Alcoholics' self-assessment of their neuropsychological functioning in everyday life

Self-reports of impairment in everyday cognitive and perceptuomotor functioning for the 6 months that preceded treatment were investigated in 60 male, middle-aged alcoholics and for a comparable time period in 60 nonalcoholic controls matched on age, education, and Shipley Vocabulary age. Alcoholics reported significantly more everyday impairment than did controls in memory, higher cognitive functions, language skills, and perceptual-motor function. Laboratory tests of neuropsychological performance revealed that the alcoholics were significantly poorer than controls on measures of memory, higher cognitive functions, and overall neuropsychological functioning, but test performances essentially were uncorrelated with self-reported everyday impairment and with self-reported levels of depression and anxiety. However, in both groups, measures of depression and anxiety were correlated significantly with self-perception of impairment. In alcoholics, quantity-frequency of drinking (QFI) was also correlated with reported impairment; chronicity was not. Multiple regression analyses indicate that in alcoholics, both quantity-frequency measures of alcohol intake and affective distress (depression, anxiety) made independent and roughly equal contributions to reported everyday impairment; in controls, only affective distress contributed significantly.     

Locus of control and neuropsychological performance in chronic alcoholics

Correlated neuropsychological performance and three dimensions of Locus of Control (LOC) were examined in 62 hospitalized male chronic alcoholics and 24 non-alcoholic males drawn from the community. Performance deficits in alcoholic Ss correlated significantly with high scores on the Chance (LOC-C) and Powerful Others (LOC-PO) scales for approximately half of the measures employed, while no such correlations were significant in the controls. Correlations between performance and scores on the Internal (LOC-I) scale were negligible. Controls scored significantly higher than alcoholics on the Internal dimension; Chance and Powerful Others orientation were not significantly different in the two groups. From these and other results we conclude: (a) alcoholics and controls manifest similar but not identical LOC orientations; (b) alcoholics and controls show different relationships between neuropsychological performance and LOC orientation; and (c) the correlation between LOC variables and performance in alcoholics cannot account for the widespread differences in performance levels between the two groups.     

Subject selection biases in alcoholic samples: effects on cognitive performance

The effects of subject selection bias in research on cognitive deficits in sober alcoholics were studied in a sample of 523 subjects (98 controls, 276 ineligible alcoholics, 40 eligible alcoholics who declined to participate, and 144 eligible and participatory alcoholics). All subjects received the Shipley Institute of Living Scale (Vocabulary and Abstracting subscales) and measures of anxiety, depressive symptoms, childhood hyperkinesis and attentional deficit disorders were obtained. Results indicate that current guidelines for alcoholic subject selection are biasing analyses toward support of the null hypothesis. Declined alcoholics performed more poorly on the Shipley Abstracting than did the "Used" group, yet did not differ significantly from the Used alcoholic groups on depression or anxiety. Declined alcoholics did, however, report significantly fewer Hk/MBD symptoms than did other alcoholic groups. ANCOVAs that used the affective and childhood disorders as covariates did not alter the differences in cognitive performance described above.     

Hemispheric activity of 40 Hz EEG during recall of emotional events: differences between low and high hypnotizables

This study evaluates individual differences in hypnotizability as reflected in waking-state hemispheric engagement during recollection of 3 positively and 3 negatively valenced personal life events. The State-Trait Anxiety Inventory, Maudsley Personality Inventory, Tellegen Absorption Scale and Harvard Group Scale of Hypnotic Susceptibility (Form A) were administered. Electromyogram (EMG) and bilateral electroencephalogram (EEG) activities within the 40-Hz band were recorded during rest and task conditions in 22 high and 21 low hypnotizable women. Self-report rating scores for vividness of visual imagery and emotional feeling of the material recalled were evaluated. The 40-Hz EMG amplitude and both hemisphere 40-Hz EEG densities were obtained. A 40-Hz EEG ratio, as a measure of hemispheric asymmetry, and a hemispheric specificity index were also computed. High hypnotizables showed significantly lower 40-Hz EEG density than low hypnotizables in all experimental conditions. The relationship between lateralization of 40-Hz EEG and emotional processing was moderated by hypnotizability. High hypnotizables, with respect to rest condition, showed an increase of density over both left and right hemispheres during two of the three positive emotional tasks, while they showed a depressed activity over the left and an increased activity over the right during negative emotional tasks. Low hypnotizables, on the other hand, did not exhibit differential hemispheric patterns that could be attributed to different emotional valences. The high group showed greater hemispheric specificity in the predicted direction than the low group. High subjects exhibited greater ratings of absorptive ability and emotional feeling than low subjects. Anxiety and EMG levels did not differ between groups. EMG was dependent on the type of emotion which showed greater activity in the negative emotion condition compared with the positive one.     

