Showing papers in "Journal of Clinical and Experimental Neuropsychology in 1989"
TL;DR: The findings indicate that autobiographical and personal semantic memory show a consistent pattern of impairment, when a comparison is made which controls for the age of the memories and the subject's own past experience.
Abstract: This paper describes a new technique for assessing "autobiographical" and "personal semantic" memory in amnesic patients and healthy controls. It provides evidence of the reliability and validity of the procedure, and reports an age-related temporal gradient in amnesic patients. The results are considered in terms of the severity, the rate of onset, and the duration of the amnesia; and a preliminary analysis is given of the findings in different diagnostic groups. The findings indicate that autobiographical and personal semantic memory show a consistent pattern of impairment, when a comparison is made which controls for the age of the memories and the subject's own past experience.
887 citations
TL;DR: An integrative theoretical framework is proposed to account for unawareness of deficits in diverse neuropsychological syndromes and possible directions for future research are outlined.
Abstract: Damage to different regions of the brain can cause a variety of neuropsychological deficits, including specific disturbances of language, memory, perception and motor function. A significant number of brain-damaged patients are unaware of their deficits, even when they are profound and have debilitating effects on patients' performance. This article reviews clinical observations and experimental investigations concerning unawareness of deficits, considers methodological issues, and critically evaluates different interpretations of the phenomenon. An integrative theoretical framework is proposed to account for unawareness of deficits in diverse neuropsychological syndromes. Possible directions for future research are outlined.
637 citations
TL;DR: The Rivermead Behavioural Memory Test is concluded that the RBMT is a short, reliable, and valid test of everyday memory problems.
Abstract: This paper describes the Rivermead Behavioural Memory Test (RMBT)-a short test of everyday memory problems with four parallel forms. It was administered to 118 control subjects aged between 16-69 years with a mean IQ of 106 (range 68-136). The limit of normal performance was established on this group and cut-off points were determined for individual components of the test. The test was also given to 176 brain-damaged people and its validity assessed both by correlating RMBT scores to performance on existing tests, to subjective ratings from patients and carers and to observation by therapists of memory lapses. Validity, parallel form and interrater reliability all proved to be high. It is concluded that the RBMT is a short, reliable, and valid test of everyday memory problems.
493 citations
TL;DR: This case illustrates some means of increasing the utility of forced-choice malingering tests, as a 45-year-old restaurant owner claimed that he was unable to work because of impaired memory for seven years following head trauma.
Abstract: For seven years following head trauma, a 45-year-old restaurant owner had claimed that he was unable to work because of impaired memory. A specially designed forced-choice memory test yielded performance significantly below the chance level and thus indicated malingering. This case illustrates some means of increasing the utility of forced-choice malingering tests.
336 citations
TL;DR: Development and initial validation of a scale for assessment of agitation in traumatic brain-injured individuals and results of initial validation are discussed in light of classic test theory and research necessary for determination of construct validity.
Abstract: Development and initial validation of a scale for assessment of agitation in traumatic brain-injured individuals is described. Items were selected from an initial 39-item pool based on their testability, differentiation of agitation, frequency of occurrence, and representation of the full domain of the construct. The resulting 14-item instrument, called the Agitated Behavior Scale (ABS), was subsequently tested on an independent sample of 35 head-injured subjects. Reliability was examined via measures of internal consistency and qualitative evaluation of principal components factor analysis. Cronbach's alpha exceeded .80 for all rates. Comparable values of theta were found and qualitative criteria of internal consistency were met. The ABS score accounted for between 36% and 62% of the variance in 15 of 16 correlations with simultaneous, independent observations of agitation. Results of initial validation are discussed in light of classic test theory and research necessary for determination of construct validity.
236 citations
TL;DR: The components of a functional memory book system as well as the three-stage behavioral training procedure for teaching individuals with severe memory impairments to independently utilize a compensatory memory book are described.
Abstract: A systematic, structured training sequence for teaching individuals with severe memory impairments to independently utilize a compensatory memory book is reviewed. The training sequence is theoretically motivated, incorporating both principles of learning theory as well as aspects of memory known to be preserved in many patients with even severe amnestic disorders. This paper describes the components of a functional memory book system as well as the three-stage behavioral training procedure. An illustrative case study reviewing the training and resultant effective use of a memory book system for daily living and employment in a severely memory-impaired patient is provided.
