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Objective: To standardize a new rating scale for the assessment of apathy in Alzheimer disease (AD) and report on its reliability, structure, and relation to other clinical features of AD., Background: apathy is a common prominent behavioral syndrome accompanying AD and is associated with excess disability and increased caregiver burden. Current instruments for the assessment of apathy in AD do not explicitly and systematically attempt to differentiate limited activity and engagement due to lack of interest from inability or longstanding, premorbid personality traits. The present assessment, the Dementia Apathy Interview and Rating (DAIR), was developed taking these discriminations into account in question construction and interview format., Methods: One hundred participants (50% women) in the University Memory and Aging Center Research Registry with Probable or Possible AD (by NINCDS-ADRDA criteria) were assessed through caregiver interview or direct patient assessment for apathy, depression, and severity of cognitive and functional deficits. Item distribution characteristics, factor analysis, and evaluation of reliability were used to develop the final item set for the DAIR, and correlations with other measures were examined., Results: A 16-item unidimensional apathy scale with excellent internal consistency (alpha = 0.89) and temporal reliability ( = 0.85 over 2 months) was developed. Individual differences in apathy on the DAIR were unrelated to dysphoria. Apathy was significantly associated with functional and cognitive impairment, while depression was not., Conclusions: The DAIR is a reliable informant-based assessment of apathy in persons with AD. Although apathy is assessed with respect to behaviors within the repertoire of patients, this behavioral syndrome remains associated with more severe deficits in cognitive and adaptive functioning. Associations between depression and dementia severity reported in some studies may reflect the confounding of apathy and depression in some assessment instruments.

Apathy, or loss of motivation, is arguably the most common change in behavior in Alzheimer's disease (AD) but is underrecognized. Apathy represents a form of executive cognitive dysfunction. Patients with apathy suffer from decreased daily function and specific cognitive deficits and rely on families to provide more care, which results in increased stress for families. Apathy is one of the primary syndromes associated with frontal and subcortical pathology, and apathy in AD appears to have multiple neuroanatomical correlates that implicate components of frontal subcortical networks. Despite the profound effects of this common syndrome, only a few instruments have been designed to specifically assess apathy, and these instruments have not been directly compared. Assessment of apathy in AD requires clinicians to distinguish loss of motivation from loss of ability due to cognitive decline. Although apathy may be misdiagnosed as depression because of an overlap in symptoms, current research has shown apathy to be a discrete syndrome. Distinguishing apathy from depression has important treatment implications, because these disorders respond to different interventions. Further research is required to clarify the specific neuroanatomical and neuropsychological correlates of apathy and to determine how correct diagnosis and treatment of apathy may improve patient functioning and ease caregiver burden.

To examine the relationship between emotional activation and information gathering in schizophrenia, the eye movements and emotional responses of 20 patients with schizophrenia and 10 patients without history of psychosis were recorded while viewing 30 images varying in pleasantness. Emotionally activating pictures were more extensively explored than neutral pictures by both groups but especially by schizophrenia patients. Comparison patients explored pictures more extensively during the early part of image exposure, whereas patients with schizophrenia took longer to engage in informative exploration. The scan path lengths and the proportions of fixation time spent in regions of interest did not differ between groups, although persons with schizophrenia had longer fixations and looked at fewer regions of interest in neutral pictures. Emotion reports did not differ between groups. Schizophrenia patients' results are consistent with the hypothesized normalizing effects of emotional activation on the distribution of attention.

Equivalent versions of the Complex Figure Test (CFT) are useful for assessing change over time in constructional skills, planning, spatial organization, and visual-spatial memory while minimizing practice effects. To address the need for an equivalent version of the CFT to the Rey, the present study compared copy and 45 min-delayed recall accuracy scores of the Rey and Mack CFTs obtained from 245 adults involved in a study of the neuropsychological correlates of sleep apnea and its treatment. Accuracy scores did not significantly differ between individuals with and without sleep apnea. Also, there was no significant difference between copy or recall accuracy scores obtained on the Rey and Mack CFTs. Similar correlations were found between relevant demographic factors, estimated IQ, and accuracy scores for both CFTs. These data suggest that the Mack figure may be a useful alternative to the Rey CFT.

This study examined the self-report and facial expressions of emotional response to pictorial stimuli and the incidental learning of pleasant and unpleasant words by depressed (n = 20) and nondepressed (n = 20) women. Depression was associated with reports of diminished emotional response and reduced frequency and intensity of facial expressions only to pleasant stimuli. The 2 groups did not differ in response to hedonically unpleasant stimuli, even those specifically relevant to the emotion of sadness. In a similar vein, depressed and nondepressed participants showed differences in incidental recall for only pleasant self-referential terms. There was no difference in recall of unpleasant words. These findings suggest the importance of hedonic deficits on psychological processes in clinical depression.

The authors tested the associations of family history and personal history of depression with mood disorders among patients with Alzheimer's disease (AD; N=161). Considered individually, a positive family history and a positive personal history each conferred increased risk for depression in AD. Conjointly, neither family nor personal history accounted for a substantial amount of the variance in syndromal depression after the onset of AD. Most depressed AD patients in this sample did not have a positive family history or a previous episode of depression. Our understanding of the etiology and course of depression and dementia may be augmented with further neuropsychological and brain-imaging studies of the neuropathological substrates shared by these illnesses.

