Neuropsychological Features of Lesion-related Epilepsy in Adults: An Overview

Lesional epilepsy is thought to be a direct consequence of focal brain lesions of dysgenetic, neoplastic, vascular, or traumatic origin. It has been estimated that at least half of all epilepsies are the result of such lesions. The current discussion includes an overview of the cognitive and behavioral presentations in adults with epilepsy secondary to focal pathology. The neuropsychological presentation in this population is influenced by many factors, including the location and nature of the underlying lesion, seizure characteristics, the effects of treatment, and patient variables. Few studies attempt to disentangle the specific contributions of these variables to cognitive performance. However, where available studies examining the separable effects of seizure-related variables on cognitive functioning in individuals with lesional epilepsy are also reviewed. This overview includes a discussion of focal malformations of cortical and vascular development and select foreign tissue and acquired lesions.     

Neuropsychological Deficits in Childhood Epilepsy Syndromes

Seizure disorders are relatively common in childhood, and the International League Against Epilepsy (ILAE) provides a hierarchical classification system to define seizure types. At the final level of classification, specific epilepsy syndromes are defined that represent a complex of signs and symptoms unique to an epilepsy condition. The present review discusses the issues related to several of these epilepsy syndromes in childhood, including those classified as generalized idiopathic epilepsies (e.g., childhood absence epilepsy, juvenile absence epilepsy, juvenile myoclonic epilepsy), focal epilepsies (benign rolandic epilepsy, occipital epilepsy, temporal lobe epilepsy, frontal lobe epilepsy) and the "epileptic encephalopathies," including Dravet's Syndrome, West Syndrome, Lennox-Gastaut Syndrome, Myoclonic Astatic Epilepsy, and Landau-Kleffner Syndrome. For each syndrome, the epidemiology, clinical manifestations, treatments, and neuropsychological findings are discussed.     

Cognitive performance in older adults with stable heart failure: Longitudinal evidence for stability and improvement

Cognitive impairment is prevalent in heart failure (HF), though substantial variability in the pattern of cognitive impairment is found across studies. To clarify the nature of cognitive impairment in HF, we examined longitudinal trajectories across multiple domains of cognition in HF patients using latent growth class modeling. 115 HF patients completed a neuropsychological battery at baseline, 3-months and 12-months. Participants also completed the Beck Depression Inventory-II (BDI-II). Latent class growth analyses revealed a three-class model for attention/executive function, four-class model for memory, and a three-class model for language. The slope for attention/executive function and language remained stable, while improvements were noted in memory performance. Education and BDI-II significantly predicted the intercept for attention/executive function and language abilities. The BDI-II also predicted baseline memory. The current findings suggest that multiple performance-based classes of neuropsychological test performance exist within cognitive domains, though case-controlled prospective studies with extended follow-ups are needed to fully elucidate changes and predictors of cognitive function in HF.     

Cognitive behaviour therapy with adults with intractable epilepsy and psychiatric co-morbidity: preliminary observations on changes in psychological state and seizure frequency

Cognitive behaviour therapy (CBT) was undertaken with six adults with chronic, poorly controlled seizures and co-existing psychiatric and/or psychosocial difficulties. During 12 sessions of CBT from an experienced CBT Nurse Specialist, treatment focused concurrently on epilepsy-related problems, associated psychopathology and on the development of psychological strategies to reduce seizure occurrence. At the end of treatment participants rated their initial epilepsy-related problem as having less impact on their daily lives and at one-month follow-up reported less deleterious impact on everyday life in terms of their psychological difficulties. In addition participants demonstrated significant improvements in terms of their self-rated work and social adjustment, and in their decreased use of escape-avoidance coping strategies. These positive findings occurred despite the absence of a significant decrease in seizure frequency. Issues raised by the complexity and severity, both of these patients' psychological/psychosocial difficulties and their epilepsy, are discussed in relation to the optimal length of treatment that may be required when adopting a CBT model in this patient group.     

Assessing Effort During Neuropsychological Evaluation with the TOMM in Children and Adolescents with Epilepsy

Effort assessment is of particular importance in pediatric epilepsy where neuropsychological findings may influence treatment decisions, especially if surgical interventions are being considered. The present investigation examines the Test of Memory Malingering (TOMM) in 60 children and adolescents with epilepsy. The overall pass rate for the sample was 90%. TOMM scores were unrelated to age, though there was a significant correlation between TOMM Trial 2 scores and intelligence estimates. Overall, the TOMM appears to be a valid measure of effort in young epilepsy patients, though caution should be used when interpreting scores for those with very low IQ, especially if behavioral problems are also evident. Caution should also be exercised in interpreting scores in children with ongoing interictal epileptiform activity that may disrupt attention.     

