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Objective The Rey Auditory Verbal Learning Test (RAVLT) is a widely used verbal memory measure that provides scores for different aspects of memory. It involves repeated auditory presentation and recall of a 15-item word list (List A) followed by presentation and recall of a distractor list (List B) and then un-cued immediate and delayed recalls (at 15 min and 1 week) of List A as well as recognition testing. Aims of this study are to provide Italian normative data for certain RAVLT Scores and Composite Indices to improve the diagnostic accuracy of the test in clinical settings and to provide further evidence on how RAVLT can differentiate different amnesia profiles due to focal lesions. Methods We enrolled 440 healthy participants and RAVLT Single Scores and Composite Indices have been analyzed by means of multiple regression to verify the influence of age, education, and gender. Results We computed the best linear models with RAVLT Single Scores and Composite Indices, as dependent variables, and the most suitable transformation of independent variables. By reversing the signs of the regression coefficients, the adjustment factors for each level of age and, if needed, education and gender have been computed and the adjusted scores have been standardized into Equivalent Scores. Conclusion Using these standardized measures, we differentiate three profiles of amnesia due to selective hippocampal sclerosis with severe encoding deficit, fornix lesions with source memory problems, and temporal lobe epilepsy with consolidation failure.

Introduction The Verbal Fluency Test (VF) is commonly used in neuropsychology. Some studies have demonstrated a marked impairment of semantic VF compared to phonemic VF in Alzheimer’s disease (AD). Since amnestic Mild Cognitive Impairment (aMCI) is associated with increased risk of conversion to incident AD, it is relevant to examine whether a similar impairment is observed in this population. The objective of the present empirical study is to compare VF performance of aMCI patients to those of AD and elderly controls matched one-to-one for age and education. Method Ninety-six participants divided into three equal groups (N = 32: AD, aMCI and Controls) were included in this study. Participants in each group were, on average, 76 years of age and had 13 years of education. A repeated measures ANOVA with the Group (AD, aMCI, NC) as between-subject factor and the Fluency condition (“P” and “animals”) as within-subject factor was performed. T-tests and simple ANOVAs were also conducted to examine the interaction. Results There was a significant interaction between the groups and the verbal fluency condition. In AD, significantly fewer words were produced in both conditions. In contrast, participants with aMCI demonstrated a pattern similar to controls in the phonemic condition, but generated significantly fewer words in the semantic condition. Conclusion These results indicate a semantic memory impairment in aMCI revealed by a simple, commonly-used neuropsychological test. Future studies are needed to investigate if semantic fluency deficits can help predict future conversion to AD.

The evolution of the concept of a multicomponent working memory is described with particular reference to the contribution from neuropsychology. Early evidence from patients with the classic amnesic syndrome, together with others showing the opposite deficit of impaired short-term but preserved long-term memory argued strongly for a separation between long- and short-term memory systems. Simulation of the short-term deficit in healthy participants using a dual task approach suggested the need to assume a three component system serving as a multi-purpose working memory comprising an overall attentional control system, the Central Executive, aided by separable temporary buffer stores for phonological and visuospatial information. An account is then given of the way in which evidence from patients was combined with the study of healthy participants to test and expand the model over subsequent years. This led to the need to propose a fourth component, the Episodic Buffer, a system that combines information from multiple sources and makes it accessible to conscious awareness. I conclude with a brief account of how the multicomponent approach resembles and differs from that of other current models of working memory.

