"Cinderella was attacked by the big bad wolf, but the police saved her": intrusions and confabulations on story recall in Korsakoff's syndrome and alcohol-related cognitive impairments.

BACKGROUND: The relation between confabulations and intrusions in patients with Korsakoff's syndrome (KS) and patients with alcohol-related cognitive impairments (ARCI) remains under debate. This study examines (1) differences in the production of confabulations and intrusions between patients with KS and ARCI, (2) whether an altered fairy tale induces more intrusions, and (3) whether different types of intrusions were significantly related to confabulations. METHODS: Twenty-three patients with KS and twenty-two patients with ARCI recalled three different types of stories: a novel story, a fairy tale, and a modified fairy tale. Different types of intrusions were correlated with confabulation measures. RESULTS: Patients with KS produced more intrusions in the modified fairy tale condition than patients with ARCI, but these were unrelated to confabulations. Only unrelated intrusions were related to provoked confabulations. CONCLUSIONS: The results of this study indicate that researchers and clinicians must be aware that in general, intrusions on memory tests should not be interpreted as confabulations. Especially spontaneous confabulations appear to be something completely different from intrusions on any type of story recall. When measuring confabulations it is crucial to use validated instruments.

Personal semantic and episodic autobiographical memories in Korsakoff syndrome: A comparison of interview methods.

OBJECTIVE: The temporal gradient in patients with Korsakoff's syndrome has been of particular interest in the literature, as many studies have found evidence for a steep temporal gradient, but others have observed more uniform remote memory impairment across all past time periods. Inconsistencies might be the result of the nature of remote memory impairment under study (i.e., nonpersonal or autobiographical memory) and of methodological differences in the examination of remote memory loss. The aim of this study was to examine whether differences between autobiographical memory interview (AMI) and autobiographical interview (AI) procedures influence the presence of a temporal gradient in semantic and episodic autobiographical memory in Korsakoff patients. METHOD: The procedure used in the present study combined the AMI and AI into one study session. We compared the performance of 20 patients with Korsakoff's syndrome and 27 healthy controls. First, participants were asked to recall knowledge from different life periods. Second, participants were asked to recall memories from five life periods. Thirdly, participants were asked to rate their subjective experience of each event recalled on a 5-point scale. Finally, we analyzed the findings in terms of all the memories recalled versus the first memory from each life-period only. RESULTS: Both the AMI and the AI showed a temporally graded retrograde amnesia in the Korsakoff patients for personal semantic and episodic autobiographical memories. The pattern of amnesia in Korsakoff patients was not affected by examining only one event per life-period. Subjective ratings of recalled memories were largely comparable between the groups. CONCLUSIONS: The findings were generally consistent across the AMI and AI. Varying the number of events did not affect the pattern of the gradient. Hence, the temporal gradient in Korsakoff patients is not an artefact of either the AMI or the AI method.

Intrusions and provoked and spontaneous confabulations on memory tests in Korsakoff's syndrome.

INTRODUCTION: Intrusions on verbal memory tests have been used as an index for clinical confabulation. Severe memory impairments in combination with executive dysfunction have been suggested to be the underlying mechanism of confabulation, but to date, this relation is unclear. The aim of this study was (a) to examine the relation between (different types of) intrusions and confabulations in a large sample of confabulating patients with Korsakoff's syndrome (KS) and (b) to investigate whether different measures of executive functioning and memory performance are related to provoked and spontaneous confabulation. METHOD: The Dutch version of the California Verbal Learning Test (CVLT) and various executive function and memory tests were administered to a group of 51 confabulating patients with KS. Professional caregivers rated the severity of provoked and spontaneous confabulation behavior of the patients using the Nijmegen-Venray Confabulation List-20 (NVCL-20). RESULTS: The total number of intrusions on the CVLT was not related to either provoked or spontaneous confabulation scores. None of the CVLT intrusion scores correlated significantly with any of the confabulation scores, but we did find small-to-medium, positive correlations between unrelated intrusions and both provoked confabulations and spontaneous confabulation. Provoked confabulation behavior was associated with executive dysfunction and poorer memory performances. Spontaneous confabulation was not related to performance on measures of executive function and memory. CONCLUSIONS: The total number of intrusions on verbal memory tests and clinical confabulations appear to be different phenomena. Only unrelated intrusions produced on the CVLT might possibly be related to confabulations. The production of provoked, but not spontaneous, confabulation is associated with executive dysfunction and memory deficits.

