Shifted inferior frontal laterality in women with major depressive disorder is related to emotion-processing deficits.

BACKGROUND: Facial emotion perception (FEP) is a critical human skill for successful social interaction, and a substantial body of literature suggests that explicit FEP is disrupted in major depressive disorder (MDD). Prior research suggests that weakness in FEP may be an important phenomenon underlying patterns of emotion-processing challenges in MDD and the disproportionate frequency of MDD in women. Method Women with (n = 24) and without (n = 22) MDD, equivalent in age and education, completed a FEP task during functional magnetic resonance imaging. RESULTS: The MDD group exhibited greater extents of frontal, parietal and subcortical activation compared with the control group during FEP. Activation in the inferior frontal gyrus (IFG) appeared shifted from a left >right pattern observed in healthy women to a bilateral pattern in MDD women. The ratio of left to right suprathreshold IFG voxels in healthy controls was nearly 3:1, whereas in the MDD group, there was a greater percentage of suprathreshold IFG voxels bilaterally, with no leftward bias. In MDD, relatively greater activation in right IFG compared with left IFG (ratio score) was present and predicted FEP accuracy (r = 0.56, p < 0.004), with an inverse relationship observed between FEP and subgenual cingulate activation (r = - 0.46, p = 0.02). CONCLUSIONS: This study links, for the first time, disrupted IFG activation laterality and increased subgenual cingulate activation with deficient FEP in women with MDD, providing an avenue for imaging-to-assessment translational applications in MDD.

Predictors of well-being among significant others of persons with multiple sclerosis.

OBJECTIVE: To examine patient and significant other characteristics as predictors of significant other well-being. METHODS: A total of 74 persons with multiple sclerosis (MS) and their significant others participated. Executive functioning was measured using neuropsychological tests. Awareness of cognitive deficit was measured as the discrepancy between the patient's reports of their abilities and objective test results. Awareness of functional deficit was measured as the discrepancy between the patient's and significant other's reports of the patient's functional abilities. Patient neurobehavioral disturbance was measured using a significant-other rated questionnaire. Significant other perceived social support and well-being (ie, psychological distress, life satisfaction, and general health status) were assessed using questionnaires filled out by the significant other. RESULTS: Executive dysfunction, neurobehavioral disturbance, and lack of awareness of functional deficits in patients were associated with poor well-being outcomes; whereas, lack of awareness of cognitive deficits was only weakly related to well-being. Social support was associated with positive well-being outcomes. CONCLUSIONS: Diminished insight regarding functional limitations may increase significant others' supervisory burden as patients attempt activities independently, whereas lack of awareness of cognitive deficits may not be directly associated with behavior-relevant impairments that significant others find distressing. Social support appears to be a powerful aid in diffusing the distress among significant others of MS patients.

Neuropsychological symptoms associated with low-level exposure to solvents and (meth)acrylates among nail technicians.

OBJECTIVE: To evaluate reports of neuropsychological symptoms among women occupationally exposed to products commonly used in nail studios. BACKGROUND: Typical preparations found in nail studios contain a variety of organic solvents (e.g., toluene, acetone, formaldehyde) and (meth)acrylates with known neurotoxic properties. Little research has focused on the neuropsychological sequelae of exposure to these substances occurring in the cosmetics industry. METHOD: Participants included nail salon technicians (n = 150) and controls (n = 148). Nail technicians were compared with demographically similar controls using the Neuropsychological Impairment Scale, a self-reported measure of neuropsychological and psychological symptoms. Aspects of the workplace environment (e.g., square footage of the salon, adequacy of ventilation, hours worked) also were assessed. RESULTS: A MANOVA revealed small but significant differences in the overall level of symptoms as well as in individual scales measuring neurologic complaints, cognitive efficiency, memory, verbal learning, and academic skills (p < 0.001). Moreover, nail technicians were significantly more likely to score above the clinical cutoffs than were controls on four of the seven clinical scales and two of the three summary indices. Multiple regression analysis indicated that the severity of symptoms was associated with level of occupational exposure (p < 0.01). The cumulative impact of workplace size and ventilation were most strongly associated with symptom severity. CONCLUSIONS: Exposure to low-level neurotoxins common to nail studios results in the self-reported experience of cognitive and neurologic symptoms similar to other types of solvent and (meth)acrylate exposure. The profile of reported symptoms is consistent with deficits typically observed in this type of neurotoxic exposure: neurologic complaints as well as perceived problems with cognitive efficiency, memory, and learning. Additionally, the nail technicians reported a higher overall level of complaints and greater severity of symptoms than did the controls.

