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To synthesize quantitatively the mild cognitive impairment (MCI) literature with respect to the relationship between cognitive reserve and neuropsychological and functional outcomes.Participants with a diagnosis of MCI (total n = 7,871; 53% female) were included in this random-effects meta-analysis. Neuropsychological measures were combined into composite scores (e.g., overall cognitive functioning, screening measures, memory, language, visuospatial, attention/processing speed/working memory, executive functioning, and motor functioning). Measures assessing real-world abilities were combined into an activities of daily living (ADL) composite.Nearly all neuropsychological composite values were significantly correlated with education, with effect sizes ranging from small to moderate. The effect between overall neuropsychological functioning and occupation was weak and varied by cognitive domain. For cognitively stimulating leisure activity, only overall neuropsychological functioning demonstrated a significant relationship, with a weak effect size (r = .16). In contrast, ADLs were most strongly associated with leisure experience (r = .27), with a negligible relationship with education (r = 0.08) and occupation (r = 0.09).Of the cognitive reserve proxies examined in this study, participation in leisure activity had the largest magnitude of effect size with ADL functioning. This was in stark contrast to the negligible relationship found for education and occupation. Although education has been widely considered the most important cognitive reserve proxy with respect to cognition, this work questions whether other lifestyle factors may play a more important role in preserving real world functioning.

We sought to determine whether the diagnostic terms 'mild traumatic brain injury (mTBI)' and 'concussion' result in differences in perceived cognitive, emotional, and post-concussive sequelae.A total of 81 healthy university students (79% female; 69% of Asian descent) were randomly assigned to one of two conditions: mTBI (There were no significant group differences between expected cognitive, emotional, or post-concussive consequences. However, both groups received poorer scores than the normative data.These results suggest that diagnostic terminology does not appear to influence anticipated recovery following mild brain injury. However, the presentation of information about the injury itself may impact recovery outcomes. This study provides preliminary support for the potential negative effects that may arise as a result of providing participants with non-evidence based information about mild brain injuries.

The ability to use feedback to guide optimal decision-making is essential for goal-directed behaviour. While impairments in feedback-driven decision-making have been associated with schizophrenia and depression, this has been examined primarily in the context of binary probabilistic choice paradigms. In real-world decision-making, however, individuals must make choices when there are more than two competing options that vary in the frequency and magnitude of potential rewards and losses. Thus, the current study examined win-stay/lose-shift (WSLS) behaviour on the Iowa Gambling Task (IGT) in order to evaluate the influence of immediate rewards and losses in guiding real-world decision-making in patients with schizophrenia and major depressive disorder. Fifty-one patients with schizophrenia, 43 patients with major depressive disorder, and 51 healthy controls completed the IGT, as well as a series of clinical and cognitive measures. WSLS was assessed by quantifying trial-by-trial behaviour following rewards and losses on the IGT. Multivariate analyses of variance revealed that patients with schizophrenia demonstrated intact lose-shift behaviour, but significantly reduced win-stay rates compared to healthy controls. In contrast, no WSLS impairments emerged in the depressed group. Win-stay impairments in the schizophrenia group were significantly related to deficits in motivation and cognition. Patients with schizophrenia exhibit impaired reward-driven decision-making in the context of multiple choices with concurrent rewards and losses, and this appears to be driven by a reduced propensity for advantageous win-stay behaviour. With the importance of reward learning and decision-making in generating goal-directed behaviour, these findings suggest a potential mechanism contributing to the motivation deficits seen in schizophrenia.

Traumatic brain injury (TBI) is a leading cause of death and disability, with injuries classified as mild in severity being the most frequently sustained. While the majority of patients recover within 3 months post-injury, many individuals continue to experience debilitating emotional sequelae several months after the injury. While spiritual well-being has been shown to carry protective benefits against both depression and anxiety in the general population, it has not been investigated as a protective factor in this population. The aim of this study was to investigate whether spiritual well-being leads to a reduction in anxious and depressive symptomatology following mild TBI (mTBI). The Beck Anxiety Inventory, Beck Depression Inventory-II, and Spiritual Well-Being Scale were administered to a sample of 83 litigating examinees who had undergone neuropsychological testing to assess their present functioning secondary to mTBI. The existential well-being (EWB) subscale significantly predicted depressive symptomatology. These findings support the role of EWB as contributory factor related to depressive symptomatology following mTBI. Rehabilitation practitioners should consider treatment paradigms that address EWB as a primary contributor to reduce depressive symptomatology, which may ultimately lead to improved functional ability.

BACKGROUND Gender differences in instrumental activities of daily living (IADLs) in mild cognitive impairment (MCI) and Alzheimer's disease may be explained by gender differences in IADL involvement. OBJECTIVE We introduce a novel theoretical construct, termed functional reserve, and empirically examine gender differences in IADL experience as a proxy of this reserve. METHODS We cross-sectionally examined men (n = 502) and women (n = 340) with MCI from the Alzheimer's Disease Neuroimaging Initiative (ADNI). Demographic factors, depressive symptoms, neuropsychological scores, and IADL experience were included as independent variables and total Functional Activities Questionnaire (FAQ) scores as the dependent variable. Regression analyses were performed on the full cohort and stratified by gender to identify differential predictive relationships for men and women. RESULTS Gender was associated with total FAQ (p

Cognitive impairments in depression contribute to disability. According to prevailing cognitive theories, one's perception related to cognitive ability can cause and maintain depression, and related outcomes. Here, we investigate the degree to which perceived cognitive impairment predicts functional impairment above and beyond objective neurocognition. A sample of young adults (n = 123) completed a battery of tests measuring objective cognitive ability, perceived cognitive function (e.g., Perceived Deficits Questionnaire), disability (e.g., World Health Organization Disability Assessment Schedule) and depressive symptoms (Beck Depression Inventory-2). Hierarchical multiple regression analyses tested the incremental variance that perceived cognitive impairment accounts for above and beyond neuropsychological test measures and disability related to depression. Results show that perceived cognitive impairment accounts for significant incremental variance in depressive symptoms beyond neuropsychological test scores; disability measures were significantly associated with depressive symptoms, as was perceived cognitive impairment. Individuals with depression and related disorders are more likely to report cognitive impairments and experience diminished cognitive ability - relative to healthy controls - regardless of objective impairments, highlighting the importance of considering, measuring, and treating this perceived cognitive impairment, that is, Cognitive Impairment Bias ( Dhillon and Zakzanis, 2019 ).