M1 - acaa108 In sports concussion research, the importance of an individualized approach incorporating neuropsychological assessment data has been emphasized. This study examined the impact of acute signs of concussion on post-injury cognitive functioning using reliable change methodology in a sample of Finnish, elite-level, youth ice hockey players.From a sample of 1,823 players (all male, 14–20 years old) who completed preseason baseline testing with the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT®) battery, two subgroups were identified. First, in total, 312 uninjured athletes, who completed baseline testing twice—1 year apart. The scores were contrasted to calculate reliable change indices (RCIs). Second, from a subsample of 570 athletes participating in an intensive follow-up arm of the project, the analysis included 32 concussed athletes. The RCIs were determined for the five ImPACT composite scores and used in identifying athletes with declined performance 3 days post-injury.Test-retest reliability ranged from .39 to .71. Athletes who had experienced an acute loss of consciousness, amnesia, or postural instability had increased odds for declines in two or more areas assessed by ImPACT (odds ratio = 7.67–8.00, p

Objective Wernicke-Korsakoff’s Syndrome (WKS), caused by thiamine deficiency and characterized by altered mental status, amnestic memory loss, confabulation, and lack of awareness, has a global prevalence rate up to 3% and is most commonly observed in alcoholics. Cases of non-alcoholic WKS are exceptionally rare and often go undiagnosed until after the critical treatment period, resulting in permanent brain damage. Despite the paucity of research in this group, there is some evidence that there may be differences in demographic factors, neuroanatomic changes, and cognitive functioning between alcoholic and non-alcoholic WKS patients. Thus, case studies are necessary to understand how non-alcoholic WKS may present and determine whether regular testing in individuals diagnosed with disorders or undergoing medical interventions that can cause thiamine deficiency should be encouraged. Methods Patient is a 65-year-old African American woman with a history of hypothyroidism, obesity, and sleep apnea. She complained of gastrointestinal problems one-month into a pre-bariatric surgery diet. Subsequent medical workups were negative, but she was hospitalized 2–3 months post-symptom onset for thiamine deficiency. Acute neuroimaging was reportedly negative. Results Results from a neuropsychological evaluation indicated temporal disorientation, delusions, and hallucinations. Psychometric testing revealed severe impairments in learning and memory. Some variability was noted in other cognitive domains, but attention, processing speed, executive functioning, language, and visuospatial and motor skills were generally intact. Symptoms of minimal depression and moderate anxiety were endorsed. Conclusion Thiamine deficiency is easily treatable, but different presentations between alcoholic and non-alcoholic cases may complicate diagnosis, delay treatment, and result in WKS. Increased awareness of these differences can inform clinical recommendations.

Objective Preexisting health conditions are associated with worse outcome following mild traumatic brain injury (MTBI), which is especially important in MTBI management among older adults. This study focused on older adults who presented to an emergency department (ED) following uncomplicated MTBI, examining the relationship between clinical signs of MTBI, preexisting conditions, and the location of ED discharge. Method Participants included older adults (n = 616, men = 44.8%, ≥55 years-old) who presented to the Tampere University Hospital ED with uncomplicated MTBI (GCS = 15; ground-level falls = 72.4%). Data were collected retrospectively from hospital records, including clinical signs of injury, preexisting health conditions [including preinjury abnormalities on head computed tomography (CT)], and location of follow-up (i.e., home versus other health/rehabilitation facility). A higher odds ratio (OR) indicated a greater likelihood of continued care discharge to another health facility. Results Among participants 55–69 years-old, preexisting neurological diseases (OR = 2.92), mental/behavioral health conditions (OR = 3.05), and CT abnormalities (OR = 3.02) were associated with greater odds of continued care. Among participants 70+ years-old, preexisting neurological diseases (OR = 2.60) and CT abnormalities (OR = 2.12) were associated with greater odds of continued care. Preexisting circulatory system diseases, loss of consciousness, and amnesia were not associated with greater odds of continued care for either age group. Conclusions Among older adults with uncomplicated MTBIs, preexisting health conditions were associated with greater odds of continued care than loss of consciousness or amnesia. These findings reveal the importance of preexisting health conditions in the acute clinical management of MTBI in older adults, in that preexisting conditions have greater associations with care planning than clinical signs of injury.

