Impaired memory and learning abilities in patients with systemic lupus erythematosus as measured by the Rey Auditory Verbal Learning Test.

OBJECTIVE: The purpose of this study was to assess and characterise verbal memory impairment in patients with systemic lupus erythematosus (SLE) by the Rey Auditory Verbal Learning Test (Rey AVLT). METHODS: 40 consecutive, unselected patients with SLE were evaluated with the Rey AVLT, a clinical and research tool for the study of multiple learning and memory measures. All patients were assessed for disease activity, damage, presence of antiphospholipid antibodies and depression. Findings were compared with those of 40 healthy controls matched for age, sex and education. RESULTS: The study group included 40 patients with SLE (37 females, 3 males), median age 33 years (range 20-59), median disease duration 8 years (range 0.3-32). The median disease activity measured by the SLE Disease Activity Index (SLEDAI) was 4 (range 0-16). Median damage measured by the SLICC/ACR (Systemic Lupus International Collaborating Clinics/American College of Rheumatology) damage index score was 0 (range 0-4). Depression was detected in 16/40 patients. Several aspects of the memory domain, as measured by the Rey AVLT, were impaired in the SLE group, using analysis of variance with repeated measures. The learning curve of patients with SLE was significantly less steep compared with that of controls, (p = 0.036), the rate of words omitted from trial to trial was higher in the SLE group (p = 0.034) and retrieval was less efficient in SLE compared with controls (p = 0.004). The significance of these findings was maintained after omitting patients with stroke or depression. CONCLUSION: Learning ability was impaired in patients with SLE with a poor and inefficient learning strategy, as reflected by an impaired learning curve, repeated omissions and impaired retrieval. This pattern of memory deficit resembles that seen in patients with frontal lobe damage and warrants further localising brain studies.

Differential effect of right and left hemispheric lesions on two memory tasks: free recall of items and recall of spatial location.

The effect of lateralized cerebral damage on free recall of items and recall of spatial location, under intentional and incidental learning conditions, was investigated. Eleven right brain-damaged (RBD) patients, 10 left brain-damaged (LBD) patients, 14 young and 11 elderly normal controls, participated in this study. The overall performance of the control groups was better than that of the patient groups. For all groups, free recall was better under intentional than under incidental learning condition. On recall of spatial location the learning condition had a differential effect on the groups. The RBD group performed better than the LBD group under intentional learning condition, while the reverse was found under incidental learning condition. The young-control group showed an advantage over the elderly-control group under intentional but not under incidental learning condition. The results are discussed in regard to different approaches to the distinction between automatic and effortful memory processes and their lateralization in the cerebral hemispheres.

Motor and non-motor sequence learning in patients with basal ganglia lesions: the case of serial reaction time (SRT).

In order to address the question of whether the basal ganglia are involved exclusively in regulation of motor sequence learning, or if they are involved in non-motor sequence learning as well, two versions of the serial reaction time (SRT) task were administered: First is the standard version of the SRT task in which the sequence is executed motorically, and the second is a non-motor version of the task which requires response only to a particular position of the sequence. Sixteen patients with damage restricted to the region of the basal ganglia and 16 matched control subjects participated in this study. In addition to the motor and non-motor SRT tasks, two declarative memory tests (Visual Paired Associates and Rey Auditory-Verbal Learning Test) were administered to the participants. Results indicate that the two groups did not differ either on learning rate of the two declarative tasks, or on the declarative component of the SRT tasks (i.e., 'generate'). However, the control group was significantly superior to the basal ganglia (BG) group in learning a specific sequence in the motor and non-motor SRT tasks. Results suggest that the basal ganglia are involved in the regulation of non- motor as well as motor sequence learning.

Differential effect of right and left hemispheric lesions on two memory tasks: free recall and frequency judgement.

