The neurocognitive impact of the clade C viral strain of human immunodeficiency virus (HIV) has not been determined. The purpose of this study was to examine neurocognitive function in southern India among individuals with the clade C virus with advanced HIV. A battery of cognitive tasks sensitive to the effects of HIV on brain function was translated and administered in Tamil and Telegu, two widely spoken languages in southern India. A sample of 30 treatment-naïve HIV-positive individuals with a median CD4 cell count of 97, and 30 age and education matched healthy controls obtained from the same region of India, were included in the study. Results revealed significant differences on most cognitive tests, with lower performances obtained by the HIV-positive individuals. These results suggest that cognitive difficulties are present among individuals with the clade C virus in India, with as many as 56% of the patients with advanced HIV meeting the criterion for impairment in two cognitive domains. Additional study is needed to determine if clade C HIV infection is more or less prone to cause neurocognitive deficit than the clade B virus. Furthermore, the impact of antiretroviral therapy on neurocognitive dysfunction in clade C virual infection needs to be determined. (JINS, 2006, 12, 424–430.)

Many patients with multiple sclerosis (MS) show cognitive and emotional disorders. The purpose of this study is to evaluate the role of contingency learning in decision-making in young, non-depressed, highly functioning patients with MS (n = 21) and in matched healthy controls (n = 30). Executive functions, attention, short-term memory, speed of information processing, and selection and retrieval of linguistic material were also investigated. Contingency learning based on the cumulative effect of reward and punishment was assessed using the Iowa Gambling Test (IGT). In the classic ABCD version of the IGT, advantageous decks are characterized by immediate small reward but even smaller future punishment. In the modified EFGH version, advantageous decks are characterized by immediate large punishment but even larger future reward. Results revealed that patients with MS showed significant dysfunctions in both versions of the IGT. Performances on neuropsychological tests sensitive to dorsolateral prefrontal functions did not predict and did not correlate with the IGT scores. These results suggest that patients with MS show impaired performances on tasks designed to assess decision-making in a situation requiring the evaluation of long-term outcomes regardless of gain or loss, and that this deficit is not a pure consequence of executive dysfunctions (JINS, 2006, 12, 559–565.)

Prosopagnosia is currently viewed within the constraints of two competing theories of face recognition, one highlighting the analysis of features, the other focusing on configural processing of the whole face. This study investigated the role of feature analysis versus whole face configural processing in the recognition of facial expression. A prosopagnosic patient, SC made expression decisions from whole and incomplete (eyes-only and mouth-only) faces where features had been obscured. SC was impaired at recognizing some (e.g., anger, sadness, and fear), but not all (e.g., happiness) emotional expressions from the whole face. Analyses of his performance on incomplete faces indicated that his recognition of some expressions actually improved relative to his performance on the whole face condition. We argue that in SC interference from damaged configural processes seem to override an intact ability to utilize part-based or local feature cues. (JINS, 2006, 12, 884–895.)

There is controversy regarding the nature and degree of intellectual and memory deficits in chronic Lyme disease. In this study, 81 participants with rigorously diagnosed chronic Lyme disease were administered the newest revisions of the Wechsler Adult Intelligence Scale (WAIS-III) and Wechsler Memory Scale (WMS-III), and compared to 39 nonpatients. On the WAIS-III, Lyme disease participants had poorer Full Scale and Performance IQ's. At the subtest level, differences were restricted to Information and the Processing Speed subtests. On the WMS-III, Lyme disease participants performed more poorly on Auditory Immediate, Immediate, Auditory Delayed, Auditory Recognition Delayed, and General Memory indices. Among WMS-III subtests, however, differences were restricted to Logical Memory (immediate and delayed) and Family Pictures (delayed only), a Visual Memory subtest. Discriminant analyses suggest deficits in chronic Lyme are best characterized as a combination of memory difficulty and diminished processing speed. Deficits were modest, between one-third and two-thirds of a standard deviation, consistent with earlier studies. Depression severity had a weak relationship to processing speed, but little other association to test performance. Deficits in chronic Lyme disease are consistent with a subtle neuropathological process affecting multiple performance tasks, although further work is needed to definitively rule out nonspecific illness effects. (JINS, 2006, 12, 119–129.)

