Repeated neuropsychological testing gives rise to practice effects in that patients become familiar with test material as well as test-taking procedures. Using alternate forms prevents the learning of specific test stimuli, potentially mitigating practice effects. However, changing forms could diminish test-retest reliability coefficients. Our objective was to examine test-retest effects in multiple sclerosis (MS) patients randomly assigned to same- (SF) or alternate-form (AF) conditions. Thirty-four MS patients underwent neuropsychological evaluation. The battery included the California Verbal Learning Test II (CVLT-II) and the Brief Visuospatial Memory Test–Revised (BVMT-R), memory tests recommended by a recently convened consensus panel. Patients were randomly assigned to SF or AF groups and then tested at baseline and follow-up examination 1 week later. Analysis of variance tests (ANOVAs) revealed significant group × time interactions, with SF patients showing greater gain than AF patients. SF practice effects were often large, compromising test validity. Reliability coefficients were either equivalent or higher in the AF group, a finding attributed to ceiling effects and reduced variance in the SF group at retest. The generalizability of the findings may be limited to short test-retest intervals and the MS population. Nevertheless, I conclude that the use of CVLT-II and BVMT-R alternate forms likely helps preserve test validity without compromising test-retest reliability. (JINS, 2005, 11, 727–736.)

Action (verb) fluency is a newly developed verbal fluency task that requires the examinee to rapidly generate as many verbs (i.e., “things that people do”) as possible within 1 min. Existing literature indicates that action fluency may be more sensitive to frontal–basal ganglia loop pathophysiology than traditional noun fluency tasks (e.g., animal fluency), which is consistent with the hypothesized neural dissociation between noun and verb retrieval. In the current study, a series of analyses were undertaken to examine the psychometric properties of action fluency in a sample of 174 younger healthy participants. The first set of analyses describes the development of demographically adjusted normative data for action fluency. Next, a group of hypothesis-driven correlational analyses reveals significant associations between action fluency and putative tests of executive functions, verbal working memory, verbal fluency, and information processing speed, but not between action fluency and tests of learning or constructional praxis. The final set of analyses demonstrates the test–retest stability of the action fluency test and provides standards for determining statistically reliable changes in performance. In sum, this study enhances the potential clinical applicability of action fluency by providing demographically adjusted normative data and demonstrating evidence for its reliability and construct validity. (JINS, 2005, 11, 408–415.)

Alzheimer's disease (AD) patients perform worse on category than letter fluency tasks, while Huntington's disease (HD) patients show the reverse pattern or comparable impairment on both tasks. We developed a random word generation task to further investigate these deficits. Twenty AD and 16 HD patients and 20 elderly and 16 middle-aged controls guessed which of three pictures (hat, cat, or dog) landed on a die's top face sixty times. Three consecutive response pairings were possible: semantic (cat–dog), phonemic (hat–cat), and neutral (hat–dog). Since healthy individuals avoid repeating meaningful associates (“repetition avoidance”), an increased pairing frequency reflects processing deficits. AD patients produced more semantic and HD patients more phonemic pairings compared to their respective control groups, indicating selective semantic and phonemic processing deficits in AD and HD patients, respectively. (JINS, 2005, 11, 303–310.)

The present study examines whether illusory movement (IM) of a horizontal line, induced by a moving background (MB), influences line-bisection performance in normal subjects. The first experiment attempted to identify the speeds of MB that induce IM. We found that when speed is increased from 1.53° to 13.3°/sec, IM increases, but that with further speed increases, IM decreases. Leftward MB induces rightward IM, and vice versa. In the second experiment, we had subjects bisect lines at MB speeds that had been shown to induce IM in the first experiment. We found that leftward MB induced a rightward bias, and vice versa. We also found that there was a relationship between the magnitude of IM and the degree of bias. In the third experiment, by making the target line larger than the MB, we made the conditions where IM was presumably absent. Unlike the results of bisection performed with IM, subjects showed a bias in the direction of the MB. Overall, these experiments demonstrated that the perception of motion induces subjects to attend in the direction of movement. (JINS, 2005, 11, 881–888.)

