Emotional disturbances and their interaction with neuropsychological deficits

The interaction and relationships between neuropsychological tests (which are principally oriented to intellectual and cognitive abilities) and tests of personality and emotional status are complex, but nevertheless important in the clinical assessment of brain-damaged persons. Are indications of emotional disturbances to be expected as a direct consequence of brain damage? If so, how can the indications of emotional disturbances be differentiated from results obtained with psychiatrically disturbed (non-brain-damaged) subjects? Some authors have presumed that emotional disturbances, such as depression, acute anxiety, etc., in their own right cause impaired performances on neuropsychological tests, whereas other authors have proposed that brain damage predisposes the individual to demonstrate evidence of emotional disturbances. If emotional disturbances cause impairment on neuropsychological tests, why is it that so many emotionally disturbed persons without brain damage tend to perform normally on neuropsychological tests? This review of relevant publications considers (1) different general approaches to these questions and their implications for neuropsychology, (2) evidence of differential sensitivity to brain damage of neuropsychological and emotional instruments, (3) the sensitivity and specificity of self-assessments and complaints of head-injured subjects, (4) MMPI findings among head-injured subjects and in interaction with neuropsychological measurements, and (5) principles and guidelines that may be of value in clinical application of findings reported in the literature.     

Prediction of driving ability after stroke and the effect of behind-the-wheel training

The aim of this study was to examine the predictive value of a neuropsychological test battery relating to an on-the-road driving evaluation and to determine whether patients who failed the driving test could improve their driving through behind-the-wheel training. Thirty-four stroke patients were compared with 20 healthy, matched controls. Patients who failed the driving test were offered driving practice at a driving school and were then reassessed (neuropsychologically and practically). On most of the cognitive tests, patients performed significantly less well than control subjects. Almost 50% of the controls and the patients failed the driving evaluation. None of the neuropsychological tests was able to predict the driving outcome. Of the patients who failed the first driving evaluation, 85% passed the second evaluation after driving practice. There are few controlled studies focusing on the stroke population and the effect of behind-the-wheel training. It is suggested that more controlled studies are needed with more homogenous patient-groups and reliable and quantitative outcome measures.     

Analysis of the elements of attention: A neuropsychological approach

A model for conceptualizing the components or elements of attention is presented. The model substitutes for the diffuse and global concept of attention a group of four processes and links them to a putative system of cerebral structures. Data in support of the model are presented; they are derived from neuropsychological test scores obtained from two samples, the first consisting of 203 adult neuropsychiatric patients and normal control subjects, and the second, an epidemiologically-based sample of 435 elementary school children. Principal components analyses of test scores from these two populations yielded similar results: a set of independent elements of attention that are assayed by different tests. This work presents a heuristic for clinical research in which the measurement of attention is essential.     

To drive or not to drive: Neuropsychological assessment for driver's license among stroke patients

Seventy-two stroke patients, 43 with right hemisphere (RHD) and 29 with left hemisphere damage (LHD), and 7 coronary infarct controls with no evidence of cerebral damage, were neuropsychologically tested as part of an assessment program for driver's license. Mean age in the group was 53 years. Stroke patients were tested on average 4 months post injury. The groups did not differ on major demographic variables except that RHD patients were more often hemiplegic than LHD patients. The test battery was factor analyzed into 4 valid principal components: (I) visual perception , (II) spatial attention , (III) visuospatial processing , and (IV) language/praxis. The presence of hemianopia (factor I) excludes driving. In addition, measures of neglect and reduced speed of mental processing from factor II, III and IV, were found to be the most discriminating variables when classifying patients for driving. Even though neglect was more frequently observed among RHD than LHD patients, the two hemisphere groups did not differ significantly in number of patients denied driving, 58% RHD compared to 41% LHD patients. The need for comprehensive neuropsychological assessment is underlined.     

