The Hopkins Verbal Learning Test (HVLT) is a brief verbal learning and memory test with six alternate forms. The HVLT is ideal in situations calling for repeated neuropsychological examinations, but it lacks a delayed recall trial which is essential for the assessment of abnormal forgetting. We present a revised version of the HVLT which includes a delayed recall trial, and therefore delays the yes/no recognition trial. The equivalence of test forms was examined in two separate studies using between-groups and within-subjects research designs. In both studies, the six forms of the revised HVLT (HVLT-R) were found to be equivalent with respect to the recall trials, but there were some modest differences in recognition. Recommendations for the use of the HVLT-R in serial neuropsychological examinations are provided, as well as normative data tables from a sample of 541 subjects, spanning ages 17 to 88 years.

Hopkins Verbal Learning Test—Revised: Normative data and analysis of inter-form and test–retest reliability.

on to develop full blown Parkinson's disease with rigidity and bradykinesia in the next few years. For those interested in the mechanisms of tremor, there are the customary authoritative reviews by Llinas, De Long, Lamarre, Rothwell and Deuschl, but uncertainty remains with respect to the relative importance of central autonomous generators and instability of peripheral reflex loops. Well written chapters are also included on primary orthostatic tremor and its relationship to essential tremor, writing tremor, neuropathic tremor, midbrain tremor and the increasingly acknowledged psychogenic tremors. Complex interrelationship between dystonia and postural tremor is also covered in depth. This cornucopia will be coveted and dipped into by those neurologists with a special interest in abnormal movement disorders, but who would not consider themselves to have a research interest in tremor. However, for the majority of clinicians involved in the hurly burly of clinical practice, I suspect that regrettably time and cost factors will conspire together to keep this excellent book out of reach. ANDREW LEES

https://jnnp.bmj.com/content/jnnp/59/3/346.1.full.pdf

Contributions to Neuropsychological Assessment

https://scholarlypublications.universiteitleiden.nl/access/item%3A2860436/view

Relationships between cognitive emotion regulation strategies and depressive symptoms: A comparative study of five specific samples

Context Cognitive impairment in late-life depression (LLD) is highly prevalent, disabling, poorly understood, and likely related to long-term outcome. Objectives To determine the characteristics and determinants of neuropsychological functioning LLD. Design Cross-sectional study of groups of LLD patients and control subjects. Setting Outpatient, university-based depression research clinic. Participants One hundred patients without dementia 60 years and older who met DSM-IV criteria for current episode of unipolar major depression (nonpsychotic) and 40 nondepressed, age- and education-equated control subjects. Main Outcome Measures A comprehensive neuropsychological battery. Results Relative to control subjects, LLD patients performed poorer in all cognitive domains. More than half exhibited significant impairment (performance below the 10th percentile of the control group). Information processing speed and visuospatial and executive abilities were the most broadly and frequently impaired. The neuropsychological impairments were mediated almost entirely by slowed information processing (β = .45-.80). Education (β = .32) and ventricular atrophy (β = .28) made additional modest contributions to variance in measures of language ability. Medical and vascular disease burden, apolipoprotein E genotype, and serum anticholinergicity did not contribute to variance in any cognitive domain. Conclusions Late-life depression is characterized by slowed information processing, which affects all realms of cognition. This supports the concept that frontostriatal dysfunction plays a key role in LLD. The putative role of some risk factors was validated (eg, advanced age, low education, depression severity), whereas others were not (eg, medical burden, age at onset of first depressive episode). Further studies of neuropsychological functioning in remitted LLD patients are needed to parse episode-related and persistent factors and to relate them to underlying neural dysfunction.

https://jamanetwork.com/journals/jamapsychiatry/articlepdf/482019/YOA30368.pdf

The nature and determinants of neuropsychological functioning in late-life depression.

This article reviews the changing epidemiology of HIV-associated dementia, current concepts of the different patterns of dementia under the influence of highly active antiretroviral therapy, and reviews therapeutic aspects.

/pdf/human-immunodeficiency-virus-associated-dementia-an-evolving-4bbl0p0952.pdf

Human immunodeficiency virus-associated dementia: An evolving disease

Older adult outpatients with major depression (n=25) and healthy control subjects (n=25) were compared using the Geriatric Depression Scale (GDS) and the Beck Depression Inventory (BDI). Both measures were sensitive in detecting clinical depression. Subjects were, however, more likely to endorse multiple responses in BDI items, suggesting that the GDS is simpler for older adults to complete. Viewed within the context of previous relevant research that used these instruments to compare older dults, our results yield additional evidence of cross-study consistency in the functional efficiency of both measures

The Geriatric Depression Scale and the Beck Depression Inventory as screening instruments in an older adult outpatient population.

