Application of the multilingual aphasia examination-spanish in the evaluation of Hispanic patients post closed-head trauma.

Despite the rapid increase of Hispanics in the U.S., there continues to be a lack of adequate psychological assessment tools to examine Spanish-speaking patients with cognitive or neuropsychological disturbances. We investigated the clinical utility of the Multilingual Aphasia Examination-Spanish (MAE-S) in the evaluation of language functions of Hispanic subjects post-traumatic brain injury (TBI). The performance of 40 TBI patients was compared to that of 40 age-, gender-, and education-matched normal controls. Subject groups differed on the Visual Naming (VN), Controlled Oral Word Association (COWA), and Token Test subtests. The VN and COWA subtests were the best discriminators of group membership. Distribution of scores for the patient group on the Rating of Articulation scale additionally indicate subtle articulatory difficulties post-TBI. For all subtests, trauma severity per Glasgow Coma Scale was the best predictor of language performance, over and above the contribution of other clinical and demographic variables. These results are consistent with prior reports of dysphasia post-TBI and suggest that the MAE-S is a sensitive and accurate measure to assess language disturbances in Hispanic populations.

Hemispheric preference in visuospatial processing: a complementary approach with fMRI and lesion studies.

Historically, the left cerebral hemisphere has been considered specialized for language, whereas the right cerebral hemisphere is aligned with spatial processes. However, studies have called into question adherence to this model and suggested that both hemispheres participate in language and spatial cognition. Using functional Magnetic Resonance Imaging (fMRI) and human brain lesion studies, we determined whether these complementary techniques could clarify issues of hemispheric dominance. Using a modified Benton Judgement of Line Orientation (JLO) test, considered a relatively pure spatial processing task, we found robust and significant (p < 0.0005) bilateral superior parietal lobe activation on fMRI in ten right-handed male adult volunteers. This was corroborated by lesion data in a cohort of 17 patients who showed significant JLO impairments after either right or left parietal lobe damage, with right parietal damage associated with somewhat more severe deficit. Detailed wavelet analysis of the fMRI time-series did, however, reveal a more dominant role of the right parietal lobe in "kick-starting" the task. To our knowledge, this is a novel way of using fMRI to address functional hemispheric differences in a cognitive task that is known to have bilateral representation.

Geriatric performance on the Benton Visual Retention Test: demographic and diagnostic considerations.

We examined relationships between demographic and diagnostic variables and Benton Visual Retention Test performance in older adults aged 55 to 97 years. We derived extended geriatric norms for BVRT total number correct scores adjusted for variables that contributed significantly to the variance. We also investigated BVRT performance in two commonly presenting diagnostic groups: (1) normal adults with memory concerns, and (2) a group with mixed neurologic disorders. Age and education but not gender were significantly associated with BVRT performance in both normals and normals with memory concerns. Level of cognitive deficit was a moderating factor in that age and education also contributed significantly to the BVRT performance of no/low deficit neurologic patients but had no impact in patients whose cognitive deficits were moderate/severe.

Gerstmann's syndrome.

Recent case reports describe the occurrence of a more or less pure Gerstmann syndrome in association with a focal lesion in the posterior perisylvian territory of the brain's left hemisphere. In addition, an electrocortical stimulation study reported the Gerstmann symptom combination and a number of other symptom combinations on stimulation of small areas in the left posterior parietotemporal cortex. The neuropsychological implications of these and other recent findings are considered in light of the variety of "syndromes" produced by lesions in this region, the rare occurrence of Gerstmann's syndrome, and its appearance as a consequence of lesions in diverse cerebral areas.

Constructional praxis performance of Japanese and American, normal and brain-damaged patients.

Numerous studies have suggested population differences between Japanese and Americans concerning various cognitive functions. Transcultural differences in spatial reasoning, language, and dominance for emotional expression raise important questions concerning current conceptions of hemispheric cerebral dominance for cognitive functioning. If cultural differences in cognition exist, learning may play a greater role in determining laleralizalion of cognitive functions than is presently accepted. To investigate these issues, we initiated two collaborative studies comparing Japanese with American normals and brain-damaged patients on the Three-Dimensional Constructional Praxis Test. In normal subjects, there were no significant differences between the two cultures in the distribution of visuoconstructive ability. In patients with brain damage, the effects of unilateral brain lesions and their neuropsychological consequences on visuoconstructive ability were similar in both cultures. Thus, there are no apparent differences between the Japanese and American peoples in visuoconstructive abilities, or in the underlying cerebral organization of skills required to execute these functions.

Neuropsychologic detection of abnormal mental decline in older persons.

We conducted comprehensive neuropsychologic assessment in normal 60- to 88-year-old persons and in patients with dementia of various causes, matched for age and sex. Patients with dementia performed significantly poorer on tests of short-term memory, temporal orientation, visual perception, and language. Further data analysis, including multivariate classification procedures, identified a combination of three tests (Visual Retention, Controlled Oral Word Association, and Temporal Orientation) that in a cross-validation study correctly classified 89% of cases with a high degree of probability. Only 6.5% of cases were misclassified, while 4.5% were in a questionable, borderline category. The battery constituted by these three discriminating tests provides a brief, easily administered neuropsychologic screening instrument that may be used by a variety of health professionals for the detection of abnormal mental decline in older persons.

Problems and conceptual issues in neuropsychological research in aging and dementia.

