Stroke is the leading health care problem requiring rehabilitation services today (CDC, 2001; Lee et al., 1996) with the worldwide incidence estimated to be between 300 and 500 per 100,000 people (Sudlow & Warlow, 1997). In most recent years, the rates of mortality are decreasing, resulting in a significant increase in the number of survivors living with the disabilities/handicaps associated with stroke (Thorvaldsen et al., 1997). Not only is stroke a common health problem, but the cognitive disorders that result are common as well (Mayo, 1993; Paolucci et al., 1996).This article is based in part on a Presidential Address by the first author to the Annual meeting of the International Neuropsychological Society in Honolulu, Hawaii in February, 2002.

It remains essential to document the neuropsychological profile of acquired immunodeficiency syndrome (AIDS) dementia complex (ADC) and minor forms human immunodeficiency virus (HIV)-associated neurocognitive impairment by quantifying the magnitude of impairment across eras of treatment. Indeed, with the introduction of the highly active antiretroviral therapy (HAART), there is evidence of changes in aspects of ADC. To allow quantitative and qualitative comparisons with the HAART era studies, we developed a summary of neuropsychological performance acquired in pre-HAART era studies in advanced HIV infection and ADC. Using a meta-analytical procedure and a test nomenclature that accounts for task complexity, we found that individuals with symptomatic infection (but no AIDS) demonstrated a global mild level of cognitive impairment, except for the domains complex attention/psychomotor speed, motor coordination, and learning, which showed moderate impairment. Individuals with AIDS demonstrated a global moderate level of cognitive impairment with a predominance of deficits in attention, complex attention/psychomotor speed, learning, motor coordination, with additional deficits in verbal memory and reasoning. Individuals with ADC demonstrated the most severe cognitive disturbances in domains of learning, motor coordination, with additional deficits in verbal fluency and verbal memory. Moderate impairment was evidenced in domains of complex attention/psychomotor speed, whereas naming and visuospatial functions were relatively preserved. The profile of deficits in ADC suggests that it may not be only interpreted as a worsening form of the impairment that is seen in the AIDS and symptomatic stages of HIV disease but that there are also additional deficits suggestive of an alternate pathogenetic process(es). (JINS, 2006, 12, 368–382.)

This study examined implicit semantic and rhyming cues on perception of auditory stimuli among nonaphasic participants who suffered a lesion of the right cerebral hemisphere and auditory neglect of sound perceived by the left ear. Because language represents an elaborate processing of auditory stimuli and the language centers were intact among these patients, it was hypothesized that interactive verbal stimuli presented in a dichotic manner would attenuate neglect. The selected participants were administered an experimental dichotic listening test composed of six types of word pairs: unrelated words, synonyms, antonyms, categorically related words, compound words, and rhyming words. Presentation of word pairs that were semantically related resulted in a dramatic reduction of auditory neglect. Dichotic presentations of rhyming words exacerbated auditory neglect. These findings suggest that the perception of auditory information is strongly affected by the specific content conveyed by the auditory system. Language centers will process a degraded stimulus that contains salient language content. A degraded auditory stimulus is neglected if it is devoid of content that activates the language centers or other cognitive systems. In general, these findings suggest that auditory neglect involves a complex interaction of intact and impaired cerebral processing centers with content that is selectively processed by these centers (JINS, 2006, 12, 649–656.)

Sex differences in executive speech tasks, favoring women, have been noted in behavioral studies and functional imaging studies. In the present study, the clustering and switching components of semantic and phonemic verbal fluency tests were examined in 40 healthy men and 40 healthy women. Possible sex differences in the influence of cognitive factors such as speed of information processing, word knowledge, and/or verbal long-term memory on these verbal fluency factors were also assessed. The results showed that women switched more often between categories in the phonemic fluency test, whereas men showed a trend toward a larger cluster size leading to a smaller total number of words generated. Additionally, higher performance on the Digit Symbol test was associated with better performance on the semantic and phonemic verbal fluency test in men, whereas in women, better memory performance was associated with better performance on these verbal fluency tests. Our data indicate that men and women are using different processing strategies for phonemic verbal fluency tests to optimize verbal fluency task performance. In the current study, women adopted a more successful strategy of balancing clustering and switching in the phonemic fluency task. (JINS, 2006, 12, 502–509.)

