Journal of Clinical and Experimental Neuropsychology

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Abstracts To cite this article: (1992) Abstracts, Journal of Clinical and Experimental Neuropsychology, 14:3, 369-402, DOI: 10.1080/01688639208407612 To link to this article:

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Symposium 1

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Organizer and Chair: D. Bowers Discussants: U. Fritb and K.M. Heilman

The focus of this symposium is on children who present with unique abnormalities in social communication. Such children have been described by researchers over the past 20 years from numerous perspectives and various discipline-specific labels have been applied (social emotional learning disability, nonverbal learning disability, righthemispheredeficit syndrome, Asperger’s syndrome, autism). One common thread that links these subsets of children is the presence of chronic social impairmentsinvolving aspects of both verbal and nonverbal pragmatic communication (i.e., facial expression, prosody, and gesture). In this symposium, children with these “social deficits” will be approached from neurologic, behavioral, neuropsychologic, and psychiatric perspectives. One crucial question is whether these various “syndromes” reflect different points along a “spectrum”of related disorders and whether they share similar neurobiological underpinnings. K.K.S. VOELLER. Neural Substrates of Social-Communication Disorders in Children. It is hypothesized that right-hemisphere lesions in children will result in impaired ability to comprehend and produce social signals. Based on a study of the impact of lateralized cerebral lesions on affective processing in children, data from 30 children (18 controls, 6children with right- and 6 with left-hemispherelesions, documented by MRI scan) will be presented. All children underwent an extensive neurological, neuropsychological assessment that included specific assessment of the ability to comprehend and produce social signals. Preliminary results suggest that the ability to process both facial and prosodic affect is present in normal young school-age children. Young children with RHD are impaired in their ability to process facial affective information. This suggests that the right hemisphere is specialized for affective processing in children as it is in adults.

B.P. ROURKE. Syndrome of Nonverbal Learning Disabilities: Psychosocial Manifestations in Neurological Disease, Disorder, and Dysfunction. The syndromeof Nonverbal Learning Disabilities (NLD) is characterizedby deficient performances in visual-spatial-organizationalabilities,complex psychomotor and tactile perceptual skills (both usually m 6 e marked on the left side of body), and conceptuuaUproblem-solvingabilities.Over the course of development, above-average facility in single-word reading and spelling and below-average skills in mechanical arithmetic are evident. Extreme difficulties in dealing with novel and otherwise complex material are especially apparent. Automatic, rote-language skills become increasingly well developed and psychosocial disturbances of the internalized variety become more apparent with advancing years. These and other developmental manifestations of the NLD syndrome are examined within the context of several types of neurological disease/developmenral disabilities, including cranio-cerebral trauma, hydrocephalus, callosal agenesis, and autism/Asperger’s syndromes,and are related to a neurodevelopmental model (Rourke, 1989) designed to encompass these manifestations. M.K. MORRIS. Social-Emotional Learning Disability. Abnormalities in social+/communicativebehavior characterize some subtypes of learning-disabled children, particularly those with arithmetic disability. Social deficits may be secondary to primary cognitive deficits, particularly in visuospatial ability, which also characterize this subtype. Alternatively, social-emotional behavior may be subserved by independent neural networks, dissociable from nonemotional processing systems. In contrast to previous studies that have selected subjects based on cognitive/acadernic disability and assessed their social functioning, we have selected children for the presence of qualitative social abnormalities. A wide range of cognitive/ academic skills was represented. Socially impaired children were impaired in the interpretation of facial/prosodicaffect relative to clinical and normal controls.

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F.G.E. HAPPE. Cognitive Models of Socipl Communication Dmrders: Insights From Autism. Children with social and communicative disorders may receive many different diagnoses. from Nonverbal Learning Disability to Asperger's syndrome. It may be impossible to draw clear distinctions between these different disorders on the basis of surface behaviom, which seems to form a continuum of impairment. Cognitive theories. however. may allow us to "carve nature at the joints", to distinguish different con deficits. This "fine cuts" methodology has helped refine our expianations of the socialand communicative impairments in autism. Experiments arc reported which explore the cognitivemechanisms 7 for understanding figurative language, the^ impairment in autism, and their role in social understanding. Implications of this work for other syndromes of social and communicative impairment are discussed.

K. AHOLA, J. VILKKI, & P. HOLST. The Predktiom d Outcome After Closed-Head Injury (CHI) With Neurobchaviollral EvaIuation. The behavim of 51 CHI patients was evaluated usingLevin'sNeurobehavidRathgScale(?+lRS) 4 months postinjury by a psychologist who also predicted the future work status of the patient. A factor analysis of the NRS items yielded three factors (Cognitiveand Motor Ineffiiency, Depression. Emotional Reactivity) which were partly

similartotheEscasnpaedbyLevia~ and depression factor scored w m signirrcantly correlated to the OLsgOw ouiume s c m (GOS) and work status. A s t n ~ ~ t u r interview ai of the patient's closest m h t i revealsd ~ three factors of psychosocialncavay:deaease m social activities, impulsiveness.and social withdrawal. The inefficiency factor score8 were correlated to impulsiveness. Depression or reactivity were not related to social ncovery. The psychologist's prediction of the patient's futun work status was most efficient in predicting outcome. It comlated especially with GOS and work suitus but also with psychosocial recovery.


8:30-1050, Joachim Hall Chair: L.E. Trexler

J. VILKKI, P. HOLST, & K. AHOLA. Mental Programming Predicts Psychowcia1 Recovery After Closed-Head Injury (CHI). The aim was to demonstrate that a factor of mental programming can be identified in cognitive test results and that it predicts psychosocial recovery after CHI. A series of 51 CHI patients was examined with a test battery 4 months after injury. Pmgramming (i.e.. aprocess in which the subject analyses the task requirements into subgoals by which he or she aims to reach the final goal in an optimal way) was measured with a spatial sequence learning by standardand self-set subgds. The programming score dependedon the subject's ability to set subgoals appropriate for his or her learningcapacity. A factor analysisof 11 variables yielded two factors: Cognitive Skills (WAIS subtests and memory) and Mental Pmgramming (in spatial sequence learning and sorting). The programming factorpredicted return m work and good psychosocial recovery evaluated by a close relative of the patient 1 year after CHI, but was unrelated to the Glasgow Outcome Score (GOS) evaluated by a neurosurgeon6 months after CHI.The factor of cognitive skills was associated with GOS,but was unrelated to work status and psychosocialrecovery.

S. McDONALD. Hints and Innuendo: Does Subtlety Exist After Head Injury? Indirectspetchactssuchashintsarcanimportant aspect of normal discourse. Formulation of effective hints requires a capacity to think at a conceptual level and also to be able to inhibit the desire to state one's intentions baldly. Given that closed-bead injury (CHI)frequently results in frontal-lobeinjury leadingtorigid collcnte thought prccessesanddisinhibition,suchpaticntsmaywell be compromised in this form of communication. In order to explore this, CHI subjects and normal controls were given a task in which they were required to make socially acceptable requests in the form of hints. As predicted CHI subjects, in coneasttoconuols,wereunablctous+ccnccptuslly remote references and were also unable to refrain from stating their request baldly. G. KINSELLA, A. MANDALIS, & V. ANDERSON. Procedural Learning in He8d-Injured Children. The primary aim in the study was to examine the nature of learning and memory functioning in a sample of severely head-injured chiidnn (-18) using the proccdural-declarative distinction of memory systems. In comparison to a matched sample of newologically intact children (r(118).the head-injured children demonstrated deficits on a procedural learning task (jigsaw puzzle assembly) as well as on the more traditional measures of declarative memory (verbal word list learning). Frontal system functioningwas also examined and

ABSTRACTS contrary to hypothesis was not related to prqcedural learning but interestingly was related to declarative memory.

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Symposium 2 THE RELATIONSHIP BETWEEN NEUROPSYCHOLOGICALDEFICITS AND BRAIN ABNORMALITIES I N DISORDERS OF CHILDHOOD INSIGHTS PROVIDED BY MAGNETIC RESONANCE IMAGING AND SPECTROSCOPY 1050-1245, Room ED-101 Organizer and Chair: F. Vargha-Khadem Discussant: G.D. Jackson This symposium attempts to integrate neuroradiological findings with patterns of neuropsychological dysfunction in patients with neuro-developmental disorders. A variety of aetiological conditionsresulting in neuropsychological deficits are considered and. overall, the presentations provide support for the conclusion that such deficits are reflections of underlying structural, morphological, and/or degenerative pathologies. The presentationsprovide a basis for a direct link between cerebral pathology and cognitive dysfunction in childhood disorders. G.D. JACKSON, R. CORCORAN, P. THOMPSON, D. UPTON, J. DUNCAN, & A. CONNELLY. Neuropsychological Deficits and High-ResolutionStructural Magnetic Resonance Imaging in Patients With Intractable Complex Partial Seizures. Patientswith severe intractablefocal epilepsy may be considered for ‘curative’ surgery if the site of seizure origin can be lccalised, and the surgery performed without causing unacceptable cognitive deficits. Recently, we have developed a MR technique to preoperatively assess hippocampal pathology with a high degree of sensitivity and specificity. To date, 25 patients with intractable focal epilepsy from an outpatient epilepsy clinic have undergone detailed neuropsychological testing and MRI at 1.5 tesla, both reported blind to other clinical information.There was good concordance between MRI-detected lesions and neuropsychological data regarding lateralisation and localisation of cerebral pathology. Focal hippocampal damage also correlated with decreased verbal or performance IQ appropriate to the side of the lesion.

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Correlation of 1H Magnetic Resonance spectroscopy (MRS) With Neuropsychology in Children with Intractable Epilepsy. Neuropsychological deficits in epilepsy may be due to developmental abnormalities that are the cause of the epilepsy, or they may be secondary to the effects of seizures or drugs. Abnormalities of the hippocampus and temporal lobe are common in intractable focal epilepsy. Magnetic resonance imaging (MRI) has allowed reliable assessment of the mesial structures, while M R S can monitor neuronal loss or damage through changes in the N-acetyl aspartate (NAA) signal. MRI, M R S ,and neuropsychological asSessment were carried out in 13 children with inuactable seizure disorders. Imaging and spectroscopic abnormalities show good correlation with neuropsychologicalprofiles with regard to side of abnormality and bilateral vs. unilateral involvement. In this presentation, the M R S results are discussed in detail and related to functional deficits. A. INCISA DELLA ROCCHETTA, F. VARGHA-KHADEM, A. CONNELLY, & C.

POLKEY. Selective Right Mesiotemporal Lesion and Supraspan Spatial Learning in Childhood. Temporal lobectomies that include. the hippocampus impair incidental learning of supraspan verbal and spatial sequences. Right Selective Amygdalo-hippocampectomy (AH) in a 10-yearold boy (case SR) provided the opportunity to test whether a lesion limited to the amygdala and the hippocampus will impair spatial supraspan learning. Magnetic Resonance Imaging (MRI) and Spectroscopyallowed verificationof extent of the surgical lesion and of the absence of structural abnormalitieselsewhere. Postoperative MRI confirmed that the surgical lesion was limited to the mesial structures and that thec o n t r a l a d temporal lobe was normal. The neuropsychological findings demonstrated impaired incidental learning of a supraspan spatial sequence but normal learning of a digit sequence, thereby confirming the Original hypothesis and suggestingthat the effect of aright mesial temporal lesion on spatial sequence learning may be similar in childhood to the effects of such a lesion in adulthood.

F. VARGHA-KHADEM, E.B. ISAACS, & K.E. WATKINS. Medial Temporal-Lobe Versus Diencephalic Amnesia in Childhood. Chronic anterograde amnesia resulting from either mesial temporal-lobe or diencephalic damage in childhood is a rare occurrence. Two boys with amnesia of differing aetiology and age of onset showed impairment in the acquisition and retention



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of declarative knowledge. Case JF had normal

development except for a memory and learning deficit developing from age 4. Case JL became amnesic at age 12 following diagnosis and excision of a cmiopharyngioma of the pituitary. MRI scans showed bilateral mesial temporal sclerosis and hippocampal atrophy in the case of JF and ventral diencephalic pathology encompassing the mammillary bodies in the case of JL. At age 13, both patients were impaired in tests of declarative memory whereas performance on tasks of procedural memory was normal. It is concluded that the evidence from childhood amnesia is consistent with the distinction in adulthood between declarative and procedural memory systems. Paper Session 2 DEMENTIA 1050-12:45, Joachim Hall Chair: A.M. Raymer

B. ANDREE, M. HITTMAIR, & TH. BENKE. Recognition and Explanation of Proverbs in Alzheimer’s Disease. The ability to explain common proverbs was studied in 14 subjects suffering from dementia of the Alzheimer type (DAT) in the early to mid stage of the disease and in a group of age- and education-matched controls. A separate analysis of recognizing and explaining revealed that DAT patients were quite good at understanding the proverbs, but had difficulties in explaining them. Frequent error patterns were wrong, incomplete, circumstantial. and long-winded explanatory attempts, whereas literal and “concrete” interpretations were found only rarely. Thus, the DAT patients’ poor ability to explain proverbs may rather be caused by metalinguistic and problem-solving deficits than by loss of abstract thinking, as claimed by other studies. T. HAMANAKA, A. MATSUI, K. HADANO, T. KATO, S. YOSHIDA, S. TSUBOI, H. MIZUTANI, & T. BANNO. Slowly Progressive Cognitive Impairments Caused by Predominantly Right-Hemisphere Pathology: Report of Two Cases with PET-Findings. In the past only a limited number of cases have been reported presenting as slowly progressive selective cognitive disorders (agnosias, apraxias, etc.) without generalized dementia, presumably caused by cerebral degenerative diseases. This paper details one case of dressing apraxia and visuospatial impaitments and another with modality-independent selective amnesia for familiar persons. Case 1 exhibited predominant hypometabolism (PET-FDG) of the right parietal lobe,

while Case 2 showed moderate atrophy lurd predominant hypometabolism of the right ternpod lobe. WAIS revealed the preserved VIQ (Case 144-87, Case 2==) in both right-handed patients. Them were no global amnesic syndrome nor dementia (DSM-3-R) during 2-3 years postonset.

S. CLYDESDALE & A. KERTESZ. Comparative Changes of Language Abilitiics im Alehcimer’s D i s a w and Multi-Infarct-Dementia. Forty-eight Alzheima’s disease(AD) Matsand 13 Multi-hfarct-D6mentia (MID) patients, diagnosed using DSM-3 and“CDS-ADRDA~riteth, were administmd the Westera Aphasia Battery (WAB) at baseline, and 1 year later. The dementia groups were not significantly different, either initially or over time, on overall measures of intelligence. dementia, or memory. The MID group’s significant greater decline in a comprehension test was not accompanied by greater dysfunction of attention, memory, or praxis. Both MID and AD groups declined equally in tests requiring comprehension of a verbalstimulus anda specific word response, but not in tests using real objects and drawings as stimuli. This discrepancy is attributed to common increasing impairment of a modular mechanism supportingan auditory processinglexical access channel. M. NAKANISHI, K. MIZUNO, K. KAWAMURA, S. YOSHIDA, A. MATSUI, A. OGASAWARA, K. WATANABE, S. OJIKA, . & T. HAMANAKA. Neuropaychological Findings in Leuko-arafosis. The correlation of the severity of leuco-araiosis (LA: MRLT2) and the pertorman~esin a c m prehensive set of neuropsychological tests was investigated in this study on 26 cases with various degrees of LA. The statistical analysis yielded (1) lowered performance to a certain degree in 34 out of 49 test items in casea with sevcrc as compared with mild or moderart LA. (2) significantly po&ive correlation of LA severity and deteriorated performanceon 10(aatnti-tration, digit span, mnestic retrieval, verbal fluency, andcomplex task solution) out of 34 test items, (3) no unequivocal manifestations of cortical dysfunctions (aphasia, apraxia, agnosia). The results suggest a neuropsychological profile which partially overlaps that of subcortical dementia.



