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Individuals with mild cognitive impairment (MCI) can often progress into Alzheimer's Disease (AD). Research suggests that decline in episodic memory and semantic memory, as well as functional abilities, can be sensitive in predicting disease progression. This study aimed to (a) investigate episodic and semantic memory performance differences between AD and MCI, (b) determine if memory performance predicts observation-based activities of daily living (ADLs), and (c) explore whether semantic memory mediates the relationship between episodic memory and ADLs. Fifty-eight AD, 53 MCI, and 72 healthy control participants were administered the Rey-O, California Verbal Learning Test, Animal Fluency Test, Boston Naming Test, and Direct Assessment of Functional Status (DAFS). The results revealed, first, that AD participants performed significantly lower than the MCI participants across semantic memory and episodic memory tasks, with the exception of the Boston Naming Test. Second, hierarchical-stepwise regression analyses found that semantic memory significantly predicted DAFS orientation, communication, and financial skills in AD, but episodic memory predicted shopping skills. Furthermore, semantic memory significantly predicted DAFS transportation skills in AD and MCI. Third, within the overall sample, semantic memory mediated the relationship between episodic memory and ADLs. Taken together, the findings suggest decline in semantic memory (as measured by confrontational naming and category fluency) and episodic memory (as measured by list and complex visual design learning and recall) may lead to decline in different and specific aspects of functional abilities in AD and MCI.

There is a growing need to conduct a neuropsychological assessment with bilingual Middle Eastern populations, particularly those who speak the Persian language (Farsi). Although validated neuropsychological and language tests have emerged in Iran, there remains a shortage of appropriate psychometric tests in the U.S. that have been validated for use with the Iranian-American population. This often leads to an assortment of using U.S. tests in English, U.S. tests translated into Farsi, and Iranian tests in Farsi, which can complicate the clinical assessment. To better understand common testing issues when working with bilingual Iranian-American patients, we review the first report of a 62-year-old, bilingual (English-Farsi) Iranian-American male with 18-years of education who was tested using U.S.-developed and Iranian-developed tests in both English and Farsi language. Pre-surgical, 6 months post-surgical, and 1.5 years of post-surgical assessment data are discussed. We highlight the strengths and limitations of naming tests, test used in the native country versus U.S. language tests, the importance of baseline testing, general bilingual Persian-English assessment considerations, and case-based learning points.

As the Farsi-speaking Iranian population continues to grow in the United States, examination of their cognitive performance is an imperative first step to providing this group with culturally competent services. Thirty-six healthy primarily Farsi-speaking Iranian adults completed Farsi-translated and adapted versions of three frequently used measures of executive/subcortical functioning: Wisconsin Card Sorting Test (WCST), Trail Making Test (TMT), and Color Trails Test (CTT). Participants' performance on each measure was compared to published normative data resulting in 0-85% of cognitively and medically healthy individuals being classified as impaired depending on the executive/subcortical test score examined, with the highest impairment rates for specific WCST outcome scores. These findings raise questions for the use of published norms with Farsi-speaking Iranians residing in the US. The present study provided normative data from this group of Farsi-speaking Iranians on the Farsi-translated and adapted versions of the WCST, TMT, and CTT.

Abstract. Mild cognitive impairment (MCI) is a risk state for dementia. The present study assessed daily functioning in MCI individuals (amnestic [aMCI] and nonamnestic [naMCI]) relative to those with Alzheimer’s disease (AD) and healthy controls (NC). Twenty AD participants, 14 aMCI, 12 naMCI, and 30 healthy controls were administered the Direct Assessment of Functional Status (DAFS). The AD group performed poorer than all groups on all DAFS subscales. The aMCI group performed poorer than controls on the shopping subtests, while the naMCI group performed poorer than controls on only the free recall shopping. Finally, DAFS subscales discriminated the AD and aMCI groups well, but only recognition shopping discriminated between naMCI and aMCI individuals. These findings suggest that circumscribed ADL deficits distinguish subtypes of MCI and AD.