We investigated the relationship between lateralized cerebral damage and two memory tasks; free recall and frequency judgement. Free recall is considered to be processed effortfully while frequency judgement is considered to be processed automatically (Hasher and Zacks). Nine right brain-damaged patients (RBD), nine left brain-damaged patients (LBD) and nine control subjects participated in this study. It was hypothesized that RBD would show an advantage over LBD on the free-recall task, whereas LBD would show an advantage over RBD on the frequency-judgement task. In accordance with our hypothesis, free-recall was more impaired in LBD than in RBD. In the frequency-judgement task, an effect of laterality of lesion was found in high (4-6) and low (0-1) frequencies, but not in the medium (2-3) frequencies. The anticipated LBD advantage was shown in judgement of the high frequencies, but unexpectedly RBD performed better than LBD in low frequencies. The results are discussed in terms of the relationship between effortful and automatic memory processes and cerebral lateralization.

The effect of electroconvulsive therapy (ECT) on implicit memory: skill learning and perceptual priming in patients with major depression.

While explicit memory in amnesics is impaired, their implicit memory remains preserved. Memory impairment is one of the side effects of electroconvulsive therapy (ECT). ECT patients are expected to show impairment on explicit but not implicit tasks. The present study examined 17 normal controls and 17 patients with severe major depressive disorder who underwent right unilateral ECT. Patients were tested in three sessions: 24-48 hours prior to, 24-48 hours following the first ECT, and 24-48 hours following the eighth ECT. The controls were tested in three sessions, at time intervals that paralleled those of the patients. Implicit memory was tested by the perceptual priming task - Partial Picture-Identification (PPI). The skill learning task used entailed solving the Tower of Hanoi puzzle (TOHP). Explicit memory was tested by picture recall from the PPI task, verbal recall of information regarding the TOHP, and by the Visual Paired Association (VPA) test. Results showed that explicit questions about the implicit tasks were impaired following ECT treatment. Patients' learning ability, as measured by the VPA task, was only impaired in the first testing session, prior to ECT treatment, reflecting the effect of depression. In addition, groups only differed in the first session on the learning rate of the skill learning task. Perceptual priming was preserved in the patients' group in all sessions, indicating that it is resilient to the effect of depression and ECT. The results are interpreted in terms of the differential effect of depression and ECT on explicit and implicit memory.

Effect of breakfast timing on the cognitive functions of elementary school students.

OBJECTIVE: To study the effect of breakfast timing on selected cognitive functions of elementary school students. DESIGN: A 2-week randomized control intervention trial. SETTING: Five elementary schools. SUBJECTS: The subjects comprised 569 children, 51% of them boys, aged 11 to 13 years; the children were in grades 5 through 6 (17 classes). The subjects lived in different areas and had different socioeconomic backgrounds. INTERVENTION: Each subject was tested twice, by 2 versions of the Rey Auditory-Verbal Learning Test, 2 alternative forms of the logical memory subtest of the revised Wechsler Memory Scale, and 2 versions of the Benton Visual Retention Test. On the first test, before any nutritional intervention, the subjects were asked to complete a questionnaire about their food intake on the day of testing. Two thirds of the subjects received 200 ml of 3%-fat milk and 30 g of sugared cornflakes for the next 14 days, and all the subjects were reexamined on the 15th day. MAIN OUTCOME MEASURE: Scoring on the different tests was compared with baseline scores. RESULTS: After 15 days, children who ate breakfast at school scored notably higher on most of the test modules than did children who ate breakfast at home and children who did not at breakfast. CONCLUSIONS: Our results indicate that routinely eating breakfast 2 hours prior to being tested does not improve cognitive functions in 11- to 13-year-old elementary school students, but food supplementation 30 minutes prior to taking a test notably improves scoring. We suggest further studies on the relationship between meal content, feeding time, and scholastic performance.

Indirect influence of modality on direct memory for words and their modality: closed-head-injured and control participants.

Twenty closed-head-injured (CHI) patients and 28 control participants were tested on recall and recognition of words. In addition, memory for modality (i.e., visual vs. auditory) of word presentation was measured directly (i.e., recognition) and indirectly (i.e, by its influence on word and modality recognition). As predicted, the CHI patients were impaired relative to controls on all of the direct memory tasks; that is, word recall, word recognition, and modality judgment. However, the CHI and control groups did not differ significantly on the magnitude of the modality effect (i.e., facilitation due to correspondence of modality in learning and test). The findings are interpreted in the theoretical framework that distinguishes between item (i.e., words) and source (i.e., modality) memory and between direct and indirect measures of memory.

