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Functional Magnetic Resonance Imaging (fMRI) has been successfully used by the neuroscientists for diagnosis and analysis of neurological and neurodevelopmental disorders. After transforming fMRI data into functional networks, graph classification algorithms have been applied for distinguishing healthy controls from impaired subjects. Recently, classification followed by tensor decomposition has been used as an alternative, since the sparsity of the functional networks is still an open question. In this work, we present five tensor models of fMRI data, considering the time series of the brain regions as the raw form. After decomposing the tensor using CANDECOMP/PARAFAC (CP) and Tucker decomposition, we compared nearest neighbor classification accuracy on the resulting subject factor matrix. We show experimental results using an fMRI dataset from adult subjects with neurodevelopmental reading disabilities and normal controls.

The Saint Louis University Mental Status (SLUMS) Examination is a brief screening measure for mild neurocognitive disorder developed for use with veterans. To date, there has been a paucity of research on its psychometric properties. The purpose of this study is to evaluate the psychometric properties of the SLUMS in a referred sample to a specialty clinic. Using a sample of 148 male veterans referred to a Mild Cognitive Impairment (MCI) Clinic for evaluation, the ability of the SLUMS to discriminate between MCI versus Major Depressive Disorder (MDD) or no diagnosis was compared to results from a more comprehensive neuropsychological battery. The SLUMS was significantly correlated with every neuropsychological measure (r = .25 to .46), except for Trails B (r = .14). Diagnostic discriminability was comparable to a typical, longer, neuropsychological battery for discriminating between MCI and no diagnosis, and between MCI and MDD. The study provides additional psychometric support for the SLUMS as a viable brief cognitive screening measure in veteran populations, particularly when discriminating between MCI and MDD.

Background and Purpose— Cerebral small vessel disease (SVD) is the most common cause of vascular cognitive impairment, with a significant proportion of cases going on to develop dementia. We explor...

Cerebral small vessel disease (SVD) is the primary cause of vascular cognitive impairment and is associated with decline in executive function (EF) and information processing speed (IPS). Imaging biomarkers are needed that can monitor and identify individuals at risk of severe cognitive decline. Recently there has been interest in combining several magnetic resonance imaging (MRI) markers of SVD into a unitary score to describe disease severity. Here we apply a diffusion tensor image (DTI) segmentation technique (DSEG) to describe SVD related changes in a single unitary score across the whole cerebrum, to investigate its relationship with cognitive change over a three-year period. 98 patients (aged 43-89) with SVD underwent annual MRI scanning and cognitive testing for up to three years. DSEG provides a vector of 16 discrete segments describing brain microstructure of healthy and/or damaged tissue. By calculating the scalar product of each DSEG vector in reference to that of a healthy ageing control we generate an angular measure (DSEG θ) describing the patients' brain tissue microstructural similarity to a disease free model of a healthy ageing brain. Conventional MRI markers of SVD brain change were also assessed including white matter hyperintensities, cerebral atrophy, incident lacunes, cerebral-microbleeds, and white matter microstructural damage measured by DTI histogram parameters. The impact of brain change on cognition was explored using linear mixed-effects models. Post-hoc sample size analysis was used to assess the viability of DSEG θ as a tool for clinical trials. Changes in brain structure described by DSEG θ were related to change in EF and IPS (p

Unawareness of deficit has been shown to affect the outcome of targeted cognitive intervention programmes applied to patients with Alzheimer' disease (AD), but the effects on multimodal therapeutic approaches have not yet been explored. This research investigated the efficacy of the Multi-Intervention Programme (MIP) approach on improving cognitive, functional, affective, and behavioural symptoms in people with mild AD. In addition, we examined whether the presence of unawareness influences the MIP outcomes. Sixty-one mild stage AD patients were randomly assigned to either an experimental group which carried out an MIP individually (48 sessions, 16 weeks duration), combining diverse cognitive tasks, training in daily life and recreational activities, or a waiting list group which did not receive any treatment for the same time period. The efficacy of MIP (vs. waiting list) was tested using various standardised neuropsychological, functional, and behavioural outcome measures. Planned analyses were carried out to determine the effect of unawareness versus awareness on such outcomes. The results showed that patients overall benefited from the MIP in terms of both cognitive and non-cognitive symptoms. AD patients with awareness of deficits showed positive effects on all outcome measures in comparison with the waiting list group, while AD patients with unawareness showed improvements in non-cognitive symptoms only. In conclusion, the presence of unawareness reduces the cognitive and functional effects of MIP in patients with mild AD.

Attention Deficit Hyperactivity Disorder (ADHD) is frequently linked with antisocial behaviour, yet less is known about its relationship with sociomoral reasoning, and the possible mediating effect of intelligence. A pilot study was designed to investigate the relationship between antisocial personality traits, intelligence and sociomoral reasoning in adults with ADHD. Twenty two adults with ADHD and 21 healthy controls, matched for age, gender and IQ completed a battery of measures including the National Adult Reading Test, Gough Socialisation Scale and Sociomoral Reflection Measure-Short Form. There was no difference between the groups and levels of sociomoral reasoning, despite the ADHD group reporting greater antisocial personality traits. Sociomoral reasoning was positively correlated with intelligence. Results from a hierarchical multiple regressions indicated that both antisocial traits and IQ were significant predictors of sociomoral reasoning, with IQ proving the most powerful predictor. Whilst antisocial personality traits may explain some of the variance in levels of sociomoral reasoning, a diagnosis of ADHD does not appear to hinder the development of mature moral reasoning. Intellectual functioning appears to facilitate the development of sociomoral reasoning. A further analysis showed that both ADHD and low sociomoral reasoning were significant predictors of antisocial traits. The current findings have important treatment implications.