Schizophrenia is characterized by profound disturbances in cognition, emotion, and social functioning. Catechol-O-methyl transferase (COMT) is the important enzyme for the metabolism of monoamines, which play important part in the pathogenesis of schizophrenia. COMT exists in high and low activity forms. The low activity form was found to be an amino acid substitution (Val-108-Met), which reduces the thermostability of the enzyme. This genetic polymorphism has been reported to be associated with schizophrenia and its associated clinical features (Li et al., 1996).

Higher rates of alcohol use have been reported in HIV+ individuals compared to the general population. Both heavy alcohol use and HIV infection are associated with increased risk of neuropsychological (NP) impairment. We examined effects of heavy active alcohol use and HIV on NP functioning in a large sample of community-residing HIV+ individuals and HIV− controls. The four main study groups included 72 HIV− light/non-drinkers, 70 HIV− heavy drinkers (>100 drinks per month), 70 HIV+ light/non-drinkers, and 56 HIV+ heavy drinkers. The heavy drinking group was further subdivided to assess effects of the heaviest levels of active alcohol use (>6 drinks per day) on NP functioning. A comprehensive NP battery was administered. Multivariate analysis of covariance was employed to examine the effect of HIV and alcohol on NP functioning after adjusting for group differences in age and estimated premorbid verbal intellectual functioning. The analyses identified main effects of heavy drinking and HIV on NP function, with greatest effects involving the contrast of HIV+ heavy drinkers and the HIV− light drinkers. Synergistic effects of heaviest current drinking and HIV infection were identified in analyses of motor and visuomotor speed. Supplementary analyses also revealed better NP function in the HIV+ group with antiretroviral treatment (ART) and lower level of viral burden, a finding that was consistent across levels of alcohol consumption. Finally, heavy alcohol use and executive functioning difficulties were associated with lower levels of self-reported medication adherence in the HIV+ group. The findings suggest that active heavy alcohol use and HIV infection have additive adverse effects on NP function, that they may show synergistic effects in circumstances of very heavy active alcohol use, and that heavy drinking and executive functioning may mediate health-related behaviors in HIV disease. (JINS, 2005, 11, 70–83.)

Numerous outcome studies have found fatigue to be a common problem following traumatic brain injury (TBI). This study examined the magnitude, causes and impact of fatigue following TBI using three subjective fatigue scales, and investigated its relationship with demographic and injury-related factors, and mood. Forty-nine controls and 49 TBI participants (36.2% with GCS score of 13–15, 29.8% with GCS score of 9–12, and 34% with GCS score of 3–8) were seen at a mean of approximately 8 months post injury. All participants completed three subjective fatigue measures, including the Fatigue Severity Scale (FSS), Visual Analogue Scale–Fatigue (VAS–F) and Causes of Fatigue Questionnaire (COF). TBI participants reported a significantly greater impact of fatigue on their lifestyle on the FSS relative to controls, and reported activities requiring physical and mental effort as more frequent causes of fatigue on the COF. There were, however, no significant group differences on subscales of the VAS–F. Greater time since injury and higher education levels were associated with higher fatigue levels, independent of the effects of mood. Injury severity and age were not found to be significant predictors of subjective fatigue severity in TBI participants. (JINS, 2005, 11, 416–425.)

To explore verbal memory impairments associated with multiple sclerosis (MS), we compared proactive and retroactive interference effects on the California Verbal Learning Test (CVLT; Delis et al., 1987) in a sample of 83 community-residing individuals with MS and 80 healthy participants. Individuals with MS demonstrated normal accumulation of proactive interference (PI), but attenuated release from PI relative to healthy individuals. Furthermore, accumulation of retroactive interference (RI) at short-delay free recall (SDFR) was intensified for those with MS as compared to healthy participants. Interestingly, accumulation of RI predicted long-term memory (LTM) only for participants with MS. These findings suggest that individuals with MS may experience particular difficulty when required to use semantic properties of information flexibly to facilitate verbal LTM. (JINS, 2005, 11, 737–746.)