A long-standing problem in psychopathology research is establishing that patterns of differences between groups reflects differences of underlying constructs and not artifacts of research design, measurement, or analysis. This introduction provides a context for 4 articles that consider several controversial issues regarding this problem and presents a précis. Although these articles focus on schizophrenia, it is noted how the issues are of more general relevance to psychopathology researchers.

Cognitive deficits associated with psychopathology often do not occur in isolation. Consequently, identifying a specific deficit in a disorder requires comparing the magnitude of group differences on theoretically relevant measures with those on control tasks measuring other constructs. L. J. Chapman and J. P. Chapman (1973) noted that common forms of such Group x Task interactions are theoretically ambiguous unless performance measures have comparable discriminating power. The principles of psychometric matching for discriminating power developed in the Chapmans' research program are reviewed, and both criticisms and alternative psychometric approaches are evaluated. Psychometric matching can be mindful of threats to the construct validity of measures and frequently remains methodologically necessary. Otherwise, interactions involving measures that vary in sensitivity to individual differences may be misinterpreted as evidence for specific deficits.

The effects of aging on visuospatial attention were investigated with event-related brain potentials (ERPs). A central arrow pointed towards (75% valid cues) or away from (25% invalid cues) the location of upcoming visual targets to which subjects made two choice discriminations. Young and older adults responded faster following valid than invalid cues. The absolute magnitude of the cueing effect was larger for older than young subjects, but cueing effects were similar between groups when estimated proportionally to overall response time. Under the present conditions, the electrophysiological manifestations of visuospatial attention were similar for young and older adults. Early ERP components following the target stimulus (P1, N1, Nd1) were slower for older than young subjects, but amplitude was similarly affected by cueing in each group. The temporal correspondence between component latencies and the observed cueing effects are consistent with theories positing that attention amplifies the sensory gain of early perceptual processes. The observation that aging slowed latency of the ipsilateral but not the contralateral P1, is consistent with age differences in interhemispheric transfer times. A broadly distributed 200-400 ms validity effect on ERP amplitude was similar between groups in timing, spatial distribution, and magnitude. The 200-400 ms attention effect appeared to be a modulation of the P3 in younger subjects, as earlier observed. However, the present study dissociated the 200-400 ms attention effects from the P3 component because the P3 did not peak until 526 ms in older subjects.

Objective: The purpose of this study was to investigate eye movement patterns of patients with Alzheimer disease (AD) and healthy older adults while viewing photographs of facial expression., Background: Individuals with Alzheimer disease appear to have deficits in emotion perception, but the underlying mechanisms are not understood well. It is not known whether individuals with AD visually explore facial stimuli and extract information needed to make emotion identification from faces in the same way as do healthy older adults., Method: Seventeen AD patients and 15 older adult control patients were shown faces that depicted different emotions and were asked to identify the emotion displayed from two alternatives. The eye movements of participants were recorded during the emotion identification task., Results: No differences were seen between AD patients and older adult controls regarding their accuracy of emotion identification. However, AD patients differed from older adult controls on eye movement patterns during the emotion identification task. Alzheimer disease patients fixated less on the face and, in particular, on the eyes. Alzheimer disease patients also spent more time viewing areas off the face. There was no relationship between the severity of cognitive impairment and emotion identification or eye movement patterns., Conclusions: Although the AD patients and older adult controls showed similar accuracy for the emotion identification task, their visual processing strategies differed. Relative to older adult controls, AD patients fixated less on discriminating regions and attended more to irrelevant aspects of stimuli. The eye movement differences were particularly evident in AD patients who did more poorly for the emotion identification task. These differences were not attributable to the global cognitive deterioration accompanying AD, but suggested a specific deficit in visual processing abilities.

Structural equation modeling (specifically, analysis of moment structures; J. L. Arbuckle, 1996) was used to evaluate the goodness of fit of a model of components of attention (A. F. Mirsky, B. J. Anthony, C. C. Duncan, M. B. Aheam, & S. G. Kellam, 1991) to neuropsychological test data from 2 samples. One sample consisted of psychiatrically normal persons with and without sleep-disordered breathing, and the other sample consisted of the adults studied by A. F. Mirsky et al. (1991), who gave rise to this model. That sample included psychiatric patients as well as normals. An exploratory data reduction procedure, principal-components analysis, suggested that attention might be conceptualized as composed of 4 independent elements or components: focus-execute, sustain, shift, and encode. Neither the proposed orthogonal model nor a model permitting correlated factors adequately fit either data set, suggesting that these 4 attention constructs are as yet not clearly validated in the measures used to assess them.

