Chronic exposure to elevated glucocorticoid levels in Cushing's syndrome (CS), is associated with deficits in cognitive function and in emotion. The hippocampus plays a crucial role in the behavioral manifestations of the syndrome as it is richest in glucocorticoid receptors and is thus particularly vulnerable to glucocorticoid excess. The wide distribution of glucocorticoid receptors throughout the cerebral cortex, however, suggests that several cognitive functions can also be affected by the dysregulation of glucocorticoids. In this study, we investigated how an excess of glucocorticoid hormones affects cognitive processes. Nineteen patients with chronic hypercortisolemia due to CS were compared to healthy controls matched for age, sex, education, and occupation in tests of processing of visual and spatial information, memory, reasoning and concept formation, language and verbal functions, and attention. Multivariate and univariate analyses revealed overall differences in tests of treatment of visual and spatial information, reasoning and concept formation as well as in verbal and language performance, with poorer performance from CS patients. Differences were also observed in nonverbal aspects of memory and in attention tasks. The results suggest that chronic exposure to elevated levels of cortisol is associated with deficits in several areas of cognition, particularly those involving processing of selective attention and visual components. This study also shows that hormones play an important role in the modulation of cognitive function and that their influence on cerebral structure and function merits closer scrutiny. (JINS, 2000, 6, 20–29.)

Whereas the ventral cortical visual stream is important in object recognition, the dorsal stream is specialized for spatial localization. In humans there are also right and left hemisphere asymmetries in visual processing: the left hemisphere being more important in object recognition and the right in specifying spatial locations. Based on these dorsal–ventral and right–left where–what dichotomies, one would expect that the dorsal right hemisphere systems would be most activated during spatial localization tasks, and this activation may induce a leftward spatial bias in lower space. To determine if visual stimuli in upper and lower body space evoke different hemispheric activation, we had 12 normal participants bisect horizontal lines above and below eye level. Participants erred leftward in lower body space relative to upper body space (M = 1.3345 mm and 0.4225 mm, respectively; p = .011). In upper body space, bisection errors did not differ from zero, but in lower body space, errors tended to deviate leftward (M = 1.3345 mm, differs from null hypotheses at p = .0755). Our results are consistent with dorsal stream/right hemisphere activation when performing a spatial localization task in lower versus upper body space. (JINS, 2000, 6, 455–459.)

Recent evidence suggests that HIV-seropositive drug users are impaired on tasks of visuospatial working memory compared with drug users seronegative for HIV. In the current study we evaluated the performance of 30 HIV-seropositive male drug users and 30 risk-matched seronegative controls on two measures of verbal working memory, the Listening Span and the verbal Self Ordered Pointing Task. Impaired working memory performance was significantly more common among HIV-seropositive persons compared to controls, with the highest incidence of deficit among symptomatic participants. These findings indicate that working memory deficits in persons with HIV are not domain-specific and can be demonstrated reliably in drug users. (JINS, 2000, 6, 548–555.)

Although roles have been proposed for both graphomotor speed and learning in the execution of Digit Symbol, few data have been available concerning performance across the adult lifespan on the Symbol Copy, paired associates, or free recall measures derived from Digit Symbol and recommended in the WAIS–R–NI. We report findings on 177 healthy older adults (ages 50–90), providing normative data by age group, education level, and gender. As previously reported, Digit Symbol scores decline steeply with age (r = −.64). Symbol Copy speed declines almost as steeply (r = −.58). Incidental learning, however, declines only modestly (r = −.26 on both measures). Symbol Copy is a far stronger correlate of Digit Symbol (r = .72) than are paired associates or free recall (r = .26 and r = .28, respectively). The 2 incidental learning measures do, however, offer valuable supplementary information as part of a comprehensive individual assessment. When low Digit Symbol scores are produced by slowing on Symbol Copy, further evaluation of perceptual and motor speed and dexterity are indicated. When low incidental learning scores are obtained, further evaluation of memory is warranted. Qualitative analysis of errors (e.g., rotations) made on the incidental learning procedures may also be valuable. (JINS, 2000, 6, 770–780.)