Neuropsychological measures and event-related potentials in alcoholics: Interrelationships,long-term reliabilities,and prediction of resumption of drinking

Sober male and female alcoholics and peer controls were tested and then retested 14 months later on neuropsychological performance tests (NTP) and also had event-related potentials (ERPs) recorded (non-concurrently) to visual stimulation. Both NTP and ERP measures distinguish male alcoholics from peer controls at test and retest; NTP, but not ERP, scores distinguish female alcoholics from peer controls. Both measures manifest moderate to high reliabilities over time and are correlated modestly. NTP and ERP measures obtained at the end of treatment predict future resumers and abstainers 8 to 14 months later. The results demonstrate the utility of biopsychological approaches to alcoholism and support Grant's (1986) concept of alcoholics as suffering from an intermediate duration (subacute) organic mental disorder.     

Compare mDCs and pDCs between two distinct patients groups in acute HIV-1 infection

The role of DCs in primary HIV-1 infection remains uncertain. In this study, we enrolled two different groups of subjects with acute HIV-1 infection. One group progressed to CD4 counts below 200 cells/μl within 2 years of HIV-1 infection (CD4 Low Group), while the other group maintained CD4 counts above 500 cells/μl (CD4 High Group). We did not find statistical difference in the pDC number between the two groups during acute HIV-1 infection. However, the mDC number was significantly lower in the CD4 Low Group than in the CD4 High Group.     

The efficacy of structured memory retraining in a group comparison of head trauma patients.

Empirically proven mnemonic techniques from the literature were assembled into a comprehensive treatment program for brain injured clients. Twenty head injured subjects with mild to moderate neuropsychological impairments were matched on the variables of age, sex, years of formal premorbid education, and elapsed time since insult. These patients were then randomly assigned to either the control or experimental remediation group. Both groups attended a six-week program and were blind as to what type of treatment they were receiving. Each followed identical daily schedules where the experimental group received the formal memory remediation and the controls received treatment focusing on psychosocial issues. Both groups improved on the neuropsychological memory measures over the course of the study. The experimental group did not improve significantly more than did the control group; however, once the groups were subdivided according to the severity of neuropsychological functioning at intake, significant treatment effects were observed. More specifically, only those patients with mild residual impairments seemed to benefit from rehabilitative efforts, and those with more moderate deficits did not respond to treatment. Clinical implications and future research are discussed.     

Pretest expectancies and cognitive impairment in alcoholics

Alcoholics' neurological deficits have been attributed to cognitive impairment associated with brain dysfunction. Because alcoholics perceive themselves as impaired in higher cognitive functions, we investigated the alternative hypothesis that their deficits are predicted by lowered expectancies for successful performance. Ss were 48 male, middle-aged Veterans Administration inpatient alcoholics and 36 community controls. Subjects completed a standard series of neuropsychological tests. Before taking each test, Ss were asked how well they expected to do on that test in relation to members of their community. As predicted, means for the overall measures of expectancies and performance were significantly lower for alcoholics than for control Ss. Although expectancies were significantly correlated with performance, regression analyses indicated they could not account for the obtained performance differences.     

Variable expression of the fragile X syndrome in heterozygous females of normal intelligence

The cognitive, linguistic and memory functions of non-retarded fragile X heterozygotes and matched controls were examined by a detailed protocol of neuropsychological measures in order to determine the incidence of specific learning disabilities in this subgroup, and to compare their performance profiles with those of control subjects (mothers of Down syndrome sons). There were no group differences in psychometric intelligence, but the heterozygotes scored significantly lower than controls on most academic achievement tests, as well as on language-based neuropsychological measures. By neuropsychological criteria, 8 of the 15 heterozygotes, but only one of the controls, exhibited performance profiles consistent with a diagnosis of specific learning disability, and similar to cognitive profiles commonly seen in individuals from the general population with developmental dyslexia.     