231 citations
TL;DR: The results suggest that MS patients exhibit a slowing of mental processing independent of motor involvement, which is similar to that seen in normal controls.
Abstract: We have recently proposed that the cognitive deficits of patients with multiple sclerosis (MS) share numerous characteristics associated with the syndrome of subcortical dementia. One such characteristic, slowness of mental processing, was evaluated in the present study. Thirty-six MS patients were compared to 26 normal controls of equivalent age, education, and verbal intelligence on the Sternberg memory scanning test. As anticipated, the motor-involved MS patients had an overall slower reaction time than did controls. Their scanning rate, a measure of pure cognitive speed, was also significantly slower than controls. These results suggest that MS patients exhibit a slowing of mental processing independent of motor involvement.
203 citations
TL;DR: The results suggest that the memory disturbance in MS results primarily from an imparied ability to access information from secondary memory, while encoding and storage capacity is intact.
Abstract: Thirty-seven patients with multiple sclerosis (MS) were compared to 26 normal controls of equivalent age, education, and verbal intelligence on measures of verbal learning and memory (Digit Span and Supraspan, Brown-Peterson Distractor Task, Selective Reminding Test, Story Recall, and Free Verbal Recall) and verbal fluency (Letter and Animal Fluency). The MS patients exhibited deficits on measures of secondary (long-term) memory and verbal fluency, but performed normally on measures of primary (short-term) memory, recognition memory, and rate of forgetting from secondary memory. These results suggest that the memory disturbance in MS results primarily from an imparied ability to access information from secondary memory, while encoding and storage capacity is intact. Degree of memory impairment was unrelated to length of illness, severity of disability, or self-reported depression.
190 citations
TL;DR: In this article, it has been suggested that the normal aging process is characterized by a pattern of neuropsychological performance decline that implies relatively greater vulnerability of right-hemisphere functions.
Abstract: It has been suggested that the normal aging process is characterized by a pattern of neuropsychological performance decline that implies relatively greater vulnerability of right-hemisphere functions. This hypothesis was tested in a sample of 68 volunteers aged 20–75 who were free of systemic and neurologic illness. Neuropsychologic measures of lateralized and focal function were specifically selected to eliminate systematic procedural differences among tests (e.g., timed vs. untimed, overlearned vs. unfamiliar). Inferences about the localizing significance of each measure were based on previously demonstrated double dissociation of function in lesion studies. Results suggested that declines in cerebral efficiency are not differentially lateralized. Age correlated performance changes implied bilateral reduction that was significantly more pronounced on operations associated with frontal-lobe function. Anatomic and theoretical explanations for this pattern were discussed.
174 citations
TL;DR: Voice perception (recognition of familiar voices and discrimination of unfamiliar voices) was studied in brain-damaged patients and normal controls and indicated that an intact right parietal-lobe was present in all cases of normal voice recognition.
Abstract: Voice perception (recognition of familiar voices and discrimination of unfamiliar voices) was studied in brain-damaged patients and normal controls. Left- and right-brain-damaged subjects were tested on familiar voices (25 famous males) and 26 pairs of unfamiliar voices. Deficits in recognizing familiar voices were significantly correlated with right-hemisphere damage; discrimination of unfamiliar voices was worse in both clinical groups than in normal controls. Computerized tomographic scans indicated that an intact right parietal-lobe was present in all cases of normal voice recognition, while right parietal-lobe damage was significantly correlated with a deficit in voice recognition. Temporal-lobe damage of either hemisphere was associated with a voice discrimination deficit.
159 citations
TL;DR: Demented patients showed significantly greater semantic priming than either normal group on both tasks, arguing against the hypothesis that the semanticPriming found in demented patients is due solely to automatic processes.
Abstract: Previous studies using a word-naming task have suggested that in demented patients, semantic priming results only from automatic spreading activation and not from attention-dependent processes. If this is true, then on a lexical-decision task where attention-dependent processes are a major source of the semantic-priming effect, demented patients should show little or no priming. To test this prediction, three groups of 16 subjects (young and normal-old individuals and patients with Alzheimer's disease) were given a Word-Naming and a Lexical-Decision task. In both tasks, the amount of semantic priming (the difference in response time to a word preceded by a semantically unassociated vs. a semantically associated word) was determined. Demented patients showed significantly greater semantic priming than either normal group on both tasks. This result argues against the hypothesis that the semantic priming found in demented patients is due solely to automatic processes.