Individuals with left-hemisphere damage often have concomitant impairment of spoken and written language. Whereas some treatment studies have shown that reading paired with spoken naming can benefit both language modalities, little systematic research has been directed toward the treatment of spelling combined with spoken naming. The purpose of this study was to examine the therapeutic effect of pairing a lexical spelling treatment referred to as Copy and Recall Treatment (CART) with verbal repetition of target words. This approach (CART + Repetition) was compared with treatment using verbal repetition without the inclusion of orthographic training (Repetition Only). Two individuals with moderate aphasia and severe impairment of spelling participated in the study using a multiple baseline design across stimulus sets and treatment conditions. Both participants improved spelling of targeted words as well as spoken naming of those items, but improvement in spoken naming was marked for one individual in the CART + Repetition condition, while the other participant made smaller gains in spoken than written naming irrespective of treatment condition. Consideration of the participant profiles suggested that CART + Repetition provides greater benefit when there is some residual phonological ability and the treatment serves to stimulate links between orthography and phonology. (JINS, 2006, 12, 816–827.)

Very few empirically validated interventions for improving metacognitive skills (i.e., self-awareness and self-regulation) and functional outcomes have been reported. This single-case experimental study presents JM, a 36-year-old man with a very severe traumatic brain injury (TBI) who demonstrated long-term awareness deficits. Treatment at four years post-injury involved a metacognitive contextual intervention based on a conceptualization of neuro-cognitive, psychological, and socio-environmental factors contributing to his awareness deficits. The 16-week intervention targeted error awareness and self-correction in two real life settings: (a) cooking at home; and (b) volunteer work. Outcome measures included behavioral observation of error behavior and standardized awareness measures. Relative to baseline performance in the cooking setting, JM demonstrated a 44% reduction in error frequency and increased self-correction. Although no spontaneous generalization was evident in the volunteer work setting, specific training in this environment led to a 39% decrease in errors. JM later gained paid employment and received brief metacognitive training in his work environment. JM's global self-knowledge of deficits assessed by self-report was unchanged after the program. Overall, the study provides preliminary support for a metacognitive contextual approach to improve error awareness and functional outcome in real life settings. (JINS, 2006, 12, 54–63.)

The role of the human frontal lobes in episodic memory is becoming better understood, thanks mainly to focal lesion and neuroimaging studies. Here we review some recent findings from basic research on the frontal lobes in memory encoding, search, and decision-making at retrieval. For each of these processes, researchers have uncovered cases in which frontal memory impairments can be attenuated by various task manipulations. We suggest ways in which these findings may inform clinical evaluation and rehabilitation of memory problems following frontal damage. (JINS, 2006, 12, 210–223.)

Patients with schizophrenia exhibit normal memory for separate objects or locations but are disproportionately impaired when the items must be bound for later recognition in a working memory (WM) setting (Burglen et al., 2004). This study aimed at further evaluating the contribution of each WM component to the patients' binding deficit, using selective articulatory, visuospatial, and executive suppression tasks. In the object–location binding task used, a trial comprised the successive presentation of three drawings of familiar objects and of three spatial locations in a grid, either separately (i.e., objects alone or locations alone) or bound (i.e., object+location), and required a recognition test following an 8-s delay. In the suppression modalities, suppression was continuous from presentation to test. A total of 22 patients with schizophrenia and 24 healthy controls participated. The results confirmed the binding deficit in patients' performance in the baseline modality where no suppression was required. They also showed that patients were particularly disrupted when suppression was visuospatial. This last finding extends the specific visuospatial vulnerability in schizophrenia to the operations of binding. (JINS, 2006, 12, 510–518.)Note: The data provided in this study have been partly matter of a university thesis presented by Franck Burglen.

