White matter hyperintensities in dementia of Alzheimer's type and in healthy subjects without cerebrovascular risk factors. A magnetic resonance imaging study.

T2-weighted (0.5 T) magnetic resonance images were used to study the prevalence of subcortical white matter hyperintensities (WMHIs) in 22 patients with dementia of Alzheimer's type (DAT), 20 age-matched older healthy control subjects, and 10 younger healthy control subjects. Exclusionary criteria for all groups included cerebrovascular risk factors. All subjects had Hachinski Ischemic Index scores of less than 2 and computed tomographic scans showing no infarct. The WMHIs were classified as periventricular WMHIs or deep WMHIs and graded 0 through 3 (0 indicated absent, and 3, severe). For the group with DAT and older control subjects, periventricular WMHIs and deep WMHIs were graded 2 or 3 in fewer than 17% and 27% of subjects, respectively, whereas in the younger control subjects, all ratings were grade 1 or less. Serum cholesterol and systolic blood pressure values, although within the normal range, were elevated significantly in older control subjects when compared with those in younger control subjects. No significant differences in WMHI ratings, blood pressure, cholesterol, or triglyceride levels were found between patients with DAT and age-matched control subjects. Systolic blood pressure levels correlated with the severity of periventricular WMHIs only in older control subjects. Age correlated with periventricular WMHIs and deep WMHIs within both the older control subjects and the patients with DAT. There was no significant correlation between WMHIs and the severity of dementia in the group with DAT. These results suggest that, in subjects screened for cerebrovascular risk factors, WMHIs are rare and occur with identical frequency in patients with DAT as in age-matched healthy control subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood buffy coat from Alzheimer's disease patients and their relatives does not transmit spongiform encephalopathy to hamsters.

There was a report of spongiform encephalopathy transmitted to Syrian hamsters by intracerebral inoculation with the blood buffy coat of patients with Alzheimer's disease (AD) and their unaffected first-degree relatives. We attempted to verify that report, taking measures to reduce the risk of contaminating samples with agents causing spongiform encephalopathies. We obtained blood from 50 subjects, including six patients with familial AD, 21 unaffected first-degree relatives (siblings and offspring) of patients with familial AD, and 20 control subjects. We inoculated the buffy coats intracerebrally into Syrian LVG hamsters, observed them for signs of neurologic disease, examined their brains for neuropathologic changes at time of death, and performed serial (blind) passages by inoculating suspensions of all recovered brains into fresh LVG hamsters. We discerned no clinical illness or histopathologic changes resembling experimental spongiform encephalopathy in any hamster inoculated with human buffy coat nor in blind-passage hamsters, nor were the life spans of those hamsters shortened. We conclude that AD is not caused by an agent that transmits spongiform encephalopathy to hamsters.

Test-retest reliability of the Advanced Psychodiagnostic Interpretation (API) scoring system for the Bender Gestalt in chronic schizophrenics.

This study assesses the test-retest reliability of the revised Advanced Psychodiagnostic Interpretation (API) scoring system for the Bender Gestalt Test (BGT). The API system identifies 207 possible distortions in a BGT protocol. Test-retest reliability for 40 schizophrenic patients tested twice with a mean interval of 6.4 years (SD=3.8 years) was good, ranging from .71 to .80. Further reliability and validity studies are needed to further demonstrate the effectiveness of the system.

Diagnosing MPD with two new Rorschach signs: are the signs valid or are the MPDS atypical?

The validity of newly developed "Splitting" and "Dissociative" signs on the Rorschach for diagnosing multiple personality disorder (MPD) was questioned. It was pointed out that the mean number of Rorschach responses for what were ostensibly patients with MPD was so high as to render the sample atypical. It was suggested that perhaps the Splitting and Dissociative signs were diagnostic of either dissociation in general or MPDs who have experienced decompensation, leading to hospitalization.

Personality dimensions measured by projective techniques: a formulation based on structural analysis.

It is suggested that a better understanding and more effective use of projective techniques can be achieved by viewing each test in terms of the depth of personality assessed and its unique amalgamation of emotional and intellectual aspects of personality. With these considerations in mind, a refurbished definition of a projective test is presented and implications for the phenomenon of projection are discussed.

Loss of reality contact on the Rorschach: a formal analysis.

Based on an analysis of the TRAUT system for scoring autisms, it was concluded that a loss of reality contact on the Rorschach is indicated by responses that do not comply with the demand characteristics of the blots themselves or entail relationships among blot areas counter indicated by the demands of external reality. It was postulated that these same two perceptual/cognitive errors could be used as markers to signal problems with reality testing as they are manifested on other projective techniques.

Reductio ad absurdum: a formal analysis of Rorschach autisms.

Generalizing from the rationales underlying the scoring of the three types of Rorschach autisms included in the TRAUT system, it was shown that all perceptual autisms can be subsumed under a single, all-encompassing principle based upon a reductio ad absurdum argument. Therefore, in a way, autisms can be viewed as "cheating," i.e., getting around the explicit and implicit rules governing the evaluation of Rorschach percepts.

Perceptual integrations and the "normal" Rorschach percept.

The "normal" Rorschach percept is characterized by congruency (correspondence between blot and reality) and good form (an appropriate synthesis among elements comprising the blot). Both congruency and good form arise from perceptual integrations and can be objectified in terms of providing false information (incongruency) and maximizing identifying information about the blot (good form), thus providing a logical foundation for Rorschach interpretation.

Measured intelligence of problematic patients with chronic pain.

