Measures of episodic memory are often used to identify Alzheimer’s disease (AD) and mild cognitive impairment (MCI). The Neuropsychological Assessment Battery (NAB) List Learning test is a promising tool for the memory assessment of older adults due to its simplicity of administration, good psychometric properties, equivalent forms, and extensive normative data. This study examined the diagnostic utility of the NAB List Learning test for differentiating cognitively healthy, MCI, and AD groups. One hundred fifty-three participants (age: range, 57–94 years; M = 74 years; SD, 8 years; sex: 61% women) were diagnosed by a multidisciplinary consensus team as cognitively normal, amnestic MCI (aMCI; single and multiple domain), or AD, independent of NAB List Learning performance. In univariate analyses, receiver operating characteristics curve analyses were conducted for four demographically-corrected NAB List Learning variables. Additionally, multivariate ordinal logistic regression and fivefold cross-validation was used to create and validate a predictive model based on demographic variables and NAB List Learning test raw scores. At optimal cutoff scores, univariate sensitivity values ranged from .58 to .92 and univariate specificity values ranged from .52 to .97. Multivariate ordinal regression produced a model that classified individuals with 80% accuracy and good predictive power. (JINS, 2009, 15, 121–129.)

We investigated the neuropsychological profile of subjects in a subclinical obsessive-compulsive disorder (OCD) sample. Psychometrically defined subclinical obsessive-compulsive (n = 21) and control (n = 22) subjects were examined. Comprehensive neuropsychological tests evaluating verbal/nonverbal memory, attention, and executive function were administered. The subclinical obsessive-compulsive group showed poorer performances on the Wisconsin Card Sorting Test (WCST), F(1, 41) = 13.80, p < .001, and Trail-Making Test (TMT), F(1, 41) = 5.48, p < .05, compared with the control group. The subclinical obsessive-compulsive group showed higher rates of total errors, perseverative errors, and perseverative responses. In addition, the subclinical obsessive-compulsive group committed a greater number of errors in the TMT. However, the groups showed no performance differences in the TMT after controlling for the effects of depression and anxiety, F(1, 39) = 0.11, p = .739. These results suggest that subclinical obsessive-compulsives seemed to display deficits in executive functioning. This neuropsychological profile is consistent with current theories proposing that executive dysfunction may serve as the pathophysiological mechanism underlying the development of obsessive-compulsive disorder. (JINS, 2009, 15, 286–290.)

Deficits in multiple sclerosis (MS) patients’ performance on the Stroop Test have been attributed to problems with processing speed and selective attention. Data for 248 MS patients and 178 controls on all three trials of the Stroop were combined using various scoring formulas proposed for assessing processing speed, color difficulty, and interference. The greatest differences between patients and controls involved processing speed. Formulas purporting to measure interference yielded highly inconsistent results: Significant differences between groups were found on two of the most common measures but were in opposite directions. This contradiction stems from the failure of both measures to effectively control for processing speed when assessing interference. Three alternative measures, using relative, ratio, and residualized scores, offer much better indices of interference. When assessed with these alternative measures, interference increased with age, but no differences between patients and controls were found. Difficulties that MS patients have with the Stroop Test are confined to processing speed. (JINS, 2009, 15, 451–458.)

Clinicians are accustomed to interpreting diagnostic test scores in terms of sensitivity and specificity. Many clinicians also appreciate that sensitivity and specificity need to be interpreted in terms of local base rates (i.e., pretest probability). However, most neuropsychological tests contain a wide range of scores. Important diagnostic information may be sacrificed when valid test scores are reduced to the simple dichotomy of “positive” or “negative” diagnosis that underlies sensitivity and specificity analysis. The purpose of this study is to provide an introduction to multiple-level likelihood ratios, a method for preserving the information in a wider range of scores. These statistics are first described using a hypothetical example of dementia screening, then with patient data from an epilepsy surgery sample. Multiple-level likelihood ratios have several advantages over sensitivity and specificity analysis because they are applied across a wider range of diagnostic scores, and generalize to settings with different base rates. We suggest that the diagnostic validity of many psychological tests may be underestimated by relying solely on traditional dichotomous sensitivity and specificity analysis. (JINS, 2009, 15, 769–776.)