Computer-assisted training for improving wheelchair mobility in unilateral neglect patients.

OBJECTIVE: To investigate whether a computer-assisted training (CAT) program for patients with left unilateral neglect would decrease symptoms of this disorder. DESIGN: Case-control study. SETTING: Inpatient rehabilitation unit of a government medical center. PATIENTS: Twenty right-handed patients who showed left unilateral neglect on screening measures (Rey-Osterrieth Complex Figure, Random Letter Cancellation Test) were assigned to a CAT treatment group; and 20 patients who showed similar levels of unilateral neglect on the screening measures were assigned to a control group. INTERVENTIONS: All subjects were inpatients in an acute rehabilitation unit and received rehabilitation therapy, including physical and occupational therapy. The treatment group received the experimental, CAT program, 12 to 20 sessions of about 45 minutes each. Treatment consisted of 5 modules, each of increasing complexity, to improve attention to stimuli in the left hemisphere, and 2 simulated wheelchair obstacle courses to propel a wheelchair while avoiding obstacles. MAIN OUTCOME MEASURES: Computer tasks designed for this study (Video Tracking Test, Video Obstacle Course Test), a real-life wheelchair obstacle course (WCOC), and incident reports indicating falls and accidents. RESULTS: Trained subjects performed significantly better on the WCOC than control subjects (F(1,36) = 23.41, p = .00003). Also, trained subjects had fewer incident reports than control subjects during their hospitalization (chi(2)(1,)(n)(=38) = 5.15, p = .023). CONCLUSIONS: CAT can reduce unilateral neglect symptoms on experimental tasks and some measures of accident risk.

Executive functioning in adult attention-deficit hyperactivity disorder.

The present study examined the executive abilities of 35 adults diagnosed with Attention-Deficit Hyperactivily Disorder (ADHD) and 32 adults without the disorder (n = 67) who were equivalent in age, gender, years of education, and Full Scale IQ. The ADHD group performed significantly worse on Stroop Color-Word (eta(2) =.18) and Interference (eta( 2) =.08), as well as time to complete Trails B (eta(2) =.08) than the controls (all ps <. 05). Analysis of Design Fluency indicated that the ADHD group committed more perseverative (eta(2) =.06) and non-perseverative (eta(2) =.12) errors than did controls; however, novel output was equivalent for the groups. No group differences were observed on tests measuring cognitive initiation, abstract thinking, or working memory (all ps >.30; eta(2) =.00-.01). The distributions of WCST variables showed severe skew associated with high-functioning performance on the test among both groups. The pattern of results suggests the presence of specific deficits in response inhibition, with intact abilities in other cognitive domains, such as primary verbal and visuospatial skills. These findings are consistent with the literature on neuropsychological deficits among children with ADHD. That persons with ADHD present a primary deficit of behavioral inhibition supports Barkley's (1997) theory of ADHD, as opposed to theories by Denckla (1996) and Roberts and Pennington (1996) that emphasize intention and working memory.

Measures of executive functioning as predictors of functional ability and social integration in a rehabilitation sample.

OBJECTIVE: To examine the utility of executive function tests in predicting rehabilitation outcome. DESIGN: A prospective, descriptive study of the value of neuropsychologic and motor functioning measures in the prediction of functional outcome 6 months after acute rehabilitation. SETTING: A Midwestern, urban, university-affiliated rehabilitation hospital. PATIENTS: Ninety consecutive admissions to traumatic brain injury, orthopedic, and spinal cord injury units. Age of the participants ranged from 17 to 73. MAIN OUTCOME MEASURES: Community Integration Questionnaire (CIQ), Disability Rating Scale (DRS), SF-36 Health Survey. RESULTS: Canonical correlation analyses indicated that measures of executive functioning and verbal memory were strongly related to measures of functional outcome 6 months after rehabilitation, as measured by the DRS and the CIQ. In contrast, perceived health status as measured by the SF-36 was highly related to estimated premorbid IQ and modestly related to visuospatial impairment. CONCLUSIONS: Executive functioning, verbal memory, and estimated premorbid intelligence predict functional dependence after discharge from rehabilitation beyond information regarding basic sensory and motor skills. Moreover, there is a dissociation between measures of functional outcome, such that objective and behaviorally oriented measures of disability (CIQ and DRS) are strongly related to each other; however, they are not related to perceptions of general health status (SF-36).

Neuropsychological deficits associated with antiphospholipid antibodies.