While it is well established that individuals with schizophrenia exhibit a wide range of neurocognitive deficits, there is significant heterogeneity in this regard. Impairments in verbal fluency appear to present consistently across most individuals with the illness. The present study examined the stability of verbal fluency abilities in chronic schizophrenia longitudinally. It was hypothesized that semantic but not phonemic verbal fluency performance would be stable over one year. Data was extracted from a larger study that followed 53 outpatients (70% male; mean age = 39.2 years) diagnosed with schizophrenia or schizoaffective disorder. At each testing interval (baseline, 6, and 12 months), the Brief Assessment of Cognition in Schizophrenia was administered, which included phonemic (i.e., F, S) and semantic (i.e., animals) verbal fluency tasks. No significant differences were found across time points for semantic and phonemic verbal fluency with respect to mean number of words generated, clustering, and switching. The findings provide evidence of stability in semantic and phonemic verbal fluency abilities in chronic schizophrenia. Moving forward, it would be valuable to examine verbal fluency performance longitudinally across multiple stages of illness (i.e., clinically high-risk to chronic schizophrenia).

Research suggests decreased cortical dopamine is a neural correlate of cognitive deficits in schizophrenia. Evidence of impaired cognitive task-induced cortical dopamine release was demonstrated in patients with psychosis. However, whether cortical dopamine release in response to a cognitive task in clinical high risk for psychosis (CHR) is also impaired, is currently unknown. We aimed to test dopamine release in the dorsolateral prefrontal cortex (DLPFC) and the anterior cingulate cortex (ACC) in antipsychotic-free CHR participants and healthy controls (HC) performing the Wisconsin Card Sorting Task (WCST). Two [

It is well established that most people recover soon after a mild traumatic brain injury (mTBI), yet protracted neuropsychological impairment is evident in many individuals. We sought to elucidate the relationship between apathy and neuropsychological impairment and disability as it pertains to real-world function in patients who sustained a mTBI reporting and demonstrating protracted neuropsychological impaired (i.e., more than three months post-injury). We employed a battery of neuropsychological and psychological measures, along with a measure of apathy in 104 patients who sustained a mTBI reporting neuropsychological complaints (38 in the not disabled group and 66 in the disabled group). Their ability to return to work was used as proxy for real-world disability. Specific deficits in verbal fluency, memory, and information processing predicted real-world disability but apathy did not, suggesting that psychological factors may play less of a mediating role than specific neuropsychological factors in the relationship between impairment and real world disability. Our research furthers our understanding of the cognitive and psychological differences that exist in patients with mTBI who have real-world disability compared to those who do not.

Prospection is the ability to plan ahead by creating a series of intentions and sequential steps to achieve a particular goal. The current study examined whether prospection was compromised in patients who had sustained a mild traumatic brain injury (mTBI) and who claimed to be disabled because of their chronic cognitive impairment, as operationalized by an inability to achieve goals (e.g. return to work) well after their expected recovery.This study employed the Tower of London (TOL) to measure prospection and compared two groups of patients who sustained a mTBI who both presented with cognitive impairment, but were or were not disabled in terms of their real world functioning (as defined by their instrumental activities of daily living, IADLs).The results revealed that the TOL could reliably discriminate between these two groups. In subsequent structural equation modelling, TOL scores were used to create a prospection model that was able to predict IADLs functioning.This study demonstrates that prospection is a critical component of one's ability to function independently following the onset of a mTBI when chronic cognitive impairment is evident and that clinicians should routinely investigate prospection in this context.

Purpose: To investigate the prevalence of post-traumatic growth (PTG) following mild traumatic brain injury (mTBI) and to examine whether PTG is associated with vocational status. Materials and methods: Archival data from a random sample of 74 individuals who sustained mTBI (mean age: 43.23; male, 55%) were obtained from a larger sample of litigating patients who were referred for a neuropsychological examination. Factors associated with return to work were ascertained using a multiple regression analysis. The demographic variables age, sex, and education were added to the first block, whilst relating to others, new possibilities, personal strength, spiritual change, and appreciation of life, as measured by the Posttraumatic Growth Inventory (PTGI), were added in the second block. Results: Approximately 31% of the sample exhibited moderate levels of PTG, as defined by endorsing a 3 or more on each item of the PTGI, with the most common aspects of PTG being appreciation of life, relating to others, and personal strength. The multiple regression analysis revealed that new possibilities and personal strength were independently associated with return to work. Conclusions: Results of this study suggest that there is evidence for the development of PTG among individuals with mTBI. These findings have important implications for rehabilitation planning, individual and family adjustment, and the prediction of long-term outcome as it pertains to return to work in particular. Implications for Rehabilitation Return to work is an integral component of rehabilitation following mild traumatic brain injury (mTBI) and should not be overlooked. Results of this study indicate that post-traumatic growth (PTG) can be used to inform intervention approaches that seek to promote growth and resiliency post-injury. Informing patients about the prospects of a positive post-injury recovery trajectory could help manage the individual's expectations of recovery.

Amotivation and reduced goal-directed activity engagement are prominent features of schizophrenia. Previous investigations of patients' activities have relied on accounts of daily living activities, rather than objective measures. This study used wireless motion capture to objectively evaluate activity preference when individuals are provided an explicit choice between an active versus passive engagement option. Twenty outpatients with schizophrenia and twenty matched healthy controls completed the Activity Preference Task, in which participants play a motion-based game (active) or watch a film (passive), and were administered clinical and cognitive assessments. Schizophrenia participants' duration, intensity, and persistence of active engagement were associated with apathy and community functioning. No group differences emerged from comparisons of task measures; however, exploratory cluster analysis identified a distinct subgroup of schizophrenia patients with reduced engagement and increased apathy compared to other patients and controls. The Task provides a means of quantifying activity engagement, which may be particularly valuable given the lack of objective measures for intrinsically motivated behaviours. Our initial findings suggest that schizophrenia patients as a group are equally inclined as healthy individuals towards actively engaging activities when presented an explicit choice, but such provision may be insufficient for initiation and maintenance of functional behaviours among amotivated patients.