Observation of figural reproductions of right temporal lobe epilepsy (RTLE) patients have revealed overall configuration errors, whereas in left temporal lobe epilepsy (LTLE) patients, the global aspect of performance is generally preserved. This study compared performance of individuals with temporal lobe epilepsy (LTLE, n = 83; RTLE, n = 63) on a global/local modification of the Rey-Osterrieth Complex Figure Test (RCFT). In Phase I, neuropsychologists (n = 6) and neuropsychology fellows (n = 3) completed a survey identifying the global and local aspects of the RCFT. Questionnaire responses were used to categorize a list of global and local items (five global, five local) for re-scoring the protocols of TLE patients during study Phase II. Results showed that the RTLE and LTLE groups were not differentiated according to the global or local indices F(1,141) = .385; p = not significant. There were lower local scores for both groups in the copy F(1,142) = 5.23; p = .024, immediate F(1,142) = 445.26; p < .001, and delay trials F(1,142) = 427.82; p < .001, indicating less retention of local information over time. Results suggest general declines in figural memory for local stimulus properties in both unilateral TLE groups. However, this relationship was weakened after controlling for global and local item verbalizability. (JINS, 2006, 12, 383–390.)

Cognitive impairments in patients with basal ganglia dysfunction are primarily revealed where performance relies on internal, voluntary control processes. Evidence suggests that this also extends to impaired control of more automatic processes, including visuospatial attention. The present study used a non-predictive peripheral cueing paradigm to compare and contrast visuospatial deficits in patients with Parkinson's disease (PD) with those previously revealed in patients with Huntington's disease (HD) (Fielding et al., 2006a). Compared to age-matched controls, both PD and HD patients exhibited increased distractibility or poor fixation, however only PD patients responded erroneously to cue stimuli more frequently than control subjects. All subjects demonstrated initial facilitation for valid versus invalid cues following the shorter stimulus-onset asynchronies (SOAs) and a performance decrement at the longer SOAs (inhibition of return), although there was a clear differentiation between these groups for immediate SOAs. Unlike both control and PD subjects, where IOR manifested between 350 and 1000 msec, IOR was evident as early as 150 msec for HD patients. Further, for PD patients, spatially valid cues resulted in hyper-reflexivity following 150 msec SOAs, with saccadic latencies shorter than those generated in response to un-cued targets. Thus contrasting deficits were revealed in PD and HD, emphasizing the important contribution of the basal ganglia in the control of more automatic behaviors (JINS, 2006, 12, 657–667.)

The behavioral syndrome resulting from damage to the ventromedial prefrontal (VM) region presents major challenges for clinical assessment and management, stemming from the absence of reliable neurologic or psychometric markers, coupled with often debilitating impairments of decision-making and behavior regulation. Damage to this region disrupts neural circuitry critical for emotion, which in turn may contribute to impairments in real-world competencies. Here we present findings from patients with focal lesions in the VM region acquired either in childhood or adulthood, and show that there is a relationship between emotional dysfunction and impairments in real-world behavioral competencies. Emotion was rated by participants' relatives on dimensions including frustration tolerance, lability, anxiety, and blunted affect. Real-world competencies were rated by the relatives on dimensions including judgment, planning, and initiation, and were evaluated by clinician ratings in areas including social, financial, and occupational function. VM damage resulted in severe disruption of emotion, and this emotional dysfunction accounted for a significant portion of impaired real-world competencies. The long-term impairments associated with childhood-onset lesions were at least as severe as those resulting from adult-onset damage. Greater focus on the contribution of emotional dysfunction to the real-world competencies of patients with damage in the VM region may sharpen their neuropsychological assessment and facilitate rehabilitation efforts. (JINS, 2006, 12, 224–235.)

Neuropsychological test results are affected by multiple factors, but usually age and education are the only variables by which norms are stratified. Some authors have questioned whether these variables alone are sufficient (e.g., Marcopulos et al., 1997; Manly et al., 2002), since such norms have lead to problems, such as poor specificity for African Americans on dementia screening devices (Fillenbaum et al., 1990). Recent research has shown that reading ability, a measure of educational quality, attenuated racial differences in test performance (Manly et al., 2002). We specifically examined whether reading ability would account for a greater amount of variance than education in executive function tests in a population traditionally subject to poor educational quality. Results determined that reading ability accounted for a significantly greater amount of variance than years of education for Letter-Number Sequencing, Similarities, COWA, Trail Making Test, and Coloured Progressive Matrices. Reading ability was found to significantly mediate the relationship between each of these tests and education. Animal naming appears to be least affected by educational quality or quantity. These findings hold implications for the interpretation of neuropsychological test results, especially in those exposed to substandard educational quality, and for the way that test norms are constructed. (JINS, 2006, 12, 64–71.)