One of the most common chromosomal deletions is a loss of genetic material from the long arm of chromosome 18. Most individuals with this condition exhibit mental retardation (68%), yet previous attempts to link cognitive status to deletion size have not shown an association, possibly because cases with additional genetic abnormalities were included. We studied 46 participants ranging from 3 to 35 years of age who had a pure genetic abnormality by excluding those with mosaicism or complex genetic rearrangements. Our patients had terminal deletions ranging from a proximal breakpoint at 18q21.1 (greater genetic abnormality, larger deletion size) to a more distal breakpoint at 18q23 characterized with molecular genetic techniques. Cognitive ability, assessed with the age-appropriate measure (Bayley, 1993, Differential Ability Scale, Wechsler Scales), ranged from IQ = 49 to 113, with a predominance of mild and moderate mental retardation. Using multivariate regression, deletion size breakpoint rank order was predicted by cognitive ability, age, and adaptive behavior (Vineland Adaptive Behavior Scales), accounting for 36% of the variance in deletion size. However, lower cognitive ability (beta = .34, p = .032) and younger age (beta = .296, p = .024) predicted a larger deletion size, but adaptive behavior (beta = .225, p = .15) did not. An additional multivariate regression showed that cognitive ability and age together accounted for 33% of the variance in deletion size, whereas univariate regression showed that cognitive ability accounted for 26% of the variance and age accounted for 11% of the variance. These findings suggest that degree of cognitive impairment is associated with genetic abnormality when a large sample of individuals with “pure” deletions of genetic material from chromosome 18 is examined. (JINS, 2005, 11, 584–590.)

Information processing speed and episodic memory are two commonly affected cognitive abilities in MS. Insights into the mechanisms of and relationships between these abilities have recently come from structural neuroimaging techniques, but few studies have used fluid-attenuated inversion recovery (FLAIR), a neuroimaging sequence known to be sensitive to cortical and juxtacortical lesions in MS. We hypothesized that a volumetric index of FLAIR total lesion volume (TLV) would be associated with slowed processing speed and verbal memory dysfunction in MS. Twenty MS patients underwent FLAIR imaging and were administered measures of verbal memory and processing speed. Correlational and regression analyses indicated that TLV was directly and independently related to measures of processing speed and verbal memory, and TLV accounted for 56% of the variance in cognitive performance. These findings, considered in the context of prior work, suggest that FLAIR TLV is a useful predictor of commonly impaired cognitive functions in MS, and shows promise as a functionally relevant biomarker for disease status. (JINS, 2005, 11, 205–209.)

Three hypotheses for cognitive deficits among psychopaths were tested: Response modulation, left hemisphere activation, and an interaction between the 2. Twenty-six psychopathic and 32 nonpsychopathic criminal offenders identified with the Hare Psychopathy Checklist–Revised were randomly assigned to left- and right-hemisphere activation groups. An auditory processing task was administered, such that the ability to classify nonverbal auditory signals and the ability to manage subgoals were assessed under left- and right-hemisphere activation conditions. The results showed that psychopaths' information processing in general, including response modulation, was deleteriously affected by left-hemisphere activation, supporting 2 of the 3 hypotheses tested. These results offer an explanation for inconsistent findings of executive deficits among psychopaths. (JINS, 2005, 11, 311–321.)

We examined, among those persons working preinjury, the risk of unemployment 1 year after traumatic brain injury (TBI) relative to expected risk of unemployment for the sample under a validated risk-adjusted econometric model of employment in the U.S. population. Results indicate that 42% of TBI cases were unemployed versus 9% expected, relative risk (RR) = 4.5, 95% confidence interval (CI) (4.12, 4.95). The relative risk for unemployment was higher among males, those with higher education, persons with more severe injuries, and more impaired early neuropsychological or functional status. Difference in unemployment rates gave similar results for gender, severity of injury, and early neuropsychological and functional status. However, for education, the excess was smaller among those more highly educated, but the unemployment rate in the more highly educated in the general population was sufficiently small to yield a larger relative risk. In conclusion, after accounting for underlying risk of unemployment in the general population, unemployment is substantially higher after TBI for people who were employed when they were injured. The differential employment status varies depending on demographics, severity of brain injury, early functional outcome, and neurobehavioral indicators. For characteristics such as education, associated with rates of unemployment in the general population, different methods used to compare the rates may yield different results. (JINS, 2005, 11, 747–752.)

