Social and non‐social measures of cognition for predicting self‐reported and informant‐reported functional outcomes in early psychosis

The main aim of this study was to investigate the individual contributions of neurocognitive and social‐cognitive domains to self‐reported and informant‐reported functional outcome in early psychosis. We also sought to further characterize the nature of cognitive impairments in this sample and explore the interrelationships between the social‐cognitive measures and how they correlate with measures of neurocognition and clinical symptoms. In this study, 70 patients (mean age: 24.1; 87.1% males) with primary psychotic disorder diagnosed in the previous 5 years were assessed on multiple neurocognitive (processing speed, attention, working memory, immediate verbal memory, delayed recall, visual reasoning, inhibition, planning, cognitive flexibility), and social‐cognitive domains (theory of mind (ToM), emotion recognition, attributional style, metacognitive overconfidence) as well as measures of clinical symptoms. Functional outcome was assessed with three self‐reports and two informant‐reports. On average, patients performed one or more SD below healthy controls on measures of delayed recall, ToM and metacognitive overconfidence. Emotion recognition and ToM were intercorrelated and correlated with multiple neurocognitive domains and negative symptoms. Attributional style correlated with positive symptoms. In the context of multiple variables, self‐reported functional outcomes were predicted by attributional style, whereas emotion recognition and immediate verbal memory predicted variance in informant‐reported community functioning. These results support the suggestion of a likely distinction between the predictive factors for self‐reported and informant‐reported functional outcome in early psychosis and suggest that consideration of self‐assessment of functional outcome is critical when attempting to evaluate the effects attributional style has on functional disability.     

A free and simple computerized screening test for visual field defects

About 30–40% of stroke patients suffer from visual field defects following injury. These can interfere with the standard neuropsychological assessment and complicate the interpretation of tests that use visual materials. However, information about the integrity of a patient's central visual field is often unavailable. We, therefore, designed a screening tool, the computerized visual field test (c‐VFT), specifically targeted at providing easily available, but rough, information about patients' central visual field. c‐VFT was tested in two samples of stroke patients. Eleven patients were tested on c‐VFT and on the Esterman test. Five patients were tested on c‐VFT and the Humphrey Visual Field Analyzer (HFA), central 10‐2. Criterion validity of the c‐VFT was investigated by calculating quadrantwise intraclass correlation for both comparisons. For the HFA comparison, we also calculated point‐to‐point intraclass correlation, sensitivity, and specificity. Analyses revealed moderately good correspondence between c‐VFT and the Esterman test, and between c‐VFT and HFA 10‐2, respectively. When looking specifically at test points within one degree of visual angle apart in the two tests, intraclass correlation increased. For these points, the sensitivity of c‐VFT was 0.89 and specificity was 0.97. While the c‐VFT is not designed to be diagnostic nor to replace the detailed visual field analysis, this study shows that it provides a reasonable screening of the central visual field. The test can easily be used and will be made freely available to neuropsychological clinicians and researchers.     

Neuropsychological Functioning Associated with High-Altitude Exposure

This article focuses on neuropsychological functioning at moderate, high, and extreme altitude. This article summarizes the available literature on respiratory, circulatory, and brain determinants on adaptation to hypoxia that are hypothesized to be responsible for neuropsychological impairment due to altitude. Effects on sleep are also described. At central level, periventricular focal damages (leuko-araiosis) and cortical atrophy have been observed. Frontal lobe and middle temporal lobe alterations are also presumed. A review is provided regarding the effects on psychomotor performance, perception, learning, memory, language, cognitive flexibility, and metamemory. Increase of reaction time and latency of P300 are observed. Reduced thresholds of tact, smell, pain, and taste, together with somesthetic illusions and visual hallucinations have been reported. Impairment in codification and short-term memory are especially noticeable above 6,000 m. Alterations in accuracy and motor speed are identified at lower altitudes. Deficits in verbal fluency, language production, cognitive fluency, and metamemory are also detected. The moderating effects of personality variables over the above-mentioned processes are discussed. Finally, methodological flaws found in the literature are detailed and some applied proposals are suggested.     

Rohling's Interpretive Method and Inherent Limitations on the Flexibility of “Flexible Batteries”

Miller and Rohling (2001) proposed a 24-step algorithm, the Rohling Interpretive Method (RIM), for quantitative interpretation of results from flexible neuropsychological test batteries. We believe that the RIM as presented in that paper has several conceptual problems, including (a) a failure to distinguish "statistically significant" from pathological differences, (b) an assumption that declines in specific abilities can be inferred when a particular test score deviates from an estimate of general premorbid ability, and (c) confusion between the standard deviation associated with individual test scores versus that of a composite of those scores. As an alternative, we suggest the value of developing and using co-normed comprehensive neuropsychological test batteries from which test users might select subsets of tests.     