Individuals given a series of words to memorize normally show better immediate recall for items from the beginning and end of the list than for midlist items. This phenomenon, known as the serial position effect, is thought to reflect the concurrent contributions of secondary and primary memory, respectively, to recall performance. The present study compared the serial position effects produced on Trial 1 of the California Verbal Learning Test (CVLT) in mildly demented (N = 25; M MMSE = 20.0) and very mildly demented (N = 25; M MMSE = 25.5) patients with Alzheimer's disease (AD), and age- and education-matched normal control (NC) participants (N = 50). In addition, the serial position effects of the very mildly demented AD patients were compared to those of patients with a transient, circumscribed amnesia arising from a prescribed series of electroconvulsive therapy (ECT) treatments for the relief of depressive illness (N = 11). While the NC group exhibited the typical serial position effect, AD patients recalled significantly fewer words than NC participants overall, and exhibited a significantly reduced primacy effect (i.e., recall of the first 2 list items) with a normal recency effect (i.e., recall of the last 2 list items). Patients with circumscribed amnesia due to ECT were as impaired as the very mildly demented AD patients on most standard CVLT measures of learning and memory, but exhibited primacy and recency effects, which were within normal limits. These results suggest that a reduction in the primacy effect, but not the recency effect, is an early and ubiquitous feature of the memory impairment of AD. It is not, however, a necessary feature of all causes of memory impairment. (JINS, 2000, 6, 290–298.)

Since constructional apraxia is often concomitant with brain lesions, the study of constructional tasks in the non-brain-damaged population might be useful in helping to disentangle other causal factors. This paper explores the performance of illiterate individuals (N = 29) as compared to that of semiliterates (N = 21) and literates (N = 23) in order to see the effect of reading and writing abilities on constructional tasks. Each participant was asked to construct 4 figures based upon models having varying degrees of complexity. A global criterion of lack of fidelity and several analytic criteria (related to distortion, rotation, and disarticulation errors) were used to evaluate performance. Although illiterates generally made more errors than semiliterates and semiliterates more than literates, only some of these differences were statistically significant. Significant differences were found for lack of global fidelity and disarticulation errors when all 4 figures were considered together. Subtler data emerged with respect to single figures. (JINS, 2000, 6, 668–672.)

Cognitive impairment in schizophrenia may be related to reduced availability of information-processing resources (resource limitations hypothesis). An abnormally accelerated age-related decline in processing resource availability may also occur in older patients with schizophrenia (neurodegeneration hypothesis). To test these hypotheses, pupillary responses were recorded as an index of processing resource availability during performance of the span of apprehension (SOA) task in 33 middle-aged and older patients with schizophrenia and 37 age-comparable nonpsychiatric participants. Consistent with the resource-limitations hypothesis, the patients with schizophrenia showed impaired detection accuracy and abnormally small pupillary responses (reduced resource allocation) only in the higher processing load SOA conditions. This pattern of results suggests that the patients depleted their available processing resources at lower processing loads than the nonpsychiatric participants. Consistent with the neurodegeneration hypothesis, cross-sectional analyses showed abnormally accelerated rates of age-related decline in SOA performance and pupillary responses in the patients with schizophrenia relative to age-comparable normal participants. (JINS, 2000, 6, 30–43.)

Two studies assessed the effects of a training procedure (Goal Management Training, GMT), derived from Duncan's theory of goal neglect, on disorganized behavior following TBI. In Study 1, patients with traumatic brain injury (TBI) were randomly assigned to brief trials of GMT or motor skills training. GMT, but not motor skills training, was associated with significant gains on everyday paper-and-pencil tasks designed to mimic tasks that are problematic for patients with goal neglect. In Study 2, GMT was applied in a postencephalitic patient seeking to improve her meal-preparation abilities. Both naturalistic observation and self-report measures revealed improved meal preparation performance following GMT. These studies provide both experimental and clinical support for the efficacy of GMT toward the treatment of executive functioning deficits that compromise independence in patients with brain damage. (JINS, 2000, 6, 299–312.)

