Decision making cognition in primary progressive aphasia

We sought to investigate the decision making profile of Primary Progressive Aphasia (PPA) by assessing patients diagnosed with this disease (n = 10), patients diagnosed with behavioral variant frontotemporal dementia (bvFTD, n = 35), and matched controls (n = 14) using the Iowa Gambling Task, a widely used test that mimics real-life decision making. Participants were also evaluated with a complete neuropsychological battery. Patients with PPA were unable to adopt an advantageous strategy on the IGT, which resulted in a flat performance, different to that exhibited by both controls (who showed advantageous decision making) and bvFTD patients (who showed risk-appetitive behavior). The decision making profile of PPA patients was not associated with performance on language tasks and did not differ between sub-variants of the disease (namely, semantic dementia and progressive nonfluent aphasia). Investigating decision making in PPA is crucial both from a theoretical perspective, as it can shed light about the way in which language interacts with other cognitive functions, as well as a clinical standpoint, as it could lead to a more objective detection of impairments of decision making deficits in this condition.     

Neuropsychological differentiation of progressive aphasic disorders

The differentiation of subtypes of primary progressive aphasia (PPA) remains challenging. We aimed to identify optimum neuropsychological measures for characterizing PPA, to examine the relationship between behavioural change and subtypes of PPA and to determine whether characteristic profiles of language, working memory, and behavioural changes occur in PPA. Forty-seven patients with PPA and multi-domain Alzheimer's disease (AD) together with 19 age-matched controls underwent a large battery of working memory and language tests. We found that simple tasks of sentence ordering, narrative production, and buccofacial praxis were particularly useful in differentiating non-fluent/agrammatic variant PPA (nfvPPA) from other PPA subtypes, whereas a test of single word comprehension was useful in detecting semantic dementia (SD). No individual tests were discriminating for logopenic variant PPA (lvPPA) relative to nfvPPA. LvPPA and multidomain AD exhibited similar language profiles. A principal components analysis revealed that characteristic PPA profiles extended beyond the realms of language, in particular, the presence of apraxia in nfvPPA, behavioural changes in SD, and working memory deficits in lvPPA. These findings suggest that not all tests are equally discriminatory for PPA and highlight the importance of a test profile in differentiating PPA. These results also support the view that lvPPA is a focal form of AD and emphasize the difficulties classifying lvPPA.     

Fluent versus nonfluent primary progressive aphasia: a comparison of clinical and functional neuroimaging features

To better characterize fluent and nonfluent variants of primary progressive aphasia (PPA). Although investigators have recognized both fluent and nonfluent patients with PPA, the clinical and neuroimaging features of these variants have not been fully defined. We present clinical and neuropsychological data on 47 PPA patients comparing the fluent (n=21) and nonfluent (n=26) subjects. We further compared language features with PET/SPECT data available on 39 of these patients. Compared to the nonfluent PPA patients, those with fluent PPA had greater impairment of confrontational naming and loss of single word comprehension. They also exhibited semantic paraphasic errors and loss of single word comprehension. Patients with nonfluent PPA were more likely to be female, were more often dysarthric, and exhibited phonological speech errors in the absence of semantic errors. No significant differences were seen with regard to left hemisphere abnormalities, suggesting that both variants result from mechanisms that overlap frontal, temporal, and parietal regions. Of the language measures, only semantic paraphasias were strongly localized, in this case to the left temporal lobe. Fluent and nonfluent forms of PPA are clinically distinguishable by letter fluency, single word comprehension, object naming, and types of paraphasic errors. Nevertheless, there is a large amount of overlap between dysfunctional anatomic regions associated with these syndromes.     