The degree to which changes in caregiver burden over a one-year period can be predicted by functioning of dementia patients and caregiver psychological stress was examined. The Direct Assessment of Functional Status (DAFS) was administered to 44 patients and the Caregiver Burden Inventory and the Brief Symptom Inventory were administered to their next-of-kin caregivers. All patients and caregivers were assessed at baseline and again in approximately one year with the same measures. Hierarchical regression revealed that baseline patient functioning predicted overall changes in caregiver burden, but that increases in psychological symptoms of caregivers such as depression, anxiety, and hostility were the best predictors for specific types of increased caregiver burden, such as social, developmental, or physical burden. These results suggest that interventions should target reduction of particular psychological symptoms in order to reduce caregiver burden over time.

Members of the National Academy of Neuropsychology were surveyed in 2005 to assess then current practices regarding Boston Naming Test (BNT) administration, interpretation, and reporting procedures. Nearly half of 445 respondents followed discontinuation rules that differed from instructions published with the test, and nearly 10% did not administer items in reverse order to achieve the required 8 consecutive item basal. Of further concern, between 40% and 55% of respondents indicated that they did not interpret BNT scores in light of linguistic and ethnic background, and over 25% reported that they did not consider educational level. Despite the fact that non-normal distribution of BNT test scores renders use of percentiles misleading, nearly 60% of respondents endorsed using percentiles when reporting BNT data. The implications of these results are discussed, and recommendations are provided.

More research is needed to examine the relationship between specific neuropsychological functions and observation-based daily activity tests in patients with Alzheimer's disease (AD). Fifty-six patients with AD were administered tests of attention and processing speed and an observation-based activities-of-daily-living (ADL) task. Complex short-term attention capacity best predicted real-world task performance, accounting for several domains of ADL functioning. These results suggest that complex attention requiring working-memory systems, but not simple attention or processing speed, account for moderate portions of variability in daily task performance. These results may aid in understanding the attentional processes required for performing daily activities and can be useful to health care professionals in treatment planning.

The 2008 Diversity Summit recognized the many advantages of increasing the number of neuropsychologists from ethnically diverse backgrounds. The Summit addressed the aspiration of creating a more ethnically diverse body of neuropsychologists by increasing the recruitment of ethnic minority students to neuropsychology training programs. Challenges to successful recruitment and retention of ethnic minority students were discussion points at the Summit. This paper summarizes and expands these points and also suggests solutions to these challenges with the aim of stimulating innovative approaches to increasing the representation of ethnic minorities in neuropsychology.

Impairment in odor-naming ability and in verbal and visual semantic networks raised the hypothesis of a breakdown in the semantic network for odors in Alzheimer's disease (AD). The current study addressed this hypothesis.Twenty-four individuals, half patients with probable AD and half control participants, performed triadic-similarity judgments for odors and colors, separately, which, utilizing the multidimensional scaling (MDS) technique of individual difference scaling analysis (INDSCAL), generated two-dimensional configurations of similarity. The abilities to match odors and colors with written name labels were assessed to investigate disease-related differences in ability to identify and conceptualize the stimuli. In addition, responses on attribute-sorting tasks, requiring the odor and color perceptions to be categorized as one polarity of a certain dimension, were obtained to allow for objective interpretation of the MDS spatial maps.Whereas comparison subjects generated spatial maps based predominantly on relatively abstract characteristics, patients with AD classified odors on perceptual characteristics. The maps for patients with AD also showed disorganized groupings and loose associations between odors. Their normal configurations for colors imply that the patients were able to comprehend the task per se. The data for label matching and for attribute sorting provide further evidence for a disturbance in semantic odor memory in AD. The patients performed poorer than controls on both these odor tasks, implying that the ability to identify and/or conceptualize odors is impaired in AD.The results provide clear evidence for deterioration of the structure of semantic knowledge for odors in AD.