Objective This study aimed to examine the relationship between developmental stages and concussions that resulted in amnesia as measured by ImPACT. Method Participants were selected from an archival de-identified sports medicine ImPACT database. The sample (N = 4,200) was primarily male (62.2%) student athletes with ages ranging from 10 to 25 years. Participants were divided into three groups: Young athletes (n = 1,400), Adolescent (n = 1,400), and Adult (n = 1,400). A One-Way ANOVA was conducted to determine the relationship between age group and prevalence of concussions resulting in anterograde or retrograde amnesia. Results The One-Way ANOVA revealed significant differences between age group and anterograde F(2,4197) = 107.449, p Conclusions The findings of this study suggest adolescent athletes tend to experience more amnesia-related concussions compared to young and adult athletes. Additionally, adolescent athletes miss more games following these types of concussions. This study highlights the impact that certain types of concussions have on athletes across the developmental stages. Future research should analyze the cognitive effects of various types of concussions across the developmental stages.

Objective This case illustrates the complexities of concussion resulting in Conversion Disorder, rarely discussed in the literature, in a 12-year-old female. Diagnosis, treatment, and recurrence of symptoms through three injuries and retirement from sports are presented. Method Initial injury, with disorientation and amnesia, occurred following three impacts during a soccer tournament. Patient was a high average student, in a divorced family, who recently lost her maternal grandfather and began middle school. Subsequent to initial injury, she reported a loss of memory for all family members, colors and numbers. Family was seen by Neurology, multi-disciplinary Concussion Clinic (CC) providers, and cranial MRI was completed. Neuropsychological testing included IQ, academics, memory, executive functions, emotional, and effort testing. Return to play occurred seven months later, although school avoidance continued through a second injury. A third injury occurred 32 months after initial injury, with additional neuropsychological testing and retirement. Interventions included alternating courses of cognitive-behavioral therapy, family interventions, headache clinic, academic modifications, psychiatry, and continuous CC follow-up. Results All imaging results were normal. Neuropsychological results were average to above average in all areas except calculation tasks and effort testing, with minimal change over time. Significant relation between emotional symptoms, social stressors, self-concept, and cognitive symptoms supported Conversion Disorder. Lack of clearance to return to play motivated initial recovery. Multiple courses of varied interventions addressed complex self-identity issues. Conclusions As research indicates, diagnosis of conversion requires medical and psychological methods. The complex components of this case highlight change resulting from a CC coordinating equally complex medical and psychological treatment.

The measurement of effort is now considered to be an important component of neuropsychological assessment. In addition to stand-alone measures, built-in, or embedded measures of effort have been derived for a limited number of standard neurocognitive tests. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a widely used brief battery, employed as a core diagnostic tool in dementia and as a neurocognitive screening battery or tracking/outcome measure in a variety of other disorders. An effort index (EI) for the RBANS has been published previously (Silverberg, N. D., Wertheimer, J. C., & Fichtenberg, N. L. 2007. An EI for the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Clinical Neuropsychology, 21 (5), 841-854), but it has been reported to result in high false positive rates when applied to patients with "true" amnesia (e.g., Alzheimer's disease). We created a new effort scale (ES) for the RBANS based on the observation of patterns of free recall and recognition performance in amnesia versus inadequate effort. The RBANS ES was validated on a sample of patients with amnestic disorders and a sample of mild traumatic brain injury participants who failed a separate measure of effort. The sensitivity and specificity of the new ES was compared with the previously published EI. Receiver-operating characteristic analyses demonstrated much better sensitivity and specificity of the ES, with a marked reduction in false positive errors. Application and limitations of the RBANS ES, including indications for its use, are discussed.

Episodic autobiographical memory (ABM) is important for social functioning. Loss of specificity in ABM retrieval has been observed in people with mild to moderate Alzheimer's disease (AD). Our aim was to extend these findings to subjects with amnestic mild cognitive impairment (aMCI) and very early AD. We performed a cued ABM task with both subject groups and healthy elderly controls. Although aMCI participants performed better than early AD subjects both showed reduced specificity of ABM retrieval when compared with controls. We conclude that qualitative memory retrieval deficits could contribute to social functioning impairment in people with aMCI and early AD, and highlight the complexity of symptoms already present in early stages of cognitive impairment.