Objectives: An update of a study of workers exposed to 2-mercaptobenzothiazole (MBT) at a rubber chemicals plant in Nitro, West Virginia is reported. The earlier study found high rates of lung cancer, prostate cancer, and bladder cancer in these workers who also had potential exposure to 4-aminobiphenyl (PAB), a potent bladder carcinogen., Methods: This cohort mortality study examines the mortalities of 1059 full time white male production workers employed at the plant from 1955 to 1977. A detailed exposure assessment was done on the 600 workers with exposure to MBT. Nine years of additional follow up to the previous study are added., Results: It was found that MBT workers have expected rates of lung (standardised mortality ratio (SMR) = 1.0 95% confidence interval (95% CI) 0.7 to 1.5) and prostate (SMR = 0.9, 95% CI 0.2 to 2.3) cancer. There was an excess of bladder cancer among MBT workers who had definite exposure to PAB (SMR = 27.1, 95% CI 11.7 to 53.4), and MBT workers with potential exposure to PAB (SMR = 4.3, 95% CI 1.4 to 10.0). However, there were no deaths from bladder cancer among workers with no exposure to PAB (SMR = 0.0, 95% CI 0.0 to 24.7), although there were only 0.2 deaths expected., Conclusions: The potential confounding of exposure to an unknown portion of PAB in the MBT workers makes it impossible to evaluate risk of bladder cancer in this population at this time. However, exposure to MBT does not seem to increase the risk of most cancers including cancers of the lung and prostate.

Seventeen patients with sleep apnea syndrome [SAS, Respiratory Disturbance Index (RDI) = 12-85] were compared with 16 normal controls (RDI < 7) on neuropsychological tests of executive functions, a domain in which SAS patients have been suggested to have deficits. SAS patients demonstrated greater deficits in the retrieval of information from semantic memory (Controlled Oral Word Association task) and in shifting responses in the face of error (Wisconsin Card Sort Test), but differences in working memory were not observed. Eliciting deficits in cognitive executive functions in SAS may require more sensitive measures than are typically used in neuropsychiatric research.

The authors selected 69 participants from an Alzheimer's disease research registry and diagnosed them as depressed or nondepressed by use of a semi-structured clinical interview. Responses to selected BRSD items were compared between the depressed and nondepressed groups. Differences between responses of the two groups on BRSD items related to anxiety and depression were significant. The groups did not significantly differ in their responses to items related to other content areas. On the basis of their responses to the BRSD anxiety and depression items, 70% of participants were correctly classified as depressed or nondepressed.

Latinos, principally Puerto Rican, and Euro-American psychiatric outpatients diagnosed with schizophrenia or major depression were compared on their responses to the Brief Symptom Inventory (BSI). The internal consistency reliability of the BSI dimensions and factor structures were comparable in the two cultural groups. Puerto Rican respondents scored significantly higher than Euro-Americans on the Global Severity Index, an index of distress, as well as on several subscales of the instrument. Multiple regression analysis suggested differences in expression of symptoms between Latinos and Euro-Americans only for obsessive compulsive and anxiety symptoms once general severity of symptom expression was controlled. Differences in symptom expression on the BSI associated with ethnicity were greater than those associated with diagnosis.

A group of 30 individuals with schizophrenia and a comparison group of 10 individuals who had never experienced a psychotic episode rated the pleasantness and arousal of 54 slides varying in normative pleasantness. Individuals with schizophrenia rated the slides as less pleasant than the comparison group. Positive symptom, negative symptom and disorganization symptom ratings were made for all patients with schizophrenia. Higher levels of disorganization symptoms were associated with lower ratings of pleasant slides and with more negative mood at the conclusion of the study. The conclusion from previous research that the self-reported emotional response of schizophrenia patients is not diminished compared to other groups may be premature, especially for patients with higher levels of disorganization.

Assessment procedures for personality disorders (PDs) typically rely on self-reports, even though some people with PDs may be unable to view themselves realistically or are unwilling to report socially undesirable traits. Close associates may provide important information regarding the presence of PD traits. Peer nomination is a reliable and valid assessment procedure that can be adapted to the study of PDs for research purposes. This study focused on characteristic features that define narcissistic, dependent, and obsessive-compulsive PDs using information collected from both self and others in a nonclinical sample of women. It was designed to identify specific areas of agreement and discrepancy between self-report and peer assessment in the measurement of characteristic features of these disorders.

The aim of this randomized controlled trial was to assess the effects of treatment with continuous positive airway pressure versus conservative therapy (CT) on well-being, mood, and functional status in subjects with mild sleep-disordered breathing (SDB). One hundred and eleven subjects, aged 25 to 65 yr, with a respiratory disturbance index (RDI) of 5 to 30 and without subjective pathologic sleepiness, were randomized to nasal CPAP or to CT. Ninety-seven subjects were followed-up after 8 wk. Treatment response was assessed from changes between baseline and follow-up measures of mood, energy/fatigue, and functional status/general health. Of the 51 subjects randomized to CPAP, 25 (49%) experienced an improved outcome, as compared with 12 of 46 of subjects (26%) randomized to CT (p < 0.05). The odds of experiencing a treatment response in the CPAP as compared with the CT group were 2.72 (OR: 1.18 to 6.58, 95% CI). A beneficial effect of CPAP over CT was most evident among individuals without sinus problems and among subjects with hypertension or diabetes. Differential treatment responses were not related to degree of baseline sleepiness or SDB. This suggests that middle-aged snorers with relatively low levels of SDB (RDI < 30) may benefit more from nasal CPAP than from less specific therapy directed at improving breathing during sleep. CPAP therapy may be beneficial to a broader group of subjects than previously appreciated.