Objective Previous research suggests that overall experience participating in instrumental activities of daily living (IADLs) is associated with reduced IADL impairment in individuals with mild cognitive impairment, possibly because of an increased functional reserve. Given that difficulties managing finances tend to occur with mild cognitive impairment, this study explores whether experience managing one's finances is associated with independence across various IADLs. Methods Participants with a screen or baseline diagnosis of mild cognitive impairment (n = 862) were taken from the Alzheimer's Disease Neuroimaging Initiative study. Functional dependence and experience were quantified from the Functional Activities Questionnaire. Results No group differences between those with and without financial management experience existed in Mini-Mental State Examination scores, age, and years of education, although women were more likely to have experience managing finances (P

Obsessive-Compulsive Disorder (OCD) is characterized by persistent and unwanted obsessions generally accompanied by ritualistic behaviors or compulsions. Previous research proposed specific disgust facial emotion recognition deficits in patients with OCD. This research however, remains largely inconsistent. Therefore, the results of 10 studies contrasting facial emotion recognition accuracy in patients with OCD (n=221) and non-psychiatric controls (n=224) were quantitatively reviewed and synthesized using meta-analytic techniques. Patients with OCD were less accurate than controls in recognizing emotional facial expressions. Patients were also less accurate in recognizing negative emotions as a whole; however, this was largely due to significant differences in disgust and anger recognition specifically. The results of this study suggest that patients with OCD have difficulty recognizing specific negative emotions in faces and may misclassify emotional expressions due to symptom characteristics within the disorder. The contribution of state-related emotion perception biases to these findings requires further clarification.

Background Rates of cannabis use among patients with schizophrenia are high, however little is understood about clinical effects of continued cannabis use and cessation after illness onset. Therefore, we investigated the effects of 28-days of cannabis abstinence on psychotic and depressive symptomatology in cannabis dependent patients with schizophrenia. Method Males with cannabis dependence and co-morbid schizophrenia (n = 19) and non-psychiatric controls (n = 20) underwent 28-days of monitored cannabis abstinence. Clinical symptoms were assessed at baseline and then weekly. Abstinence was encouraged using weekly therapy sessions and contingency reinforcement, confirmed by twice-weekly urine assays. Results Forty-two percent (8/19) of patients and 55% (11/20) of controls achieved 28-days of sustained cannabis abstinence. In patients, PANSS subscores did not change over time irrespective of abstinence status. In contrast, patient abstainers demonstrated a more pronounced reduction in depression scores compared to non-abstainers, however, the Abstinence Status x Time interaction was non-significant. Discussion Short-term (28-days) cannabis abstinence is not associated with improvement in psychotic symptoms, but may be associated with improvement in depressive symptomatology in patients with schizophrenia. Future studies employing larger samples as well as a continuous cannabis-using group may help to better characterize the causal effects of cannabis on symptom outcomes in this disorder.

Anhedonia has traditionally been considered a characteristic feature of schizophrenia, but the true nature of this deficit remains elusive. This study sought to investigate consummatory and anticipatory pleasure as it relates to motivation deficits. Eighty-four outpatients with schizophrenia and 81 healthy controls were administered the Temporal Experience of Pleasure Scale (TEPS), as well as a battery of clinical and cognitive assessments. Multivariate analyses of variance were used to examine the experience of pleasure as a function of diagnosis, and across levels of motivation deficits (i.e. low vs. moderate. vs. high) in schizophrenia. Hierarchical regression analyses were also conducted to evaluate the predictive value of amotivation in relation to the TEPS. There were no significant differences between schizophrenia and healthy control groups for either consummatory or anticipatory pleasure. Within the schizophrenia patients, only those with high levels of amotivation were significantly impaired in consummatory and anticipatory pleasure compared to low and moderate groups, and compared to healthy controls. Further, our results revealed that amotivation significantly predicts both consummatory and anticipatory pleasure, with no independent contribution of group. Utilizing study samples with a wide range of motivation deficits and incorporating objective paradigms may provide a more comprehensive understanding of hedonic deficits.

Background Motivational impairments are a core feature of schizophrenia and although there are numerous reports studying this feature using clinical rating scales, objective behavioural assessments are lacking. Here, we use a translational paradigm to measure incentive motivation in individuals with schizophrenia. Methods Sixteen stable outpatients with schizophrenia and sixteen matched healthy controls completed a modified version of the Effort Expenditure for Rewards Task that accounts for differences in motoric ability. Briefly, subjects were presented with a series of trials where they may choose to expend a greater amount of effort for a larger monetary reward versus less effort for a smaller reward. Additionally, the probability of receiving money for a given trial was varied at 12%, 50% and 88%. Clinical and other reward-related variables were also evaluated. Results Patients opted to expend greater effort significantly less than controls for trials of high, but uncertain (i.e. 50% and 88% probability) incentive value, which was related to amotivation and neurocognitive deficits. Other abnormalities were also noted but were related to different clinical variables such as impulsivity (low reward and 12% probability). These motivational deficits were not due to group differences in reward learning, reward valuation or hedonic capacity. Conclusions Our findings offer novel support for incentive motivation deficits in schizophrenia. Clinical amotivation is associated with impairments in the computation of effort during cost-benefit decision-making. This objective translational paradigm may guide future investigations of the neural circuitry underlying these motivational impairments.

Cross-sectional studies of the effects of cannabis on cognition in schizophrenia have produced mixed results. Heavy and persistent cannabis use in schizophrenia is a common clinical problem, and effects of controlled abstinence from cannabis in these patients have not been carefully evaluated. The present study sought to determine the effects of cannabis abstinence on cognition in patients with schizophrenia and co-occurring cannabis dependence. We utilized a 28-day cannabis abstinence paradigm to investigate the state-dependent effects of cannabis on select cognitive outcomes in cannabis-dependent patients with schizophrenia and non-psychiatric controls. Nineteen patients and 20 non-psychiatric male cannabis-dependent participants underwent 28 days of cannabis abstinence. Cognition was assessed on day 0, 14, and 28 using a comprehensive neuropsychological battery. Clinical symptoms were assessed weekly. Abstinence was facilitated by contingency reinforcement confirmed by twice weekly urinalysis. Forty-two percent of patients and 55% of controls achieved end-point abstinence (p=0.53), which was biochemically-verified (day 28 urinary THC-COOH

BackgroundEmotion dysregulation represents a core symptom of borderline personality disorder (BPD). Deficits in emotion perception are thought to underlie this clinical feature, although studies examining emotion recognition abilities in BPD have yielded inconsistent findings.MethodThe results of 10 studies contrasting facial emotion recognition in patients with BPD (n = 266) and non-psychiatric controls (n = 255) were quantitatively synthesized using meta-analytic techniques.ResultsPatients with BPD were less accurate than controls in recognizing facial displays of anger and disgust, although their most pronounced deficit was in correctly identifying neutral (no emotion) facial expressions. These results could not be accounted for by speed/accuracy in the test-taking approach of BPD patients.ConclusionsPatients with BPD have difficulties recognizing specific negative emotions in faces and may misattribute emotions to faces depicting neutral expressions. The contribution of state-related emotion perception biases to these findings requires further clarification.