Background Cognitive impairment is a common consequence of human immunodeficiency virus (HIV) infection, and dementia is one of the diseases that defines the acquired immunodeficiency syndrome. Peptide T (d-ala-peptide-T-amide) has been reported to block the binding of gp120 to brain tissue and to protect neurons from the toxic effects of gp120 in vitro. In pilot studies, administration of peptide T to HIV-positive patients with cognitive impairment was associated with improvement in cognition and constitutional symptoms. Objective To determine whether the intranasal administration of peptide T would improve cognitive function of HIV-positive patients with cognitive impairment. Patients and Methods This was a 3-site, double-blind, placebo-controlled trial of peptide T given intranasally at a dosage of 2 mg 3 times a day for 6 months. Participants were HIV-seropositive persons with evidence of cognitive deficits on a screening test battery. Concomitant antiretroviral therapy was allowed. Randomization to the 2 study arms was balanced according to several stratification variables, such as CD4 + cell count, severity of cognitive impairment, and antiretroviral therapy at study entry. A comprehensive neuropsychological (NP) battery, which yielded 23 scores, was administered at baseline and the study end point. The primary outcome measure was a global NP score derived from the 23 standardized scores. The efficacy end point was the change in NP score at 6 months compared with baseline. Secondary efficacy measures were 7 cognitive domain scores and deficit scores of global and domain performance. The patients who completed the baseline and final NP evaluations (after at least 4 months in the randomized treatment arm) were included in the efficacy analyses. Additional analyses were conducted on subgroups of patients according to the CD4 + count and baseline NP deficit. The incidence of NP improvement in the 2 treatment arms was also compared. Results There was no statistically significant difference between the peptide T and placebo groups on the global NP change score, the individual domains, or the deficit scores. Because of an imbalance in the baseline CD4 + cell count between treatment arms, analyses were also adjusted for this variable. These CD4 + -adjusted analyses suggested ( P =.07; analysis of covariance [ANCOVA]) a greater improvement in the peptide T group. Subgroup analyses indicated a treatment effect for patients whose CD4 + cell count was above 0.200×10 9 /L (200 cells/µL) at baseline. Moreover, peptide T treatment was associated with overall cognitive improvement in patients with baseline global deficit scores of at least 0.5, while overall deterioration was more common among the placebo group ( P =.02; Mantel-Haenszel χ 2 test). Conclusions Peptide T was not significantly different from placebo on the study primary end points. However, additional analyses indicated that peptide T may be associated with improved performance in the subgroup of patients with more evident cognitive impairment (ie, NP global deficit score ≥0.5) or with relatively preserved immunological status (ie, CD4 + cell count >0.200×10 9 /L).

https://jamanetwork.com/journals/jamaneurology/articlepdf/773550/noc7082.pdf

Randomized Double-blind Placebo-Controlled Trial of Peptide T for HIV-Associated Cognitive Impairment

Cognitive performance was assessed in older (60-75 years) and middle-aged (40-59 years) unmedicated outpatients with major depression and in healthy controls to examine potential interactive effects of age and depression. Cognitive performance was assessed from three categories of tasks: verbal, visual-spatial, and visuo-motor scanning tasks. Depressed subjects did not perform as well as controls on visuo-motor scanning tasks that included the Trail Making Tests A and B, and the Symbol Digit Modalities Test. Likewise, the older compared to the middle-aged group was slower on the visuo-motor scanning tasks. In addition, the older group showed poorer performance on visual-spatial tasks. Neither depression nor age group effects were observed for the primarily verbal tasks. Age and depression combined in an additive (noninteractive) fashion such that the older depressed subjects performed worse than the middle-aged depressed subjects, and older and middle-aged controls, on visuo-motor scanning tasks. Language: en

Cognitive performance in older and middle-aged depressed outpatients and controls

Improvement in AIDS patients on peptide T.

The University of Southern California Repeatable Episodic Memory Test (USC-REMT) was developed to provide a brief assay of memory in clinical drug trials where the same subject is tested multiple times over days or weeks. Therefore, it had to be minimally affected by repeated testing. The test also provides a measure of subjective organization, a cognitive strategy that might be sensitive to frontal lobe dysfunction and HIV-related memory deficits. The USC-REMT has seven different lists, each composed of 15 semantically unrelated, high-frequency nouns. The words are presented in a different order on three study-test trials. After each study trial the subject recalls the words in any order. The test takes about 10 min to administer and score. The recall protocol can be scored for (a) global mnemonic efficiency, (b) primary and secondary memory, (c) subjective organization, (d) recall consistency and (e) recall as a function of serial position. We report initial data showing that the test is sensitive to memory decrements. Thirty-six HIV-1 seropositive men, at various stages of illness, recalled significantly fewer words and exhibited less subjective organization than 14 matched controls. The test had no significant practice effects over the first three administrations when separated by several days. The seven alternate lists are essentially equivalent. The USC-REMT appears to complement currently published verbal memory tasks.

Elaine M. Eaton

Papers

The Geriatric Depression Scale and the Beck Depression Inventory as screening instruments in an older adult outpatient population.

Randomized Double-blind Placebo-Controlled Trial of Peptide T for HIV-Associated Cognitive Impairment

Cognitive performance in older and middle-aged depressed outpatients and controls

Improvement in AIDS patients on peptide T.

University of southern california repeatable episodic memory test