TL;DR: Results indicated no significant differences on all AVLT measures of learning, recall, and recognition, suggesting that the parallel version can be used as an equivalent form of the AVLT.
Abstract: The purposes of the present study were (1) to investigate whether significant savings occur with repeat testing on Rey's Auditory-Verbal Learning Test and (2) to develop a parallel version of the AVLT. Subjects (N = 60) were divided into pairs (individually matched for sex, age, and education) to form two groups and were administered either the AVLT or a parallel version. Results indicated no significant differences on all AVLT measures of learning, recall, and recognition, suggesting that the parallel version can be used as an equivalent form of the AVLT. Subjects were retested after an interval of 27 (+/- 3) days, with half receiving the same version and half receiving a different version. In contrast to subjects receiving different lists, those who were retested with the same version demonstrated a significant improvement in performance on the majority of AVLT variables.
TL;DR: It is suggested that the SR test has considerable clinical utility in differentiating normal aging from dementia, and has promise as a useful tool in the preclinical detection of ATA.
Abstract: The selective reminding (SR) procedure, a popular technique for the study of verbal memory, was used to investigate aspects of memory functioning in a large group of normal elderly and in a smaller group of elderly subjects with Alzheimer Type Dementia (ATD). One hundred thirty-four normal elderly (mean age = 79.53 years) subjects and 21 ATD subjects (mean age = 68.3 years) were administered four versions of the SR test as part of a longitudinal study of risk factors in the development of dementia. Normative data were obtained for multiple components of memory functioning within the elderly sample. Test-retest reliability was .84 for long-term retrieval (LTR), .89 for sum of recall, and .92 for consistent retrieval. Clinical validity studies revealed that the components of sum of recall, storage estimate, LTR, and consistent long-term storage (CLTS) were most valuable in distinguishing mild ATD from normal aging. Positive predictive values ranged from 86% for CLTS, 89% for LTR, 91% for sum of recall, and 100% for storage estimate. These findings suggest that the SR test has considerable clinical utility in differentiating normal aging from dementia, and has promise as a useful tool in the preclinical detection of ATA.
TL;DR: An investigation of unilateral visual neglect in 23 patients with right cerebro-vascular accident (CVA) and 3 with left CVA shows the typical errors of omission in the hemispace contralateral to the lesion; there is a significant effect of stimulus position in the vertical dimension.
Abstract: We report an investigation of unilateral visual neglect in 23 patients with right cerebro-vascular accident (CVA) and 3 with left CVA. On a modified version of Albert's test of line cancellation the patients show the typical errors of omission in the hemispace contralateral to the lesion. In addition, however, there is a significant effect of stimulus position in the vertical dimension; the patients made most errors in the lower quadrant of the array, contralateral to the site of lesion. We emphasize the importance of studying the distribution of attention along all spatial dimensions in the hemispatial neglect syndromes.
TL;DR: In children, the BNT relates more to word knowledge than to retrieval or fluency, and verbal memory appears to be relatively independent of these linguistic functions.
Abstract: The Peabody Picture Vocabulary Test-Revised (PPVT-R), Boston Naming Test (BNT), Paired Associate Learning of the Wechsler Memory Scale (PAL), and verbal fluency tests were administered to 241 normal children aged 6-12 years. Normative data were compiled for the BNT, PAL, and verbal fluency tests. A Principal Components Factor Analysis with Varimax Rotation was conducted to determine whether the tests evaluated similar or differential functions. Three factors emerged, accounting for 67.7% of the variance: Factor 1 contained loadings from two semantic fluency measures (animals and food), Factor 2 contained the PPVT-R and the BNT, and Factor 3 contained two measures from the PAL (easy and hard associations). In children, the BNT relates more to word knowledge than to retrieval or fluency, and verbal memory appears to be relatively independent of these linguistic functions.