Driving fear and driving skills: comparison between fearful and control samples using standardised on-road assessment

The present study explores driving skills in a group of 50 media-recruited driving-fearful and 50 control drivers, all of whom were women. Participants completed an on-road practical driving assessment with a professional driving instructor. Diagnostic as well as pre-post self-report and instructor driving assessments were conducted. Fearful drivers made more errors on the driving assessment than controls. However, the pattern of errors was identical for both groups, indicating that fear and anxiety may be associated with the number rather than the type of driving errors made. These differences remained when factors such as driving history, current driving frequency, and diagnosis were controlled using case selection. More research is needed to replicate the findings in more diverse samples. Additional work should also aim to clarify the specific role of driving skills in driving fear, which will facilitate treatment planning for exposure-based treatments and help identify cases where driving skills assessment may be appropriate.     

Neuropsychological assessment with the Visual Gestalt Test: psychometric properties and differential diagnostic probabilities

The Visual Gestalt Test is a neuropsychological instrument developed for evaluation of learning and memory of visuo-spatial material. A revised strategy of scoring has motivated the present study, where data from 153 normal persons, 99 epilepsy patients, and 24 depressed patients are presented and compared. The Visual Gestalt Test is observed to discriminate between normal and diagnosed groups in several ways. Additionally it is found to discriminate between depressed and brain damage subgroups of patients. Data are presented in order to supplement previously published ways of scoring and norms. Practical guidelines for the clinical applications of the test are suggested as perspectives.     

Improving the driving practices of pizza deliverers: Response generalization and moderating effects of driving history

A practical intervention program, targeting the safety belt use of pizza deliverers at two stores, increased significantly the use of both safety belts (143% above baseline) and turn signals (25% above baseline). Control subjects (i.e., pizza deliverers at a third no-intervention store and patrons driving to the pizza stores) showed no changes in belt or turn signal use over the course of 7-month study. The intervention program was staggered across two pizza stores and consisted of a group meeting wherein employees discussed the value of safety belts, received feedback regarding their low safety belt use, offered suggestions for increasing their belt use, and made a personal commitment to buckle up by signing buckle-up promise cards. Subsequently, employee-designed buckle-up reminder signs were placed in the pizza stores. By linking license plate numbers to individual driving records, we examined certain aspects of driving history as moderators of pre- and postintervention belt use. Although baseline belt use was significantly lower for drivers with one or more driving demerits or accidents in the previous 5 years, after the intervention these risk groups increased their belt use significantly and at the same rate as drivers with no demerits or accidents. Whereas baseline belt use was similar for younger (under 25) and older (25 or older) drivers, younger drivers were markedly more influenced by the intervention than were older drivers. Individual variation in belt use during baseline, intervention, and follow-up phases indicated that some drivers require more effective and costly intervention programs to motivate their safe driving practices.     

The impact of culture and education on non-verbal neuropsychological measurements: a critical review

Clinical neuropsychology has frequently considered visuospatial and non-verbal tests to be culturally and educationally fair or at least fairer than verbal tests. This paper reviews the cross-cultural differences in performance on visuoperceptual and visuoconstructional ability tasks and analyzes the impact of education and culture on non-verbal neuropsychological measurements. This paper compares: (1) non-verbal test performance among groups with different educational levels, and the same cultural background (inter-education intra-culture comparison); (2) the test performance among groups with the same educational level and different cultural backgrounds (intra-education inter-culture comparisons). Several studies have demonstrated a strong association between educational level and performance on common non-verbal neuropsychological tests. When neuropsychological test performance in different cultural groups is compared, significant differences are evident. Performance on non-verbal tests such as copying figures, drawing maps or listening to tones can be significantly influenced by the individual's culture. Arguments against the use of some current neuropsychological non-verbal instruments, procedures, and norms in the assessment of diverse educational and cultural groups are discussed and possible solutions to this problem are presented.     

Computerized assessment in neuropsychology: A review of tests and test batteries

This article contains detailed reviews of 13 computerized neuropsychological and performance test batteries and six stand-alone computer tests. Tasks found on these instruments are described and tables illustrate which batteries employ which measures. In addition to issues of reliability and validity, special considerations apply to computerized assessment. These issues are discussed and readers are provided information to help them assess computerized tests in relation to their particular clinical and research needs. Since many computerized tests were developed as performance assessment tools, the relationship between performance and neuropsychological assessment is examined.     

