The Simple Copy Task: Detecting Higher Order Visual Processing Deficits in Schizophrenia,Dementia, and Movement Disorder Groups

The Simple Copy Task (SCT) is a figure copying test with inherent appeal due to its short administration time, graded task difficulty, varied stimuli, and potential to eliminate floor effects. Despite this, there is a lack of data regarding its construct validity and diagnostic utility. The present study compared SCT performance of schizophrenia (n = 29), dementia (n = 64), and movement disorder (n = 12) groups with that of unmatched healthy control participants (n = 49). Movement disorder patients committed a high degree of misplacement errors, whereas dementia patients tended to omit items, add extraneous detail, and perseverate. The schizophrenia group was most similar to the dementia group in their performance on the SCT, committing primarily omission and perseveration errors. The SCT was most closely related to the Rey Complex Figure Task (r = 0.68, p < .01) and the Block Design Task (r = 0.62, p < .01). Age (r = ?0.14, p < .01) and education (r = 0.35, p < .01) effects were present; however, there was no impact of gender and handedness. Taken together, these findings provide support for the utility of the task and directions for clinical interpretation.     

Distinct performance profiles on the Brixton test in frontotemporal dementia

The Brixton Spatial Anticipation Test is a well-established test of executive function that evaluates the capacity to abstract, follow, and switch rules. There has been remarkably little systematic analysis of Brixton test performance in the prototypical neurodegenerative disorder of the frontal lobes: behavioural variant frontotemporal dementia (bvFTD) or evaluation of the test’s ability to distinguish frontal from temporal lobe degenerative disease. We carried out a quantitative and qualitative analysis of Brixton performance in 76 patients with bvFTD and 34 with semantic dementia (SD) associated with temporal lobe degeneration. The groups were matched for demographic variables and illness duration. The bvFTD group performed significantly more poorly (U = 348, p < .0001, r = .58), 53% of patients scoring in the poor–impaired range compared with 6% of SD patients. Whereas bvFTD patients showed problems in rule acquisition and switching, SD patients did not, despite their impaired conceptual knowledge. Error analysis revealed more frequent perseverative errors in bvFTD, particularly responses unconnected to the stimulus, as well as random responses. Stimulus-bound errors were rare. Within the bvFTD group, there was variation in performance profile, which could not be explained by demographic, neurological, or genetic factors. The findings demonstrate sensitivity and specificity of the Brixton test in identifying frontal lobe degenerative disease and highlight the clinical value of qualitative analysis of test performance. From a theoretical perspective, the findings provide evidence that semantic knowledge and the capacity to acquire rules are dissociable. Moreover, they exemplify the separable functional contributions to executive performance.     

Speech monitoring skills in Alzheimer's disease, Parkinson's disease, and normal aging.

We examined the abilities of 15 patients with dementia of the Alzheimer type (DAT), 22 patients with Parkinson's Disease (PD), and 141 healthy subjects (ranging in age from 30 to 79 years) to detect and correct their own speech errors. Each subject was shown the Cookie Theft picture of the BDAE (Goodglass & Kaplan, 1972. The assessment of aphasia and related disorders. Philadelphia: Lea & Febiger.) and instructed to tell the examiner the "...story of what's happening in the picture." Self-monitoring performance was assessed by tabulating the number of uncorrected errors as well as repaired errors. We divided repairs into two types based on the psycholinguistics literature (van Wijk & Kempen, 1987. Cognitive Psychology, 19, 403-440). Speech corrections were judged to be lemma repairs when the reparandum was a single word, and reformulation repairs when a new syntactic constituent was added to the reparandum. Patients with DAT corrected only 24% of their total errors and patients with PD only 25%. Healthy subjects, by contrast, corrected from 72 to 92% of their total errors. Patients with DAT tended to rely on reformulation repairs while patients with PD used both repair types about equally often. While healthy elderly Ss (in the 70s group) utilized lemma repairs more often than the reformulation strategy, all other healthy Ss used both strategies about equally often. Across all groups naming performance correlated negatively with numbers of undetected errors. Results point to a previously unrecognized communication disorder associated with PD and DAT and manifested by an impairment in the ability to correct output errors. This impairment may be related to attentional and frontal dysfunction in the two patient groups.     