According to the cognitive reserve hypothesis, neuropsychological expression of brain disease is attenuated among persons with higher education or premorbid intelligence. The current research examined cognitive reserve in multiple sclerosis (MS) by investigating whether the negative effect of brain atrophy on information processing (IP) efficiency is moderated by premorbid intelligence. Thirty-eight persons with clinically definite MS completed a vocabulary-based estimate of premorbid intelligence (Wechsler Vocabulary) and a composite measure of IP efficiency (Symbol Digit Modalities Test and Paced Auditory Serial Addition Task). Brain atrophy was estimated from measurements of third ventricle width using high-resolution anatomical brain magnetic resonance imaging (magnetization-prepared rapid gradient echo). In a hierarchical regression analysis controlling for age and depressive symptomatology, brain atrophy predicted worse IP efficiency (R2 = .23, p = .003) and cognitive reserve predicted better IP efficiency (R2 = .13, p = .013), but these effects were moderated by an Atrophy × Cognitive Reserve interaction (R2 = .15, p = .004). The negative effect of brain atrophy on IP efficiency was attenuated at higher levels of reserve, such that MS subjects with higher reserve were better able to withstand MS neuropathology without suffering cognitive impairment. Results help explain the incomplete and inconsistent relationship between brain atrophy and IP efficiency in previous research. (JINS, 2009, 15, 606–612.)

The purpose of this study was to evaluate longitudinally, using the Iowa Gambling Task (IGT), the dynamics of decision-making capacity at a two-year interval (median: 2.1 years) in a group of patients with multiple sclerosis (MS) (n = 70) and minor neurological disability [Expanded Disability Status Scale (EDSS) ≤ 2.5 at baseline]. Cognition (memory, executive functions, attention), behavior, handicap, and perceived health status were also investigated. Standardized change scores [(score at retest-score at baseline)/standard deviation of baseline score] were computed. Results showed that IGT performances decreased from baseline to retest (from 0.3, SD = 0.4 to 0.1, SD = 0.3, p = .005). MS patients who worsened in the IGT were more likely to show a decreased perceived health status and emotional well-being (SEP-59; p = .05 for both). Relapsing rate, disability progression, cognitive, and behavioral changes were not associated with decreased IGT performances. In conclusion, decline in decision making can appear as an isolated deficit in MS. (JINS, 2009, 15, 291–295.)

Diffusion tensor imaging was used to investigate white matter (WM) integrity in adults with traumatic brain injury (TBI) and healthy adults as controls. Adults with TBI had sustained severe vehicular injuries on the average of 7 years earlier. A multivariate analysis of covariance with verbal IQ as the covariate revealed that adults with TBI had lower fractional anisotropy and higher mean diffusivity than controls, specifically in the three regions of interest (ROIs), the centrum semiovale (CS), the superior frontal (SPF), and the inferior frontal (INF). Adults with TBI averaged in the normal range in motor speed and two of three executive functions and were below average in delayed verbal recall and inhibition, whereas controls were above average. Time since injury, but not age, was associated with WM changes in the SPF ROI, whereas age, but not time since injury, was associated with WM changes in the INF ROI, suggesting that the effects of WM on time since injury may interact with age. To understand the utility of WM changes in chronic recovery, larger sample sizes are needed to investigate associations between cognition and WM integrity of severely injured individuals who have substantial cognitive impairment compared to severely injured individuals with little cognitive impairment. (JINS, 2009, 15, 130–136.)

Although several brief sensitive screening tools are available to detect cognitive dysfunction, few have been developed to quickly assess executive functioning (EF) per se. We designed a new brief tool to evaluate EF in neurodegenerative diseases. Patients with an established diagnosis of behavioral variant frontotemporal dementia (bvFTD; n = 22), Alzheimer disease (AD; n = 25), and controls (n = 26) were assessed with a cognitive screening test, the INECO Frontal Screening (IFS), and EF tests. Clinical Dementia Rating Scale (CDR) scores were obtained for all patients. Internal consistency of the IFS was very good (Cronbach’s alpha = .80). IFS total (out of 30 points) was 27.4 (SD = 1.6) for controls, 15.6 (SD = 4.2) for bvFTD, and 20.1 (SD = 4.7) for AD. Using a cutoff of 25 points, sensitivity of the IFS was 96.2%, and specificity 91.5% in differentiating controls from patients with dementia. The IFS correlated significantly with the CDR and executive tasks. The IFS total discriminated controls from demented patients, and bvFTD from AD. IFS is a brief, sensitive, and specific tool for the detection of executive dysfunction associated with neurodegenerative diseases. The IFS may be helpful in the differential diagnosis of FTD and AD. (JINS, 2009, 15, 777–786.)