Neuropsychological aspects of driving after a stroke—in the simulator and on the road

Thirty patients with stroke and 30 matched controls participated in the study (mean age 68 years, mean interval since stroke onset 8.6 months). The patients performed significantly worse on cognitive and attentional processing measured by a neuropsychological test battery. The patients had significantly greater difficulty in allocating processing resources to a secondary information processing task during driving in an advanced simulator. The patients performed worse driving in real traffic, and had less driving skill; fifty per cent did not pass the driving test. The neuropsychological test battery showed a pattern with three factors: (1) attentional processing (2) executive capacity, and (3) cognitive processing. Regression models based on simulator driving variables and neuropsychological test variables respectively, overall classified correctly in 85% and 83% of the cases with respect to driving skill. Decreased cognitive and attentional processing were suggested to be associated with an overall speed impairment. Copyright © 2000 John Wiley & Sons, Ltd.     

An overview on Primary Progressive Aphasia and its variants

We present a review of the literature on Primary Progressive Aphasia (PPA) together with the analysis of neuropschychological and neuroradiologic profiles of 42 PPA patients. Mesulam originally defined PPA as a progressive degenerative disorder characterized by isolated language impairment for at least two years. The most common variants of PPA are: 1) Progressive nonfluent aphasia (PNFA), 2) semantic dementia (SD), 3) logopenic progressive aphasia (LPA). PNFA is characterized by labored speech, agrammatism in production, and/or comprehension. In some cases the syndrome begins with isolated deficits in speech. SD patients typically present with loss of word and object meaning and surface dyslexia. LPA patients have word-finding difficulties, syntactically simple but accurate language output and impaired sentence comprehension. The neuropsychological data demonstrated that SD patients show the most characteristic pattern of impairment, while PNFA and LPA overlap within many cognitive domains. The neuroimaging analysis showed left perisylvian region involvement. A comprehensive cognitive, neuroimaging and pathological approach is necessary to identify the clinical and pathogenetic features of different PPA variants.     

Emotional and pain-related factors in neuropsychological assessment following mild traumatic brain injury

A critical issue in the field of clinical neuropsychology is the idea that emotional or pain-related factors may compromise the validity of neuropsychological assessment. In this study, 53 individuals suffering from mild traumatic brain injury related to motor vehicle accident injury completed commonly used measures of emotional and pain-related functioning. A battery of commonly used neuropsychological tests, assessing attention, learning and memory, language, visuospatial and visuomotor functions, speeded processing, fine-motor skill, and symptom validity, was administered concurrently. Findings revealed a significant and negative correlation between anxiety and impaired delayed verbal memory, suggesting that as anxiety increased, delayed verbal memory decreased. The results otherwise provided little support for the idea that emotional or pain-related factors are detrimental to neuropsychological test performance following mild traumatic brain injury.     

Neuropsychological performance in older insomniacs

ABSTRACT

The purpose of this study was to examine daytime performance in older adults fulfilling the diagnostic criteria for DSM-IV Insomnia, using a comprehensive battery of neuropsychological tests, and to compare these objective findings with measures of self-reported cognitive functioning. A total of 121 participants (69% women) with a mean age of 64.0 were part of a thorough neuropsychological examination at a University-based neuropsychological clinic in Western Norway. Twenty-five percent of the participants fulfilled the diagnostic criteria for insomnia. In sum, the insomnia patients were not different from the good sleepers on any neuropsychological test measure, and none of the results on the performance measures were associated with the sleep-related daytime complaints. However, the insomniacs did rate their subjective memory performance as significantly worse than the good sleepers, and they also reported more depressive symptoms. We conclude that DSM-IV defined insomnia was not associated with any performance based measure; only with self-reported symptoms.     

A comparison of implicit memory tests in schizophrenic patients and normal controls

The objective of the current study was to compare the performance of schizophrenic patients and normal controls on implicit memory tests. Two neuropsychological tasks were administered to 29 patients and normal participant samples. The implicit tests were: Word fragment completion and Word production from semantic categories. The priming score was the variable of interest. Priming effects are obtained in normal subjects and schizophrenia patients, regardless of the implicit test used. However, a dissociation in priming between normal and patient groups was observed, depending on the test used. For word fragment test, priming was identical between the two groups. However, for word production, priming obtained in schizophrenics was lower than priming in normal controls. Results confirm a dissociation effect in implicit memory tests. These results could be explained in the context of the Roediger and Blaxton (1987) distinction between data-driven and conceptually-driven processing. This evidence suggests that a complete neuropsychological assessment of memory in schizophrenia should include different kinds of implicit memory tests (procedural, perceptual, and conceptual tasks).     