Most older individuals with dementia live in the community 1 and often survive an average of 8 years (range 3–25 years) postdiagnosis.2 A number of factors, including age at diagnosis and the severity of other medical conditions, determine average survival time.3 According to a study conducted in 1996 by the National Alliance for Caregiving and the Alzheimer’s Association, more than 70% of caregivers are relatives who provide care at home. Furthermore, approximately 75% of caregivers are women between the ages of 35 and 64. A growing body of literature on the caregivers of patients with dementia indicates that these individuals experience physical, psychological or emotional, social, and financial problems.4 A study5 using a brief screening measure to characterize cognitive impairment in patients with Alzheimer’s disease found that patients’ cognitive scores played a significant role in predicting the amount of time caregivers spent caring for the patient. A number of recent studies have found that caregivers of patients with dementia frequently report physical and emotional distress and that the most common complaints among caregivers include anger, depression, guilt, worry, feeling of isolation, and marital stress.6–13 One study found that caregivers of patients with cognitive impairment who displayed high levels of anxiety and depression also showed high levels of care-giver burden.14 Less research has been conducted examining the relationship between patients’ specific functional impairments and the burden and psychological distress experienced by caregivers. One study15 revealed that scores of dementia patients on the Mini-Mental State Examination (MMSE) and behavioral inventories were related to the burden reported by caregivers. They also found significant associations between caregiver burden and a nonobservation-based activity of daily living (ADL) scale over a 2-year observation period. Similarly, another study16 found that, when dementia severity surpassed a threshold of MMSE ( < 20), the level of involvement with making medical decisions for the patient and burden increased for caregivers. A third study17 found that burden ratings by caregivers of patients with mild dementia correlated more strongly with a caregiver-rated ADL measure than with a rater-observed ADL (patient functional) measure. This suggests that a caregiver’s level of burden may affect his or her perception of the patient’s ability or disability level. The literature suggests that a large number of patients with cognitive impairment dwell in the community and are cared for by relatives who experience significant burden and that there may be a relationship between the patient’s cognitive impairment and functional abilities and the level of caregiver burden. The present study was designed to assess the performance-based and caregiver-rated ADLs of patients with relatively mild cognitive impairment and their relationship to the burden and psychological distress experienced by caregivers. An additional objective was to identify how well specific functional abilities of patients predict caregiver burden.

The objective of this study was to examine differences between fluent English-speaking ethnically diverse (ED) individuals (from Hispanic, Asian, and Middle-Eastern descent) and monolingual English-speaking Anglo-Americans (MEAA) on the Wechsler Abbreviated Scale of Intelligence (WASI). A sample of 86 (50 ED and 36 MEAA) healthy individuals participated. The results revealed that the MEAA group outperformed the ED group on the verbal (i.e., Vocabulary and Similarities), but not the nonverbal (i.e., Block Design and Matrix Reasoning) subtests. Various cultural factors such as the level of acculturation and the degree to which the English language was used correlated with verbal skills. Number of years the education was obtained outide of the US was an important predictor of verbal and some nonverbal performance in the ED group. The findings from this study underscore the importance of taking cultural factors, particularly level of acculturation, into account when interpreting test scores of ED individuals.

The relationship between ethnicity and cognitive test performance was examined in a sample of 161 patients referred for evaluation at a public hospital-affiliated neuropsychology clinic; 83 patients were Caucasian (non-Hispanic), 31 were African-American, 30 were Hispanic, and 17 were Asian. Significant group differences were present on some measures of language (Boston Naming Test), attention (Digit Span ACSS), constructional ability (Rey-Osterrieth [RO] copy), nonverbal processing speed (Trails A), and executive skills (Wisconsin Card Sorting Test [WCST]). Comparison of those who spoke English as a first language (or who learned English concurrently with a second language) versus those who spoke English as a second language (ESL) revealed significantly higher performance in the non-ESL group for Digit Span, Boston Naming Test, and FAS, and a higher score in the ESL group for RO copy. Boston Naming Test scores were significantly related to years educated in the United States; Boston Naming Test and Digit Span scores were significantly correlated with age at which conversational English was first learned and number of years in the United States; and finally, FAS scores were also significantly related to number of years in the United States. These findings are consistent with data from published literature on ethnic differences and the effects of acculturation on cognitive test performance in nonpatients, and also indicate that these observations are not attenuated by the presence of psychiatric or neurologic illness. The results further caution that normative data derived on Caucasian samples may not be appropriate for use with other ethnic groups.

The objective of this study was to examine differences between fluent English-speaking ethnically diverse (ED) individuals (from Hispanic, Asian and Middle-Eastern descent) and monolingual English-speaking Anglo-Americans (MEAA) on commonly used tests of information processing and attention. A sample of 123 (84 ED and 39 MEAA) healthy individuals participated. The results revealed that the MEAA group outperformed the ED group on Trail Making Test Part B, Stroop B and C, and Auditory Consonant Trigrams (18s delay condition). Additionally, a host of acculturation variables such as score on a formal acculturation scale, amount of time educated outside of the U.S., and the amount of English spoken when growing up correlated with these various neuropsychological tests. The findings from this study highlight the importance of taking acculturation into account for fluent English-speaking ED individuals when administering and interpreting neuropsychological tests.