Functional Magnetic Resonance Imaging of Language in Epilepsy

Functional magnetic resonance imaging (fMRI) has revolutionized our understanding of functional networks and cerebral organization in both normal and pathological brains. In the present review, we describe the use of fMRI for mapping language in epilepsy patients prior to surgical intervention including a discussion of methodological issues and task design, comparisons between fMRI and the intracarotid sodium amobarbital test, fMRI studies of language reorganization, and the use of fMRI laterality indexes to predict outcome after anterior temporal lobectomy.     

Cognitive predictors of posttraumatic stress disorder in children: results of a prospective longitudinal study

The present study explored whether cognitive factors specified in the Ehlers and Clark model (Behav. Res. Ther. 38 (2000) 319) of posttraumatic stress disorder (PTSD) predict chronic PTSD in children who had experienced a road traffic accident. Children were assessed at 2 weeks, 3 months, and 6 months after the accident. Data-driven processing during the accident, negative interpretation of intrusive memories, alienation from other people, anger, rumination, thought suppression and persistent dissociation at initial assessment predicted PTSD symptom severity at 3 and 6 months. On the basis of sex and stressor severity variables, 14% of the variance of PTSD symptoms at 6 months could be explained. The accuracy of the prediction increased to 49% or 53% when the cognitive variables measured at initial assessment or 3 months, respectively, were taken into account.     

Peer Difficulties in Children with Epilepsy: Association with Seizure,Neuropsychological, Academic,and Behavioral Variables

Purpose/Objective: A developmental psychopathology framework was used to examine variables associated with peer problems in children with epilepsy (CWE). Variables commonly associated with peer difficulties in typically developing children, such as inattentive behavior, anxious behavior, and academic achievement were investigated. Neuropsychological functioning, age at epilepsy onset, and seizure status were also examined.

Research Method/Design: Participants were 173 CWE, ages 8–15. Structural equation modeling (SEM) was used to determine which variables predicted peer problems in CWE and to test hypothesized interrelations among variables.

Results: The SEM revealed that anxious behavior mediated relations between neuropsychological functioning and peer difficulties and seizure status and peer difficulties. Inattentive behavior mediated the association between neuropsychological functioning and peer difficulties. Neuropsychological functioning mediated the relation between age at epilepsy onset and inattentive behavior, anxious behavior, and academic achievement.

Conclusions/Implications: As seen with typically developing children, inattentive and anxious behaviors are related to peer difficulties in CWE. Neuropsychological functioning, age at epilepsy onset, and seizure status are indirectly associated with peer difficulties; therefore, these variables are important to examine in CWE who are experiencing peer problems.     

Cognition and the development of temperament from late childhood to early adolescence

Temperament is related to cognition, but it is unclear whether reciprocal associations exist with early developmental trajectories. Children from the Longitudinal Study of Australian Children (N = 8,677) were assessed over four waves on verbal ability at ages 8/9, nonverbal ability at ages 8/9 and 10/11, and parent-rated temperament every two years from ages 8/9 to 14/15. Latent difference score analyses indicated correlated changes between ages 8/9 and 10/11. Increased nonverbal ability over the first two years was associated with declined reactivity and increased persistence. Latent growth curve models further indicated that nonverbal and verbal ability at baseline were associated with declined reactivity and increased persistence over the six years. These findings suggest bidirectional associations between childhood cognitive ability and temperament development.     

Cognitive imitation in typically-developing 3- and 4-year olds and individuals with autism

Individuals diagnosed with autism suffer from numerous social, affective and linguistic impairments. It has also been suggested that they have a global imitation deficit. That hypothesis, however, is compromised by the fact that individuals with autism suffer from various motor impairments. Here we describe an experiment on cognitive imitation, a type of imitation that doesn’t require motor learning. Nine male autistic subjects and 20 typically-developing 3- and 4-year olds were trained to respond, in a prescribed order, to different lists of photographs that were displayed simultaneously on a touch-sensitive monitor. Because the position of the photographs varied randomly from trial to trial, sequences could not be learned by motor imitation. In three different imitation treatments, including a ghost control, autistic subjects learned new sequences more rapidly after observing a model execute those sequences than when they had to learn new sequences entirely by trial and error. Moreover, the performance of autistic subjects did not significantly differ from the performance of typically-developing controls. The result of this and other studies suggests that individuals with autism suffer from a specific novel motor imitation deficit.     

