Despite the sensitivity of neuropsychological tests to educational level, improved diagnostic accuracy for demographically corrected scores has yet to be established. Diagnostic efficiency statistics of Wechsler Adult Intelligence Scale-III (WAIS-III) and Wechsler Memory Scale-III (WMS-III) indices that were corrected for education, sex, and age (demographically corrected) were compared with age corrected indices in individuals aged 16 to 75 years with moderate to severe traumatic brain injury (TBI) and 12 years or less education. TBI participants (n = 100) were consecutive referrals to an outpatient rehabilitation service and met careful selection criteria. Controls (n = 100) were obtained from the WAIS-III/WMS-III standardization sample. Demographically corrected indices did not provide higher diagnostic efficiency than age corrected indices and this result was supported by reanalysis of the TBI group against a larger and unmatched control group. Processing Speed Index provided comparable diagnostic accuracy to that of combined indices. Demographically corrected indices were associated with higher cut-scores to maximize overall classification, reflecting the upward adjustment of those scores in a lower education sample. This suggests that, in clinical practice, the test results of individuals with limited education may be more accurately interpreted with the application of demographic corrections. Diagnostic efficiency statistics are presented, and future research directions are discussed. (JINS, 2009, 15, 938–950.)

Few studies have evaluated the prevalence of impairments of financial capacity among individuals with psychiatric disorders. Late life depression (LLD) is a common psychiatric disorder associated with significant disability and cognitive impairment. The purpose of this investigation was to determine the prevalence and cognitive correlates of impairments of financial capacity among individuals with LLD. Participants included 65 LLD individuals and 32 comparison subjects. Assessments included measures of financial capacity, cognitive functioning, and depression symptom severity. Individuals with LLD exhibited a significantly higher rate of impaired financial capacity (22%) than the comparison group (6%). Results of a multiple regression analysis indicated that performance on measures of executive functioning and attention, but not depression severity, were most strongly associated with financial capacity performance in LLD. Our results suggest impairments of financial capacity in LLD are largely explained by cognitive functioning in these domains. (JINS, 2009, 15, 793–798.)

We examined differences in response latencies obtained during a validated video-based hazard perception driving test between three healthy, community-dwelling groups: 22 mid-aged (35–55 years), 34 young–old (65–74 years), and 23 old-old (75–84 years) current drivers, matched for gender, education level, and vocabulary. We found no significant difference in performance between mid-aged and young-old groups, but the old-old group was significantly slower than the other two groups. The differences between the old-old group and the other groups combined were independently mediated by useful field of view (UFOV), contrast sensitivity, and simple reaction time measures. Given that hazard perception latency has been linked with increased crash risk, these results are consistent with the idea that increased crash risk in older adults could be a function of poorer hazard perception, though this decline does not appear to manifest until age 75+ in healthy drivers. (JINS, 2009, 15, 799–802.)

The purpose of the present study was to investigate the ability to perceive facial and vocal affect in a group of patients with obsessive–compulsive disorder (OCD) and to explore the specific emotions that might be troublesome for them. Participants were 25 patients with OCD and 25 healthy controls, matched for age, education, and gender. They were assessed with computerized tests of affect perception using visual faces [Kinney’s Affect Matching Test (KAMT)], visual everyday scenarios [Fantie’s Cartoon Test (FCT)], and prosody [Affective Prosody Test (APT)], as well as a facial recognition test [Kinney’s Identity Matching Test (KIMT)]. Severity of OCD symptoms in the patient group was measured with the Yale–Brown Obsessive Compulsive Scale. Patients with OCD were not impaired in the perception of emotion, in either the visual [still photographs (KAMT) or sketches of everyday scenarios (FCT)] or the vocal (APT) modality, as compared with age-, sex-, and education-matched healthy individuals. Moreover, patients with OCD did not differ from healthy individuals in discriminating facial identity (KIMT). With regard to each emotion type separately, patients performed equally well as healthy individuals in all the emotions examined. Emotion processing of both facial expressions and prosody does not appear to be deficient in patients with OCD (JINS, 2009, 15, 148–153).