Objectives Recent studies have linked apathy to frontal lobe dysfunction in persons with dementia, but few studies have explored this relationship in older, depressed persons without dementia. We examined the association between apathy and cognitive function in a group of older persons with major depression using standardized neuropsychological tests. We hypothesized that presence of apathy in depression is associated with poorer frontal executive performance. Methods We analyzed data from 89 older adults with major depression. We defined apathy using four items from the Hamilton Psychiatric Rating Scale for Depression which reflect the clinical state of apathy, including ‘diminished work/interest,’ ‘psychomotor retardation,’ ‘anergy’ and ‘lack of insight.’ Results Apathy most strongly correlated with two verbal executive measures (Stroop C and FAS), a nonverbal executive measure (Wisconsin Card Sorting Test—Other Responses), and a measure of information processing speed (Stroop B). Apathy was not associated with age, sex, education, medical illness burden, Mini-Mental State Examination score and Full Scale IQ score. Stepwise regression analyses of significant cognitive tests showed that apathy alone or apathy plus depression severity, age, or education accounted for a significant amount of the variance. Conclusions The results of this study provide support for an apathy syndrome associated with poorer executive function in older adults with major depression. Copyright © 2003 John Wiley & Sons, Ltd.

Bernard (1990), and Bernard, Houston, and Natoli (1993) identified a discriminant function, derived from Rey figure recall score and RAVLT trial 1 and recognition, which discriminated simulators and controls with 77--85% accuracy. However, in the current study, application of the discriminant function to patients with suspect effort, brain injured patients, and controls, revealed excellent sensitivity (95%) but low specificity (33% for patients, 61% for controls). A new discriminant function using the same Rey figure and RAVLT scores, derived from actual patients with documented suspect effort and patients with confirmed brain injury, resulted in an overall classification of 85% correct, with only 16% of suspect effort and 15% of brain injured patients misidentified. Use of a discriminant function score of/=-.40 resulted in sensitivity of 71% while maintaining specificity of/=91%.

This meta-analysis summarizes the broad spectrum of neuropsychological research on HIV disease across a sample of 41 primary studies and an aggregate of 8,616 participants for 10 major neuropsychological ability areas. Analyses of the course of cognitive decline within and across Centers for Disease Control classifications reveals statistically significant cognitive deficits from asymptomatic HIV to AIDS. Effect sizes (Cohen, 1988) were calculated to reflect between-group (asymptomatic, symptomatic, AIDS) differences in each neuropsychological domain. Relatively small effect sizes were obtained for the asymptomatic (0.05–0.21) patients, and generally small to moderate effect sizes were obtained for symptomatic (0.18–0.65) HIV+ patients, with motor functioning exhibiting the greatest effects in this later disease stage. The most notable deficits in cognitive functioning were found in the AIDS group with moderate (attention and concentration) to large (motor functioning) effect sizes with values ranging from 0.42–0.82. Comparison of cognitive functioning as a function of disease progression revealed that motor functioning, executive skills, and information processing speed were among the cognitive domains showing the greatest decline from early to later stages of HIV. These findings indicate that cognitive deficits in the early stages of HIV are small and increase in the later phases of the illness, and that specific patterns of cognitive deficits can be detected with disease progression. These results and their clinical utility are further discussed. (JINS, 2002, 8, 410–424.)

The performance of 16 patients with Alzheimer's disease (AD) was compared to 11 patients with right-frontotemporal dementia (FTD) and 11 patients with left-FTD on a comprehensive neuropsychological battery. Standardized scores (i.e., z scores based on normal control data) were analyzed for 5 cognitive domains. The results revealed that the AD group displayed significant impairment in visual–constructional ability relative to the two FTD groups; however, no significant difference was found between the groups on memory scores (verbal and nonverbal). Patients with left-FTD scored significantly below patients with AD on the language measures (e.g., word retrieval, verbal semantic memory), and verbal executive ability (phonemic fluency); AD patients did not differ from patients with right-FTD on these measures. Patients with right-FTD exhibited significantly more perseverative behavior than AD patients; AD patients did not differ from left-FTD patients on this parameter. These results indicate that the pattern of neuropsychological performance of AD patients is distinguishable from patients with left and right frontal frontotemporal dementia. (JINS, 2001, 7, 468–480)