We reply to commentaries on our discussion paper (2013), clarifying our position on the points raised and expanding the scope of our description. We discuss, in particular, the dichotomy between explicit/implicit processes, the heterogeneity of anosognosia, the notion of awareness as an emergent process, and the pervasive role of emotion on awareness expression. We conclude by pointing to clinical implications of the phenomenon of implicit awareness.

Almost half of American adults struggle with reading but there is a dearth of reading-related assessments for these adults. In turn, researchers and practitioners use assessments designed for children with these adults. This study examined the psychometric and descriptive attributes of the Comprehensive Test of Phonological Processing (CTOPP) Elision and Blending Words subtests with struggling adult readers. The sample included 207 native English speaking adults reading between the third- and fifth-grade levels. Analyses included comparisons of struggling adult readers to the CTOPP norm group. Results revealed lower overall performance and reliability and validity for struggling adult readers compared to the norm group. In addition, analyses included comparisons of performance, reliability, and validity within the group of struggling adult readers by age. The older adults had lower overall performance as well as more questionable reliability and validity. This study raises concern about administering and interpreting Elision and Blending Words subtests with struggling adult readers.

OBJECTIVE This study investigated the relationship between word reading and white matter (WM) integrity within a neuroanatomical-based reading system comparing adult survivors of childhood brain tumors and controls. It was predicted that the association between WM integrity and word reading would be mediated by processing speed, and this indirect effect would be moderated by group. METHOD Thirty-seven adult survivors of childhood brain tumor and typically developing adults participated (age M = 24.19 ± 4.51 years, 62% female). DTI Tractography identified the WM tract for 3 of the reading system connections: inferior fronto-occipital fasciculus (IFOF), arcuate fasciculus (AF), and parietotemporal-occipitotemporal connection (PT-OT). RESULTS Fractional anisotropy values (FA) of the PT-OT tract were significantly correlated with word reading in survivors and controls (r = .45, .58, respectively; p < .05) and IFOF values were associated with reading in survivors only (r = .59, p < .01). Further, the moderated mediated model was significant for PT-OT and IFOF, such that the indirect effect of processing speed was only present for survivors (CI: PT-OT: 2.90, 28.41, IFOF: 2.92, 40.17). CONCLUSION Results suggest the tracts emerging from the occipitotemporal area are a critical component of the reading system in adults. The finding that processing speed was the mechanism by which WM was associated with reading in survivors is in alignment with the developmental cascade model. Current findings bolster the existing theory-based models of reading using innovative diffusion tensor imaging and moderated mediation statistical neurodevelopmental model, establishing the role of processing speed and specific WM pathway integrity in word reading skill.

A common feature of Alzheimer’s disease (AD) is lack of awareness of neuropsychological deficit or illness, including poor appreciation of impaired task performance. Nevertheless, it has been shown in different clinical groups that levels of awareness may vary according to whether appraisal of symptoms is made in a first-or third-person perspective. This study explored this issue further in two experiments in which people with AD and control participants completed tests of memory and reaction time and had to judge both how difficult the tasks were for them and also for other people if they attempted the same tasks. Results showed that the AD group systematically indicated that others would do as well as they themselves had done. In comparison, control participants indicated other people would perform worse than they did themselves on the reaction time tasks, but similarly on the memory tasks. In addition, attribution of difficulty for self/other correlated with pre-morbid personality traits, such as neuroticism and agreeableness, in the AD group. The theoretical and clinical implications of these findings are discussed.

Research into metacognitive abilities of clinical populations has indicated pervasive defi cits in terms of monitoring of cognitive performance. Nevertheless, there are important methodological issues regarding the validity of these fi ndings. In the current paper, we describe the development of novel experimental procedures to mitigate some of these limitations. Specifi cally, we report the creation of computerised tasks based on success-failure manipulation (SFM), which allow experimental control over the performance of participants. We discuss the theoretical implications of this new procedure and also results obtained so far with the tasks. Finally, we present future research directions stemming from the use of the tasks.

The aim of this study was to investigate the reliability and validity of the computer based application of the Secret Agent (SA) task of risk-taking and moral decision-making. The participants were 100 male patients in a maximum security hospital (50 with severe mental illness and 50 with personality disorder) and 50 community based healthy controls. All participants completed the SA task, the Iowa Gambling Task (IGT), and measures of IQ, antisocial personality traits, sensation-seeking, impulsivity and sociomoral reasoning. The SA risk-taking and moral decision-making scales had satisfactory levels of reliability (Cronbach’s alpha). Risk-taking correlated significantly with sensation-seeking across all three participant groups. In contrast, risk-taking only correlated with impulsivity among the severe mental illness group. Moral decision-making correlated with sociomoral reasoning among the personality disorder group. No correlation was found between the SA scores and the IGT score and the IGT did not correlate with sensation-seeking or impulsivity. IQ and antisocial personality traits did not correlate with the SA or IGT scales. The study highlights the importance of context, the nature of the risk-taking task, and ‘problem framing’ of the instructions in their relationship with individual differences.