100 patients with chronic pain judged "problematic" by their referring physicians were administered the Wechsler Adult Intelligence Test-Revised. 38 obtained IQs of 85 or less while only 11 earned IQs of 101 or higher. While a number of confounds may have influenced these results, low intelligence appears to be a marker for negative treatment prognosis, at least as perceived by physicians, and its influence would seem to merit further investigation and clarification.

Predicting normal age-related changes with intelligence, projective, and perceptual-motor test variables.

From four tests, the WAIS, Rorschach, Hand Test, and Bender-Gestalt, 67 variables were derived and used to predict age for 240 individuals. Ages ranged from 15 to 65 yr., divided into five age intervals, with 48 subjects per group. 36 variables correlating with age were further reduced to 12 by means of a stepwise multiple R. A final R of .73 was obtained, accounting for 53% of the variance. While variables from all four of these tests correlated with the criterion, most of the significant variance could be attributed to intellectual factors.

Validity of the hand test for diagnosing organicity in a clinical setting.

When validated against a clinical sample, the Hand Test was able to differentiate between 50 brain-damaged and 50 functionally disturbed individuals with 69% accuracy. Significant variables were Description, Withdrawal, Pathology, Automatic Phrasing, Gross, Hiding, and Demonstration. The Hand Test seems to have some value for diagnosing organicity, but it should be used with caution and preferably as part of a test battery.

Comparison of WAIS and WAIS-R scaled scores for an outpatient clinic sample retested over extended intervals.

High correlations were obtained between WAIS and WAIS-R scores for an outpatient clinic sample tested and retested over extended periods. While the WAIS-R scores were generally lower than the WAIS values, the decrements were slight, suggesting that a previously administered WAIS can serve as a good estimate of what might be obtained from a second administration of the WAIS-R for this type of sample.

Comparison of Rorschach anatomy responses from psychosomatic out-patients and a matched group of psychiatric controls.

35 out-patient Ss with demonstrable psychosomatic symptoms were matched with 35 psychiatric out-patients with "milder" forms of psychopathology, i.e., neurosis, personality disorders and latent schizophrenia. The psychosomatic group showed significantly more anatomy responses on the Rorschach but there was much overlap, leading to the conclusion that anatomy does not directly reflect simply psychosomatic disturbances but, rather, is associated with psychodynamics which tend to underlie psychosomatic illnesses.

Redundancy in perceptual-motor testing: confirmation and generalization.

The Developmental Test of Visual-motor Integration was administered to 63 children in regular classrooms and 51 children in Special Education. Prediction based on total score (r = .68) was similar to a multiple R utilizing only five scores (.67). The over-all raw test score, based on all 24 designs, correctly classified 85% of the children while a combined abbreviated score utilizing only 5 designs achieved an 80% differentiation. Results were interpreted as confirming the hypothesis of redundancy in this perceptual-motor test.

A proposed classification scheme for Rorschach autisms.

Exner's WSUM6 score includes only a select few of the Rorschach "autisms" (i.e., perceptual-cognitive distortions) observed by various authors over the years. A logical and clinically relevant classification scheme was presented which is inclusive enough to capture most types of Rorschach autisms. These include relationship errors (RELERs), hyperattentional errors (HYPERs), and errors of underattention (HYPOs). Empirical comparisons among diagnostic groups on these three categories of autisms were recommended.

Correlations between the Hand Test Pathology score and Personality Assessment Inventory scales for pain clinic patients.

Pearson correlations between the Hand Test Pathology (PATH) score and Personality Assessment Inventory scales produced a cluster of relationships characteristic of an antisocial orientation. Likewise, PATH significantly differentiated between a "P" (Pathology) group flagged by a high Negative Impression score on the inventory, and an "N" (Normal) group of 100 pain patients. It was suggested that the interpretive simplicity of Hand Test scores renders the scores amenable to further correlational studies involving the inventory.

WAIS test-retest reliability for a clinical out-patient sample.

WAIS test-retest reliabilities were calculated for a clinical out-patient sample with testing intervals varying from 1 to 10 yr. There was no relationship between test-retest interval and the stability of test scores and the correlations between IQs were quite satisfactory (Full Scale IQ = .897, Verbal IQ = .906, Performance IQ = .876). Reliabilities remained high even when the sample was divided by diagnosis into organic, neurotic, personality disorder, and schizophrenic subgroups.

The extrapolated area response: a pathognomic sign of mania on the Rorschach?

A pathognomic sign of mania, the Extrapolated Area Response (EAR), was described and explicated within the context of the TRAUT (Tripartite Classification of Autisms) system of categorizing Rorschach autisms. The EAR was interpreted as reflecting a person's tendency to expand his ambit beyond the confines of objective reality. Empirical validation is required.

Diagnostic and intellectual implications of the fragmented Rorschach W:D ratio.

A "fragmented" Rorschach W:D ratio, where D exceeds W by 3:1 or more, occurred in about one-tenth of an outpatient clinical population (n = 938). Subjects showing this imbalance tended to be diagnosed as organic or schizophrenic and to have a differentially higher WAIS Similarities score. Implications of these findings were discussed.

Maximized split-half reliabilities and distributional characteristics for Harris-Lingoes subscales with few items: a reevaluation for the MMPI-2.

100 MMPI-2 protocols were obtained from the files of an outpatient clinic. Distributions of all possible split-half combinations were computed for selected Harris-Lingoes subscales with few items. As expected, max r reliability estimates were significantly greater than alpha estimates and distributions of correlations were negatively skewed. Inspection of the distributions suggested that the Amorality scale contains an ambiguous item which does not appear to belong in this grouping. Serious problems were noted with the Hy5 subscale. Alpha reliabilities were comparable to previously reported estimates, and max r reliability estimates closely resembled reported test-retest estimates.