The complex process of cortical reorganization of language-related brain regions during recovery from aphasia and the effects of therapeutic interventions on brain systems are poorly understood. We studied two patients with chronic aphasia and compared their functional neuroanatomical responses to a younger control group on two tasks, an oral-reading task involving overt speech and a “passive” audiovisual story-comprehension task. Following identical therapy, we re-examined behavioral (language) and functional neuroanatomical changes using the same functional magnetic resonance imaging (fMRI) tasks. We hypothesized that better recovery would be associated with brain activation patterns more closely resembling healthy controls, whereas positive responses to language treatment would be associated with increased activity in undamaged left perisylvian areas and/or right-hemisphere areas homologous to the damaged regions. For the participant with a frontal lesion who was most responsive to therapy, brain activation increased in the right hemisphere during oral-reading, but decreased bilaterally in most regions on story-comprehension. The other participant with a temporal–parietal lesion showed decreased activation, particularly in the right hemisphere, during oral-reading but increased activation bilaterally on story-comprehension. Results highlight individual variability following language therapy, with brain activation changes depending on lesion site and size, language skill, type of intervention, and the nature of the fMRI task. (JINS, 2006, 12, 828–842.)

Attentional impairments in children occur in the context of both developmental and acquired disorders involving the central nervous system (CNS) and may have implications for ongoing development, potentially impeding cognitive, educational, and behavioral functions. Using a continuous performance paradigm (CPT), this study compared attentional profiles of children with developmental and acquired conditions impacting on the CNS: (i) attention deficit–hyperactivity disorder (ADHD: n = 27); (ii) moderate traumatic brain injury (TBI: n = 41); (iii) acute lymphoblastic leukemia (n = 31); and (iv) insulin-dependent diabetes mellitus (n = 39). A healthy control group (n = 46) was also examined. Groups were compared on measures of sustained attention, selective attention, and response inhibition. In addition, measures of performance variability and deterioration and processing speed were examined. Results showed that children with ADHD exhibited global and severe attentional impairments in contrast to all other groups. Children with moderate TBI displayed mild attentional difficulties, restricted to selective and sustained attention domains. In conclusion, although CPT parameters differentiated the ADHD group from all others, a disorder-specific profile was not observed. (JINS, 2006, 12, 519–531.)

This investigation reports the results of a pilot study concerning the application of principles of use-dependent learning developed in the motor rehabilitation literature as Constraint Induced Therapy to language rehabilitation in a group of individuals with chronic aphasia. We compared treatment that required forced use of the language modality, Constraint Induced Language Therapy, (CILT) to treatment allowing all modes of communication. Both treatments were administrated intensively in a massed practice paradigm, using the same therapeutic stimuli and tasks. Results suggest that whereas both interventions yielded positive outcomes, CILT participants showed more consistent improvement on standard aphasia measures and clinician judgments of narrative discourse. These findings suggest that CILT intervention may be a viable approach to aphasia rehabilitation. (JINS, 2006, 12, 843–852.)

Production of complex discourse—lengthy, open-ended utterances and narratives—requires intact basic language operations, but it also requires a series of learned procedures for construction of complex, goal-directed communications. The progression of clinical disorders from transcortical motor aphasia to dynamic aphasia to discourse impairments represents a progression of procedural deficits from basic morpho-syntax to complex grammatical structures to narrative and a progression of lesions from posterior frontal to polar and/or lateral frontal to medial frontal. Two cases of impaired utilization of language exemplify the range of impairments from clearly aphasic agrammatic, nonfluency to less and less “aphasic” and more and more executive impairments from transcortical motor aphasia to dynamic aphasia to narrative discourse disorder. The clinical phenomenology of these disorders gradually comes to be more accurately defined in the terminology of executive deficits than that of aphasia. The executive deficits are, in turn, based on impairments in various components of attention. Specific impairments in energizing attention and setting response criteria associated, respectively, with lesions in superior medial and left ventrolateral frontal regions may cause defective recruitment of the procedures of complex language assembly. (JINS, 2006, 12, 236–247.)