Following a neuropathological event, individuals left with moderate-to-severe memory impairment are unable to reliably form new memories. The most common challenges involve the capacity to perform a task in the future and to consciously recall a recent event. Disruption of these memory processes leaves the individual trapped in the present, unable to stay on track, and alienated from ongoing events. Memory research has demonstrated that implicit memory is often preserved despite severe explicit memory impairment and that preserved memory systems can provide avenues for acquiring new skills and knowledge. A within-subject single-case A1-B1-A2-B2 experimental design was used to introduce an established theory-driven training program of technology use for individuals with moderate-to-severe memory impairment. We describe its application to enabling RR, an individual with memory impairment postcolloid cyst removal, to independently support her memory using a commercial smartphone. RR showed successful outcome on both objective and qualitative measures of memory functioning. Moreover, she demonstrated consistent and creative generalization of acquired smartphone skills across a broad range of real-life memory-demanding circumstances. Our findings suggest that individuals with moderate-to-severe memory impairment are able to capitalize on emerging commercial technology to support their memory. (JINS, 2009, 15, 629–638.)

The objective of this study is to identify whether decline in cognitive functioning after chemotherapy in women with breast cancer is associated with health/disease, treatment, and psychological variables. Neuropsychological performance, health/disease, and treatment-related information of 136 women with breast cancer (age M = 49.38; SD = 7.92; range = 25.25–67.92) was assessed pre-chemotherapy and 1-month post-chemotherapy. The Reliable Change Index corrected for practice (RCIp) identified women whose performance significantly declined, while Pearson correlations assessed the relationship between cognitive change and predictor variables. A total of 16.9% of women showed significant decline post-chemotherapy, with affected domains including verbal learning and memory, abstract reasoning, and motor coordination. Decline in hemoglobin levels and increased anxiety over the course of chemotherapy was found to significantly predict impairment in multiple cognitive measures. Change in specific cognitive measures was significantly associated with baseline fatigue, depression, and functional well-being (r = 0.23 to 0.33; p = .01 to < .001). Although the effects are small, there is evidence that psychological and health factors may increase vulnerability to cognitive dysfunction after chemotherapy for breast cancer. Significant associations reported in this study may be useful in the identification and treatment of at-risk individuals. (JINS, 2009, 15, 951–962.)

Six individuals with probable Alzheimer’s disease (AD) participated in a phase 1 study employing a repeated measures, parallel baseline design testing the hypothesis that error-free experience during word production practice combined with an acetyl cholinesterase inhibitor would improve confrontation naming ability. While acetyl cholinesterase inhibitors are safe and delay cognition decline associated with AD, improvement over baseline cognition is less evident; clinically significant cognitive deficits persist and progress. Both animal and clinical research strongly implicate acetylcholine in learning, a form of neuroplasticity. In clinical practice, however, people with AD are given cholinergic medications without concomitant systematic/targeted retraining. In this study six participants with probable AD and taking donepezil participated in targeted word production practice using an errorless learning strategy. Results showed that combining behavioral enrichment training and an acetyl cholinesterase inhibitor resulted in significant improvements in verbal confrontation naming of trained items for three of six participants. Differences in baseline dementia severity, living conditions, and medications may have influenced the training response. Detection of substantial treatment effects in 50% of subjects suggests further language treatment studies in AD in combination with an acetyl cholinesterase inhibitor are warranted and provide useful information on inclusion/exclusion criteria for use in subsequent studies. (JINS, 2009, 15, 311–322.)

The aim of this study was to examine discrepancies between immediate/delayed recall and recall/working memory in middle-aged and older persons by age and education. Participants were 322 healthy individuals from the community who were stratified into three age and three education groups. Immediate and delayed recall distributions of WMS-III Logical Memory (LM) scores approximated normal curves, and LM savings scores showed a significant, but small, effect of age. LM (immediate, delayed) and Letter-Number Sequencing (LNS) discrepancies varied as a function of age and education. The difference between LM and LNS was not significant in the younger and less educated participants, but increased with age in the most educated group, and in the oldest group LNS exceeded LM (immediate and delayed). The results indicate deterioration in encoding and retrieval, rather than storage, with age, and show a differential, but small, effect of age and education on the memory measures. Working memory was resistant to age-related decline relative to immediate and delayed recall in the oldest, most educated group. Delayed recall–working memory discrepancy is relatively stable with age and education and may be a useful index of the onset of memory pathology across different ages and levels of education.(JINS, 2009, 15, 963–972.)

