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Metaphors are a fundamental aspect of human cognition. The major neuropsychological hypothesis that metaphoric processing relies primarily on the right hemisphere is not confirmed consistently. We propose ways to advance our understanding of the neuropsychology of metaphor that go beyond simple laterality. Neuropsychological studies need to more carefully control confounding lexical and sentential factors, and consider the role of different parts of speech as they are extended metaphorically. They need to incorporate recent theoretical frameworks such as the career of metaphor theory, and address factors such as novelty. We also advocate the use of new methods such as voxel-based lesion-symptom mapping, which permits precise and formal tests of hypotheses correlating behavior with lesions sites. Finally, we outline a plausible model for the neural basis of metaphor. (JINS, 2010, 16, 1–5.)
The Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) is a consensus neuropsychological battery with established reliability and validity. One of the difficulties in implementing the MACFIMS in clinical settings is the reliance on manualized norms from disparate sources. In this study, we derived regression-based norms for the MACFIMS, using a unique data set to control for standard demographic variables (i.e., age, age2, sex, education). Multiple sclerosis (MS) patients (n = 395) and healthy volunteers (n = 100) did not differ in age, level of education, sex, or race. Multiple regression analyses were conducted on the performance of the healthy adults, and the resulting models were used to predict MS performance on the MACFIMS battery. This regression-based approach identified higher rates of impairment than manualized norms for many of the MACFIMS measures. These findings suggest that there are advantages to developing new norms from a single sample using the regression-based approach. We conclude that the regression-based norms presented here provide a valid alternative to identifying cognitive impairment as measured by the MACFIMS. (JINS, 2010, 16, 6–16.)
Sustained attention has been shown to be vulnerable following traumatic brain injury (TBI). Sleep restriction and disturbances have been shown to negatively affect sustained attention. Sleep disorders are common but under-diagnosed after TBI. Thus, it seems possible that sleep disturbances may exacerbate neuropsychological deficits for a proportion of individuals who have sustained a TBI. The aim of this prospective study was to examine whether poor sleepers post-TBI had poorer sustained and general attentional functioning than good sleepers post-TBI. Retrospective subjective, prospective subjective, and objective measures were used to assess participants’ sleep. The results showed that the poor sleep group had significantly poorer sustained attention ability than the good sleep group. The differences on other measures of attention were not significant. This study supports the use of measures that capture specific components of attention rather than global measures of attention, and highlights the importance of assessing and treating sleep problems in brain injury rehabilitation. (JINS, 2010, 16, 17–25.)
Design Fluency (DF) is typically assumed to assess planning, cognitive flexibility, and fluency in generation of visual patterns, above and beyond contributions from motor speed (Delis, Kaplan, & Kramer, 2001; Ruff, 1998). The present study examined these assumptions, as little construct validation research has been done in the past. Sixty one community-dwelling elderly participants were administered the DF, Trail Making, and Letter Fluency tests from the Delis-Kaplan Executive Function System (D-KEFS), as well as electronically administered measures of motor planning and motor sequence fluency. Hierarchical regressions were used to parse out unique variance contributions to DF performance. The results showed that generation of novel designs (i.e., the first two trials on the D-KEFS DF) relied primarily on motor planning, the ability to generate novel motor actions, and, to a lesser extent, speed of drawing with a writing implement. In contrast, generation of unique designs while switching (i.e., the third trial on the D-KEFS DF) relied primarily on visual scanning and perhaps visual-attentional resources. These findings highlight the wisdom of interpreting the switching trial of the D-KEFS DF separately. Interestingly, cognitive flexibility did not contribute to performance on any of the three D-KEFS DF trials. (JINS, 2010, 16, 26–37.)
Cognitive deficits are associated with HIV disease, and HIV-related cognitive deficits have been associated with declines in everyday functioning and vocational status. We administered a baseline neuropsychological (NP) test battery designed to assess estimated full-scale IQ, achievement, attention/concentration, executive function, language, mental speed, motor function, nonverbal memory, verbal memory, and visual-spatial function to a sample of 174 disabled, HIV-positive individuals enrolled in a randomized, controlled trial of a vocational-rehabilitation program. We then used these NP scores to predict employment at the end of participants’ study participation, using both hierarchical multiple regression and ordinal logistic regression models. The hierarchical multiple regression analyses did not predict participants’ employment activities at the end of study participation. In the ordinal logistic regression model, executive functioning weakly predicted employment status at the end of study participation and inspection of the predicted classifications revealed that 63% of the participants were incorrectly classified using this model. These results suggest that although predicting workforce reentry from NP testing may be statistically significant, NP testing may be of limited clinical value for informing the workforce reentry of disabled people with HIV who are interested in returning to work. (JINS, 2010, 16, 38–48.)