Cognitive and Interpersonal Predictors of Stress Generation in Children of Affectively Ill Parents

Stress generation is a process in which individuals, through their depressive symptoms, personal characteristics, and/or behaviors, contribute to the occurrence of stressful life events. While this process has been well documented in adults, few studies have examined it in children. The present study examines whether cognitive and interpersonal vulnerability factors to depression contribute to stress generation in children, independent of their current depressive symptoms. Participants included 140 children (ages 6 to 14) and one of their parents. During an initial assessment, children completed self-report measures assessing cognitive and interpersonal vulnerability factors to depression. Children and their parents also completed measures assessing depressive symptoms. One year later, children and their parents participated in a semi-structured interview assessing the occurrence of stressful life events in the past year. Multi-level modeling results provided strong support for the stress generation process in children of affectively ill parents and highlight the importance of considering gender and age moderation effects.

A Clinical Comparative Study Evaluating the Effect of Epilepsy Versus Adhd on Timed Cognitive Tasks in Children

Both children with epilepsy and children with ADHD may be characterized by slowing on reaction-time measurement. This is of particular interest, as neuropsychological assessment is often requested in the differential diagnosis between children with short non-convulsive epileptic seizures and children with ADHD. In this study we attempt to identify patterns of impairment on timed tasks that are specific for epilepsy, relative to ADHD. This study was an open, controlled parallel-group clinical investigation which included two groups of patients: 60 children with ADHD and 60 children with epilepsy. These children were compared with a control group (n =30) on two types of timed cognitive tasks: tasks with low information load (simple reaction-time measurement) and tasks with high information load (multiple decision reaction-time measurement). The simple reaction-time measurements show significant differences between ADHD and controls (all except for visual RT non-dominant hand) and between epilepsy and controls (only one test). No significant differences were found between epilepsy and ADHD. The two tests with high information load show significant slowing compared with the controls for epilepsy on the Binary Choice Reaction-Time Test and for ADHD on the Visual Searching Test. On both tests also the differences between epilepsy and ADHD are significant. The two tests in combination have a relatively satisfactory potential to classify the children with ADHD (75% correct classification) and the children with epilepsy (55% correct classification). We may conclude that complex reaction-time tests (i.e., timed tasks with high information load) have potential for assessing the differential impact of ADHD and epilepsy on attentional function. These tasks specifically reveal general slowing for children with epilepsy and slowing as an effect of failures of inhibitory self control on unstructured tasks for ADHD.     

Cognitive effects of language on human navigation

Language has been linked to spatial representation and behavior in humans, but the nature of this effect is debated. Here, we test whether simple verbal expressions improve 4-year-old children’s performance in a disoriented search task in a small rectangular room with a single red landmark wall. Disoriented children’s landmark-guided search for a hidden object was dramatically enhanced when the experimenter used certain verbal expressions to designate the landmark during the hiding event. Both a spatial expression (“I’m hiding the sticker at the red/white wall”) and a non-spatial but task-relevant expression (“The red/white wall can help you get the sticker”) enhanced children’s search, relative to uncued controls. By contrast, a verbal expression that drew attention to the landmark in a task-irrelevant manner (“Look at this pretty red/white wall”) produced no such enhancement. These findings provide further evidence that language changes spatial behavior in children and illuminate one mechanism through which language exerts its effect: by helping children understand the relevance of landmarks for encoding locations.     

Development of Cognitive Skills in Children with Motor Coordination Impairments at 12-Month Follow-up

The current study presents a 1-year follow-up investigation of the development of executive functions (i.e., inhibition, updating, and shifting) in children with motor coordination impairments. Cognitive and motor coordination skills of children (N = 94) aged between 5 and 7 years with and without motor coordination impairments were compared. A second focus of the study was on pre-academic skills. The results indicate marked stability of motor coordination impairments and persistent executive functioning deficits in motor-impaired children. Inhibition and shifting performance was consistently lower, compared to the children without motor coordination impairments. Moreover, children with motor coordination impairments showed lower pre-academic skills, facing a substantial disadvantage at the beginning of formal schooling. The combined cognitive and motor problems may be the result of an underlying inhibition deficit or a general automation deficit. Implications for intervention are discussed.     