A novel virtual reality executive function task (Multitasking in the City Test [MCT]) was developed with the aim of investigating planning and multitasking with ecological validity in mind in a normal population. Thirty healthy participants (21 females) completed a neuropsychological test battery that included the MCT along with standardized tests of executive and other cognitive functions. The sample performed within normal limits on the standardized tests. The MCT was performed successfully, although specific types of errors occurred frequently. Spearman correlation coefficients were computed between the various test measures. Only the plan score from the MCT was significantly associated with one of the executive function tests administered (Modified Six Elements Test), suggesting that both variables may be measuring a similar construct. Statistically significant correlations were also found between the MCT and the Trail-Making Test Part A and Judgment of Line Orientation, suggesting that "basic" cognitive functions such as information-processing speed and visuospatial skills are being tapped on the MCT. Preliminary evidence from this study suggested that the MCT may be an ecologically valid method of evaluating executive functioning. The clinical implications of these findings are discussed.

The present study examined the relationship between multiple neuropsychological symptom validity tests (SVTs) and psychological presentation. More formally, we set out to determine if performance on neuropsychological SVTs was related to psychological symptom credibility and which specific neuropsychological SVTs were most associated with noncredible psychological presentation. Archival records from 106 litigating examinees were utilized in this study. Our results illustrate that neuropsychological SVTs are modestly related to psychological symptom credibility and that specific neuropsychological SVTs are variably associated to this end. We conclude that when multiple, but not independent, neuropsychological SVTs are employed within the context of a neuropsychological examination, they do have clinical utility as it relates to credibility of psychological presentation and these constructs do share variance reciprocally in clinically meaningful ways. When independently employed, however, the observed relationship is modest at best. Hence, to place clinical opinion on firmer scientific grounds within the context of a neuropsychological examination, multiple cognitive SVTs, in hand with psychological test instruments that include validity indexes, are essential to derive opinion that is based on science rather than faith in the instance of litigation when an incentive to manifest disability for the sake of an external reward holds probable.

Borderline personality disorder (BPD) is a genetically influenced psychiatric illness with disruptions in neural systems supporting cognition and emotion regulation. Volumetric decreases of the hippocampus and amygdala may characterize BPD and serve as putative endophenotypes for the illness. The purpose of the present study was to evaluate whether the magnitude of these volume reductions and their associations with state-of-illness factors and psychiatric disorders which often co-occur with BPD warrant their consideration as potential endophenotypes. Volumetric magnetic resonance imaging results from 11 studies comprising 205 BPD patients and 222 healthy controls were quantitatively synthesized using meta-analytic techniques. Patients showed an average 11% and 13% decrease in the size of the hippocampus and amygdala, respectively. These volumetric differences were not attenuated in patients being treated with psychotropic medications. Comorbid depression, post-traumatic stress disorder, and substance use disorders were unrelated to volumetric decreases in either structure. These findings suggest modest volume reductions of the amygdala and hippocampus bilaterally in BPD which cannot be attributed to illness state or comorbid psychopathology. Decreased volumes of these key limbic structures may hold promise as candidate endophenotypes for BPD.

The purpose of this preliminary study was to investigate differences in base rates of post-concussion syndrome (PCS) symptomatology in healthy individuals separated by cultural identity and language. In this study, we sought to determine if differences exist in terms of base-rate endorsement of PCS symptomatology in healthy individuals and whether culture and language-based specific clusters of PCS symptomatology exist in healthy individuals. A total of 151 participants, consisting of 33 Caucasians, 49 Chinese, Filipinos, and Southeast Asians, 43 Arabs, West Asians, and South Asians, and 26 participants of African descent completed four questionnaires and two subtests of a test of verbal ability. We found that the occurrence of PCS symptoms did not differ by culture and language-based groups in general, but that there were differences between groups in the base rates of individual symptom endorsement. Our preliminary findings illustrate that cultural and linguistic background may play a moderating role in the endorsement of PCS symptomatology and that false-positive conclusions may be reached disproportionally between groups. Our results underscore the importance of considering the influence of culture and language, in conjunction with a growing list of factors that can influence, maintain, and/or mimic persistent PCS.

Dysregulation of hypothalamic-pituitary-adrenal axis activity in major depressive disorder has been found to normalize with successful treatment, though inconsistencies exist. To determine the magnitude of change in cortisol levels from pre to post-treatment in individuals with unipolar depression quantitative methods of meta-analysis were applied. Thirty-four studies met inclusion criteria and consisted of a total of 1049 depressed patients across study samples. The overall mean effect size of pre-post-treatment cortisol measures indicated that approximately 56% of depressed participants had similar cortisol levels before and after treatment regardless of symptom improvement. The mean effect size of pre-post cortisol measures for those who responded to treatment was larger than the mean effect size of non-responders; however, this difference did not reach statistical significance. As well, no significant differences in mean effect size of pre-post cortisol measures based on type of treatment (e.g. antidepressant vs. ECT) were found. Subtype of depressive illness and length of treatment may contribute to the magnitude of change in cortisol measure before and after treatment. Inconsistent findings within the reviewed literature may confound the overall results. The type of treatment and response to treatment do not appear to impact the magnitude of change in cortisol level pre to post-treatment. Our findings suggest that the utility of cortisol as an outcome measure may be limited to specific subsets of the depressed population, and that given the variability in HPA results between studies, it is premature to state that cortisol is not a good outcome measure.