Background: Little evidence is available about how quality of life (QoL) changes as dementia progresses. Objectives: We explored QoL trajectories over a 20-month period and examined what predicted change in QoL. Method: Fifty-one individuals with a diagnosis of Alzheimer’s, vascular or mixed dementia (PwD) participating in the MIDAS study rated their QoL using the QoL-AD scale at baseline and at 20-month follow-up. PwD also rated their mood and quality of relationship with the carer. In each case the carer rated his/her level of stress and perceived quality of relationship with the PwD. Results: There was no change in mean QoL score. Nearly one-third of PwD rated QoL more positively at 20-month follow-up and nearly one-third rated QoL more negatively. These changes could be regarded as reliable in one-quarter of the sample. Participants taking AChEI medication at baseline were more likely to show a decline in QoL score. There were no other significant differences between those whose scores increased, decreased or stayed the same on any demographic or disease-related variables, or in mood or perceived quality of relationship with the carer. While baseline QoL score was the strongest predictor of QoL at 20 months, the quality of relationship with the carer as perceived by the PwD was also independently a significant predictor. Conclusions: There is a degree of individual variation in QoL trajectories. Use of AChEI medication appears linked to decline in QoL score, while positive relationships with carers play an important role in maintaining QoL in early-stage dementia.

The recognition of whether someone, something or somewhere has been experienced before rests on a decisionmaking process. In humanmemory, information is not reproduced as it would be in a computer, but is a reflective, conscious process. This is more so the case when encountering the same scene, environment or idea for a second time. When we recognize something as having been encountered before we arguably make a comparison between what is represented in the cognitive system and what is currently perceived. Consider that somebody uses the word ‘loquacious’, a word which you have only just encountered recently, and up until then, you did not know its meaning, or even existence. When encountering the word a second time, a number of processes and sources of information bring to bear on your processing of the word: how fluently you can process it, its distinctiveness in the perceptual trace, the feelings generated when encountering it a second time, the effort involved in retrieving its meaning, and whether you can recall the specifics of your first encounter with the word. This information can be used to retrieve the meaning of the word, or to gauge the certainty with which you have encountered the word before, and so on. Recent advances in human decision making suggest that complex tasks requiring problem solving and judgement rely on two categories of information, giving rise to dual process models of reasoning and judgement (Evans, 2008; Kahneman, 2011). The dual process account explains how people make decisions based on two separable streams of information: a fast, intuitive feeling and a slower, more deliberative evaluation, captured in the quote fromCharles Darwin, above. These separable processes in cognition are arguably at play in memory decision making too (e.g., Arango-Munoz, 2010; Hintzman and Curran, 1994; Koriat and Levy-Sadot, 2001) and map neatly onto the concepts of familiarity and recollection (for reviews see Mandler, 2008; Yonelinas, 2002), two key concepts which we describe below. In fact, the neurosciences have long had dual process theorists who posit two separate processes in the mind, probably inspired by the division of the brain into two hemispheres. Many early scholars posited that the brain was a ‘double organ’ (e.g., Holland, 1840). Wigan’s influential text (1844), The Duality of the Mind was an extreme position: that there were literally two separate brains which could work with each other or against each other. It was this kind of physiological view of the dual brain that Ribot drew upon in his early conceptions of human memory and its disorders (Taylor and Shuttleworth, 1998) and it undoubtedly influenced early theories of memory. In time, Stewart in the mid nineteenth century developed a distinction between recollectione the ability to consciously retrieve specific information e and memory more generally e a store of experiences and information which is not necessarily available for conscious report (Taylor and Shuttleworth, 1998). These dual process ideas of the mind have undoubtedly been influential in early neuroscientific works, but they have also helped shape the general public’s thinking on this matter: we can talk about being ‘in two minds’ about an issue, and many lay people’s conceptualization of deja vu e an infrequent but striking memory error e is that it arises from a mismatch between separate

Background and Purpose— Cerebral microbleeds (CMBs) are common in cerebral small vessel disease. They may cause cognitive impairment, possibly via white matter tract disruption but previous studies have produced inconsistent results. We determined whether CMB number and location are associated with impaired cognition in symptomatic small vessel disease and whether any association was independent of other magnetic resonance imaging markers of small vessel disease. Methods— One hundred sixteen patients with lacunar stroke and radiological leukoaraiosis were studied. Neuropsychological assessment was performed. CMBs on gradient echo images were assessed using the Brain Observer Microbleed Rating Scale criteria. Magnetic resonance imaging measures, including diffusion tensor imaging, were also analyzed. Associations between cognitive function and the presence, number, and location of CMBs were determined. Results— CMBs were present in 46 (39.7%) patients. CMB number correlated weakly with executive function ( r =0.22; P =0.022) but not with other cognitive indices. CMBs count in the top decile (≥9 CMB, N=12) was more strongly associated with poor executive function; this association remained significant after controlling for T2-lesion load, brain volume, lacune count, and mean diffusivity (b=−0.51; P =0.043). Conclusions— In symptomatic small vessel disease, CMB number was weakly associated with executive dysfunction. There seemed to be a threshold effect with the association being largely accounted for by an association of impaired executive function with high CMB count. No association of CMBs with other cognitive domains, including processing speed, was found.