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.)
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.)
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.)
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.)
A group of 94 nondemented patients self-referred to an outpatient memory clinic for memory difficulties were studied to determine the incidence of single versus multi-domain mild cognitive impairment (MCI) using Petersen criteria. Fifty-five community dwelling normal controls (NC) participants without memory complaints also were recruited. Tests assessing executive control, naming/lexical retrieval, and declarative memory were administered. Thirty-four patients exhibited single-domain MCI, 43 patients presented with multi-domain MCI. When the entire MCI sample (n = 77) was subjected to a cluster analysis, 14 patients were classified with amnesic MCI, 21 patients with dysexecutive MCI, and 42 patients were classified into a mixed/multi-domain MCI group involving low scores on tests of letter fluency, “animal” fluency, and delayed recognition discriminability. Analyses comparing the three cluster-derived MCI groups versus a NC group confirmed the presence of memory and dysexecutive impairment for the amnesic and dysexecutive MCI groups. The mixed MCI group produced lower scores on tests of letter fluency compared with the amnesic MCI and NC groups and lower scores on tests of naming and memory compared with the NC group. In summary, multi-domain MCI is quite common. These data suggest that MCI is a highly nuanced and complex clinical entity. (JINS, 2010, 16, 84–93.)
The occurrence of postconcussive symptoms (PCS) following mild traumatic brain injury (TBI) in children may depend on cognitive reserve capacity. This prospective, longitudinal study examined whether the relationship between mild TBI and PCS is moderated by cognitive ability, which served as a proxy for cognitive reserve. Participants included 182 children with mild TBI and 99 children with orthopedic injuries (OI), ranging from 8 to 15 years of age when injured. Mild TBI were classified as complicated (n = 32) or uncomplicated (n = 150) depending on whether they were associated with trauma-related intracranial abnormalities on magnetic resonance imaging. PCS were assessed initially within 3 weeks of injury, and again at 1, 3, and 12 months post injury. The initial assessment also included standardized tests of children’s cognitive skills and retrospective parent ratings of pre-injury symptoms. Hierarchical linear modeling indicated that ratings of PCS were moderated jointly by cognitive ability and injury severity. Children of lower cognitive ability with a complicated mild TBI were especially prone to cognitive symptoms across time according to parents and to high acute levels of PCS according to children’s self-ratings. Cognitive reserve is an important moderator of the outcomes of mild TBI in children and adolescents. (JINS, 2010, 16, 94–105.)
This fMRI study investigates the neural bases of cognitive control of emotion processing in pediatric bipolar disorder (PBD) and attention deficit hyperactivity disorder (ADHD). Seventeen un-medicated PBD patients, 15 un-medicated ADHD patients, and 14 healthy controls (HC) (mean age = 13.78 ± 2.47) performed an emotional valence Stroop Task, requiring them to match the color of an emotionally valenced word to the color of either of two adjacent circles. Both patient groups responded significantly slower than HC, but there were no group differences in accuracy. A voxel-wise analysis of variance on brain activation revealed a significant interaction of group by word valence [F(2,41) = 4.44; p = .02]. Similar group differences were found for negative and positive words. For negative versus neutral words, both patient groups exhibited greater activation in dorsolateral prefrontal cortex (DLPFC) and parietal cortex relative to HC. The PBD group exhibited greater activation in ventrolateral prefrontal cortex (VLPFC) and anterior cingulate cortex (ACC) relative to HC. The ADHD group exhibited decreased VLPFC activation relative to HC and the PBD group. During cognitive control of emotion processing, PBD patients deployed the VLPFC to a greater extent than HC. The ADHD patients showed decreased VLPFC engagement relative to both HC and PBD patients. (JINS, 2010, 16, 106–117.)
