There are a number of devices now used in automobiles that allow subscribed companies to track the car and to aid the owner in the case of accidents, lockouts, being lost, etc. Even in the age of the cell-phone, having a human whom you can routinely contact and who is paid to help you when a problem occurs is reassuring. Given the forthcoming graying of the baby boomers with a significant proportion of us developing a dementia, along with the large number of people who suffer head injuries, strokes, and similar disorders, the market for a similar device, worn on the body—perhaps as a secured bracelet—appears obvious. Compensatory aids may have an important role to play in helping patients become functional—particularly when used as a reminder, to orient them to time and place, or to provide a human voice to give instructions when necessary. Since one operator potentially can handle many patients at the same time, it could be a cost-effective device to obtain. I say “may have an important role” because very few studies have used such a device, much less carefully evaluated its usefulness. In this issue, Fish, Manly, and Wilson (2008) describe a very nice application of a single-case design to evaluate the use of a compensatory device in a patient with a frontal lobe lesion associated with deficits in planning that were characterized as goal-neglect by the authors.

The objective of this study is to identify the clinical, neuropsychological, neuropsychiatric, and functional variables that correlate with metacognitive self-awareness (SA) in severe traumatic brain injury (TBI) outpatients and to assess the influence of the same variables on the sensory-motor, cognitive, and behavioral-affective indicators of SA. This cross-sectional observational study evaluated 37 outpatients from May 2006 to June 2007 in a neurorehabilitation hospital on the basis of the following inclusion criteria: (1) age ≥ 15 years; (2) diagnosis of severe TBI (Glasgow Coma Scale, GCS ≤ 8); (3) posttraumatic amnesia (PTA) resolution; (4) capacity to undergo formal psychometric evaluation despite cognitive and sensory-motor deficits; (5) absence of aphasia; (6) availability of informed consent. A neuropsychological battery was used to evaluate attention, memory, and executive functions. SA was assessed by the awareness questionnaire (AQ), administered to both patients and relatives. Decreased metacognitive self-awareness is significantly correlated with increased problems in some components of executive system, even when the AQ subscales were considered separately. The significant correlation found between some components of executive system and metacognitive self-awareness confirmed the importance of addressing this issue to treat SA contextually in the rehabilitation of executive functions. (JINS, 2008, 14, 862–868.)

A formula for the reliability of difference scores was used to estimate the reliability of Delis-Kaplan Executive Function System (D-KEFS; Delis et al., 2001) contrast measures from the reliabilities and correlations of their components. In turn these reliabilities were used to calculate standard errors of measurement. The majority of contrast measures had low reliabilities: of the 51 reliability coefficients calculated in the present study, none exceeded 0.7 and hence all failed to meet any of the criteria for acceptable reliability proposed by various experts in psychological measurement. The mean reliability of the contrast scores was 0.27, the median reliability was 0.30. The standard errors of measurement were large and, in many cases, equaled or were only marginally smaller than the contrast scores' standard deviations. The results suggest that, at present, D-KEFS contrast measures should not be used in neuropsychological decision making. (JINS, 2008, 14, 1069–1073.)

Methods in Mind. Carl Senior, Tamara Russell, and Michael S. Gazzaniga (Eds.). 2006. Cambridge, MA: The MIT Press, 394 pp., $55.00 (HB)

In the preface of Methods in Mind, the editors express their intent to provide a text that integrates different cognitive neuroscience methods. The chapter authors were given the lofty charge of describing their method of choice, considering the method's strengths and limitations, and how other methods might be integrated. By-and-large, the editors have achieved their goal.

Progress in Neurotherapeutics and Neuropsychopharmacology. Volume 1. Jeffrey L. Cummings (Ed). 2006. Cambridge, England: Cambridge University Press, 169 pp., $122.00 (HB).

