"Brain-Specific" Nutrients: A Memory Cure?

We review the experimental evaluations of several widely marketed nonprescription compounds claimed to be memory enhancers and treatments for age-related memory decline. We generally limit our review to double-blind placebo-controlled studies. The compounds examined are phos-phatidylserine (PS), phosphatidylcholine (PC), citicoline, piracetam, vinpocetine, acetyl-L-carnitine (ALC), and antiox-idants (particularly vitamin E). In animals, PS has been shown to attenuate many neuronal effects of aging, and to restore normal memory on a variety of tasks. Preliminary findings with humans, though, are limited. For older adults with probable Alzheimer's disease, a single study failed to demonstrate positive effects of PS on memory performance. For older adults with moderate cognitive impairment, PS has produced consistently modest increases in recall of word lists. Positive effects have not been as consistently reported for other memory tests. There is one report of consistent benefits across a number of memory tests for a subset of normal adults who performed more poorly than their peers at baseline. The choline compounds PC and citicoline are thought to promote synthesis and transmission of neurotransmitters important to memory. PC has not proven effective for improving memory in patients with probable Alzheimer's disease. The issue remains open for older adults without serious degenerative neural disease. Research on citicoline is practically nonexistent, but one study reported a robust improvement in story recall for a small sample of normally aging older adults who scored lower than their peers in baseline testing. Animal studies suggest that piracetam may improve neuronal efficiency, facilitate activity in neurotransmitter systems, and combat the age-related decrease in receptors on the neuronal membrane. However, for patients with probable Alzheimer's disease, as well as for adults with age-associated memory impairment, there is no clear-cut support for a mnemonic benefit of piracetam. Vinpocetine increases blood circulation and metabolism in the brain. Animal studies have shown that vinpocetine can reduce the loss of neurons due to decreased blood flow. In three studies of older adults with memory problems associated with poor brain circulation or dementia-related disease, vinpocetine produced significantly more improvement than a placebo in performance on global cognitive tests reflecting attention, concentration, and memory. Effects on episodic memory per se have been tested minimally, if at all. ALC participates in cellular energy production, a process especially important in neurons, and in removal of toxic accumulation of fatty acids. Animal studies show that ALC reverses the age-related decline in the number of neuron membrane receptors. Studies of patients with probable Alzheimer's disease have reported nominal advantages over a range of memory tests for ALC-treated patients relative to placebo groups. Significant differences have been reported rarely, however. Whether ALC would have mnemonic benefits for aging adults without brain disease is untested as far as we know. Antioxidants help neutralize tissue-damaging free radicals, which become more prevalent as organisms age. It is hypothesized that increasing antioxidant levels in the organism might retard or reverse the damaging effects of free radicals on neurons. Thus far, however, studies have found that vitamin E does not significantly slow down memory decline for Alzheimer's patients and does not produce significant memory benefits among early Parkinson's patients. Neither did a combination of vitamins E and C significantly improve college students' performance on several cognitive tasks. In sum, for most of the "brain-specific" nutrients we review, some mildly suggestive effects have been found in preliminary controlled studies using standard psychometric memory assessments or more general tests designed to reveal cognitive impairment. We suggest that future evaluations of the possible memory benefits of these supplements might fruitfully focus on memory processes rather than on memory tests per se.

Clinical assessment

Are clinical psychologists' assessment practices cost-effective? Are they scientifically sound? Are they fair and unbiased? Financial pressures from managed care interests, recent developments in the law, and multicultural issues are forcing the profession to confront these hard questions regarding accountability. Our review discusses the important changes that have begun to alter the field of personality assessment and describes recent research on clinical judgment and its implications for the future. We conclude that clinical psychology can adapt to future conditions by developing assessment strategies that are economical, scientifically sound, and culturally sensitive.

Rationality

This chapter reviews selected findings in research on reasoning, judgment, and choice and considers the systematic ways in which people violate basic requirements of the corresponding normative analyses. Recent objections to the empirical findings are then considered; these objections question the findings' relevance to assumptions about rationality. These objections address the adequacy of the tasks used in the aforementioned research and the appropriateness of the critical interpretation of participants' responses, as well as the justifiability of some of the theoretical assumptions made by experimenters. The objections are each found not to seriously impinge on the general conclusion that people often violate tenets of rationality in inadvisable ways. In the process, relevant psychological constructs, ranging from cognitive ability and need for cognition, to dual process theories and the role of incentives, are discussed. It is proposed that the rationality critique is compelling and rightfully gaining influence in the social sciences in general.