Evidence is presented for the efficacy of a new method of assessing reading comprehension using a standardized reading test that was formatted for computer presentation with simultaneous event-related brain potential (ERP) recordings. Reading comprehension abilities of 23 healthy undergraduate students were evaluated using ERPs. The results revealed a differential ERP response pattern for correct and incorrect test items. These response patterns were observed at individual participant levels. The findings provided further support for the use of ERPs in the neuropsychological assessment of patients who are difficult or impossible to assess using behavioral responses because of concomitant motoric and/or communicative limitations. (JINS, 2000, 6, 556–567.)

A personality and behavioral disorder is an important and defining feature of frontal lobe dementia (FLD) or frontotemporal degeneration (FTD). The diagnosis usually depends on the progressive development of various behavioral symptoms rather than a set of neuropsychological measures. Quantification of the personality–behavior disorder is important for standardizing the diagnosis. An inventory was constructed to capture the major positive and negative behaviors and personality change, and it was administered prospectively to caregivers of 108 patients in a cognitive neurology clinic, at the time of first diagnostic assessment. The prevalence and extent of behavioral abnormality was quantitated in the clinic population of FLD, vascular dementia (VaD), Alzheimer's disease (AD), primary progressive aphasia (PPA), and depressive disorder (DD) patients. The mean scores of FLD patients were significantly above all other groups. Scores in VaD were also higher than in AD, PPA, and DD. Interrater reliability (Cohen's kappa of .90) and item consistency (a Cronbach alpha of .89) were both high. Perseveration, indifference, inattention, inappropriateness, and loss of insight rated highest in FLD, significantly different from all other groups. Apathy, aspontaneity, inflexibility, disorganization, impulsivity, personal neglect, and poor judgment were also significantly higher in FLD. Discriminant function correctly classified 92.7% versus all other patients (NON-FLD) in the study. A total of 18.8% of VaD patients were misclassified as FLD. Indifference, alien hand, and inappropriateness were the highest discriminant functions. Perseveration and verbal apraxia were important discriminatory items for FLD and PPA, respectively. The FBI is a standardized behavioral inventory useful to diagnose FLD, to differentiate it from other dementias, and to quantify the behavior disorder. (JINS, 2000, 6, 460–468.)

Many retrospective analyses of remote memory have demonstrated recency effects in that memory for events proximal to the time of testing is superior to memory for events from remote time periods. However, the rate at which information decays over time and the specific pattern of forgetting may vary depending upon the distinct attributes of stimuli used as indices of memory. Studies examining long-term forgetting of well rehearsed, conceptually integrated information underscore preservation of remote events, some of which are thought to be permanently stored in memory. A different pattern of forgetting emerges in relation to recall of discrete facts whereby recall declines according to a negatively accelerated decay curve. In the current study long-term retention of transient news events was examined. Results were examined in relation to the effects of age and sex. All age groups demonstrated recency effects in that events from the recent past were recalled better than remote events. Age did not exert a negative influence on recall of remote or recent events with the exception of younger participants who did not recall items predating their dates of birth. Older female participants were less adept at recalling very old events than their male counterparts. (JINS, 2000, 6, 44–51.)