TL;DR: The present data indicate that it is important to use detailed norms by gender and criterion level if clinical interpretations are to be valid and to establish normative data and to provide a comparison with measures of immediate attention, verbal IQ, and verbal memory.
Abstract: Verbal learning was assessed according to the Selective Reminding Test (SRT) in order to establish normative data and to provide a comparison with measures of immediate attention, verbal IQ, and verbal memory. The 392 subjects, stratified by sex (202 women, 190 men), age (4 groups: 16-70 years), and education (3 groups), were free of conflicting pathologies. Learning curves were established on centiles (75, 50, 25, 5). Sex differences favoring women were found in percent of finishers (those who reached criterion), and at all percentile levels of acquisition. Data were analyzed for group differences in performance on the SRT and related concurrent measures, but sex differences were not found on the VIQ or immediate attention tests. Also, assumptions of age and education stratification were not confirmed. However, those who completed the task were better able to form associational strategies than those who were unable to finish. The present data indicate that it is important to use detailed norms by gender and criterion level if clinical interpretations are to be valid.
TL;DR: Results revealed a pattern of preserved attention and concentration, language skills, and most visuospatial construction abilities in the presence of more notable deficits in nonverbal memory and speeded psychomotor tasks.
Abstract: This study examined the pattern of neuropsychologic abnormalities in three groups of subjects: 20 patients diagnosed with Acquired Immunodeficiency Syndrome (AIDS); 14 patients diagnosed with AIDS Related Complex (ARC); and 13 seronegative controls. Subjects with past history of chronic substance abuse, neurologic disease, or focal findings on MRI or CT were excluded. All subjects were administered a comprehensive neuropsychological battery. Results revealed a pattern of preserved attention and concentration, language skills, and most visuospatial construction abilities in the presence of more notable deficits in nonverbal memory and speeded psychomotor tasks. Practical implications for the early detection of HIV-1 related cognitive dysfunction are addressed.
TL;DR: The hypothesis that cholinergic neurons are important in the neuronal networks generating the P3 potential is supported, despite the fact that Serotonergic neurons do not appear to play a major role in the networks that generate the P2 potential.
Abstract: The effects of scopolamine (anticholinergic) and methysergide (antiserotonergic) on memory and long-latency auditory cognitive evoked potentials (EPs) were tested in 16 normal adults. Recent memory was impaired by both drugs. In contrast, scopolamine, but not methysergide, significantly delayed P3 latency and decreased P3 amplitude. Immediate memory and the earlier EP components (i.e., N1 and P2) were unaffected. The findings support the hypothesis that cholinergic neurons are important in the neuronal networks generating the P3 potential. Serotonergic neurons do not appear to play a major role in the networks that generate the P3.
TL;DR: The gradiental model implies that at least from the macroscopic standpoint, functional neocortical organization is to a substantial degree continuous, interactive, and emergent, as opposed to mosaic, modular, and prededicated.
Abstract: Examination of neuropsychological syndromes suggests strong congruence between neuroanatomical and functional neocortical metrics. Two cortical syndromes disrupt cognitively close functions if and only if their neuroanatomical territories are close. To capture this relationship, the concept of a cognitive gradient is introduced as a basic unit of macroscopic neocortical brain-behavioral analysis. A cognitive gradient is a continuous distribution of related functions along an axis defined at its extremes by a pair of sensory projection or motor areas. Cortical gradiental structure is viewed as a fundamental symmetric organization on which hemispheric elaborations are superimposed. The gradiental structure of the left hemisphere is presented in detail as an illustration of the concept. It is presumed that a similar set of elaborations can be uncovered for the right hemisphere. The gradiental model implies that at least from the macroscopic standpoint, functional neocortical organization is to a sub...
TL;DR: This study would appear to be the first to suggest that occupational exposure to cadmium is associated with cognitive impairment in adults.
Abstract: Neuropsychological functioning was measured in 31 male workers exposed to cadmium in a refrigerator coil manufacturing plant. Workers with high urinary cadmium levels performed less well than did those with low urinary cadmium levels on measures of attention, psychomotor speed, and memory. There were modest correlations between one of two biologic measures of cadmium exposure and neuropsychological performance. The neuropsychological impairments cannot readily be attributed to exposure to other neurotoxins, alcohol intake, CNS effects of renal dysfunction, or psychological distress. Cadmium body burden has previously been related to intelligence and school achievement of children; this study would appear to be the first to suggest that occupational exposure to cadmium is associated with cognitive impairment in adults. Cadmium interferes with several important nervous system functions, but the mechanisms of neurotoxicity remain uncertain.