Studies have shown that parkinsonian signs are related to cognitive function in aging. What remains unclear is whether this association is stronger for some cognitive domains than it is for others, and precisely how much variability in global and specific cognitive functions is explained by the motor signs. We examined the associations between four parkinsonian signs (gait, rigidity, bradykinesia, tremor) and five cognitive domains (episodic memory, semantic memory, working memory, perceptual speed, visuospatial ability) in a large cohort of older persons who were free of Parkinson's disease and dementia and were participating in the Rush Memory and Aging Project. In a series of regression equations that controlled for age, sex, and education, higher levels of three signs (gait, rigidity, and bradykinesia) were related to lower levels of cognitive function, but they accounted for less than 5% of the variance in most measures. The results did not change when the presence of depressive symptoms, diabetes, and hypertension were added to the models. The cross-sectional association between parkinsonian signs and cognitive function did not vary substantially across specific cognitive domains or specific cognitive tests. The results suggest that parkinsonian signs have a modest, but statistically reliable, association with level of cognitive function in old age. (JINS, 2005, 11, 591–597.)

Limited research has investigated specific attentional sequelae following pediatric traumatic brain injury (TBI), such as sustained, selective, and shifting attention, as well as speed of processing. Little is known about the pattern of recovery of these skills or their interaction with ongoing development. The present study examined attentional abilities at acute, 6-, 12-, and 24-month time points postinjury in a group of 71 children who had sustained a mild, moderate, or severe TBI. Results indicated that children who sustained a severe TBI generally performed poorest, but showed most recovery over time. The pattern of recovery was dependent on the attentional component being measured. Specifically, deficits were most evident on more complex and timed tasks. While a number of areas showed recovery over time, for some attentional components, difficulties persisted to 24 months postinjury. (JINS, 2005, 11, 84–98.)

Educational attainment is an important factor in the interpretation of cognitive test scores but years of education are not necessarily synonymous with educational quality among racial/ethnic minority populations. This study investigated the comparability of educational attainment with reading level and examined whether discrepancies in education and reading level accounted for differences in neuropsychological test performance between HIV+ racial/ethnic minority and nonminority participants. Study participants (N = 200) were derived from the Manhattan HIV Brain Bank (MHBB) where 50% of the cohort had ≤8th grade reading level but only 5% had ≤8 years of education. Significantly lower reading ability and education was found among African Americans and Hispanics, and these participants were more likely to have discrepant reading and education levels compared to non-Hispanic Whites. Discrepancy in reading and education level was associated with worse neuropsychological performance while racial/ethnic minority status was not. As years of schooling overestimated racial/ethnic minority participants' educational quality, standard norms based on education may inflate impairment rates among racial/ethnic minorities. Identifying appropriate normative standards is and will continue to be important in the detection of cognitive impairment in racial/ethnic minorities with HIV. (JINS, 2005, 11, 889–898.)

Problem: Inferential reasoning in language involves the ability to deduce information based on context and prior experience. This ability has been generally studied as a right-hemisphere function. Recent research, however, has suggested that inferencing involves anterior regions of both the left and right hemispheres. Methods: We further explored this idea by testing a group of non-aphasic, focal frontal patients (right and left hemisphere) on a new test of inferencing, the Word Context Test. The Word Context Test requires examinees to identify the meaning of a made-up word (e.g., prifa) based on its use in a series of sentences. Findings: Patients with frontal lobe lesions were significantly impaired on this task relative to a group of age- and education-matched controls. Contrary to earlier research focusing on a special role for the right hemisphere in inferencing, there was considerable overlap in performance of right- and left-frontal patients, with right-frontal patients performing better. Conclusions: These findings suggest that inferencing is disrupted following focal frontal injury and have implications for discourse comprehension in non-aphasic patients. (JINS, 2005, 11, 426–433.)