Although the majority of research in theory of mind (TOM) has focused on young children or individuals with autism, recent investigations have begun to look at TOM throughout the lifespan and in other neurological and psychiatric populations. Some have suggested that TOM may represent a dissociable, modular brain system that is related to, but separable, from other brain functions including executive functions (EF). Recently, studies have shown that TOM performance can be compromised following an acquired brain insult (e.g, damage to the right hemisphere). However, the relationship of such impaired TOM performance to other brain functions in these cases has not been explored. This study investigated the effects of both normal human aging and Parkinson's disease on TOM. The relationship of TOM performance and EF in these groups was also examined. The results suggested that although TOM performance appeared compromised in the group of individuals with Parkinson's disease, the elderly control participants were relatively unimpaired relative to younger individuals. Significant relationships between several measures of TOM and EF were also found. The implications of these findings, and also the finding that failure on one measure of TOM did not necessarily predict failure on all measures of TOM, are discussed. (JINS, 2000, 6, 781–788.)

Although body dysmorphic disorder (BDD) is receiving increasing empirical attention, very little is known about neuropsychological deficits in this disorder. The current study investigated the nature of memory dysfunction in BDD, including the relationship between encoding strategies and verbal and nonverbal memory performance. We evaluated 17 patients with BDD and 17 healthy controls using the Rey–Osterrieth Complex Figure Test (RCFT) and the California Verbal Learning Test (CVLT). BDD patients differed significantly from healthy controls on verbal and nonverbal learning and memory indices. Multiple regression analyses revealed that group differences in free recall were statistically mediated by deficits in organizational strategies in the BDD cohort. These findings are similar to patterns previously observed in obsessive–compulsive disorder (OCD), suggesting a potential relationship between OCD and BDD. Studies in both groups have shown that verbal and nonverbal memory deficits are affected by impaired strategic processing. (JINS, 2000, 6, 673–681.)

Measuring recovery of function may mean testing the same individual many times, a procedure that is inevitably open to improvement due to learning on the specific tests rather than recovery per se. This is particularly likely to be an issue with measures of memory performance. We therefore studied the performance of normal and brain-injured people across 20 successive test sessions on measures of orientation, simple reaction time, forward and backward digit span, visual and verbal recognition, word list learning and forgetting, and on three semantic memory measures, namely, letter and category fluency and speed of semantic processing. Differences in overall performances between the two groups occurred for all tests other than orientation, digit span forward, and simple reaction time, although the tests differed in their degree of sensitivity. The tests varied in the presence or absence of practice effects and in the extent to which these differed between the two groups. Data are presented that should allow investigators to select measures that are likely to optimize sensitivity while minimizing possible confounding due to practice effects. (JINS, 2000, 6, 469–479.)

We examined short duration perception (400 ms), long duration estimation (30 and 60 min), and spatiotemporal estimation in long-term survivors of childhood cerebellar tumors with a mean time since diagnosis of 14.2 years. Groups of individuals with tumors treated with surgery only (astrocytoma, N = 20) were compared to those with tumors treated with surgery, focal radiation, and craniospinal radiation (medulloblastoma, N = 20), and to age- matched controls (N = 40). Childhood lesions of the cerebellum produced enduring deficits in short-duration perception, but spared the ability to functionally estimate long durations, regardless of the pathology or treatment of the tumor. Evidence did not support any functional recovery over time of the cerebellar system that underlies short-duration perception. Younger age at treatment was not a protective factor. Although no group differences were present in the functional measures of long-duration estimation, tumor-related prospective memory deficits interfered with the ability to produce long-duration prospective estimates. The utilization of sensory and somatomotor information to refine real-world spatiotemporal estimates was compromised in the medulloblastoma group only. (JINS, 2000, 6, 682–692.)

One theory of normal cognitive aging asserts that decreases in simple processing speed mediate the age-related decline of fluid intelligence. Another possibility is that age-related atrophic changes in frontal brain structures undermine the functioning of executive abilities, thereby producing the same decline. In this study, we used principal components analysis to derive a measure of fluid–spatial intelligence in 197 normal adults between 20 and 92 years of age. Measures of perceptual comparison speed, working memory, and executive ability, as well as regional brain volumes based on high resolution magnetic resonance imaging were obtained from a subsample of 112 participants. We then conducted a series of hierarchical multiple regression analyses to test whether (1) the processing speed theory, (2) frontal–executive theory, or (3) some combination of these best accounted for age-related variation in fluid intelligence. The results showed that perceptual comparison speed, executive ability, and frontal lobe volume each made significant contributions to a regression equation that explained 57% of the variance in fluid intelligence. These findings suggest that both the processing speed and frontal–executive theory of cognitive aging are partially correct and complement one another. (JINS, 2000, 6, 52–61.)