Twenty-four depressed and twenty-three nondepressed male patients rated pleasantness of slides varying in hedonic content. Depressed patients rated positive slides as less pleasant and less arousing but did not differ from nondepressed patients in subjective response to normatively unpleasant images. Analysis of videotapes of facial expressions while watching the slide images showed that depressives exhibited more negative expressions than nondepressives to negative slides. Groups did not differ in facial expression to positive stimuli, but neither group displayed much affect to those stimuli. These data suggest a possible dissociation between self-reported and observable responsivity to emotional stimuli in depression and that diminished subjective emotional response in depression is restricted to hedonically positive stimuli and does not reflect generalized diminished emotional responsivity. These results also imply that clinical assessment of emotional responsivity in depression should be made using modalities in addition to observer evaluation of expressed emotion.

Objective: The purpose of this study was to determine whether adolescent schizophrenia is characterized by neuropsychological deficits., Method: The performance on a battery of neuropsychological tests of 17 adolescents with schizophrenia (mean age = 15.71 years) was compared with that of 17 normal adolescents (mean age = 15.12 years)., Results: Compared with the normal subjects, the patients were impaired on 10 of the 13 measures; larger effect sizes were shown for measures involving working memory and attention than for those involving secondary memory, generative naming, and executive functions., Conclusions: Adolescents with schizophrenia have generalized cognitive dysfunction, which is most apparent on tests of attention and working memory.

Objective: To evaluate the extent to which the previously reported relationship between premorbid personality and psychopathological symptoms after the onset of Alzheimer disease (AD) is due to the use of a single informant for both personality and symptom information., Design: Premorbid personality descriptions of patients with AD were obtained from 2 sources, primary caregivers and secondary informants, using the Personality Assessment Schedule and NEO-PI-R Neuroticism Scale, respectively. All information regarding depression and anxiety since the onset of AD was obtained from primary caregivers using clinical interviews and the Cornell Scale for Depression in Dementia., Results: When data were obtained from the same informant, significant relationships were found between premorbid personality and both presence of depression and the severity of anxiety symptoms. When data were obtained from 2 different informants, the only significant relationship was between premorbid neuroticism and anxiety severity., Conclusion: As in a previous report, there was a relationship between premorbid personality and depressive symptoms in AD, but only when personality and symptom information was obtained from the same informant. On the other hand, there was a relationship between premorbid personality and severity of anxiety symptoms both when personality and symptom information came from different informants as well as from the same informant. These data suggest that retrospective bias contributes to the apparent consistency between premorbid personality and some aspects of psychiatric symptoms in AD, specifically depression.

Objective: Previous studies of attention/information processing impairments in schizophrenia suggest that patients with the deficit syndrome should be characterized by impaired performance on measures of visual information processing. Therefore, the authors examined whether two measures of visual information processing, a degraded stimulus version of the continuous performance test and a forced choice span of apprehension task, were uniquely related to the deficit syndrome., Method: Performance on the continuous performance test and span of apprehension task was examined in 20 deficit and 56 nondeficit patients with schizophrenia and in 27 subjects in a normal comparison group., Results: Deficit patients performed significantly less well than both nondeficit patients and the normal comparison group on the continuous performance test and span of apprehension task. There were no significant differences between the nondeficit patients and the normal group on the continuous performance test, but nondeficit patients performed significantly less well on the span of apprehension task than the normal group. Differences between the deficit and nondeficit patients in performance on the continuous performance test and span of apprehension task were not related to total scores on the Brief Psychiatric Rating Scale factor 1 or on the Thought, Language, and Communication scale or to neuroleptic level., Conclusions: The results suggest that deficit patients are uniquely characterized by impaired performance on the continuous performance test. The deficit patients' differential performance on the continuous performance test may be related to either an inability to activate and allocate attention or an impairment in the perceptual organization of visual information.

Although a broad range of neuropsychological deficits has been reported in patients with severe sleep disordered breathing (SDB), little is known about the impact of mild SDB on neuropsychological performance. In this study, we compared neuropsychological test performance in two groups of carefully screened volunteers who differed clearly according to the respiratory disturbance index (RDI). Controls (n = 20) were identified on the basis of an RDI < 5; cases (n = 32) had an RDI in the range of 10-30. Cases and controls were well matched with regard to IQ, age, and sex. Cases had significantly more self-reported snorting and apneas and a higher body mass index than controls but did not differ according to sleepiness as measured by either the multiple sleep latency test or the Epworth sleepiness scale. An extensive battery of neuropsychological and performance tests was administered after an overnight sleep study. Cases performed significantly more poorly on a visual vigilance task (perceptual sensitivity, d': 2.24 +/- 0.64 vs. 2.70 +/- 0.53, p = 0.01, for cases and controls, respectively) and a test of working memory, the Wechsler adult intelligence scale-revised digits backwards test (6.12 +/- 2.20 vs. 7.55 +/- 2.22, p = 0.02), than controls. The groups did not differ in their performance on other tests of memory, information processing, and executive functioning. In summary, subjects with mild SDB may manifest a vigilance deficit in the absence of substantial sleepiness. Subjects with a mildly elevated RDI (10-30) without sleepiness do not appear to suffer appreciable deficits in more complex neuropsychological processes (e.g. executive functions).