Progress in Neurotherapeutics and Neuropsychopharmacology provides an overview of what is for most neuropsychologists a new content area—clinical trials. Had I not spent five years in the pharmaceutical industry, I probably would have not given the topic of neurotherapeutics a second thought. This book can be useful on a number of counts. First, knowledge of neurotherapeutics is an indirect method for understanding the basic science of neurological diseases since drug development hinges upon appreciating the pathology of the disease. Second, three factors make neuropsychologists uniquely qualified to understand neurotherapeutics in the form of clinical trials—knowledge of most neurological disease states and research training. Finally, all clinical trials have a primary outcome measure. When the primary outcome measure is cognition, our contribution as neuropsychologists can be paramount. My introduction to neurotherapeutics was as outcome rater. An increasing number of neuropsychologists are being recruited by the pharmaceutical industry to work in medical affairs, mostly as medical science liaisons. For those interested in a career alternative, or the topic of neurotherapeutics, this text provides a starting point.

This research compares the performance of a sample of non-litigating participants with severe brain injury on both the WMT and TOMM under conditions of (1) full effort, (2) distraction, or (3) simulated malingering. The study included 60 participants with a severe brain injury and used restricted randomization to assign participants to the groups. Following Craik (1982) an auditory distraction task was used during the learning phase of each test in the distraction group, while a scenario adapted from Tombaugh (1997) was used to encourage simulation of memory impairment in the simulated malingering group. The results of this study clearly showed that while both tests demonstrated excellent sensitivity, the false positive rates for the WMT were significantly greater than those for the TOMM. It was concluded that the so-called “effort” components of the WMT required more cognitive capacity than was previously believed. (JINS, 2008, 14, 1074–1080.)

Memory is arguably the most important function of cognition. When left undetected, memory impairments are linked to life long underachievement and negative social consequences. Given that the construct of memory is multidimensional, the current study examined patterns of multiple indicators associated with memory across individuals ranging in age from 5 to 85 years who had been administered the Wide Range Assessment of Memory and Learning – Second Edition (WRAML-2). Multistage cluster analysis with independent age replications was used to empirically identify normative profiles in a sample of (n = 1172) typically developing individuals. This procedure considered how various indicators of memory operate in concert by accounting for the nonlinear multivariate relationships among them. Results supported nine common (or core) profile types that satisfied all formal heuristic and statistical criteria, including complete coverage, satisfactory within-type homogeneity, between-type dissimilarity, and replicability. A summary of the defining characteristics for each profile is provided. (JINS, 2008, 14, 869–877.)

Evans et al. (1998) described compensatory strategy use in R.P., a patient with executive dysfunction following bilateral frontal lobe damage who had difficulty acting upon her intentions. A pager was used to remind R.P. of regularly scheduled activities, along with a checklist that aimed to moderate a perseverative routine. Although successful, 10 years after the original intervention, the strategies were no longer used, and considerable everyday problems were evident. In the current study, we conducted a follow-up assessment to examine potential reasons for this deterioration. No change in neuropsychological functioning was evident. Whereas the previous study introduced the two strategies together, and examined effects upon separate goals, in the current study we reintroduced the two strategies separately, and examined effects on three common goals. In addition to prompting specific activities, we aimed to support completion of more general goals (those that could be enacted within a wider window of time). The paging intervention had a dramatic effect on all three measured behaviors, at a much more consistent level than the checklist. We suggest that, in addition to direct reminders, the pager can cue a process of goal monitoring that bridges the gap between intention and action. (JINS, 2008, 14, 154–163.)

Cold water near-drowning is often thought to be neuroprotective in individuals with anoxia of a longer duration than that usually required to produce irreversible neurologic damage. There is a paucity of data in adults with cold water near-drowning that assess neuropsychological outcomes. Information regarding long-term effects of near cold water near-drowning on neuropathology, neuropsychological and neurobehavioral outcomes are uncommon. This paper provides an introduction to two cases of cold water near-drowning reported in this issue of JINS by Sameulson and colleagues and provides background information for interpretation of the findings of these cases in the context of outcomes following anoxia. (JINS, 2008, 14, 656–659.)