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1:45-3:15, Room ED-101 Chair: E. De Haan R.F. KAPLAN, M.-E. MEADOWS, & M. VERFAELLIE. Lateralization of Memory for the Physical Attributes of Objects: Evidence From the PCA Sodium Amobarbital Test. We used the PCA Sodium Amobarbital Test to examine how each temporal lobe mediates memory for objects. Eight temporal-lobectomy candidates were presented with four objects while one hemisphere was anaesthetized. Recall and recognition were assessed following recovery from the drug. Recognition memory was tested with two identical objects, two objects that shared the same name but had different physical characteristicsand two foils. While the two hemispheres did not differ in their ability to discriminate identical and similar objects from foils, the right hemisphere was significantly better at judging whether an object was identical or similar. These data suggest that the right temporal lobe mediates memory for physical atfributes of objects. C. GUARIGLIA, A. PADOVANI, L. PIZZAMIGLIO, & P. PANTANO. Selective Deficit of Visual Imagery in the Left Hemispace in a Right Frontal Lesion. A patient with a large right frontal lesion showed a selective impairment in representation of the left side of mental images. The patient was subjected to an extensive evaluation of unilateral neglect including perceptual (Wundt-Jastrow Area Illusion Test), perceptual-motor (Letter and Line Cancellation tests), and motor (Purdue) tests. Perceptual and perceptual-motor tests were presented both in near (SO an)and far (200 cm) space. In none of these tasks did the patient show any attentional impairment in the space contralateral to the lesion. The presence of a selective representational deficit is discussed in relation to componential models of mental-image generation. N.D. COOK, M. REGARD, & T. LANDIS. Visuospatial Rotations: Which of Two Objects Do You Rotate? Fifty-five adults and 53 children were given eight trials in determining if two geometrical objects are the same or different. All objects were 3-D figures of the Metzler and Shephard type. They were presented askew (not gravitationally stable) and in every left-right, up-down combination. Subjects were then asked which of the two objects in each trial they rotated to obtain their answer. A highly significant tendency was found for right-

handers to rotate objects on the right, and lefthanders objects on the left. There were no sex or age dfferences. Among the 59 subjects for which bimodal (a~ditDv-~iSual) language dominance tests were also given, there was a significant correlation with language dominance, where left-hemispheredominant individuals rotated the right-visual-field object and vice versa. The results are interpreted as supportingthe idea that the dominant“languagemanipulating” hemisphere is also dominant for the manipulation (rotation) of visuospatial objects, and the nondominant hemisphere is employed as a stable “reference” against which the manipulations are compared. Paper Session 4 APHASIA 1:45-315, Joachim Hall Chair: A. Castro-Caldas A. SCHWEIGER & B. HADLER. Preserved Expressive Skills in an Aphasic Actor: A Case Study. The dissociation of expressive from receptive language is now well documented, and the specialization of the right hemisphere for artistic expression has also been hypothesized. We report a case study of a professionally trained actor, WK, who sustained a left temporal-parietal lesion and consequently exhibited impairments in most linguistic functions, such as auditory and reading comprehension, naming, writing, repetition. and verbal expression. Appreciation of syntax in production and reading was compromised, and his speech was laced with a variety of paraphasias. In contrast, WK was able to express himself clearly and fluently in pantomime, to play tunes on the piano with good harmonization (although unable to read music), and could read a Sentence with dramatic expression that was unrelated to the verbal content, so that prosody was unmatched with semantics. Thus, WK exhibits specific deficits in language skills while his ability to use the syntax of nonverbal, affective expression is spared. We suggest that this patient presents evidence that even elaborate syntax of affective expression that may require left-hemisphere mechanisms, can be dissociated from linguistic syntax, perhaps only in individuals who develop nonverbal expression intensively over years.

A.D. FRIEDERICI & H. SCHRIEFERS. Controlled Processes During Language Comprehension in Aphasia. The loss of the automaticity hypothesis as a characterization of Broca’s aphasia is tested in a

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sentence-priming experiment. Agrammatic Broca’s aphasics (n=6),fluent Wernicke’s aphasics (n=5), age-matched (n=17) and student controls (n=22) were tested. Subjects were required to perform a lexical decision on a visual target preceded by a sentence fragment which made a semantically and/or syntactically incorrect context. Broca patients clearly differed from normal controls in that they terminated further integration processes upon the detection of a syntactic violation. In conuast to normals, whose language processes seem to run automatically till the end of the phrase, Broca patients seem to apply controlled processes during language comprehension. K. HADANO, H. TANAKA, Y. MIYAKE, A. TSUJI, S. ISHIGURO, S.M. HASHIZUME, & T. HAMANAKA. Transcortical Sensory Aphasia Caused by Ischemic Lesion of the Left Frontal Lobe. The functions of the frontal lobe are often referred to as “enigma“. “paradox” or even “mystery”. This paper details 5 right-handed patients (2 females, 3 males, 60-80years old) who exhibited the picture oftranscortical sensory aphasia (TSA), caused not by damage to the left posterior or thalamic lesions, as usually reported, but unexpectedly enough by an ischemic cortical-subcortical lesion of the left 2nd and/or 3rd frontal gyms ( B m - a r e a more or less damaged: CT). TSA (first observed on the 6th to 30th day postonset; duration: 1 to 9 months) was preceded by initial muteness in two cases, but not alwaysin others. The findings are discussed in terms of the anatomical substrate of nonpersisting fluency and preserved repetition as well as semantic confusion of frontal-lobe origin. Paper Session 5 MEMORY 3:30-4:45, Room ED-101

Chair: R.M. Bauer A. KERTESZ, M. POLK, & A. KIRK. Visuo-

verbal Dissociation and Semantic Deficit in Dementia. This is a report of experiments in a patient with loss of visuosemantic processing due to degenerative dementia. Behavioral testing suggested visual associative agnosia and transcortical sensory aphasia. Detailed language, memory, and nonverbal performance tests revealed mainly semantic impairments with preserved perceptual processes. Lexicosemantic experiments of categorization, naming, pointing, description of visual and auditory stimuli showed a striking preservation of phonological, orthographic, and visual structural

input and output, and specific impairment of visuoverbal semantics. Consistency of errors argues for loss of knowledge, in addition to internal access deficits. Further dissociations with relative preservation of man-made object categorie.verbs, objects, and lexicosemantic elements contribute to our knowledgeof semantic organization of the brain and its impairment in Alzheimer’s disease.

J.R. HODCES, D.P. SALMON, & N. BUTTERS. Semantic Memory Impairment in Alzheimer’s Dise~se:Fmlhre of Accessor Degraded Knowl. edge? A bamry of nwropsychologicaltests designed to assess semantic knowledge about the same items both within and across different modalities was administered to a group of 22 patients with dementia of Alzheimer type @AT) and 26 matched controls.The DAT patients were impaired on tests of category fluency, picnaming, spoken wordto-picture matching, picture sorting, and generalion of verbal definitions. A reMive preservation of superordinateknowledge on the sorting and definitions test, as well as a dispioportionatereduction of generation of exemplars from low-order categories was noted. Analysis of the errors made by each patient across the different tests revealed a significantcorrespondencebetween the individual items. These findings offer compelling evidence that the breakdown of semantic memory in DAT is due to storage degradation. A.D. BADDELEY, PJ. McKENNA, & L. CLARE. Memory in Scbhophrenia: What is Impaired and Wbat is Spared? An earlier study demolrstrateda substantial degree of memocy impairment in a sample of schizophrenic patients on the Rivemeed Behavioural Memory Test, with the degree of disruption being greater than associated impairments In other cognitive capacities.Thcpesantstudycompmdthememory deficit of 12 patients selected as having memory impairment,while being relatively unimpairedon Mini-Mental-State Examination with a control group matched for premorbid IQ as estimated by the NART. The study confirmed the episodic memory deficit using Warrington’sname and face recognition memory tests, and a test of prose recall. Semantic memory was then assessed using the Mill Hill Vocabulary Scale, a categoryjudgement test, and a sentence verification test. Significant impairment was found on Mill Hill (p < .01). sentence verification speed (p < .001). and m u racy of sentence verification and categorization (p c .01). Procedural and implicit memory was then tested using the pursuit rotor, jigsaw completion, reading of transformed script, primed homophone spelling, and word stem completion. Although overall performance on some of these



showed impairment. rate of learning was comparable in schizophrenicand control subjects. Similaritiesand differences to other memory disorders are discussed. tests


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k304.45,Joachim Ha11 Chair: K.M. Heilman L.X. BLONDER, A. BURNS, D. BOWERS, R.W. MOORE, & K.M. HEILMAN. Spontaneous Gesturing Following Right-Hemisphere Damage. Studies of spontaneousgesturing have largely been limited to left-hemispheredamaged (LHD) patients. Given the role of the right hemisphere in nonverbal communication,we postulated that righthemisphere damage (RHD) would produce decreased gesturing in the hand ipsilateral to the lesion (the nonhemiparetic hand). We compared spontaneousgesturing in RHD patients, LHD patients,and normal controls (NHD) during videotaped interviews. Two judges coded expressive, symbolic, grooming, and repetitivegestures in 120 ten-second segments of videotape per patient (Kappa = .49-.70). We found that RHD patients made significantly more total gestures and grooming gestures with the hand ipsilated to their lesion than did LHD patients. There were no differences between the right and left hands of NHD patients, suggesting that RHD produces enhanced gesturing, particularly involving auto-grooming behavior. D. LeGALL, J.L. TRUELLE, P.A. JOSEPH, P. MERCIER, G . AUBIN, C. DEROUESNE, & M.D. LEZAK. Gestural Disturbances Following Frontal-Lobe Lesions: A Qualitative Analysis. This systematic examination of Luria's semiologic theories was undertaken to identify the types of gestural errors most closely associated with lesions in different frontal subdivisions. Seventy-five patients with defined and limited frontal involvement were examined by a protocol assessing gestural activity.Three types of errors were identified: simplification, deautomatization,and disinhibition. Simplification was linked with prefrontal lesions (p < .05), deautomatization was associated with premotor lesions (p c .001),disinhibition was linked with lesions in orbitomedial areas (p < .OOOI). Demented controls and patients with postcentral lesions also made the three types of errors but with different frequencies as 67% of errors made by demented patients were simplifi-

cation, while the errors made by patients with postcenual lesions were predominantly deautomatization (65%).

M.L. GREENWALD, LJ. GONZALEZ ROTHI, L.M. MAHER, A. CHATTEWEE, C. OCHIPA, & K.M. HEILMAN. Impaired Tool Knowledge With Reserved Object and Action Knowledge in Limb Apraxia. We describea previously unreported typeof apraxia error (i.e.. HAND) which provides evidence for the fractionation of tool, action, and object knowledge in limb praxis. We observed the HAND error in a task wherein subjects were pmsented with an object to be acted upon and were required to pantomime the use of an imagined tool upon the object. In the HAND error, the subject appears to lack knowledge of the mechanical advantage afforded by tools and uses his hand to perform the action directly upon the object. This is distinct from a Body Part as Tool error, which does reflect the tool's presence. High incidence of HAND errors appears to be associated with the co-occurre.nce of poor auditory comprehension and left-hemispheredisease. Poster Session 1 8:30-400, Caedmon Hall A. ASBJaRNSEN, K. HUGDAHL, P. IVERSEN, & B.H. JOHNSEN. Perception of Facial Emotional Expressions: Does the Sex of the Stimulus Interact With the Sex of the Subject? Visual half-field (VHF) studies of lateralization of facial emotional expressions have not been conclusive. A possible confounding factor is that the sex of the stimulus face may interact with the sex of the subject. This was investigatedin a 2 x 2 x 2 x 3 factorial design (male/female subjects x male/female stimulus faces x lefvright half-field x positive, negative, neutral emotional expressions). Seventy right-handed subjects (35 females and 35 males) participated. The stimulus faces were taken from the &man standardizedset. Presentation time was 180 ms. Reaction time and accumcy were measured. The results show that females are overall more sensitive than males, and particularly to angry male faces presented to the right hemisphere. Males are particularly sensitive to positive female faces presented to the left hemisphere.

S.R. SCHWEINBERGER, C: BUSE, R.B. FREEMAN, Jr., P.W. SCHdNLE, & W. SOMMER, Memory Search for Faces and Digits in Patients With Unilateral Cerebral Lesions. In a hemifield study, we recently found evidence that the superiorityof the right hemisphere in face

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recognition is related to mnestic but not perceptual processing stages. To clarify whether the impairment of right-braindamaged (RBD) patients in face recognition is related to perceptual or mnestic pocessing stages, we tested unilartlally lesioned patients and conwls in a Smnbexg-type memory search task. Subjects had to memorize sets of 1.2. or 3 faces (or,in a conml condition, digits)and Were then torecognize these memorized stimuli among new ones by speeded choice mctions. In this task, deficits in stimulus encoding and memory search should show up in increased intercepts and slopes, respectively. of the RT function over memory set size. A face-specific impairment of the RBD patient group, consisting in longer reaction times and higher error rates, was confiied but could not be unequivocally attributed to either stimulus encoding or memory search. However, inspection of individual data suggestedthat (1) someRBD patients are virtually unimpaired in face recognition and (2) if impairment after right-hemisphere damage is present,it may selectively affect either stimulusencoding or memory search. J.A. OGDEN, E.W.MEE, & M. HENNING. A

Prospective Study of Memory Impairment and Recovery Following Subaracbnoid Haemorrhage. A series of 90 patients with subarachnoid haemorrhage (SAW graded as alert were assessed on memory tests prior to hospital discharge, at 10 weeks and at 12 months post-SAH. As a group they were impaired on verbal and nonverbal memory tests at discharge, and on nonverbal tests at 10 weeks and 12 months. Regression analyses compared patients categorized according to ( 1 ) site of aneurysm, (2) location of blood on CT,(3) vasospasm and ischaemic deficit (ID), and (4) Grade on admission and discharge and Glasgow Outcome Scale. The main findings were for left and right location of blood, associated with verbal and nonverbal memory impairments respectively at both 10 weeks and 12 months, for ID, associated with impaired verbal and nonverbal memory at all assessment periods,and for Grade on discharge, associated with verbal memory impairment at 10 Weeks. R.J. SIMENSEN. Pre/post Treatment Neuropsychological Assessment in a Patient With Cryptococcal Meningitis (CM). Cryptococcus neoformans, a fungal pulmonary infection. can spread silently resulting in meningeal involvement. Cryptococcal infection is a common mycotic infectionamong AIDS and other immunosupressed patients. The patient was administered the Indiana Adult Neuropsychological

Battery (HaLptead-Ritan) due to referral fos behavioral cbangc. The results WQC coasietent with

a severe ne\lropsychologicaleatity tbat was considered pmgrcssive in ~ t u r e H . ead CT r e v d c d hydrocephalus without atrophy or lesions. LP showed elevated potein. decreased sugar, and pleocytosis. A latex f d o n titer of 1:32 in CSF confirmed the diagnosis of CM.The paticat was successfully treated with Amphotuicin B and Hucytosine.Pretreatmentandporrmeatmeatflmos and 50 m o d ~ y d t d o g k adata l denxmsaated marked positive cbange in PU areas. The initial VIQ of 84 m e to 102. Data availabk for review include the WAIS. WRAT. Trails,TPT,Category Test, Seashore Rhythm, Speech Perception. Aphasia Screening,tapping, hand dynamometer. and sensory measures.

M A .HUA & C.-S. LU. Visuospatial Function in Patients with Multiple System Atrophy. An examinationof visuoqmtid functioning in patients with Multiple System Atrophy was performed. Two subject gmups were employed in the present study. One group was composed of 12 adult patienu and another consisted of 18 normal healthy adults. EPfh subject received a serim of visuospatial function tests including Judgment of Line Orientation. Tbnc-Dimensional Block Construction Test,and FacialRecognition Test Results indicate thatno re-ble impairmentwas evident in patients with Multiple System Atrophy. Since the present results were based on a small sample of patients, furhex investigation to validate the fiidings seems to be mandatory.

H. TANAKA, K. ISOBJC, S. ISHIKAWA, A. TAKEDA, & T. HAMANAKA. A Case d Crossed Pure Ak.i. Following Right Temporal Hemorrhage With M) Lesion in the Splenium. Very few cases of crossad p l ~ alexia e have been reported in the past. A 28-year-old right-handed male with no familial sinistrality developed pure alexia. amnesic aphasia. optic aphasia. memory disturbance, and left homonymous hemianopsia following right temporal hemorrhage aspirated surgically. Alexia tended to be more severe when reading Kana characters than reading Kanji. Reading cwld be improved with kinesthetic facilitation,particularly in Kana. He pafamed much beaer than chance on the task of lexical decision of Kana words and of multiple-choice semantic categorizationof Kanji words which be couid not explicitly read A cranial MRI demonstrated a ksion involving the paraventricular white matter of the right occipital lobe and the basal occipitotemporal area, although tbe spleniumof the corpus callosum remained completely intact.

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ABsmCrs M.D. VAN DEN BROEK, C.M. BRADSHAW, & E. SZABADI. The Relationship Between ‘Impulsiveness’ and Hemispheric Functional Asymmetry. Recent theorising has suggested that impulsiveness may be associated with a deficit in dominanthemisphere information processing, particularly in the Lateralisationof language functions. Thirtysix subjects underwent a divided visual-field task in which four-letter words were presented simultaneously in the left and right visual hemifields. The proportion of words reported in the right hemifield (R%) was significanlly negatively correlated with impulsiveness as assessed by the Matching Familiar Figures Test Age, IQ, and trait anxiety were also independently related to R I . The results support the view that information processing of verbal stimuli in the dominant hemisphere is less efficient in impulsive individuals than in reflective individuals. M.L. BERTHIER. Phonemic Jargon Aphasia With Spared Auditory and Reading Comprehension. A Case Study. The case is presentedof a 63-year-oldright-handed Ucranian-Spanish bilingual man (AG) who developed a phonemic jargon aphasia after a traumatic left inferior parietal-lobe hemorrhage. AG’s verbal production, repetition, naming, and reading aloud were unintelligible, perseverative, and repleted with phonemic deviations, but unlike previously reported patients with jargon aphasia, he did not show the expected deficits in awareness or in auditory and reading comprehension. AG’s performance on a variety of phonological and lexical processing tasks (phoneme discrimination, rhyme judgments, word-picture matching, written word-picture matching, visual and auditory lexical decision, semantic categorisation, and sentence comprehension) demonstrated unimpaired comprehension of spoken or printed words. These findings suggest (1) that a selective damage to the phonologicaloutput lexicon is sufficient to produce a phonemic jargon aphasia, and (2) that impaired auditory and/or reading comprehension or anosognosia are not essential for the production of jargon aphasia.