Neurologic events associated with antiphospholipid antibodies (aPAs) include transient ischemic attack, stroke, and vascular dementia in individuals much younger than is typically observed with these disorders. The present study evaluated 27 non-elderly adults with aPAs but without concurrent disease processes or history of neurologic event and 27 age- and education-matched controls. MANOVA (p <.01) indicated group differences in executive functioning, verbal learning and memory, and visuospatial ability. In contrast, gross attentional processes and fine motor skills appeared unaffected by the syndrome. Moreover, the frequency of impaired neuropsychologic performance was greater among individuals with aPAs than among controls (p <.01). The presence of cognitive deficits in otherwise asymptomatic patients with aPAs indicates a preclinical phase of neurologic involvement and may prove to be the most sensitive markers of the syndrome.

The diagnostic meaning of "nervous breakdown" among lay populations.

Two studies investigated the nature of nervous breakdown (NB): a mental illness commonly referred to by individuals not professionally related to the field of mental health. The clinical profile of NB was first surveyed among 121 undergraduates using a symptom checklist. Descriptive statistics and analysis of variance indicated NB is a time-limited condition that presents with primarily anxious and depressed features, associated with a series of external precipitating stressors (e.g., interpersonal, employment, and financial losses). Dimensions significantly uncharacteristic of NB included psychoticism, somatization, phobic anxiety, and mania. These results were replicated in a community sample of 189 adults from urban and suburban areas of a large metropolitan city. Respondents held a relatively unitary view of NB: Combined-sample cluster analysis (N = 310) revealed 2 groups with similar symptom profiles that differed primarily with regard to level of distress associated with disorder. Thus, among this population, NB is not an amorphous term for generalized psychiatric disturbance.

Effects of coaching on detection of malingering on the California Verbal Learning Test.

The diagnostic accuracy of California Verbal Learning Test (CVLT) indices to detect malingered head injury was examined using a simulation paradigm that included naive malingerers, malingerers provided with information about head injury, and normal controls (N = 90). The application of diagnostic cutoff scores for Recognition Discriminability and Recognition Hits derived from populations of individuals with bona fide head injury and individuals suspected of malingering (Millis et al., 1995) proved highly sensitive and modestly specific in detecting feigned head injury among both simulation groups. Results of analyses of variance and logistic regression support previous findings that malingerers overestimate memory impairment associated with mild head injury; however, they indicate that exposure to a simple instructional set may render insensitive many indices of malingering. In contrast, indices based on more subtle principles of learning theory hold promise in the detection of malingering, even in the presence of an instructional set.

Validation of the Warrington theory of visual processing and the Visual Object and Space Perception Battery.

Competing hypotheses regarding the nature of visual processing were examined using the performance of 111 healthy older persons on the Warrington and James (1990) Visual Object and Space Perception Battery (VOSP). Confirmatory factor analysis indicated that a two-factor model corresponding to the Warrington theory of object and space perception as discrete domains showed excellent congruence with the data, despite limitations in the VOSP space perception tests that may have resulted in underestimation of model fit. Moreover, compared to a unidimensional model of visual processing, the Warrington model demonstrated a superior fit to the data. These findings add to the bodies of evidence supporting a dissociation between object- and space-perception abilities and defining the construct validity of the VOSP battery.

Childhood celebrity, parental attachment, and adult adjustment: the young performers study.

The associations between celebrity, parental attachment, and adult adjustment were examined among 74 famous, former young performers in television and film. As adults, former young performers whose parents served as their professional managers viewed their mothers as less caring and more overcontrolling than did performers whose parents were not their managers. Other factors affecting the quality of the parent-child relationship included dissatisfaction with money management, poor peer support, the perception that involvement in acting was determined by others, and the specific nature of professional experience. Together, these variables accounted for 59% of the variance in perceived caring and 40% of the variance in perceived autonomy support. The relation could not be attributed to a generalized response bias, as attachment was unrelated to degree of positive thinking. A Celebrity x Parental Attachment interaction indicated that the quality of the parent-child relationship moderated the effects of celebrity on adult adjustment: Among participants with good parental attachment, there was no relation between professional experience and adjustment; however, among participants with poor attachment, this relation was strong. Possible implications for parenting child actors and analogous populations of talented children in high-stress arenas are discussed.

Effects of coaching on malingered motor function profiles.

