The use of neuropsychological tests in non-English-speaking populations and among those with less education has been limited because most tests have been standardized for English-speaking populations with relatively high levels of education. In effort to establish norms, a battery of neuropsychological tests was administered, in either English or Spanish, to 995 normal elders with a wide range of educational attainment, residing in the community of Washington Heights–Inwood in northern Manhattan. Results indicate that age, education, and language all influence test performance and should be considered when evaluating neuropsychological measures. (JINS, 1998, 4, 311–318.)

To define the combined effects of drug and alcohol abuse on verbal learning and memory, 70 alcoholic and 80 polysubstance abuse (PSA) individuals with concurrent alcohol abuse were compared on a list learning task, the California Verbal Learning Test (CVLT). Despite demonstrating similar learning strategies, response styles, and error patterns, the PSA group nonetheless exhibited significantly greater recall deficits than the alcoholic group on the CVLT. These deficits were particularly evident in those who were heaviest abusers of cocaine. PSA participants did not, however, evidence greater recognition memory deficits. This pattern of greater deficits on recall than on recognition memory, as well as poor consolidation, is consistent with the initiation–retrieval difficulties of patient groups with subcortical dysfunction. It is concluded that the combined use of alcohol and drugs, cocaine in particular, may compound memory difficulties beyond what is typically observed in alcoholic individuals. (JINS, 1998, 4, 319–328.)

Computerized reaction time (RT) tasks are sensitive measures of subclinical HIV-related mental slowing. We previously reported that nondemented HIV-seropositive patients on antiretroviral therapy at the time of testing had faster choice RTs compared to matched untreated seropositive participants. In the present study, we evaluated the performance of 163 nondemented HIV-seropositive participants on a reaction time version of the Stroop task as a function of antiretroviral status. Persons on antiretroviral therapy at the time of testing had significantly faster reaction times than untreated individuals, although treated asymptomatic participants showed significantly less Stroop interference than treated symptomatic participants. These effects could not be attributed to differences in demographic variables, disease status, substance abuse, or psychological distress. These data indicate that central information processing is faster for patients treated with antiretroviral compounds compared to untreated patients, and suggest that reaction time tasks may have significant potential utility in clinical trials of neuroprotective compounds. (JINS, 1998, 4, 329–335.)

Normal elderly control participants showed short-term (10-min delay) and long-term (12 months delay) priming on the Gollin Figures Test. Nearly all patients with Alzheimer's disease or vascular dementia showed short-term priming, but the magnitude of their priming was less than that of controls. Significant long-term priming was not observed for the dementia groups. Differences between controls and dementia patients on the short-term priming test may depend upon structural–perceptual processes that are intact in dementia patients and controls and explicit memory functions available only to controls. The same model could account for differences between normal elderly and dementia patients on the long-term priming test, but several other explanations are also plausible. (JINS, 1998, 4, 336–341.)

The goal of this study was to further characterize episodic memory functioning in schizophrenia. This study compared verbal and visual learning and memory performance in (1) patients with schizophrenia (N = 35), (2) patients with temporal lobe epilepsy (TLE; N = 30), and (3) normal controls (N = 25). Results indicated significant memory impairments in patients with schizophrenia and TLE. “Savings” score measures of memory decay showed that the loss of information in schizophrenia and TLE was approximately equal, and quantitatively mild compared to that found in most neurologic groups with memory disorders. The severe difficulty shown by the schizophrenia group on a task of incidental recall suggested that the absence of instructional set added to a vulnerability to memory deficit. In contrast, relatively mildly impaired performance on paired associate learning suggested that patients with schizophrenia benefited from retrieval cues, multiple trials, and short (nonsupraspan) informational loads. Because patients with schizophrenia consisted of a relatively nonchronic sample with a mean IQ of 99.7, their memory disorder could not be attributed to schizophrenic dementia, nor was it accounted for by other potential confounds. Patients with schizophrenia, even those relatively early in the course of illness, have a mild episodic memory disorder. (JINS, 1998, 4, 342–352.)

A cluster analytic solution based upon a battery of tests consisting of the Halstead Category and Tactual Performance Tests, the Trail Making Test, and the Wisconsin Card Sorting Test was compared with a solution based on the subtests of the Wechsler intelligence scales, utilizing a sample of 221 schizophrenic patients. Both analyses permitted four-cluster solutions, and we found a weak but significant degree of association between solutions. Examination of external validity of the two solutions revealed stronger associations with clinical variables for the Wechsler-scale-based solution. The major conclusions were that the existence of cognitive heterogeneity in schizophrenia exists across a broad range of abilities, and appears to reflect a combination of continuity of ability level and existence of possible subtypes requiring further neuropsychological and neurobiological verification. (JINS, 1998, 4, 353–362.)