An examination of interrater reliability for scoring the Rorschach Comprehensive System in eight data sets

In this article, we describe interrater reliability for the Comprehensive System (CS; Exner. 1993) in 8 relatively large samples, including (a) students, (b) experienced re- searchers, (c) clinicians, (d) clinicians and then researchers, (e) a composite clinical sample (i.e., a to d), and 3 samples in which randomly generated erroneous scores were substituted for (f) 10%, (g) 20%, or (h) 30% of the original responses. Across samples, 133 to 143 statistically stable CS scores had excellent reliability, with median intraclass correlations of.85, .96, .97, .95, .93, .95, .89, and .82, respectively. We also demonstrate reliability findings from this study closely match the results derived from a synthesis of prior research, CS summary scores are more reliable than scores assigned to individual responses, small samples are more likely to generate unstable and lower reliability estimates, and Meyer's (1997a) procedures for estimating response segment reliability were accurate. The CS can be scored reliably, but because scoring is the result of coder skills clinicians must conscientiously monitor their accuracy.

A brief screening tool for suicidal symptoms in adolescents and young adults in general health settings: reliability and validity data from the Australian National General Practice Youth Suicide Prevention Project

Using data from a nationwide project on young people in Australia aimed at assessing suicidality in general health settings, we present a brief screening tool for suicidality (the depressive symptom index suicidality subscale). Two thousand eight hundred and fifty-one (15-24 year old) patients presenting to 247 Australian general practitioners between 1996 and 1998 were assessed. In addition to the suicide screen, patients completed the general health questionnaire-12 and the Center for Epidemiological Studies depression scale. Patients' chief complaints were taken from the summary sheets completed by their general practitioners. Using inter-item correlational and factor-analytic techniques, as well as a general approach to construct validity, we show that the measure has favorable reliability and validity characteristics. We also provide results on cut-points that may facilitate its use in clinical and research settings. Because the screen is brief, easy to use, reliable, and valid, we encourage its use to combat the vexing international health problem of suicide.

Traps in the route to models of memory and decision

It is proposed that the products of investigations of learning, memory, and decision over the last half century that are most likely to endure have resulted from interactions between models and experimental research. In this article, some of the traps that must be coped with to make fruitful interactions possible are examined and illustrated with case studies from research on probability learning, category learning, and recognition memory. Topics addressed include functions of models in research; the logic of model testing; fitting models to signal plus noise; values and hazards of averaging data; and potential contributions of neural science to the development of cognitive models.

Diagnostic utility of the Learning Disability Index

The Learning Disability Index (LDI) is one of many diagnostic indicators proposed for the identification of students with learning disabilities that relies on patterns of performance on cognitive tests. The LDI is hypothesized to relate to students' specific neuropsychological deficits. The present study investigated the diagnostic utility of the LDI with the third edition of the Wechsler Intelligence Scale for Children by comparing students previously diagnosed with learning disabilities (n = 2,053) to students without learning disabilities (n = 2,200). Subsamples of youth with specific reading (n = 445) and math (n = 168) disabilities permitted further assessment of the efficacy of the LDI. Receiver operating characteristic (ROC) curves revealed that the LDI resulted in a correct diagnostic decision only 55% to 64% of the time. These results demonstrate that the LDI is not a valid diagnostic indicator of learning disabilities.

Exploring possible ethnic differences and bias in the Rorschach Comprehensive System

In this study I conducted a series of analyses to explore potential ethnic bias in Rorschach Comprehensive System variables using a consecutive series of 432 patients evaluated in 1 setting. The simple association between 188 scores and ethnicity revealed no significant findings after matching on several salient demographic variables. Next, 17 analyses of convergent validity found no evidence for differential validity and no evidence for slope bias. For 13 analyses, there was also no evidence for intercept bias. However, with 4 variables predicting psychotic disorders, regression lines favored minorities and worked against European Americans. These findings are the opposite of what should be seen if the Rorschach was biased against minorities and most likely emerged for statistical reasons related to unmeasured confounds. Finally, principal components analyses revealed no evidence of ethnic bias in the Rorschach's internal structure. Although these findings need to be replicated, the available data support using the Comprehensive System across ethnic groups.

The hard science of Rorschach research: what do we know and where do we go?

As the final article in the Special Series on "The Utility of the Rorschach for Clinical Assessment," the authors provide an overview of this instrument's current status. They begin with a thorough review of global and focused meta-analyses, including an expanded analysis of K. C. H. Parker, R. K. Hanson, and J. Hunsley's (1988) data set, and conclude that Rorschach, Minnesota Multiphasic Personality Inventory, and IQ scales each produce roughly similar effect size magnitudes, although all tests have greater validity for some purposes than for others. Because this evidentiary foundation justifies addressing other issues, the authors build on contributions to the Special Series to identify 11 salient theoretical and empirical gaps in the Rorschach knowledge base and make recommendations for addressing these challenges to further the evolution of the Rorschach and document its strengths and inherent limitations.