Relative importance of informational units and their role in long-term recall by closed-head-injured patients and control groups.

The purpose of this study was to apply qualitative analysis to the information recalled by control Ss and closed-head-injured (CHI) patients. The Logical Memory subtest of the Wechsler Memory Scale (Wechsler, 1945) was administered to 40 CHI and 40 control Ss. Recall was tested immediately after administration, 40 min later, and 24 hr later. The analysis took into account the importance of recalled information as determined by a prior rating according to 3 levels of importance. Results suggest that CHI patients have difficulty selectively retrieving the most important information after a long delay.

Declarative and procedural learning in Parkinson's disease patients having tremor or bradykinesia as the predominant symptom.

The distinction between procedural and declarative memory is widely accepted in the memory literature. Converging evidence makes a strong case that the medial aspects of the temporal lobes and the diencephalon subserve the declarative memory system. However, the neuroanatomy of procedural memory is much less clear. In animal studies, damage to the basal ganglia has been found to affect procedural memory, but studies of patients suffering from degenerative diseases of the basal ganglia (e.g., Parkinson's and Huntington's disease) are less conclusive. Two groups of Parkinson's disease subtypes, with tremor (PDt) and bradykinesia (PDb) as the predominant motor symptom, were compared to controls on declarative and procedural memory tasks. The two patient groups did not differ from each other on the declarative tasks. However, in the procedural learning tasks, the PDb but not the PDt group, was significantly impaired compared to the control group. The results are discussed in terms of the differential involvement of discrete neuroanatomic loops connecting the basal ganglia and the prefrontal cortex.

Total amount learned versus learning rate of verbal and nonverbal information, in differentiating left-from right-brain injured patients.

Twenty Left-Brain Damaged (LBD), 20 Right-Brain Damaged (RBD), and 20 control subjects were compared on three different learning tasks: (a) verbal, the Paired Associate Learning subtest of the Wechsler Memory Scale; (b) figural, the Gollin Incomplete Figures task, which can be easily verbalized, and (c) spatial, the Stylus Maze. When learning ability was measured, by assessing the total amount learned (sum of items learned in all trials), the results showed that, on all three tasks, the control group's performance significantly surpassed that of the patient groups. The RBD group performed better than the LBD group on the verbal learning task, while LBD subjects performed better than their RBD counterparts on the spatial learning task. No significant difference between the two patient groups was detected on the figural task, suggesting that a task using visually and verbally codable stimuli is not useful in differentiating between LBD and RBD groups. When the learning rate was measured, similar results were obtained in the verbal and figural task. However, in the spatial task, the learning rates of the three groups did not significantly differ, probably because the specific task used required procedural learning, which is normally preserved in amnesics.

Baseline performance and learning rate of procedural and declarative memory tasks: younger versus older adults.

Twenty-five older and 25 younger adults were compared on declarative (i.e., Rey Auditory-Verbal Learning Test and Visual Pair Associations) and procedural (i.e., Tower of Hanoi puzzle and Porteus mazes) learning tasks. A dissociation between learning rate on declarative and procedural tasks was demonstrated for the elderly participants. The younger group showed a steeper learning rate than the older group on the declarative tasks. By contrast, the learning rate of both groups on the procedural tasks did not differ consistently, whether the measure was number of errors/moves or time elapsed (with one exception in which the older group showed a steeper learning rate than the younger group). The younger group's baseline performance was better than that of the older group on all tasks employed in this study. These results reinforce the importance of distinguishing between baseline performance and the rate of learning on procedural learning tasks.

Procedural and declarative memory processes: individuals with and without mental retardation.