Frontal lobe dysfunctions in borderline personality disorder? Neuropsychological findings

This study aims to determine whether specific neuropsychological performance impairments in borderline patients can be objectified and whether these findings indicate frontal dysfunctions. Twenty-three patients with borderline personality disorder and 23 normal controls were examined using a neuropsychological test battery to assess intelligence, attentiveness, proneness to interference, learning and memory, as well as planning and problem solving. All subjects filled out standardized questionnaires to assess aggressiveness and impulsiveness in the context of these cognitive performance areas. The neuropsychological test results of the borderline patients were comparable to those of the controls. Although there were no indications of frontal dysfunction of cognitive information processing, inverse correlations were found between the severity of borderline-related personality traits regarding impulsiveness and various areas of cognitive performance. Borderline personality patients show no indications of frontal cognitive dysfunction. Further research is needed to clarify the relationship between impulsiveness and cognitive information processing in borderline personality disorder, including a dimensional approach to personality and personality disorder.     

The classification of neuropsychological deficit

The study involves classification of neuropsychiatric patients on the basis of neuropsychological and intelligence test performance. One hundred twenty-five hospitalized male neuropsychiatric patients with various diagnoses were administered the Halstead-Reitan and Luria-Nebraska neuropsychological test batteries, as well as the Wechsler Adult Intelligence Scale. A cluster analysis was performed for each of those three procedures utilizing Ward's method. It was found in all cases that clusters were determined on the basis of level rather than pattern of performance. Relationships were found between cluster membership and age, education, and presence or absence of structural brain damage but were not found for diagnoses of schizophrenia or alcoholism. Schizophrenic and alcoholic patients were found in all clusters in the case of all three test procedures. Differences in clustering among the three test procedures were noted, with the WAIS being relatively more sensitive to educational differences while the Halstead-Reitan was more sensitive to age differences. The clinical utility of classifying patients on the basis of neuropsychological and cognitive test performance was discussed.Acknowledgement is made to the Veterans Administration for support of this research.     

HIV-related neuropsychological impairment and immunodeficiency. CD8+ lymphocytes and neopterin are related to HIV-encephalopathy

The relationship between neuropsychological test performance and immunological parameters was studied in 52 HIV-positive patients within different stages of the infection. All subjects were neuropsychologically tested, the CD4 + and CD8 4- lymphocyte count were measured in peripheral blood, and the concentration of neopterin and HIV-p24 antigen were measured in serum. Ten patients with AIDS were defined as neuropsychologically impaired. The CD8 + cell count was the only immunological parameter that could significantly discriminate between AIDS patients with and without neuropsychological impairment. For the total group, significant positive correlations were found between neuropsychological test results and the number of CD8 + and CD4 + lymphocytes, and significant negative correlations were observed between serum concentration of neopterin and neurocognitive function. Regression analyses showed that up to 51% of the variance in test performance could be explained by CD8 + cells and neopterin concentration. The possible role of CD8 + lymphocytes and neopterin in the pathogenesis of HIV-related CNS-dysfunction is discussed.     