Simple and complex rule induction performance in young and older adults: contribution of episodic memory and working memory.

This study tested the hypothesis that part of the age-related decline in performance on executive function tasks is due to a decline in episodic memory. For this, we developed a rule induction task in which we manipulated the involvement of episodic memory and executive control processes; age effects and neuropsychological predictors of task performance were investigated. Twenty-six younger (mean age, 24.0; range, 19-35 years) and 27 community-dwelling older adults (mean age, 67.5; range, 50-91 years) participated. The neuropsychological predictors consisted of the performance on tests of episodic memory, working memory, switching, inhibition and flexibility. Performance of the older adults was worse for the learning and memorization of simple rules, as well as for the more demanding executive control condition requiring the manipulation of informational content. Episodic memory was the only predictor of performance on the simple learning and memorization task condition whereas an increase in rule induction complexity additionally engaged working memory processes. Together, these findings indicate that part of the age-related decline on rule induction tests may be the result of a decline in episodic memory. Further studies are needed that examine the role of episodic memory in other executive function tasks in aging.

On the relationship between autistic traits and executive functioning in a non-clinical Dutch student population.

We examined the association between autistic traits and different aspects of executive functioning (EF), using non-clinical Social Science and Science students as participants. Autistic traits, and associated personality traits, were measured using the Autism Quotient (AQ) and the Temperament and Character Inventory (TCI), respectively. EF was examined by means of a random number generation test and a phonemic fluency test. Using appropriate dependent measures, the following EF components were examined: 1) inhibition of prepotent responding, 2) simple output inhibition, 3) working memory monitoring and updating, and 4) switching. No significant relationship was found between the AQ and each of the four components of EF. However, two TCI subscales were reliably correlated with either the working memory or the shifting component. These results were discussed in view of the concept of an autism spectrum with respect to executive abilities.

An investigation of different aspects of overgeneralization in patients with major depressive disorder and borderline personality disorder.

OBJECTIVE: The aim of this study was to investigate whether (a) overgeneralization is restricted to negative attributions directed at the self; or whether it also extends to positive self-attributions and to attributions of situations in the outside world, and (b) whether the valence and direction (positively or negatively, to the self- or across situations) of overgeneralization processes vary among different patient populations. METHODS: Patients with major depressive disorder (MDD, n = 34), borderline personality disorder (BPD, n = 18), or both (n = 35), and never-depressed non-patients (NPs; n = 50) completed various measures of overgeneralization. RESULTS: Patients with MDD show higher levels of negative overgeneralization but lower levels of positive overgeneralization to the self- and across situations than NPs. Patients with MDD show more negative than positive overgeneralization to the self: a negative bias. They, however, do show higher levels of positive than negative overgeneralization across situations. Patients with BPD show the same pattern for overgeneralization to the self, but their higher levels of negative overgeneralization across situations are not exceeded by their positive counterpart. CONCLUSIONS: Results indicate that patient groups differ from NPs not only with respect to negative, but also with respect to positive overgeneralization. Furthermore, the valence and direction of overgeneralization processes vary among MDD and BPD patient populations. More specifically, findings suggest that, as compared to never-depressed individuals, patients with BPD and patients with MDD alike, lack a buffer against negative overgeneralization directed at the self. In patients with BPD, not only the high level of overgeneralization to the self, but also the high level of overgeneralization across situations seems to be problematic, since both types of overgeneralization appear not to be buffered by their positive counterparts.

Assessing executive functioning: on the validity, reliability, and sensitivity of a click/point random number generation task in healthy adults and patients with cognitive decline.

