Is anorexia nervosa a neuropsychological disease?

Evidence for central nervous system, and more particularly cortical, etiology of anorexia nervosa is reviewed. Topics covered are neuropsychiatric comorbidity, inheritance patterns, the neurobiology of body-image disturbance and of the eating function, perinatal and alcoholic insult to the brain, neurochemical and neuroelectric disturbance, anatomic and metabolic brain imaging, and neuropsychological impairment. It is concluded that there is indeed an important neuropsychological etiological dimension to anorexia nervosa. The profile most frequently associated with anorexia nervosa is right posterior hypometabolism, followed by right anterior hypermetabolism, both associated with right-sided abnormal electroencephalogram spiking. It is also proposed that bulimia consists of a positive neurological subtype and that restricting anorexia represents a negative neurological subtype. Priorities for further research into anorexia nervosa are specified to include twin adoption studies, brain electrical topography studies, postmortem histological studies, and experimentally inspired neuropsychological studies.     

Is there something special about the self? A neuropsychological case study

One of the most exciting trends in psychology has been the increasing use of data and conceptual tools derived from the study of patients with neuropsychological syndromes to address questions about normal mental function. To date, however, personality theorists seldom have considered neuropsychological case material (Klein & Kihlstrom, 1998). In this paper we show how neuropsychological evidence can afford new insights for personality theorists. In particular, we show how examination of persons suffering from amnesia and autism can shed light on the way in which knowledge about self is represented in memory. We first review the literature on clinical amnesia and then present evidence from a new case study exploring the relation between personal and nonpersonal knowledge in a patient with autism. We conclude that the mind may have learning systems that are specialized both for acquiring and retrieving information about one's own personality.     

Association rule learning in neuropsychological data analysis for Alzheimer’s disease

Efficient methods of analysis readily available for clinicians continue to be limited within neuropsychological assessment at the raw data level. Here, a novel approach for generating predictive response patterns and analysing neuropsychological raw data is offered. In order to assess the usefulness of association rule learning as an analysis tool for neuropsychological raw data, Frequent Pattern Growth (FP-Growth) was used to mine patterns from the Consortium to Establish a Registry for Alzheimer’s Disease Neuropsychological Battery (CERAD-NB) database. Complete assessment data for 84 post-mortem confirmed Alzheimer’s disease (AD) cases and 294 age, race, and education matched controls were analysed across baseline and one-year follow-up using FP-Growth, for the purpose of assessing the clinical utility of a finer analysis at the raw data level and the feasibility of predicting response patterns for clinical/control groups. Output from FP-Growth, in terms of the number of frequent itemsets retained across both evaluation timepoints, was discernable between controls, mild, and moderate to severe Alzheimer’s disease cases (p < .001, and η² = .488). Patterns within raw data scores, both in terms of frequent itemsets and predictive association rules, appear to be differentiable across groups within neuropsychological analysis, which indicates that FP-Growth is applicable as a supplementary analysis tool for neuropsychological assessment by means of offering an additional level of data analysis, predictive item response capabilities, and aiding in clinical decision making.     

What underlies the neuropsychological pattern of irregular > regular past-tense verb production?

The disadvantage in producing the past tense of regular relative to irregular verbs shown by some patients with non-fluent aphasia has been alternatively attributed (a) to the failure of a specific rule-based morphological mechanism, or (b) to a more generalised phonological impairment that penalises regular verbs more than irregular owing to the on-average greater phonological complexity of regular past-tense forms. Guided by the second of these two accounts, the current study was designed to identify more specific aspects of phonological deficit that might be associated with the pattern of irregular > regular past-tense production. Non-fluent aphasic patients (N = 8) were tested on past-tense verb production tasks and assessed with regard to the impact of three main manipulations in other word-production tasks: (i) insertion of a delay between stimulus and response in repetition; (ii) presence/number of consonant clusters in a target word in repetition; (iii) position of stress within a bi-syllabic word in repetition and picture naming. The performance of all patients deteriorated in delayed repetition; but the patients with the largest discrepancy between regular and irregular past-tense production showed greater sensitivity to the other two manipulations. The phonological nature of the factors that correlated with verb-inflection performance emphasises the role of a phonological deficit in the observed pattern of irregular > regular.     