Treatment response in late-onset depression: relationship to neuropsychological, neuroradiological and vascular risk factors

BACKGROUND: Late-onset depressive disorder is associated with white matter lesions and neuropsychological deficits that in some studies are linked to a poorer outcome for depression. Some white matter lesions may be vascular in origin. This study investigated the relationship between response or non-response to antidepressant monotherapy and neuropsychological function, structural brain measures and vascular factors. METHOD: This was a case control study. Fifty patients with late-onset major depressive disorder (29 who were responders to antidepressant monotherapy and 21 who were not) were compared with 35 non-depressed control subjects. Measures included assessment of vascular risk factors, neuropsychological testing and a magnetic resonance imaging (MRI) scan. RESULTS: After adjustment for depressed mood and medication at evaluation, both patient groups had significantly more impairment compared to control subjects on verbal learning tasks involving immediate or delayed recall. Patients who did not respond to antidepressant monotherapy had significantly poorer performance than controls on tests involving visuospatial ability, language, word recognition and tests of executive function, whereas there were no differences between control subjects and responders. On two tests of executive function (verbal fluency and the Stroop test) non-responders scored significantly worse than responders. There were no significant group differences on MRI measures of atrophy or of white matter lesions apart from a higher periventricular hyperintensity score in non-responders compared to controls. There were no group differences on measures of vascular disease. CONCLUSION: The results lend support to the emerging evidence that resistance to treatment in late-onset depression may be associated with impaired executive function. Subtle cerebrovascular mechanisms may be involved.     

Declining immune function in children and adolescents with hemophilia and HIV infection: effects on neuropsychological performance. Hemophilia Growth and Development Study

OBJECTIVE: To determine whether declines in immune functioning are associated with changes in neuropsychological performance in children and adolescents with hemophilia who are infected with the human immunodeficiency virus (HIV). METHODS: Participants were 333 males with hemophilia, ages 6-19 years at entry. A baseline and four annual neuropsychological evaluations were given. A longitudinal growth curves analysis of data was performed to detect changes associated with declining immune function. The cohort was stratified into four groups: (1) HIV- (n = 126); (2) HIV+, average of first two and last two CD4 counts > or = 200, (n = 106; High CD4 group); (3) HIV+, average first two counts > or = 200, average last two counts < 200 (n = 41; CD4 Drop group); and (4) HIV+, average first two and last two counts < 200 (n = 60; Low CD4 group). RESULTS: There were significant differences among the four groups over time in nonverbal intelligence, perceptual/performance skills, nonverbal memory, academic achievement, and language. The Low CD4 group consistently showed the greatest decrement in performance. On measures showing a practice effect for repeated measurements, the Low CD4 group participants' scores remained stable over time, suggesting opposing effects of practice and HIV-related declines. Lowered academic performance relative to IQ was found in all groups. CONCLUSIONS: Declines in neuropsychological functioning are directly related to declines in immune functioning in HIV+ children, adolescents, and young adults with hemophilia. Hemophilia itself may be a risk factor for academic underachievement.     

Discrepancy between subjective symptomatology and objective neuropsychological performance in insomnia

STUDY OBJECTIVES: While daytime impairment is a defining feature of primary insomnia (PI), prior research using objective measures has not yielded clear and reliable evidence of global or specific deficits. In this investigation subjective and neuropsychological measures of daytime impairment were concurrently evaluated in subjects with primary insomnia (PIs) and in healthy good sleeper subjects (GSs). The goals for the study were to assess (1) whether PIs differ from GSs on subjective and/or objective measures and (2) the extent to which subjective and objective measures provide discordant information. DESIGN: Subjects were evaluated on multiple self-report measures of sleep and daytime performance and were administered a comprehensive set of neuropsychological tests. SETTING: The University of Rochester Sleep and Neurophysiology Research Laboratory (Rochester, NY). PATIENTS OR PARTICIPANTS: Forty-nine subjects (32 PIs and 17 GSs). Seventy-one percent of the sample was female; average age 39 +/- 11 yrs. RESULTS: Overall, PIs reported worse sleep, diminished activity levels, and a greater number and severity of daytime complaints. However, PIs did not show deficits on neuropsychological tests. Additionally, neuropsychological measures were not associated with severity of daytime complaints. Objectively measured sleep was found to be associated with performance (motor speed), while prospective and objective sleep measures were associated with level of daytime complaint. CONCLUSIONS: The discrepancy between subjective daytime complaints and objective performance in individuals with insomnia is common, but poorly understood. This discordance may suggest that daytime impairment corresponds less to "output" and more to attentional bias or to the realistic appraisal that "effort" is required to maintain normal performance.     