Measures of motor functioning were evaluated to assess a nonphysiological performance pattern initially revealed in a sample of litigating patients with postconcussive syndrome (grip strength < finger tapping < grooved pegs). The opposite pattern is observed in patients with traumatic brain injury, whose performance follows a gradient of increasing impairment corresponding to the sensory-motor complexity of these tasks. Naive and coached malingerers performed worse on all three motor tests relative to controls (N = 92); however, the presence of nonphysiologic configurations showed poor predictive accuracy among malingerers and controls. Exploratory analyses suggested that IQ may mediate the ability to dissimulate successfully. Although worthy of additional study, the use of pattern analysis in evaluation of malingered motor functioning has not been proven reliable or valid.

Intermanual and alternate-form equivalence on the trail making tests.

Intermanual discrepancies in performance and alternate-form equivalence on the Trail Making Test were examined among 40 left- and 40 right-hand-preferred normal adults (N = 80). The findings indicate that administration of the Trail Making Tests to the nonpreferred hand does not result in a clinically meaningful difference in score. Neither hand preference nor task complexity (numeric or numeric/lexical) significantly affected the magnitude of the intermanual discrepancy. Mixed-model analyses of variance revealed an interaction (p < .001) indicating that the alternate form for the numeric/lexical Trial Making Test (Trail Making Test, Part D; TMT-D) is slightly more difficult than is the original form Trail Making Test, Part B (TMT-B). Therefore, individuals exposed first to TMT-D performed relatively better in the second trial, whereas individuals exposed first to TMT-B first produced equivalent scores when presented the more difficult form (TMT-D) on the second trial. Thus, although TMT-D is not an equivalent form to TMT-B, it may serve as an excellent alternate form at retest.

Executive functioning and predictors of falls in the rehabilitation setting.

OBJECTIVE: To examine the incremental utility of executive function tests in the prediction of inpatient falls. DESIGN: Evaluation of neuropsychologic and medical risk factors for fall was completed at admission. Inpatient falls were tabulated following discharge. SETTING: A freestanding, urban rehabilitation hospital. PATIENTS: Ninety consecutive admissions to traumatic brain injury, orthopedic, and spinal cord injury wards. Age of the participants ranged from 17 to 73 years old. MAIN OUTCOME MEASURE: Incident reports of inpatient falls. RESULTS: Standard multiple regression analyses indicated that measures of executive functioning sensitive to self-monitoring accounted for unique variance in falls beyond that explained by age and functional motor ability as assessed by the Functional Independence Measure. Visuospatial functioning, although not directly related to falls, was a significant predictor in combination with measures of executive functioning. Together, these variables accounted for 30.3% of the variance in inpatient falls (multiple r = .55; p < .001). CONCLUSION: The findings suggest that the influence of motor and sensory impairments on falls are moderated, in part, by executive functioning. Patients with intact executive functioning are less likely to act in ways that could result in a fall; thus, aggressive fall prevention measures may be unnecessary. In contrast, executive dysfunction may signal the need for intervention, even among patients whose profiles are unremarkable with regard to traditional risk factors for fall.

Effects of practice in repeated administrations of the Wechsler Memory Scale Revised in normal adults.

Practice effects were examined over four administrations of the immediate (I) and delayed (II) portions of three subtests of the WMS-R: Logical Memory (LM), Verbal Paired Associates (VPA), and Visual Reproduction (VR). A repeated measures ANOVA revealed that large and significant (p < .001) increases occurred in the General Memory (GM) and Delayed Recall (DR) indices and in the LMI, LMII, and VPAI subtests (Effect Sizes [ESs] = 0.70-0.87). Small but significant (p < .001) increases occurred in VRI (ES = 0.24) and VRII (ES = 0.43). The greatest increase in scores occurred at the first retest session, whereas increases of smaller magnitudes occurred at Sessions 3 and 4. Ceiling effects occur in subtests (VPAII, VRI, and VRII) on which individuals score most of the total possible points at the first testing session; this makes interpretation of practice effects difficult. Test-retest reliability coefficients, mean change scores from Session 1 to Session 2, standard errors of prediction, and 95% confidence intervals are presented. These score changes need to be taken into consideration when interpreting performance at retest.

Relationship of IQ to verbal learning and memory: test and retest.

The relationship between Wechsler Adult Intelligence Scale-Revised (WAIS-R) IQ and performance on measures of memory was examined in 64 adults tested twice at a 2-week interval. Repeated measures analyses of variance revealed that individuals with Low-Average WAIS-R Full Scale IQ scores performed significantly more poorly than did individuals with Average and High-Average Full Scale IQs on memory measures including the Wechsler Memory Scale-Revised (WMS-R) General Memory and Delayed Recall indices, as well as California Verbal Learning Test (CVLT) Total Words. Learning Slope, and Discriminability. Although all three groups demonstrated significant practice effects on each memory measure, group differences in performance persisted at retest. Multiple regression analyses revealed that WAIS-R factor scores Verbal Comprehension and Freedom from Distractibility accounted for up to 42% of the variance in WMS-R and CVLT indices. Moreover, WAIS-R performance at initial testing accounted for 22-41% of the variance in memory performance at retest. These results are discussed in the context of the construct stabilities of intelligence and memory, as well as the psychometric precision of the tests used to measure these constructs.

