Selected neurodevelopmental delay syndromes and their impact on adult neuromaturation and adjustment.

A selective survey of neurodevelopmental delay syndromes is presented and discussed from neural, cognitive, and behavioral perspectives to highlight their impact on adult neuromaturation, learning abilities, psychosocial expression, and psychiatric adjustment. Emphasis is placed on the discussion of major factors and issues that influence neurodevelopmental delays, dysfunctions, and selective clinical examples of how they are manifested in adult adjustment.

Hooper Visual Organization Test performance in lateralized brain injury.

The Hooper Visual Organization Test (VOT) is frequently used in measuring the cognitive functioning of brain-damaged patients. It is not clear, however, whether the VOT measures general or specific neurological dysfunction, specifically those resulting from right parietal lesions. The present study addressed this issue by examining archival data from 41 brain-damaged patients who were seen in a medical hospital's acute rehabilitation unit. Patients were selected on the basis of a diagnosis of either right or left hemisphere damage, and VOT scores on these two patient groups were compared. Additionally, lesion site, as measured primarily by CT scan, was compared with VOT scores. No significant hemispheric differences were found on VOT scores. However, VOT scores, when adjusted for age and education, were significantly lower in patients with lesions involving the right parietal lobe. The implications of the findings for the use of the VOT with brain-damaged individuals are discussed.

Re-examination of CPM performance and neglect in lateralized brain injury.

The current study examines the effects of lateralized brain injury on Raven's Coloured Progressive Matrices (CPM) performance. Archival data on 106 unilateral brain-damage patients, 59 with right hemisphere damage and 47 with left, was utilized to examine four aspects of differential performance. Right brain-damaged subjects performed significantly lower than left brain-damaged subjects overall on the CPM. They also showed evidence of a higher incidence of and greater severity of hemi-neglect. After partialling out the effects of hemi-neglect, the subject groups were no longer significantly different on overall CPM performance. Evidence supporting the presence of heterogeneous subtests was not found. The results support the emerging pattern in research findings indicating that hemi-neglect plays a central role in differential performance. The CPM appears limited in its application and interpretation for patients with hemi-neglect.

Comparison of seven psychometric instruments used for evaluation of treatment effect in Alzheimer's dementia.

Standards of assessment of treatment effect in Alzheimer's disease have been wanting. We report here a comparison of seven methods of assessment of the severity of Alzheimer's disease used in demented subjects (n = 18) and in nondemented controls (n = 18). The instruments tested were the Names Learning test, the Orientation test, the Mini-Mental State Examination, the Alzheimer's Staging Scale (the AZSS), the Global Deterioration Scale, the Clinical Dementia Rating Scale, and the Alzheimer's Deficit Scale (ADS). Two examiners did the testing per telephone methodology, and test/retest design. Results showed all tests to be reliable. A ceiling and/or basement effect was noted in all but the AZSS and the ADS.

Oral tetrahydroaminoacridine in long-term treatment of senile dementia, Alzheimer type.

We treated 17 patients who had moderate to severe Alzheimer's disease with oral tetrahydroaminoacridine (THA), a centrally active anticholinesterase, in a three-phase study. In the nonblinded first phase of the study, significant improvement occurred in subjects who received the drug, as compared with their pretreatment status, on the global assessment (P = 0.001), the Orientation Test (P = 0.001), and the more sophisticated Names Learning Test (P = 0.001). During the second phase, the subjects served as their own controls in a double-blind, placebo-controlled, cross-over study in which the order of administration of the drug and placebo was randomly assigned. Among the 14 subjects completing Phase II, THA treatment produced significantly better results than placebo on the global assessment (P = 0.003), the Orientation Test (P = 0.004), the Alzheimer's Deficit Scale (P = 0.003), and the Names Learning Test (P = 0.001). Twelve subjects have entered Phase III, which involves long-term administration of oral THA. The average duration of treatment in these subjects at present is 12.6 months; symptomatic improvements have occurred, and no serious side effects attributable to THA have been observed. These encouraging initial results suggest that THA may be at least temporarily useful in the long-term palliative treatment of patients with Alzheimer's disease. We stress that further observations will be required before a clear assessment of the role of this agent can be made.

Cognitive information processing and learning mechanisms of the brain.