The extent to which letter-by-letter reading results from a specific orthographic deficit, as compared with a nonspecific disturbance in basic visuoperceptual mechanisms, is unclear. The current study directly compared processing of letters and digits in a letter-by-letter reader, G.M., using a rapid serial visual presentation (RSVP) task and a speeded matching task. Comparisons were made to a group of six brain-damaged individuals without reading deficits. In the RSVP task, G.M. had increased difficulty reporting the target identities when they were letters, as compared with digits. Although this general pattern was also evident in the control group, the magnitude of the letter–digit accuracy difference was greater in G.M. Similarly, in the matching task, G.M. was slower to match letters than digits, relative to the control group, although his response times to both item types were increased. These data suggest that letter-by-letter reading, at least in this case, results from a visuoperceptual encoding deficit that particularly affects letters, but also extends to processing of digits to a lesser extent. Results are consistent with the notion that a left occipitotemporal area is specialized for letter processing with greater bilaterality in the visual processing of digits. (JINS, 2008, 14, 164–173.)

Two men, 56 and 33 years old, (case 1 and case 2) were examined neuropsychologically after successful resuscitation from circulatory arrest following extreme accidental hypothermia and near drowning. After submersion in ice water for at least 20 minutes they received CPR for 45 to 60 minutes. Body-core temperature at start of CPB was 24°C and 22°C, respectively. A neuropsychological examination was performed within two months after the accident and 1 year later. An additional follow-up interview was made 3 years after the accidents. Both had severe problems with memory, visuospatial performance, executive function, and verbal fluency. The follow-up demonstrated improvement in the visuospatial test in both and in the verbal learning, recall, and logical reasoning tests in case 2. Both still had problems with executive function, and case 2 also in verbal fluency. Case 1 also had problems with flexibility, planning and abstract ability. Despite the protective effects of hypothermia and gradual improvement of symptoms over time, some of the deficits were permanent. A thorough neuropsychological examination of patients suffered from anoxia is advisable, because gross neurological examination and MRI scans may not always reveal underlying brain dysfunction. (JINS, 2008, 14, 660–666.)

Recent and relevant.

Controversy continues about which brain structures and circuitry underlie the retrieval of past (remote) memories—autobiographical, personal semantic, or general semantic—and also about which lesion sites are critical for retrograde amnesia (RA) to occur (Kopelman, 2008). This issue relates, of course, to the differential predictions of consolidation theory and of multiple trace theory regarding patterns of retrograde amnesia (and indeed the predictions of other theories). The controversy also relates to issues regarding the differential pattern of left hemisphere versus right hemisphere damage, particularly in the temporal lobes, an issue which has influenced the literature since important studies by De Renzi et al. (1987) and O'Connor et al. (1992). De Renzi et al. (1987) described a woman who, following an episode of herpes encephalitis that affected the left temporal lobe, showed a severe impairment of semantic memory with relatively preserved autobiographical memories, whereas O'Connor et al. (1992) reported a patient with right temporal lobe damage (also from herpes encephalitis), who showed disproportionately severe impairment in the recall of autobiographical incidents, relative to remote semantic memories. It is this latter contrast between left- and right-sided damage which the present authors address.

Assessment of Malingered Neuropsychological Deficits. Glenn J. Larrabee (Ed.). 2007. New York: Oxford University Press, 540 pp., $69.50 (HB)

Developments in the area of malingering detection parallel several of Thomas Kuhn's observations concerning the nonlinear trend of progress in the history of science (Kuhn, 1962). For example, the naive assumption that traditional neuropsychological assessment procedures would straightforwardly generalize to compensation-seeking populations characterized an earlier status quo, a period Kuhn referred to as normal science. The central fallacy of this assumption was the idea that litigants and other claimants did not, as a group, behave differently from those seen in strictly clinical settings. The untenable presumption that astute clinicians were generally capable of forming accurate judgments about the validity of effort on the basis of observation was another received belief that characterized this now archaic era of practice.

Impulsivity has been identified as a behavioral precursor to addiction, and may be the manifestation of a neurological vulnerability. The present study investigated whether individual differences in impulsivity were associated with performance on the Iowa Gambling Task (IGT, a test of emotional decision making thought to be associated in part with ventromedial prefrontal cortex function) and the Wisconsin Card Sorting Task (WCST, a set-shifting thought to be associated in part with dorsolateral prefrontal cortex function). Subjects were screened for impulsivity using the BIS-11 (self-report) and a delay discounting questionnaire (a behavioral measure of impulsivity). High impulsivity was associated with poorer performance on the final block of trials of the IGT but was not significantly related to WCST performance. Both measures were significantly correlated with scores on the BIS. These results provide support for hypothesis that, in a nonclinical sample, impulsivity may vary systematically with performance on neuropsychological indicators of prefrontal function. (JINS, 2008, 14, 878–882.)