Response consistency on a semantic memory task in persons with dementia of the Alzheimer type

The purpose of this investigation was to determine the test-retest response consistency rate on a semantic memory task in persons with dementia of the Alzheimer type (DAT). Ten mildly and 13 moderately impaired DAT subjects and 14 normal controls matched for age, years of education, and estimated IQ participated in this study. The Peabody Picture Vocabulary Test (PPVT) was administered twice to each subject with a 7-day intertest interval. The mild and moderate DAT subjects responded inconsistently to significantly more PPVT items than normal controls. When the effects of guessing were considered, moderate DAT subjects gave significantly more inconsistent PPVT responses than normal controls and mild DAT subjects showed a trend toward giving more inconsistent responses. These results substantiate the conclusion that the impairment of specific conceptual knowledge in DAT subjects cannot be reliably measured with a single administration of a semantic memory task such as the PPVT.     

Does substance abuse contribute to further risk of falls in dementia

This study aimed to predict the risk of falls by focusing on substance abuse in the elderly with dementia. Our national cross-sectional survey included 1210 elderly Malaysian demented subjects. The study identified the effects of age, ethnicity, sex differences, marital status, educational level, and substance abuse on the likelihood of falls in the elderly with dementia. The multivariate logistic regression model was used to analyze data collected from samples. The prevalence of falls was about 17% among subjects and significantly increased with age (p = .006). Furthermore, the results showed that age (OR = 1.03), ethnicity (OR = 1.69), substance abuse (OR = 1.68), and female sex (OR = 1.45) significantly enhanced the risk of falls in respondents (p < .05). Educational level and marital status had no significant effects on the likelihood of falls (p > .05). However, the findings provided evidence of an additional effect of substance abuse on further risk of falls in older adults with dementia.     

Pictorial priming and cued recall in Alzheimer's and Huntington's disease

A picture fragment test was used to compare the priming and cued recall performances of patients with Huntington's disease (HD), patients with dementia of the Alzheimer type (DAT), and neurologically intact normal control (NC) subjects. On the pictorial priming test, subjects were asked to say "the first thing you think of" when shown incompletely drawn pictures, half of which were previously exposed to the subject during an unrelated naming task. Normal controls and HD patients, but not DAT patients, demonstrated similar increases in their ability to identify fragmented versions of previously seen pictures relative to novel pictures. These results are consistent with the previously observed pattern of preserved and impaired verbal priming ability in HD and DAT patients, respectively. The NC subjects, as expected, also demonstrated better performance on the cued recall than on the priming version of the picture fragment test, whereas the HD patients evidenced the opposite relationship on these two tasks and DAT patients were found to be equally impaired on both tests. This finding provides further support for the notion that HD patients' memory impairment is characterized primarily by an inability to initiate systematic retrieval strategies.     

The impact of conventional versus robust norming on cognitive characterization and clinical classification of MCI and dementia

We examined the impact of conventional versus robust normative approaches on cognitive characterization and clinical classification of MCI versus dementia. The sample included participants from the National Alzheimer's Coordinating Center Uniform Data Set. Separate demographically adjusted z-scores for cognitive tests were derived from conventional (n = 4273) and robust (n = 602) normative groups. To assess the impact of deriving scores from a conventional versus robust normative group on cognitive characterization, we examined likelihood of having a low score on each neuropsychological test. Next, we created receiver operating characteristic (ROC) curves for the ability of normed scores derived from each normative group to differentiate between MCI (n = 3570) and dementia (n = 1564). We examined the impact of choice of normative group on classification accuracy by comparing sensitivity and specificity values and areas under the curves (AUC). Compared with using a conventional normative group, using a robust normative group resulted in a higher likelihood of low cognitive scores for individuals classified with MCI and dementia. Comparison of the classification accuracy for distinguishing MCI from dementia did not suggest a statistically significant advantage for either normative approach (Z = −0.29, p = .77; AUC = 0.86 for conventional and AUC = 0.86 for robust). In summary, these results indicate that using a robust normative group increases the likelihood of characterizing cognitive performance as low. However, there is not a clear advantage of using a robust over a conventional normative group when differentiating between MCI and dementia.     

Associative encoding and retrieval in Alzheimer's and Huntington's disease

The associative encoding and retrieval abilities of patients with dementia of the Alzheimer type (DAT) and patients with Huntington's disease (HD) were investigated using an encoding specificity paradigm. When compared to age- and education-matched intact control subjects, both patient groups were severely (and equally) impaired on overall memory for word lists. However, the HD and DAT patients showed differential improvement in recall performance with the introduction of associated cues during stimulus presentation and recall. Although the HD patients, like intact subjects, were able to benefit from semantic retrieval cues (strong and weak) which were present during input, the performance of the patients with DAT improved only with the introduction of strong cues at output, regardless of whether the cues were present or absent during initial presentation. These findings suggest that patients with DAT failed to encode the semantic relationship between the to-be-recalled and cue words and simply generated free associations to the cue words during retrieval. Similarities between the performances of the patients with DAT and alcoholic Korsakoff patients are noted and discussed with regard to the neuropathological basis of the disorders.     