Virtual reality (VR) was used to create an ecologically valid spatial-navigation task in hand with functional magnetic resonance imaging (fMRI) to articulate the neural basis of planning behavior. A virtual version of a traditional planning measure, the Tower of London, was also developed to ascertain convergent and divergent validity in terms of planning behavior and functional neuroanatomy. This VR-fMRI case study experiment was performed at 3.0 Tesla on a young healthy male subject. The obtained image data suggest both convergent and divergent specificity between the two conditions in terms of location and overall intensity of activation. Overall, the present case study provides supportive evidence that the activity of various brain regions associated with planning tasks is largely modulated by the ecological validity of the measure being used. This finding may extend to all domains of inquiry in neuropsychological research and assessment when deductive conclusions are formulated on the results of neuropsychological test measures that could be considered contrived in nature.

This study assessed the convergent validity of a virtual environment (VE) navigation learning task, the Groton Maze Learning Test (GMLT), and selected traditional neuropsychological tests performed in a group of healthy elderly adults (n = 24). The cohort was divided equally between males and females to explore performance variability due to sex differences, which were subsequently characterized and reported as part of the analysis. To facilitate performance comparisons, specific "efficiency" scores were created for both the VE navigation task and the GMLT. Men reached peak performance more rapidly than women during VE navigation and on the GMLT and significantly outperformed women on the first learning trial in the VE. Results suggest reasonable convergent validity across the VE task, GMLT, and selected neuropsychological tests for assessment of spatial memory.

Negative symptoms are a prominent feature of schizophrenia that are intimately linked to poor outcomes characterizing the illness. One mechanistic model suggests that these symptoms are produced and maintained, at least in part, through maladaptive attitudes. Beyond mechanisms, it remains phenomenologically unclear if these symptoms are particularly distressing. In the present study we examined whether subclinical negative symptoms evaluated in a non-clinical sample of young adults (N=370) were distressful or bothersome to participants and, further, whether these symptoms were associated with dysfunctional attitudes. We found that greater severity of subclinical negative symptoms such as amotivation and anhedonia were associated with higher ratings of distress specifically attributable to these symptoms. This relationship held even after controlling for severity of depressive symptoms. Moreover, greater negative symptom burden was associated with greater endorsement of defeatist performance beliefs. Negative symptoms expressed in the general population were found to be particularly distressing. Maladaptive cognitive schemas are implicated in the expression of these symptoms, as well as the amount of distress these symptoms instil. A greater understanding of the mechanisms underlying negative symptoms, including both neurobiological and cognitive, is needed in order to effectively develop treatment strategies for these disabling symptoms.

The objective of the current study was to explore the potential cognitive benefits of an anticholinesterase inhibitor, donepezil, in a former chronic drug user. A neuropsychological test battery composed of the vocabulary and matrix reasoning subtests of the Wechsler adult intelligence scale-III, measures of everyday executive functioning (behavioural assessment of the dysexecutive syndrome [BADS]), and verbal learning and memory tasks (California verbal learning test-II; Rivermead behavioural memory test) was completed at baseline, at 3 months after introducing donepezil, and at 3 months after donepezil was discontinued. After donepezil treatment, substantial improvements were found on tasks of nonverbal fluid reasoning (i.e. matrix reasoning) and other executive functioning tests (i.e. BADS). At entry into the study, poor academic performance and subjective problems with memory and concentration were reported, particularly after amphetamine use (i.e. MDMA and crystal methamphetamine); after donepezil treatment, dramatic increases in memory, concentration and academic achievement were observed. The finding of improvements in tests of executive functioning and in academic performance in this case study, together with the minimal adverse side effects of donepezil, warrants the investigation of controlled studies of cholinergic enhancement in chronic amphetamine and other drug users.

The uncertain relationship between negative symptoms, and specifically motivational deficits, with cognitive dysfunction in schizophrenia is in need of further elucidation as it pertains to the interpretation of cognitive test results. Findings to date have suggested a possible mediating role of motivational deficits on cognitive test measures, although findings from formal examinations of effort using performance validity measures have been inconsistent. The aim of this study was to examine the relationships between motivation, effort exerted during cognitive testing, and cognitive performance in schizophrenia. Sixty-nine outpatients with schizophrenia or schizoaffective disorder were evaluated for psychopathology, severity of motivational deficits, effort exerted during cognitive testing, and cognitive performance. Motivation and degree of effort exerted during cognitive testing were significantly related to cognitive performance, specifically verbal fluency, verbal and working memory, attention and processing speed, and reasoning and problem solving. Further, effort accounted for 15% of the variance in cognitive performance, and partially mediated the relationship between motivation and cognitive performance. Examining cognitive performance profiles for individuals exerting normal or reduced effort revealed significant differences in global cognition, as well as attention/processing speed and reasoning and problem solving. These findings suggest that cognitive domains may be differentially affected by impairments in motivation and effort, and highlight the importance of understanding the interplay between motivation and cognitive performance deficits, which may guide the appropriate selection of symptom targets for promoting recovery in patients.

Background Movement disorders are common in individuals with schizophrenia, even in those who are not exposed to antipsychotic medications. Extrapyramidal symptoms (EPS) are among the most common abnormal movements in schizophrenia, but their relationship with other features of the illness such as cognition is not well characterized. Methods Three hundred and twenty-five individuals with schizophrenia who were not receiving any antipsychotic or anticholinergic medication and participated in the baseline visit of the Clinical Antipsychotic Treatment of Intervention Effectiveness study were included in the present study. EPSs were assessed using the Simpson-Angus Scale, while cognition was measured with a comprehensive neuropsychological test battery. The relationship between EPS and cognitive test performance was evaluated both dimensionally and categorically. Results Greater severity of EPS was significantly associated with worse cognitive test performance evaluated using a composite score. Eighty-six patients were identified as having parkinsonism and these patients performed worse on cognitive tests than non-parkinsonian patients. These findings remained significant even after accounting for other variables such as severity of psychopathology, sedation, akathisia and dyskinesia. Conclusions The present results demonstrate that severity of EPS is reliably linked with poorer scores on tests of cognition. While this may reflect a common pathophysiology underlying neuromotor and neurocognitive deficits, it may also be the case that parkinsonian symptoms such as rigidity and bradykinesia impede test taking ability. Regardless of mechanism, inferences regarding cognitive impairment should take into account the presence of EPS, as well as other variables that may mediate cognitive test findings.