Learning and retention of procedural versus declarative memory tasks were examined with 26 young adults with mild mental retardation and 27 school children matched for MA. Results revealed a similar pattern of task performance. Performance of the young adults with mild mental retardation was inferior to that of the control subjects on both types of tasks. However, learning rate and retention over time were comparable, thereby maintaining the control group's consistent advantage throughout all repeated trials. These results are consistent with previous findings for individual's with mental retardation tested on memory and problem-solving tasks. Theoretical implications of this pattern of results for individuals with mild mental retardation were discussed.

Interpretation of facial expressions of affect in children with learning disabilities with verbal or nonverbal deficits.

The ability to identify facial expressions of happiness, sadness, anger, surprise,fear, and disgust was studied in 48 nondisabled children and 76 children with learning disabilities aged 9 through 12. On the basis of their performance on the Rey Auditory-Verbal Learning Test and the Benton Visual Retention Test, the LD group was divided into three subgroups: those with verbal deficits (VD), nonverbal deficits (NVD), and both verbal and nonverbal (BD) deficits. The measure of ability to interpret facial expressions of affect was a shortened version of Ekman and Friesen's Pictures of Facial Affect. Overall, the nondisabled group had better interpretive ability than the three learning disabled groups and the VD group had better ability than the NVD and BD groups. Although the identification level of the nondisabled group differed from that of the VD group only for surprise, it was superior to that of the NVD and BD groups for four of the six emotions. Happiness was the easiest to identify, and the remaining emotions in ascending order of difficulty were anger, surprise, sadness, fear, and disgust. Older subjects did better than younger ones only for fear and disgust, and boys and girls did not differ in interpretive ability. These findings are discussed in terms of the need to take note of the heterogeneity of the learning disabled population and the particular vulnerability to social imperception of children with nonverbal deficits.

Part I: the effect of long-term exposure to organic solvents on memory: a cross sectional study.

This study focuses on a wide range of different aspects of memory functions trying to ascertain a possible profile of memory changes, which take place following long-term exposure to organic solvents. The research design was cross-sectional. Study population included 31 industrial painters who were exposed at work to organic solvents and 31 unexposed workers. Workers after long-term exposure to organic solvents showed significant decline in memory as indicated in all three standard memory tests (i.e. Wechsler Memory Scale - Revised, Benton Revised Visual Retention Test, and Rey Auditory Verbal Learning Test). The results of Rey Auditory Verbal Learning Test showed a negative correlation with exposure index indicating that the more intensive and longer the time of exposure was, the more impaired is the verbal memory. It was also found that the affect of age on memory was stronger among workers after long-term exposure to organic solvents compared to the unexposed workers.

Cognitive procedural learning among children and adolescents with or without spastic cerebral palsy: the differential effect of age.

INTRODUCTION: Children learn to engage their surroundings skillfully, adopting implicit knowledge of complex regularities and associations. Probabilistic classification learning (PCL) is a type of cognitive procedural learning in which different cues are probabilistically associated with specific outcomes. Little is known about the effects of developmental disorders on cognitive skill acquisition. METHODS: Twenty-four children and adolescents with cerebral palsy (CP) were compared to 24 typically developing (TD) youth in their ability to learn probabilistic associations. Performance was examined in relation to general cognitive abilities, level of motor impairment and age. RESULTS: Improvement in PCL was observed for all participants, with no relation to IQ. An age effect was found only among TD children. CONCLUSIONS: Learning curves of children with CP on a cognitive procedural learning task differ from those of TD peers and do not appear to be age sensitive.

Clinical neuropsychology and brain injury rehabilitation in Israel: a twenty-year perspective.

The development of the field of neuropsychology in Israel is primarily the result of the development of rehabilitation services for traumatic brain-injured patients. The responsibility to care for and help disabled veterans has always been an important motivation for the establishment of rehabilitation services. Israel is probably one of the first countries in the world to develop community-based services specifically designed to address the needs of young patients with severe traumatic brain injury. The fairly extensive therapeutic and community services available today for both military and civilian brain-injured persons in Israel ae the result of initiatives and funding by the Israel Ministry of Defense's Department of Rehabilitation. There are two principles that characterize most of the programs in Israel: (1) multidimensional remedial intervention and (2) life-time commitment to provide support. The accessibility of patients in a small country enables professionals to conduct follow-up studies in order to evaluate the long-term effects of brain injury. Current developments in neuropsychology are in three directions. First, formal training programs in neuropsychology are being set up. Second, the involvement of neuropsychologists is being extended beyond the treatment of young patients suffering from traumatic brain injury to include the treatment of different brain pathologies in children and the elderly. Third, sophisticated neuroimaging techniques are being applied to studies in cognitive neuropsychology.