A multicenter randomized control trial (RCT) was conducted to evaluate the effects of a treatment for dysexecutive problems after acquired brain injury (ABI) on daily life functioning. Seventy-five ABI patients were randomly allocated to either the experimental treatment, multifaceted strategy training for executive dysfunction, or a control treatment, computerized cognitive function training. Assessment took place before, directly after, and 6 months post-treatment. The primary outcome measure, the Role Resumption List (RRL), and two other follow-up measures, the Treatment Goal Attainment (TGA) and the Executive Secretarial Task (EST), were indications of daily life executive functioning. The experimental group improved significantly more over time than the controls on the RRL and attained significantly higher scores on the TGA and EST. We conclude that our treatment has resulted in significant improvements of executive functioning in daily life, lasting at least 6 months post-treatment. Although control patients’ satisfaction and subjective well-being were at the same level, the experimental group had better abilities to set and accomplish realistic goals, to plan, initiate, and regulate a series of real-life tasks, and to resume previous roles with respect to work, social relations, leisure activities, and mobility. (JINS, 2010, 16, 118–129.)
Recent studies have reported specific executive and attentional deficits in preterm children. However, the majority of this research has used multidetermined tasks to assess these abilities, and the interpretation of the results lacks an explicit theoretical backdrop to better understand the origin of the difficulties observed. In the present study, we used the Child Attention Network Task (Child ANT; Rueda et al. 2004) to assess the efficiency of the alerting, orienting and executive control networks. We compared the performance of 25 preterm children (gestational age ≤ 32 weeks) to 25 full-term children, all between 5½ and 6½ years of age. Results showed that, as compared to full-term children, preterm children were slower on all conditions of the Child ANT and had a specific deficit in executive control abilities. We also observed a significantly higher correlation between the orienting and executive control networks in the preterm group, suggesting less differentiation of these two networks in this population. (JINS, 2010, 16, 130–137.)
A microanalysis of task events in a common go/no-go task was completed to examine how task events impact individual reaction times. Predictors of long reaction times were analyzed to better understand increased intra-individual variability (IIV) among children with ADHD compared with normal controls. Sixty-five children with ADHD and 65 normal controls matched on gender, ethnicity, and age completed a go/no-go task. Children across both groups were slower before and after omission errors than all other trials. They were also slower on the trial before successfully inhibiting their response to no-go trials. Children with ADHD exhibited a pronounced slowing on trials prior to omission errors and trials prior to successful inhibitions compared with the normal control group. Pre-error slowing in children with ADHD may represent the beginning stages of attentional disengagement that subsequently results in the absence of responding (i.e., errors of omission or successful inhibition). While these event-related increases in reaction time explain some of the increased IIV observed in children with ADHD, the removal of these trials did not remove the pronounced between-group differences in IIV, suggesting that additional unmeasured processes are contributing to IIV in children with ADHD. (JINS, 2010, 16, 138–147.)
Previous studies had revealed no specific effect under haloperidol (typical) and risperidone (atypical) neuroleptic (NLP) treatments for schizophrenia (SZ) on a variety of neurocognitive functions relying on the dopaminergic meso-cortico-limbic system (Rémillard et al., 2005, 2008). Considering the different affinities of D2 dopamine receptors for typical and atypical NLPs, these drugs may differentially affect the functions of the striatum, a determinant brain structure involved in procedural learning. The influence of risperidone (2–6 mg) and haloperidol (2–40 mg) on a nonmotor procedural task involving semantically related pairs of words with inverted letters was investigated in this double-blind study. The performance of 26 patients with SZ, randomly assigned to risperidone or haloperidol, was compared to that of 18 healthy controls at baseline, 3, 6, and 12 months. Results revealed that all patients with SZ exhibited slower reading speed of the word pairs than healthy controls at all assessment periods. In addition, procedural learning – characterized as a significant decrease in the time taken to read aloud the target word pairs – was more impaired in the haloperidol- than in the risperidone-treated group at all assessment periods. Healthy controls showed steady improvement in reading speed over the 12 months of the study, in contrast to SZ patients, who reached a plateau in their capacity to improve mirror-reading skill over time. However, all SZ participants in the study showed near normal learning profiles from exposure to semantic associations embedded in the procedural memory task, providing evidence for the preservation of associative connections in the semantic network of these patients. The observed impairment in procedural learning in SZ may thus reflect, at least in part, the influence of neuroleptic medication on striatal functions. (JINS, 2010, 16, 148–156.)