Relatively few studies have examined the use of cognitive rehabilitation in patients with mild cognitive impairment (MCI), largely due to the assumption that training will not improve functioning in patients with progressive conditions. Face-name association, an ecologically valid task, is both dependent on the explicit memory system and difficult for MCI patients. During three hour-long sessions, eight patients diagnosed with MCI were trained in the use of explicit memory strategies with 45 face-name pairs. For each pair, they were taught to visually identify a facial feature, link a phonological cue to that feature, and recall the associated name. There was significant improvement in recognition accuracy, along with faster reaction times, for trained face-name pairs. Improved accuracy persisted when tested one month after training. Significant, but less, improvement was also found on untrained stimuli, raising the possibility of generalization of training strategies. Preliminary results suggest strategy-based cognitive rehabilitation may be beneficial in patients with MCI, though these results must be replicated with a control group to rule out practice effects. (JINS, 2008, 14, 883–889.)

The Frontal Lobes: Development, Function and Pathology. Jarl Risberg and Jordan Grafman (Eds.). 2006. New York: Cambridge University Press. 240 pp., $70.00 (PB)

The Frontal Lobes: Development, Function and Pathology is an edited volume comprised of chapters that are the result of presentations at the annual Advanced Studies Institute sponsored by the International Neuropsychological Society (INS) and by the Vivian Smith Foundation. The eight chapters represent multiple approaches to studying or understanding the frontal lobes, including: evolution and genetics, primate frontal lobe neuroanatomy, cognitive neuroscience models of frontal lobe functioning, microcircuit models based on single neuron recording, developmental models of frontal lobe functioning, case studies of frontal lobe lesion patients, functional neuroimaging of frontal lobe activity, and postmortem neuropathological findings in demented patients. This is a solid but not comprehensive list of approaches to understanding frontal lobe functioning, but the editors clearly state that this volume is not designed to be an exhaustive review. Rather, it is a volume that is better viewed as the state of the art of selected approaches to frontal lobe research as of about 2004, when most of the authors presented a variation of the chapter to the INS Summer Institute. With these qualifications in mind, I can say that the volume is a useful overview that will inform the reader of current and future directions in frontal lobe research.

Evolutionary Cognitive Neuroscience. 2007. Steven M. Platek, Julian P. Keenan, & Todd K. Shackelford (Eds.). Cambridge, MA: MIT Press, 616 pp., $65.00 (HB)

Clinical neuropsychologists are most interested in the ‘what’ of brain function. Neuropsychological assessment requires only a working knowledge of functional localization and the tests best suited to capture that specialization. The ‘why’ of cortical specialization is not necessary for good clinical work. The edited volume Evolutionary Cognitive Neuroscience is entirely devoted to the ‘how’ and ‘why’ of brain specialization based on the fact (not ‘theory’) of natural selection. Editors Steven Platek, Julian Keenan, and Todd Shackelford are well qualified to organize and write this book; they devoted their careers to understanding neuropsychological functions as evolved mechanisms designed to solve recurrent survival and reproduction problems of our evolutionary past. In this view, our brains are Stone Age computers.

Mild Traumatic Brian Injury and Postconcussion Syndrome: The New Evidence Base for Diagnosis and Treatment, by Michael A. McCrea. 2007. New York: Oxford University Press. 224 pp., $39.95 (PB).

Few topics in neuropsychology, or healthcare for that matter, have been as controversial for as long a time as mild traumatic brain injury (MTBI) and postconcussive syndrome (PCS). The controversy spills from healthcare into the medico-legal arena for obvious reasons, but is far from being only an issue of interest in forensic circles. Patients with MTBI who report symptoms of PCS are among the most common customers in clinics around the world. The controversy persists, in large part, because of the challenges associated with objectively capturing, describing and understanding the issue. Dr. McCrae's book speaks directly to these challenges by reviewing the dramatic increase in research on MTBI and PCS over the last ten or so years.