Reductions in the integrity of white matter microstructure are thought to be a significant cause of age-related decline in mnemonic abilities, including working memory (WM) and long-term episodic memory (LTM). This study uses tract-based spatial statistics (TBSS) applied to diffusion tensor magnetic resonance images to explore correlations between white matter microstructure and verbal WM and LTM in a sample of 98 normal older adults. WM performance was associated with microstructure in left fronto-parietal pathways and LTM was associated with bilateral fronto-temporal pathways. Interhemispheric-frontal pathways (genu of the corpus callosum) were associated with both types of mnemonic function. We hypothesize that in normal aging, damage to certain white matter pathways may reduce the dynamic efficiency of mnemonic abilities by disrupting the connections within multiple distributed networks. By correlating white matter with two mnemonic functions in the same analysis, we have demonstrated that regional white matter networks may share common mnemonic functions but also may be differentiated for memory types.

People with Anorexia Nervosa (AN) display reduced facial expression of emotions. This study investigated the expression of positive affect in response to a film, examining Duchenne and non-Duchenne smiles in 20 women who have recovered from AN (REC), 20 with acute AN and 20 healthy controls (HC). The results indicated that the REC group exhibited Duchenne and non-Duchenne smiles with higher duration and intensity than the AN group, comparable to the HC group. The findings warrant longitudinal studies to confirm that reduced expressivity is linked to acute AN, ameliorating after recovery.

In this chapter we describe the theoretical and technological principles that underlie an innovative application of cross-disciplinary work in cognitive neuroscience, linguistics, child development, education, and technology: The global literacy initiative, Curious Learning. We will delineate the basic principles about the reading brain from cognitive neuroscience that guided the content of our work, and the principles from technology that guided design, implementation, and data collection. This initiative represents our ongoing efforts to develop and implement a comprehensive, tablet-based digital learning experience to help children learn to read on their own, particularly those children who either possess no school or whose schools are so inadequate that the children never achieve functional literacy.

Cerebral small vessel disease (SVD) is associated with deficits in working memory, with a relative sparing of long-term memory; function may be influenced by white matter microstructure. Working and long-term memory were examined in 106 patients with SVD and 35 healthy controls. Microstructure was measured in the uncinate fasciculi and cingula. Working memory was more impaired than long-term memory in SVD, but both abilities were reduced compared to controls. Regression analyses found that having SVD explained the variance in memory functions, with additional variance explained by the cingula (working memory) and uncinate (long-term memory). Performance can be explained in terms of integrity loss in specific white matter tract associated with mnemonic functions., Highlights • Working and long-term memory are both impaired in SVD compared to healthy adults. • SVD explained a significant proportion of the variance in both mnemonic functions. • Variance in working memory was explained by microstructure of the cingula. • Variance in long-term memory was explained by microstructure of the uncinate.

Objective: To determine whether MRI markers, including diffusion tensor imaging (DTI), can predict cognitive decline and dementia in patients with cerebral small vessel disease (SVD). Methods: In the prospective St George's Cognition and Neuroimaging in Stroke study, multimodal MRI was performed annually for 3 years and cognitive assessments annually for 5 years in a cohort of 99 patients with SVD, defined as symptomatic lacunar stroke and confluent white matter hyperintensities (WMH). Progression to dementia was determined in all patients. Progression of WMH, brain volume, lacunes, cerebral microbleeds, and a DTI measure (the normalized peak height of the mean diffusivity histogram distribution) as a marker of white matter microstructural damage were determined. Results: Over 5 years of follow-up, 18 patients (18.2%) progressed to dementia. A significant change in all MRI markers, representing deterioration, was observed. The presence of new lacunes, and rate of increase in white matter microstructural damage on DTI, correlated with both decline in executive function and global functioning. Growth of WMH and deterioration of white matter microstructure on DTI predicted progression to dementia. A model including change in MRI variables together with their baseline values correctly classified progression to dementia with a C statistic of 0.85. Conclusions: This longitudinal prospective study provides evidence that change in MRI measures including DTI, over time durations during which cognitive change is not detectable, predicts cognitive decline and progression to dementia. It supports the use of MRI measures, including DTI, as useful surrogate biomarkers to monitor disease and assess therapeutic interventions.

OBJECTIVE The study investigated the effect of education on cognitive outcome following a multicomponent intervention program (MIP) for people with Alzheimer's disease (AD), also exploring the additional effect of level of awareness. METHODS Fifty-five participants with mild AD were randomized to an MIP (intervention group; IG) or a waiting-list (WL) group. They were further stratified into 4 groups by educational attainment (high vs. low) and level of awareness (aware [IGU-] vs. unaware [IGU+]). MIP efficacy in the different groups was measured using the mean change scores (MCSs) in the Cognitive subscale of Alzheimer's disease Assessment Scale, with pre- and post-treatment testing. RESULTS A negative correlation was found between educational level and the MCS in the IG, whereas the correlation in the WL group was positive. Moreover, an interaction effect emerged between education and awareness. Here, in the group of aware individuals, those with high education benefited more from the intervention than those with low education. This difference was not observed in the unawareness group. CONCLUSION Higher education may diminish the progression of cognitive decline after MIP, but this potentially depends on the level of awareness.