M.-C. GOLDBLUM, C. TZORTZIS, G.F. DALLA BARBA, M, PANISSET, & P. DAVOUS. Progressive Conduction Aphasia: A Case Study. We report the case of a progressive aphasia in a 75-year-old right-handed woman. The first neuropsychological examination revealed that her cognitive disabilities were confined to left-hemisphere functions,and presented a cluster of features characteristic of conduction aphasia (impaired repetition without articulation and comprehension


deficits), with constructional apraxia, acalculia, and ideomotorapraxia.Six months Later.thegend picture of the. patient remained unchanged from a qualitative point of view. However, her conduction aphasia and related symptoms had all worsened. As far as conduction aphasia is concerned, in addition to the repetition deficit initially observed, a reproduction disorder became evident in the second evaluation. K. SHAHROKHI, M.A. FOLEY, & T. WILLIAMS. Language Function and Agitation in Alzheimer’s Patients. The present study investigated the relationship between specific language functions and agitation in 16 AD patients. Neuropsychologicalassessments and behavioral rating scales were collected on all residents. Measures of language function were correlated with behavioral ratings using Spearman’s Rho. Significant results were found Language production and Agitation (-53, p = .03), Naming and Agitation (-.52, p = .04),Vocabulary and Agitation (-.65, p = .01) and Reading and Agitation (-.74, p = .004). Language comprehension was not significantly related to agitation although the correlation was in the expected direction. The findings suggested that not being able to make one’s self understood appeared to have negative impact on behavior. The current findings also suggested potentially important interventions where caregivers can adjust the language of the environment to the particular needs of agitated patients. A single case study has already demonstrated the usefulness of such an approach. This matching of interventions to cognitive profiles seems especially pertinent in light of the OBRA legislation (OBRA = advance directives). Behavioral techniques that match significant cognitive/ behavioral profiles are discussed. L. WILLIS & M. BEHRENS. Differentiating Neuropsychological Performance in Multi-Infarct and Alzheimer’s Dementia. Levels of performance on tasks of ideomotor apraxia, upper-extremity motor skills, expressive and receptive language were compared between mild to moderate Alzheimer’s (AD) or small-vessel multi-infarct (MID) dementia, and age- and education-matched control groups. Demented subjects were prematched on level of cognitive decline. Hypotheses were derived from recent neurological models of apraxia (Geschwind Heilman & Gonzales Rothi). Performance differed between AD and MID groups. Frontal-lobe performance (expressivelanguage and motor skills) significantly predicted apraxic performance in the AD group. Results, interpreted in terms of the proposed neurological model, demonstrate quantitative and qualitative differences between early AD and MID, that have often resisted differentiation.

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written. It is argued that a -very G. DALLA BARBA & C. WONG. Encoding of the conversion rules led to tbe impmvment. Specificity and Confabulatien in Alzheimer's Dwase (AD) 8nd Amnesla. This study addresses the relationship between K. SUZUKI, T. IMAMURA, & M. SAHARA. confabulption and specificity of encoding in AD fOr tk 'FrOIktd h b C s p and amnesic patients. All subjects (8 AD patients, drome'. 8 amnesics of mixed etiology. and 17 normal A 54-year-old right-handed man was admitted to controls) participated in two experiments which hospital with a 1-month history of increasing differed in encoding conditions of word lists ( e p lethargy, dywrUuh, micrographia, and unstcadiisodic vs. semantic), whereas they were the same ncss of gait On examin8tion. apart from extrapyin retrieval conditions (free recall and semantic ramidal signs, pmmincnt features wen perseveration in writing and speech. and "utilization becued recall). It was found that in n o d subjects and in patients with unimpaired semantic memohaviour". Hc swsd writing without any irrstnrcry the rats of confabulation decnased drastically tion and could not stop despite warning. l demonS0;ltcdbilotanl ksolganglia lcaions. on the s e m a n t i c - e n ~ i n ~ ~ ~ t i c - r e t r i e v aMRI condition compared to the episodic-encodiglseCerebmspind fluid contained slightly incressad mantic-retrievalcondition. By c o n a t in patients protein and cells. Trastment withamantadhe was with impaired semantic memory the confabulathen begun, 200 mg a day. S e v d days later. tion rate was comparably high on cued d l in improvement was obsavcllin gait, pasenration. both experiments. No difference was found acand "utilization bchaviour". One month later,when cording to the etiology of memory impairment. amantadine was withdrawn because of hallucination, the clinical status dueriorpted rapidly. His S.A. RASKM & W.A. GORDON. Cognitive symptomsretumcdto thepmreament kwi. when Remediation of Cognitive Deficits Secondary the treatment with amantedine was recommenced to Exposure to Toluene. 1 month later, b m a t i c improvementoccurred. A case study is presented of an individual who presented for a neuropsychological evaluationand R. SPRENCELMEYER, A.C.M. CANAVAN, cognitiveremediation 10 years following exposure H. LANCE, 10 V. HOMBERG. The Basal to a neurotoxin. i.e.. toluene. She reported her Ganglii: ConditioPal Learning. greatest distress to be from an inability to enjoy Conditional Leatning is impairad after frontal lereading and so she participated in a three-part sesions. But then is evidence that disruption of the quentialcognitiveremediation treatment. The fist striato-thalamo-conicaconicalloops even at subcortical phase involved retraining in basic visual auention levels may also affect fronto-cortical functions. to detail, the second phase involved reading We investigated 10 patients with Huntington's comprehension,and the third phase involved redisease (HD), 10patients with Parkinson's diacasc tention of material that had been read. At the (PD) and 10 controls on a Conditional Learning completion of this training. follow-up nemopsytask, in which subjects had to learn by trial and chological testing revealed that she had not only error arbitrary usociotionS between colours and improved on those tasks which were specifically words. Tats ofmemoryand intelligencewere. also trained, but that the benefits also generalized to a administered. Although HD and PD patients are reduction of faclings of depression. impaired in learning the associations between d o u r s and words, both group are able to reH. GROTZBACH, P. FROMMELT, & U. member verbal itcms and colours used in the SCHMELZER. Treatment of Pboaologieal Conditional Learning task. These data indicate a Agraphia. possible role of the basal ganglia in relating "cues A case study of a patient is presented who suffered to actions". from a phonological agraphia as a consequenceof a left hemispheric stroke involving the suppleEJ.A. SCHERDER, A. BOUMA, & A.M. mentory motor area, supmmarginal and angular STEEN. Effects of Transcutaneous Electrical gyri. On dictation the patient cwld correctly write Nerve Stimulation (TENS) on Memory Deficit 15% of nonwords. 24% of verbs, 40% of adverbs, AgPoelated With Dementia of the Alzbeiwr and 44% of high imaginable nouns. Speach theraType. py focused on a Ppining of the phoneme-graphThe purpose of this study was to examine the ineme conversion rules: First,singk sounds had to fluence of TENS on memay deficit rpsociated be converted into letters. Lam. the conversion of with dementia of the AlzReima type @AT). Assyllables into letter-stringswas trained. After 2 suming that DAT can be considered as a transmonths of daily speech therapy 50% of the nonnwonal rttiognde-, it was hypothesized words, 68% of the verbs, 90% of the adverbs,and that, in the early stage of the disease, electrical 85% of the high imaginable nouns were correctly stimulationcould activate the affected Cortical re-


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gions by stimulatingthe neurotransmittersystems projexting to these areas. The present results suggest that TENS improves not only the patients’ ability to learn new verbal information, but also their ability to retrieve familiar, categorized information from their memory store. Electrical stimulation does not influence the visual long-term memory of the patients, nor does if affect their verbal and nonverbal short-term memory. Underlying thee retical mechanisms are discussed.

S. FAURE & J. BLANC-GARIN. Right-Hemisphere Semantic Performance and Competence in a Case of Partial Interhemispheric Disconnection. The objective of the study was to analyze righthemisphere (RH)implementation in apatient with a partial interhemisphericdisconnection, without damage to the RH. Two tachistoscopic, dividedvisual-field experiments were conducted, focusing on RH functioning in this partial split-brain patient. In the preliminary semantic decision task, RH performance was found to be at chance level. The first experiment was aimed at selectively activating the RH by priming with a spatial activity. The objective of the second experiment was to release RH systems by overloading the left hemisphere. The semanticperformance level of the left visual field improved in both experiments. These findings support our hypothesis of a facilitating effect of RH activation. The results provide convergent evidence of some of the dynamic aspects of cerebral functioning,and specifically the RH’s sensitivity to activation conditions in situations of left-hemispheresuperiority. V. PARLATO, 0. LOPEZ, M. PANISSET, A. IAVARONE, J. CRAFMAN, & F. BOLLER. Dyscalculia as an Early Sign of Alzheimer’s Disease. To verify whether dyscalculia is an early sign of AD we examined 28 probable AD patients in an early stage of the disease and 28 normal controls matched for age and educationallevel. All patients were able to read, understand,and repeat numbers. The ability to perform mental calculation was assessed by two tests: the Stamp Test (ST) and the Serial Seven Subtraction Test (SSST). The other cognitive domains were evaluated with an extensive newpsychological battery. Significant differences in performances on the calculation tests were found between patients and controls. The tasks, ST correlated with attention and vis~~~~spatial whereas the SSST correlated with receptive and productive language. This study suggests that impairment of mental calculation with relative sparingof number processing can be an early sign of AD.


M.L. GREENWALD, LJ. GONZALEZ ROTHI, L.M. MAHER, A. CHATTERJEE, C. OCHIPA, & K.M. HEILMAN. Concrete Object Errors in Praxis Performance. We observed Concrete Object (CO) errors in praxis performance on a task wherein subjects were presented with a tool and required to pantomime the use of that tool upon an imagined object. CO errors occurred when the subject used the tool upon an object in the environment (e.g., sawing the arm of his chair). Unlike previous reports. we observed CO errors on the subject’s own body and on nearby objects. One brain-damaged subject made distinctly more CO errors than the other subjects, suggesting that object knowledge may be represented differently than other f m s of p i s knowledge. However, we also observed CO e m in normal subjects, suggesting tha~these errors may not necessarily be associated with brain pathology.

K. HENKE. Lateralized Perception of Words, Faces, and Pictures Presented Below the Awareness Threshold. Three experiments were performed in order to determine the possible ways of processing “subawareness” stimuli - stimuli presented below the awareness threshold. In these experiments, tachistoscopically and laterally presented pictures, faces, and words were used as stimuli. The influence of the stimuli on the subsequent intuitive recognition decision (orin identification) was tested by controlling for the influence of gender and location of stimulus presentation (visual half-field presentation). The most remarkable fiiding for the series of all three experiments was the clear evidence for subliminal perception. The stimuli were found to be processed up to the semantic level, and the same general and sex-specific principles of lateralization applied as in suprathreshold perceptual experiments. Neither sex was found to be more sensitive overall for all experiments. D.L. MATALLANA. Agnosia Versus Aphasia: Changes Within a Patient as a Result of a Pneumoencephalon Movement. The author describes the evaluation of a patient, FMB. whose performance changed upon the movement of a pneumoencephalon she had after a surgery. On a number of neuropsychological evaluations, F M B presented classical aphasia symptoms when she was in a horizontal position, as well as other frontal related behaviour. As 80011 as FMB changed position, the pneumoencepbalon moved toward posterior areas resulting in a completely different clinical syndromeh o r n when she was seated Visual Associative Agnosia witbout Alexia, mild Prosopagnosia. Colour Agnosia, Si-



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multanagnosia,and Spatial Agnosia. FMB had the pneumoencephalon for about a month, making possible a complete evaluation in both positions. A CT-scan showed a left hemorrhage. However, at clinical evaluation, FMB changed cognitive impairments exclusively in relation to positional changes of the pneumoencephalon. R. BAST PETTERSEN, LO. GOFFENG, & P.A. DRABLOS. Neuropsychological Test Results of Workers Occupationally Exposed to Aluminium. Aluminium has long been considered as virtually nontoxic and as nonabsorbable from the gastrointestinal tract. Studies during the last decade have shown absorption of inhaled and ingested aluminium compounds. The present study aimed to investigate a group of elderly workers (age 63 years) occupationally exposed to aluminium (inhalation): 14 smelter workers, 8 foundry workers, and a control group of 16 workers without occupational exposure to aluminium. The level of aluminium in the urine was significantly elevated in the smelter workers. There was a significant difference in motor (static) steadiness (Kleve-Matthews) in the smelter workers compared to the two other groups. There was a tendency (n.s.) towards slower psychomotor tempo and impaired visual analysis in the smelter workers. Simple reaction time was identical in the three groups. M. J6DAR, M. MATAR6, C. GARCiA, M.A. JURADO, & C. JUNQU$ PLAJA. Attentional Asymmetry in the Elderly. Many studies on the neuropsychological consequences of aging have suggested that there is an asymmetry in cognitive impairment. This asymmetry consisted in a marked right-brainfunctional deficit with a relative preservation of verbal abilities. We have studied the verbal/visuospatial asymmetries using two tests involving sustained attention and visuomotor speed. Tests were administered to 40 healthy older subjects (ages between 65 and 85) and 15 young subjects (ages between 20-27 years). In the older group there were verbal/visuospatial asymmetries in the attentional task (number of omission errors) but not in the mwurement of speed. These results suggest that in normal aging there is an asymmetry in the deterioration of sustained attention and they offer some support for the cognitive asymmetry thesis. D. ERMINI-FmFSCHILLING, M. REGARD, & H.STAHELIN. Memory Training for Patients

in the Early Stage of Senile Dementia. For the last 5 years the "Memory-Clinic" of Basel has been offering memory training (MT) groups

for dementia patients in their early stages. With a repeared-measuredesign we looked at the efficacy of our MT by comparing the cognitive and emotional paramwrs of a therapy ( n = 23) and of a control group (n = 23) before and after 1 year of therapy. The patients were computer matched on the following variables: Diagnosis. MMSE, age, and the Geriatric Depression Scale GDS. The MT group was shown to be less depressed and showed constant or bemr performance than the control group on GDS and MMSE. Alzheimer patients profitedmostfromMTasshownbytestsmeasuring nonverbal fluency and MMSE. D. MONTALDI & G.E. BHUTANI. The Involvement of the Frontal Lobes in Dementia of the Alzheimer Type (DAT): Evidence from Neuropsychologiccll and Regional Cerebral Blood Flow (rCBF) Studies. The involvementof the Prontal lobes in DAT is of particular interest with the emergence of a Frontal Lobe Dementia (FLD). This study investigates the neuropsychological frontal-lobe deficits present in 25 DAT patients and relates them to frontallobe damage. Four muropsychological tests (Verbal Fluency, Delayed Alternation. Subject Ordered Pointing, and the Wisconsin Card Sorting Task) were used. The first three demonstrated that a frontal-lobe impairment is present at all stages of the disease and is related to disease severity. The implicationsof this study for the diagnosisof FLD are discussed. Finally, these neuropsychological findings are discussed in relation to the specific rCBF patterns identified in our patient population using single photon emission tomography.

M. PANISSET, F. BOLLER, & R.-M. MAN$. Visuospatlal Deficits in Parkinson's Disease. The nature of visuospatial disorder of Parkinson's disease (PD)is not well known. Thirty-two patients with idiopathic PD and 21 normal controls were given the Benton Visual Discrimination and Retention Tests (BVDT and BVRT), the Trail part A, and the Stroop test. No difference appeared between controls and MMS-matched patients on the BVDT. but patients were signifiiantly inferior on the BVRT. Patients with lower MMS scores showed a trend for inferior performances on the BVRT and on the Tmil A. Correlations were significant between performances on the BVRT and the Stroop. Patients with PD and normal MMS have visual immediate memory impairment that cannot be explained by visuo-penxptive disorder but rather in part by disturbedexecutive functions. Visuo-spatialdysfunction deteriorateswith MMS scores.