This study delineated patterns of alcohol use 1 year after traumatic brain injury (TBI) in a large, population-based, epidemiological, nonclinical sample, and identified predictors of heavy alcohol use in these individuals. Participants were 1,606 adults identified by review of a South Carolina statewide hospital discharge data set, on the basis of satisfying the Centers for Disease Control case definition of TBI, and were interviewed by telephone 1 year after TBI-related discharge. Alcohol use in the month prior to interview was classified according to categories from the Quantity–Frequency–Variability Index; heavy drinking was defined as nearly daily use with ≥ 5 drinks at least occasionally, or at least three occasions with ≥ 5 drinks. A polychotomous logistic regression with 3 response levels (heavy, moderate, and abstinent/infrequent/light drinking) was used to identify predictors of heavy drinking. Heavy drinking in the month prior to interview was reported by 15.4% of participants, while 14.3% reported moderate drinking and 70.3% reported abstinence or light/infrequent drinking. Risk factors for heavy drinking included male gender, younger age, history of substance abuse prior to TBI, diagnosis of depression since TBI, fair/moderate mental health, and better physical functioning. There was no association between drinking patterns and TBI severity. (JINS, 2005, 11, 322–330.)

Neuropsychological Assessment, Fourth Edition. Muriel D. Lezak, Diane B. Howieson, and David W. Loring, with H. Julia Hannay and Jill S. Fischer. 2004, New York: Oxford University Press. 1016 pp., $89.50 (HB).

When I was in my 3rd year of graduate school, I became interested in neuropsychology and purchased the first (1976) edition of Muriel Lezak's Neuropsychological Assessment to help prepare for my qualifying examination. It was the first neuropsychology book I ever owned and it was one of the few textbooks I have ever read from cover to cover. Neuropsychological Assessment is one of the classics in the field of clinical neuropsychology. It and the subsequent three editions of this classic have both reflected and shaped the field it represents. The book, often referred to as “Lezak,” is without question the most widely-consulted source on neuropsychological assessment as a clinical enterprise. The fourth edition continues in the great tradition of its predecessors, except that the sheer scope and magnitude of current work in neuropsychological assessment has now made an exhaustive and inclusive review of available tests impossible. As indicated in the preface, the revised goal of “Lezak IV” is to provide a “broad but necessarily and selectively restricted range of the information that is currently relevant and necessary for understanding and undertaking neuropsychological assessment.”

A topic much considered in research on acalculia was its relationship with aphasia. Far less attention has been given to the natural course of acalculia. In this retrospective study, we examined the relationship between aphasia and acalculia in an unselected series of 98 left-brain-damaged patients and the spontaneous recovery from acalculia in 92 acalculic patients with follow-up. There was a significant association between aphasia and acalculia although 19 participants exhibited aphasia with no acalculia and six acalculia with no aphasia. We observed significant improvement between a first examination carried out between 1 and 5 months post-onset and a second examination carried out between 3 and 11 months later (mean: 5 months). The mechanisms of spontaneous recovery are discussed. (JINS, 2005, 11, 99–107.)

We determined the rates of cognitive change associated with twenty individual measures. Participants included 547 noninstitutionalized septuagenarians and octogenarian residents of a comprehensive care retirement community who were studied over three years. Latent growth curves (LGC) of multiple cognitive measures were compared to a LGC model of the rates of change in Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). All curves were standardized relative to each variable's baseline distribution. Baseline scores were within their expected normal age-specific ranges. Most measures showed significant rates of change over time. There was also significant variability about those rates, suggesting clinical heterogeneity. Many deteriorated over time, as did ADLs and IADLs. However, performance on some measures improved, consistent with learning effects. The rates of change in two measures, the Executive Interview and the Trail Making Test, were closely related to decline in IADLs. These results suggest that age-related cognitive decline is a dynamic longitudinal process affecting multiple cognitive domains. Heterogeneity in the rates of cognitive change may reflect the summed effects of age and comorbid conditions affecting cognition. Some measures may be ill-suited for measuring age-related changes in cognition, either because they are insensitive to change, or hindered by learning effects. Nonverbal measures appear to be particularly well suited for the prediction of age-related functional decline. These observations are relevant to the definition and diagnosis of “dementing” conditions. (JINS, 2005, 11, 899–909.)