The impact of borderline personality disorder and anxiety on neuropsychological performance in major depression

Previous studies of neuropsychological performance in borderline personality disorder (BPD) have exhibited mixed results. The high rate of co-occurring major depressive disorder (MDD) in BPD makes it difficult to specify whether neuropsychological deficits in BPD predominantly reflect co-occurring MDD or unique aspects of their psychopathology. To address this issue, 22 participants with borderline personality disorder and concurrent major depressive disorder (BPD-MDD) and 33 participants with MDD and no concurrent personality disorder were compared on a neuropsychological battery that assessed seven domains of performance: general intellectual functioning, motor skill, psychomotor speed, attention, memory, working memory, and executive function. Neuropsychological performance did not differ between BPD-MDD and MDD. However, BPD-MDD participants reported higher levels of anger, anxiety, and of overall emotional distress compared to MDD. When levels of anxiety were controlled, BPD-MDD participants exhibited superior general intellectual performance, psychomotor speed, and attention. Deficits found in previous BPD samples may reflect their susceptibility to co-occurring MDD. The impact of anxiety on neuropsychological performance in BPD, though, indicates a need for future experimental studies of the effects of mood on cognitive function to determine whether mood dysregulation, rather than core depressive symptoms, underlie cognition impairments in BPD.     

Primary Progressive Aphasia: A Review of 112 Cases

Primary progressive aphasia (PPA) was first recognized by Mesulam in 1982. Although dozens of cases have since been described, it has been difficult to place these cases into a coherent framework due to the wide variation in measures which have been reported. We review 170 contacts with 112 patients to provide a clinical, neuroanatomical, and neuropsychological profile of patients with the disorder. The progression of the disease is analyzed over a 10-year reporting period starting from symptom onset to show how progression affects five general linguistic skills: oral and written naming, reading, repetition, and general comprehension. The pattern of functional and neurological deficits in PPA is heterogeneous. Differences in the distribution of neurological anomalies between patients with bilateral and unilateral changes suggest that there may be two separate disease processes involved.     

Comprehensive driving assessment: neuropsychological testing and on-road evaluation of brain injured patients

The study investigates the correspondence between neuropsychological test results and on-road driving performance among 55 patients with a CT-verified brain damage or documented neurological disorder (cerebrovascular accident: 43, traumatic brain injury: 5, multiple sclerosis: 4, other: 3). 5 patients showed unimpaired test profiles and passed the on-road evaluation. 18 patients showed severe neuropsychological deficits contrary to driving and were not recommended for on-road evaluation. Of the remaining 32 patients with some neuropsychological deficits, all 100% in the minor impaired group (n = 8) passed the driving evaluation, compared to 69% in the mildly impaired (n = 16) and 38% in the moderately impaired group (n = 8). Measures of reduced visuoconstructive ability, reaction time, visual attention, and awareness of cognitive impairments, were found to discriminate between groups. It is concluded that neuropsychological assessment of targeted functions provide an ecological valid prediction of driving skill after brain damage, but that on-road evaluation is needed as supplement in cases with ambiguous test findings.     

Predictors of neuropsychological test performance after pediatric traumatic brain injury

The influence of neurological and demographic variables on neuropsychological test performance was examined in 100 9-to 16-year-old children with traumatic brain injury (TBI). Regression analyses were conducted to determine the relative contributions of coma, neuroimaging findings, ethnicity, socioeconomic status, and gender to variance in performance on the Wechsler Intelligence Scale for Children-Third Edition (WISC-III), California Verbal Learning Test--Children's Version (CVLT-C), and the Children's Category Test. Both neurological and demographic variables contributed to performance on various WISC-III factor index scores as well as the CVLT-C. No evidence for a moderating effect of demographic variables was found, but speed of information processing mediated the effect of neurological and demographic variables on CLVT-C performance. It is concluded that demographic variables have an incremental effect on the neuropsychological test performance of children with TBI above and beyond the influence of injury severity.     

Neuropsychological test norms controlled for physical health: Does it matter?