Earwitness Testimony: Never Mind the Variety,Hear the Length

Three aspects of voice recognition were investigated in the study reported here: memory for familiar voices, memory for the words spoken, and the relative effects of length and variation in a voice extract on long- and short-term memory. In Experiment 1, recognition memory for the briefly heard voice of a stranger was superior with longer extracts (p<0.01), but increasing vowel variety did not improve performance. This pattern was repeated for short-term memory (p<0.01) in Experiment 2. Scores for the above task correlated significantly (p<0.05) with scores for recognizing well-known voices. In a further test of well-known voice memory in Experiment 3, a weak and non-significant positive correlation (r=0.29) was found between memory for well-known voices and memory for a once-heard voice. Memory for the words spoken did not correlate significantly with memory for the unknown voice itself. The possibilities of a memory-for-voices general ability, and forensic applications of the findings are discussed. © 1997 by John Wiley & Sons, Ltd.     

Neuropsychological tools to predict conversion from amnestic mild cognitive impairment to dementia. The TREDEM Registry

Most of the studies about conversion from Mild cognitive impairment (MCI) to dementia have focused on amnestic MCI (aMCI) which is considered a preclinical phase of Alzheimer’s disease. The aim of the present study was to identify neuropsychological tools that would best predict conversion from aMCI to dementia. Fifty-five aMCI subjects on the Treviso Dementia Registry were investigated. They underwent a neuropsychological evaluation during their first assessment and again at follow-up. Cox proportional-hazard regression models were created to measure the association between the dependent variable (dementia diagnosis or MCI status maintenance) and the neuropsychological test scores at baseline. The sample (28 women and 27 men; mean age 76.82 ± 5.88 years; education 7.62 ± 3.99 years) was observed for an average time of 2.17 ± 1.25 years. A Cox backward stepwise regression showed that the Rey Auditory Verbal Learning Test, Delayed Recall (p = .041) and Semantic Verbal Fluency tests (p = .031) appear to be useful in predicting conversion to dementia.     

Positive and negative affect,depression, and cognitive processes in the Cognition in the Study of Tamoxifen and Raloxifene (Co-STAR) Trial

ABSTRACT

Objectives: This study examined the relationship between positive and negative affect, depressive symptoms, and cognitive performance. Methods: The sample consisted of 1479 non-demented, postmenopausal women (mean age = 67 years) at increased risk of breast cancer enrolled in the National Surgical Adjuvant Breast and Bowel Project’s Study of Tamoxifen and Raloxifene. At each annual visit, women completed a standardized neuropsychological battery and self-report measures of affect and depression. Data from three visits were used in linear mixed models for repeated measures using likelihood ratio tests. Separate analyses were performed to relate positive/negative affect and depression to each cognitive measure. Results: Higher positive affect was associated with better letter fluency (p = .006) and category fluency (p < .0001). Higher negative affect was associated with worse global cognitive function (p < .0001), verbal memory (CVLT List B; p = .002), and spatial ability (p < .0001). Depressive symptoms were negatively associated with verbal knowledge (p = .004), figural memory (p < .0001), and verbal memory (p’s ≤ .0001). Discussion: Findings are consistent with some prior research demonstrating a link between positive affect and increased verbal fluency and between depressive symptoms and decreased memory. The most novel finding shows that negative affect is related to decreased global cognition and visuospatial ability. Overall, this research in a large, longitudinal sample supports the notion that positive affect is related to increases and negative affect to decreases in performance on distinct cognitive measures.     

Psychophysiological correlates of organizational change and threat of unemployment among police inspectors