Pituitary adenomas, even after successful treatment, are associated with cognitive dysfunctions. We hypothesized that an association between the age of the patients at pituitary surgery and neuropsychological outcome may exist. Forty-two patients (mean age 51 ± 10 years) who had been successfully treated for pituitary adenoma (surgery with or without subsequent radiotherapy) underwent neuropsychological testing. Age at treatment (mean 37 ± 11 years) was significantly associated with Trail Making Test, Part B (TMT-B) results, a measure of executive control and attention (r = .60, p < .0001). This association remained significant after adjustment for age at testing and time since treatment (r = .42, p = .008). No associations were detected between age at treatment and Trail Making Test, Part A (TMT-A, attentional speed), the digit span test (acoustic working memory), and the German version of the Auditory Verbal Learning and Memory, and Memory Test (verbal memory, all p ≥ .3). Our data suggest a favorable effect of younger age at treatment in adults on neurocognitive outcome after surgery for pituitary adenoma. (JINS, 2009, 15, 803–806.)

We investigated the relative discriminatory efficacy of an event-based prospective memory (PM) task, in which specificity of the instructions and perceptual salience of the PM cue were manipulated, compared with two widely used retrospective memory (RM) tests (Rivermead Paragraph Recall Test and CERAD-Word List Test), when detecting mild cognitive impairment of suspected Alzheimer’s disease etiology (MCI-AD) (N = 19) from normal controls (NC) (N = 21). Statistical analyses showed high discriminatory capacity of the PM task for detecting MCI-AD. The Non-Specific-Non-Salient condition proved particularly useful in detecting MCI-AD, possibly reflecting the difficulty of the task, requiring more strategic attentional resources to monitor for the PM cue. With a cutoff score of <4/10, the Non-Specific-Non-Salient condition achieved a sensitivity = 84%, and a specificity = 95%, superior to the most discriminative RM test used (CERAD-Total Learning: sensitivity = 83%; specificity = 76%). Results suggest that PM is an early sign of memory failure in MCI-AD and may be a more pronounced deficit than retrospective failure, probably reflecting the greater self-initiated retrieval demands involved in the PM task used. Limitations include the relatively small sample size, and the use of a convenience sample (i.e. memory clinic attenders and healthy active volunteers), reducing the generalizability of the results, which should be regarded as preliminary. (JINS, 2009, 15, 154–159.)

Research has indicated that there may be age-related and Alzheimer’s disease (AD) -related reductions in regional cerebral blood flow (rCBF) in the brain. This study explored differences in age- and AD-related rCBF patterns in the context of cognitive aging using a multivariate approach to the analysis of H215O PET data. First, an rCBF covariance pattern that distinguishes between a group of younger and older adults was identified. Individual subject’s expression of the identified age-related pattern was significantly correlated with their performance on tests of memory, even after controlling for the effect of age. This finding suggests that subject expression of the covariance pattern explained additional variation in performance on the memory tasks. The age-related covariance pattern was then compared to an AD-related covariance pattern. There was little evidence that the two covariance patterns were similar, and the age-related pattern did a poor job of differentiating between cognitively-healthy older adults and those with probable AD. The findings from this study are consistent with the multifactorial nature of cognitive aging. (JINS, 2009, 15, 973–981.)

Neuropsychological data on an extended series of cases of variant Creutzfeldt-Jakob Disease (vCJD) are presented, complementing earlier findings from smaller sample studies of this condition. Distinct neuropsychological features in this extended series included relatively preserved verbal knowledge, immediate verbal memory span, and elementary visual processing. This sparing contrasted with ubiquitous impairment in every vCJD patient on timed tests of verbal fluency and digit-symbol substitution. There were also high rates of impairment on tests of memory, and of visuoperceptual and visuospatial reasoning. Our findings lend support to the view that distinctive neuropsychological features may be one of the diagnostic markers of the condition. (JINS, 2009, 15, 807–810.)