Motivational and cognitive deficits are core features of schizophrenia, both closely linked with functional outcomes. Although poor effort and decreased motivation are known to affect performance on cognitive tests, the extent of this relationship is unclear in patients with schizophrenia.To evaluate the association between intrinsic motivation and cognitive test performance in patients with schizophrenia.Cross-sectional and 6-month prospective follow-up study performed at 57 sites in the United States, including academic and community medical treatment centers, participating in the Clinical Antipsychotic Trials of Intervention Effectiveness study. The primary sample included 431 stable patients with a DSM-IV diagnosis of schizophrenia currently receiving a stable medication regimen.Cognitive performance and intrinsic motivation were evaluated using a comprehensive neuropsychological test battery and a derived measure from the Heinrichs-Carpenter Quality of Life Scale, respectively. Symptom severity and functional status were also assessed.The primary outcome variable was global neurocognition. Individual domains of cognition were also evaluated for their association with motivation.Level of intrinsic motivation was significantly and positively correlated with global cognitive test performance, a relationship that held for each domain of cognition evaluated (correlation range, 0.20-0.34; P .001). This association was found to be reliable after statistically accounting for positive, negative, depressive, and overall symptom severity (P .05) and after accounting for community functioning (P .001). The relationship between motivation and cognitive performance also remained significant after controlling for antipsychotic dose (P .05). Prospective increase in motivation during the 6-month follow-up was also found to be significantly related to improvement in global cognitive performance (P .05).The present findings provide strong support for a robust and reliable relationship between motivation and cognitive performance and suggest that test performance is not purely a measure of ability. Future studies assessing cognition in patients with schizophrenia should consider potential moderating variables such as effort and motivation. Implications for the assessment and interpretation of cognitive impairment based on neuropsychological test measures in schizophrenia are discussed, especially in the case of clinical trials for cognition-enhancing treatments.clinicaltrials.gov Identifier: NCT00014001.

Psychometrically sound screening of cognitive functioning can be advantageous in identifying persons most likely at risk for some specified condition or in need of further diagnostic study, and where brevity is required-whether because of the press of patients who may benefit from an assessment or because the patient's condition may preclude a lengthy assessment (Lezak, Howieson, & Loring, 2004 ). Moreover, computerized screening can improve access for underserved patients, who by virtue of economic, socioeconomic, geographical, logistical, or cultural reasons are not referred for, or cannot access, needed services (Bauer et al., 2012 ). With these provisos in mind, we set out to examine the psychometric properties of a Web-based real-time examination of cognitive functioning called BRAINscreen. The present study demonstrates how the measure was developed, its technical properties and features, the normative sample from which prospective performance is compared, and the relationship between accuracy of performance and reaction time on BRAINscreen test items across stratified age and education groups along with differential sensitivity of the test between healthy controls and various clinical populations. The present findings demonstrate that BRAINscreen may be a reliable and valid screening measure of cognitive functioning.

To examine the neurotoxic potential of continued MDMA (“Ecstasy”) use in humans and its functional consequences over the course of 1 year, 15 MDMA users participated in a longitudinal study in which they completed a brief neuropsychological test battery composed mainly of retrospective and prospective memory tasks. Subjects were abstinent for 2 weeks on initial and 1-year testing. Continued use of MDMA was associated with progressive decline in terms of immediate and delayed recall.

The strength and sensitivity of neuropsychological test findings in patients with Parkinson's disease (PD) was reviewed using meta-analytic principles to provide a basis of comparison of deficits in nondemented and demented patients with PD. The review revealed significant relationships among duration of disease, physical disability, and cognitive impairment in nondemented patients, and qualitative and quantitative differences in the pattern of neuropsychological test impairments between nondemented and demented patients with PD. The disparate profiles of neuropsychological impairment in nondemented and demented patients may indeed reflect disease progression in keeping with the significant clinical correlations in nondemented patients. That is, as the duration of the disease endures, it appears that performance on tasks of delayed recall deteriorates first, followed by performance on measures of manual dexterity, cognitive flexibility, and abstraction.

Meta-analytic methods were used to determine the sensitivity of neuropsychological, structural, and physiological measures to temporal-hippocampal system function in dementia of the Alzheimer's type. Effect sizes are reported for the California Verbal Learning Test, the Wechsler Memory Scale-Revised, structural (i.e., magnetic resonance imaging [MRI]), and functional (i.e., positron emission tomography [PET], single photon emission computed tomography [SPECT]) neuroimaging methods. Overall, effect sizes from MRI studies are larger than those obtained from SPECT and PET, respectively, but not as large as those obtained from the neuropsychological measures. On the basis of this finding, the neuropsychological and gross pathologic similarities between Alzheimer's disease, other dementing conditions, and mixed dementias, warrants the coupling of neuropsychological evaluation for its sensitivity with neuroimaging visualization for its specificity in improving diagnostic and differential accuracy.

The stability and validity of a neurocognitive typology for schizophrenia were studied in 55 chronic patients who met DSMIII-R criteria for the illness. Subtypes were based on an earlier cluster analytic study by Heinrichs and Awad (1993) that utilized the following variables: IQ (WAIS-R), categories (Wisconsin Card Sorting Test), free recall intrusions (California Verbal Learning Test), and bilateral motor performance (Purdue Pegboard). Stability was examined by analyzing subtype assignment at the original assessment and 3 years later at follow-up. Stability over this interval was variable with an overall kappa of .45 and individual kappas from .12 to .66. Adjunct cognitive and clinical data gathered at follow-up provide evidence for the validity of several subtypes, especially in terms of their cognitive and functional differences. There was no evidence of symptom differences in this relatively asymptomatic medicated sample of patients. The results are discussed in terms of the possibility that several patterns of neurocognitive dysfunction may underlie schizophrenia, with implications for understanding the heterogeneity of the illness and its variable functional outcomes.