Investigation of Cloninger's subtypes in a male alcoholic sample: Applications and implications

Cloninger's Type 1/Type 2 classification scheme was examined in 82 male alcoholics. Only 16% were classified by presence/absence of Type 1/Type 2 symptoms. When age of symptom onset was considered, 75.6% were classified into early (ESO) and late symptom onset (LSO) groups. Relatively few group differences were found: ESOs were younger, had lower SES, began drinking earlier, reported greater frequency of maternal alcoholism and more severe paternal alcoholism, and reported more antisocial behaviors. ESO/LSOs did not differ on neuropsychological performance, although both performed poorer then controls. Differences between these findings and those found with female ESO/LSO alcoholics are discussed and clinical implications considered. © 1996 John Wiley & Sons, Inc.     

Performance of alcoholic and brain-damaged subjects on the Luria memory words test

Verbal memory was evaluated in groups of 36 community controls, 50 pseudoneurological controls, 50 alcoholics, and 50 brain-damaged patients. All participants were men between the ages of 22-61. Groups did not differ in age or educational levels (F < 1). Groups were compared on their performance on the Luria Memory Words Test. Dependent variables included the number of correct words over learning trials, the trial of best performance, and the number of words recalled at three delayed trials (2, 8, and 30 min after learning). Brain-damaged subjects were inferior to community controls on all measures. Pseudoneurological controls were inferior to community controls on delayed recall, but were equivalent on measures of learning. Alcoholics were inferior to controls on measures of learning but did not differ on measures of recall. Implications regarding the underlying deficit in alcoholics' verbal memory, the use and interpretation of the Luria Memory Words test, and the use of pseudoneurological patients as controls are discussed.     

Neurocognitive deficits of alcoholism: an intervention

This study investigated the impact of cognitive retraining on a sample of neurocognitively impaired alcoholics (N = 45). The treatment group received training on a hierarchical cumulative learning program. In this paradigm, the subjects mastered an isolated concept to automaticity, at which point a second and then a third concept were added. The training group demonstrated significantly improved performance over the practice and control groups on the three measures taken from the Wisconsin Card Sorting Test: total number of categories, perseverative errors, and nonperseverative errors. Neither the practice nor the control group exhibited significantly improved performance. These data lend support to an information processing perspective and are at odds with research that infers that neurophysiological substrates preclude normal functioning in alcoholics and argues that mere exposure of alcoholics to training stimuli prompts significant improvements. Treatment implications are discussed.     

Patterns of neuropsychological deficit in alcoholic Korsakoff's syndrome

Twenty-five male and 13 female patients with alcoholic Korsakoff's syndrome (AKS) were compared with age- and sex-matched non-Korsakoff chronic alcoholics and healthy volunteers in a neuropsychological study, which included computer-administered tests of cognitive function. The performance of male Korsakoff patients was significantly inferior to that of healthy male controls, not only in tests of memory, but also in visuo-perceptual tasks with a speed or motor component, and on category sorting and verbal fluency measures. Compared with male alcoholics, the performance of male Korsakoff patients was again inferior on similar tests. Female Korsakoff patients showed more extensive deficits compared with female controls, but differed less from matched female alcoholics. The results suggest that, in addition to their amnesia, many Korsakoff patients have sustained widespread cognitive deficits, affecting particularly visuo-perceptual and abstracting functions, which are sensitive to cortical lesions. The range of deficits falls short of what may be regarded as 'global' in male, but probably not in female, Korsakoffs. The implications for a dual aetiology of AKS involving thiamine deficiency and other features associated with alcoholism, probably direct alcohol neurotoxicity, are discussed.     

Neuropsychological assessment of young people at high genetic risk for developing schizophrenia compared with controls: preliminary findings of the Edinburgh High Risk Study (EHRS)