Background: In this study, we tested the hypothesis that low smooth pursuit gain in schizophrenia is related to an abnormality in motion perception., Methods: The subjects were 19 schizophrenics treated with clozapine and 19 controls. In addition to smooth pursuit and motion perception paradigms, sustained attention was also assessed using a continuous performance task (CPT)., Results: In the patient group, there was a statistically significant negative correlation between smooth pursuit gain and motion perception threshold (r = -0.60, P < 0.01). This relationship was not secondary to attention deficits as assessed by the CPT., Conclusions: Our results are consistent with the notion that the smooth pursuit gain deficit is related to a deficit in motion perception rather than in attention. Brain area V5 (also referred to as "MT' in macaque), located in the parieto-occipital region, is known to be critically important both for motion perception and gain. Thus, our results point to an abnormality in this area in schizophrenia.

Objective: The authors' goal was to replicate an earlier finding of a familial liability for depression in Alzheimer's disease., Method: The family histories of depression and dementia were compared in 28 patients experiencing a first episode of major depression after onset of Alzheimer's disease and 74 nondepressed patients with Alzheimer's disease., Results: Significantly more families of depressed dementia patients included depressed first-degree relatives. There was no difference between Alzheimer's disease patients with and without depression in the proportion of families with a history of dementia., Conclusions: Major depression in Alzheimer's disease is associated with a familial liability for depression that is independent of any familial liability for dementia.

Computer-based testing in neuropsychology potentially offers important advantages. These include improvement in reliability and more efficient use of resources. For tests such as the Wisconsin Card Sorting Test (WCST) in which examiners must provide on-going feedback to subjects, reliability may be decreased by variability and errors in test presentation, errors in response recording and feedback, and errors in scoring. In addition, an important aspects of neuropsychological assessment is qualitative, that is, observations of the processes by which the subject responds to the test situation. The mechanics of administering the WCST hinder the examiner from allocating attention for observing these processes. Accordingly, we have automated both the administration and the scoring of the WCST. Although potential benefits of computerizing the WCST seem likely, it is possible that factors which cannot at present be duplicated by a computer may effect performance. This study compared performance between the standard manual Heaton version of the WCST and the computerized version. In a group of 33 normal and psychiatric subjects, there were significant differences in the number of Errors and the number of Correct responses, but no significant differences in performance were found for Perseverative Responses, Perseverative Errors, and Set Breaks. The mean number of Categories achieved was 2.0 for the computer administered version and 2.4 for the manual version: this difference was only marginally significant (p = 0.065). The computerized form of the WCST appears to yield similar quantitative results on scores which are most specifically affected by brain injuries in testing with the manual form. Lower variance was seen in the computer scores. This result is consistent with more reliable administration and accuracy in data acquisition and scoring in the computer version. The results overall indicate that the computer version is not a substitute for a human examiner, rather, the computer can function as a reliable partner, carrying out the mechanics of test presentation and scoring, freeing the examiner to more fully support the subject in taking the test and to observe the non-quantitative aspects of test performance.

The aim of this study was to examine multivariate patterns of relationships between oculomotor performance, psychopathology, and neuropsychology. Performance on smooth pursuit and saccadic eye movement tasks was assessed in three DSM-III-R diagnosis-based groups of subjects; normal (N = 55), schizophrenic (N = 29), and bipolar disorder (N = 26) and analyzed in relation to age, gender, scale for the Assessment of Negative Symptoms, Scale for the Assessment of Positive Symptoms, and Brief Psychiatric Rating Scale scores, Shipley intelligence quotient, and Wisconsin Card Sorting Test Performance. The greatest difference was a higher proportion of errors in the antisaccade task in the schizophrenic and bipolar groups, which was related to worse Wisconsin Card Sorting Test performance and was not accounted for by gender, age, education, or intelligence quotient. A significant gender and bipolar interaction showed bipolar women to have worse antisaccade performance. Abnormal smooth pursuit was more specific to schizophrenia. Antisaccade task and sine wave root-mean-square error were correlated in bipolar but not schizophrenic subjects. Scale for the Assessment of Negative Symptoms and Scale for the Assessment of Positive Symptoms scores had independent associations with the antisaccade task. Faster reaction times in the schizophrenic group to antisaccade errors were observed, suggesting an abnormality in visual attention processing and perhaps sensory gating functions. These results confirm abnormal smooth pursuit in schizophrenia and suggests that impairments in saccadic function are less specific to diagnostic group. Oculomotor performance and psychopathology seem related in complex ways to age, gender, intelligence quotient, and executive neuropsychological and possibly visual attention functions.