Estimating Full Scale IQ While Minimizing the Effects of Practice.

The present study attempted to ascertain the best estimate of true Wechsler Adult Intelligence Scale-Revised (WAIS-R) Full Scale IQ (FSIQ) when confronted with an individual who recently had been administered the WAIS-R. Sixty-five college undergraduate participants were administered the WAIS-R twice within 14 days. WAIS-R summary scores, factor scores, and short-form estimates obtained from the second assessment were compared to FSIQ at the first evaluation. The results indicated that Verbal IQ, the Verbal Comprehension factor score, and subtracting 6 points from the current FSIQ are the least affected by repeat assessment and the most accurate estimates of FSIQ at the first evaluation. Use of these estimates of FSIQ are encouraged when evaluating an individual who has been administered the WAIS-R in the recent past.

Rightward orienting bias, wheelchair maneuvering, and fall risk.

OBJECTIVE: To investigate whether rightward orienting bias, without neglect of left hemispace, increased accident risk. DESIGN: Case-control study. SETTING: Inpatient rehabilitation unit of department of government medical center. PATIENTS: Successive right-cerebrovascular accident (CVA) admissions were reviewed over a 2-year period. Only patients with left hemisphere damage, recent abusive drinking, dementia, or inpatient stays of less than 3 weeks were excluded. Fifty-five right-CVA subjects were divided into three groups, based on starting point and omissions in left hemispace on the Rey-Osterreith Complex Figure Drawing and Random Letter Cancellation test. Thirty-two patients were placed in the L-OMIT group (omitted stimuli in left hemispace), 11 patients were placed in the R-BIAS group (began tasks to the right without omissions), and 12 patients were placed in the Non-Neglect Stroke group (no evidence of unilateral neglect). Twenty male inpatients with no history of brain damage served as controls (Normal Control). MAIN OUTCOME MEASURES: Frequency of hospital falls and wheelchair obstacle course contacts. RESULTS: Both the L-OMIT and the R-BIAS groups had more inpatient falls than the other groups F(3,71) = 6.11, p < .001. On the wheelchair obstacle course, the L-OMIT group made more left-sided wheelchair collisions than any other group. However, the R-BIAS group also made more errors than the Non-Neglect Stroke and the Normal Control groups, F(3,55) = 5.72, p < .01). CONCLUSIONS: Results suggest that rightward orienting bias has clinical significance, even without more serious symptoms of unilateral neglect.

Digit span performance and unilateral neglect.

This study tested the alternative hypotheses of Weinberg et al. (J. clin. Psychol. 28, 361, 1976) and Robertson (Neuropsychologia 28, 217-222, 1990) regarding the nature of dysfunctions underlying impaired backward digit span among patients with unilateral neglect. Results support the Weinberg et al. hypothesis that visual imagery plays a primary role in performance of Digits Backward. The findings also indicate a unilateral component to the Digits Backward task. Both neglecting and non-neglecting patients with high digit span discrepancy (DD) evidenced attentional bias to right space and a specific impairment in rotating objects in left space. Results were not consistent with Robertson's hypothesis that high DD arises from a general attentional deficit. In fact, patients with low DD evidence greatest impairment on tests of attention.

Effect of attentional bias to right space on wheelchair mobility.

The impact of hemispatial neglect on wheelchair navigation was investigated using a wheelchair obstacle course. The results replicated the findings of Webster et al. (1988): Right-CVA patients with hemispatial neglect (n = 25) struck more objects on their left and ran directly into obstacles placed in their path (p < .0001). Right-CVA patients who did not omit left-space targets on letter cancellation (n = 23) did not run directly into obstacles; however, they did sideswipe more obstacles and struck more left-sided obstacles than did left-CVA (n = 20) and nonpatient controls (n = 19; p < .0001). Both hemi-neglecting patients and right-CVA patients who committed left-space sideswipes (n = 12) evidenced attentional bias to right space, as measured by more rightward starting points on letter cancellation and the Rey-Osterreith Complex Figure copy (p < .0001).