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ABsTRAcrs M. PANISSET, F. BOLLER, V. PARLATO, J.T. BECKER, 0. LOPEZ, & A, GANASIAGANEM. The Trail Making Tests in Mild-Stage Alzheimer’s Disease. The Trail Making Test (TMT) is brief and simple to administer, and thus should be ideal to assess “frontal” functionsin dementia. Twenty-eight AD patients with an MMS of more than 18 and a’high educationallevel (2 12 years) were evaluated with the TMT.With a 240-s limit, no control subject but 8% of patients failed Part A. Seventy-six percent of patients failed part B and so did 4% of controls. Specificityand sensibilityof part B were 96%and 9 5 5 , respectively.This study shows that TMT B is very sensitive in differentiating AD patients from controls, but that it has a strong floor effect even in mildly impaired patients. Other tasks which allow a greater downward extension of performances are preferable, especially for longitudinal studies. J.A. MEERSON. The Recognition and Differ-

entiation of Visual Images in Patients with Local Brain Lesions. Of shape elements we investigated the following aspects: differentiation, classification, spatial transformation, and differentiationof complex signs composed of elements of shapes. Patients did not reveal any form of disorder when the task had sufficientexposure time and a 1-s interval between exposures (ISI). Shortening exposure time to 0.5 s or increasing IS1 to 10 s caused a threefold increase in the differential threshold in occipital patients. Occipital patients could not classify elements of shapes. Parietal patients experienced difficulties in differentiating variously oriented shape elements. The parietal patients had disturbances discriminating complexes differing in the spatial relationship of elements, whereas the occipital patients had difficulty discriminating the separate elements of these complexes. Occipital patients tend to analyze the elements successively, whereas nonoccipital patients perceive the complex as a whole. S.S. BASSETT. Residual Semantic Knowledge in Alzheimer’s Disease: Evidence from Picture Sorting. Research suggests that a loss of semantic knowledge for objects may impede confrontation naming in patients with Alzheimer’s disease (AD). It has been suggested that a difficulty with word production may hinder naming as well. If this is the case, it is possible that tasks that require verbal report do not allow for an accurate assessment of retained semantic knowledge. Twenty AD patients and 20 matched controls were given a confrontation naming test and two category picturesorting tests. AD patients with moderate naming

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deficits retained the ability to distinguish general category membership. but were not able to provide verbal labels for their correct groupings. This suggests that some AD patients retain semantic knowledge evident only on nonverbal assessment.

E.POUTIAINEN 8c I. ELOVAARA. A 2-Year Follow-up of Cognitive Performance of HIV-1Infected Individuals. Cognitive functioning of 14 HIV-1-infected subjects was evaluated three times during a 2-year follow-up period. Ten subjectswere at early stages of HIV-I infection (CDC 11,111) and four had an advanced infection (CDC IVa, c, d). Initially subjects with-any other possible causes of cognitive changes than HIV-1 in history or at present, as well as subjects with Zidovudine treatment were excluded. Cognitive functioningwas evaluatedby neuropsychological examination including testsof intelligence, memory, visuospatial,language, and motor skills. Cognitive performance of subjmts at early infection improved during the follow-up. significantimprovement was found in visuospatial processing (Mental Rotation test, WAIS/PC), and in memory (MQ/WMS. Rey’s Figure). This may be explained by practice effect by repeated measurement. Although depression of the patients at advanced infection was more severe than that of the patients at early infection,no change was found in it during the follow-up period in the two groups. In subjects at advanced infection a trend to improvement was also found in some tests, although not as prominent as in the early-infection group. However, in tests measuring complex mental processing and control (Verbal Fluency, TrailMaking B, Calculation time, Strmp Interference) a declining trend was observed indicating a slight progression of cognitive performance in patients at advanced HIV- 1 infection. J.L. FISK, N. JANAKIRAMAN, & S. O’CONNELL. Cognitive Functioning in Patients Treated with High-Dose Chemotherapy. We report on the preliminary findings of an investigation designed to evaluate whether and to what extent there i s any evidence of cognitive impairment following autologous bone m m w rescue and high-dose chemotherapy in patients suffering from Hodgkin’s and non-Hodgkin’s lymphoma. Subjects were administered a battery of neuropsychologicaltests (1) prior to treatment and (2) 6 weeks and 12 months posttreatment. At 12 months posttrearment, we were unable to detect any significantchanges in the neuropsychological test performances of these patients. On the basis of this limited sample of subjects, it is concluded that this particular form of high-dose chemotherapy does not produce any measurable decrements in cognitive functioning, at least at 1 year post-



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treatment. The need for continued monitoriag of thesc patients in the context of largez sample sizes is discussed. A.W. KORNHUBER, B. DREHER, W.LANG, & M. LANG. Deterioration d the Working Memory by Lesions d bssofiPt&m F I k s In the Depth ofthe Left F m t d Lobe. In this study we tried to localize worlting memory functions in frontal-lobe lesions mom precisely with a moqhmeaic method. Forty-six patients with frontal-lobelesions Qcumeated by computerized tomogrpphy were selected. Lesions were digitized (cantbomutal, 9 plracp,VOXEL 3 m m raster, 10mm slim).Subjects with a WAIS-IQ

bcbw 80 were ao( included. Fifty-~hreeconaols mnlched to age. Thra tcJu welt applied (colorfigure auociatioq poririoaof a figure. guraating numbas in a RaQm s q u a w ) . Normal values w e n defiwd from tbe coatrds. For each VOXEL the awocirtioa tetwmrl lesion md pw lest perfwas m l d (exrt Fisbu tcst (p < .05). Sipilicmt usaciaionsbctwcu~ lesion aod performane below noanal vdoe WQC visible in thebeptb oftbe [email protected] frontal gyrus. ne rrspluof this rtudy indictc thc hvolvemcnt of the left s u p a i a froarrl M d its deep association fibers, pabrp its priedmd tsmponlp jectiom in u9s tbu rsquim waking memory.




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8:30-10:30, Room ED-101 Organizer and Chair: V. Homberg Discussant: G.E. Stelmach The purpose of this symposium is to give a multidisciplinary overview over current studies, looking at the organization and localization of human memory and its abnormalities under pathological conditions. First activation studies during motor learning tasks are reviewed to clarify the contribution of cortical and subcortical structures in motor-learning processes. This is further elaborated by a study using electro- and magnetoencephalography in a variety of motor learning tasks. The third presentation provides a careful clinical study on dissociations between motor and declarative memory in a variety of patient populations. Finally hemispheric asymmetries and geometrical restraints of trajectorial storage mechanisms are discussed for the learning of new ideograms. The symposium provides a thorough survey about current research trends in motor learning.

R.J. SEITZ. Plasticity of the Human Motor System Studied With Positron Emission Tomography (PET). It is well established that PET is a powerful tool to map task-specific activity changes in the human brain. In this contribution, PET measurements of the rCBF addressing aspects of motor programming and motor execution are presented. In one experiment, nine healthy volunteers were examined before and after they had learnt a complicated finger movement sequence. Significant involvement of the parietal cortex and the basal ganglia occurred. In contrast, changing the execution characteristics of simple finger movements by acceleration has recently been shown to significantly affect the cerebellum. PET studies in neurological patients during recovery from subcortical stroke provide further insight into the processes underlying learning of movement execution. Evidence is presented showing that finger movements are associated with activation of the motor hand area ipsilaterally to the moving hand. L. DEECKE & W. LANG. Brain Areas Involved in Motor Learning. Sixteen subjects participated in a visual tracking paradigm involving motor learning. Cortical DC potentials revealed learning-relatedextra negativity correlated with the success in learning over fron-

tal areas only (frontal convexity of both hemispheres and supplementary motor area, SMA). The same 16 subjects participated in an HMPAOSPECT study, and showed significant learningrelated cortical extra activity in frontal cortex only (middle frontal gyrus of both hemispheres and SMA),which nicely fits the BP results.Maximum increase in cortical activity was found in the right hemisphere, which can be explained by the spatial character of the tracking task. Two other (subcortical) regions showed significant learning-related extra activity: basal ganglia (righDleft) and cerebellum (leftxight). A.G.M. CANAVAN. Dissociations Between Motor and Declarative Memory. Although alcoholic amnesics (n=10) are very poor at remembering stories or learning word pairs,they are as good as healthy (n-9) and nonamnesic alcoholic controls (n=8) in developing mirror-tracing skills. In a new task involving the recording of eye movements these same subjects could be examined for their patterns of visual inspection over 3 days during the course of learning and recognizing masked photos of famous faces, and further dissociations between procedural and declarative mnemonic processes could be demonstrated. In a related study Parkinsonian patients (n=19) with intact verbal memory were not able to use conditional associative processes to facilitate motor reaction times.

U. HALSBAND & V. HOMBERG. Learning Trajectories: Hemispheric Specialization and Impairment by Brain Lesions. The concept of invariance of movement time irrespective of movement amplitude is a general principle of learned motor skills. But little is known about the temporal organization of new trajectorial information within the time domain. In this contribution, experiments addressing the question of hemispheric preponderance in time control are presented. In one experiment, 48 healthy righthanded volunteers revealed a clear preponderance of the dominant left hemisphere in generalizing storage of learned trajectories to either upper extremity, whereas the nondominant hemisphere was found to be restricted in its control properties to the contralateral hand. Changing the orientation or switching between the start- and end-point coordinates showed that the generalization of a trajectory has clear geometrical restraints. In a second experiment, recall of stored kinetic memories and the acquisition of new temporal adjustments was assessed in 14 patients with unilateral lesions of the premotor cortex (PMX) or supplementarymotor



area (SMA, not including tissue from the lateral hemispheric surface). Evidence is presented showing a crucial role of PMC and SMA and a left-hemispherepreponderancein the reproduction of motor sequences that had to be stored and retrieved from memory. Paper Session 7

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THE ADULT NEUROPSYCHOLOGY OF VARIOUS NEUROPATHOLOGIES 8 9 0 - 1 0 3 0 , Joachim Hall Chair: E. Wertman TH. GASSE, M. HITTMAIR, E. SCHMUTZHARD, & TH. BENKE. Neuropsychology of Late Lyme Encephalopathy. This study investigated the neuropsychological status of 15 subjects who suffered from Lyme disease (post-LD) years ago (mean duration since disease onset 65.5 months), had been treated regularly, and had recovered neurologically. PostLD subjects were compared with patients who had suffered from viral meningitidencephalitis(postVM). and with matched normal controls. Post-LD and post-VM subjects had significantly impaired verbal learning and memory (immediate, delayed and cued recall, recognition). Post-LD subjects were also disabled on word list generation and syllable repetition, whereas they performed normally on tests of psychomotor speed, sustained attention, executive and visuospatial functions. These results indicate that Lyme disease, and also viral meningitivencephalitis, may cause a longlasting encephalopathy-like state with severe neuropsychological deficits, predominantly in memory. P.A. CLELAND, M.P. McANDREWS, & P.L. CARLEN. Cognitive Functioning in Cocaine Abusers. The purpose of this study was to describe the effects of chronic cocaine use on cognitive functioning. Thirty-three chronic cocaine users were tested approximately 1 week after their last use. The domains covered included: vocabulary, learning and memory, perceptual motor skills, visual-spatial skills and problem solving, and abstraction. Deficits were found only on the immediate recall of a complex figure on which 83% were impaired. Their performance on the copying portion of this task showed a lack of planning and a segmented approach. D. CAINE, C. ROBERTS, J. HENDY, & R. BUSKELL. The Neuropsychological Sequelae of Anoxic Brain Damage. While the principle of 'selective vulnerability' of

particular brain structures to oxygen depletion is well recognised neluopatbologically. the distribution of lesions is knownto vary between patients. Disruption to the brain's oxygen supply is also known toresultfmpe.ntlyinsignifkantanddiverse

cognitive neuropsycholagicaldeficits. This study is an attempt to systematically investigate the renge of neuropsychological impairments following anoxic events. The f m t phase, reported here, involved retrospective analysis of a number of patients with known hypoxic brain damage. Several distinct patterns of deficits w a e found ranging from 'pure"amnesia to a global impairment of cognitive and behaviour functioning. Further, different paacms of recovery w a e observed. The range of deficits and of recovery patterns has significantimplications for rehabilitationplanning.

L. HOKKANEN, E. POUTIAINEN, M.L. NIEMI, & M FIRKKILK. Cognitive Effects of High-Dose a-Iaterferm h a Plscebo-Controlled Study 011 Amyotrophic Lateral Sclerosis (ALS). The cognitive effeets of high-dose human leucocyte a-interferon (IFN-a) treatment were evaluated among 24 patients with amyotrophic lateral sclerosis (ALS). To c o n f m the earlier finaings showing reversible effects in cognitive performance, and to exclude confounding effects. a doubleblind placebo-controlled study was conducted. Nineteen patients were treated with IFN-a and 5 with human albumin with continuous iv-infusion during 5 days. The neuropsychologicalexamination included tests of intelligence. memory, complex mental processing, viswconstructionalskiis. writing, and calculation. A clear difference in the performance profiles of the placebo and the IFNa treated patient groups was detected: a learning effect in repeated measurements was seen in the placebo group. The IFN-a group showed statistically significantdeterioration during treatment in digit span backwards, logical verbal memory, calculation. and signature writing time while an improving trend was seen afw treatment. The reversible deterioration indicates a clear CNS effect during the IFN-atreatment. Symposium 4 NEUROPSYCHOLOGICAL ASPECTS OF PROCESSING WITHOUT AWARENESS 1O:SO-12:45, Room ED-101 Organizer and Chair: B.A. Wilson Discussant: A.D. Baddeley Processing without conscious awareness has become an increasingly influential topic within


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ABSTRACTS cognitive neuropsychology. Typically research studies concentrate on specific paradigms. This symposium aims to draw together examples of unconscious processing from a range of different areas. The first paper is concerned with learning during coma, the second with implicit memory and unconscious learning during general anaesthesia, the third looks at dissociations between explicit and implicit memory and the fourth focuses on blindsight studies in which visual discriminations can be made in the absence of conscious visual awareness. The discussant attempts to identify common threads which could provide a more coherent framework for the study of the role of conscious awareness. MJ. WATSON, A.M. SHIEL, B.A. WILSON, S.A. HORN, & D.L. McLELLAN. Learning During Coma: A Preliminary Study. We wanted to know whether learning is possible during coma. Not only would such information be interesting for theories of learning but it could also have practical implications for rehabilitation. As part of a larger study (monitoring recovery from severe head injury) we administered behavioural assessment items to comatose patients. One item involved placing a cloth over the subject’s face and observing whether the cloth was removed by the subject. The typical sequence was for the subject to (a) become quiescent when the cloth was placed on the face; (b) become agitated, and (c) remove thecloth. For a small subgroup (n=8) of patients we prompted removal of the cloth through physical guidance and using a backward chaining procedure. Five of the eight patients leamed to remove the cloth before emerging from coma. B. BONKE. Implicit Memory and Unconscious Learning During General Anaesthesia. We stumed implicit memory (IM) and learning in a series of double-blind, randomized procedures during general anaesthesia (GA). First, an IM-test (word category exemplars) yielded a significant IM-effect in patients under GA. A second study successfully replicated this outcome. A different test of IM in children (colouring task after appropriate stimulation) produced a null effect. Study 4 tested patients on a ‘common facts test’ or a test of unconscious learning (Jacoby et al.’s fame-test) following suitable stimulation. The tests showed continued processing of information under GA, both as IM, and as unconscious learning. R. GREEN. Can Intentional Retrieval Inhibit Incidental Retrieval? An advance made in the study of implicit memory was the demonstration that indirect tests of memory are not process pure, that is, that indirect tests can tap both intentional and incidental remieval pro-

cesses. The present paper examines the relationship between intentional and incidental retrieval processes on a variant of the Gollin figures task, a nominally indirect test of memory. A comparison of the performance of young, elderly, and amnesic subjects on this task revealed that the activity of intentional retrieval can inhibit the activity of incidental retrieval. This inhibition was observed under conditions where intentional retrieval processes were not favoured, but were nevertheless employed. Trying (unsuccessfully) to rehieve items from the study episode seems to suppress the o p eration of incidental retrieval. L. WEISKRANTZ. Dissociations in Blindsight. In the absence of primary visual cortex, V1, retinal information can still reach targets in the brain, including V2, 3 , 4 . and 5, over 10 pathways. Not surprisingly, monkeys without V1 can be trained to make a variety of visual discriminations. In man, paradoxically, regions of apparent blindness occur after V1 lesions. But some human subjects can be trained to make discriminations within this area of phenomenal blindness, even though there need be no acknowledged visual awareness as such. Different subtypes of human blindsight will be discussed in relation to the putative involvement of particular extrastriate regions additional to V1, with a focus on location, orientation, colour, and movement. Implicit methods of testing are also discussed, with particular emphasis on pupillometry. Paper Session 8 DEVELOPMENTAL NEUROPSYCHOLOGY 1050-12:45, Joacbim Hall Chair: K.K.S. Voeller

P.J. McNAMARA, K. FLANNERY, L.K. OBLER, & S. SCHACTER. Geschwind and Galaburda’s Theory of Special Talents: An Examination in a Female Population. Geschwind and Galaburda proposed that special talents are associated with markers of anomalous dominance (AD). Testosterone (T) inhibition of the left hemisphere results in compensatory enlargement on the right. Since females are spared excessive exposure to prenatal T, those who report special talents should evidence no increased frequency of markers of AD as compared to those reporting no special talents. We tested this prediction in a population of 526 females who completed an extensive questionnaire. Comparing talented subjects to subjects reporting no special talents we found no differences in age, education-



al level, or AD markers at either the individual or familial level. Geschwind and Galaburda’s theory of special talent may apply only to males since special talents were not associated with AD in this female population.