OBJECTIVES: To examine the relation between cognitive dysfunction and pseudobulbar features in patients with amyotrophic lateral sclerosis (ALS). METHODS: The performance of two patient groups, ALS with pseudobulbar palsy (n = 24) and ALS without pseudobulbar palsy (n = 28), was compared with 28 healthy age matched controls on an extensive neuropsychological battery. Tests used were the national adult reading test, short form of the WAIS-R, recognition memory test, Kendrick object learning test, paired associate learning, Wisconsin card sorting test, verbal fluency, Stroop and negative priming tests, a random movement joystick test, and a computerised Tower of Hanoi test. RESULTS: Tests of executive function showed a pronounced deficit on written verbal fluency in both ALS groups in comparison to controls, which tended to be more prominent in patients with ALS with pseudobulbar palsy. The random movement joystick test (a non-verbal test of intrinsic movement generation) showed an impairment in the generation of random sequences in patients with pseudobulbar palsy only. The computerised Tower of Hanoi showed a subtle planning impairment (shorter planning times) in all the patients with ALS compared with controls on trials requiring more complex solutions. In addition the pseudobulbar patients displayed shorter planning times on complex trials, and tended to solve these trials less accurately. There was also evidence of a deficit for all patients with ALS in comparison with controls on total errors and number of categories achieved on the Wisconsin card sorting test and a strong tendency towards an impairment on a task of selective attention and cognitive inhibition (negative priming). A word recognition memory deficit was showed across both ALS groups. CONCLUSIONS: This study elicited cognitive deficits (involving predominantly executive processes, with some evidence of memory impairment) in patients with ALS and further strengthened the link between ALS and frontal lobe dysfunction, this being more prominent in patients with pseudobulbar palsy. However, cognitive impairments suggestive of extramotor cortical involvement were not exclusive to this subgroup.

Extensive work focuses on the uses of technology at scale for post-literate populations (e.g., MOOC, Learning Games, LMS’s). Little attention is afforded to non-literate populations, particularly in the developing world. This paper presents an approach using mobile devices with the ultimate goal to reach 770 million people. We developed a novel platform with a cloud backend to deliver educational content to over a thousand marginalized children in different countries:specifically, in remote villages without schools, urban slums with overcrowded schools, and at-risk, rural schools. Here we describe the theoretical basis of our system and results from case studies in three educational contexts. This model will help researchers and designers understand how mobile devices can help children acquire basic skills and aid each other’s learning when the benefit of teachers is limited or non-existent., Italian Development Council, MRP Foundation, Roanoke County Schools

Background and Purpose— Cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a monogenic form of cerebral small vessel disease leading to early-onset stroke and dementia, with younger patients frequently showing subclinical deficits in cognition. At present, there are no targeted cognitive screening measures for this population. However, the Brief Memory and Executive Test (BMET) and the Montreal Cognitive Assessment (MoCA) have shown utility in detecting cognitive impairment in sporadic small vessel disease. This study assesses the BMET and the MoCA as clinical tools for detecting mild cognitive deficits in CADASIL. Methods— Sixty-six prospectively recruited patients with CADASIL, and 66 matched controls completed the BMET, with a subset of these also completing the MoCA. Receiver operating characteristic curves were calculated to examine the sensitivity and specificity of clinical cutoffs for the detection of vascular cognitive impairment and reduced activities of daily living. Results— Patients with CADASIL showed more cognitive impairment overall and were poorer on both executive/processing and memory indices of the BMET relative to controls. The BMET showed good accuracy in predicting vascular cognitive impairment (85% sensitivity and 84% specificity) and impaired instrumental activities of daily living (92% sensitivity and 77% specificity). The MoCA also showed good predictive validity for vascular cognitive impairment (80% sensitivity and 78% specificity) and instrumental activities of daily living (75% sensitivity and 76% specificity). The most important background predictor of vascular cognitive impairment was a history of stroke. Conclusions— The results indicate that the BMET and the MoCA are clinically useful and sensitive screening measures for early cognitive impairment in patients with CADASIL.

Objectives: In addition to neuropsychological difficulties, patients with cerebral small vessel disease (SVD) can have reduced activities of daily living and a poorer quality of life compared to healthy adults. The Brief Memory and Executive Test (BMET), is a cognitive screening tool designed to be sensitive to the neuropsychological profile of patients with SVD. While the BMET is sensitive to the cognitive consequences of SVD, it is unclear how well scores on this measure relate to functional outcomes. The aims of this study are to investigate the relationship between scores on the BMET and functional outcomes (activities of daily living and quality of life) in SVD, and to compare this with other commonly used cognitive screening tools. Methods: This study included 184 participants with SVD (mean age=63.2; SD=9.9) and 299 healthy controls (mean age=62.4; SD=13.8) who were tested using the BMET, Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), Stroke Specific - Quality of Life Scale (SS-QoL), Geriatric Depression Scale (GDS), and measures of both instrumental activities of daily living (IADL) and basic activities of daily living (BADL). Results: After controlling for covariates the scores on the BMET, but not the MoCA or MMSE, were significantly related to poorer IADL and quality of life in the SVD group. In addition to the BMET scores, symptoms of depression were found to be significant associated with functional outcome. Conclusion: These results support the clinical utility of using of the BMET, in combination with a standardized depression questionnaire, during the early assessment of patients with SVD. (JINS, 2016, 22, 1–9)

To date research has been inconclusive in explaining the relationship between sociomoral reasoning and adult offending, with some researchers suggesting that this relationship is mediated by intelligence. This study investigated sociomoral reasoning among 100 mentally disordered offenders in a maximum security hospital, 50 with a primary diagnosis of personality disorder (PD) including psychopathy and 50 with severe mental illness (SMI). Participants completed a battery of measures including the Gough Socialisation Scale, the Wechsler Abbreviated Scale of Intelligence, and the Sociomoral Reflection Measure – Short Form. Between-group differences showed that, compared with the PD group, the SMI group had significantly fewer antisocial personality traits, lower IQ, and lower-level sociomoral reasoning. Hierarchical multiple regressions showed that IQ was the most powerful predictor of sociomoral reasoning after controlling for a number of other variables including social desirability. While psychiatric diagnosis may appear to predict sociomoral reasoning, intellectual function is an important mediator of the process.