Obtaining some low memory scores across a battery of tests is common. The purpose of this study was to examine the prevalence of low scores on the Children’s Memory Scale (CMS). Participants were 1000 children and adolescents between 5 and 16 years of age from the CMS standardization sample. Consistent with research on other batteries, having some low memory scores is common in healthy children and adolescents. The prevalence of low memory scores also increases with lower intelligence. Clinicians should be cautious when interpreting isolated low memory scores as sole evidence of memory impairment. Knowing the prevalence of low scores as a supplement to clinical judgment should reduce the likelihood of misdiagnosing memory problems. (JINS, 2009, 15, 613–617.)

We hypothesized that specific neuropsychological deficits were associated with specific patterns of atrophy. A magnetic resonance imaging volumetric study and a neuropsychological protocol were obtained for patients with several frontotemporal lobar dementia phenotypes including a social/dysexecutive (SOC/EXEC, n = 17), progressive nonfluent aphasia (n = 9), semantic dementia (n = 7), corticobasal syndrome (n = 9), and Alzheimer’s disease (n = 21). Blinded to testing results, patients were partitioned according to pattern of predominant cortical atrophy; our partitioning algorithm had been derived using seriation, a hierarchical classification technique. Neuropsychological test scores were regressed versus these atrophy patterns as fixed effects using the covariate total atrophy as marker for disease severity. The results showed the model accounted for substantial variance. Furthermore, the “large-scale networks” associated with each neuropsychological test conformed well to the known literature. For example, bilateral prefrontal cortical atrophy was exclusively associated with SOC/EXEC dysfunction. The neuropsychological principle of “double dissociation” was supported not just by such active associations but also by the “silence” of locations not previously implicated by the literature. We conclude that classifying patients with degenerative dementia by specific pattern of cortical atrophy has the potential to predict individual patterns of cognitive deficits. (JINS, 2009, 15, 459–470.)

Cancer patients frequently report cognitive complaints following chemotherapy, but the results from the available studies, mainly of women with breast cancer, are inconsistent. Our aim was to compare cognitive function of men with testicular cancer (TC) who had orchiectomy and chemotherapy (bleomycin, etoposide, cisplatin) with men who had orchiectomy only or orchiectomy and radiotherapy. Thirty-six chemotherapy patients and 36 nonchemotherapy patients were tested 2–7 years after treatment for TC with standardized neuropsychological tests. Chemotherapy and nonchemotherapy patients displayed similar performances on cognitive tests (p values adjusted for multiple comparisons: .63–1.00). Moreover, there was no difference in the proportion of cognitively impaired patients in the chemotherapy group (5.6%) compared to the nonchemotherapy group (8.3%) (χ2 = 0.22, p = .64). Our results are discordant with previous findings indicating cognitive impairment following chemotherapy and suggest that TC patients do not need to fear long-term cognitive consequences following chemotherapy. (JINS, 2009, 15, 296–301.)

Survivors of severe traumatic brain injury (TBI) often demonstrate impairments in the cognitive control functions of detecting response conflict and signaling for recruitment of cognitive resources to appropriately adjust performance. These cognitive control functions can be measured using conflict adaptation effects, wherein manifestations of conflict detection and processing are reduced following high- relative to low-conflict trials. Event-related potentials (ERPs) were collected while 18 survivors of severe traumatic brain injury (TBI) and 21 demographically matched control participants performed a modified Stroop task. The incongruent-minus-congruent trial Stroop effect for trials preceded by incongruent (high conflict) and congruent (low conflict) trials were compared for behavioral (response time [RT] and error rate) and ERP reflections of cognitive control. Behavioral data showed a reduction in the Stroop effect for both control and TBI participant RTs when preceded by incongruent trials. The magnitude of these effects did not differentiate control and TBI participants. ERP data revealed a centro-parietal conflict slow potential (conflict SP) that differentiated incongruent from congruent trials. Planned comparisons showed a decreased amplitude conflict SP when ERPs were preceded by incongruent trials in control, but not TBI participants. Results indicate subtle TBI-related impairments in conflict resolution mechanisms in the context of intact RT-related conflict adaptation. (JINS, 2009, 15, 927–937.)