Are we documenting performance validity testing in pediatric neuropsychological assessments? A brief report

A 2016 survey of pediatric neuropsychologists found that 92% of clinicians reported use of “at least one” performance validity test (PVT) in each assessment. The present investigation sought to verify documented PVT use among clinicians by review of actual reports. A convenience sample of pediatric neuropsychological reports of children ages 6–17 were reviewed over an 24-month period (January 2015–January 2017); reports were those seen as part of our routine practice, including reports on children we were reevaluating, cases that we consulted on, or cases evaluated elsewhere presenting to our centers that required record review for clinical decision making (e.g., presurgical epilepsy evaluations). A total of 131 reports, from 102 unique neuropsychologists were reviewed. PVT usage was documented in only six reports, from six unique clinicians, representing only 4.58% of the reports (or 5.88% of clinicians), far below expectations recent survey results. Though sampling differences and documentation factors may account for some of this disparity, a “social desirability bias” on surveys is likely a major factor in explaining these discordant findings.     

Cognitive function after open-heart surgery: Are postoperative neuropsychological deficits caused by cardiopulmonary bypass?

Despite the many technological developments in arterial perfusion and cardiac surgical procedures, open-heart surgery is still believed to pose a significant risk for cerebral injury. There are several potential causes of brain damage during open-heart surgery, including prolonged or severe arterial hypotension, as well as emboli emanating from the cardiopulmonary bypass circuit or the operative field. This article reviews the available neuropsychological studies of outcome following cardiac valve replacement and coronary artery bypass grafting. Because both procedures are life-saving operations, the research in this area has been quasi-experimental and fraught with methodological problems. Nonetheless, the findings converge to suggest that cognitive dysfunction occurs after open-heart surgery, and that the deficits are attributable, at least in part, to factors specific to the operation or to the patient being maintained on cardiopulmonary bypass. Preliminary findings suggest that embolization is the primary cause of perioperative deficits in uncomplicated operations. Studies have also consistently found preoperative deficits in this population, suggesting that neuropsychological dysfunction is caused by severe chronic cardiac disease as well as open-heart surgery.     

Relational trauma in infancy. Psychoanalytic,attachment and neuropsychological contributions to parent–infant psychotherapy

Abstract

The paper argues that residential projects working mainly with those diagnosed schizophrenic are specialized work groups, in Bion's terms, operating upon the assumption of pairing, and illustrates this with reference to a period of organizational change at one such project. The reasons why this might be so are discussed, and are related to the central issue of hope and despair in work with those who are unlikely to recover.     

Do young and older adults rely on different processes in source memory tasks? A neuropsychological study

Source memory has consistently been associated with prefrontal function in both normal and clinical populations. Nevertheless, the exact contribution of this brain region to source memory remains uncertain, and evidence suggests that processes used by young and older adults may differ. The authors explored the extent to which scores on composite measures of neuropsychological tests of frontal and medial temporal function differentially predicted the performance of young and older adults on source memory tasks. Results indicated that a frontal composite measure, consistently associated with source memory performance in older adults, was unrelated to source memory in young adults, although it was sensitive to a demanding working memory task. The memory composite score, however, predicted performance in the young group. In addition, item and source memory were correlated in young but not older people. Findings are discussed in terms of age-related differences in working memory and executive functions, and differential binding processes necessary for item and source memory. The requirement to integrate item and source information at encoding appears to place greater demands on executive or working memory processes in older adults than in younger adults.     