The view that the two cerebral hemispheres of the human brain are characterized by different cognitive processing modes that handle information received in various forms is commonly accepted by neurobehavioral scientists and neuropsychologists. Selected neuroanatomical, electrophysiological, neurochemical, biochemical, and neuropsychological data that bear on a cognitive information-processing model of the brain are presented. Processes involved in memory functions are discussed in regard to the nature of thought and the characteristics of mental life, e.g., internalization of thought, perception, arousal, attention, cognitive development, problem solving, the development of cognitive encoding, and selective recall. We present a position that argues for the brain as being flexible vs. fixed in its characteristics and limitations, drawing from various theories and viewpoints. We also present a review of selected mechanisms believed to be involved in brain-behavior processes, e.g., learning, cognition, pain, emotion, reward, cognitive development, and memory formation. A major theme addressed in terms of human information processing is that cognitive functioning, in a variety of instances, comprises subsets of more general processes, e.g., selective recall, cueing that is capable of addressing schemas, notions of inhibition and disinhibition, and the modulation of excitatory properties of certain neural transmitter substances. Questions such as "how is information stored in memory in the first place?" and "how do elements of motivation (i.e., goal orientation) get connected and then send their messages to appropriate inbound behaviors?" are addressed from the point of view that learning, although not understood completely, is somehow involved. Another unresolved question of theoretical and practical significance that we address is "how does learning result in neural connections?" Such questions are discussed in light of their implications for human memory, thought, and behavioral events.

Dopaminergic (DA) systems: their role in pathological neurobehavioral symptoms.

Two established dopamine (DA) systems (i.e., the nigrostriatal and the mesolimbic-mesocortical) are the focus of this article. Their neuroanatomy is briefly outlined to relate neurochemical with neurobehavioral events and alterations in DA-affected systems with the behavioral consequence. Selected theories and major ideas related to DA systems and their implicated role in neurobehavioral symptoms that have emerged over the last decade are included. Correlations with behavioral consequences of disturbances in DA systems lack clarity as to precisely known clinical effects relating to human behavioral and motor acts. The purpose of this article is to review selectively the literature pertaining to two of the six major DA mechanisms. The principal question addressed in this article is, "How do DA mechanisms promote neurobehavioral consequences such as the symptoms of schizophrenia?" Other topics covered include Parkinson's disease, Huntington's chorea, and intracranial self-stimulation drive-reward mechanisms. These clinical features and their possible underlying basis are discussed in terms of evidence suggesting that DA neurotransmitter alterations are likely to be several steps removed from a primary causal locus, which has more than one biochemical or neurotransmitter mechanism.

Current neuropsychological approaches in assessment, rehabilitation, and clinical research of central nervous system disorders.

A current review of selected clinical neuropsychological approaches in the assessment, rehabilitation, and clinical research of central nervous system (CNS) disorders is presented. Clinical neuropsychology occupies a unique place among the sciences of the human nervous system. Over the past 50 years it has been concerned mainly with brain systems involving human psychological activity and its organization and how these systems are altered upon disturbances in brain-behavior functions. The field of clinical neuropsychology differs from other groups of neurological disciplines in that its major goal to introduce selected neuropsychological functions involving the higher cortex, to discriminate between functional and structural disorders, to standardize the collection of base line information needed in assessment of the efficacy of rehabilitation techniques, and to define the role of neuropsychology in building conceptual models of the brain's functional organizaton from research. The topics covered are neuropsychological test batteries, the systems of Luria and Halstead-Reitan, implications for rehabilitation planning, and current research and its application for the future use of neuropsychoclogical test batteries.

Coding A and coding B of the WISC are not equivalent tasks.

WISC Coding A and Coding B were administered to 50 subjects with minimal brain dysfunction and 75 controls whose ages ranged from 7 yr., 8 mo. and 0 days to 8 yr., 3 mo. and 30 days, with half of each group above 8 and half below. Standard scores showed significant differences between Coding A and Coding B suggesting that the two tasks are not equivalent forms. These differences suggested that separate information-processing modes related to hemispheric dominance may be present. Coding probably should not be used in calculating IQs but Coding B should be retained and separately utilized because it is directly related to symbol learning.

Methylphenidate: a review.

Methylphenidate is a useful, proven method for the effective treatment of minimal brain dysfunction (MBD). Dosage should be titrated individually for each patient, and it is best to start with small doses given at least 15 to 30 minutes before meals. Toxicity, side effects, and drug abuse are not major problems. Unfortunately it is not yet possible to determine in advance who will and will not benefit from drug therapy; not all patients do. Treatment of MBD requires a multidisciplinary approach, for no one discipline alone can satisfactorily solve the problems involved. We believe, however, that medicine is the primary therapy in most instances.