This study aimed to investigate outcome in adults with mild traumatic brain injury (TBI) at 1 week and 3 months postinjury and to identify factors associated with persisting problems. A total of 84 adults with mild TBI were compared with 53 adults with other minor injuries as controls in terms of postconcussional symptomatology, behavior, and cognitive performance at 1 week and 3 months postinjury. At 1 week postinjury, adults with mild TBI were reporting symptoms, particularly headaches, dizziness, fatigue, visual disturbance, and memory difficulties. They exhibited slowing of information processing on neuropsychological measures, namely the WAIS–R Digit Symbol subtest and the Speed of Comprehension Test. By 3 months postinjury, the symptoms reported at 1 week had largely resolved, and no impairments were evident on neuropsychological measures. However, there was a subgroup of 24% of participants who were still suffering many symptoms, who were highly distressed, and whose lives were still significantly disrupted. These individuals did not have longer posttraumatic amnesia (PTA) duration. They were more likely to have a history of previous head injury, neurological or psychiatric problems, to be students, females, and to have been injured in a motor vehicle accident. The majority were showing significant levels of psychopathology. A range of factors, other than those directly reflecting the severity of injury, appear to be associated with outcome following mild TBI. (JINS, 2000, 6, 568–579.)

In this study, we investigated 2 possible mechanisms by which interhemispheric interaction (IHI) might facilitate performance. Twenty university students performed 3- and 4-item versions of a less complex physical identity (PI) task in which they decided whether 2 letters were perceptually identical (e.g., ‘A’ and ‘A’) and a more complex name identity (NI) task in which they decided whether 2 letters had the same name (e.g., ‘A’ and ‘a’). Consistent with prior work, IHI facilitated performance more for the relatively complex NI task than for the simpler PI task regardless of how many items were in the display. However, for each task IHI facilitated performance less in the 4-item displays than in the 3-item displays. These results indicate that IHI facilitates performance by allowing (1) a division of processing across the hemispheres, and (2) task-relevant information to be processed by a hemisphere that receives a relatively light processing load. (JINS, 2000, 6, 313–321.)

Departing from the observation that illiterates significantly underscore in some neuropsychological tests, a learning-to-read method named NEUROALFA was developed. NEUROALFA is directed to reinforce these underscored abilities during the learning-to-read process. It was administered to a sample of 21 adult illiterates in Colima (Mexico). Results were compared with 2 control groups using more traditional procedures in learning to read. The NEUROPSI neuropsychological test battery was administered to all the participants before and after completing the learning-to-read training program. All 3 groups presented some improvement in the test scores. Gains, however, were significantly higher in the experimental group in Orientation in Time, Digits Backward, Visual Detection, Verbal Memory, Copy of a Semi-Complex Figure, Language Comprehension, Phonological Verbal Fluency, Similarities, Calculation Abilities, Sequences, and all the recall subtests, excluding Recognition. Performance in standard reading tests was also significantly higher in the experimental group. Correlations between pretest NEUROPSI scores and reading ability were low. However, correlations between posttest NEUROPSI scores and reading scores were higher and significant for several subtests. Results are interpreting as supporting the assumption that reinforcement of those abilities in which illiterates significantly underscore results in a significant improvement in neuropsychological test scores and strongly facilitates the learning-to-read process. The NEUROALFA method of teaching reading to adult illiterates is beginning to be used extensively in Mexico. To our knowledge, this is the first attempt to apply neuropsychological principles to social problems. (JINS, 2000, 6, 789–801.)