The results from controlled intervention research have indicated that effective reading interventions exist for children with reading difficulties. Effect sizes for older struggling readers, however, typically have not matched the large effects demonstrated with younger children. Standardized effect sizes for intervention/control comparisons obscure important individual differences within intervention and control groups—differences potentially relevant to the who and why of intervention success. The present study reports the outcomes of PHAST Reading, a research-based multiple component reading intervention. Participants were 270 Grade 6, 7, and 8 students reading significantly below age-level expectations, who participated in a year-long intensive small-group intervention. Four methods were applied to characterize individual change: (a) normalization relative to age-appropriate standards; (b) statistically-reliable pre–post change using the Jacobson–Truax index; (c) individually-estimated growth rates using hierarchical linear modeling; and (d) change to a fixed criterion across multiple measures. Each method was evaluated for its ability to identify intervention outcomes, replicate traditional group-based effect size metrics, and characterize individual differences across participants depending on whether change was demonstrated. Each method replicated traditional group-based effect sizes, with advantages in consistency and predictive power for the reliable change index and growth curve approaches.

The study simulated risk-taking and explored its relationship with aspects of personality (i.e., EPQ-R Psychoticism, IVE impulsivity and venturesomeness). The simulation used a multi-tasking board game task, which comprised a behavioural (experimental) measure rather than the more traditional questionnaire approach. This was investigated in 60 community based healthy male control participants and among 30 forensic in-patients (offenders). Among the forensic patients, risk-taking correlated negatively with social desirability and positively with impulsivity and venturesomeness. By contrast, correlations were not significant for the control participants other than risk-taking and impulsivity. The forensic patients exhibited lower rates of risk-taking on the risk simulation task than the healthy controls, and social desirability may be a protective factor against risk-taking among the forensic patients. The findings suggest that a restricted institutional environment influences patients’ approach to risk-taking tasks that may not translate into the community. The study represents a pilot of an experimental procedure, which now requires a computer based application in order to improve its reliability and validity.

Objective: While it is increasingly accepted that people with dementia retain a sense of self, there is a need for empirical evidence regarding the nature of the self-concept in early-stage dementia, how this changes over time, and how it relates to quality of life. Methods: Self-concept was assessed using the short form of the Tennessee Self-Concept Scale in 95 individuals with early-stage dementia; 63 were reassessed after 12 months and 45 were seen again at 20 months. Participants also completed measures of mood, cognitive functioning and quality of life. Caregivers provided proxy ratings of self-concept, completed measures of symptoms and distress at symptoms, and rated their own levels of stress and well-being. Results: Self-ratings of self-concept were close to the average range for the standardisation sample and the distribution did not differ significantly from expected values. Although caregiver ratings were slightly lower, discrepancies were small. There were no significant changes over time in self- or informant ratings or discrepancies. At Time 1, self-ratings were predicted by anxiety, depression and memory, caregiver ratings were predicted by caregiver distress and by depression in the person with dementia, and discrepancies were predicted by caregiver distress. These models remained predictive at later time points. Self-rated self-concept predicted quality of life, with the relationship only partially mediated by depression and anxiety. Conclusions: Self-concept appears largely intact in early-stage dementia, but in view of the association between self-concept and quality of life, a preventive approach focused on supporting - self-concept may offer benefits as dementia progresses.

A common cause of neuropsychological impairment in older adults is cerebral small vessel disease (SVD), but little is known as to whether lack of awareness of neuropsychological impairment is a feature of this clinical condition. In this study, we investigated awareness deficits in a well-phenotyped population of patients with SVD (n= 45; 21 with defined concomitant neuropsychological impairment) and made comparisons with 24 Alzheimer's disease (AD) patients and a further 80 control participants. Awareness of performance on a range of neuropsychological measures was examined based on the Brief Memory and Executive Test Battery (BMET) (Brookes, Hannesdottir, Lawrence, Morris, & Markus, 2012), exploring the relationship between awareness and memory and executive function. The results revealed significant awareness deficits in both the SVD and AD groups. When splitting the SVD group into those with or without concomitant neuropsychological impairment, only those with neuropsychological impairment showed reduced awareness. For the SVD group, executive function was significantly correlated with awareness but memory was not. By comparison, memory was significantly correlated with awareness in the AD group, with executive function showing a trend but remaining non-significant. The results show that lack of awareness of deficit is a clinical feature of SVD and indicate that there are distinct neuropsychological associations with awareness deficit for SVD and AD.

The aim of this study was to apply the Rasch model to an analysis of the psychometric properties of the Peabody Picture Vocabulary Test--III Form A (PPVT--IIIA) items with struggling adult readers. The PPVT--IIIA was administered to 229 African American adults whose isolated word reading skills were between third and fifth grades. Conformity of the adults' performance on the PPVT--IIIA items was evaluated using the Winsteps software. Analysis of all PPVT--IIIA items combined did not fully support its use as a useful measure of receptive vocabulary for struggling adult readers who were African Americans. To achieve an adequate model fit, Items 73 through 156 were analyzed. The items analyzed showed adequate internal consistency reliability, unidimensionality, and freedom from differential item functioning for ability, gender, and age, with a minor modification. With an appropriate treatment of misfit items, the results supported the measurement properties, internal consistency reliability, unidimensionalit...

