James R. Youngjohn

Brain damage or compensation neurosis? The controversial post-concussion syndrome

Abstract Neuropsychological evaluations were performed on 55 consecutive patients with persisting post-concussion syndrome (PCS). All were in litigation or were pursuing/receiving financial compensation for their injuries. No PCS patients who were not in litigation or compensated were referred over the 2-year span of the study. Many patients had deficits on neuropsychological testing. However, 15% of the patients were shown to be unconsciously or consciously motivated to do poorly on the Portland Digit Recognition Test (PDRT) and 33% fell below the cut-offs suggesting poor motivation reported by previous investigators. Only 28% of the PCS patients performed at or above the levels of patients with documented brain damage, established by previous investigators. When an additional measure of cooperation was considered (the Dot Counting Test), 48% of all patients had questionable motivation during testing. The average MMPI-2 profile of the entire PCS group suggested the presence of somatization and functional...

Head Injury and the MMPI-2: Paradoxical Severity Effects and the Influence of Litigation

Minnesota Multiphasic Personality Inventory-2 (MMPI-2) profiles of 30 consecutive patients with moderate/severe head injury were compared with those of 30 consecutive symptomatic minor/mild head injury patients. Of the severely injured, 18 had ongoing litigation and 12 did not. All 30 minor/mild patients were in litigation. The severe litigating group had significant elevations on Hypochondriasis (Hs), Hysteria (Hy), Schizophrenia (Sc), and Health Concerns relative to the severe nonlitigating group. The minor/mild group had significant elevations on Hs, Depression (D), Hy, and Psychasthenia (Pt) over both the litigating and nonlitigating severe groups and additional elevations on Sc and Health Concerns over the severe nonlitigating group. Results are discussed in terms of the influence of litigation and injury severity on symptom endorsement on the MMPI-2. A model explaining persisting claims of disability after minor/mild head injury is proposed.

Overreporting of Closed-Head Injury Symptoms on the MMPI-2.

Minnesota Multiphasic Personality Inventory (MMPI-2) validity scales were compared in 4 groups : nonclinical participants answering under standard instructions (n = 20), nonclinical participants instructed to fake closed-head injury (CHI) symptoms (n = 18), non-compensation-seeking CHI patients (n = 31), and compensation-seeking CHI patients (n = 30). The highest scores on MMPI-2 overreporting scales were obtained by nonclinical participants faking CHI, and significantly higher scores on these scales were obtained by compensation-seeking relative to non-compensation-seeking CHI patients. These results suggest that MMPI-2 overreporting scales are sensitive to fabrication of CHI complaints, and possibly to exaggeration of CHI complaints, although further research is necessary to evaluate the latter hypothesis fully.

Test-retest reliability of computerized, everyday memory measures and traditional memory tests

Abstract Test-retest reliabilities and practice effect magnitudes are considered for nine computer-simulated tasks of everyday cognition and five traditional neuropsychological tests. Most measures showed significant practice effects upon reevaluation. Test-retest reliabilities of the computerized recall measures were equal to or superior to the traditional memory tests, but traditional measures of attention and concentration had superior reliabilities to the everyday tests. Test-retest reliabilities of everyday recognition memory tests were disappointing. Advantages of computerization of psychometric assessment and the need for multiple test forms are discussed.

Learning, forgetting, and retrieval of everyday material across the adult life span

Levels and rates of acquisition and amounts of forgetting of name-face associations and grocery list items were assessed in a sample of 1,921 normal participants that was divided into five age groups (i.e., 17-39, 40-49, 50-59, 60-69, and 70+). Retrieval was assessed via the consistent long-term retrieval score (CLTR) from the Grocery List Selective Reminding Test (GLSRT). Substantial linear age-associated declines in level of acquisition were noted for both name-face associations and grocery list items. There was a significant age-related drop in rate of acquisition of name-face associations. Remarkably, very little forgetting occurred over a 40-min delay at any age on either measure. There was a significant linear age-related decline in retrieval efficiency for grocery list items, when variance due to both level of acquisition and retention was removed. The nature of age-associated memory decline and its possible neuroanatomic correlates is discussed.

Accelerated forgetting in Alzheimer-type dementia

Accelerated forgetting of name-face associations and grocery list items within the first hour postpresentation is demonstrated in 80 persons with Alzheimers disease (AD) compared to 80 control subjects matched on age, education, and gender. Differences in forgetting which exceeded statistical regression effects remained, even when AD and control subjects were matched on rate of acquisition during the learning trials of name-face associations. Results are discussed in relation to the neuropathology of AD, organic amnestic disorders, and methodological factors concerning previous research on forgetting in persons with AD.

New adult age-and education-correction norms for the benton visual retention test

Adult age-and education-corrected norms for the Revised Visual Retention Test (BVRT) are presented. Our sample included 1,128 healthy individuals, ranging in age across the adult life span. Stepwise multiple regression analyses demonstrated significant negative associations between age and BVRT performance and significant positive associations between education and BVRT performance. Gender was not associated with performance. Both the regression equations, for predicting expected levels of performance in individuals, and tabular data are presented.

Discriminating Age-Associated Memory Impairment from Alzheimer's Disease.

The authors attempt to provide a better understanding of the differences between the normal memory declin characteristic of age-associated memory impairment (AAMI) and the pathological decline tupical of mild Alzheimers disease (AD). Batteries of traditional memory tests and computer-simulated everyday-memory tests discriminated between the 2 groups, which were matched on age, gender, and education, with reasonable degrees of accuracy (87.5% and 88.4%, respectively). False positives were the most frequent classification errors when using either battery. These results indicate that is possible to use ecologically valid memory assessment paradigms without sacrificing discriminant validity. The clinical significance of discriminating mild AD from AAMI is discussed

Psychogenic Stuttering and Other Acquired Nonorganic Speech and Language Abnormalities

Three cases are presented of peculiar speech and language abnormalities that were evaluated in the context of personal injury lawsuit or workers compensation claims of brain dysfunction after mild traumatic brain injuries. Neuropsychological measures of effort and motivation showed evidence of suboptimal motivation or outright malingering. The speech and language abnormalities of these cases probably were not consistent with neurogenic features of dysfluent speech including stuttering or aphasia. We propose that severe dysfluency or language abnormalities persisting after a single, uncomplicated, mild traumatic brain injury are unusual and should elicit suspicion of a psychogenic origin.

The influence of age, gender, and cues on computer‐simulated topographic memory

Topographic memory failure is reported to be a common occurrence among elderly patients being evaluated for dementia. The deficit is at least partly due to an inability to either encode or effectively use landmarks for orientation. A computer‐simulated task was created to measure experimentally the relative influence of landmark and memory cues, as well as the demographic variables of age and gender, on topographic memory ability. We used several versions of the task, including presence or absence of map symbols and tracing routes with a moving dot versus a dotted line. There were significant age effects on the task, but the actual magnitude of decline was modest. Gender effects were also significant, but effect size was so small it made this difference trivial. The landmark cuing afforded by map symbols did not affect performance. Increased time of exposure to the path resulted in a small improvement. Modest associations were found between topographic memory task performance and other memory measures.