Predicting aggressive driving behavior: The role of macho personality,age, and power of car

A study is presented that explored the role of macho personality, age, and power of car as predictors of aggressive driving behavior. A total of 154 male motorists completed two subscales of the Hypermasculinity Inventory as a measure of macho personality and self‐reports of aggressive driving behavior based on the Driver Behaviour Questionnaire. They also provided information about their age, annual mileage, horsepower of their car, and features that had guided their choice of a car. A multiple regression analysis showed that each of the predictors was significantly related to aggressive driving: Younger motorists, those driving powerful cars, and those showing macho personality were significantly more likely to report driving aggression. Together, the three predictors accounted for 35.8% of the variance. In addition, macho men assigned greater importance to speed and sportiness of a car and less importance to safety aspects than nonmacho men. The findings are discussed with reference to individual and situational explanations of driving aggression. Aggr. Behav. 28:21–29, 2002. © 2002 Wiley‐Liss, Inc.     

Interactions of space and language: Insights from the neglect syndrome

The current article speculates about the interrelations between space and language from the perspective of the neglect syndrome. Various conflicting findings are reviewed and the effect of cultural factors is strongly emphasised. Current scientific literature describes relationships between space and language; however, the available data render it difficult to conclude whether it is the primacy of spatial representations or the complex two‐way interaction between linguistic and spatial representations that determines the nature of cognitive processing. It is hoped that studying the neglect syndrome will provide a solution to this problem. Finally, directions for future research are provided that requires bridging the gap between cognitive theorising and neuroscientific approaches.     

Screening for drugs in oral fluid: Illicit drug use and drug driving in a sample of urban and regional Queensland motorists

Police services in a number of Australian states and overseas jurisdictions have begun to implement or consider random road-side drug testing of drivers. This paper outlines research conducted to provide an estimate of the extent of drug driving in a sample of Queensland drivers in regional, rural and metropolitan areas. Oral fluid samples were collected from 2657 Queensland motorists and screened for illicit substances including cannabis (delta 9 tetrahydrocannibinol [THC]), amphetamines, ecstasy, and cocaine. Overall, 3.8% of the sample (n = 101) screened positive for at least one illicit substance, although multiple drugs were identified in a sample of 23 respondents. The most common drugs detected in oral fluid were ecstasy (n = 53), and cannabis (n = 46) followed by amphetamines (n = 23). A key finding was that cannabis was confirmed as the most common self-reported drug combined with driving and that individuals who tested positive to any drug through oral fluid analysis were also more likely to report the highest frequency of drug driving. Furthermore, a comparison between drug vs. drink driving detection rates for one region of the study, revealed a higher detection rate for drug driving (3.8%) vs. drink driving (0.8%). This research provides evidence that drug driving is relatively prevalent on Queensland roads, and may in fact be more common than drink driving. This paper will further outline the study findings’ and present possible directions for future drug driving research.     

Gasoline conservation: a procedure for measuring and reducing the driving of college students

The study sought to motivate college students to reduce the number of miles they drove each day and thus save gasoline. Students in two psychology classes were divided by class into two groups. The experimental group was offered various combinations of prizes such as cash, a tour of a mental-health facility, car servicing, and a university parking sticker for reducing driving. The value of the prize received was scaled in terms of per cent reduction in driving. The contrast group received no inducements. The condition in which the experimental group's mileage reduction was reinforced was counterbalanced by two baseline conditions. Several special recording procedures were used to reduce and detect the possibility of subjects altering their odometers, the source of the driving data. Experimental subjects reduced their average daily mileage by 20% relative to the initial baseline; the contrast group did not change. During the one-month reinforcement condition, the 12 experimental subjects saved some 170 gallons (worth $102) of gasoline.     