In random number generation (RNG) tasks, used to assess executive functioning, participants are asked to generate a random sequence of digits at a paced rate, either verbally or by writing. Some previous studies used an alternative format in which participants had to randomly press different response keys, assuming that this task version demands the same cognitive processes as those implied in the standard version. The present study examined the validity of this assumption. To this end, the construct validity, reliability, and sensitivity of a conceptually similar task version of the key-press task were examined. Participants had to randomly click on, or point to, the digits 1-9, laid out orderly in a 3 × 3 grid on a computer screen. Psychometric properties of this task were examined, based on the performance of 131 healthy participants and 80 patients with cognitive decline. The results suggest that the click/point RNG task version can be used as a reliable and valid substitute for standard task versions that use the same response set and response pacing rate as those used in the present study. This task might be a useful alternative, demanding no separate recording and recoding of responses, and being suitable for use with patients with speech or writing problems.

Rose or black-coloured glasses? Altered neural processing of positive events during memory formation is a trait marker of depression.

BACKGROUND: Valence-specific memory enhancement is one of the core cognitive functions that causes and maintains Major Depressive Disorder (MDD). While previous neuroimaging studies have elucidated the neural underpinnings of this emotional enhancement effect in depressed patients, this study aimed at detecting processing biases that are maintained throughout remission while patients were euthymic. METHODS: Fourteen medication-free women remitted from unipolar MDD and 14 matched controls were scanned while learning negative, positive, and neutral words, which were subsequently tested with free recall. RESULTS: The two groups did not differ in memory performance and showed no neural differences during successful encoding of neutral or negative words. However, during successful encoding of positive words, patients exhibited a larger recruitment of a set of areas, comprising cingulate gyrus, right inferior- and left medial-frontal gyrus as well as the right anterior hippocampus/amygdala. LIMITATIONS: Restriction to female participants may limit the generalization of the findings. CONCLUSION: Female MDD patients in clinical remission exert greater neural recruitment of memory-related brain regions when successfully encoding positive words, suggesting that neural biases related to memory formation of positive information do not entirely normalize. Further research is needed to establish whether this processing bias during successful memory formation of positive information is predictive for future relapse thereby offering the possibility to develop more focused therapeutic interventions to specifically target these processes.

Attentional set shifting in autism spectrum disorder: differentiating between the role of perseveration, learned irrelevance, and novelty processing.

Autism spectrum disorders (ASD) are associated with impaired attentional set shifting, which may reflect enhanced perseverative responding, enhanced learned irrelevance, and/or reduced novelty processing. We assessed the contribution of these potential error sources in ASD adults. A total of 17 ASD and 19 matched comparison individuals first solved a discrimination learning task. Thereafter, the participants faced three types of attentional shift, specifically designed to isolate the effect of the three possible error sources. ASD participants made more errors than comparison individuals in a shift implying a choice between a novel relevant stimulus attribute and a familiar attribute that was previously relevant but now irrelevant. However, they made fewer errors in a shift involving a choice between a novel irrelevant attribute and a familiar, previously irrelevant but now relevant attribute. The results in combination suggest that the performance difference, at least in the present shift task, is caused by reduced novelty processing in ASD participants.

Working memory in schizophrenia: a systematic study of specific modalities and processes.

Although many researchers agree that working memory (WM) impairments are a core symptom of schizophrenia, it remains unclear how the disturbances on specific WM components relate to one another. In this study, we presented a Delayed-Matching-To-Sample task to 24 schizophrenia patients and 24 healthy controls, matched on demographical variables. Verbal and visuospatial WM performance was investigated with pseudowords and Chinese characters as stimuli, respectively. Processing demands (maintenance and manipulation, measured with delay and mental rotation) were low or high. Reaction time and accuracy were recorded. All experimental factors had significant effects. In general, patients were slower and less accurate than controls. Patients were especially slower on verbal tasks but they were not less accurate. Accuracy differences did not increase when either maintenance or manipulation demands increased alone but they did when both maintenance and manipulation demands increased simultaneously. These findings indicate that performance impairment in patients was non-specific and that no specific deficit of any WM component was observed.

Diurnal spectral EEG fluctuations in narcoleptic patients during rest and reaction time tasks.