TL;DR: Attempts to improve the recall performance of an adolescent (GC) who had suffered a closed-head injury and executive strategy training was provided to improve GC's ability to identify a memory problem and to initiate a general plan for dealing with that problem.
Abstract: This case study reports attempts to improve the recall performance of an adolescent (GC) who had suffered a closed-head injury GC had a very limited range of ways of processing both spoken and written information and showed significant recall problems Initial training in the use of strategies for list learning resulted in improvement in paired-associate recall but showed that initiation and use of the newly learned strategies would not occur without prompting Executive strategy training was provided to improve GC's ability to identify a memory problem and to initiate a general plan for dealing with that problem This training involved consideration of task analysis, strategy selection and initiation, and monitoring of strategy use Evidence of long-term maintenance of improvement in level of recall on both paired-associate and free recall tests was noted following the executive strategy training
TL;DR: Evidence supporting the possibility that both learning disabilities and emotional disorders, or at least some subforms of them, may have a common origin in neurological dysfunction is discussed.
Abstract: Emotional disorders may precede learning disabilities, follow learning disabilities, or occur at the same time. This paper discusses evidence supporting each of these hypotheses, focussing on the possibility that both learning disabilities and emotional disorders, or at least some subforms of them, may have a common origin in neurological dysfunction. A model of interaction of the many factors involved in both the development and the persistence across age for both learning disabilities and emotional disorders is presented and avenues of research are discussed. Data from a 15-year follow-up study which illustrate some of these complex relationships are presented.
TL;DR: Patients with Parkinson's disease displayed a different pattern of cognitive deficit from patients with dementia resulting from Alzheimer's disease, and patients with impaired mental status examination scores showed a deficit in set formation on Picture Arrangement not seen in the AD patients.
Abstract: Patients with Parkinson's disease (PD) displayed a different pattern of cognitive deficit from patients with dementia resulting from Alzheimer's disease (AD). Specifically, PD patients, whether or not impaired on a mental status examination, had deficient Picture Arrangement but normal Vocabulary test scores whereas AD patients were impaired on both measures. Furthermore, PD patients with impaired mental status examination scores showed a deficit in set formation on Picture Arrangement not seen in the AD patients. Finally, when recent memory performance, as measured by the Wechsler Memory Scale, was predicted from an estimated IQ, 71% of PD patients who had normal mental status examination scores were seen to have at least a mild memory impairment.
TL;DR: The observation of hypoxic effects on Digit Symbol and Finger Tapping tests is consistent with previous findings of neuropsychological changes secondary to hypoxia and is likely that methodological differences contributed to these discrepancies.
Abstract: We evaluated the cognitive effects of hypoxemia independent of hypocapnia in 20 right-handed male subjects using a battery of brief neuropsychological tests. Results of a profile analysis indicated that performance during hypoxia was reliably different for Digit Symbol and Finger Tapping tests. Trend analysis demonstrated a significant linear pattern for Finger Tapping results, such that lower levels of oxygen were associated with slower rates of tapping. No significant trends were observed for Digit Symbol results. The observation of hypoxic effects on Digit Symbol and Finger Tapping tests is consistent with previous findings of neuropsychological changes secondary to hypoxia. The negative results observed for the remaining tests are inconsistent with past literature. It is likely that methodological differences contributed to these discrepancies, including previous reliance on inspired air to index hypoxemia rather than monitoring arterial oxygen saturation directly and failure to control for d...
TL;DR: Whereas all but one of the head injured who returned to work scored normally on the Tinker Toy Test, nearly half of the nonreturnees performed below the level of the worst control.
Abstract: Fifty patients who had suffered closed-head injury with no resultant physical disabilities and 25 normal controls were administered a modified version of Lezak's Tinker Toy Test. All head-injured patients were examined at least 24 months following medical clearance to return to work. Twenty-five of the head injured had been unable to return to work or sustain normal competitive employment as a result of their head injuries. The remaining 25 had returned to their previous jobs successfully or had been employed for at least 6 months prior to assessment. Whereas all but one of the head injured who returned to work scored normally on the Tinker Toy Test, nearly half of the nonreturnees performed below the level of the worst control.