The development of Israeli children's images of Jews and Arabs and their expression in human figure drawings

The development of images of "a Jew" and "an Arab" in Jewish Israeli children who were 4-15 years of age was investigated by means of human figure drawings followed by the administration of questionnaires. The drawings were scored on structural and thematic variables. The questionnaires assessed beliefs and intentions. The hypotheses predicted a differential perception of in- and out-groups and peaks in negativity toward the out-group at preschool age and in early adolescence. Results indicate that, irrespective of age, Jewish Israeli children have generalized images of the two ethnic groups. Preschoolers expressed both positive biases toward the in-group and negativism toward the out-group. and early adolescents manifested mainly negative biases toward the out-group. Children in middle childhood and mid-adolescents manifested reductions in both in-group favoritism and out-group negativity.

The use of phase in the detection of auditory steady-state responses

OBJECTIVE

To investigate how phase measurements might facilitate the detection of auditory steady-state responses.

METHODS

Multiple steady-state responses were evoked by auditory stimuli modulated at rates between 78 and 95 Hz and with intensities between 50 and 0 dB SPL. The responses were evaluated in 20 subjects after 1, 2, 4, and 6 min. The responses were analyzed in the frequency domain using 4 different detection protocols: (1) phase-coherence, (2) phase-weighted coherence, (3) F test for hidden periodicity, and (4) phase-weighted t test. The phase-weighted measurements were either based on the mean phase of a group of normal subjects or derived for each subject from the phase of the response at higher intensities.

RESULTS

Detection protocols based on both phase and amplitude (F test and phase-weighted t test) were more effective than those based on phase alone (phase coherence and phase-weighted coherence) although the difference was small. Protocols using phase-weighting were more effective than those without phase-weighting. The lowest thresholds for the steady-state responses were obtained using the phase-weighted t test.

CONCLUSION

Threshold detection can be improved by weighting the detection protocols toward an expected phase, provided that the expected phase can be reliably predicted.

Problems for judgment and decision making

This review examines recent developments during the past 5 years in the field of judgment and decision making, written in the form of a list of 16 research problems. Many of the problems involve natural extensions of traditional, originally rational, theories of decision making. Others are derived from descriptive algebraic modeling approaches or from recent developments in cognitive psychology and cognitive neuroscience.

Rationality in medical decision making: a review of the literature on doctors' decision-making biases

The objectives of this study were to describe ways in which doctors make suboptimal diagnostic and treatment decisions, and to discuss possible means of alleviating those biases, using a review of past studies from the psychological and medical decision-making literatures. A number of biases can affect the ways in which doctors gather and use evidence in making diagnoses. Biases also exist in how doctors make treatment decisions once a definitive diagnosis has been made. These biases are not peculiar to the medical domain but, rather, are manifestations of suboptimal reasoning to which people are susceptible in general. None the less, they can have potentially grave consequences in medical settings, such as erroneous diagnosis or patient mismanagement. No surefire methods exist for eliminating biases in medical decision making, but there is some evidence that the adoption of an evidence-based medicine approach or the incorporation of formal decision analytic tools can improve the quality of doctors' reasoning. Doctors' reasoning is vulnerable to a number of biases that can lead to errors in diagnosis and treatment, but there are positive signs that means for alleviating some of these biases are available.

In search of realistic optimism. Meaning, knowledge, and warm fuzziness

Is it better to be realistic or optimistic? A realistic outlook improves chances to negotiate the environment successfully, whereas an optimistic outlook places priority on feeling good. But are realistic and optimistic outlooks necessarily in conflict? The author suggests that the fuzzy nature of accuracy typically places only loose boundaries on what it means to be realistic. As a result, there are many forms of optimism that do not, in principle, yield unrealistic assessments. Nevertheless, there remain numerous "optimistic biases" that do involve self-deception, or convincing oneself of desired beliefs without appropriate reality checks. The author describes several ways that realistic and unrealistic optimism can be differentiated and explores the impact of this distinction for current views of optimism. This critique reveals how positive psychology may benefit from a focus on personal meaning and knowledge as they relate to making the most of life.

Psychological tests used in child custody evaluations

Controversy has long surrounded the use of psychological testing in child custody evaluations. The present study explored the current status of psychological testing in these evaluations using a national survey of 198 psychologists. Findings revealed that participants viewed testing as one source among many for data collection, neither under- nor over-valuing its importance. Results also indicated that participants were more discriminating in their test selection, with a greater focus on objective assessment, particularly in the use of parent inventories and rating scales. These findings tend to negate much of the past criticism and reflect closer adherence to APA guidelines.