Personality changes in 7 participants with bilateral ventromedial prefrontal lesions (PF-BVM), 14 participants with prefrontal lesions but not bilateral ventromedial involvement (PF-NBVM), and 36 with nonprefrontal lesions (NPF) were investigated with the Iowa Rating Scales of Personality Change. Informants rated 30 specific characteristics for degree of disturbance and change from premorbid personality. PF-BVM participants showed a higher rate of acquired disturbances than NPF participants in blunted emotional experience, apathy, low emotional expressiveness, inappropriate affect, poor frustration tolerance, irritability, lability, indecisiveness, poor judgment, social inappropriateness, lack of planning, lack of initiation and persistence, and lack of insight. Differences between the PF-BVM and PF-NBVM groups were significant for several of these characteristics. All 7 PF-BVM participants developed a syndrome, including general dampening of emotional experience; poorly modulated emotional reactions; defective decision making, especially in the social realm; impaired goal-directed behavior; and striking lack of insight. Similarities between this syndrome of "acquired sociopathy" and developmental psychopathy in characteristic personality disturbances and psychophysiological abnormalities suggest that diminished emotionality, impaired decision making, and psychosocial dysfunction may be related to ventromedial prefrontal dysfunction in both groups.
ABSTRACT Background: The problems that some community-dwelling elderly persons develop in real-world decision-making may have disastrous consequences for their health and financial well-being. Investigations across the adult life span have identified personality as an important individual differences variable that is related to decision-making ability. The aim of this study was to investigate the relationship between personality characteristics, as rated by an informant, and complex decision-making performance among elderly persons. It was hypothesized that deficits in decision-making would be associated with personality characteristics reflecting weak executive functioning ( Lack of Planning, Poor Judgment, Lack of Persistence, Perseveration, Lack of Initiative, Impulsivity, and Indecisiveness ). Methods: Fifty-eight elderly persons participated. Their health and cognitive status were deemed intact via comprehensive neuropsychological evaluation. The Iowa Scales of Personality, completed by an informant, was used to assess personality characteristics, and the Iowa Gambling Task, completed by the participant, was used to assess complex decision-making abilities. Results: Longstanding disturbances in executive personality characteristics were found to be associated with poor decision-making, and these disturbances remained predictive of poor decision-making even after taking into consideration demographic, neuropsychological, and mood factors. Acquired personality disturbances did not add significantly to prediction after longstanding disturbances were taken into account. Disturbances in other dimensions of personality were not significantly associated with poor decision-making. Conclusions: Our study suggests that attentiveness to the personality correlates of difficulties with aspects of executive functioning over the adult years could enhance the ability to identify older individuals at risk for problems with real-world decision-making.
We investigated whether Persian Gulf War veterans (GWVs) were more likely than Persian Gulf War-era veterans deployed elsewhere (GEVs) to have noncredible neuropsychological examinations. A total of 301 GWVs and 99 GEVs underwent neuropsychological testing. The credibility of 173 examinations showing impairment was evaluated based on test performances, clinical background, psychometric measures, and other self-report data. All 11 examinations judged less than fully credible by one neuropsychologist, plus 19 examinations judged impaired but credible, were then evaluated independently by two more neuropsychologists. Noncredibility was judged with excellent reliability (93% agreement). Seven examinations were judged noncredible. Rates of noncredibility did not differ between GWVs (1%) and GEVs (4%). The pattern of associations of noncredible examinations with cognitive, psychological, and clinical variables generally indicated defective neuropsychological scores, with no coherent pattern, and personality disorder. Findings supported the validity of noncredibility judgments and suggested that noncredible examinations are not a significant problem in neuropsychological investigations of GWVs.
The effect of normal aging on route learning ability was investigated, employing a complex, real‐life route. Performance was not related to gender or education but was strongly related to age. Difficulty learning the route (i.e., total errors across three repeated trials) increased monotonically in successive age groups. Decline became particularly apparent in the 60‐ to 69‐year‐old group and was even more pronounced in the 70+ group, which averaged more than four times as many errors as the youngest group (18 to 39 years) on each of the three trials. In addition to normal age‐related decline, defective route learning was seen in subjects in the oldest groups. The findings indicate that an ecologically valid test may be especially sensitive to age‐related decline in route learning ability.
