Objectives: To investigate whether the relationship between arm use and motor impairment post-stroke is influenced by the hemisphere of damage. Methods: Right-handed patients with unilateral left hemisphere damage (LHD) or right (RHD) (n=58; 28 LHD, 30 RHD) were recruited for this study. The Arm Motor Ability Test and Functional Impact Assessment were used to derive arm use patterns. The Fugl-Meyer motor assessment scale was used to quantify the level of motor impairment. Results: A significant interaction between patient group and impairment level was observed for contralesional, but not ipsilesional arm use. For lower impairment levels, contralesional (right arm for LHD and left arm for RHD) arm use was greater in LHD than RHD patients. In contrast, for greater levels of impairment, there were no arm use differences between the two patient groups. Conclusions: When motor impairment is significant, it overrides potential effects of stroke laterality on the patterns of arm use. However, a robust influence of hemisphere of damage on the patterns of arm use is evident at lower impairment levels. This may be attributed to previously described arm preference effects. These findings suggest adoption of distinct strategies for rehabilitation following left versus right hemisphere damage in right-handers, at least when the impairment is moderate to low. (JINS, 2019, 25, 470–478)

This paper highlights major developments over the past two to three decades in the neuropsychology of movement and its disorders. We focus on studies in healthy individuals and patients, which have identified cognitive contributions to movement control and animal work that has delineated the neural circuitry that makes these interactions possible. We cover advances in three major areas: (1) the neuroanatomical aspects of the “motor” system with an emphasis on multiple parallel circuits that include cortical, corticostriate, and corticocerebellar connections; (2) behavioral paradigms that have enabled an appreciation of the cognitive influences on the preparation and execution of movement; and (3) hemispheric differences (exemplified by limb praxis, motor sequencing, and motor learning). Finally, we discuss the clinical implications of this work, and make suggestions for future research in this area. (JINS, 2017, 23, 768–777)

Objectives: The cardinal motor deficits seen in ideomotor limb apraxia are thought to arise from damage to internal representations for actions developed through learning and experience. However, whether apraxic patients learn to develop new representations with training is not well understood. We studied the capacity of apraxic patients for motor adaptation, a process associated with the development of a new internal representation of the relationship between movements and their sensory effects. Methods: Thirteen healthy adults and 23 patients with left hemisphere stroke (12 apraxic, 11 nonapraxic) adapted to a 30-degree visuomotor rotation. Results: While healthy and nonapraxic participants successfully adapted, apraxics did not. Rather, they showed a rapid decrease in error early but no further improvement thereafter, suggesting a deficit in the slow, but not the fast component of a dual-process model of adaptation. The magnitude of this late learning deficit was predicted by the degree of apraxia, and was correlated with the volume of damage in parietal cortex. Apraxics also demonstrated an initial after-effect similar to the other groups likely reflecting the early learning, but this after-effect was not sustained and performance returned to baseline levels more rapidly, consistent with a disrupted slow learning process. Conclusions: These findings suggest that the early phase of learning may be intact in apraxia, but this leads to the development of a fragile representation that is rapidly forgotten. The association between this deficit and left parietal damage points to a key role for this region in learning to form stable internal representations. (JINS, 2017, 23, 139–149)

Background: The influence of psychotherapy on neurocognition in post-traumatic stress disorder (PTSD) has not been examined methodically. This is despite evidence that pre-treatment learning and memory has been associated with treatment success and that executive function theories emphasize weak executive functions (especially inhibition/switching) are associated with PTSD. Objectives: To determine (1) if higher pre-treatment learning/memory, inhibition/switching, or both predict treatment success; and (2) if treatment success is associated with specific improvement in inhibition/switching and not learning/memory or working memory, another aspect of executive function. Methods: Pre-treatment neurocognition and neurocognitive changes (inhibition/switching, learning/memory, working memory) were examined in female veterans with PTSD. They were evaluated before and after 16-weeks of group psychotherapy for PTSD that included three counterbalanced modules (cognitive restructuring therapy, exposure therapy, skills training) with fidelity checks for therapist adherence. Results: Only pre-treatment learning/memory predicted better treatment outcome. Treatment success was associated with improvement in inhibition/switching only, even after controlling for mild traumatic brain injury, and changes in depressive symptoms, working memory, and learning/memory. Conclusions: Our finding that learning/memory predicted treatment success is consistent with previous studies. We extended these studies by showing that the effect was restricted to learning/memory, which is contrary to the executive function theory of PTSD. In contrast, the fact that only inhibition/switching significantly improved with better treatment success is consistent with its potential importance in maintaining PTSD symptoms. Future research should determine whether inhibition/switching abilities are a risk for development and maintenance of PTSD or whether such abilities have a broader reciprocal relationship with PTSD symptom change. (JINS, 2016, 22, 643–651)