Auditory and visual differences in time perception? An investigation from a developmental perspective with neuropsychological tests

Adults and children (5- and 8-year-olds) performed a temporal bisection task with either auditory or visual signals and either a short (0.5-1.0s) or long (4.0-8.0s) duration range. Their working memory and attentional capacities were assessed by a series of neuropsychological tests administered in both the auditory and visual modalities. Results showed an age-related improvement in the ability to discriminate time regardless of the sensory modality and duration. However, this improvement was seen to occur more quickly for auditory signals than for visual signals and for short durations rather than for long durations. The younger children exhibited the poorest ability to discriminate time for long durations presented in the visual modality. Statistical analyses of the neuropsychological scores revealed that an increase in working memory and attentional capacities in the visuospatial modality was the best predictor of age-related changes in temporal bisection performance for both visual and auditory stimuli. In addition, the poorer time sensitivity for visual stimuli than for auditory stimuli, especially in the younger children, was explained by the fact that the temporal processing of visual stimuli requires more executive attention than that of auditory stimuli.     

Cerebral perfusion and neuropsychological follow up in mild traumatic brain injury: Acute versus chronic disturbances?

In a subgroup of patients with mild traumatic brain injury (TBI) residual symptoms, interfering with outcome and return to work, are found. With neuropsychological assessment cognitive deficits can be demonstrated although the pathological underpinnings of these cognitive deficits are not fully understood. As the admission computed tomography (CT) often is normal, perfusion CT imaging may be a useful indicator of brain dysfunction in the acute phase after injury in these patients.In the present study, directly after admission perfusion CT imaging was performed in mild TBI patients with follow-up neuropsychological assessment in those with complaints and a normal non-contrast CT. Neuropsychological tests comprised the 15 Words test Immediate Recall, Trailmaking test part B, Zoo Map test and the FEEST, which were dichotomized into normal and abnormal. Perfusion CT results of patients with normal neuropsychological test scores were compared to those with abnormal test scores.In total eighteen patients were included. Those with an abnormal score on the Zoo Map test had a significant lower CBV in the right frontal and the bilateral parieto-temporal white matter. Patients with an abnormal score on the FEEST had a significant higher MTT in the bilateral frontal white matter and a significant decreased CBF in the left parieto-temporal grey matter. No significant relation between the perfusion CT parameters and the 15 Words test and the Trailmaking test part B was present.In conclusion, impairments in executive functioning and emotion perception assessed with neuropsychological tests during follow up were related to differences in cerebral perfusion at admission in mild TBI. The pathophysiological concept of these findings is discussed.     

Separating cognitive impairment in neurologically asymptomatic alcoholism from Wernicke-Korsakoff syndrome: is the neuropsychological distinction justified?

Recent studies that have combined neuropathological data and clinical histories in a retrospective fashion have shown that Wernicke-Korsakoff neuropathology is often unsuspected antemortem and that, in terms of clinical presentation, it is more heterogeneous than previously assumed. Thus, many studies of neurologically normal alcoholics may have been confounded by the inclusion of patients with neurologically asymptomatic Wernicke-Korsakoff neuropathology. Postmortem and in vivo studies have shown that alcoholics, irrespective of neurological diagnosis, have widespread pathology involving many cortical and subcortical sites. In addition, clinical studies have indicated that, like neurologically asymptomatic alcoholics, alcoholic Korsakoff patients may enjoy substantial recovery in cognitive function. Furthermore, the common research strategy of identifying a subset of neurologically diagnosed Wernicke-Korsakoff syndrome as a discrete group of "pure" Korsakoff's amnesia by using a definitional IQ-Wechsler Memory Scale quotient difference may have created a neuropsychological stereotype that is not representative of the broader clinical group. In light of these considerations, the separate treatment of cognitive impairment in groups of alcoholics distinguished by the clinical signs of Wernicke-Korsakoff syndrome may not be justified.     