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T.T. KORHONEN. Subtle Dysnomia in Learning-Disabled (LD) Children: Deficit or Developmental Lag? A subgroup of eight LD children with specific difficulties in rapid naming and a matched control gmup(n=lO)werefollowedupfrom9to 18years. The LD group was originally derived from a statistical subgroup study of 82 LD subjects. In addition to dysnomic problems, the group had no other marked language or perceptual problems. Tests of rapid naming (RAN, RAS). reading, spelling, general intelligence. articulation speed, and word fluency were administered in the initial study and at follow-up. Both dysnomia and reading and spelling problems were maintained at follow-up. Significant correlationsbetween naming test results and reading and spelling performances were found in both phases of the study. The RAN test results in childhood also predicted significantly some reading and spelling performancesin early adulthood. The development of subtle dysnomia was i n t e v t e d to follow a deficit model. S.C. LEVINE, R. BARANES, & P.R. HUTTENLOCHER. Effects of Early Unilateral Lesions: Changes Over the Course of Development. The present study examines the long-term effects of focal unilateral brain damage on cognitive functioning in congenitally hemiplegic children. Ten congenitally hemiplegic children were administeredpsychological testsat two times during development,o m before age 7 (mean age 5 years 9 months) and once after age 7 (mean age 13 years 3 months). Results showed that IQ was significantly lower at the time of second testing than at the time of f i t testing (92.9 vs. 83.6). Results conf m the importance of considering the age of the child at the time of testing, as well as the age of the child at the time of lesion, in assessing the effects of brain damage incurred early in life. Possible explanations for changes in functioning over time may involve developmental changes in the normal comparison group, limitations of functional plasticity in the brain-damaged group, or both. S. CIPCIC-SCHMIDT, N. JERONCIC, & S. PHILIPPS. Neuropsychological Follow-Up of Children at Developmental Risk. We here present the model of work of a Childrenat-Risk-Follow-up Program at the Center for Children with Neurodevelopmental Disorders in Zagreb. Results of neuropsychological assessment

of prematurelyborn childnn, a subset of the study population. are reported. We compared 131 twoYearS-Old p n ~ ~ t m With e 52 ~ full-term matched controlson five stoles of the RTC-developmental test (RTC) and on Attention (As) and Activity Scales (Hs).Although the results of both groups arc within the average range, the premature group attainssignifiitly lower results on the RTC-test. with greater intascrle variability. On the AS and HS scales the pnmatum gmup shows higher incidence of elements of attention defdt.The use of more specific outcome measures, continuous follow-up, and early remedial intenention are discussed.

Paper Seapion 9 EXTINCTION AND NEGLECT 1:45-3:45, Room ED-101 Chair: B.A. Cnwson E.H. TROMP & TH.W. MULDER. The Extinction-Lilc Reaction Pattern in Left-BrainDamaged (LBD) and Right-Brain-Damaged (RBD) Patients. In this study visual extinction in LBD and RBD patients with neglect is studied. using a tabletop apparatusto generate stimuli and record responses. Surprisingly, RBD patients did not show contralateral extinction but a more general attentional deficit. A possible explpnation may be a strategy effect brought about by recent application of CVA protocols in the region. A different explanation discussed is associated with the spatial lay out of the task. In previous studies, a monitor and kcyboard were. used. so stimuli appearad in the upper visual field, and responses wen given at a much lower level. In the present study S-R compatibility was maximal, and both stimuli and responses occurred in the lowet visual field uppaand lower visual fields have different functional urganisations and may differentially contribute to neglect. C.N. HUBLET, G.L. DEMEURISSE, CM. COLSON, MJ. VERHAS, J.A. PATERNOT, & A.P. CAPON. Cortical Dimchisis aa a Possible Cause of Subcortical Neglect? In subcorticalneglect, it has been suggested that a remote cortical parietofrontal reduction of blood flow or metabolism akin to diaschisis could be responsible for the occurrence of neglect. However, to assess such hypothe&, it is also necessary to demonstrate that in the absence of neglect cortical remote effects arc also absent. For this purpose, we studied a population of right-handed stroke patients presenting a morphological lesion restricted to deep-seated right-hemisphere struc-





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tures. In all cases, two methods were used to measure cerebral blood flows, i.e., two-dimensional xenon 133 inhalation method and SPECT-HMPAO. A cortical regional hypoperfusion was present even in patients without neglect. Thus the sole presence of cortical diaschisis cannot be considered as sufficient to provoke the clinical syndrome. G . ANTONUCCI, A. JUDICA, G. MENGHINI, & L. PIZZAMIGLIO. Optokinetic Stimulation in the Rehabilitation of Visual Neglect. The aim of the present research was to test whether the systematic use of an automatic reflex such as the optokinetic stimulation, applied together with an already developed method of rehabilitation, could produce some additional advantages in the recovery of severe and chronic patients with hemiinattention. Two groups (A and B) of right-braindamaged patients were examined. Group A was subjected to a computerized rehabilitation training without optokinetic stimulation and group B received the Same training with optokinetic stimulation. Within group B a comparison between trials with and without optokinetic stimulation showed a significant advantage over the former condition only in the early stages of treatment. Comparison between the two groups showed an increasing rate of recovery for group B.

A. BOUMA & K. ZDANIECKI. A Further Investigation Into Left-Ear Extinction in Patients With Dementia of the Alzheimer Type. The present study was designed to investigate the effects of directional attention on dichotic listening performance (three-digit pairs) in 25 patients with dementia of the Alzheimer type (DAT) and 25 normal controls. In previous research, we had observed that DAT patients had a strong attentional bias to the right ear and that they were unable to give selective attention to the left ear. In order or explore further these findings, all subjects received a monaural task condition and three dichotic task conditions (free recall, random-ordered recall, and blocked-ordered recall). In a dual-task condition, the effect of musical priming on dichotic listening was examined. Also a dichotic musical task condition was included in this study, The results suggest that left-ear extinction in DAT patients is only obtained in the dichotic verbal task conditions, although diminished in the blocked-ordered recall condition. Theoretical implications of the findings are discussed.


J.P. WILLIAMS, M.C. BRODSKY, & M.L. GRIEBEL. Differing Prognoses in Subsets of Septo-Optic Dysplasia. Septo-optic dysplasia has traditionally resulted in a guarded to poor prognosis concerning develop mental outcome. However, diverse clinical symptoms ranging from normal neurological functionidg to significant developmental delays suggest a highly heterogeneous syndrome. Present findings involved the assessment of a subset of six children who demonstrated optic nerve hypoplasia, absence of the septum pellucidum, and normal endocrine functioning. An in-depth assessment including psychoeducational, neuropsychological, and language functioning suggests normal development in five of the six children. A reclassification of patients based on morphology and correlated neuropsychological functioning appears to be in order. Further research is needed to determine the developmental status of patients with more severe neuropathologic findings often associated with septo-optic dysplasia. V.A. ANDERSON,K. GRIMWOOD,E.KEIR, T. NOLAN, R. HORE, & C. CATROPPA. LongTerm Sequelae of Bacterial Meningitis in Childhood.

Bacterial meningitis is a relatively common infection, occurring in children under age 2, and acting on the immature brain, possibly disrupting cerebral development. This study is a prospective investigation of 80 children suffering from bactaial meningitis documenting acute and long-term recovery patterns. Children were evaluated at three stages: (i) time of discharge, (ii) 12 months postmeningitis, and (iii) 6 years postmeningitis. At stage (iii) the postmeningitic sample was compared to a matched control group. Initial evaluation documented deficits in motor function and behaviour in 20% of children. At 12 month followup problems were identified in language and behaviour. Complicated recovery and convulsions were related to lower intellectual ability. Six-year follow-up found postmeningitic children to be of average intellectual ability, with deficits in expressive language, memory, and reading.

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J. PIETZ, E. SCHMIDT, A. KUTSCHA, & U. MEYDING-LAMADE. Sustained Attention DefKits and White Matter .Changes WRI) in

reading comprehension is dependent on verbal Short-tenn m e n r ~ r y .

Pbenylketonuria (PKU). Cranial magnetic resonance imaging (MRI) was performed in 28 adult patients with early-treated PKU. A small group of four patients were found to be severely affected with extension of the lesions to the frontal, temporal. and subcortical white matter. These patients showed distinct deficits of sustained attention in a continuous performance task (CPT)and a sgnificantlylower IQ (WAIS-R) in comparison to the other patients. Within the other patients ( ~ 2 4 the ) extent and location of white matter changes (mainly located within the posterior cerebd hemispheres) was not comlated with CPT and IQ results. CPT and IQ results of the PKU patients differedsignificantly from healthy wntrols.

M. MIRA. An Atypical Case of Nonverbal Learning Disnbilities (NVLD).

E. SCHMIDT, A. RUPP, P. BURGARD, & J. PIETZ. Information Processing in EarlyTreated Pbenylketonuria (PKU). Ninety early-treated children with PKU from the German CollaborativePKU-Study and 61 conmls were tested at the mean age of 8.7 years with a neuropsychological test battery. There are information-processing deficits in PKU patients compared to healthy controls on different stages according to Stemberg's Additive Factor Model, as well as in sustained attention and calculation abilities. The deficits are significantly influenced by the quality of long-term dietary control and the concentration of phenylalanine in the blood at the time of testing. Correlationsbetween informationprocessing variables and IQ are different for patients and controls. Implications for research and treatment are discussed. Poster Session 2

8:30400, Caedmon Hall G. SPYER & M.DEKKER. Reading Comprehension in L- and P-type Dyslexia. A preliminary study was conducted to investigate whether differences exist in the reading comprehension of L- and P-dyslexic children. The reading styles of L- and P-dyslexia are characterized by an extreme use of left hemispheric (topdown) and right hemispheric (bottom-up)readiig strafegies, respectively. L-dyslexics were predicted to show better reading comprehension than P-dyslexics whose comprehensionof text will be hampered by their excessive use of bottom-up (lower order decoding) strategies. L-dyslexics were shown to have superior reading comprehension,in comparison to P-dyslexics, in those situations where

This paper presents neuropsychologid findings of a 13-yeor-old left-handad b y who presented featum of developmental NVLD.Thaee include superiority of verbal over nonverbal IQ, reduced psychomotor ability. bilateral tactile peaceptupl deficits. impaired nonverbal communication and pragmaticswithgOOdphonabgicalawarencssand rote verbal skills. Psychcw0ci.l impairments included social isolrtion. obsessive featuns. and

depression trtoted with medicotion and psyche therapy. History indicated early limited motor exploration, problems with novel or excessive stimulation, and changes from hyperactivity and verbosity to inactivity and terseness. Features at variance with the NYLD panem included superiority in arithmetic, good wnccpt formation, and inconsistentlyexpressed lateralization of deficits. The results are discussed in terms of the collcep tion of NVLD and of the factors which may influence the dissociation of sptial and social cognition and math. S. DUCKE'IT, W. GIBSON, & M. SALAMA.

A Clinical and Cross-Cultural Exploration of the Levy and Reid Hypothesis. The inwnsistencies in the research fiidings looking to test for the Levy-Reid hypothesis on the relationship between hand posture and laterality have been accounted for in various ways. Some authors have suggestsd chatexisting methodologies for experimentally establishing l a t e d t y of Ianguage functioning are unreliable. To overcome this constraint, we have taken Halsey's suggestion of using CVA patients in which laterality of expressive speech has been established incontrovertibly. We examined 74 CVA subjects assessing hand posture. handedness, and side of stroke. Our findingslend support for Levy-Reid. nevertheless fiutherexaminarionofthehypotheskusingacrosscultural sample underscores the impact that education and culture have on hand posture. A. CHATTERTEE,M. MENNEMEIER,& KM.

HEJLMAN. Functional Significance of the Power Function in Unilateral Neglect. Patients with neglect may bisect lines such that their response (R) is related to stimuli (S) by a power function: R=KSB (K and B are experimentally derived). The power function accounted for over 99%of the variance in perfarmanceof a patient with mild unilateral neglect when bisecting lines of varying lengths wider five conditions: spatial placement of arrays to the right, middle or left, and attentional cues to the tight or left. The pat-


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tern of change in the exponent and constant induced by experimental conditions suggests,that the exponent represents a capacity limitation to attend to increasingline lengths, that is not confined to a specific spatial location: and the constant represents a quantitative measure of a cognitive estimate made from partially attended stimuli. J.M. HODGSON & C. JONES. Phonological Dyslexia in the Presence of Metaphonological Skills: A Case Report. Many models of reading development suggest that phonologically driven mechanisms of visual word recognition grow directly out of metaphonological knowledge via general processes of incremental skill acquisition. A case is reported in which good reading comprehension and spelling and proficient surface metaphonological knowledge, as revealed in pseudoword pronunciation and spelling tasks, are accompanied by a marked deficit in exploiting underlying sublexical phonological structure. Reading is insensitive to spelling-sound regularity. It is argued that this orthographic reader is comparable to Campbell and Butterworth’spatient RE, but for her proficient knowledge of specific letter-sound correspondences. This knowledge has not proven sufficient to permit the development of normal phonologically driven word recognition processes. These findings contradict the strong metalinguistic hypothesis of phonological reading development. MJ. NESTER, G.G. GASCON, & J. CROWELL. Use of Brief Assessment Exam in a Pilot Study Involving Isoprinosine and Alpha-Interferon Treatment of Subacute Sclerosing Panencephalitis (SSPE). SSPE is a lethal disease of children and young adults. It is endemic in the Middle East. At the King Faisal Specialist Hospital, Riyadh, a pilot study involving treatment of SSPE with isoprinosine and alpha-interferon was undertaken. A method of evaluating patient progress was needed that was particularly sensitive to cognitivebehavioraVlinguisticchange. A brief assessment exam was devised, modeled on similar tests used in carotid-amatol procedures. It proved effective in tracking progress among stage I and I1 patients, less so among stage 111. It was clearly superior to the Neurologic Disability Assessment and Index for the purposes of this study. Recommendations for revision are discussed along with proposed use in a larger. multi-center study. A.G.B. WIRSEN, B. ECKERT, & C-D. AGARDH. Neuropsychological Effects of Insulin-Induced Relative Hypoglycaemia in Habitually Hyperglycaemic Diabetic Patients. Cognitive function has in several studies been found to deteriorate during hypoglycaemia in both dia-


betic patients and in normal subjects. The aim of the present study was to investigate the effect of relutive hypoglycuem’u in poorly controlled. hyperglycaemic diabetic patients. Cerebral function was measured with a neuropsychological test battery, before, during, and immediately after insulin-induced relative hypoglycaemia @-glucose approx. 8 mmolfl) in young hyperglycaemic diabetic patients (mean HbAlc > 10%:mean average blood glucose level 17 mmow). All patients had normal performance levels at their habitual hyperglycaernicblood glucoselevels. When the blood glucose was decreased by insulin infusion, the neuropsychologicalperformance was impaired.The results are strikingly similar to the performance impairment Seen during absolute hypoglycaemia (blood-glucose2.0 mmol/l) in both normal subjects and well-controlled diabetic patients. Relative hypoglycaemia, where the blood glucose level is actually above the normal range (normal 3.3-5.6 mmol/l), causes both subjective symptoms of hypoglycaemia, and a significant neuropsychological impairment in patients whose habitual blood glucose level lies in the hyperglycaemic range. L.E. TREXLER & Th.M. DIXON. Psychogenic Amnesia Versus Traumatically Induced Severe Retrograde Amnesia: A Case Study. Mnestic disorders following traumatic injury typically include posttraumatic (PTA) and retrograde amnesia (RA). Extensive periods of RA in the absence of significant PTA are often considered to be psychogenically motivated. The case of a 38-year-old male after two traumatic brain injuries is presented, with complete retrograde amnesia for autobiographical memories and compromise of semantic memory, without significant PTA. The patient presented a history of a very emotionally “traumatic” childhood. which may have served to motivate repression or dissociation. However, the patient also evidenced a lesion of the left ventral aspect of the midbrain on MRI, structures implicated in autobiographical memory. This case is discussed in context of the theoretical literature on psychogenic amnesia and the pathophysiology of mnestic disorders.

B.P. UZZELL.Word Fluency Cueing Following Head Injury. Word fluency has reportedly been reduced following head injury, but reports of effective strategies for improving fluency have been limited. In this study phonetic and semantic cueing were examined with 12 severe-to-moderate and 12 minor head-injured patients, 3 months postinjury. While word fluency was unimpaired after minor head injury, greater improvement was observed after phonetic than after semantic cueing in the severeto-moderate head injured. The results have impli-



cations for rehabilitation of language functioning after severe-to-moderatehead injuries.