A series of studies was initiated to model the organization of semantic memory in Alzheimer's disease (AD) patients using multidimensional scaling (MDS) and Pathfinder analyses. The resulting models (cognitive maps or semantic networks) embed studied stimuli in a coordinate space or network where distances between points are assumed to reflect psychological proximity between items. The organization of semantic networks in verbal and sensory domains were modeled based upon the frequency of the subject's choice of two concepts as most alike. Results suggested that while the organization of concepts in the semantic networks of AD patients was primarily based upon a concrete perceptual dimension in both verbal and olfactory domains, those of normal controls subjects were predominantly organized by an abstract conceptual attribute. Also, networks of AD patients were more complex and chaotic than normal, that is, they consisted of more unnecessary connections and of atypical strengths of association between concepts.

An estimated 7–28% of patients infected by the human immunodeficiency virus (HIV) develop dementia and at least 50% develop mild neurocognitive impairment. Past studies have shown odor identification impairments in HIV + neurocognitively impaired patients. It is difficult, however, based on an odor identification test to state with certainty that individuals with cognitive impairment have sensory olfactory deficits, because odor identification tests are known to draw upon cognitive skills. In the present study odor detection sensitivity was evaluated using an ascending, forced-choice, two-alternative, odor threshold test for butanol. Subjects were divided into three groups, HIV seropositive (HIV +) neurocognitively impaired, HIV + neurocognitively unimpaired, and HIV negative, based on neurological and psychological testing. An analysis of variance revealed significantly poorer odor sensitivity for the HIV + neurocognitively impaired group than for the two control groups. A significant negative correlation between degree of cognitive impairment and olfactory sensitivity was also found. We suspect that the olfactory deficits found in the HIV + neurocognitively impaired subjects are primarily due to damage to the central nervous system; however, nasal infection may be a contributing etiology.

Previous research has identified patterns of cognitive deficits in patients with Alzheimer disease (AD), but little is known about their pattern of daily functional impairment. A total of 49 patients with AD and 52 healthy elderly controls were administered neuropsychological tests as well as the Direct Assessment of Functional Status (DAFS) test, an observation-based test of activities of daily living (ADLs). In this project, we assessed 14 separate tasks assessed by the DAFS. To analyze the data, 4 cognitive domains were created using neuropsychological composite z scores (means and standard deviation obtained from control data) for patients with AD. Results revealed that patients with AD performed worse on the memory, language, and visual-spatial relative to the executive domain. Additionally, patients with AD performed poorer than the controls on nearly all 14 DAFS tasks, with their worse performance being on the shopping-related tasks which, in part, requires memory skills. Logistic regression revealed better specificity than sensitivity classifications based on the DAFS tasks, and stepwise regression analyses indicated that cognitive domains predicted specific aspects of functional abilities. These findings suggest that patients with AD display a distinct pattern of ADLs performance, that traditional neuropsychological tests are useful in predicting daily functioning, and the DAFS has some strengths and weaknesses in classifying AD and controls.

The Mini-Mental State Exam (MMSE) is a widely used cognitive screening measure. The purpose of the present study was to assess how 5 specific clusters of MMSE items (i.e., subscores) correlate with and predict specific areas of daily functioning in patients with dementia. Sixty-one patients with varied forms of dementia were administered the MMSE and an observation-based daily functional test (the Direct Assessment of Functional Status; DAFS). The results revealed that the orientation and attention subscores of the MMSE correlated most significantly with nearly all of the functional domains. The MMSE language items correlated with all but the DAFS shopping and time orientation tasks, while the MMSE recall items correlated with the DAFS time orientation and shopping tasks. Stepwise regression analyses found that among the MMSE subscores, orientation was the single, best independent predictor of most of the DAFS functional domains, with language, attention and recall subscores accounting for additional variance on DAFS functional tasks. These results indicate that the MMSE is not only a good cognitive screening tool, but its specific subsores can predict functional disabilities in patients with dementia.