BACKGROUND: Finding risk indicators for schizophrenia among groups of individuals at high genetic risk for the disorder, has been the driving force of the high risk paradigm. The current study describes the preliminary results of a neuropsychological assessment battery conducted on the first 50% of subjects from the Edinburgh High Risk Study. METHODS: One hundred and four high risk subjects and 33 normal controls, age and sex matched, were given a neuropsychological assessment battery. The areas of function assessed and reported here include intellectual function, executive function, perceptual motor speed, mental control/ encoding, verbal ability and language, learning and memory measures, and handedness. RESULTS: The high risk subjects performed significantly more poorly than the control subjects in the following domains of neuropsychological function: intellectual function, executive function, mental control/encoding and learning, and memory. Controlling for IQ, high risk subjects made significantly more errors on the Hayling Sentence Completion Test (HSCT), took longer to complete section A of the HSCT, had lower scores on the delayed recall condition of the visual reproductions subtest of the Wechsler Memory Scale-Revised, and had significantly poorer Rivermead Behavioural Memory Test (RBMT) standardized scores. The presence of significant group by IQ interactions for the RBMT and time to complete section A of the HSCT suggested that differences among the groups were more marked in the lower IQ range. Performance on the HSCT was found to be related to the degree of family history of schizophrenia. CONCLUSIONS: High risk subjects performed more poorly than controls on all tests of intellectual function and on aspects of executive function and memory.     

Factors associated with neuropsychological performance in HIV-seropositive subjects without AIDS

BACKGROUND: Previous research has suggested that several factors may influence the presence of cognitive impairment in human immunodeficiency virus (HIV) infection. The objective of this study was to assess the impact of cognitive reserve capacity and other variables on neuropsychological performance in early HIV infection. METHODS: The neuropsychological performance of 100 HIV-seropositive subjects without AIDS (71 men and 29 women) was compared with that of 63 seronegative controls (51 men and 12 women). Measures included a neuropsychological battery, a medical examination and a psychiatric assessment. Cognitive reserve scores were based on a combination of years in school, a measure of educational achievement, and an estimate of pre-morbid intelligence. RESULTS: HIV-positive subjects had longer reaction time latencies than HIV-negative subjects. Those in the HIV-positive group with low cerebral reserve scores showed the poorest performance on the neuropsychological tests. The prevalence of cognitive impairment was significantly higher in the HIV-positive group (27%) than in the controls (32%). Multiple regression analysis and logistic regression analysis were used to identify factors associated with global neuropsychological performance and cognitive impairment. Older age, lower cerebral reserve scores and not being on zidovudine treatment were associated with lower global neuropsychological scores and with the presence of cognitive impairment. CONCLUSIONS: Our results suggest that although cognitive impairment is not characteristic of early HIV infection, there is a subgroup of subjects who perform more poorly than expected. A lower reserve capacity, older age and not being on zidovudine treatment are factors that lower the threshold for neuropsychological abnormalities in cases of early HIV infection.     

The Child Abuse Potential Inventory: a study of concurrent validity

Forty-four subjects were assigned to a High or Low Abuse Potential Group based upon their Child Abuse Potential (CAP) Inventory's abuse scale scores. Each subject's heart rate (HR) and skin conductance (SC) were monitored while the subject was viewing videotape presentations of an infant smiling, crying, or quiescent. The High Abuse Potential Group had a faster peak HR throughout the videotape presentations with no significant differences among videotape segments. The Low Abuse Potential Group had a slower peak HR and had a significantly lower HR during the Smile and Cry segments than in the second Quiescent segment. The males accounted for most of the significant SC variability among tape segments. The pattern of SC responses revealed that the males were less aroused than the females, the Low Abuse Potential Group was less aroused than the High Abuse Potential group, and all four groups showed a decrease in arousal toward the end of the videotape presentations. The results provide support for the concurrent validity of the CAP inventory.     

Wechsler Verbal-Performance IQ discrepancies among psychiatric inpatients: implications for subtle neuropsychological dysfunctioning.

One hundred seventy-nine psychiatric inpatients were administered the WAIS-R and several neuropsychological and academic achievement tests. All subjects were assigned to three groups based on their WAIS-R's VIQ-PIQ discrepancy scores: (i) Low Verbal (Verbal IQ < Performance IQ. by at least 13 points); (ii) Low Performance (Performance IQ < Verbal IQ by at least 13 points); and (iii) Equal (Verbal IQ-Performance IQ within 13 points). The Low Verbal group made significantly more errors on the Speech Sounds Perception Test, demonstrated lower spelling scores, evinced more aphasic signs, and had had more special education placements than did the Equal or Low Performance groups. The Low Performance subjects demonstrated significantly more signs of constructional dyspraxia and performed more poorly on the Grooved Pegboard test. The neuropsychiatric patients who had Verbal-Performance IQ discrepancies of at least one standard deviation may be at risk for specific, subtle neuropsychological deficits.