Neuropsychologists frequently are asked to comment on everyday functioning, but the research relies mostly on questionnaire-based assessment of daily functioning. While performance-based assessment of everyday functioning has many advantages over commonly used questionnaires, there are few empirically validated comprehensive performance-based measures. We present data here on a performance-based battery of daily living skills, the Functional Impact Assessment (FIA) in 47 unilateral stroke patients and 37 matched healthy controls. The FIA was validated by comparing it to performance on the self- and informant-report version of the Functional Activities Questionnaire (FAQ). We also examined the relationship between the FIA and cognitive functioning using the Neuropsychological Assessment Battery (NAB). The stroke group's performance on the FIA, FAQ (self and informant), and NAB (total and domain scores) was significantly (d′s ≥ .80) lower than the control group. The NAB total score and all domain scores were highly correlated with the FIA in the stroke group (r's > .7), and only one NAB domain score (visuospatial) was a unique predictor. This may be due to the fact that most of the NAB domains have a statistical problem of multicollinearity, which may explain why only the spatial domain was a unique predictor. While the informant FAQ was significantly correlated with FIA total score (r = .48, p < .01), the NAB total score was a significantly better predictor (r = .83, p < .001) than the informant FAQ. NAB total scaled score of less than 86 predicted impairment on the FIA with 92% sensitivity and 84% specificity. Our findings argue that the FIA is sensitive to deficits associated with stroke and is highly associated with all neuropsychological domains (attention, executive functions, language and spatial skills, and memory). (JINS, 2011, 17, 832–840)

This study evaluated the clinical utility of the Neuropsychological Assessment Battery (NAB) in a stroke sample by examining the NAB’s ability to differentiate a chronic stroke group with radiologically confirmed unilateral damage (n = 42) and a demographically matched healthy control (HC) group (n = 36). The stroke group performed more poorly than the control group across NAB Total score and all five Domain scores. Receiver operator curves (ROC) were derived and area under the curve (AUC) showed moderate diagnostic effectiveness (AUC .70 to .90) for NAB Total score, all five Domain scores, a motor composite, and a Global Deficit Score (GDS) that has been shown to closely approximate clinical ratings of neuropsychological impairment. The NAB Total, GDS, and motor composite had comparable clinical utility, whereas the Attention and Executive domain scores demonstrated better classification utility compared with the Memory domain. Because 90.5% of our stroke sample had middle cerebral artery territory strokes, the comparison of motor and cognitive classification utility may be biased. However, follow-up analyses showed that the NAB accounted for additional variance even when motor composite was included in the model. Sensitivity, specificity, and odds ratios at various clinical cutoffs are provided. These results suggest that the NAB is a useful clinical tool for detection of cognitive deficits in individuals with chronic unilateral stroke, although lenient clinical cutoffs appear warranted to maximize sensitivity. (JINS, 2010, 16, 813–821.)

The manuscript by Stefanatos, Gershkoff, and Madigan is the inaugural contribution to the new Neurobehavioral Grand Rounds feature of JINS. Case reports have been published in JINS in the past, but the goal of this new feature is to highlight the importance of case reports that are theoretically driven and have the potential to influence future research in the area. You will see that this case fits that description very well. In order to emphasize the larger context of the case, for each Grand Rounds an expert in the area will be asked to provide a short introduction. Dr. Jeffrey Binder, a neurologist at the Medical College of Wisconsin and an expert in the neural basis of language, has written an introduction that emphasizes the value of this case in terms of its utilization of a careful perceptual analysis combined with anatomical data to better characterize this classic syndrome.

This marks the official beginning of my tenure as Editor-in-Chief of JINS though the transition has been ongoing for more than a year. The change you will notice most is the cover, but I have also instituted a new section, Neurobehavioral Grand Rounds, which is a way to emphasize the importance of case studies by including an introduction by an expert in the field who will put the case in a broader context. Other sections will remain the same except I have changed the name of Research Letters to Rapid Communications, and I want to encourage you to submit such papers that are short, and are put on a fast track for review. Electronic submission and review is still in its infancy, but I am optimistic that it will speed the review process. Speedy publication is in all of our interests, but rapid, high quality reviews are the cornerstone of that speed. Therefore, when JINS asks you to review a manuscript, please agree to do it. We will be relying heavily on your help in order to improve the review lag.

I am very honored to be the new Editor-in-Chief of the Journal of the International Neuropsychological Society, JINS, beginning in January 2005. It is a daunting task to follow in Dr. Grant's footsteps. He has done a stellar job of developing this journal from its conception to its current status, and the statistics that he presents tell only part of the story. He appropriately recognizes all of the help he has received, but JINS' success is largely due to his vision, organization, innovation, and leadership. In order to concretely recognize that vision and its continuing influence on JINS, Dr. Grant's name will be listed on the cover of JINS as its Founding Editor. He had the vision to develop a journal that “fits” the INS from the standpoint of its breadth, multidisciplinary contributions, and scientific rigor. He selected and has led an impressive group of senior editors with expertise in a variety of areas, and these editors have provided a level of editorial expertise that would not be possible with a single Editor-in-Chief. Dr. Grant has also brought electronic submission and review to JINS. Web-based submission began August 1. Even though electronic submission and review should facilitate logistics, the quality of JINS will still be most dependent on high quality peer review provided by the Editorial Board and a large group of dedicated reviewers.