The objective of the present study was to investigate the effects of physical health on neuropsychological test norms. Medical and neuropsychological data from 118 healthy volunteer controls, aged 26–91 years, were collected during five recruitment occasions. The examinations included a clinical investigation, brain neuroimaging, and a comprehensive neuropsychological test battery. Test‐specific statistical regression‐weights for age, education and gender were calculated to establish preliminary test norms. Hierarchical regression analyses demonstrated that control in addition for physical health moved best performance from age 60 to 65 for abstraction; replaced a plateau above age 70 for verbal fluency, with a continued rise in performance; eliminated significant negative influences of age on auditory learning, spatial reasoning and complex copying; reduced them on wordlist recall, psychomotor speed, visual scanning and mental shifting; and slightly reduced negative influences of low education on most verbal tests, several memory tests, and psychomotor speed, indicating rises in normative scores of up to 0.8 SD at age 80 and 0.4 SD at age 60. No differences were found at age 40. Although the sample size is not adequate to be used for normative data, the findings indicate that norms uncontrolled for health overestimate the negative influence of advanced age and low education, implying a risk of drawing false diagnostic conclusions.     

Factors predicting success in picture naming in Alzheimer's disease and primary progressive aphasia

The aim of the present study was to determine the predictive value of all important variables in the picture naming performance of 8 patients with probable Alzheimer's disease (AD) and 8 patients with primary progressive aphasia (PPA). The experimental investigation controlled for (i) visual complexity, (ii) name agreement on dominant response, (iii) age of acquisition, (iv) frequency, (v) word length, (vi) concept familiarity, and (vii) category membership. The results of the multiple regression analyses showed that age of acquisition and name agreement were significant for 10/16 subjects. Visual complexity, frequency, familiarity, and category were also significant for four patients respectively. Word length had no effect. These results are at variance with those of series of patients with AD (Gaillard et al., 1998) and with PPA (Lambon Ralph et al., 1998) where concept familiarity was found to be one of the most predictive factors of naming success.     

A Neuropsychological Investigation of Perfectionism

Perfectionism entails a burdensome preoccupation with one’s self-evaluation in the context of performance outcomes. Although perfectionism has been subject to extensive research, scant literature on its effect on cognitive functioning is available, let alone in nonclinical populations. The aim of the present study is to utilize a comprehensive neuropsychological battery to assess cognitive functions among college students with high and low levels of perfectionism. Participants were 98 college students who were screened for clinical status, completed a neuropsychological battery, and assessed for perfectionism and related symptomatology. Results revealed that the high negative perfectionism group had significantly higher levels of depression and stress compared to the low negative perfectionism group. However, no group differences were found across neuropsychological outcomes. Gradient differences on clinical outcome measures were found when three groups characterized by high adaptive, high maladaptive, and mixed perfectionism were compared. However, no differences were found on neuropsychological tests. These findings suggest that higher levels of negative perfectionism are associated with significant psychopathological burden, but with intact neuropsychological test performance. These results are important, particularly in the context of the need to identify and treat students struggling with high levels of perfectionism and related psychopathological burden, which can be overlooked given that they present with intact cognitive and academic performance.     

Who is exaggerating cognitive impairment and who is not?

This chart review examined the effects of effort on neuropsychological assessment and test performance patterns among genuine and exaggerating patients, with and without neurological findings, as aids to diagnosing symptom exaggeration. The sample consisted of 561 consecutive patients involved in compensation claims. With a flexible neuropsychological test (NPT) battery, the claims were assessed over 2 days. The sample included 303 patients evaluated for traumatic brain injury, 55 patients with neurological disease, and 203 patients assessed for other conditions (eg, depression or chronic pain). An average of 38 ability measures per patient were used to generate an overall NPT domain score. Composite scores were also computed for symptom validity tests, self-report measures of psychiatric symptoms, and memory complaint inventory. Seven NPT cognitive subdomain scores were multiply regressed onto the symptom validity test composite, accounting for 45% of its total variance. Patients were also assigned to Genuine or Exaggerator groups based on symptom validity test performance. The NPT for Exaggerating patients averaged 1.43 standard deviations below that of Genuine patients, suggesting that NPT scores for most Exaggerating patients are underestimates of their true ability. Factor analysis results differed between these groups. As a result, clinicians might avoid falsely identifying genuine patients as exaggerating by incorporating their self-reports of psychiatric symptoms and memory complaints into the diagnostic process.