This study set out to examine the sensitivity of verbal fluency component scores in severe traumatic brain injury (TBI).A retrospective cross-sectional design was used, with control participants chosen at random from the community and TBI patients from litigation cases.Fifty-four healthy controls and 28 patients who had incurred a severe TBI were included in the study. The Controlled Oral Word Association test was rescored to include clustering and switching scores for phonemic and semantic fluency separately. The scores were compared between controls and TBI patients using independent samples t-tests.The findings demonstrate that component scores for semantic fluency yielded the largest effect sizes overall (d = 1.32 and d = 1.53), but not phonemic fluency. Total words generated in phonemic fluency yielded the largest effect size, although still modest (d = 0.62).While verbal fluency may be a useful test tool to elicit evidence of neuropsychological impairment after TBI, these findings are consistent with previous research demonstrating that component scores are more sensitive indices. There is potential clinical utility in using component scores for examining the specific severity of verbal fluency impairment in TBI and guiding rehabilitation efforts.

The current investigation sought to further establish the psychometric properties and ecological validity of the Multitasking in the City Test (MCT) in a clinical population. Ecological validity was addressed via correlational analyses between performance on this test and a subjective measure of everyday executive functioning (Frontal Systems Behavior Scale; FrSBe). The sample was composed of 13 individuals (11 males) who suffered a stroke or traumatic brain injury. A neuropsychological test battery consisting of the MCT and common executive and nonexecutive measures was administered. The only executive function tests that were significantly related to the FrSBe were the MCT and a semantic fluency test. Compared with a sample of normal participants, the patient group produced better plans but completed fewer tasks on the MCT. Patients made similar types of errors as normals, although some of these errors occurred more frequently in the patient sample. This study demonstrated the ecological validity of the MCT and suggested that patients can be differentiated from healthy individuals by quantitative (i.e., number of errors) rather than qualitative (i.e., type of errors) aspects of performance. Further interpretation of MCT performance and comparison with existing executive function tests is discussed.

Poor effort by examinees during neuropsychological testing has a profound effect on test performance. Although neuropsychological experiments often utilize healthy undergraduate students, the test-taking effort of this population has not been investigated previously. The purpose of the present study was to determine whether undergraduate students exercise variable effort in neuropsychological testing. During two testing sessions, participants (N = 36) were administered three Symptom Validity Tests (SVTs), the Test of Memory Malingering, the Dot Counting Test, and the Victoria Symptom Validity Test (VSVT), along with various neuropsychological tests. Analyses revealed 55.6% of participants in Session 1 and 30.8% of participants in Session 2 exerted poor effort on at least one SVT. Poor effort on the SVTs was significantly correlated with poor performance on various neuropsychological tests and there was support for the temporal stability of effort. These preliminary results suggest that the base rate of suboptimal effort in a healthy undergraduate population is quite high. Accordingly, effort may serve as a source of variance in neuropsychological research when using undergraduate students.

Knowledge of neurocognitive performance patterns of normal, healthy individuals is necessary, as clinicians may not always take into account normal intra-individual variability, demonstrated here in a sample of 20 healthy individuals with particularly high educational achievement (i.e., holding doctorate degrees). The data indicate that neurocognitive abilities are not equally distributed within a given individual. Some participants in the sample achieved some test scores at the intellectually disabled to borderline range but also some scores in the high average to superior range. The practice of deductive reasoning in clinical neuropsychology may be prone to false positive conclusions about neurocognitive functioning where base rates of neurocognitive impairments are low and pre-existing educational achievements are high.

We set out to examine the sensitivity of switching and clustering component scores of verbal fluency in patients with mild traumatic brain injury (mTBI). Clustering and switching scores were compared between patients with mTBI and healthy normal controls as well as those with moderate TBI and severe TBI. Fifty-four healthy controls along with 20 mild TBI, 8 moderate TBI, and 12 severe TBI patients were included in the study. Our findings demonstrate that component score effect sizes were larger than those of total words generated for both phonemic and semantic fluency. This pattern of finding held true regardless of comparison group. In addition, semantic fluency component scores were found to correspond to larger component score effect sizes than did phonemic fluency component scores. Our findings demonstrate that component scores derived from the Controlled Oral Word Association Test may be sufficient to reliably capture the effects of unremitting injury (i.e., more than 3 months post status) to the frontal and temporal brain as evinced in cases of unremitting mTBI. This differential pattern of performance provides preliminary evidence for the potential usefulness of switching and clustering in the assessment of mTBI. Given the small sample sizes employed in our study, however, future studies are needed to determine whether component measures of verbal fluency have discriminative ability.

Emerging evidence suggests that motivational deficits are a central component of negative symptoms in schizophrenia, and linked to functional impairment characterizing this illness. This study extends previous cross-sectional findings by examining the concurrent contributions of baseline motivational deficits, other negative symptoms, and other symptom domains on longitudinal functional outcomes in schizophrenia. Results of this longitudinal examination of 18 patients from our previous pilot study reveal that amotivation accounts for 74% and 72% of the variance in functional outcomes at baseline and 6-month follow-up, respectively. These findings further suggest a fundamental role for motivational deficits in predicting functional outcomes in schizophrenia.

Patients with schizophrenia frequently report cannabis use, yet its effects on neurocognitive functioning in this population are still unclear. This meta-analysis was conducted to determine the magnitude of effect of cannabis consumption on cognition in schizophrenia without the confounding effects of other co-morbid substance use disorders. Eight studies met inclusion criteria yielding a total sample of 942. Three hundred and fifty six of these participants were cannabis users with schizophrenia, and 586 were patients with no cannabis use. Neuropsychological tests were grouped into seven domains (general cognitive ability and intelligence; selective, sustained and divided attention; executive abilities; working memory and learning; retrieval and recognition; receptive and expressive language abilities and visuo-spatial and construction abilities). Effect sizes were computed for each cognitive domain between cannabis-using patients and patients with no history of cannabis use. Effect size differences in cognitive performance in the schizophrenia group as a function of cannabis use were in the small to medium range, denoting superior performance in cannabis-using patients. Explanations for these findings are discussed and suggestions for future research in this area are recommended.

Negative symptoms have consistently been found to contribute to functional impairment in schizophrenia. In this pilot study, we sought to delineate the core negative symptoms that contribute to this functional impairment. Adult outpatients with schizophrenia were evaluated for the severity of positive, negative, cognitive, and depressive symptoms. The Quality of Life Scale was used to assess current functioning. Results from 21 participants revealed that a motivation was the sole predictor of functioning, accounting for 74% of the variance in current functioning. This suggests that motivational deficits are the central link between negative symptoms and functional impairment in schizophrenia.