Much of the literature shows various regional structural brain abnormalities in schizophrenia, but the complexity and variability of brain makes it difficult to determine how these regions are related. Statistical methods which estimate factors underlying patterns of covariance have not been widely used, but could be useful for analyzing such complex data. We applied exploratory and confirmatory factor analysis procedures to specific cortical and subcortical regional brain volume measures from MRI data in 60 normal and 44 schizophrenic subjects. Basal ganglia, heteromodal cortical gray, and medial temporal lobe factors were present in both the normal and the schizophrenia groups. The factor structure observed in the normal group showed a high degree of bilateral symmetry which is present but disrupted in the schizophrenia group. In the bilateral data, the disruption is most pronounced with medial and lateral temporal lobe structures including entorhinal cortex and anterior and posterior superior temporal gyri. There was a significant correlation between the basal ganglia factor and the heteromodal cortical gray factor in the normal group that was not present in the schizophrenia group. In the unilateral data, left posterior superior temporal gyrus did not load onto any factor in the schizophrenia group. Confirmatory factor analyses showed significant differences between the two groups in factor structure. A number of specific brain regions are affected in schizophrenia, and structural relationships between groups of regions also are abnormal. The results suggest that heteromodal dorsolateral prefrontal and superior temporal cortical gray regions are structurally related, whereas inferior parietal cortical gray is less so. These results should be viewed as preliminary as the ratio of parameters to subjects was relatively low, and replication is needed. However, the results demonstrate the potential utility of latent structure methods such as factor analysis in study of complex relationships in neuropsychiatric data.

Knowledge of earlier intellectual functioning can be very helpful in the diagnosis of neurocognitive disorders. The National Adult Reading Test (Nelson, 1982), based on the observation that reading irregularly spelled words remains intact in mild dementia, may be useful for this purpose. A version for speakers of American English (AMNART) was recently published (Grober & Sliwinski, 1991). The present study evaluated the validity of the AMNART with demented and nondemented African-American and White elderly veterans. The average differences between African-American and White participants on the AMNART and WAIS-R were similar. The differences between demented and nondemented patients were greater on the WAIS-R than on the AMNART, as expected. Paradoxically, the AMNART appears to over-estimate IQ among nondemented individuals with lower WAIS-R scores, but underestimate IQ among more impaired demented patients. Using Grober and Sliwinski's (1991) 10-point discrepancy rule between AMNART and WAIS-R VIQ scores, 70% of demented and nondemented veterans were successfully classified. No discontinuation rule for the AMNART could be established because word difficulty order varies across samples.

L.A. Clark and D. Watson (1991) proposed a tripartite model that groups symptoms of depression and anxiety into 3 subtypes: symptoms of general distress that are largely nonspecific, manifestations of somatic tension and arousal that are relatively unique to anxiety, and symptoms of anhedonia and low Positive Affect that are specific to depression. This model was tested in 5 samples (3 student, 1 adult, and 1 patient sample) using the Mood and Anxiety Symptom Questionnaire (MASQ; D. Watson & L. A. Clark, 1991), which was designed to assess the hypothesized symptom groups, together with other symptom and cognition measures. Consistent with the tripartite model, the MASQ Anxious Arousal and Anhedonic Depression scales both differentiated anxiety and depression well and also showed excellent convergent validity. Thus, differentiation of these constructs can be improved by focusing on symptoms that are relatively unique to each.

L. A. Clark and D. Watson (1991) proposed a tripartite model of depression and anxiety that divides symptoms into 3 groups: symptoms of general distress that are largely nonspecific, manifestations of anhedonia and low positive affect that are specific to depression, and symptoms of somatic arousal that are relatively unique to anxiety. This model was tested by conducting separate factor analyses of the 90 items in the Mood and Anxiety Symptom Questionnaire (D. Watson & L. A. Clark, 1991) in 5 samples (3 student, 1 adult, 1 patient). The same 3 factors (General Distress, Anhedonia vs. Positive Affect, Somatic Anxiety) emerged in each data set, suggesting that the symptom structure in this domain is highly convergent across diverse samples. Moreover, these factors broadly corresponded to the symptom groups proposed by the tripartite model. Inspection of the individual item loadings suggested some refinements to the model.

Background: Previous studies have suggested that functional impairments of the frontal and parietal lobes are related to the deficit symptoms of schizophrenia. The purpose of the current study was to examine whether neuropsychological measures of frontal and parietal lobe function differentiated deficit from nondeficit patients. Neuropsychological measures of temporal lobe function were used as contrast measures., Methods: The performance of 18 deficit and 21 nondeficit schizophrenic patients was examined on neuropsychological measures of executive, visuospatial, and memory functions, selected on the basis of their association with lesions of either the frontal, parietal, or temporal lobes. The results from the schizophrenic subgroups were compared with the results on the same measures obtained from 30 normal controls., Results: Deficit patients performed more poorly than nondeficit patients on two frontal lobe measures, the Stroop Color-Word Interference and Trails Making B tests, and one parietal lobe measure, the Mooney Faces Closure Test. There were no differences in performance on the temporal lobe measures between the two groups. Both groups performed more poorly on the tests than the normal controls., Conclusions: The results suggest that deficit patients may have greater performance impairments on neuropsychological measures associated with frontal and parietal neuropsychological abnormalities.