Narcolepsy is associated with lowered vigilance. Diurnal variation in vigilance appears altered, but the exact nature of this change is unclear. It was hypothesized that the homeostatic sleep drive is increased in narcolepsy. Decreased levels of vigilance are reflected in low frequency band power in the electroencephalogram (EEG), so these frequencies were expected to be increased in the narcolepsy group. Furthermore, it was expected that low frequency power should increase over the day. Narcoleptic patients and healthy controls participated (36 participants in total); they were not allowed to take medication or naps on the experimental day. EEG was measured at 9:00, 11:00, 13:00, 15:00, and 17:00 hours, during rest and during reaction time tasks. In the narcolepsy group, alpha power was lower at rest at all times. Delta and theta power during rest and task performance increased steadily over the day in this group, from 11:00 hours onwards. Additionally, in the narcolepsy group beta1 and beta2 power during rest appeared increased at the end of the day. The effects in the lower frequency bands strongly suggest that vigilance is low at all times. The progressive increase in low frequency power indicates that the sleep drive is enhanced. It is not clear whether this pattern reflects an extreme state of low vigilance, or a pathological brain condition. The effects in the higher frequencies suggest that narcoleptic patients may make an effort to counteract their low vigilance level.

Mental and physical effort affect vigilance differently.

Both physical and mental effort are thought to affect vigilance. Mental effort is known for its vigilance declining effects, but the effects of physical effort are less clear. This study investigated whether these two forms of effort affect the EEG and subjective alertness differently. Participants performed a physical task and were subsequently presented with a mental task, or vice versa. Mental effort decreased subjective alertness and increased theta power in the EEG. Both results suggest a vigilance decline. Physical effort, however, increased subjective alertness and alpha and beta1 power in the EEG. These findings point towards an increase in vigilance. Beta2 power was reduced after physical effort, which may reflect a decrease in active cognitive processing. No transfer effects were found between the effort conditions, suggesting that the effects of mental and physical effort are distinct. It is concluded that mental effort decreases vigilance, whereas physical effort increases vigilance without improving subsequent task performance.

Depressive symptom quality and neuropsychological performance in dementia.

BACKGROUND: It is unknown to what extent depression and cognitive dysfunction are related in subjects with dementia. A limitation of earlier studies is that only general measures of depression have been studied. METHODS: In a sample of 60 subjects with dementia according to DSM-III-R criteria depressive symptoms were divided into factors of mood and motivation disturbance according to a principal components analysis. Correlations were computed between the factor scores and the performance on a number of specific neuropsychological tests. As the symptom content of motivation disturbance suggests subcorticofrontal dysfunction it was hypothesized that this factor is related to impaired executive functions. RESULTS: 77% of the depressive symptoms contributed to the dimension of motivation disturbance and most of these symptoms occurred outside the context of a major depressive episode. Our hypothesis was supported by a significant negative correlation between motivation symptoms and semantic verbal fluency. This relationship seems to have specificity, as both the dimensions of mood symptoms and of general depressive symptoms did not correlate significantly with specific neuropsychological test scores. CONCLUSIONS: The division of depressive symptoms in factors of mood and motivation disturbance contributes to insight into the relationship between depression and cognitive dysfunction in dementia. An advantage of the motivation disturbance factor compared to the regular apathy scales is that it consists of depressive symptoms. Therefore, it becomes evident that apathy or impaired motivation may occur in patients with dementia both in and outside the context of a depressive syndrome.

Decreased movement speed in girls with turner syndrome: a problem in motor planning or muscle initiation?

In three experiments with graphical tasks we examined whether the decreased movement speed in girls with Turner Syndrome (TS) is caused either by a diminished planning capacity or by more peripheral motor execution problems. Fourteen girls with TS and 14 matched controls (mean age 11.6 years) participated. Task difficulty addressed the muscle-initiation, size control, and shape-programming level (Van Galen, 1991). The influence of task difficulty on accuracy, velocity, velocity profile and dwell time was analyzed and confirmed that girls with TS do not plan and program their movements differently from normals. We conclude that the decreased movement speed in TS is caused by problems at the muscle initiation level.

Mental effort affects vigilance enduringly: after-effects in EEG and behavior.

Vigilance is assumed to decline with sustained task performance. The EEG-effects during performance on mental tasks, however, cannot be ascribed indisputably to vigilance decline per se. During task performance itself, effects of information processing and vigilance decline may be confounded. In this study, effects of sustained mental effort were studied in the absence of specific information processing, after sustained information processing had taken place, namely after an effortful 70-min intelligence test. Vigilance was determined by means of EEG-measures in a rest condition. Furthermore, behavioral performance was assessed on two different tasks, the traditional Clock test and the SART. After mental effort, theta power in the EEG and errors on the SART were increased. Beta2 power, however, also appeared enhanced. We conclude that sustained mental effort produces an enduring decrease in vigilance, but that some active processing is enhanced at the same time. A second study replicated the EEG-results after mental effort.