The effect of level of processing on perceptual and conceptual priming: control versus closed-head-injured patients.

Twenty-four closed-head-injured (CHI) and 24 control participants studied two word lists under shallow (i.e., nonsemantic) and deep (i.e., semantic) encoding conditions. They were then tested on free recall, perceptual priming (i.e., perceptual partial word identification) and conceptual priming (i.e., category production) tasks. Previous findings have demonstrated that memory in CHI is characterized by inefficient conceptual processing of information. It was thus hypothesized that the CHI participants would perform more poorly than the control participants on the explicit and on the conceptual priming tasks. On these tasks the CHI group was expected to benefit to a lesser degree from prior deep encoding, as compared to controls. The groups were not expected to significantly differ from each other on the perceptual priming task. Prior deep encoding was not expected to improve the perceptual priming performance of either group. All findings were as predicted, with the exception that a significant effect was not found between groups for deep encoding in the conceptual priming task. The results are discussed (1) in terms of their theoretical contribution in further validating the dissociation between perceptual and conceptual priming; and (2) in terms of the contribution in differentiating between amnesic and CHI patients. Conceptual priming is preserved in amnesics but not in CHI patients.

A supplementary measure in the Rey AVLT for assessing incidental learning of temporal order.

Temporal order judgment is considered an important aspect of memory, both clinically and theoretically. Theories treat temporal order variously as an example of automatic process, contextual information, or source memory. However, despite its significance, temporal order is not well represented in standard memory tests or batteries. The well-known Rey AVLT (Auditory-Verbal Learning Test) was judged suitable for incorporation of a temporal order measure because it already includes several measures of learning and memory. The measure was administered to 190 healthy subjects divided into four age groups, who then were given list A in random order and asked to rewrite the words in their original order. Memory for temporal order was found to be sensitive to age and gender. Although temporal order judgment was part of incidental learning, scoring was significantly higher than could be attributed to chance. The correlation pattern between temporal order and other Rey AVLT scores suggests that temporal order is related to retention rather than to acquisition.

Rey Auditory-Verbal Learning Test: structure analysis.

One of the major advantages of the Rey Auditory-Verbal Learning Test (AVLT) is its multiple measures of learning and memory. This study evaluated empirically whether the different scores are, in fact, not merely different expressions of a single factor, but, rather, measures of different memory domains. The Rey AVLT was administered to 146 normal subjects. Factor analyses produced one, two, or three factors depending on the combination of scores included in the analysis and on the criteria used to determine the number of factors. The basic factors identified were acquisition and retention. The latter can be subdivided further into storage and retrieval, thus yielding a total of three factors.

Criterion validation of premorbid intelligence estimation in persons with traumatic brain injury: "hold/don't hold" versus "best performance" procedures.

The goal of the present study was to validate previously suggested regression equations for the estimation of premorbid ability against a real premorbid intellectual criterion. Fifty-four patients with traumatic brain injuries, for whom a premorbid military Primary Psychometric Rating (PPR) was available, participated in the study. Two prediction procedures were validated: (a) "BEST-10", which generates a predicted score from the highest observed score of 10 WAIS-R subtests, according to the "best performance" estimation principle. (b) "BEST-2", which generates the predicted score from the higher of two subtests considered a priori resistant to neurological damage according to the "hold/don't hold" principle. The two procedures showed similar correlation with the premorbid criterion. However, the BEST-10 method provided a more accurate estimation, generating a non-significant 2-point underestimation. The results support the application of previously proposed equations for estimating premorbid intelligence, and suggest that the use of the best performance principle is preferable as compared to the hold/don't hold principle.