Kerry deS. Hamsher

Prediction of outcome in anorexia nervosa from neuropsychological status

To evaluate the possibility that subtle brain dysfunction may exist in anorexia nervosa and indicate a poor prognosis, 20 anorexia nervosa patients received neuropsychological assessments covering a broad array of cognitive performances. The patients were examined at admission and again at the end of an inhospital treatment program when they were at normal weight for their age and height. Pretreatment performance on the assessment battery was not associated with outcome 1 year after discharge. However, posttreatment performance and significantly associated with outcome. A majority (71%) of patients with two or more cognitive deficits showed an unfavorable outcome (i.e., did not maintain their weight). In contrast, a majority (85%) of patients with less than two cognitive defects had a favorable outcome (i.e., maintained or increased their weight). The findings suggest that the hypothesis of a central nervous system disorder limiting the capacity for anorectics to recover deserves further exploration.

Visuospatial Judgment and Right Hemisphere Disease

The performances of patients with stroke-produced unilateral hemispheric lesions on a test requiring the identification of lines were examined in the light of a recent report that contradicted previous observations. The study confirmed the results of earlier studies that patients with lesions of the right hemisphere show a remarkably high frequency of defective performances while those with lesions of the left hemisphere do not. Possible reasons for findings that deviate from this rule are discussed.

Neuropsychological findings in toxicometabolic confusional states

Patients with acute confusional states display impaired attention and memory with difficulty following complex verbal commands. In addition to these deficits, we have observed a selective impairment in spatial thinking similar to that present following right-hemisphere lesions. Consequently, we compared patients with acute confusional states (CS) to patients with focal right-hemisphere disease (RHD) and controls on a standard neuropsychological battery. Although impaired relative to controls, both CS and RHD groups did not differ from each other on those tests typically associated with right-hemisphere lesions. These included performance IQ, constructional praxis, spatial judgment, and cancellation tasks. In light of these findings, the neurological correlates of selective deficits in spatial processes include not only unilateral right-hemisphere lesions, but also diffuse disorders such as CS. Thus, there is the potential to misinterpret the neuropsychological test results of patients with diffuse cerebral disorders as indicating focal abnormalities when none exist.

Assessment of Visuocognitive Processes

The specialized role of the posterior right hemisphere in visual perception was first advanced by John Hughlings Jackson in 1864. Twelve years later, Jackson (1876/1958) described a patient whose course of illness confirmed his speculations about the lateralization of higher visual function. The clinical onset of illness in Jackson’s patient was marked by a sudden episode of spatial disorientation. Although the patient had resided in the same neighborhood for 30 years, she could not find her way to a nearby park that she had visited frequently. Jackson observed that his patient suffered from what he called “imperception”: the inability to recognize objects, persons, and places. Within months, the patient developed a left hemiplegia and rapidly deteriorated to coma and death. Autopsy revealed a large tumor in the posterior right hemipshere, with two smaller tumors in close proximity.

Constructional ability in two- versus three-dimensions: relationship to spatial vision and locus of cerebrovascular lesion.

INTRODUCTION Clinical evaluation and research on constructional ability have come to rely almost exclusively on two-dimensional tasks such as graphomotor copying or mosaic Block Design (BD). A return to the inclusion of a third dimension in constructional tests may increase the spatial demands of the task, and improve understanding of the relationship between visual perception and constructional ability in patients with cerebral disease. METHOD Subjects were patients (n=43) with focal or multifocal cerebrovascular lesions as determined by CT or MRI. Tests of temporal orientation, verbal intelligence, language, object vision and spatial vision were used to determine which factors were predictive of performance on two-dimensional BD and Three-Dimensional Block Construction (3-DBC) tasks. RESULTS Stepwise linear regression indicated that spatial vision predicted BD performance, and was even more strongly predictive of 3-DBC. Other cognitive domains did not account for significant additional variance in performance of either BD or 3-DBC. Bilateral cerebral lesions produced more severe deficits on BD than did unilateral cerebral lesions. The presence of a posterior cerebral lesion was the significant factor in producing deficits in 3-DBC. CONCLUSIONS The spatial aspect of a constructional task is enhanced when the patient is required to assemble an object in all three dimensions of space. In the typical patient with cerebrovascular disease, constructional deficits typically occur in the context of a wider syndrome of deficits in spatial vision.

Presidents Test performance in varieties of diffuse and unilateral cerebral disease.

Two studies addressed issues concerning the validity of the Presidents Test. The results of Study 1 substantiated that generalized impairment for recent presidents occurs frequently in the context of multifocal and diffuse cerebral disease. Performances of normal elderly (n = 31) on all four Presidents subtests were superior to those of patients with confusional states (n = 7), uncomplicated dementia (n = 24), and dementia with confusion (n = 20). Overall, 88% of the combined sample was correctly classified (control v. diffuse cerebral disease). In Study 2, generalized memory impairment for recent presidents was found to be rare among samples of patients with unilateral right- and left-hemisphere lesions (n = 40 each). A selective impairment in temporal sequencing was preferentially associated with right-hemisphere disease, whereas verbal deficit patterns were more common in patients with left-sided lesions. These findings further document the validity of the Presidents Test as an efficient, objective method for assessing recent memory impairment due to widespread cerebral disease and suggest that qualitative analysis of performance patterns may be useful for detecting certain nonmnemonic cognitive defects in patients with focal brain disease.

Constructional praxis performance of Japanese and American, normal and brain-damaged patients.

Numerous studies have suggested population differences between Japanese and Americans concerning various cognitive functions. Transcultural differences in spatial reasoning, language, and dominance for emotional expression raise important questions concerning current conceptions of hemispheric cerebral dominance for cognitive functioning. If cultural differences in cognition exist, learning may play a greater role in determining laleralizalion of cognitive functions than is presently accepted. To investigate these issues, we initiated two collaborative studies comparing Japanese with American normals and brain-damaged patients on the Three-Dimensional Constructional Praxis Test. In normal subjects, there were no significant differences between the two cultures in the distribution of visuoconstructive ability. In patients with brain damage, the effects of unilateral brain lesions and their neuropsychological consequences on visuoconstructive ability were similar in both cultures. Thus, there are no apparent differences between the Japanese and American peoples in visuoconstructive abilities, or in the underlying cerebral organization of skills required to execute these functions.

Aging and Remote Memory Declines: Preliminary Findings

Abstract Relatively little research has examined the effect of aging upon remote memory, especially among individuals who have entered their 10th decade of life. The present study examined whether remote memory deteriorates in a group of 132 neurologically normal men and women ranging in age from 50 to 97. Remote memory was measured with a modification of the Presidents Test. The data revealed that higher levels of education corresponded with better remote memory. Additionally, age-related differences in memory occurred only in men, with those aged 90 years and older showing significantly worse remote memory than other age groups. Potential explanations and implications of these data are delineated.