Caregivers of Alzheimer's disease patients provided characterizations of the patients' premorbid personality traits and current personality traits on two occasions nearly 1 year apart. Characterizations of pre-illness personality traits did not differ between the two assessments. Changes in personality over the year were found for neuroticism, extraversion, and conscientiousness. The findings support the reliability of observer's descriptions of premorbid personality using the NEO-PI and the sensitivity of the instrument to personality change in dementia.

The behavioral symptoms associated with AD are a critical aspect of the disease. They provide an additional avenue not only for understanding AD but for implementing interventions. The nature of behavioral disorders in AD is complicated by a number of factors that interact and contribute to the development of problematic behavior. It is difficult to determine whether the behavior is the result of neurodegeneration, cognitive dysfunction, previous experiences, current stressors, independently coexisting psychopathology, or a combination of these factors. In any case, behavioral disturbances need to be more clearly defined and objectively measured. To understand and treat behavioral disturbances in AD, all biopsy-chosocial factors must be examined simultaneously. Currently, there is little that can be done to treat the cognitive components of AD. Consequently, our most successful and beneficial interventions may focus on the remediable behavioral manifestations of the disease. The most valuable treatment approach for patients with AD and their caregivers interweaves medications, psychosocial services, environmental strategies, and caregiver education.

To evaluate observer bias and to estimate observer concordance for descriptions of personality changes in dementia, the authors examined the personality descriptions of dementia patients provided by 2 informants. Twenty-two patients with Alzheimer's disease were rated on the NEO-PI by each of 2 informants, the primary caregiver and another relative or friend. Each informant completed the NEO-PI to describe current behavior and premorbid behavior. Significant differences between premorbid and current descriptions were found for 4 of the 5 personality dimensions measured. There was substantial agreement between independent raters, as indicated by significant correlations between raters for 4 dimensions and the absence of significant differences between rater averages. These results suggest that both primary caregivers and others who know a patient well may serve as informants for studies of personality in dementia.

Mortality trends for 1059 production workers at a rubber chemicals plant in Nitro, West Virginia were examined to find whether they had increased mortality from cancer associated with exposure to 2-mercaptobenzothiazole (MBT). This chemical and its derivatives are vulcanising agents that have been manufactured at the plant since 1935. Analyses were conducted on MBT exposed employees by cumulative exposure and time since first exposure, and were also stratified by past assignment to p-aminobiphenyl (PAB) related departments; PAB is a potent bladder carcinogen that was used at the plant between 1935 and 1955. There was an excess of bladder cancer in MBT workers who had PAB related assignments (standardised mortality ratio (SMR) = 3200, 95% confidence interval (95% CI) 1286-6593). In employees without a job assignment with exposure to PAB, there were no associations between exposure to MBT and increased rates of most malignant neoplasms. The SMR for bladder cancer was increased based on three deaths (SMR = 455, 95% CI 94-1328), although these results were too few to evaluate trends by cumulative exposure category. The possibility of confounding by PAB for exposures for jobs that covered all areas of the plant for these three cases must be considered in the light of the potency of PAB as a bladder carcinogen. There were no deaths from bladder cancer among MBT workers hired after the end of manufacture and use of PAB, but the expected number of deaths was only 0.03.

1. Sixty-six patients were assessed by one of three physicians employing CERAD assessment and were staged by CDR criteria. 2. The same day, trained raters completed the Brief Psychiatric Rating Scale, the Cornell Scale for Depression in Dementia and the Mini-mental State Examination. 3. Clinician's Global Rating of the CDR is strongly related to the Mini-mental State Examination Score. 4. The CDR is insensitive to mild psychopathology in this population.

Information-processing impairments have been suggested to be at the core of the cognitive deficits observed in schizophrenia and may represent preclinical markers of genetic vulnerability to the illness. Of particular importance in information-processing research have been measures such as the Continuous Performance Test (CPT) and the Partial Report Span of Apprehension (SPAN) that place high momentary loads on processing resources. The relationships between the two cognitive measures and between the two measures and clinical symptoms were examined in 50 patients with either DSM-III-R schizophrenia or schizoaffective disorder. The information-processing measures were modestly correlated with each other and with an estimate of verbal, but not nonverbal IQ. The SPAN was correlated with negative symptoms and the CPT with formal thought disorder. These results provide some evidence of convergent validity but also suggest that constructs other than high momentary processing load are implicated in their sensitivity to schizophrenia.

Schizophrenia is characterized by a variety of cognitive dysfunctions. Information-processing dysfunctions differ between clinical subtypes such that nonparanoid schizophrenia patients attend less than paranoid schizophrenia patients to connotative or contextual aspects of stimuli. The positive and negative symptom dimensions are also associated with distinct cognitive deficits. In general, positive symptoms are related to auditory-processing deficits and negative symptoms to visual/motor dysfunctions. The interaction of frontal and septohippocampal brain systems, and failures of information-processing automaticity and self-monitoring, have been proposed as the bases of positive symptoms. Negative symptoms are thought to arise from abnormalities in the complex interactions of frontal and striatal systems. Recent theoretical analyses have recommended a focus on the cognitive and neuropsychological analysis of specific symptoms (e.g., hallucinations and delusions) instead of on the more heterogeneous symptom clusters or dimensions. Studies of specific symptoms indicate that patients with hallucinations have deficits in discriminating the source of information. Delusions have been related to abnormal inference processes as well as abnormal perceptual experiences. Studies should now examine the links between information-processing abnormalities and symptoms over time, as the latter change, within the framework of explicit, disconfirmable theoretical models.