Individual neuropsychological profiles at age 5½ years in children born preterm in relation to medical risk factors

Follow-up studies of preterm children have reported a range of cognitive deficits, particularly in executive functions, visuospatial abilities, and learning. However, few researchers have adopted a person-oriented approach, exploring individual neuropsychological profiles. The aim of this study was to identify typical neuropsychological profiles among preterm children and control children, respectively. A second aim was to investigate if neuropsychological profiles at age 5½ might be associated with perinatal medical risk factors. As part of the longitudinal Stockholm Neonatal Project, NEPSY for 4- to 7-year-old children (Korkman, 1990 Korkman, M. 1990. NEPSY, Neuropsychological Assesment 4–7 years: Swedish Version, Stockholm, , Sweden: Psykologiförlaget AB.  [Google Scholar]), WPPSI-R, and Movement ABC were administered at age 5½ years to 145 preterm (mean gestational age 28 weeks) and 117 control children born at term. For the present study, the NEPSY results of each child were transformed into summary z scores for each of 5 neuropsychological domains: attention, memory, sensory-motor, verbal, and visuospatial functions. Subsequently, Ward's cluster analysis was performed for the preterm and control groups separately, identifying 5 neuropsychological profiles in both groups explaining around 56% and 57% of the variance, respectively. Overall, preterm children had lower neuropsychological results but also more diverging profiles compared to controls. The variability in outcome could not be sufficiently explained by birth weight, gestational age, or medical risks. The results suggest that prematurity interacts dynamically with genetic, medical, and environmental factors in neuropsychological development.     

CNS prophylaxis of childhood leukemia: What are the long-term neurological,neuropsychological, and behavioral effects?

Current medical treatments for childhood acute lymphoblastic leukemia (ALL) have improved the outlook to where more than 50% can be expected to survive five years or more. The use of CNS prophylaxis has contributed in a significant way to these improved survival statistics by reducing the likelihood of CNS relapses. The literature relating to the potential adverse psychological consequences of CNS prophylaxis, which include cranial radiation therapy (CRT), is reviewed and analyzed. The majority of published papers of children in first remission report that CNS prophylaxis, which include both CRT and intrathecal methotrexate, results in a variety of learning problems in many children who were younger than age 5 when treated. The available literature on the social, emotional, and educational sequelae of childhood ALL is also reviewed.Contributing Childrens Cancer Study Group investigators, institutions, and grant numbers are given in the Appendix. Address reprint requests to the Childrens Cancer Study Group, 440 East Huntington Drive, Suite 300, P.O. Box 60012, Arcadia, California 91066-6012.     

A neuropsychological assessment of dual-task costs in closed-head injury patients using Cohen’s effect size estimation method

A test of whether patients suffering from a severe closed-head injury (CHI) were affected by disproportionate dual-task costs compared to those of healthy control participants was carried out through a direct comparison of CHI effects on dual-task (psychological refractory period, or PRP) performance and on single-task performance. In the dual-task condition of the present experiment, independent choice-responses were required to two sequential stimuli presented at a variable stimulus onset asynchrony (SOA). A significant delay of the reaction time (RT) to the second stimulus was reported by both CHI patients and controls at short (SOA) compared to long SOA, i.e., a PRP effect. The PRP effect was more pronounced for CHI patients than controls. In the single-task condition, a single choice-response was required to a stimulus presented in isolation. The RT produced by CHI patients in the single-task paradigm was longer than the RT produced by controls. CHI effects on dual-task performance and on single-task performance were compared following (1) their transformation into Cohen’s ds, and (2) the application of a correction algorithm taking into account the different reliability of single-task and dual-task measures. The analysis of Cohen’s ds revealed that CHI effects on performance were, if anything, smaller in the dual-task condition than in the single-task condition. The results imply that CHI patient’s slower responding in single- and dual-task performance reflects a single common cause—slowing of the central processing.     

Visual — motor organization and memory in the right-handed and the left-handed child: A comparative neuropsychological approach

The visual-motor organization of the child was investigated with the primary aim of defining the relationships between the cognitive changes taking place during problem solving (mnemonic reproduction of a complex figure) and the structural functional elements involved. The sample consisted of 840 right-handed and left-handed children aged 5.5 to 12.5 years, who were group-matched on the basis of age, sex, and hand preference. Statistical evaluation revealed significant differences for boys and girls across the various age groups. Statistically significant differences also appeared between right- and left-handed children. The differences in performance can be attributed to neuropsychological functional differences between right-and left-handed children.     