“认知科学”与“第二代认知科学”刍议

以计算隐喻为核心假设的传统认知心理学以及联结主义心理学均不能克服离身心智（disembodied mind）的根本缺陷,当代认知心理学正面临着新的范型转换。以具身性和情境性为重要特征的第二代认知科学将日受重视,并促使认知神经科学进入新的发展阶段。作者认为在身心关系上应该坚持生理只是心理的必要条件,而非充分条件的立场,克服生理还原论的危险;应该重新审视基于二元论的生理机制这种说法;心理学传统中的科学主义和人文主义有可能在第二代认知科学强调认知情境性的基础上达成某种融合;第一代认知科学对意识的研究是不成功的,因为对知觉、注意、记忆、思维等心理过程的研究不能代替意识的研究,同时还应避免以意识内容的研究取代心理学研究的倾向。第二代认知科学中的动力系统理论关于变量（因素）之间的偶合（coupling）关系完全不同于变差分析中的变量之间的交互作用关系”,其动力系统模式可能更有助于破解意识的产生（涌现）之谜,并引发心理学研究的方法论的变革新潮。第二代认知科学的兴起将启发人们对身心关系、生理还原论、意识研究在心理学中的地位、人工智能对心智完全模拟的可能性等重大问题重新思考     

"认知革命"与"第二代认知科学"刍议

以计算隐喻为核心假设的传统认知心理学以及联结主义心理学均不能克服离身心智（disembodied mind）的根本缺陷,当代认知心理学正面临着新的范型转换．以具身性和情境性为重要特征的第二代认知科学将日受重视,并促使认知神经科学进入新的发展阶段。作者认为在身心关系上应该坚持生理只是心理的必要条件,而非充分条件的赢场,克服生理还原论的危险;应该重新审视基于二元论的生理机制这种说法;心理学传统中的科学主义和人文主义有可能在第二代认知科学强调认知情境性的基础上达成某种融合;第一代认知科学对意识的研究是不成功的,因为对知觉、注意、记忆、思维等心理过程的研究不能代替意识的研究,同时还应避免以意识内容的研究取代心理学研究的倾向、第二代认知科学中的动力系统理论关于变量（因素）之间的偶合（coupling）关系完全不同于变差分析巾的变量之间的交互作用关系,其动力系统模式可能更有助于破解意识的产生（涌现）之谜,并引发心理学研究的方法论的变革新潮,第二代认知科学的兴起将启发人们对身心关系、生理还原论、意识研究在心理学中的地位、人工智能对心智完全模拟的可能性等重夫问题重新思考。     

Cognitive ability, right-wing authoritarianism, and social dominance orientation: A five-year longitudinal study amongst adolescents

We report longitudinal data in which we assessed the relationships between intelligence and support for two constructs that shape ideological frameworks, namely, right-wing authoritarianism (RWA) and social dominance orientation (SDO). Participants (N = 375) were assessed in Grade 7 and again in Grade 12. Verbal and numerical ability were assessed when students entered high school in Grade 7. RWA and SDO were assessed before school graduation in Grade 12. After controlling for the possible confounding effects of personality and religious values in Grade 12, RWA was predicted by low g (β = − .16) and low verbal intelligence (β = − .18). SDO was predicted by low verbal intelligence only (β = − .13). These results are discussed with reference to the role of verbal intelligence in predicting support for such ideological frameworks and some comments are offered regarding the cognitive distinctions between RWA and SDO.     

认知风格和信息呈现方式对学习者认知负荷的影响

该研究采用2×2的被试间实验设计,探讨了认知风格和信息呈现方式对认知负荷的影响。研究结果表明：信息呈现方式对学习时间有显著的影响;认知风格对学习者的认知负荷有显著的影响;认知风格和信息呈现方式无显著的交互作用;学习时间、心理努力量和材料难度具有一致性,但它们可能对不同的认知负荷敏感,即学习时间可能反映了总认知负荷量,心理努力量和材料难度可能分别对内在和有效认知负荷敏感。     

The role of historical intuitions in children's and adults' naming of artifacts

It is commonly assumed that artifacts are named solely on the basis of properties they currently possess; in particular, their appearance and function. The experiments presented here explore the alternative proposal that the history of an artifact plays some role in how it is named. In three experiments, children between the ages of 4 and 9 years and adults were presented with familiar artifacts whose appearance and function were then radically altered. Participants were tested as to whether they believed that the modified objects were still members of the artifact kind. Results indicate that object history becomes increasingly important over the course of development.