Assessment of activities of daily living is an important element in the diagnosis of dementia, with research suggesting a link between functional ability and cognition. We investigated the relationship between self- and informant ratings of instrumental activities of daily living (iADL) and verbal executive functioning in early-stage dementia. A total of 96 people with early-stage Alzheimer's disease or vascular or mixed dementia and their carers completed the Functional Activities Questionnaire; people with dementia also completed a test of letter fluency. Letter fluency was associated with self-ratings of iADL, while informant ratings of iADL were associated with the age and Mini-Mental State Examination score of the person with dementia. Self-ratings of perceived functioning suggested significantly less impairment than informant ratings. Those with impaired letter fluency rated themselves as having greater difficulties in iADLs than those who performed better. People with early-stage dementia vary in their subjective level of awareness of their iADL functioning, and difficulties with language production may contribute to better awareness of iADL impairments.

Objectives: In early-stage dementia, awareness at the meta-representational level involving a person’s appraisal of his/her own condition and its implications has usually been assessed by interview, but contextual factors may influence responding. We examined the utility of an indirect, vignette-based method of eliciting awareness.\ud Method: Three vignettes describing early-stage dementia, established dementia and healthy ageing were used to elicit views of the problem and the kinds of advice that might be helpful for the characters depicted. Responses were obtained from 91 people with early-stage Alzheimer’s, vascular or mixed dementia, 87 carers, and 80 older controls. For the participants with dementia, awareness was assessed in separate in-depth interviews and rated on a 5-point scale for comparison purposes.\ud Results: Participants with dementia were often able to correctly identify the problems described in the vignettes, although scoring lower than carers or controls. Participants with dementia were also able to offer advice for those depicted, although to a lesser extent than carers or controls. Ability to offer advice was greater where MMSE scores were higher. For participants with dementia, vignette scores were moderately correlated with ratings derived from interviews, and those showing limited or no awareness offered fewer items of advice than those showing some or good awareness. In addition, 29% of participants with dementia spontaneously pointed out similarities between their own condition and that of the person depicted.\ud Conclusions: The vignette method may be useful where resources preclude the use of in-depth interviews, and may supplement in-depth interviews as part of a multi-dimensional assessment of awareness.

Background: cerebral small vessel disease (SVD) is the most common cause of vascular cognitive impairment (VCI). Despite this, there is a paucity of rapid simple screening tools to identify cognitive impairment in SVD and differentiate it from other common dementia types. Objective: to validate a new screening test for cognitive impairment in SVD, the Brief Memory and Executive Test (BMET) battery, and examine its ability to detect SVD and differentiate it from Alzheimer's disease (AD). Subjects: 45 patients with SVD, 27 patients with AD and 80 normal controls. Methods: the BMET includes brief tests of executive functioning and processing speed, with comparative tests of memory and orientation. Group discrimination was calculated using discriminant function analysis. Results: the BMET took an average of 10 min to administer. It showed high sensitivity (91%) and specificity (85%) in differentiating SVD patients with cognitive impairment from AD patients. As a comparison the mini-mental state examination had lower sensitivity (63%) and specificity (62%). Conclusions: the BMET is a simple and quick to administer clinical tool for the detection of VCI in SVD and its differentiation from AD impairment. Further multicentre studies are required to evaluate and compare it with other existing screening tests.

Background: Unawareness of cognitive deficit in people with dementia (PwD) has wide clinical implications, impacting on help-seeking behavior, treatment compliance, and patient safety. Most studies on unawareness among PwD have been conducted in small clinical samples. This study investigated the frequency of unawareness of memory impairment in dementia, exploring regional differences and sociodemographic and health status correlates in large population-based surveys.Methods: Community samples (total n = 15,022) from three world regions (Latin America, China, and India) were obtained using cross-sectional population-based surveys. Out of these, 897 (5.97%) PwD with memory impairment were identified using standardized interviews, diagnostic algorithms (DSM-IV or 10/66 criteria), and neuropsychological memory assessment. Unawareness of memory deficits was ascertained from the participants’ subjective report. The frequency of unawareness was calculated for each region and associations with demographic variables and health status were investigated using prevalence ratios and Poisson regressions.Results: Regional differences in frequency of unawareness were found, from 63% in China to 81% in India. Unawareness was associated with depression in China and Latin America, dementia severity in India and Latin America, and education and socioeconomic level in Latin America.Conclusions: Unawareness of memory impairment in PwD varies across international regions. Our data support the notion that unawareness should be seen not only as a common neurobiological feature of dementia, increasing with severity of dementia, but also as a phenomenon influenced by social and cultural factors.

Aims: To explore emotional reactivity in mild to moderate Alzheimer’s disease (AD) using film material, investigating the influence of dementia-related material and awareness of condition. Methods: Twenty-two patients with AD and 21 healthy older adults viewed films with positive, neutral or negative content, including a film about dementia. Reactivity was measured through a self-report questionnaire and filming of facial expressions. Awareness of condition was assessed contrasting patients’ versus informants’ versions of an anosognosia questionnaire. Results: The AD patients showed reduced self-reported reactivity to negative films, but exhibited a pattern of facial responses similar to controls for all films. Awareness was associated with frequency of negative facial expressions during the dementia film. Conclusions: AD patients may have impairments in self-reported reactivity to negative stimuli. Awareness may mediate responses to dementia-related material.