In recent years there has been extensive research in neuropsychological sequelae of a variety of etiologies, including traumatic brain injury, dementia, stroke, Parkinson's disease, schizophrenia, and cardiac surgery. With the exception of stroke and cardiac surgery, significantly fewer studies have been published regarding neuropsychological outcome in adults with disorders associated with anoxia or ischemia. Outcomes research in anoxic or ischemic disorders in pediatric patient populations are even more limited.

Behavioral neurologists and neuropsychologists have debated the role of the thalamus and basal ganglia in cognition and behavior for more than a century (e.g., Bucy, 1942; Marie, 1906; Penfield & Roberts, 1959; Wernicke, 1874). However, over these 100-plus years, there is little consensus regarding whether or how these structures contribute to cognition. Fortunately, recent research findings are rapidly changing this state of affairs. It is now obvious we will not understand how the brain controls complex activities until we understand the contribution of these deep brain structures. In healthy and brain-damaged individuals, application of methodologies such as semantic priming, event related potentials, and functional neuroimaging to the question of subcortical functions is beginning to resolve this conundrum. This symposium demonstrates the utility of combining these different approaches. It features empirical work from six laboratories that have engaged in systematic inquiries regarding the role of the thalamus and basal ganglia in cognition. This body of work represents both new directions and convergence of recent findings in the quest to integrate our understanding of this complex issue.

The standardization sample from the WMS–III (N = 1250), which varied in age from 16 to 89, was used to determine whether encoding, retrieval, or storage of verbal and spatial information was most affected by normal aging. Immediate and delayed recall and recognition of Logical Memory and Visual Reproduction were examined. Immediate verbal and spatial recall significantly deteriorated with increasing age, and the age-associated deterioration in delayed recall and recognition was largely explained by poorer immediate memory. These findings, in concert with the smaller aging effects for percent retention after a delay, suggest that the aging effect is due to deterioration in encoding more than retrieval or storage of new information. While Visual Reproduction deteriorated more rapidly with age than Logical Memory, the pattern of performance decrements as a function of age were comparable across both tests. Decreases in performance were first seen in the fifth decade with gradual deterioration until the eighth decade when there was another precipitous drop. These results suggest that functions that are more dependent on the frontal lobes are more vulnerable to aging than those that are more dependent on the temporal lobes. (JINS, 2003, 9, 89–96.)

While some of the modifications made to produce the WAIS–III and WMS–III (Wechsler, 1997a, 1997b) make sense from a neuropsychological standpoint, there are many questions still unanswered about the validity and reliability of these tests and their ultimate utility to neuropsychologists. The new tests have been criticized for having long administration times, which is problematic given pressures to decrease rather than increase the length and cost of neuropsychological evaluations (Ryan et al., 1998). Clinical neuropsychologists want to know if these tests can help them evaluate their patients more accurately with greater sensitivity and specificity than the alternatives, and experimental neuropsychologists want to know if they can help answer theoretical questions.

Connolly's preface to this book ends with Jacob Bronowski's very apt quote, “the hand is the cutting edge of the mind.” The “Preface” illustrates his fascination with the complexity of human movement.

Charles G. Matthews will be missed for his enormous contributions to clinical neuropsychology, but even more for his wisdom, integrity, wit, humility, compassion, and eloquence. It was these personal characteristics which made Chuck an extraordinary, yet quiet leader. His influential role in the inception and continuing development of our major organizations earned him a position among our profession's “Founding Fathers.” He was president of Division 40 (1989), INS (1991), and ABCN (1991–1993), but his influence spanned decades. He quietly served behind the scenes as an advisor to presidents of these organizations who recognized his perspicacity and ability to see all sides of a given issue.

A traumatic spinal cord injury (SCI) is accompanied by a documented moderate to severe head injury in significant numbers of SCI patients. In a previous study (Dowler et al., 1995), cognitive deficits were found in 41% of the SCI individuals who were studied with a chronic injury from a traumatic event. The present study investigated whether clinically useful subtypes of normal and impaired cognition could be identified in a chronic (M = 17 years postinjury) SCI sample using a cluster analysis of neuropsychological test performance. A battery of 16 neuropsychological tests was administered to 91 SCI patients and 75 control participants. Composite scores, reflecting performance in different cognitive domains, were derived from a factor analysis of the battery, and these scores were then used in the cluster analysis. A six-cluster solution generated the most distinct and clinically relevant SCI group profiles. Two of the cognitive profiles were characterized by normal functioning in all cognitive domains, but they were distinguished by differences in performance levels. The remaining four SCI groups (60% of the sample) showed clinically significant deficits in one or more cognitive domains, with different groups showing moderate attention and processing speed deficits, mild deficits in processing speed, executive processing difficulties, or moderate memory impairments. Though age and premorbid intellectual ability were strong predictors of the cognitive profiles of some SCI groups, when these factors were controlled, the findings suggested that the patterns of cognitive impairment were likely due to a potential concomitant head injury. (JINS, 1997, 3, 464–472.)