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E.CLARK. EffectivenessofRitalin With ADHD Head-Injured Children. Using a within-subject repeated-measuredoubleblind design, Ritalin was shown to be effective in treating attention deficits of 8 head-injured children between the ages of 7 and 15. All subjects who met DSM 111-R criteria for Attention DeficitHyperactivity Disorder (ADHD) were placed on a 2-week vial of Ritalin, and similar 2-week trial of placebo. During the Ritalin eial,all 8 children were rated by parents as improved in theu attentional capacities. and all but one, achild diagnosed as ADHD prior to injury and describedas conductdisordered. showed a pattern of general improvement across most attentional measures. Measures which showed less consistent results were attentional tasks comprised of more complex stimuli and that required greater memory capacity. J.W. EHRFURTH, F.W. THEYE, & M.F. GRAPER. Postconcussional Syndrome: A Rural Perspective. The present study assessad the frequency and nature of postconcussional complaints among a consecutive wries of mild closed-head-injury victims seen through the emergency service of a large rural midwestem hospital from January to September, 1991. Sixty-three out of 101 patients (age range 1 to 79 years) were contacted 1to 4 weeks postmumaandrespondedtoastructuredinteMew.Among late adolescent and adult patientsthe most common complaints were somatic, including headache, dizziness, and fatigue. Among pediatric patients only headache was a frequent complaint. In contrast to previously published reports, there were relatively few complaints in the cognitive or affective domains in either the late adolescent/adult or the pediatric group. Factors contributing to this discrepancy are discussed. A.F. HERNANDEZ, E. COELLO, R. LOPEZ,

L.A. VanMETER, D. FEIN, & R. MORRIS. Social BeQnvlor in Autbn: An AMIYS~S of Intrasubtest kattcr on tbe Vineland Adaptive Behavior k ales. Delay versus deviance is an important concept in developmental psychopathology and, in particular. in the field of autism. This study addressed the issue of deviant development by quantifying intradomain scatter on the Vineland Adaptive Behavior Scales. Autistic children (n=30) were matched to a sample of retarded children ( ~ 3 0 ) based on their raw scores on each subdomain of the Vineland The same procedure was used to match normal and autistic children (11545). Inefficiency scorn were calculated for each group of subjects. Results indicated that autistic children had significantly more scat& on the communication and socialization domains. Chi-squaresrevealed specific behaviorsthatdifferenW autistic children from other groups. These results support the hypothesisthat autistic developmentis deviant when compared to normal and retarded children.

P.S. WESTZAAN, H.VAN MIER, T. MULDER, & W. HULSTUN. A Process-Oriented Approach to the Assessment of Cognitive Motor Disorders. In the assessment of fine motor behavior, writing or drawing tasksare frequently employed. By using special equipment it is possible to monitor the ongoing motor processes. The analysis of kinematic features of motor behavior can reveal processes that would have remained hidden if the analysis were hsui solely on the end result of the movement. Kinematic data will improve our insight in the nature of motor problems and in the relationship between cognitive and motor problems. In the present study large differences between a group of cerebral palsy children and a matched control group were found on kinematic data obtained in several drawing tasks. Kinematicdifferences between apparently similar drawings are illustrated. Theresultsdearly dwnonstrstethe value of this assessment procedure.

& R. HAMILTON. Behavior Modifcation Ef-

fects on Human Kluver-Bucy-Like Syndrome. A 17 year-old male who developed Kluver-Bucy symptomatology(KBS)followinga motor vehicle accident responded successfully to a token economy behavioral modification program. Targeted behaviorsincluded arm banging, hyperorality. and crying. Treatment involved an institutional token economy system using a multiple baseline across target behaviors design. Results demonstrated a decrease of 83% incidence in arm banging, 70% decrease in crying, and a 35% decrease in hyperorality. It appears that behavior modification techniques can be useful in the reduction of KBS symptomatology.

AJ. LAZOSKY. Primary Adrend IawN~kneg: A Cose Report of Progressive Neuropsychological Dysfunction. A 23-year-oldambidextrouswoman with primary adrenal insufficiency for the last 9 years is presented. She has been treated with glucocarticoid and mineralomrticoid replacement since. diagnosis, with response to therapy determined by physiological improvement in symptoms and by frequent measuremeat of blood pressure and serum electrolyus. All labomtory measures have generally remained within normal limits; she has been chronically mildly hypotensive. Neuropsychological assessment was made at varying time inter-


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vals from diagnosis to 9 years postdiagnosis. Results show gradual progressive decline in intellectual ability, memory, and academic achievement. with greater decline in verbal abilities. Recent constructionapraxia was noted. Executive functions remain mildly impaired. The findings document progressive neuropsychological dysfunction in Addison’s disease, despite laboratory values suggesting adequate response to therapy. C. PRADEL, V. HOMBERG, & E.R. WIST. Latency and Amplitude of Left- and Right-Sided P300 to Unilateral and Bilateral Visual Stimulation in Patients With Visual Neglect and Normal Controls. Although there have been only few studies concerned with the relationship between late componentsof evoked potentials and neglect, there is evidence of a P300 deficit in neglect patients with stimulation on the affected side. The aim of our study is to investigatethe visual P300in neglect patients for unilateral and bilateral simultaneous stimulation. We use a visual Oddball paradigm involving three simple shapes. Targets have to be counted. The EEG is recorded from mid occipital and lefvright parietal positions and analysed according to stimulation condition (unilateral vs. bilateral, target vs. nontarget) and stimulated hemifield (left vs. right). In healthy controls P300 peaks appear with a latency o l about 400 ms. In neglect patients P300 deficits are evident with stimulation on the affected side. Effects seem to be larger with unilateral stimulation. B.D. MOORE, B.M. KOPECKY, & D.R. COPELAND. Evoked Potential, Reaction Time, and Dichotic Listening Correlates of Cognitive Functioning in Pediatric Cancer Patients Treated With and Without Cranial Radiation. Evoked potential, reaction time, dichotic listening, and neuropsychological procedures were carried out with 29 long-term survivorsof W a t r i c cancer (mean a g e 1 5 years) who had been off treatment for at least 5 years. Treatments included surgery, chemotherapy (systemic/intrathecaI), cranial radiation (CRT), or some combination of these three. Subjects were placed in one of two groups, depending on whether they had (n=l1) or had not (n=18) received CRT as part of their treatment. Groups were comparable with respect to gender, race, age at diagnosis, and age at time of testing. Cognitive deficits were significantly worse in patients who had CRT, particularly in nonverbal, academic, and attentional abilities. Evoked potentials indicated that the cognitive deficits found may be related to auentional problems. Reaction time results, as well as P300 laten-


cy, showed slowing of CNS processing speed in those treated with CRT. Finally, those mated without CRT showed a significant right-ear advantage in a dichotic listening task while those treated with CRT had no specific ear advantage. Regression analyses indicate that reaction time and P300 latency and amplitude are effective predictors of neuropsychologicalperformancein these patients. These measures appear to be useful in understanding the physiological basis of cognitive deficits found in patients treated with CRT and may eventually help to predict these. deficits in patients currently undergoing treatment for cancer. A.B. KARAPETSAS & A.M. KANTAS. Visuomotor Organization of Left-Handed Children: A Neuropsyehological Approach. The visuomotor organization of left-handed children was examined in a sample of 268 boys and 235 girls from different parts of Greece. Ages ranged from 6 to 20 yrs. Left-handedness was evaluated in the way suggested by Humphrey and Oldfield. Visuomotor organization as represented by the reproduced figure was evaluated according to the typology of Osterrieth and Lezak and each subject was eventually classified to me of the seven types, according to Osterrieth’s typology. Significant relationships were found between the typology and age and sex, while the dismbution of visuomotor types differs from the one reported by Osterrieth for right-handed children. Lefthanded children show lower visuomotor organization. A. FINSET. Measuring Deficits in Regulatory Functions in TBI Patients: Sequence Analysis of a Construction Task. A construction task, using materials similar to ‘Tinker Toys’, was administered to 20 TBI (Traumatic Brain Injury) patients. Patients were told to construct whatever they would like. The behavior of the patients in terms of active performance of the task, passivity, perseveration, disinhibited and other behaviors, was recorded every 10 s over an 8-minute period. The purpose of the procedure was to study deficits in regulatory or integrative functions such as lack of initiative, perseveration, and disinhibition. Patients were on an average of 60.4% of the time working actively with the task.The percentage of active work tended to decline a liute over the 8-minute period. Patients tended to be passive and perseverate 21.2 and 14.0%of the time respectively. Judged against an observation protocol administered in a dailylife situation, there were indications that the construction task could measure some aspects of regulatory deficits.



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D. RIVA, N. MILANI, M. DEVOTI, C. ZORZI,& C. PANTALEONI. Word Production in Children With Congenital HemisphericLesions. Aim of this study is to assess verbal fluency in children with unilateral congenital brain lesions. For this purpose children aged from 7 to 16 years. with left (LJ and right (R) hemispheric lesions already present at birth. went selected.Thei WISCIQs were within normal range. The lesions were all verified by CT and/or MRI. All the subjects had normal verbal production in spontaneous speech. Word production was assessed asking the children to say as many words they could in the followingtopics: (1) any kindof wor&, (2) animals; (3) foods, (4) words beginning with the better “B” and (5) with the letter “S”.Results are as follows: (1) L and R children produced quantitatively less words than their age-matchedpairs. (2) L subjects did worse than R ones in the production of the different category words. but not in the production of words beginning with a certain letter. Since these children in a previous study had shown lexical deficits both in R and L groups, and syntactic deficits only in the L group, the relationship between these deficitsand verbal fluency is discussed.

M. REGARD, T. LANDIS, & N.D. COOK. Dynamks of Cerebral Dominance During Unilateral Seizures. We tested the model of hemispheric interaction based upon functional inhibition and release in 6 patients with unilateral limbic seizures. While seizure activity was monitored with bilaterally implanted depth or foramen ovale electrodes, the patients performed lateralizedhemisphere-specific tachistoscopicrecognitionexperiments. We found that focal limbic seizures interfere with cognitive function even when unnoticed clinically or not Seen in the surface EEG, that this interference impairs the dominant functioningof the discharging hemisphere only, and that the inhibition of the discharginghemisphereis associatedwith parallel improvement of performanceof the same function by the other hemisphere.

J.M. COCKBURN. Evidence for Hypermnesia After Brain Injury? Following clinicalreportsof accurate later retrieval of initially unrecalled informalion by some patients attending a neurologiCa1rehabilitation centre, an exploratory study was designed to investigate whether this apparent hypermnesiacould be elicited experimentally and, if so, to what material it was sensitive. Fourteen subjects with documented memory impairment. with a wide range of age and time postonset,were tested on two occasions 1 week apart, on material sampling verbal and nonverbal memory in explicit and implicit learning conditions. Although there was no overall

evidence of higher scoring over time. five sub jects showed enhanced performance on individual items. The findings have potential relevance for reliance on results of single arsscssments, and for design of therapy programmes.

K.BECKERS, C. PRADEL, & V. HOMBERG. Evaluation of Computer-Assisted Cognitive Training of Attention and Visual Memory in Brain-Injured Patients Using a Single-CaseAcross-Functions Methodology. The present study was designed to evaluate the effect of a systematic cognitive training using specific computer programmes on individual improvement of neuropsychological defkits of attention and visual memory. Brain-injund patients of different etiologies performed on specific computer aaining programmes, with each patient participating in the study for a period of 6 weeks. Computer programmes (REHACOM, Weber et al.) were administered for training of vigilance. visual memory, and visual discrimination. For a period of 10 training sessions each patient performed only one task (e.g., 2 weeks visual memory training, followed by 2 weeks vigilance training. and so forth). The task sequence varied systematically over patients. A set of traditional neuropsychological tests (e.g., WMS-R, WAIS-R, RBMT,etc.) and computerizedtests of attention were administered four times: pre- and posttraining and when each new task was used. Singlecase and group statistics yield a comparisonof the effect of training on developmentof cognitive functions within each individual patient and for the patient group during the course of training. In each subject a clear effect of specific training on each task was found. M. SPADONI, G. JANELLI, & A. MAZZUCCHI. Memory Rehabilitation by Means of Computerized Programs in a Case of Severe Global Amnesia. After a mild head injury a young woman showed a complete and isolated loss of both retrograde and anterograde information. Six months later. as retrograde amnesia remained totally unchanged. she showed capacity to learn new informations and retrieve them in a short time. However, the forget curve was abnormally rapid with final complete loss of any information in a few weeks. A conventional rehabilitation program was started without positive result. Subscquartly,apersonal portable computer was arranged with a series of record-programs and the patient was trained to use it as a “prosthesis”. The patient learned to use

theprogramsandtointroducc,organize.andncall the infamation with high proficiency. This method seems to be a useful “external aid” in case of irreversible global amnesia not associated to diffuse deterioration.

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ABSTRACTS K.D. WIEDMANN, A.McKEEMAN, J.T.L. WILSON, D.M. HAdLEY, D. WYPER, G.M. TEASDALE, & DJ. GRAHAM. Diffuse Axonal Injury and Frontal Hypoperfusion After Traumatic Brain Injury: A Comparison Between MRI, SPECT, Neuropsychological and Neuropathological Findings. A patient with traumatic brain injury was studied on CT, MRI. and SPECT within the first ,week and 5 months after injury. CT and h4RI detected only small isolated contusions but HMPAO-SECT revealed extensive anterior blood flow deficits. On initial examination the patient was in coma and remained unconscious for 2 months. At followup he was out of coma but displayed psychiatric features such as aggression, hallucinations, and fluctuating awareness and he was also cognitively impaired. Frontal hypoperfusion on SPECT remained pronounced. The patient died after 7 months from chest complications. Neuropathological findings were those of diffuse axonal injury. A comparison is made between neuroimaging,neuropsychological and neuropathologicalfindings. A.U. TARKHAN. Disturbances in Recognition of Emotional-Prosodial Characteristics of Speech and Mental Disorders in Focal Cortical Epilepsy. In planning therapeutic and rehabilitation measures for patients with focal cortical epilepsy characterizing by psychotic disorders, one must take into consideration that many of these disorders are connected to disturbances of recognition of emotional-prosodialcharacteristics of speech. A special complex of tests was applied: pair comparison of nonspeech sound complexes, melodies. voices, intonations and emotions, test of identifications of emotions, memory-tests and test of steadiness to hindrances of audio-speech system. Study of the patients revealed correlations between impressive-speech disturbances and psychotic disorders. Three types of correlations differ according to priority of psychotic or impressive disturbances. The most frequent was parallel development of psychotic and impressive disorders connected with general psychopathological mechanisms. H, ZAISER-KASCHEL, R. KASCHEL, CH. DIENER, & K. MAYER. Neuropsychological Status after Whiplash Injury. Operant and other confounding variables in the assessment of cognitive status after whiplash injury are often discusssed. We avoided these in a first study by controlling factors like 'chronicity' or 'situation'. In a second study we assessed the neuropsychological status in the fist days after whiplash injury, i.e., before issues about financial compensationsare raised. The first study revealed


no significant deterioration in test patameters in chronic whiplash patients (n=19). Groups of reference were matched for premorbid, age, and time sinceonset [minorheadtraumawith ( e 9 ) or without whiplash (n=ll); CHI (n=19)]. Testing in the acute phase after whiplash revealed no differences either (n=14; comparison to norms). Whereas impairments in objectiveparameters thus could not be demonstrated in acute or chronic patients. significant changes in subjective variables were evident only in the latter (e.g., STAI). R. KASCHEL, TH. LINGENFELSER, H. ZAISER-KASCHEL, A. WEBER, B. JAKOBER, & K. MAYER. Neuropsychological Status of-Young Hospital Doctors After a Night on Call. Research on cognitive disturbances following sleep deprivation of doctors is contradictory. The use of well-defined psychometric instruments is me. Therefore, we evaluated the cognitive-emotional status of 40 young hospital doctors using standardized tests. Subjects were tested twice (off vs. on duty). There was a highly significant deterioration of performancein all parametersafter sleep deprivation (Stroop, number connection, verbal memory, reaction time, ECG, mood). Time of testing and years of medical experienceproduced no such main effects. As several tests were selected on the basis of their ecological validity, effects of sleep deprivation on these tests suggest a reduction of the quality of medical service. This is shown most directly in a test simulatingarrythmias (ECG video) and a memory test for verbal instructions in everyday life ('things to do'). R. KASCHEL, H. ZAISER-KASCHEL, K. ACKERMANN, D. RAVENSTORF, & K.

MAYER. Behavioral Treatment of Dysexecutive Syndrome: A Controlled Case Study. Behavioral problems following frontal-lobe damage constitute a severe burden. Controlled studies concerningtheir rehabilitationare rare. We report on a 27-year-old male who had suffered closedhead injury 126 months before. All attempts for rehabilitation had failed (1979-1989). We tested the hypothesis that M"s main problem in rehabilitation was the inability to profit from delayed and negative reinforcement. We tested this in a A-B-B'-A-B-A withdrawal/multiplebaseline across behaviors design. Results of time-series analysis confirmed the hypothesis, as significantprogress could be achieved contingentupon reinforcement. Stability was seen to the degree that self-reinforcement had been successfully established. The lack of change in nontarget behaviors and the pattern of effects suggest specifity and ecological validity.

