MS who underwent detailed neuropsychological and social-cognitive assessment. They were subdivided into a cognitively intact (n=15) and cognitively impaired (n=26) group according to their neuropsychological test results. Their results were compared with those of 20 age- and education-matched controls. MS patients with cognitive impairments were found to have more difficulties attributing mental states to others than did cognitively intact MS patients and normal controls on two ToM measures; short stories (Happé, Winner, & Brownell, 1998) and video clips (Ouellet, Bédirian, Charbonneau, & Scherzer, 2009). When attention, memory, and working memory were controlled, performance on the WAIS-III Picture Arrangement task accounted for 17.3% of the variance in performance on the video clips task. Performance on a WAIS-III index composed of Similarities and Comprehension subtests, accounted for 7.0% of the variance in performance on the short stories task. These results provide some preliminary information on the effect of MS-related cognitive deficits on the ability to attribute mental states to others. (JINS, 2010, 16, 287–296.)

Recent evidence suggests that patients with Alzheimer’s disease (AD) and vascular comorbidities (VC) perform worse across measures of verbal reasoning and abstraction when compared to patients with AD alone. We performed a qualitative error analysis of Wechsler Adult Intelligence Scale-III Similarities zero-point responses in 45 AD patients with varying numbers of VC, including diabetes, hypertension, and hypercholesterolemia. Errors were scored in set if the answer was vaguely related to how the word pair was alike (e.g., dog-lion: “they can be trained”) and out of set if the response was unrelated (“a lion can eat a dog”). AD patients with 2–3 VC did not differ on Similarities total score or qualitative errors from AD patients with 0–1 VC. When analyzing the group as a whole, we found that increasing numbers of VC were significantly associated with increasing out of set errors and decreasing in set errors in AD. Of the vascular diseases investigated, it was only the severity of diastolic blood pressure that significantly correlated with out of set responses. Understanding the contribution of VC to patterns of impairment in AD may provide support for directed patient and caregiver education concerning the presentation of a more severe pattern of cognitive impairment in affected individuals. (JINS, 2010, 16, 77–83.)

This study evaluated the impact of distractor objects and their similarity to target objects on everyday task performance in dementia. Twenty participants with dementia due to Alzheimer’s disease (n = 12) or subcortical vascular disease (n = 8) were videotaped while they performed 3 discrete tasks: (1) make a cup of coffee, (2) wrap a gift, and (3) pack a lunch under two conditions that were counterbalanced across participants. The conditions differed in terms of the type of distractor objects included in the workspace: (1) Target-Related Distractor Condition - distractor objects were functionally and visually similar to target objects (e.g., salt for sugar) (2) Unrelated Distractor Condition - distractors were neither visually nor functionally similar to targets (e.g., glue for sugar). Participants touched (t = 4.19; p < .01) and used (z = 3.00; p < .01) significantly more distractors, made more distractor errors (i.e., substitutions; t = 2.93; p < .01), and took longer to complete tasks (t = 2.27; p < .05) in the Target-Related Distractor condition. The percent of steps accomplished and non-distractor errors did not differ across conditions (t < 1.26; p > .05 for both). In summary, distractors that were similar to targets elicited significant interference effects circumscribed to object selection. (JINS, 2010, 16, 484–494.)