Temporal parameters as cues to phrasal boundaries: a comparison of processing by left- and right-hemisphere brain-damaged individuals

Two experiments were conducted to examine the ability of left- (LHD) and right-hemisphere-damaged (RHD) patients and normal controls to use temporal cues in rendering phrase grouping decisions. The phrase "pink and black and green" was manipulated to signal a boundary after "pink" or after "black" by altering pre-boundary word durations and pause durations at the boundary in a stepwise fashion. Stimuli were presented to listeners auditorily along with a card with three alternative groupings of colored squares from which to select the presented alternative. Results revealed that normal controls were able to use both temporal cues to identify the intended grouping. In contrast, LHD patients required longer than normal pause durations to consistently identify the intended grouping, suggesting a higher than normal threshold for perception of temporal prosodic cues. Surprisingly, the RHD patients exhibited great difficulty with the task, perhaps due to the limited acoustic cues available in the stimuli.     

Processing homonymy and polysemy: effects of sentential context and time-course following unilateral brain damage

The present study investigated the abilities of left-hemisphere-damaged (LHD) non-fluent aphasic, right-hemisphere-damaged (RHD), and normal control individuals to access, in sentential biasing contexts, the multiple meanings of three types of ambiguous words, namely homonyms (e.g., "punch"), metonymies (e.g., "rabbit"), and metaphors (e.g., "star"). Furthermore, the predictions of the "suppression deficit" and "coarse semantic coding" hypotheses, which have been proposed to account for RH language function/dysfunction, were tested. Using an auditory semantic priming paradigm, ambiguous words were incorporated in dominant- or subordinate-biasing sentence-primes followed after a short (100 ms) or long (1,000 ms) interstimulus interval (ISI) by dominant-meaning-related, subordinate-meaning-related or unrelated target words. For all three types of ambiguous words, both the effects of context and ISI were obvious in the performance of normal control subjects, who showed multiple meaning activation at the short ISI, but eventually, at the long ISI, contextually appropriate meaning selection. Largely similar performance was exhibited by the LHD non-fluent aphasic patients as well. In contrast, RHD patients showed limited effects of context, and no effects of the time-course of processing. In addition, although homonymous and metonymous words showed similar patterns of activation (i.e., both meanings were activated at both ISIs), RHD patients had difficulties activating the subordinate meanings of metaphors, suggesting a selective problem with figurative meanings. Although the present findings do not provide strong support for either the "coarse semantic coding" or the "suppression deficit" hypotheses, they are viewed as being more consistent with the latter, according to which RH damage leads to deficits suppressing alternative meanings of ambiguous words that become incompatible with the context.     

Sex differences in brain activity, personality and intelligence: a test of arousability theory

This report describes empirical tests of the theory that females have higher levels of behavioural and cerebral arousal than males and that these differences cause higher neuroticism scores in females, as well as lower female psychoticism scores and lower scores for females on the Gsar factor of intelligence. Data were obtained from 76 subjects, with equal numbers of males and females and with all adult ages represented. EEG responses to auditory stimulation were quantified in terms of the ‘amplitude, ‘rate of change of amplitude and ‘sweep variability factors obtained from a principal components analysis (PCA). Gf, Gc and Gsar intelligence scores were obtained from a PCA of sub-tests from the Wechsler Adult Intelligence Scale plus Ravens Advanced Progressive Matrices test. Personality differences were evaluated using the Neuroticism and Psychoticism scales of the Eysenck Personality Questionnaire (EPQ). Bivariate hypotheses relating sex to the arousal, intelligence and personality variables were confirmed. A PCA demonstrated that sex, neuroticism, Gsar, wakefulness and high frequency EEG activity all have high loadings on a common factor. These results are consistent with expectations generated by the cerebral arousability theory of personality and intelligence.     

The interhemispheric transcallosal-transversal approach to the lesions of the anterior and middle third ventricle: surgical validity and neuropsychological evaluation of the outcome

Based on the observation of the course of callosal fibres and of their artero-venous support as appearing in a microanatomic study, the Authors propose a variant of standard callosotomy procedure by the introduction of the transverse section of callosal fibres. This technique would allow the surgeon to spare a larger number of callosal fibres by the combined effect of a lower direct mechanical traction on fibres and a lower impact on artero-venous microcircle. The neuropsychological outcome of the patients who underwent this kind of procedure was evaluated. Fourteen patients affected by occupying-space lesions involving the anterior and middle third ventricle were included in the study. Ten patients underwent transverse callosotomy, four subjects received standard sagittal callosotomy. A control group was also included in the study. All patients underwent a pre-operative and six months post-operative neuropsychological evaluation focused on performance at cognitive and attentional tasks. No disturbances in executive function were observed in either group. Patients receiving transverse callosotomy performed as well as control group subjects in attentive tasks, which is not the case of patients undergoing sagittal callosotomy who show a marked deficit in selective attention for left side visual field. The observed more favourable neuropsychological outcome supports transverse callosotomy as a valid alternative method to standard longitudinal callosotomy in third ventricle surgery.     