Category and letter fluency tasks have been used to demonstrate psychological and neurological dissociations between semantic and phonological aspects of word retrieval. Some previous neuroimaging and lesion studies have suggested that category fluency (semantic-based word retrieval) is mediated primarily by temporal cortex, while letter fluency (letter-based word retrieval) is mediated primarily by frontal cortex. Other studies have suggested that both letter and category fluency are mediated by frontal cortex. We tested these hypotheses using voxel-based lesion symptom mapping (VLSM) in a group of 48 left-hemisphere stroke patients. VLSM maps revealed that category and letter fluency deficits correlate with lesions in temporal and frontal cortices, respectively. Other regions, including parietal cortex, were significantly implicated in both tasks. Our findings are therefore consistent with the hypothesis that temporal cortex subserves word retrieval constrained by semantics, whereas frontal regions are more critical for strategic word retrieval constrained by phonology. (JINS, 2006, 12, 896–900.)

Spina bifida myelomeningocele (SBM), a neural tube defect that is the product of a complex pattern of gene-environment interactions, is associated with naturally occurring, systematic variability in the neural phenotype and in environmental factors that lead to systematic variability in the cognitive phenotype. We characterize the basis for variability in the cognitive phenotype of children with SBM with reference to a model of key biological, cognitive, and environmental events unfolding over the course of development from infancy to middle age. The cognitive phenotype is not domain-specific, but represents manifestations of unobservable constructs involving associative and assembled processing, the latter directly reflecting the impact of the neural phenotype on core deficits involving movement, timing, and attention orienting. The expression of the cognitive phenotype is variable, being moderated by features of the neural phenotype involving secondary CNS insults (such as hydrocephalus) that impair assembled processing, as well as by environmental factors (such as poverty, parenting, and education) that impair associative processing. The preservation of strengths in associative processing depends in part on the severity of the CNS deficits in SBM and the impact of the environment. (JINS, 2006, 12, 285–296.)

The relation of body side of motor symptom onset in Parkinson's disease (PD) to memory measures associated with hemispheric dominance was examined. Fourteen patients with right body side motor symptom onset (RPD, inferred left hemisphere dysfunction) and 16 patients with left side onset (LPD, right hemisphere dysfunction) were administered measures of verbal (Hopkins Verbal Learning Test-Revised) and visual memory (Brief Visual Memory Test-Revised), that require similar task demands and are associated with left or right hemisphere dominance, respectively. The LPD group demonstrated poorer visual than verbal memory, both within group and in comparison to the RPD group. By contrast, the RPD group showed poorer verbal than visual memory within group. These findings suggest that side of motor symptom onset is associated with asymmetrical memory dysfunction (JINS, 2006, 12, 736–740.)

Anorexia nervosa (AN) is a severe mental illness characterized in part by rigid thinking and ritualized behaviors involving eating and weight. Cognitive rigidity may play a role in the perpetuation of symptoms, and may provide information as to important brain-based abnormalities. Neuropsychological studies of patients with AN have shown cognitive dysfunction, but few have focused on cognitive flexibility. This study assessed set shifting in patients with AN, as a measure of cognitive flexibility. In this study, 15 patients with AN were compared with 11 healthy controls using a neuropsychological battery including the Wisconsin Card Sort Test (WCST). While patients with AN did not differ from controls on 5 measures of neuropsychological function, they made significantly more perseverative errors on the WCST, indicating a problem in set shifting. This finding suggests that patients with AN have a specific neurocognitive abnormality that may play a role in the development and persistence of this disorder. (JINS, 2006, 12, 431–435.)

Research conducted with the Rey-figure task has suggested that patients with obsessive-compulsive disorder (OCD) process local aspects of a complex stimulus more efficiently than the overall gestalt. The aim of the present study was to investigate if this “local bias” is established already during early stimulus encoding or occurs only during later processing, once a percept has been formed (e.g., memory retrieval). To this end, responding to local and global targets of hierarchical letters (e.g., an “E” composed out of small “T”s) was assessed in 30 OCD patients and 28 healthy controls. OCD patients and controls performed comparably on all parameters. These results lend no support to the notion of an early perceptual bias towards local elements in OCD patients. It remains to be tested whether a bias towards local features is confined to situations where local and global features compete for selection. (JINS, 2006, 12, 566–569.)

Persistent chaotic feeding behavior (i.e., bingeing and purging), despite consequent adverse health and psychosocial consequences, is central to the definition and diagnosis of bulimia nervosa (BN). Repeatedly choosing immediate short-term gratification when long-term consequences are deleterious may reflect deficits in decision-making ability. However, to date, there has been no systematic examination of decision-making ability in individuals diagnosed with BN. In the present study, 20 undergraduate women with minimal bulimic symptoms (Control Group) and 20 with a diagnosis of BN (BN Group) were administered the Iowa Gambling Task (GT). Results indicated that the BN Group performed significantly worse on the GT in comparison to the Control Group and GT performance was negatively correlated with bulimic symptomatology. The presence of BN symptoms also predicted GT performance above and beyond demographic variables and depressive symptoms. These findings provide evidence for the presence of decision-making deficits in individuals with BN (JINS, 2006, 12, 741–745.)