The primary aims of this study were to examine post-injury cognitive development in young children with traumatic brain injury (TBI) and to investigate the role of the proximal family environment in predicting cognitive outcomes. Age at injury was 3–6 years, and TBI was classified as severe (n = 23), moderate (n = 21), and complicated mild (n = 43). A comparison group of children who sustained orthopedic injuries (OI, n = 117) was also recruited. Child cognitive assessments were administered at a post-acute baseline evaluation and repeated at 6, 12, and 18 months post-injury. Assessment of the family environment consisted of baseline measures of learning support and stimulation in the home and of parenting characteristics observed during videotaped parent–child interactions. Relative to the OI group, children with severe TBI group had generalized cognitive deficiencies and those with less severe TBI had weaknesses in visual memory and executive function. Although deficits persisted or emerged across follow-up, more optimal family environments were associated with higher scores for all injury groups. The findings confirm other reports of poor recovery of cognitive skills following early childhood TBI and suggest environmental influences on outcomes. (JINS, 2010, 16, 157–168.)
With the increasing survival of extremely preterm (EP) birth infants in the surfactant era, the longer-term outcome of infants born at the threshold of viability has become a vital topic of study. The goal of this investigation was twofold. First, while taking into account the influence of sociodemographic confounds, we wished to investigate neuropsychological outcome differences between two groups of EP preschoolers: 23–24 weeks (n = 20), and 25–26 weeks’ (n = 21) gestation at delivery. Second, we wished to explore whether, within the population of EP preschoolers, gestational maturity accounts for a unique portion of the variance in neuropsychological outcome, over and above the variance explained by ante-, peri-, and neonatal complications, or treatment factors. The findings revealed group differences, ranging from .70 to .80 of a standard deviation in general intellectual abilities, nonverbal intelligence, and global motor performance, in favor of the more mature EP group. Additionally, gestational maturity was found to explain a unique portion of the variance in global intellectual and motor abilities. These findings are interpreted from the perspective that gestational age is an index of the vulnerability of the central nervous system to disruption of developmentally regulated processes. (JINS, 2010, 16, 169–179.)
Cognitive deficits are clearly associated with poor everyday life functioning in persons diagnosed with schizophrenia. However, previous studies have primarily used questionnaires to assess everyday life functioning. We developed a computerized real-life activity task (shopping task), where participants are required to shop for a list of seven grocery store items. Thirty individuals diagnosed with schizophrenia and 30 healthy controls were administered an extensive battery of cognitive tests and the computerized shopping task. Performances on the computerized shopping task significantly differentiated patients and healthy controls for several variables. Moreover, performance on the shopping task was significantly correlated with verbal episodic memory, cognitive flexibility, planning, processing speed, and inhibition. Finally, performance on the computerized shopping task was significantly correlated with various clinical variables and with a global measure of social functioning. These findings suggest that the computerized task used in the present study provides an indication of the level of everyday life functioning and cognitive functioning of persons diagnosed with schizophrenia, and, therefore, may be viewed as a valuable instrument in both an evaluation and remediation context. (JINS, 2010, 16, 180–189.)
Patients with corticobasal degeneration (CBG) often demonstrate agraphesthesia in the same hand they demonstrate apraxia. To recognize letters written in their hand subjects can develop a spatial representation and access graphemic representations. Alternatively, people can use movement working memory and match movement patterns to stored letter movement representations. To learn the method normally used without vision, normal subjects (12) had letters written on their palm either in the normal manner or in a reverse direction. If letters written on the hand are recognized by their spatial features (as when visually reading) direction should not influence letter recognition, but if letters written on the hand are recognized by movement patterns, then in the reverse condition recognition should be impaired. When letters were written normally there were no differences in error between the tactile and visual modality. When letters were written in reverse, however, normal subjects made more errors in the tactile than visual condition. Normally, people identify letters written on their hand by covertly copying (mirroring) the examiner and then access letter movement representations. This might explain why patients with CBG often have agraphesthesia associated with apraxia. (JINS, 2010, 16, 190–193.)