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A. GADE. A Nordic Netwok for Exchange of Neuropsychology Literature Reference Data. Neuropsychologists in Scandinavia and Finland have initiated a coopuative effort tn build a database of neuropsychologicalliteratoereferences supportedby a commerciallyavailaMePC refemme program. Researchers may use the dambase on their personal computers, and may tailor the base to their personal needs and interests. The database is not complete, consisting by October 1991 of about 8500 references. The network has been set up to secure efficientlines of communication, and members are expected to contribute typed references to the database.

M. KATO, H. KASHIMA, M. MIZUNO, & M. ASAI. ~ d i t i o or e pcrseveration on the Conceptual Level Within the Frontal Lobe. We investigate tbe localizntion o f p a s e v d o n on the coaceptuat level wirhin the frWW lobe by identifying the lesions on CT slices. Subjects are 54 caseswho havedaamgesonlywithin the frontal lobe. The Wisconsin Card Sorting Test (WCST,

Keio version) was administcrodStatisticalanalYJis of the results reveakd that perseveration was significantly more common when lesions included Brodmann’s srta 9, whetha they had legioaS in other pnfronral amas orw In addition. the resultssuggesttbptthedisadaof~lcarning or cue utilizarioa could come from ksion~of prcfrontal structures including Bmdmann’samas 10, 11, 12.46, and 47.



SATURDAY, JULY 11,1992 Symposium 5 NEGLECT

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8:30-10:30, Room ED-101 Organizer and Chair: M.J. Riddoch & E. De Haan Discussant: E. De Haan Neglect has proved one of the most fascinating perceptual disorders that may result from brain damage. Neglect phenomena have been interpreted in many ways over many years. Like prospectors of old working an apparently inexhaustible seam of gold, new and exciting discoveries are the prizes that fall to workers in the area. This symposium offers glimpses of the excitcments. The first paper concerns cases where the neglectcd side may vary according to the task or the hand used. The second paper addresses the issue of vestibular-environment reference frames as opposed to viewer-centred frames. The third paper considerswhether the processing of contralesional stimuli has any effect on subsequentperformance. The fourth paper rounds off the symposium by asking “Is neglect neglect?” M J . RIDDOCH & G.W. HUMPHREYS. Dissociations in Neglect. In several interesting cases of unilateral neglect, the neglected side varies according to which hand is used to perform a particular task, or according to the task itself. These effects cannot be totally accounted for in terms of hemisphere activation. Alternative possibilities are that neglect reflects damage to specific and different spatial representations mediating different tasks and/or damage to task-specific attentional processes. These possibilities are reviewed in light of new evidence from two cases in which the ncglected side varies within a single patient.

A.W. YOUNG, DJ. HELLAWELL, & J. WELCH. Locus of Impairment in Unilateral Neglect. Unilateral neglect is often discussed as if the fact that patients do not respond to left-sided stimuli implies that they are not aware of them. We report phenomena questioning this convenient assumption. We demonstrate that patient B Q (with longstanding severe neglect following a right-hemisphere stroke) can respond to left-sided stimuli under certainconditions.However, even left-sided features that BQ has accurately described (and of which we assume she is therefore aware) do not get reported or seem directly to influence her performance in other tasks. As for all neuropsychological deficits, it is therefore important to consider the level of breakdown in cases of unilateral neglect.

J.C. MARSHALL & P.W. HALLIGAN. Is Neglect Neglect? Visuo-spatialneglect is a useful term in much the sense that aphasia is; it conveys a rough and ready impression of the kind of problems that a patient will show. In left neglect, one expects to see impairments on (at least a subset of) conventional clinical tasks: cancellation,drawing and copying, line bisection, etc. The expression of these problems will involve omissions, distortionsand biases more marked in left than right space. Given such patterns there is a natural temptation to construct “theories” that directly explain the phenomenon of “ignoring the left” (sensory neglect, perceptual neglect, attentional neglect, representational neglect.. .). Per contra we argue that underlying the overt symptomatology there are “deeper” impairments of basic psychophysical functions. Paper Session 11 NAMING

K.M.HEILMAN. Spatial Dimensions in Neglect. Although space is three-dimensional, until recently most reports of neglect in man were limited to the horizontal plane. We reported patients with lower and upper vertical neglect and near radial neglect. Vertical and radial neglect may be in reference to the viewer or to gravity and the environment. By changing thc body’s orientation in respect to gravity, the vestibular-environmental reference frame can be contrasted to the viewer-centered frame. Studies suggest that the vestibular-environmental frame has a greater influence on the distribution of neglect than does the viewer-centered one.

8:30-10:30, Joachim Hall Chair: LJ. Gonzalez Rothi L. MANNING & R. CAMPBELL. Naming Depicted Objects and Depicted Actions: Evidence for Dissociation in a Case of Optic Aphasia. We describe a Spanish-born patient, AG, with a left occipital lesion. The patient showed normal semantic processing,normal naming to definition, and normal visual recognition skills. His naming deficit was specific to visual objects. Action naming was normal. We suggest that a very mild



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deficit in semantic access from vision, coupled with a very mild postsemantic deficit in phonological activation, could account for the striking features of this case. In particular, a general deficit in activation from vision might induce an apparent grammatical-class-sensitiveimpairment in naming, such that objects (that is nouns) rather than actions (that is verbs) are most affected.

S.S. BASSETT. Facilitative Effects of Phonemic Cuing on Confrontation-Naming Performance in Alzheimer’s Disease. Phonemic cues have been found to facilitate confrontation naming for normal elderly and some patients with Alzheimer’s disease (AD). It has been suggestedthat phonemic cues assist with production of a previously selected lexical item. However, it may be that phonemic cues are used in the selection of the lexical item. Twenty AD patients and 20 matched control subjects were given two sep arate confrontation-namingtests. AD patients with moderate naming difficulty used phonemic cues as successfully as controls on the Boston Naming Test, but not on a naming test which used only items with semantically and phonemically related objects (e.g., trumpet, trombone). Results suggest AD patients use phonemic cues to select lexical items rather than to produce already selected items. A.M. RAYMER, ML. GREENWALD, M.E. RICHARDSON, L J. GONZALEZ ROTHI, & K.M. HEILMAN. Optic Aphasia and Optic Apraxia: Theoretical Interpretations. A patient with inordinate impairment in naming pictures (as opposed to naming to definitions, gestures, auditory sounds, and tactile objects) produced many semanticand perseverativeerrors. Performance on tasb dependent upon presemantic visual processing was relatively intact. Concurrent deficits in gesturing to pictures and retrieving complete semantic information regarding pictures were noted. We propose that the impairment in this patient may be characterized as optic aphasia and “optic apraxia.“ Current cognitive models that attempt to provide interpretations of optic aphasia cannot account for this patient’s performance. We suggest an alternative interpretation where presemantic visual processing is insufficient to fully activate and specify phonological and gestural representations either directly or by way of semantics. A. DANIELE, L. GIUSTOLISI, M.C. SILVERI, & G . GAINOTTI. Anatomo-Functional Correlations in Patients With Category-Specific Deficits for Grammatical Word Classes. Several studies suggest that brain-damaged patients may show category-specificdeficits for classes of

words, such as nouns and verbs. In the present study we report three patients with such selective impairments. The first patient, with a striking atrophy of the left temporal lobe. showed a disproportionate impairmentin naming and comprehension of nouns. The second patient, with frontallobe atrophy, showed a selective impairment in naming and comprehension of verbs. The third patienC with a left frontal-lobe perfusion abnormality, showed a selective impairment in naming verbs. These findings suggest that distinct neural systems in the temporal and frontal lobes might play a critical role in lexical mechanisms involved in production and comprehension of nouns and verbs, respective!y.

Paper Session 12 ALCOHOLISM AND RELATED DISORDERS 1050-12:30, Room ED-101 Chair: D. Bowers

S.B. ROURKE, I. GRANT, & RJ. REED. Effects of Length of Abstinence on Neuropsychological Recovery in Alcoholics. Neuropsychological performance(NP) of 80 male recent!y detoxified (RDA abstinent mean 29.2 days), 32 male long-term abstinent &TA abstinent mean 3.6 years) alcoholics, and 39 male nonalco-‘ holic controls (NAC) were evaluated at baseline. NP deficits in attention, learning, recall. abstraction,complex perceptual-motor,and simple motor skills were observed in the RDA group; the LTA and NAC groups were indistinguishable except on manual dexterity. At 2 years follow-up, 50 (63%) RDA subjects relapsed during interim and were characterized as resumed drinkers (RES) while 30 (37%)remained abstinent and were classified as intermediate-term abstinent (ITA) alcoholics. At follow-up, the RES group performed significantly worse than LTA and NAC on learning. abstraction, and complex-perceptual-motorability domains. The ITA group (which was identical on NP to RES at baseline) improved so as to be intermediate between RES and LTA/NAC on ability domains. We conclude that graded BOYery in NP abilities occurs over long periods in alcoholics. Even after 2 years of abstinence such recovery may not be complete.

J. DEUS, J. IPUJOL, J. KULISEVSKY, P. VENDRELL, & C. JUNQUE PLAJA. MRI Changes and Neuropsychological Impairment in Chronic Hepatic Disease. No abstract received.

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H. KASHIMA, M. KATO, M. MIMURA, & M. ASAI. Neuropsychological Subtypes of ”Alcoholic Dementia”. The syndrome of “alcoholic dementia” has been a subject of controversy. In this study we tried to classify alcoholic dementia into subtypes from a neuropsychological standpoint. Thirty chronic alcoholics with clinical symptoms of dementia or a MMSE scoreof less than 24 were studied. Various neuropsychologicaltests of intellectual function, memory, frontal function, and constructional function were performed. B d on the test results, four subtypes were distinguished: Korsakoffsyndrome type, frontal-dysfunction type, severe Korsakoff-syndrometype, and general cerebraldysfunction type. The last two types may correspond to “alcoholic dementia” in a narrow sense. Frontal dysfunction and ‘amnesie de type axiale’ was present in all subtypes. The cerebral dysfunctions of “alcoholic dementia” appears to be intimately related with anterior dementia or subcortical dementia. M. KATO, H. KASHIMA, A. YOSHINO, & M. ASAI. A Case With Alcoholic Korsakoff Syndrome -The Course of Neuropsychological Deficits and Its Relation to the Appearance of Provoked Confabulation. We report a case of Alcoholic Korsakoff Syndrome in which we could administer detailed neuropsychological examinations before onset, and conduct follow-upstudies 3 months and 1 year after onset. Parallel changes were found among the results of Wisconsin Card Sorting Test (WCST), tests of antemgrade amnesia, and the appearance of provoked confabulation.In memory disorder, sudden activations of irrelevant associations and disinhibition of proactive stimuli were found. Decrease of categoriesachieved in WCST was not attributed to perseveration but to difficulty of maintaining set. The results suggest that the patient’s basic symptom is the memory disorder with disinhibition of stereotype or proactive stimuli, and that the disinhibition appearing in successive activity plays an important role in the manifestation of provoked confabulation. Paper Session 13 NEUROPHYSIOLOGY AND VISUAL PROCESSING 1O:SO-1230, Joachim Hall

M.B. DE GRAAFF, R. LICHT, P. REITSMA, & DJ. BAKKER. Electrocortical Correlates of Learning to Read. Evidence has accumulated that the development of word recognition proceeds from a slow, pho-


nological route to a fast, lexical route. In order to assess the elecmortical correlatesof these reading strategies,fmt grade primary school children were administeredtasks tapping visual, graphemic,and lexical analysis in a longitudinal design. During task performance Event-Related Potentials(ERPs) were recorded over the left and right hemisphere. It was found that visual and graphemic analysis elicited rather consistent patterns of ERP asymmetry, whereas lexical processing of words was characterizedby long-latency negativewaves over posterior locations that changed in asymmetry from right to left- This finding may indicate that different brain areas are involved in word recognition and/ or lexical analysis, as a function of reading experience. B. CROSSON, S.E. NADEAU, DJ. WILLIAMSON, S.S. SHUKLA, C.M. WILLIAMS, & J.C. HONEYMAN. Localization of Visual Activation With HMPAO SPECT and MRI Scans. Single photon emision computed tomography (SPEW is a more cost-effective tool than posilron emission tomography PET)to map brain systems involved in complex thinking activities. However, adequate localization methodologies have not been developed for SPECT. Ten subjects were given [%Tc]-HMPAO injections under both visual activation and unactivated conditions. A technique was developed to locate visual cortex on SPECT images using magnetic resonance imaging (MRI) and external markers as reference points between images. Consistent with previous visual activation studies, all subjects demonstrated increased regional cerebral blood flow to the visual (striate) cortex during visual stimulation.Results indicate that HMPAO SPECT scans can be used in combination with MRI to localize structures involved in sensory processes.

A.C. PAPAMCOLAOU, R.L. ROGERS,L.F.H. BASILE, S.B. BAUMANN, & H.M. EISENBERG. Magnetoencephalography Reveals Two Distinct Sources Associated With the P300 During Visual Oddball Paradem. Previous studies utilizing both surgically implanted depth electrodesand extensivemapping of surface potentials have indicated that the late positive potentials (P300) to unexpected, rare, or taskrelevant stimulation results from the activity of a number of distributed sources. However, to date, systematicstudies of these various generator sites have been sparse due U, the invasive nature of depth electrodes and the inability of surface recordings to separate the relative contributions of the various brain substrates to the P300. The current study used magnetoencephalography to measure and locate the sources of he. puw). Di-



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pole solutions of the current study of P300 to infrequent deviations in the presentations of visual stimulation indicated that two distinct sources could be identified,one in the area of the primary visual cortex and the other in subcortical structures beneath the temporal lobe. The ability to study the relative effectsof cognitive maniputations on these two distinct sources should help identify the contributions of these distributedneuroanatomicalsites to various types of cognitive processing. L.MJ. DE SONNEVILLE, M.H.W. GEERAETS, J.C. WOESTENBURG, & B.C.L. TOUWEN. Minor Neurological Dysfunction Sequelae Reflected in the Visual ERPs in Children* In a prospective study on late sequelae of minor neurological dysfunction in complex information processing, children (age 12) were administered a high-speed memory search task.The task involved a between-category selection (signal relevance) and within-category selection (target detection). During task performance EEGs were recorded at the 10-20 system locations Fz. Cz, Pz, and 02. DifferenceERP waves were calculated to evaluate early search-related negativity and late positive attention shifts associated with target detection and memory update processes (P300). The children were neurologically examined at test age on six neurological behaviour clusters: posture, sensorimotor, coordination and balance, fine manipulative ability, and movement quality. As a results the children fell into the followingcategories: MNW (no failure on any cluster. n=20), MNDl (did not pass optimality criteriaon 1 or 2 clusters,n=19) and MND2 (failed on 3 or more clusters, n=17). Children with MND (both groups), compared to children without MND, demonstrated a reduced positive shift, in amplitudo as well as in volume. Interestingly, the MNW and MNDl groups did not differ on reaction time measures. The results underline the nature of the attention deficit associated with MND, namely a reduced allocation of working mem?ry resources.

* Supported by the Praeventiefonds, grant # 281622. Poster Session 3 8:30-12:30, Caedmon Hall

R.M. ANDERSON, D.F. REED, B. GOODYEAR, & B.I. BODDY. Tinker Toy Test Performance: Correlations With Visumnstructional Ability and Cognitive Flexibility. Lezak's Tinker Toy Test (TIT). WAIS-R, Wisconsin Card Sorting Test (WCST), and Trail

Making Test B were administered to 34 patients who had suffered brain damage. The number of TTT pieces used (N) correlated modestly with Block Design. WCST categories completed, and WCST perreverativcresponses.A me&weof lTI' construction complexity which included N also correlated modestly with B k k Design. When N was excluded, no meaningful correlations were obtained. A factor analysis yielded four factors labled: Verbal Intelligence, CognitiveFlexibility, Visuospatial Perception, and Visuospatial Construction. When N was excluded, complexity did not load significantlyon any factors. These results suggest that the complexity score may not be measuring the areas of functioning assessed by the other tests in this study. A.B. WOLFF, K J. SASS, & J. KEIDAN. Adaptation of the Intracarotid Sodium Amytal Test for Use With a Deaf Subject. The intracarotid Amytal procedure (IAP) was conducted with a profoundly deaf young man prior to right temporal lobectomy for pharmacologically refractory partial complex seizures. The IAP required considerable modification. in order to take into account the use of varying sign language methods and related limitations. Visual memory, American Sign Language. signed English, and fingerspelling functioning were all assessed. The patient manifestedleft-hemispheredominancefor all these abilities, performing well under righthemisphere anesthesia. In contrast, no ability to function on these tasks was detectable when the left hemisphere was anesthetized This demonstrates that an intact left temporal lobe and related smctures are suffiient to support sign language functioning. The development of a deaf adaptation of the IAP is of methodologicalsignificance, as the IAP is thereby rendered accessible for deaf patients. M.D. VAN DEN BROEK, C.M. BRADSHAW, & E. SZABADI. Diagnostic Utility of the Modified Wscoasln Card Sorting Test (MCST). Nelson's modification of the Wisconsin Card Sorting Test has been recommended for use with groups such as the elderly. New threshold scores for diagnosingfrontal-lobedisorder were derived, and compared with the conventional criterion. Indices of perseveration and other performance measures did not discriminate between patients with frontal- and non-frontal-lobe lesions, using either diagnostic technique. The task also lacked lateralising significance, although it had high specificity (98:7%) and good sensitivity (45.6%) to lesions irrespective of site. These data suggest that the MCST cannot be viewed as equivalentto. or as a short-form of, the origillal Wisconsin task. although it may be a useful screening measure.