In recent years an increasing amount of research has focused on the ways in which knowledge associated with verbs can be impaired by brain damage. Many different methods have been used to investigate verb processing disorders, but most of these methods have only been employed in a small number of studies and with relatively small numbers of subjects. As a consequence, very little information is available on the variety of disorders that are possible. In order to explore this issue further, we administered a standardised battery of six tests to a group of 89 brain-damaged subjects. The tests differ systematically with respect to the kinds of verb processing mechanisms on which they depend. The goal of the experiment was to investigate how the patterns of associations and dissociations that emerged across the tests could shed light on the organisation of the functional architecture that underlies the meanings of verbs and the computational operations that are used to manipulate them. Of the 89 subjects, 30 were impaired on at least one of the six tests. These subjects manifested a total of 22 distinct performance profiles across the tests, and each test dissociated from all of the others. These findings suggest that each test has at least some unique processing requirements that can be independently disrupted. A statistical factor analysis indicted that several distinct factors accounted for 93% of the variance among impaired performances. These factors are interpretable in terms of the major processing similarities and differences across the tests. Some of the results from the study are consistent with previous research on verb disorders. Specifically, tests involving verb production were more difficult than tests involving verb comprehension, and tests involving linguistic stimuli were more difficult than tests involving pictorial stimuli. Other aspects of our results are entirely new. Most importantly, a dissociation was found between tests that require referential processing, i.e., mapping verbs onto actions in the world, and tests that require analytic or inferential processing, i.e., decomposing verb meanings into their component semantic features. Thus, the study has significant implications for theories of the nature of verb processing.
Abstract Eighteen survivors of high voltage electrical injuries (HVEI) underwent neuropsychological evaluation in the acute, short-term or long-term epochs Deficits in verbal learning and delayed recall of verbal information were present across various epochs No other cognitive performances were in the impaired range for the HVEI group, although many individual patients also had compromised attention Depression, anxiety and irritability were widespread among HVEI patients, especially beyond the acute period Extreme irritability was accompanied by assaultive behavior in several patients The neurobehavioral effects of HVEI were very similar to those of a closely matched traumatic brain injury (TBI) control group in each epoch The only significant difference between the groups was less successful immediate visual retention by TBI patients in the long-term epoch.
The present study aimed to further examine the specificity of the Exaggeration Index of the expanded Auditory Verbal Learning Test procedure for detecting inadequate effort or response bias in a nonlitigating sample with unequivocal brain damage. Data from 56 patients with intractable epilepsy undergoing presurgical evaluation for temporal lobectomy were analyzed. In this sample, specificity was excellent at the recommended cut-off (94%), and comparable to that of another well-researched instrument for detecting inadequate effort, the Recognition Memory Test. Findings strongly support the generalizability of the specificity estimates obtained by Barrash et al. and, more broadly, the clinical utility of the Exaggeration Index. To facilitate diagnostic decision-making, the probability of invalid performances associated with each score on the Exaggeration Index, based on all clinical cross-validation samples reported to date, is also presented.
Abstract Patients with amyotrophic lateral sclerosis (ALS) often show deficits on neuropsychological tests that tap functions related to the integrity of the prefrontal lobes. Various aspects of personality are also known to be mediated by prefrontal regions, particularly ventromedial prefrontal cortex (vmPFC). Other than apathy, personality changes have not been widely reported in patients with ALS, although clinical observations indicate such changes might be relatively common. Here, we report on a middle-aged woman with bulbar onset ALS (diagnosed 06/2011, examined in Spring, 2012) whose neuropsychological exam did not reveal cognitive deficits. She performed normally on tests of executive functioning. Self-report measures of mood and personality were unremarkable. However, significant personality changes subsequent to disease onset were reported by her husband and two daughters, and these changes were quantified with the Iowa Scales of Personality Change. Results show that personality disturbance may manifest in the absence of notable cognitive changes in ALS, and careful assessment of personality may be important for documenting early neurobehavioral changes in some ALS patients. Findings also show that patients with ALS may not have good insight into personality changes, underscoring the importance of acquiring collateral information. More generally, the results provide further evidence that ALS may compromise the integrity of ventromedial prefrontal regions. ( JINS , 2014, 20 , 1–8)
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