The self-regulating brain: Cortical-subcortical feedback and the development of intelligent action

To speak of cognitive regulation versus emotion regulation may be misleading. However, some forms of regulation are carried out by executive processes, subject to voluntary control, while others are carried out by “automatic” processes that are far more primitive. Both sets of processes are in constant interaction, and that interaction gives rise to a stream of activity that is both cognitive and emotional. Studying the brain helps us understand these reciprocal regulatory influences in some detail. Cortical activities regulate subcortical activities through executive modulation of prepotent appraisals and emotional responses. Subcortical systems regulate the cortex by tuning its activities to the demands or opportunities provided by the environment. Cortical controls buy us time, as needed for planning and intelligent action. Subcortical controls provide energy, focus, and direction, as needed for relevant emotion-guided behaviour. We review the neural processes at work in both directions of regulatory activity, looking at the anterior cingulate cortex (ACC) as a hub of cortical systems mediating downward control, and discussing limbic, hypothalamic, and brainstem systems that mediate upward control. A macrosystem that displays both directions of control includes the ACC and the amygdala within a feedback circuit whose features vary with clinical-personality differences. Developmental changes in ACC-mediated self-regulation support advances in directed attention, response inhibition, and self-monitoring. Developmental changes in amygdala-mediated self-regulation involve the compilation of meanings that direct thought and behaviour, thus consolidating individual differences over the lifespan. In this way, the capacity to exert voluntary control develops alongside the accumulation of associations that trigger the responses that demand control. The balance between these developmental progressions has implications for personality formation and mental health.     

Dissociable patterns of brain activity during comprehension of rapid and syntactically complex speech: evidence from fMRI

Sentence comprehension is a complex task that involves both language-specific processing components and general cognitive resources. Comprehension can be made more difficult by increasing the syntactic complexity or the presentation rate of a sentence, but it is unclear whether the same neural mechanism underlies both of these effects. In the current study, we used event-related functional magnetic resonance imaging (fMRI) to monitor neural activity while participants heard sentences containing a subject-relative or object-relative center-embedded clause presented at three different speech rates. Syntactically complex object-relative sentences activated left inferior frontal cortex across presentation rates, whereas sentences presented at a rapid rate recruited frontal brain regions such as anterior cingulate and premotor cortex, regardless of syntactic complexity. These results suggest that dissociable components of a large-scale neural network support the processing of syntactic complexity and speech presented at a rapid rate during auditory sentence processing.     

Longitudinal study of quality of life in acquired brain injury: A self- and proxy-report evaluation

Background/ObjectiveAfter an acquired brain injury (ABI), the person remains with several impairments and disabilities that cause a decrease in his/her quality of life (QoL), which could change over time. The objective of the study was to analyse the evolution patterns of QoL in a sample of persons with ABI for one-year as well as the differences in proxy- and self-report versions of a QoL instrument. Method: The sample comprised 402 persons with ABI with ages ranging between 18 and 91 years, whom 36.20% had had the accident recently (i.e., three years or less). Patients, professionals and relatives responded at three evaluation points to the CAVIDACE scale, an ABI-specific QoL tool. Results: ANOVAs showed an improvement in QoL in the two follow-ups; the improvement was especially significant in the period between baseline and six months. The respondent factor did not interact with the evaluation time, but significant differences were found between respondents, with scores of patients higher than that for proxies. Finally, the QoL’s evolution interacts with the time elapsed since injury, showing significant improvements in the most recent group (i.e., three years or less). Conclusions: QoL must be considered from the earliest moments after ABI to obtain more significant improvements.