Memory assessment is an important component of a neuropsychological evaluation, but far fewer visual than verbal memory instruments are available. We examined the preliminary psychometric properties and clinical utility of a novel, motor-free paper and pencil visuospatial memory test, the Indiana faces in places test (IFIPT). The IFIPT and general neuropsychological performance were assessed in 36 adults with amnestic mild cognitive impairment (aMCI) and 113 older adults with no cognitive impairment at baseline, 1 week, and 1 year. The IFIPT is a visual memory test with 10 faces paired with spatial locations (three learning trials and non-cued delayed recall). Results showed that MCI participants scored lower than controls on several variables, most notably total learning (p < .001 at all three time points), delayed recall (baseline p = .03, 1 week p < .001, 1 year p < .001), and false-positive errors (range p = .03 to

The Children's Orientation and Amnesia Test (COAT) was developed to assess posttraumatic amnesia (PTA) and cognitive functioning in children and adolescents who are in the early stages of recovery from traumatic brain injury. The COAT is composed of 16 items designed to assess general orientation, temporal orientation, and memory. The original norms are inadequate for several age groups because they were based on small sample sizes and may have been compromised by ceiling effects. In this study, normative data were collected for children between the ages of 8 and 13 (N=248). Regression-predicted age norms were calculated and presented in tabular form. These results provide important reference data for interpreting COAT scores of children who have sustained traumatic brain injuries.

This study compares the rate of postconcussive (PCS) symptoms at the time of injury for mild traumatic brain injury (MTBI; N=24) claimants and claimants reporting other forms of injury (OI; N=66). On checklists surveying their complaints immediately after their injury, MTBI and OI claimants reported similar levels of many PCS complaints, e.g., dazed, confused, dizzy, disoriented, trouble concentrating, numbness or loss of sensation, and loss of memory for some of what happened. One in four of the OI samples reported partial loss of consciousness (LOC), and one-third reported loss of memory for some of what happened. About 67% of the MTBI sample reported being confused and 71% dazed, but so did many of the OI sample (52% dazed, 65% confused). The authors suggest that classical PCS complaints experienced immediately after an injury are so nonspecific that they have little diagnostic specificity.

Many anecdotal cases and some clinical studies have demonstrated that formaldehyde exposure can cause multiple health-related problems and cerebral dysfunction. The U.S. Consumer Product Safety Commission has documented multiple hazards related to formaldehyde exposure. Some of this research has suggested that low levels of exposure can be very hazardous to one's health and can potentially result in heightened chemical sensitivities, seizures, and cognitive decline. Some research suggests that exposure results in long-term immunological changes, cell neurofilament protein changes, and demyelination. Symptomatically, exposure has been associated with respiratory problems, excessive fatigue, headaches, mood changes, and impaired attention, concentration, and memory functioning. This article outlines the case of a biology teacher whose chronic formaldehyde exposure resulted in heightened sensitivity to formaldehyde, three tonic-clonic seizures, and dramatic amnesia as well as other cognitive dysfunction.

The predictive accuracy of Andre Rey's malingered amnesia measures (Memory for Fifteen Items and Word Recognition List) was examined. Discriminant function and crosstabulation analytic strategies were applied to predict membership in either a traumatically brain injured group (n = 60) or in a litigated minor head injury group claiming permanent severe disability (n = 90). Satisfactory hit rates were achieved with Rey's original scoring methods, but improved hit rates were obtained with scoring modifications. Removal of dense amnesiacs from the sample resulted in even better hit rates. Rey's measures appear to be valid for the assessment of cognitive malingering in settings where litigated disability claims are out of proportion to injury characteristics. Rey's measures are not appropriate for globally and severely impaired patients in clinical settings.

Symptom Validity Testing (SVT) has been used effectively with sensory perception and short-term memory. The procedure was recently adapted to assess remote memory for specific events. Memory for remote events is particularly important to the criminal justice system, and courts are beginning to draw on neuropsychology to assist in the assessment of claimed remote memory loss. This report discusses the importance of this objective technique to neuropsychologists involved with criminal courts and presents its use in three cases from the criminal forensic arena. Normative results for the three case study tests are presented and suggest the procedure is a robust version of SVT. Implications of these results are discussed.