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ABSTRACTS P. KARZMARK. Factor Analysis of Special Wisconsin Card Sorting Test Measures in a ComprehensiveNeuropsychological Assessment. The present study evaluated the relationship of a number of Wisconsin Card Sorting Test (WCST) measures, to each other and to overall performance on a comprehensive neuropsychological assessment battery. A factor-analyticapproach was used and the subjects were 120 brain-injured patients undergoing rehabilitation. The factor analysis, accounting for 71% of total variance in the test battery, defined eight factors. Three variables from the WCST, Perseverative Responses, Categories Achieved, and Percent Conceptual Level Responses, defined a specific and unique factor which appears to represent conceptual reasoning. The WCST Failure to Maintain Set variable loaded with other measures in defining a concentration/ attention factor. The results are interpreted as indicating that the WCST adds meaningful information to that gained from a comprehensive neuropsychologicalassessment. E. SIMERNITSKAYA & J.E. DEL DOTTO. Luria-90 Neuropsychological Test Battery: Theoretical Principles and Clinical Case Illustrations. This study examines the efficacy of the “Luria-90 Neuropsychological Test” in diagnosing cerebral dysfunction in both children and adults. This approach, which focusesprimarily on the assessment of memory functioning, includes a major reliance on a qualitative analysis of psychological test performance. The approach not only provides a psychometric index of global brain functioning,it is designed to assess for the presence of specific and localized brain dysfunction. To illustrate the clinical usefulness of the “Luria-90” we present five case studies, three of which have verified central nervous system (CNS) damage, and two others with suspected CNS dysfunction.

BJ. COLLINS & A. TELLIER. Construct Validation of the Modified Visual-Verbal Test, a Measure of Conceptual Flexibility. Standard use of the Visual-VerbalTest (VVT) as a measure of mental flexibility may be confounded by conceptual difficulty. In an effort to control for this, we recently developed a modified version of the test. The current study was undertaken in an effort to validate this modified VVT (MVVT) by comparing it to a widely used measure of mental flexibility,perseverative errors on the Wisconsin Card Sorting Test (WCST). Performance on the MVVT correlatedsignificantlywith perseverative errors on the WCST but not with nonperseverative errors, while performance on the standard version correlated with both types of errors. These results provide evidence of both convergent and discri-


minant validity of the MVVT as a measure of conceptualshift and support our earlier claim that the VVT, in its original form, is not a valid measure of mental flexibility. A. TELLIER, L. DELLA MALVA, & BJ. COLLINS. An Examination of the Construct

Validity of the Benton Visual Retention Test. As its name implies, the Benton Visual Retention Test (BVRT) was initially designed as a measure of visual memory. However, deficient performance on this m est can also result from impairment in attentional. executive, visuo-spatial, and perceptual functionsand even from left hemisphericdamage. The present study was an effort to elucidate the underlying constructs assessed by the BVRT by examining its relationship to widely used measures of attention, memory,and executive functions. Two factor analyses based on 200 outpatients revealed the BVRT free recall to load significantly on a memory-related factor. In contrast, in one analysis, the variance of the BVRT recognition was more evenly distributed across three factors (Memory, Attention/Concentration, and Frontal). While these results lend support to the use of the BVRT free recall as a measure of visual memory, they warrant cautious interpretationof faulty performance on the recognition component,given its variable factor loading. F.F. LeFEVER. Search Patterns in Oral Tests

of Visual Neglect (ORTVIN) and in Their Manual Analogues,Nondirectional “Trails” (NTrails). The recently described Oral Tests of Visual Neglect (ORTVIN) are analogues of cancellation tests requiring subjectsto read aloud words with specified initial letters scattered among words with different initial letters. Transcriptionsof tape-recorded responses reveal typical search paths (vertical for patients with left neglect, horizontal for others) and other details of the process. In a manual variant, similarto “Trails”but nondirectional because the examiner does not specify the sequence (NTrails), lines drawn from target to target show search paths typical of a given patient’s ORTVIN path. Computer “touch screen” devices allowing measures of interresponsedurations and avoiding alterations of the stimulus array - ORTVIN advantages with both verbal and nonverbal targets are under study, but N-Trails can at least reveal search strategies of aphonic or dysarthricpatients. M. INMAN, C. BULLARD-BATES, & L. ROY. The Neurobehavioral Cognitive Status Examination: A Factor-Analytic Study With Stroke Patients. The NeurobehavioralCognitive Status Examination (NCSE) is a brief cognitive status examina-

tion which measures seven areas: orientation, language, construction, memory, calculations, reasoning, and attention. The factor validity of the NCSE, however, has not been established.The NCSE was administered to 102 stroke patients on admission to a rehabilitation hospital. A factor analysis of the nine subscale scorcs obtained on

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Results indicated a single, verbal factor, Using the criteria of eigenvalues 2 1. with all nine scales loading at the .01 level of signifiicance on this verbal factor. As with many other cognitive screening mearures,the NCSE does notadequately evaluate nonvabal abilities.Due to heavy hnguage requirements for all of the domains measured, results for aphasic patients are confounded by verbal requirements. S.P. JOY,E.KAPLAN, & D.FEIN. The Information Test of the WAIS-R as a Neuropsychological Instrument Among Healthy Older Adults. TheWAIS-R-NI allowsCMcianSto asses^ specific processes that underlieWAIS-Rperformance. The present study investigates properties of the Information test in a nonpatient sample (N=177)of older subjects (ages 50-90). On the standard Information test, active errors (incorrect responses) increased with age except among the oldest subjects, who made many passive e m ("don't know" responses). A multiple choice (recognition)version of the test is introduced:the instrumentscorrelated at m.81. with recognition scores typically slightly higher than free-recall scores. Scores on the standard version, but not the multiple choice version, declined significantly with age. The WAISR-NI Information test may be a useful measure of retrievaldeficits and premorbid functioning among some neuropsychologicallyimpaired subjects. P.F. PAQUIER, M. VAN MOURIK, H.R. VAN DONGEN, & C.E. CATSMAN-BERREVOETS. The Clinical Value of the Line Orientation Test and the Facial Recognition Test in Children With Acquired Unilateral Cerebral Lesions. In adults, the Line Orientation Test (LOT) and the Facial Recognition Test (FRT) are considered Valid i n s h u m ~ tfW s the detection Of rightcerebralhemisphere lesions. It is unknown, however, whether thisappliesto children as well. Therefore, we administered the LOT and the FRT to 18 children with acquired left cerebral and 15 children with acquired right cerebral lesions. Agerelated norms were obtained in 91 normal coneols, aged 6 up to 14 years. The results indicate that, in children. LOT performances are not associated with, and FRT performancesonly mildly associated with disease of the right hemisphere. These results cast serious doubt upon the clinical utility of both tests in children.

J. LACROIX. Is the General Aptitude Test Battery (GATB) Useful to Neuropsychologist8 in Assessing the Ability to Work d Persoas With a Tmu.ut& Brain Injury? N w m p s y ~ i s t are s asked to provide information regarding P pason's ability to work following a mumahc * brain injury ( TBI). There is infOmWbll8VriloblcOn thc Validity Of tk tests most commonly uaed to predict the ability of these individuals to return to work. Rcsesrch in nwropsycbology relntcd to thc i voEptiwal abilities has centred on meesuring the pason's incapacity. Thc smvivor's ability to work ~ I t from s the interaction betarcen their abilitiddisabilities and demandsof occupaions. This study examines the usefulness of the General Aptitnde Test Battery (GATB) for job matching (person-job fit) with

personswithTBI.Theirpufoll~anoeontheGATB is analyzed in relation to the demands of their present and/or past occupations which pet evaluated using a p b analysis techmquc (PAQ).

G . ZAPPALA, G. MEASSO, L. ROMANI, P. MERLIN, & E. KAPLAN. The California Verbal Learning Test (CVLT): Preliminary Report on the Development of the Italian Version. The CVLT is a recently devisedclinical instrument that can assess a broad variety of quantitative and qualitativeaspects of verbal memory perfman~e, such as verbal learning. free recall. recognition, proactiveand retroactive interference. and the use

ofserialandsernanticleamingstratcgies.AnItalian version of the CVLT was designed by selecting items on the basis of dau from a randan sample of 310 normal Italian subjects aged 2&79 years, who performed a category fluency task on the six categoriesof the originalCVLT.The Italian CVLT was then administered to a further similarraadom sample of 174 normal healthy subjects for normative purposes. Preliminary analyses show different patterns of age differences on specific measures. such as free recall scores and semantic clustering. S.A. WINGENFELD. Combining Neuropsychologknl and Interactive Methods in the Assessment of Children With Learning Dis~bilities: An Exploratory Study. This study explored the relationship between neuropsychological(Planning, Attention, Simultaneous, and Successive Cognitive Processes Model)and interactive assessment (Learning Potential Assessment Device). This study focused on Planning. Eighteen learning-disabled(LD) and 31 non-LD students aged 12 to 15 ycars completed Trail Making and a Visual Search test as r e p resentative of Planning. Instruction in cognitive strategies was provided for the Representational


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Stencil Design Test (RSDT). Between-group differenceswere significant for Trail Making, Visual Search, and a Planning score, but not the RSDT. Subjects with high Planning scores showed significantly higher improvement on the RSDT posttest. showed higher cognitive efficiency, and received less intervention on the RSDT. J. PENA-CASANOVA, J. GUARDIA OLMOS, & A. JARNE ESPARCIA. The Barcelona Test (BT) as a General Neuropsychological Test: Final Norms snd Materials. The Barcelona Test is a neolurianistic general neuropsychological test battery. The BT includes a wide series of subtests giving a basic spectrum of the neuropsychologicalactivities. In previous work, basic statistical norms were pointed out. Hereby we present the final materials and normative groups. A sample of 129 subjects was selected and stratified in groups considering age and schooling. The statistical study led to five final groups. The educational level variable is shown as significantly more important than the age variable in the group of 50- to 70-year-olds. A.M. DAVIS, J.M. COCKBURN, D.T. WADE, & P.T. SMITH. A Subjective Memory Assessment Questionnaire for Use With Elderly Stroke Patients. The aim of this study was to validate a subjective everyday memory questionnairefor use with elderly people after stroke against an objective measure of everyday memory. The questionnaire and objective measures were tested on 50 stroke patients over 60 years of age. A significant positive correlation was obtained (r=.7:p < .OOOl). A principal componentsanalysis on the individual subjective and objective items resulted in two factors with similar items weighting on the same factor. It is concluded that the questionnaire is valid for use with elderly people after stroke. M.M. SCHMIDT, G.W. TRUEBLOOD, & M. KINLAW. Comparison of Commonly Used Tests of Reasoning and Abstraction. Six measures from the WAIS-R and seven additional tests that are commonly cited as measuring reasoning and abstraction were examined in a sample of 86 individuals referred for outpatient neuropsychological evaluation. Three factors emerged: NonverbalNisual (WAIS-R Block Design, Picture Arrangement, Object Assembly; Category Test, Trail Making B, and Tactual Performance Test), ConceptPattern Detection (Wisconsin Card Sort, Verbal Concept AttainmentTest, Shipley Abstraction, and WAIS-R Arithmetic),and VerbdSymbolic (Word Finding Test, WAIS-R Comprehension and Similarities). Results are discussed in terms of prior factor-analyticstudies


of neuropsychological tests, in which reasoning factors generally do not emerge, and theories of reasoning and abstraction. GJ. LAMBERTY, L.A. BIELIAUSKAS,D.M. CHATEL, & J.D. JONES. Prediction of Wechsler Memory Scale Performance in a Geriatric Clinic Sample. We examined memory performance, as measured by the WMS, in geriamc patients referred for evaluation of dementia. Demographic variables (agdeducation), PPVT-R standard score, and the MMSE were used to predict WMS total score. The demographic factors failed to significantly predict WMS totd sore. Both PPVT-R and M M S E scores were significant predictors of the total WMS score, with the MMSE predicting 66% of the variance. Our results suggest that dementia patients’ performanceon standard memory measures is m a influenced by current mental status than by presumed premorbid abilitiesand supports the validity of using screening measures in this population. Finally, the lack of age effects on WMS within elderly groups (in normal and dementia samples) argues against using clinically intuitive adjustments for increasing age. M.V. GUSEVA & A.G. ZALTSMAN. Hemispheric Differences in Recognition of Pictures With Removed Parts of the Spectrum. Twenty-five subjects were asked to recognize object pictures tachistoscopicallypresented in the left, right, and central fields. These were full spectrum and filtered pictures with removed frequency parts of the spectrum. Results showed that, if a picture with removed mid-frequency range was addressed to the left hemisphere,recognition is substantially lowered. It may point to the great significanceof the mid-frequency range from 0.65 to 4 cycles per degree for the left hemisphere. The results also show a dramatic decrease of the recognition of the pictures if the mid- and low frequency ranges are removed and are addressed to the right hemisphere. This can be explained on one hand by the hypothesis that the right hemisphere is unable to analyze high spatial frequency range in conditions of perception time deficit and on the other hand by the significance of low and mid-frequency ranges for the right hemisphere. The results of the study support the idea of the existence of special channel filters and their interaction in the visual system. N.D. COOK,T. LANDIS, M. REGARD, & R.E. GRAVES. A Bimodal Test of Language Dominance: Auditory-Visual Word Matching. A bimodal (simultaneous auditory-visual) wordmatching task was given to 40 right-handed subjects. Conditions included a “no-go”, nonmatch

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condition and three “go”, match conditions. Advantages for words presented to the right visual field and right ear were found for most subjects when two different lateralized stimuli were presented in one modality for matching to two identical lateralized stimuli in the other modality. Much stronger asymmetries wete obtained when both modalities contained different lateralized stimuli, a condition that should maximize demands for intrahemispheric cross-modal matching. It is concluded that this bimodal test is a useful measure of language dominance and has advantages over unimodal tests.

administered. The test scatter was interpreted using the deficit measurement method of Lezak, in order to comment on the presence of organic or functional signs or a combination of both in the presentation of ME. Subjective reports and test performanceprovided a corroborative and highly consistent presentation across all subjects of deficits in the areas of verbal fluency, word naming, verbal logical memory, nonverbal immediatc and delayed recall, and hand motor dexterity. The pattern was commensuratewith that of a metabolic organic picture and not entirely explicable in terms of depression.

K.L. JOSHI-PETERS. Frequency of Self-Reinforcement Questionnaire: A Children’s Form. Initial psychometric data are presented on the Frequency of Self-Reinforcement Questionnaire Children’s Form (FSRQ-CF), a self-reponmeasure designedto measure individualdifferences in selfreinforcement skills in children aged 8-14 years. The usefulnessof a ‘positive’self-report measure, sampling children’s emotional-motivational domain, is discussed. The related, though separate issue of the role of emotional-motivationalfactors in neuropsychologicalrehabilitation or cognitive retraining is also addressed. Results from an initial factor analysis are presented. Preliminary norms are available.

A.B. SHUTTLEWORTH-JORDAN. Age and Second-Language Effects on Digit Span Backwards Relative to Digit Span Forwards, and Digit Supraspan. The Wechsler Adult Intelligence Scale (WAIS) verbal subtests do not tap or highlight certain functions which are sensitive to the nonspecific effects of diffuse brain damage: verbal short term memory, new learning ability and working memory. Since diffuse cerebral impairment accompanies a large proportion of cerebral pathology, these are important mas of potential deficit to assess in order to detect organic deterioration. This presentation draws attention to the significance of noting the difference score between Digits Forward and Digits Backward (an indication of working memory), and of noting the number of trials it takes to leam the span above the normal . span (a test of verbal short-termmemory and newlearning ability). Normative data on South African English versus non-English speakingsubjectswith a minimum of 12 years education comparing Digits Difference and Digit Supraspan s c m across three age groups (18-25,40-50 and 60-70 years), are presented.

N.C. JORDAN & A.B. SHUTTLEWORTHJORDAN. A Neuropsycbological Investigation Into the Cognitive Profile oFFour Patients with Myalgic Encephalomyelitis. The cognitive response patterns of four patients with Myalgic Encephalomyelitis (ME)were investigated. A clinical interview to elicit the subjects’ experience of their cognitive deficits and a wide battery of neuropsychological tests were

International Neuropsychological Society, 14th European Conference. Durham, England, July 8-11, 1992. Abstracts.

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