The authors assessed the unique effect of smoking history on cognitive functioning after adjusting for demographic factors such as age, education, and gender, and presence of vascular illness.A sample of 127 healthy older adults (29 men, 98 women) between the ages of 47 and 83 (mean: 66.9) were administered a comprehensive neuropsychological battery. Information regarding risk for vascular illness was assessed with a detailed self-report history and/or medical examination. Smoking history was gathered with a self-report questionnaire, and a composite score reflecting amount and duration of cigarette use was computed. From this composite score, three smoking groups were created: None-Light, Moderate, and Heavy smokers.Analyses of covariance, using age, education, gender, and vascular status as the covariates, revealed that the heavy smokers performed significantly poorer than the other groups on two scores from a test assessing executive function/problem-solving (Wisconsin Card-Sorting Test), but not on any of the other cognitive tests.Consistent with previous findings, smoking history did not appear to have deleterious effects on most cognitive domains. Heavy smoking history, however, did appear to affect performance on a measure of executive functioning.

We present 6 patients who displayed noncredible effort on neuropsychological testing (verified by failures on specialized measures designed to discreetly assess effort status and multiple behavioral inconsistencies) and complained of complete illiteracy secondary to impoverished educational history, learning disability, or acquired brain injury. The Stroop Test, a measure of a specific aspect of executive function requiring inhibition of an automatized oral reading response in favor of a less habitual, competing color-naming response, was administered to these patients. All six subjects claimed that they were unable to perform the Word-Reading trial as a consequence of total reading disability, but on the Color-Word Interference trial, they all committed "errors" by reading the written words. Five of the six subjects also performed substantially slower on the Interference condition relative to the Color-Naming trial, indicating that they were in fact inhibiting a reading response. However, in cases involving complaints of complete reading illiteracy, the observation of these individuals performing an act that they claimed to be unable to do was the most powerful and pathognomonic indicator of deliberate feigning or exaggeration of impairment in these cases.

Impaired taste sensation in the aging person may affect the appreciation of food and beverages and compromise nutritional status. Changes in flavor perception may be due to altered ability to discriminate between intensities of suprathreshold taste stimuli. An interesting question is whether all taste qualities (sweet, salty, sour, bitter) show similar age-associated decline in intensity discrimination. Taste intensity discrimination has been shown to be significantly poorer in elderly than in young women for the bitter stimulus caffeine, but not for the sweet stimulus sucrose. The present experiment investigated effects of taste substance and age on taste intensity discrimination by assessing Weber ratios (WRs) for citric acid and sodium chloride (NaCl) in 60 people, half elderly, and half women. Results indicate a significant effect of age on WRs for citric acid and NaCl, suggesting the importance of suprathreshold intensity discrimination for taste perception in the elderly.

Numerous publications on the Rey 15-item Memorization Test have cited limitations primarily in test sensitivity, as well as to some extent in specificity. In the current study, 49 patients with suspect effort, 36 neuropsychology clinic patients not in litigation or attempting to secure disability, 33 learning disabled college students, and 60 normal controls were administered the Rey Test in standard format followed by a recognition trial. A free recall score9 was found to have excellent specificity (97-100%), although sensitivity was modest (47%). However, use of a combined recall and recognition score (i.e., free recall + [recognition - false positives]20) substantially increased sensitivity (71%) while maintaining high specificity (or=92%).

Children and adolescents with Klinefelter syndrome (XXY) have been reported to show deficits in language processing including VIQ < PIQ and a learning disability in reading and spelling. However, whether this is characteristic of adults with Klinefelter syndrome has not been established. Thirty-five men with Klinefelter syndrome, aged 16 to 61, and 22 controls were evaluated with a comprehensive neuropsychological battery. The Klinefelter patients scored significantly below controls in language skills, verbal processing speed, verbal and nonverbal executive abilities, and motor dexterity. Within the Klinefelter sample, three cognitive subgroups were identified: VIQ 7 or more points below PIQ (n = 10), VIQ within 6 points of PIQ (n = 12), and PIQ 7 or more points below VIQ (n = 12). The deficits detected in language, verbal processing speed, and verbal executive skills were found to be isolated to the VIQ < PIQ subgroup, while the abnormalities in motor dexterity and nonverbal executive skills were confined to the PIQ < VIQ subgroup. Older age was significantly correlated with increases in VIQ relative to PIQ in the patient group, which suggests the intriguing possibility that the PIQ < VIQ subgroup primarily emerges in young adulthood, perhaps in response to the reported hormonal abnormalities detected in Klinefelter syndrome patients during puberty. (JINS, 2001, 7, 446–456)