Neuropsychological investigation of old age and dementia faces all the problems associated with more general gerontological study. In addition, some specific difficulties in attempting to infer cerebral status from behavioral observation arise. These include uncertainty about the nature and course of normal aging, about the influence of disease and affective disturbance on performance, and about the significance of diverse interactive effects. Further, the concept of dementia requires clarification. These issues are addressed and their clinical implications discussed.

Dyslexia and spatial thinking.

Impairment in spatial thinking has figured prominently as an assumed cause of developmental reading disability. The empirical findings relevant to the idea, with special reference to right-left orientation, visuomotor and visuoconstructive performances, and finger recognition are examined. It is concluded that, although some dyslexic children do show spatial disabilities, there is little evidence to support the existence of a visuospatial type of developmental dyslexia.

Visuoperceptual performances in aging and dementia: clinical and theoretical implications.

Spatial and nonspatial visuoperceptual abilities were assessed in normal older subjects (65-94 years of age) and in a sample of age-matched patients with various forms of dementia. Steady, moderate decline was evident with increasing age in normal subjects but severe visuoperceptual impairments occurred in many dementia patients, indicating that such assessment may be of benefit in the detection of abnormal mental decline. Dissociations in performance were frequent among dementia patients but not among normals, suggesting that dementia may be manifested in differential perceptual-cognitive decline.

Visuospatial performance in left-handed patients with unilateral brain lesions.

A test of visuospatial judgment was given to left-handed patients with lesions of either the right or left hemisphere. In right-handed patients impaired performance on the test has been found to be almost exclusively associated with right hemisphere disease, the performance of patients with left hemisphere disease being comparable to that of controls. The left-handed patients in this study showed the same performance pattern: a high proportion of patients with right hemisphere lesions performed defectively while all the patients with left hemisphere lesions performed on a normal level. Thus the findings are in accord with the conclusion that hemispheric cerebral organisation with respect to the mediation of visuospatial performance do not differ in right-handers and left-handers.

Qualitative aspects of pantomime recognition defect in aphasia.

This study investigated the performance pattern of aphasic patients on a pantomime recognition test in which one of the four response alternatives was an object semantically related to the correct choice. Aphasics with defective pantomime recognition made 71% of their total errors on the semantic foils, and for the majority of such patients, semantic errors represented 80 to 100% of total errors. Only aphasics with objective evidence of confusion failed to make highly frequent semantic errors. The findings suggest that most aphasics who fail pantomime recognition are impaired because of semantically vague understanding of the pantomimes' intended meaning rather than complete lack of understanding of the pantomime.

Point localisation in patients with unilateral brain damage.

The ability to reproduce the position of points in a plane was examined by a copying test in a control group and in unilaterally brain damaged patients. The procedure was designed to minimise the influence of visual field defects and of spatial hemi-inattention on performance. Accuracy of of localisation and direction of errors were studied in each half of the plane. Analysis showed a greater impairment of localisation ability in the patients with right hemisphere disease; however, the performance of both hemispheric groups was characterised by a reduction of accuracy in half of the plane contralateral to the side of the lesion. Both hemispheric groups showed an abnormal direction of errors in the left half of the plane, but the two groups presented a different pattern of errors.

Normative observations on neuropsychological test performances in old age.

As part of a study of dementia, 162 normal volunteers in the age range of 65-84 years were given a battery of nine neuropsychological tests assessing temporal orientation, short-term memory, language functions, and visuoperceptive capacity. When compared to subjects less than 65 years of age, the groups showed little evidence of generalized decline in cognitive function before the age of 80 years. The 80-84 years subgroup showed a higher overall failure rate on the tests than the younger subgroups. Nevertheless, 70% of all subjects in the 80-84 years subgroup made no more than one failure on the nine tests. There were substantial differences among the tests in respect to their sensitivity to the effects of aging. The largest decline in performance was shown on tests of short-term visual memory, serial digit learning, and facial recognition. The other verbal, memory, and visuoperceptive tests were performed well up to the age of 80 years. The findings are interpreted as providing limited support for the hypothesis that normal aging does not necessarily involve a general decline in level of cognitive functioning. The clinical application of the tests that were sensitive or insensitive to the effects of aging is considered.

Prediction of outcome in anorexia nervosa from neuropsychological status.

To evaluate the possibility that subtle brain dysfunction may exist in anorexia nervosa and indicate a poor prognosis, 20 anorexia nervosa patients received neuropsychological assessments covering a broad array of cognitive performances. The patients were examined at admission and again at the end of an inhospital treatment program when they were at normal weight for their age and height. Pretreatment performance on the assessment battery was not associated with outcome 1 year after discharge. However, posttreatment performance and significantly associated with outcome. A majority (71%) of patients with two or more cognitive deficits showed an unfavorable outcome (i.e., did not maintain their weight). In contrast, a majority (85%) of patients with less than two cognitive defects had a favorable outcome (i.e., maintained or increased their weight). The findings suggest that the hypothesis of a central nervous system disorder limiting the capacity for anorectics to recover deserves further exploration.

Facial recognition in patients with focal brain lesions.

The performances of patients with radiologically or surgically verified focal lesions on a test requiring the identification of unfamiliar faces were investigated. Nonaphasic patients with posterior right hemisphere lesions and aphasic patients with substantial impairment in language comprehension showed a notably high frequency of defect. The frequency of defective performance in nonaphasic patients with right anterior lesions was higher than normal but less than that of the previously mentioned groups. Nonaphasic patients with left hemisphere lesions and aphasic patients without substantial impairment in language comprehension performed on a level comparable with that of control subjects. It is concluded that the identification of unfamiliar faces is a bihemispheric process, possibly involving linguistic as well as visuoperceptive components.