Adaptations of the National Adult Reading Test (NART) for assessing premorbid intelligence in languages other than English requires (a) generating word-items that are rare and do not follow grapheme-to-phoneme mappings common in that language, and (b) subsequent validation against a cognitive battery normed on the population of interest. Such tests exist for Italy, France, Spain, and Argentina, all normed against national versions of the Wechsler Adult Intelligence Scale. Given the varieties of Spanish spoken in the United States, the adaptation of the Spanish Word Accentuation Test (WAT) requires re-validating the original word list, plus possible new items, against a cognitive battery that has been normed on Spanish-speakers from many countries. This study reports the generation of 55 additional words and revalidation in a sample of 80 older, Spanish-dominant immigrants. The Batería Woodcock-Muñoz Revisada (BWM-R), normed on Spanish speakers from six countries and five U.S. states, was used to establish criterion validity. The original WAT word list accounted for 77% of the variance in the BWM-R and 58% of the variance in Ravens Colored Progressive Matrices, suggesting that the unmodified list possesses adequate predictive validity as an indicator of intelligence. Regression equations are provided for estimating BWM-R and Ravens scores from WAT scores. (JINS, 2006, 12, 391–399.)

The agreement between neuropsychologists identifying cognitive impairment (CI) in older adults was examined, as were factors influencing the classification process. Twenty four neuropsychologists in 18 study centers classified cases with or without CI after reviewing neuropsychological findings and other relevant information. All cases were participants in the third wave of the Canadian Study of Health and Aging, a study of CI in later life. For 117 randomly selected cases, a second neuropsychologist reviewed the same material and reclassified the cases. Cases given the same (concordant) or different (discordant) classifications were compared with respect to patient and rater characteristics. The inter-rater agreement was moderate (77.7% agreement, kappa = .49). On all measures of cognitive functioning, the concordant group without impairment obtained a higher mean score than the discordant group, and the discordant group obtained a higher mean score than the concordant group with impairment. For 5 out of 8 cognitive measures, the concordant group with impairment differed from the concordant group without impairment and the discordant group, but the latter two groups did not differ significantly. The findings are comparable to others in the field and highlight the need for neuropsychologists to further clarify procedures for identifying subtle, or mild, forms of cognitive impairment. (JINS, 2006, 12, 72–79.)

Asperger's disorder (ASP), like other autism spectrum disorders, is associated with altered responsiveness to social stimuli. This study investigated learning and responsiveness to nonsocial, but motivational, stimuli in ASP. We examined choice behavior and galvanic skin conductance responses (SCRs) during the Iowa Gambling Task (IGT; Bechara et al., 1994) in 15 adolescents and young adults with ASP and 14 comparison subjects. We examined aspects of learning, attention to wins and losses, and response style with a formal cognitive model, the Expectancy–Valence Learning model (Busemeyer & Stout, 2002). The ASP group did not differ from the comparison group in proportions of selections from advantageous decks. However, ASP participants showed a distinct pattern of selection characterized by frequent shifts between the four IGT decks, whereas comparison participants developed clear deck preferences. SCR results showed some evidence of reduced responsiveness in the ASP group during the IGT. Results from the cognitive model indicated that, in contrast to the comparison group, the ASP group's selections were less consistent with the motivational significance they assigned to decks. Findings are discussed in the context of the neurobiological substrates associated with IGT performance (JINS, 2006, 12, 668–676.)

Working memory (WM) deficits are common in multiple sclerosis (MS). The Paced Auditory Serial Addition Test (PASAT) is used frequently to measure WM in clinical settings. The n-back paradigm is used often in experimental studies of WM. One unique component of the n-back task is that it provides a measure of reaction time (RT), an additional behavioral index of processing speed and task difficulty. Despite the use of both tasks to measure WM, their common variance has not been documented. We tested 32 MS patients and 20 controls; performance measures were obtained for both tasks. Compared with controls, MS patients generally had poorer performance on both the PASAT and n-back task. MS patients also had slower RTs on the n-back than controls and showed more slowing than controls as a function of WM load. Correlational analyses showed a high correspondence between performance measures on the PASAT and n-back. Principal components analysis pointed to a common feature of the PASAT, n-back, and specific other neuropsychological measures, that is, processing speed. Although the PASAT and n-back were shown to have a significant amount of shared variance, each test has specific advantages and disadvantages for use in clinical populations (JINS, 2006, 12, 677–687.)