The study examined psychosocial work-conditions and physiological reactions among thirty-six police inspectors (median age 45 years, 81% males) who participated in a reorganization. At this time, subjects were threatened by unemployment and had to reapply for their positions in a new police district. Data were collected during the reorganization and at three years follow-up, by means of questionnaires (Stress Profile) and blood samples. The blood samples were used to determine serum levels of gammaglutamyltransferase (GGT), glucose, lipids, prolactin, testosterone and cortisol. The results show a positive association betweenworry about employment and symptoms ofburnout during the reorganization. Mean scores for the Stress Profile sub-scalesworry about employment (p<.01) andwork-load (p<.05) decreased between measurements but an impairment inrelationships with management was noticed (p<.05). No significant changes were observed in terms of self-rated health complaints. Significant decreases in total cholesterol (p<.0001), LDL-cholesterol (p<.0001), LDL/HDL-ratio (p<.01), prolactin (p<.0001), as well as increases in testosterone (p<.01) and cortisol (p<.001) were observed for the whole sample. Glucose decreased with marginal significance (<.07). Controlling for age and gender, multivariate regression analyses showed that subjects who reported deteriorations insatisfaction with work manifested the most modest decreases in prolactin (p<.05). Also, the decrease in glucose was larger for subjects who experienced impairments in,satisfaction with work (p<.05), information (p<.05), task-oriented leadership, (p<.05), andrespect and dignity (p<.05). Subjects who perceived deteriorations in theethical and moral standards of the organization increased their cortisol level to a lower degree than their counterparts (p<.05). Favorable changes in employment status and psychosocial work environment seem to be related to improved physiological functioning.     

How impaired is too impaired? Exploring futile neuropsychological test patterns as a function of dementia severity and cognitive screening scores

Some older adults cannot meaningfully participate in the testing portion of a neuropsychological evaluation due to significant cognitive impairments. There are limited empirical data on this topic. Thus, the current study sought to provide an operational definition for a futile testing profile and examine cognitive severity status and cognitive screening scores as predictors of testing futility at both baseline and first follow-up evaluations. We analysed data from 9,263 older adults from the National Alzheimer’s Coordinating Center Uniform Data Set. Futile testing profiles occurred rarely at baseline (7.40%). There was a strong relationship between cognitive severity status and the prevalence of futile testing profiles, χ²(4) = 3559.77, p < .001. Over 90% of individuals with severe dementia were unable to participate meaningfully in testing. Severity range on the Montreal Cognitive Assessment (MoCA) also demonstrated a strong relationship with testing futility, χ²(3) = 3962.35, p < .001. The rate of futile testing profiles was similar at follow-up (7.90%). There was a strong association between baseline dementia severity and likelihood of demonstrating a futile testing profile at follow-up, χ²(4) = 1513.40, p < .001. Over 90% of individuals with severe dementia, who were initially able to participate meaningfully testing, no longer could at follow-up. Similarly, there was a strong relationship between baseline MoCA score band and likelihood of demonstrating a futile testing profile at follow-up, χ²(3) = 1627.37, p < .001. Results can help to guide decisions about optimizing use of limited neuropsychological assessment resources.     

The Effects of the Cognitive Interview on Recall,Identification, Confidence and the Confidence/Accuracy Relationship

The effects of two interview techniques, the Cognitive Interview (CI) and the Structured Interview (SI), were examined in relation to recall, recognition, confidence and the confidence/accuracy relationship. Volunteer subjects witnessed a live staged event, and at set time delays (48 and 96 hours) were interviewed by means of either the CI or SI and made lineup identifications from both blank and filled lineup presentations. The CI significantly improved total recall (p<0.001) and correct recall (p<0.001) relative to the SI. There were no differences in either accuracy or error rates for the two conditions. The CI produced significantly higher ‘pre-post interview’ confidence ratings than the SI (p<0.05). Within-, between- and event-confidence ratings were not predictive of recall or recognition accuracy. Failure to find a significant consistent confidence/accuracy relationship was suggested to have occurred because of the operation of an accuracy assessment heuristic. The CI did not reliably improve identification from a filled lineup presentation relative to the SI, but did produce better performance on a blank lineup presentation (p<0.001). Confidence and the confidence/accuracy relationship involving identifications were not found to differ as a function of interview condition. Throughout the study multiple regression analyses failed to reveal consistent predictors of recall or recognition accuracy, confidence or the confidence/accuracy relationship of these two domains. © 1997 by John Wiley & Sons, Ltd.     

Cognitive Ability Tests and the Situational Interview: A Test of Incremental Validity

This study investigated the validity and incremental validity of a situational interview beyond that of a composite measure of cognitive ability. Forty-seven factory service technicians underwent an interview and took four cognitive ability tests. Supervisors rated the performance of these subjects in a concurrent validation study. The interview was found to be a valid predictor of a supervisor rating of performance (r = 0.32, p < 0.05 uncorrected), however, was unable to show incremental validity over ability tests (Incremental R²= 0.05, n.s.). Limitations of the present study and directions for future research are discussed.     