Two samples of participants from the U.S.–Mexico Borderland (N = 185) versus Spain (N = 205) were compared on 16 Spanish-language neuropsychological measures. In most measures the two samples obtained similar results. There were some significant main effects of place of birth and some significant interactions between education and place of birth. Differences between the samples diminished with increasing levels of education. Within the Borderland sample, percent of life span spent in the U.S. and bilingual status were correlated with performance in some tests. Increased percent of life span spent in the U.S. was negatively correlated with performance on a Spanish word-generation task, and positively correlated with performance on the Wisconsin Card Sorting Test. Bilingual Borderland participants performed significantly better than monolingual speakers in learning a list of words. We suggest that the most likely causes for the observed interaction effects are documented regional differences in early SES-related nutrition, medical care, quality of educational experiences, and general socioeconomic conditions. (JINS, 1998, 4, 363–379.)

Impaired awareness of the effects of brain injury is a commonly observed and poorly understood finding in traumatic brain injury survivors. Nonetheless, impaired awareness has been identified as a major factor in determining outcome for traumatic brain injury survivors. Review of previous studies of impaired awareness in this patient population revealed a number of preliminary findings regarding the nature of this phenomenon. The present paper presents the results of 2 new studies with a total of 111 traumatic brain injury patients conducted to bring further clarity to this area. Findings confirmed and extended many results of previous investigations. Specific findings included patient overestimation of functioning as compared to family member ratings, patient report of greater physical than nonphysical impairment, greater patient–family agreement on specific ratings of patient functioning than on general ratings, greater agreement of family and clinician ratings of patient functioning with each other than with patient self-ratings, and partial disagreement of different methods of measuring impaired awareness. (JINS, 1998, 4, 380–387.)

A longitudinal case study of a patient with a progressive loss of meaning of objects with preserved phonology and syntax is presented. Repeated measures of language, praxis, visual cognition, and semantic processing were carried out. The patient still has preserved conversational speech, social skills, and orientation in her 8th year of her illness, but shows severe anomia and comprehension deficit in all modalities of stimulus presentation. In addition to standardized tests of language, cognition, and memory, specific experiments of categorization, modalities of word access, item consistency, category specificity, and definition of words were carried out. Results indicate a frequency dependent loss of meaning that was consistent in all modalities and throughout all object categories. However, the relative preservation of visual categorization of all categories tested and the language based categorization of animals suggested some fractionation of semantic memory. Relative preservation of autobiographical and personal memories versus semantic memory was a striking observation. Evidence for selective impairment of central semantic processing was obtained from experiments indicating item consistency of loss and the lack of semantic cuing. Neuroimaging evidence of left temporal lobe atrophy and the classical picture is compatible with similar cases published under the term semantic dementia or “transcortical sensory aphasia with visual agnosia” and suggest the diagnosis of Pick's disease. (JINS, 1998, 4, 388–398.)

The use of a mnemonic cueing system (NeuroPage®) and a paper and pencil checklist in the rehabilitation of executive problems in a 50-year-old woman are described. Following a CVA 7 years earlier, the patient, despite intact general intellectual and memory functioning, had specific executive impairments of attention, planning, realizing intended actions, and also exhibited behavioral routines similar in form to obsessive–compulsive rituals. In a series of ABAB single-case experimental designs, the efficacy of 2 external cueing systems in prompting appropriately timed action is demonstrated. It is argued that the combination of external control and increased sustained attention to action were critical to the success of NeuroPage with this patient. Furthermore it is hypothesized that the checklist was effective in facilitating the patient's ability to foresee and recognize the consequences of her actions, which in turn had an impact on the probability of her changing those same actions. (JINS, 1998, 4, 399–408.)

In their dialogue published in JINS, Wilson (1997) and Prigatano (1997) have eloquently and concisely presented the challenges facing neuropsychology with respect to cognitive rehabilitation. However, both authors neglect two important issues that must be addressed if people with cognitive disorders are to be effectively treated. First, cognitive impairment must be treated during the acute stages of recovery; as to ignore cognitive deficits until patients are more fully recovered may bypass an opportune time for intervention. Evidence is mounting that the injured brain adapts to the losses sustained and that the adaptation will be enhanced by increasing interaction with the environment, as compared to more passive states (Johansson & Ohlsson, 1996; Stein et al., 1995). Given such information, it is difficult to justify withholding cognitive stimulation and remediation from people during acute stages of recovery and instead awaiting a point when spontaneous recovery (presumably) will be complete.

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