Socioeconomic deprivation and the development of neuropsychological functions: A study with “street children” in Ecuador

Socioeconomic status (SES) is known to have a considerable influence on the development of neuropsychological functions. In particular there is strong evidence for less efficient development of prefrontal-cortex-related functions in children raised in low-SES households. “Street children” are a common feature of low SES in many low- and middle-income countries, and some researchers have suggested that the unique life experiences of street children may drive their neurocognitive development. This study compares a group of 36 former street children in Quito, Ecuador with a control group of 26 never street-connected schoolchildren. All children were assessed with a range of neuropsychological tests. Although the street children group performed significantly below the level of the control group on all measures, they did not demonstrate a generalized lower ability. By controlling the effects of fluid intelligence it was found that there are relatively independent effects on visuospatial ability and executive planning ability. Furthermore, the executive function test scores in general are significantly less affected than the other cognitive functions and may be temporary effects caused by recent substance abuse within the street child sample. The findings generally support results from other countries suggesting that low SES is associated with negative effects on neuropsychological development. However, they also suggest that the local social and economic context, such as in the case of street children, might mitigate the harmful effects of low SES on the development of some executive functions.     

Münchhausen by proxy syndrome in clinical child neuropsychology: a case presenting with neuropsychological symptoms.

Münchhausen by proxy syndrome (MBPS) is a rare but dramatic variant of child abuse. In MBPS adults, mostly the mother, invent, manipulate, or produce the child's illness, and as a consequence the child has to undergo numerous diagnostic or treatment procedures. Typically, valid information about the etiology of the child's illness is withheld by the parents, and reversible symptoms vanish, when the child and the responsible adults are separated. Although valid statistical data about the epidemiology of MBPS are not available, MBPS should be considered more often than normally recognized. Neurological and neuropsychological presentations including developmental delays and learning problems appear to be common among MBPS cases so that clinical child neuropsychologists should be aware of this problem and consider MBPS at least in some of the mysterious cases that come to their attention. The present study describes a case of MBPS in which neurological and neuropsychological symptoms predominate. It presents a MBPS variant that is characterized by developmental delays and learning problems induced by unnecessary isolation at home, hospitalization, and treatment procedures. In the present case MBPS was at first suspected following neuropsychological assessment, since some of the main features of non-authenticity of symptom presentation gave cause for suspecting deceptive behavior on the mother's (and possibly also on the maternal grandmother's) side.     

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.     

Why is "Red Cross" different from "Yellow Cross"?: a neuropsychological study of noun-adjective agreement within Italian compounds

This study investigates the performance of two Italian nonfluent aphasic patients on noun-adjective agreement in compounds and in noun phrases. A completion, a reading, and a repetition task were administered. Results show that both patients were able to correctly inflect adjectives within compounds, but not in noun phrases. Moreover, they were sensitive to constituent order (noun-adjective vs adjective-noun) within noun phrases, but less so within compounds. These results suggest differential processing for compounds as compared to noun phrases: While the latter require standard morphosyntactic operations that are often impaired in aphasic patients, the former can be accessed as whole words at the lexical level.     

The adrenergic receptor α-2A gene (ADRA2A) and neuropsychological executive functions as putative endophenotypes for childhood ADHD

There is resurgent interest in the psychiatric literature in endophenotypes, variables thought to more strongly reflect the effects of candidate genes than do manifest disorders. In a sample of 176 children with attention deficit hyperactivity disorder (ADHD) and 52 of their siblings, we examined the validity of several putative endophenotypes for ADHD that represent commonly used clinical measures of multiple cognitive/neuropsychological domains of executive functions (EFs). We review their distributional normality, their relations to ADHD symptoms in probands and unaffected siblings relative to nonADHD controls, and their correlation in siblings. We also tested the EF measures’ associations with the ADRA2A gene and whether they mediated or moderated the associations between ADHD and ADRA2A. Several EF measures showed association with ADRA2A, as well as moderation, but not mediation, of its association with ADHD. Implications of the results for evaluating the validity and utility of putative endophenotype measures and for finding candidate gene effects on ADHD are discussed.