Carlos R. Blanco

Cortical and subcortical influences on clustering and switching in the performance of verbal fluency tasks

Impairments on lexical and semantic fluency tasks occur in both cortical and subcortical dementia. Recent reports that the average size of phonemic and semantic clusters is reduced in Alzheimers disease (AD), but not in Parkinsons disease (PD) could support the hypothesis that in AD verbal fluency deficits arise from degraded memory storage while in PD the same impairments result from defective retrieval. In the present study, patients with AD, PD with dementia, or Huntingtons disease produced fewer words, fewer switching responses and smaller semantic cluster sizes. Patients with multiple sclerosis, regardless of whether or not they were demented, produced fewer words and switching responses, but normal size clusters, and patients with PD without dementia performed normally on all fluency measures. These results indicate that reductions in cluster size on verbal fluency tests are best interpreted as changes in the efficiency of access to lexical and semantic memory stores. The findings are also consistent with the idea that patterns of cognitive impairment may differ among diseases that result in subcortical dementia.

Identifying multiple sclerosis patients with mild or global cognitive impairment using the Screening Examination for Cognitive Impairment (SEFCI)

Article abstract-Cognitive impairment affects 40 to 70% of patients with multiple sclerosis (MS), but its occurrence cannot be predicted from knowledge of the individual patients age, level of physical disability, duration of disease, disease type, or performance on standard mental status examinations. To evaluate the usefulness of a brief screening battery, the Screening Examination for Cognitive Impairment (SEFCI), 103 community-dwelling MS patients and 32 healthy normal controls received the SEFCI and a 2-hour battery of other neuropsychological tests chosen for their sensitivity to the cognitive impairments most often observed in MS. Performance on the SEFCI correctly identified 86% of the patients with impairment on any of the 11 measures from the longer battery, 100% of the patients with impairments in at least three cognitive domains, and 90% of the patients without cognitive impairment. Because the SEFCI is sensitive, specific, and easily administered and scored, it should aid the physician in deciding whether to refer an MS patient for a complete evaluation. NEUROLOGY 1995;45: 718-723

Demographic, Clinical, and Cognitive Characteristics of Multiple Sclerosis Patients Who Continue to Work

To determine the factors that contribute to maintaining employment by MS patients, we compared thirty-eight patients who were still working to sixty-four patients who retired prematurely. The employed group was younger, better educated, had less severe physical disability, a shorter duration of disease, an earlier age at diagnosis, and per formed significantly better on nearly all neuropsychological variables examined. Mul tiple regression analysis indicated that walking ability, age, two measures of memory, and one test of verbal fluency, taken together, accounted for 49% of the variance in employment status. Although most patients who maintained employment had only mild to moderate physical and cognitive impairments, nine patients who continued to work were impaired on three or more of the seven cognitive domains tested. Implications for more effective rehabilitation are considered.

Impairments of attention in individuals with multiple sclerosis.

To investigate the status of attention in multiple sclerosis (MS) we administered tests of focused and divided attention to 39 MS patients and 18 age- and education-matched control subjects. In addition, a test of vigilance and a test of automatic information processing was administered. MS patients performed as well as controls on the automatic processing task and on most measures of focused and divided attention when accuracy but not speed was the dependent variable. By contrast, the MS patients performed significantly worse than controls on the more effortful measures of attention, especially those that engaged working memory or emphasized speeded responding. These results indicate that deficits of attention in MS patients are most likely to be evident on tasks which require concentrated cognitive effort.

Spatial cognition in alcoholics: influence of concurrent abuse of other drugs

Several tests of visuospatial cognition are known to be sensitive to chronic alcohol abuse, but the consequences of combined abuse of alcohol and other drugs on these measures in not known. To address this issue, groups that had abused only alcohol, alcohol and marijuana, or alcohol and multiple other drugs (Alc/Poly) were compared to community controls. Testing occurred after at least 3 weeks of treatment for the drug abusers. On all measures of visuospatial perception and construction and on all measures of visuospatial learning and memory, all groups of alcoholics were impaired relative to controls, but there were no significant differences among the groups that abused alcohol. By contrast, on all measures of geographical knowledge that required place localization, subjects in the Alc/Poly group were impaired while subjects who abused only alcohol or alcohol and marijuana performed as well as controls. Measures of alcohol consumption, mood or childhood or adult attention deficit were not consistently correlated with test performance.

Correlates of coping style in patients with multiple sclerosis

To examine certain correlates of patterns of coping with stress, 43 patients with multiple sclerosis (MS) read a vignette describing a stressful social situation and completed the Ways of Coping Checklist, describing how they would cope with the stressful situation. Performance on a test of solving problems in everyday living was positively correlated with the total number of coping responses and with the number of problem-focused strategies, but neither vocabulary nor verbal abstract reasoning were related to coping patterns. In agreement with earlier work, increases in psychological distress were positively correlated with endorsement of emotion-focused coping strategies but unrelated to the use of other coping responses.

Further Validation of Constructs from the Selective Reminding Test

The Selective Reminding Test (SRT) partitions recall into three classes. Short-Term Recall (STR), Random Long-Term Recall (RLTR), and Consistent Long-Term Recall (CLTR). Examination of conditional probabilities of delayed recall or recognition of individual words as a function of their memory status at the end of a standard 12-word, 12-trial test showed that Buschkes (1973) operational definitions of STR, RLTR, and CLTR have excellent predictive validity.