TL;DR: The results suggest that obstacle course performance is sensitive to more than hemispatial neglect, and right-hemisphere stroke victims made significantly more left-sided errors and errors in contralateral space than any other group.
Abstract: The initial experiment of this paper investigated the role of hemispatial neglect in wheelchair-related accidents of right-hemisphere stroke victims. Twelve subjects with and 12 subjects without neglect of left space drove their wheelchairs through an obstacle course. Two types of obstacle course errors were evaluated: direct hits and sideswipes. The neglecting group made significantly more direct hits but there were no significant differences between groups in sideswipe errors. In Experiment 2, the nonneglecting group's data were compared with a left-hemisphere stroke group without neglect and three motor control groups to investigate if their errors resulted from motor deficits. The right-hemisphere stroke group made significantly more left-sided errors and errors in contralateral space than any other group. In Experiment 3, 13 subjects with neglect were taught to scan to the left which resulted in significant decreases in direct hits but not in sideswipes on the obstacle course. These results suggest that obstacle course performance is sensitive to more than hemispatial neglect.
TL;DR: The findings suggest that the RST is not only highly sensitive to memory disorders in the early stages of DAT but also effective in discriminating among various stages of this disorder.
Abstract: An abbreviated form of Moss et al.'s (1986) Recognition Span Test (RST) was administered to patients with mild or moderate dementia of the Alzheimer type (DAT) and to intact control (NC) subjects. ...
TL;DR: Findings indicate that differences in acquisition and retrieval are associated with increasing impairment of psychosocial functioning.
Abstract: Memory functioning of normal elderly subjects and patients with suspected malignant memory disorders were examined using a cued recall memory assessment procedure. Levels of psychosocial functioning were rated by a multidisciplinary team. Ability to engage in free and cued recall was studied to determine the relationship between problems of acquisition and retrieval. Normal and impaired elderly showed strong differences on free recall and total recall resulting in 90.58% and 79.06% rates of accuracy of prediction of group membership. There were significant multivariate and univariate differences among the memory-impaired groups defined in terms of their psychosocial functioning. These findings indicate that differences in acquisition and retrieval are associated with increasing impairment of psychosocial functioning. Patients whose psychosocial functioning was rated as falling within the questionable range exhibited only deficits in retrieval. Patients whose psychosocial functioning was rated as more severely impaired, exhibited problems of retrieval and acquisition.
TL;DR: Data indicate that IQ scores are reliable in older normal individuals for this retest interval, but less confidence can be placed in the reliability of subtest scores and the Verbal-Performance Discrepancy.
Abstract: We examined the 1-year test-retest reliability of WAIS-R Verbal, Performance, and Full-Scale IQs in a sample of 101 older normal individuals (mean age = 67.1). The respective Pearson rs were .86, .85, and .90. The median retest reliability coefficient for the WAIS-R subtests was .71. The test-retest reliability for the Verbal-Performance Discrepancy was .69. These data indicate that IQ scores are reliable in older normal individuals for this retest interval, but less confidence can be placed in the reliability of subtest scores and the Verbal-Performance Discrepancy.
TL;DR: This study evaluated one prominent cognitive theory of time estimation from the point of view of organic memory disorder and suggested that the ability to remember new information is required in order to maintain an accurate time perspective.
Abstract: Time disorientation is a common feature of anterograde memory disorder caused by brain illness. This observation suggests that the subjective time constructions used to organize events are strongly dependent upon memory storage processes. This study evaluated one prominent cognitive theory of time estimation from the point of view of organic memory disorder. A severely amnesic subject and 10 unimpaired subjects were asked to estimate time intervals using methods gleaned from the cognitive study of subjective time estimation. Results strongly suggest that the ability to remember new information is required in order to maintain an accurate time perspective. The time context for this subject essentially resided in the past, roughly corresponding to the time of her original brain surgery for a dermoid cyst near the third ventricle. Her ability to estimate time intervals and general time perspective was constrained by her impoverished store of knowledge for personal experiences.