The Wisdom Paradox: How Your Mind Can Grow Stronger as Your Brain Grows Older, by Elkhonon Goldberg. 2005. New York: Gotham Books. 337pp., $26.00 (HB).

Creativity and the Brain, by Kenneth M. Heilman. 2005. New York: Psychology Press. 207 pp., $55.00 (HB).

Doctors Goldberg and Heilman have both written absorbing accounts of the brain for the interested public as well as scientists that address some of the most intriguing questions in neuroscience, wisdom and creativity. Dr. Goldberg is a Clinical Professor of Neurology at New York University School of Medicine and a valuable and innovative contributor to the theoretical foundations of neuropsychology. Dr. Heilman, a Distinguished Professor of Neurology and Health Psychology at the University of Florida, is recognized for his many contributions to understanding brain mechanisms underlying behavior as well as his legacy as a teacher and mentor for many neuroscientists.

Background: Despite its inhibitory control requirements, antisaccade deficits have been consistently associated with working memory impairments in schizophrenia. We investigated whether variance in antisaccade performance could be better accounted for in terms of a specific inhibitory function. Method: We assessed 48 clinically stable out-patients with schizophrenia on an antisaccade task, as well as on measures of spatial and verbal working memory, sustained selective attention, and a simple motoric go/no-go measure of response inhibition. Results: In a stepwise multiple regression analysis, go/no-go task performance accounted for a considerably greater percentage of variance in antisaccade performance (25.3%) than either working memory (8.4%) or sustained selective attention task (9.1%). Discussion: We conclude that antisaccade deficits in schizophrenia appear to be better understood in terms of a specific deficit of inhibitory control than in terms of more general difficulties with context maintenance or goal neglect. (JINS, 2006, 12, 901–906.)

Impaired recall for early items (primacy) and late items (recency) on word list recall tests are seen in Alzheimer's disease (AD). We compared conventional scoring on the Telephone Instrument for Cognitive Status (TICS) recall list with scorings based on retention-weighted recall (RWR: each item weighted by its serial position) in older adults participating in a community-based aging study. Subjects with mild AD (N = 18) did not differ from those without dementia (N = 231) with respect to recency (46% vs. 59%, p = 0.2), but had impaired primacy (2% vs. 39%, p < .001) on word recall on the TICS. RWR scoring improved the effect size (1.52 SD) compared to conventional scoring (1.08 SD). With a fixed sensitivity of 85%, specificity was lower using conventional scoring (56%) than RWR (76%) scoring. Our findings suggest that optimized RWR scoring of word list free recall can improve detection of mild AD compared to conventional scoring. (JINS, 2006, 12, 436–440.)

Amnestic mild cognitive impairment (aMCI) represents a high-risk factor for Alzheimer's disease (AD) and is characterized by a selective decline in episodic memory. Although by definition aMCI is not associated with impaired verbal fluency performance, we examined relative differences between fluency tasks because AD is characterized by poorer semantic than phonemic fluency. Phonemic and semantic fluency trials were administered to 46 healthy controls, 33 patients with aMCI, and 33 patients with AD. Results revealed a progressive advantage (controls > aMCI > AD) in semantic, relative to phonemic fluency. Difference scores between tasks distinguished each group from the others with medium to large effect sizes (d) ranging from 0.49 to 1.07. Semantic fluency relies more on semantic associations between category exemplars than does phonemic fluency. This aMCI fluency pattern reflects degradation of semantic networks demonstrating that initial neuropathology may extend beyond known early changes in hippocampal regions. (JINS, 2006, 12, 570–574.)The data were collected in accordance with the guidelines of the Helsinki Declaration and approved by the Research Ethics and Scientific Review Committee of Baycrest Centre. This is an original submission. Portions of these data were presented at the annual meeting of the International Neuropsychological Society, February 2005, St. Louis, Missouri. There is no conflict of interest.

Aphasia is extraordinarily common. Over one million people in the US currently suffer from aphasia. The personal and societal costs associated with aphasia are enormous. We live in a highly verbal world, and compromised language communication limits the aphasic's participation in society. Activities associated with a reasonable quality of life are highly constrained, and significant depression and other psychological costs are frequent. From a financial perspective, it is the aphasic's limited communicative capacity—not an associated motor disorder—that constrains employment and the ability to contribute productively to society. Thus, there are many reasons to pursue aphasia therapy. Yet effective aphasia therapies are few. Despite the frequency of aphasia and its enormous costs, resources devoted to the treatment of aphasia have been disappointingly modest.