Epidemiologic studies on dioxin, specifically 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD), have not consistently found an increased cancer risk. This study examines mortality rates for 754 employees at a chemical plant after an accident in 1949 in which 122 workers developed chloracne from high exposure to TCDD. We also examined exposure to 4-aminobiphenyl, a potential bladder carcinogen. Although the numbers are small, and confounding factors cannot be ruled out, workers exposed to 4-aminobiphenyl who developed chloracne from the accident had increased mortality rates from soft tissue sarcoma, bladder cancer, and respiratory cancer. All soft tissue sarcomas occurred among workers with potential 4-aminobiphenyl exposure, whereas no soft tissue sarcomas occurred among workers with TCDD exposure alone. In these workers, exposure to TCDD alone at levels great enough to cause chloracne was not associated with increased cancer rates.

Schizophrenic and control subjects were tested on two-flash fusion (TFF) and visual backward masking (VBM) tasks in a repeated measures design. Each subject was tested in a single session. Both tasks used the same equipment and stimuli. There was no difference between the groups in their ability to detect the presence of two separate stimuli in the TFF task. Schizophrenic subjects did require longer interstimulus intervals (ISI) than control subjects to accurately report one of the two targets in the VBM task. Analysis of individual targets reveals that the VBM deficit is a function of the similarity of the target and mask. The more feature detail discrimination necessary, the longer an ISI is required in VBM. The data are interpreted as supporting the conclusion that since the groups did not differ in their performance of the TFF task, which would also have been affected by a sensory abnormality, the deficit in VBM must be explained by reference to a higher level of information processing. The VBM deficit is a failure to decode the target stimulus, and is not simply a function of abnormalities due to an overactive transient channel system.

Posner et al. (1988) recently found a lateralized impairment in the shift of covert visual attention to the right visual field in acute schizophrenic patients. Strauss et al. (1991) did not find this lateralized attentional deficit in remitted neuroleptic-treated chronic schizophrenic outpatients. The present study examined the covert shifting of visuospatial attention in clinically ill inpatients with chronic schizophrenia and in nonpsychotic control subjects. Although patients with schizophrenia were slower in all conditions, no lateralized attentional abnormalities were found. Taken together, these studies suggest that neuroleptic treatment may affect a lateralized attentional impairment in chronic schizophrenia.

How personality changes in Alzheimer's disease is not well understood. Accentuations of premorbid personality, systematic shifts in personality traits, and specific personality changes affecting subtypes of patients have been postulated. To investigate which of these alternatives occurs in Alzheimer's disease, caregivers were given a comprehensive personality inventory standardized for use by informants. Caregivers observed more neurotic, less extroverted, and less conscientious behavior. To a smaller extent, patients with Alzheimer's disease were reported as becoming less agreeable and less open. The changes in reports of neuroticism, extroversion, agreeableness, and openness suggested consistent systematic shifts across all patients. Patients with depressive features were reported to have been more neurotic; those with paranoid delusions were reported as having been more hostile. Premorbid personality traits may predispose to subsequent psychiatric symptoms in Alzheimer's disease.

Two aspects of spatial cognition, personal and extrapersonal orientation, were studied in 21 patients with Huntington's disease, 49 individuals at risk for the disease, and 41 healthy control subjects. Personal orientation was assessed using the Standardized Road Map Test of Directional Sense. Extrapersonal orientation was measured using a route-walking task under two conditions--with and without turning the body while traversing the routes. Relative to normal controls, HD patients performed more slowly on the personal orientation test, and less accurately on the extrapersonal orientation task in the TURN, but not the NO-TURN condition. At-risk individuals performed like the normal control subjects on all measures. The results suggest a deficit in personal but not extrapersonal orientation in HD. It is suggested that disruption of fronto-striatal pathways mediates this deficit.

The influence of monetary feedback on Wisconsin Card Sort Test (WCST) performance of 14 male schizophrenics was investigated. Patients were administered the test under standard instructions and with monetary feedback in counterbalanced order. Monetary reinforcement reduced perseverative errors and increased correct responses (p less than .05). These findings suggest that the WCST perseverative errors of schizophrenics reflect motivational as well as cognitive factors.

We compared covert shift of visual attention in patients with schizophrenia or bipolar disorder, both in states of remission, to normal controls to examine the persistence of lateralized attentional deficits into nonpsychotic states. Although patients were slower in all conditions than normals, there was no difference in pattern of attentional shift among the groups. This suggests that the left-hemisphere deficit in shift of covert attention in schizophrenia may be limited to periods of florid illness.