The pattern of reading deterioration in dementia of the Alzheimer type: Observations and implications

Thirteen patients with dementia of the Alzheimer type (DAT) were tested for their ability to read aloud and to read with comprehension. Reading aloud was preserved in all but the most severely impaired cases and was found to be relatively independent of intellectual deterioration. Reading comprehension declined progressively with increasing dementia severity and correlated well with quantitative mental status assessments. The results suggest that the pattern of reading deterioration may aid in the clinical identification of DAT, that the disturbance of reading comprehension is a linguistic deficit rather than a product of visual-perceptual disturbances, and that the alexia is more consistent with an instrumental loss than a de-developmental model of dementia.     

Differences in performance in CAMCOG-R domains between old and oldest old patients with Alzheimer’s disease

The purpose of this study is to evaluate the neuropsychological performance in a ≥90-year-old population with Alzheimer disease (AD) in comparison with younger elderly patients. We retrospectively studied all patients with AD attended in a specialized clinic between 1999 and 2011. Age, sex, educational level, and sensory loss data were collected. Neuropsychological evaluation included Mini-Mental State Examination and Global Deterioration Scale. We used the eight Cambridge Cognitive Assessment (CAMCOG-R) domains to evaluate and compare the neuropsychological performance in the younger than 90 years old (<90) and older than 90 years old (≥90) groups. We selected 2931 patients, 2897 <90 (98.83%) and 34 ≥90 years old (1.17%). The ≥90 group had significant lower punctuations in memory, praxis, and abstract thinking CAMOCG-R domains with 1.49, 0.75, and 0.58 less points, respectively, (p < 0.05). Neuropsychological characteristics of cognitive decline seem to be different in ≥90 compared to <90 years old patients. According to age, the biggest differences in the CAMCOG-R performance are in the memory, praxis, and abstract thinking domains.     

Differential effects of stimulus characteristics during knee joint perturbation on hamstring and quadriceps reflex responses

When stretching muscles of the ankle joint, stretch velocity and amplitude were shown to selectively influence specific parts of the stretch reflex. The present study investigated whether similar effects can be observed at the knee joint. Seventeen subjects were exposed to sudden anterior tibial translations. The influence of stimulus amplitude was analyzed by applying a low (LIMP) or high impulse (HIMP). To investigate the influence of velocity, rate of force development of the perturbation was chosen either low (LRFD) or high (HRFD). Activation of biceps femoris (BF), semitendinosus (ST), vastus medialis (VM) and vastus lateralis (VL) was calculated in four consecutive timeframes (P0, P1, P2, P3). During P1, RFD (ST: p < .05; BF: p < .01; VM: p < .05; VL: p > .05) and during P2, impulse (ST: p < .05; BF: p < .01; VM: p < .01; VL: p < .01) did significantly influence reflex activation. The present study showed that stimulus characteristics influenced specific reflex components of knee joint muscles. As only hamstring muscles were stretched, whereas quadriceps was unloaded, it is concluded that different mechanisms like homonymous and heteronymous muscle afferents as well as joint and skin afferents might contribute to the reflex responses.     

Developmental Delays at Arrival,Early Intervention Enrollment,and Adopted Chinese Girls’ Academic Performance and Internalizing Problems in Adolescence

The author investigated the extent of developmental delays in girls adopted from China, their subsequent early intervention (EI) enrollment, and how the delays and EI were related to their academic performance and internalizing problems in adolescence. The sample included 180 adolescent girls (M = 13.4 years, SD = 2.0 years) who were adopted at 3–23.5 months (M = 11.5 months, SD = 3.7 months). Data on the adopted Chinese girls’ delays at arrival and EI enrollment in physical therapy (PT) and speech–language therapy (SLT) were collected from the adoptive mothers at the Baseline; data on the adopted Chinese girls’ present academic performance and internalizing problems were collected from the adoptive mothers and adopted girls at Wave 4 six years later. Data analyses revealed that 55% of the adoptees had moderate-to-severe delays when first arrived at the adoptive homes. Motor delays significantly increased the odds for PT (odds ratio [OR] = 3.98, 95% CI [2.18, 7.82], p <.001) and SLT (OR = 2.36, 95% CI [1.50–3.72, p <.001). Social-cognitive delays also significantly increased the odds for PT (OR = 1.90, 95% CI [1.36, 2.63], p <.001) and SLT (OR = 1.63, 95% CI [1.22, 2.17], p <.001). Motor delays were negatively associated with academic performance but positively associated with internalizing problems. General linear modeling showed that the adoptees who had developmental delays at arrival and subsequently enrolled in EI scored significantly lower on academic performance than their peers who had delays but did not enroll in EI, as well their peers who had no delays and did not enroll in EI. Implications of these findings are discussed.