Thalamic nuclei appear to play an important role in memory functioning. Severe anterograde amnesia has been reported with lesions of the dorsomedial and anterior nuclei and their connections. We report the case of a woman with discrete thalamic lesions involving the anterior and dorsomedial nuclei who had a persistent anterograde amnesia. Contrary to a previous case report describing impairment only with explicit memory, this patient had impairment with both implicit and explicit memory. This case is discussed in terms of the relevant literature associating the diencephalon, amnesia, and implicit memory.

While decrements in memory following temporal lobectomy for intractable epilepsy remain a major neurocognitive complication of surgical intervention, it has been difficult to identify patients who are most at risk for developing decrements in their memory functions following surgery. Two different models of hippocampal functioning have been posited to account for postsurgical memory losses: hippocampal reserve versus functional adequacy. This article briefly examines the basis of the traditional model of hippocampal reserve, which suggests that it is the reserve or capacity of the contralateral hippocampus to support memory after surgery that determines whether changes in memory function will be observed. A more in-depth review of emerging data from studies of function (baseline neuropsychological testing and intracarotid amytal procedure) and structure (histologic cell densities and MRI volumetrics) supporting a functional adequacy model of hippocampal functioning is then presented. Data from these latter studies provide strong convergent support for the view that the risk for memory decrements following mesial temporal lobe epilepsy surgery is inversely related to the functional adequacy of the tissue to be resected. Data reviewed here have broad implications for the field of neuropsychology. Not only do the data reported in this article challenge some of the basic tenets of our understanding of the role of the hippocampus in memory functioning, but they illustrate the importance of ongoing research, critical reevaluation of basic concepts, and the importance of self-scrutiny in light of new technologies.

An orbitomedial frontal syndrome is proposed, characterized by anosmia, amnesia with confabulation, Go-NoGo deficits, personality change, and hypersensitivity to pain. The orbitomedial frontal syndrome is distinct from the clinical picture that results from dorsolateral frontal damage. Aspects of orbitomedial damage have been discussed previously in isolation, but we argue that recognition of this syndrome in toto is clinically important. It appears to be associated with poor social and vocational adjustment after brain injury, and the co-occurrence of features of the syndrome provides clues to underlying mechanisms for disinhibition and confabulation in frontal lobe patients.

Neuropsychological investigation of minor head injury (MHI) has consistently corroborated patient subjective complaints of memory loss. An experimental group of 11 minor head-injured patients and a control group of age-matched normal volunteers were compared on the California Verbal Learning Test (CVLT) and on the Rey-Osterreith complex figure. Minor head-injured subjects were found to be impaired on measures of short-term and delayed free recall as well as on measures of organizational-semantic strategy in the retrieval phase. These findings are consistent with subjective reports from the patients and may in part explain reduced psychosocial and vocational adaptation following minor head injury.

Vocational functioning at least 2 years postinjury was examined in a group of 57 severely closed-head injured (CHI) patients and 50 nonbrain-injured spinal-cord injured (SCI) patients. The two groups were equated on the following preinjury parameters: age, education, socioeconomic status (SES), male/female ratio, and marital status. The CHI and SCI patients had a similar number of members who were employed at follow-up. However, mean follow-up socioeconomic status was significantly lower in the CHI group and premorbidly employed CHI patients suffered a greater loss of SES than did premorbidly employed SCI patients. These results indicate that the degree of vocational impairment after severe CHI goes beyond impairment seen with another chronic disabling condition (i.e., SCI) that is associated with severe physical impairment but not neuropsychological impairment. In the CHI group, the following variables were all correlated with SES at follow-up: preinjury education, posttraumatic amnesia duration, degree of neuropsychological impairment soon after injury, and emotional adjustment at follow-up.