Two patients (G01, J02) with chronic nonfluent aphasia and sentence production deficits received syntactic mapping treatment to improve sentence production. The patients had dramatically different outcomes in that improved syntax production generalized to nontreatment tasks for G01, but not for JO2. To learn how treatment influenced the neural substrates for syntax production, both patients underwent pre- and posttreatment functional magnetic resonance imaging (fMRI) of sentence generation. G01 showed more robust activity posttreatment than pretreatment in Broca's area; ventral temporal activity decreased slightly from pre- to posttreatment. Comparison of J02's pretreatment and posttreatment images revealed little change, although activity was more diffuse pre- than posttreatment. Findings suggest that for G01, rehabilitation led to engagement of an area (Broca's area) used minimally during the pretreatment scan, whereas for J02, rehabilitation may have led to more efficient use of areas already involved in sentence generation during the pretreatment scan. fMRI findings are discussed in the context of sentence-production outcome and generalization. (JINS, 2006, 12, 132–146.)

Memory performance in obsessive–compulsive disorder (OCD) is discussed as a pathogenetic risk factor for the emergence of OCD, particularly checking compulsions. At present, however, findings are mixed and little is known about memory performance in tasks relevant to everyday functioning in patients with OCD. For the present study, memory performance was assessed in 31 patients diagnosed with OCD and 33 healthy controls with the Rivermead Behavioural Memory Test (RBMT), which covers a wide range of verbal and nonverbal memory components as well as prospective memory. OCD patients performed comparably to healthy controls on the memory task for verbal, nonverbal, and prospective memory (p > .1). According to norm values, memory performance was unimpaired in most OCD patients. The present findings further challenge a broad account of the “memory deficit” hypothesis of OCD and compulsive checking, respectively (JINS, 2006, 12, 746–749.)

Recovery After Stroke. Michael P. Barnes, Bruce H. Dobkin, and Julien Bogousslavsky, (Eds.). 2005. Cambridge, UK: Cambridge University Press, 656 pp., $170.00 (HB).

Recovery after Stroke is an edited book (656 pages), and its contributors hale mostly from the United Kingdom and Western Europe. The title might suggest a focus on rehabilitation and treatment, but the contents extend well beyond, and include the neuroanatomic foundations of stroke syndromes as well as their “natural” course of recovery. The book is quite clearly intended for a general, multidisciplinary audience. As such, it covers a wide variety of topics such as spasticity/pain, imbalance and gait disorders, sleep disorders, incontinence, dysphagia, and the theory and practice of physical rehabilitation. More systemically, there are chapters addressing the principals of vocational rehabilitation, community rehabilitation, and sexual relationships after stroke.

Rehabilitation for Traumatic Brain Injury. Walter M. High, Jr., Angelle M. Sander, Margaret A. Struchen, and Karen A. Hart (Eds.). 2005. New York: Oxford University Press. 368 pp., $69.50 (HB).

Rehabilitation for Traumatic Brain Injury, the final product of a 2003 conference that assembled national experts on traumatic brain injury (TBI) rehabilitation, was written to “bring into one volume a concise and authoritative account of what is currently known in the field of TBI rehabilitation.” It is intended for TBI clinicians and researchers including neuropsychologists, physiatrists, neurologists, neurosurgeons, psychiatrists, and rehabilitation therapists. The volume is impressive for the number of chapter authors who are nationally recognized experts on various aspects of TBI rehabilitation (e.g., Drs. Prigatano, Malec, Corrigan, Levin, Boake, Diller, Sohlberg, and Cicerone), as well as the broad and inclusive range of topics covered.

Pathological Gambling is an impulse control disorder. Impulsivity has been investigated separately by neuropsychological tests and self-report scales. Although some studies have tried to correlate these approaches, their interaction has not been sufficiently explored among pathological gamblers (PG). In this study, we have compared 214 PG (162 with comorbidity and 52 with no comorbidity) to 82 healthy volunteers regarding the reaction time and number of errors at Go/No-go tasks, and scores on the Barratt Impulsiveness Scale (BIS). PG have committed more errors at the Go/No-go tasks and presented higher scores on the self-report scale. The neuropsychological tests and BIS composed a multinomial logistic model that discriminated PG from non-gamblers better than models having one or another type of measure. Impulsivity seems to be a multi-dimensional phenomenon, and PG a heterogeneous population in which different types of impulsivity are present. (JINS, 2006, 12, 907–912.)