Poor insight is associated with impaired cognitive function in psychosis. Whether poor clinical insight overlaps with other aspects of self-awareness in schizophrenia, such as cognitive self-awareness, is unclear. We investigated whether awareness of clinical state (“clinical insight”) and awareness of cognitive deficits (“cognitive insight”) overlap in schizophrenia in a sample of 51 stabilized patients with chronic schizophrenia. Cognitive insight was assessed in terms of the agreement between subjective self-report and neuropsychological assessment. Patients who show good cognitive insight did not necessarily show good clinical insight. By contrast, self-report and objective neuropsychological assessment only correlated for patients in the intact clinical insight group and not for those in the impairment clinical insight group. We conclude that while good cognitive insight may not be necessary for good clinical insight, good cognitive awareness is at least partly reliant on the processes involved in clinical insight. (JINS, 2009, 15, 471–475.)

Limb praxis can be influenced by age, gender, and education. The present study investigated the influence of these variables on gesture production by healthy elderly subjects. We evaluated 96 individuals divided into two age groups (60–74 and 75–88 years). Each group contained 48 men and 48 women and was subdivided into four groups according to education: illiterates and 1–3, 4–7, and 8 or more years of education. Individuals were requested to carry out tasks on verbal command and imitation. There were no differences between the performance of men and women, while older individuals performed worse than their younger counterparts. Regarding educational level, three major groups emerged: illiterates, individuals with 1–7 years of education, and those with 8 or more years of education. In conclusion, age and education significantly influenced the performance of individuals in limb praxis tests. (JINS, 2009, 15, 618–622.)

Poor cardiac pumping efficiency has shown to lead to cognitive impairments in patients with cardiovascular disease (CVD). The current study examined the relationship between left ventricular ejection fraction and sustained attention and inhibitory processes measured by the Adaptive Rate Continuous Performance Task and the Go/No-go test. Participants were 67 older outpatients (age 68.5 ± 7.4) with a range of CVD. Associations between cognition and ejection fraction were examined via linear regression analysis. Results were consistent with the hypothesis that lower ejection fraction is significantly associated with decrements in sustained attention and vigilance. Overall, the results provide support for the hypothesis that a change in cardiac pumping leads to decrements in some aspects of attention; however, inhibitory processes are relatively spared. (JINS, 2009, 15, 137–141.)

The frequency and characteristics of closing-in behavior (CIB) were examined in 797 patients with Alzheimer’s disease (AD), 132 of whom were followed up longitudinally. The frequency of CIB increased with the complexity of the graphic copying task and with the severity of Alzheimer’s disease. Regression analyses suggested that attentional deficits are critical factors for the appearance of CIB, but that visuospatial impairments also play an important role in the emergence of severe forms of CIB. (JINS, 2009, 15, 787–792.)

Previous cross-sectional study of ventral prefrontal cortex (VPFC) implicated progressive volume abnormalities during adolescence in bipolar disorder (BD). In the present study, a within-subject, longitudinal design was implemented to examine brain volume changes during adolescence/young adulthood. We hypothesized that VPFC volume decreases over time would be greater in adolescents/young adults with BD than in healthy comparison adolescents/young adults. Eighteen adolescents/young adults (10 with BD I and 8 healthy comparison participants) underwent two high-resolution magnetic resonance imaging scans over approximately 2 years. Regional volume changes over time were measured. Adolescents/young adults with BD displayed significantly greater volume loss over time, compared to healthy comparison participants, in a region encompassing VPFC and rostral PFC and extending to rostral anterior cingulate cortex (p < .05). Additional areas where volume change differed between groups were observed. While data should be interpreted cautiously due to modest sample size, this study provides preliminary evidence to support the presence of accelerated loss in VPFC and rostral PFC volume in adolescents/young adults with BD. (JINS, 2009, 15, 476–481.)

Shared vulnerabilities have been described across disorders of impulse control, including pathological gambling (PG) and bulimia nervosa (BN). Our aim was to compare the executive functioning of PG and BN females in order to confirm their similarity at a neurocognitive level. A total of 15 BN females, 15 PG females, and 15 healthy control (HC) females were administered the Wisconsin Card Sorting Test (WCST) and the Stroop Color and Word Test. Analysis of covariance adjusted for age and education was conducted to compare groups. PG showed the greatest impairment, that is, the highest percentage of WCST perseverative errors (p = .023), the lowest percentage of conceptual-level responses (p = .034), and the highest number of total trials administered (p = .021), while BN showed the highest percentage of WCST nonperseverative errors (p = .003). Both BN and PG females demonstrated executive dysfunction relative to HCs but different specific correlates (i.e., greater vulnerability to distraction in BN, but more cognitive inflexibility in PG). (JINS, 2009, 15, 302–306.)