Immersive virtual reality (VR) is an innovative tool that can allow study of human spatial navigation in a realistic but controlled environment. The purpose of this study was to examine age- and Alzheimer's disease-related differences in route learning and memory using VR.The spatial memory task took place in a VR environment set up on a Computer Workstation. Participants were immersed by putting video unit goggles over their eyes using a Head Mounted. Participants were shown a path within a virtual city, and then had to navigate it as quickly and accurately as possible. They were granted four learning trials on this path. An interference path was then presented before asking participants to re-navigate the first route at short and long delays. Finally, participants were tested for recognition of the city's buildings and objects.Young adults were consistently quicker and more accurate in their path navigation than older participants whilst those patients with Alzheimer's Disease made more mistakes on the recognition task in particular, being more likely to mistakenly affirm having seen an element in the city when it was in fact a foil.Our study would suggest that spatial navigation is susceptible to the effects of aging and Alzheimer's Disease. The potential applications of VR to the study of spatial navigation is seemingly important in that it may help place the science of neuropsychology on firmer scientific grounds in terms of its validity to real world function and dysfunction.

Previous research in schizophrenia has not consistently found concurrent validity between researcher-rated and self-report scales of insight. Differences in the correlations between the two types of scales have been found when order of administration is varied. The current study sought to replicate this earlier study in a sample of 21 patients with chronic schizophrenia who were given the same researcher-rated scale (Scale to Assess Unawareness of Mental Disorder; SUMD) and a different self-report measure (Self-Appraisal of Illness Questionnaire; SAIQ). A counterbalanced research design was employed. Significant correlations (p0.05) were found between the SUMD and SAIQ subscales in the SAIQ first group but not in the SUMD first group. The present study replicated earlier findings and provides further support for the importance of order of administration effects when evaluating concurrent validity between different types of insight scales. The reliability of insight scales may be substantially improved if a self-report insight scale is administered prior to a researcher-rated scale.

Past research has found that deficits in insight into illness are related to executive deficits in schizophrenia. This study further explores this relationship with the utilization of an ecologically-valid battery of executive tests. The study included 21 patients with schizophrenia who were administered the Behavioural Assessment of the Dysexecutive Syndrome (BADS) and the first three items of the Scale to Assess Unawareness of Mental Disorder. Patients were found to be impaired on the BADS and most had insight into their illness. Lack of illness awareness was not significantly correlated with all of the BADS subtests with the exception of Rule Shift Cards, a measure of cognitive flexibility. The relationship between some measures of unawareness and Rule Shift Cards was still significant or approaching significance when the effects of IQ were partialled out. These findings add to previous research by demonstrating that cognitive flexibility, specifically involving the ability to shift set, is associated with awareness of illness in schizophrenia. On the other hand, it is proposed that most of the other BADS subtests are more complex and multifactorial, thereby making it difficult to find any associations that may exist between a specific subdimension of executive function and insight into illness.

Studies on the neurocognitive effects of cocaine abuse are equivocal with respect to the specific types of deficits observed, although the vast majority of studies indicate that at least some deficits in certain broad functions such as attention, learning and memory, executive functions, and response speed exist. All of these studies based their results on null hypothesis statistical significance testing (NHSST). It is argued that effect size analysis, which provides information about the magnitude of difference, offers a more valid index of cognitive impairments in a population when compared to NHSST. Accordingly, the objective of the current study was to conduct an effect size analysis (or a meta-analysis in cases where the same test measure was utilized in more than one study) to determine the type and the magnitude of the specific cognitive deficits found as a result of cocaine use. Effect sizes were calculated for each test variable across 15 empirical studies that met inclusion criteria. The results from 481 cocaine users and 586 healthy normal controls revealed that cocaine use had the largest effect on several measures of attention (0.40d1.10). Moderate to large effect sizes (d0.50) were also obtained on tests of visual memory and working memory. Minimal effect sizes (d0.30) were obtained on tests of verbal fluency and other language functions and sensory-perceptual functions. Tests of executive functioning produced mixed findings and were interpreted in terms of degree rather than nature of impairment. The results are consistent with findings from neuroimaging and neurochemical studies that have found cocaine use to be associated with dysfunctions in the anterior cingulate gyrus and orbitofrontal cortex; these regions are highly implicated in the mediation of attentional and executive functions, respectively. Methodological limitations of the empirical studies included in the analysis are discussed.

This review was conducted in order to determine the efficacy of donepezil and galantamine in the treatment of cognitive symptoms of Alzheimer's disease, and also to determine whether galantamine was a superior pharmacological intervention. Meta-analytic methods were used to analyse the data from eight empirical studies which met the inclusion criteria specified. By finding the mean effect sizes of the treatment on the outcome measures of cognition, it was determined that neither drug was greatly efficacious. However, this result does not necessarily diminish the practical value of the drug. It was also found that galantamine was no better than donepezil at treating cognitive decline in AD.

This study investigated the cerebral correlates of the Trail Making Test (TMT), used commonly as a measure of frontal lobe function. Such work sheds additional light on the known shortcomings of the TMT as a localizing instrument, as indicated, for example, by studies of patients with focal brain lesions. Functional magnetic resonance imaging (fMRI) was used to record brain activity while participants performed the TMT using a custom-built, fiber-optic fMRI-compatible writing device, the "virtual stylus". Unlike in a previous fMRI study that used a verbal adaptation of the TMT, the virtual stylus enabled a closer depiction of the brain regions engaged by the actual paper-and-pencil task. Twelve, right-handed healthy young adults participated. In Part A of the task, participants were required to link in ascending order numbers (1-2-3 ...) that were randomly distributed on a computer screen. In Part B, participants were required to link alternately between numbers and letters (1-A-2-B ...). Although behavioral performance was somewhat less than typically obtained with the TMT due to use of the virtual stylus, distinct left-sided dorsolateral and medial frontal activity was revealed when comparing Part B versus Part A. These findings agree with existing literature showing sensitivity of the TMT to frontal regions in the left hemisphere. However, other activity was also observed (left middle and superior temporal gyrus) reinforcing that the brain-behavior correlations for the TMT are multifaceted and not restricted to the frontal lobe.