Awareness can be defined as a reasonable or realistic perception or appraisal of a given aspect of one's situation, functioning or performance, or of the resulting implications, expressed explicitly or implicitly. Disturbances of awareness have significant implications for people with dementia and their caregivers. The construction of awareness has been extensively studied in dementia, but a lack of conceptual and methodological clarity in this area means that few clear findings have emerged.This article presents a framework for conceptualizing awareness in people with Alzheimer's disease and associated dementias that can guide research and influence practice.This article begins by considering the general concept of awareness and the ways in which neurological damage can place constraints on awareness. Within an integrative biopsychosocial model that acknowledges the influence of neurocognitive, psychological, and social variables on awareness, challenges for empirical research on awareness in dementia are addressed, and a 'levels of awareness' framework is presented within which awareness operates at four levels of increasing complexity, providing a means of differentiating among awareness phenomena. Approaches to mapping awareness phenomena are discussed, and directions for future research and clinical practice are outlined.The levels of awareness framework should act as a stimulus to further research in this area, resulting in a more coherent understanding of the nature of awareness deficits, the implications of these for people with dementia and their caregivers, and the possibilities for targeted and effective interventions.

The 'beads task' is used to measure the cognitive basis of delusions, namely the 'Jumping to Conclusions' (JTC) reasoning bias. However, it is not clear whether the task merely taps executive dysfunction - known to be impaired in patients with schizophrenia - such as planning and resistance to impulse. To study this, 19 individuals with neurosurgical excisions to the prefrontal cortex, 21 unmedicated adults with Attention Deficit Hyperactivity Disorder (ADHD), and 25 healthy controls completed two conditions of the beads task, in addition to tests of memory and executive function as well as control tests of probabilistic reasoning ability. The results indicated that the prefrontal lobe group (in particular, those with left-sided lesions) demonstrated a JTC bias relative to the ADHD and control groups. Further exploratory analyses indicated that JTC on the beads task was associated with poorer performance in certain executive domains. The results are discussed in terms of the executive demands of the beads task and possible implications for the model of psychotic delusions based on the JTC bias.

Social dysfunction is intrinsically involved in severe psychiatric disorders such as depression and psychosis and linked with poor theory of mind. Children with 22q11.2 deletion syndrome (22q11DS, or velo-cardio-facial syndrome) have poor social competence and are also at a particularly high risk of developing mood (40%) and psychotic (up to 30%) disorders in adolescence and young adulthood. However, it is unknown if these problems are associated with theory of mind skills, including underlying social-cognitive and social-perceptual mechanisms. The present cross-sectional study included classic social-cognitive false-belief and mentalising tasks and social-perceptual face processing tasks. The performance of 50 children with 22q11DS was compared with 31 age-matched typically developing sibling controls. Key findings indicated that, while younger children with 22q11DS showed impaired acquisition of social-cognitive skills, older children with 22q11DS were not significantly impaired compared with sibling controls. However, children with 22q11DS were found to have social-perceptual deficits, as demonstrated by difficulties in matching faces on the basis of identity, emotion, facial speech and gaze compared with sibling controls. Furthermore, performance on the tasks was associated with age, language ability and parentally rated social competence and emotional problems. These results are discussed in relation to the importance of a better delineation of social competence in this population.

This study measured the effectiveness of various instructional approaches on the reading outcomes of 198 adults who read single words at the 3.0 through 5.9 grade equivalency levels. The students were randomly assigned to one of the following interventions: Decoding and Fluency; Decoding, Comprehension, and Fluency; Decoding, Comprehension, Fluency, and Extensive Reading; Extensive Reading; and a Control/Comparison approach. The Control/Comparison approach employed a curriculum common to community-based adult literacy programs, and the Extensive Reading approach focused on wide exposure to literature. The Fluency component was a guided repeated oral reading approach, and the Decoding/Comprehension components were SRA/McGraw-Hill Direct Instruction Corrective Reading Programs. Results indicated continued weaknesses in and poor integration of participants' skills. Although students made significant gains independent of reading instruction group, all improvements were associated with small effect sizes. When reading instruction group was considered, only one significant finding was detected, with the Comparison/Control group, the Decoding and Fluency group, and the Decoding, Comprehension, Extensive Reading and Fluency group showing stronger word attack outcomes than the Extensive Reading group.

Objective The use of neuropsychological assessment beyond diagnosis is related partly to the extent to which it can indicate everyday function. This study investigates whether the associations between neuropsychological functioning, activities of daily living (ADL) and instrumental activities of daily living (IADL) change over an 18- to 24-month follow-up, exploring whether these change with dementia progression. Method Thirty-four patients with probable Alzheimer's disease were assessed at baseline and again after between 18 and 24 months. Neuropsychological function was assessed using the revised Cambridge Cognitive Examination, which includes in it the Mini mental state examination and an executive functions scale. ADL and IADL were also measured, together with background neuropsychiatric features by using the Neuropsychiatric Inventory. Results Pearson correlations between the measures of daily functioning and cognitive abilities and neuropsychiatric symptoms showed that initially neuropsychological test results tended to correlate with IADL rather than ADL measures. Neuropsychiatric symptoms were not correlated whether IADL or ADL. At follow-up, none of the neuropsychological function measures correlated with IADL or ADL, but neuropsychiatric symptoms were correlated with IADL. Conclusions At baseline, neuropsychological function is associated with IADL but not ADL. At follow-up, the association between neuropsychological function and IADL diminishes, and associations between neuropsychiatric disturbances and IADL emerge. Copyright © 2011 John Wiley & Sons, Ltd.