Quantitative Electroencephalography (QEEG) and Neuropsychological Syndrome Analysis

The ideographic, syndrome analysis and the nomothetic, standardized test battery approaches to neuropsychological assessment are compared and contrasted within the context of advances in noninvasive technology readily available for use within the examiner's office. By demonstrating the relative strengths and benefits of syndrome analysis, it is suggested that this approach provides a thorough and efficient method of neuropsychological assessment. Subsequently, the utility of an a priori hypothesis testing process approach as a critical technique in syndrome analysis will be supported. It will be proposed that QEEG procedures provide a useful method for further substantiating conclusions generated from a syndrome analysis approach to neuropsychological assessment. Two cases are described demonstrating the utility and flexibility of the QEEG as a confirmatory test of localization following syndrome analysis. In summary, the contributions that neuropsychologists make to the understanding of brain–behavior relationships may be strengthened by combining neuropsychological and neurophysiological assessment methods.     

Mild Traumatic Brain Injury in Sports: Neuropsychology's Contribution to a Developing Field

Mild traumatic brain injuries are common at all levels of athletic competition. Although once considered a routine part of the game, a significant amount of attention has recently been placed on these injuries at the professional, college, and high school levels. This paper reviews the epidemiology of sports-related brain injuries, the pathophysiology of the injuries, and the role of neuropsychology in this newly emerging area. Issues related to the adequacy of neuropsychological test instruments and approaches are discussed in light of future directions for research.     

Fluency disorders in genetic syndromes

The characteristics of various genetic syndromes have included “stuttering” as a primary symptom associated with that syndrome. Specifically, Down syndrome, fragile X syndrome, Prader-Willi syndrome, Tourette syndrome, Neurofibromatosis type I, and Turner syndrome all list “stuttering” as a characteristic of that syndrome. An extensive review of these syndromes indicated clients diagnosed with these syndromes do show evidence of nonfluency patterns, but not all would be considered stuttering. Many of the syndromes are marked by degrees of mental retardation that probably contribute to a higher than average prevalence of stuttering, as well as a higher than average prevalence of other fluency disorders (when compared to the population at large).

An in-depth analysis of the available data indicates that some of these genetic syndromes show patterns of stuttering that may be indicative of only that syndrome (or similar syndromes) that can be differentially diagnosed from developmental stuttering. Among these patterns are the word-final nonfluencies noted in Prader-Willi syndrome; the presence of stuttering in the absence of secondary behaviors noted in Prader-Willi syndrome and; the presence of palilalia, word-final and word-medial nonfluencies, and word-medial and word-final nonfluencies in Tourette syndrome. Implications for future research are discussed in light of these findings.

Educational objectives: The reader will be able to: (1) describe the various different genetic syndromes that are associated with fluency disorders; (2) describe the types of nonfluencies that are associated with the major types of genetic syndromes that have fluency disorders; (3) describe the behaviors that may assist in differentially diagnosing different types of speech characteristics associated with various genetic syndromes.     

流式细胞术在骨髓增生异常综合征及再生障碍性贫血诊断中的应用

为探讨骨髓增生异常综合征患者与再生障碍性贫血患者骨髓髓系细胞的免疫表型变化,用流式细胞术检测骨髓增生异常综合征、再生障碍性贫血及正常对照髓系细胞的表面抗原。结果显示骨髓增生异常综合征组髓系细胞较正常对照组及再生障碍性贫血组表面抗原表达明显不同。因此,流式细胞术有助于二者的诊断及鉴别诊断。     

深层失读及其认知神经心理康复

以语义性错读为特征的深层失读症是一类特殊的阅读障碍类型,它的存在提示了人类在口语阅读过程中需要经过语义性通路。深层失读在拼音文字使用者中并不多见,但在汉语使用者中却多有发现,这种差别提示了汉字阅读与拼音文字阅读之间可能存在某种重要区别。该文概要介绍了深层失读的表现,比较了汉语深层失读与拼音文字深层失读的差异,阐述了深层失读的机制,同时介绍了深层失读病人的神经心理康复手段和方法     

Assessment and Evaluation Issues Regarding Native American Elderly Adults

This paper will detail assessment and evaluation issues with Native American elderly adults. Recommendations and implications of such assessment and evaluation follow and include areas such as general background factors, cultural and family issues that impact assessment, problems to overcome, and finally a look into neuropsychological assessment. These issues will converge on the notion that mental health and neuropsychological assessment issues are relevant to Native American elderly, not because of the paucity of research in this area, but because Native American elderly are a fast-growing population, most in need of such vital services.