Mental effort causes vigilance decrease due to resource depletion.

The resource view on vigilance performance was tested. First, a low demanding task was compared with a similar low demanding task in which stimulus presentation was less monotonous due to added, irrelevant, stimuli. The resource view, maintaining that vigilance is lowered by hard mental work, predicts that addition of irrelevant stimuli will not affect performance. The classic arousal theory, however, states that arousal drops due to monotonous stimulus presentation and predicts that decreasing monotony will enhance performance. Results showed that performance was unaffected by added stimuli. Second, we tested whether a high-demanding task (with identical stimulus presentation as the low demanding task, but different instruction) would cause a greater decline in performance than the low demanding task. Indeed, in the high-demanding task performance was affected most. In sum, it appears that vigilance decreases due to hard mental work, which requires many resources. Both overall performance and decrement in performance can be explained in terms of resources, and this suggests that vigilance tasks should be resource-demanding tasks, which do not have to be of long duration.

Slow motor performance in girls with Turner Syndrome is not related to increased neuromotor noise.

This study examined the relationship between decreased speed-accuracy trade-off and increased neuromotor noise in girls with Turner Syndrome (TS). Fifteen girls with TS and 15 age-matched controls performed isometric force contractions with both index fingers separately at 5 force levels, based on their maximum voluntary contraction. The results revealed that (a) groups did not differ in speed-accuracy tradeoff or neuromotor noise, (b) output-variability increased linearly with force level, (c) signal-to-noise ratio changed according to an inverted U-shaped function, (d) broadening in the frequency profile is highest at the lower force levels, (e) with increasing force level, the power peak in the 0-4 Hz domain dominates, (f) frequency profile broadens more in the dominant hand. These findings suggest that, in girls with TS, motor performance is not diminished in an isometric force task, that motor recruitment is intact, and that neuromotor noise is not increased. The findings are discussed with respect to motor control and neuromotor noise.

A review of neuropsychological and motor studies in Turner Syndrome.

We reviewed the literature on Turner Syndrome (TS) from 1962 until March 2003 with respect to the following questions: Is there a consistent pattern of cognitive and/or motor dysfunction in TS girls and if so, is there an explanation for the disturbance? Many studies indicate that girls with TS have a disharmonic IQ profile: a verbal IQ that seems to be at a (nearly) normal level and a decreased PIQ. This profile remains into adulthood. Visual-spatial problems are mentioned most frequently and there is some evidence for a relationship to particular neuro-anatomical structures, hormonal dysfunction, and genotype. Although much less research has been done on motor performance in TS, there is clear evidence that it is disturbed too in TS. Many authors emphasize the interaction between somatic, psychological and social factors, but we did not find a clear theoretical framework explaining this relationship. We argue that there may be two independent problems: a visuospatial and a motor deficit possible related to specific genotypes and both have implications for functioning in daily life.

Low elementary movement speed is associated with poor motor skill in Turner's syndrome.

The article aims to discriminate between 2 features that in principle both may be characteristic of the frequently observed poor motor performance in girls with Turner's syndrome (TS). On the one hand, a reduced movement speed that is independent of variations in spatial accuracy demands and therefore suggests a problem in motor execution. On the other hand, a disproportional slowing down of movement speed under spatial-accuracy demands, indicating a more central problem in motor programming. To assess their motor performance problems, 15 girls with TS (age 9.6-13.0 years) and 14 female controls (age 9.1-13.0 years) were tested using the Movement Assessment Battery for Children (MABC). In additionally, an experimental procedure using a variant of Fitts' graphic aiming task was used to try and disentangle the role of spatial-accuracy demands in different motor task conditions. The results of the MABC reestablish that overall motor performance in girls with TS is poor. The data from the Fitts' task reveal that TS girls move with the same accuracy as their normal peers but show a significantly lower speed independent of task difficulty. We conclude that a problem in motor execution is the main factor determining performance differences between girls with TS and controls.