Functional brain imaging in neuropsychology over the past 25 years

OBJECTIVE

Outline effects of functional neuroimaging on neuropsychology over the past 25 years.

METHOD

Functional neuroimaging methods and studies will be described that provide a historical context, offer examples of the utility of neuroimaging in specific domains, and discuss the limitations and future directions of neuroimaging in neuropsychology.

RESULTS

Tracking the history of publications on functional neuroimaging related to neuropsychology indicates early involvement of neuropsychologists in the development of these methodologies. Initial progress in neuropsychological application of functional neuroimaging has been hampered by costs and the exposure to ionizing radiation. With rapid evolution of functional methods-in particular functional MRI (fMRI)-neuroimaging has profoundly transformed our knowledge of the brain. Its current applications span the spectrum of normative development to clinical applications. The field is moving toward applying sophisticated statistical approaches that will help elucidate distinct neural activation networks associated with specific behavioral domains. The impact of functional neuroimaging on clinical neuropsychology is more circumscribed, but the prospects remain enticing.

CONCLUSIONS

The theoretical insights and empirical findings of functional neuroimaging have been led by many neuropsychologists and have transformed the field of behavioral neuroscience. Thus far they have had limited effects on the clinical practices of neuropsychologists. Perhaps it is time to add training in functional neuroimaging to the clinical neuropsychologist's toolkit and from there to the clinic or bedside. (PsycINFO Database Record

Neuropsychology of Learning Disabilities: The Past and the Future

Over the past 50 years, research on children and adults with learning disabilities has seen significant advances. Neuropsychological research historically focused on the administration of tests sensitive to brain dysfunction to identify putative neural mechanisms underlying learning disabilities that would serve as the basis for treatment. Led by research on classifying and identifying learning disabilities, four pivotal changes in research paradigms have produced a contemporary scientific, interdisciplinary, and international understanding of these disabilities. These changes are (1) the emergence of cognitive science, (2) the development of quantitative and molecular genetics, (3) the advent of noninvasive structural and functional neuroimaging, and (4) experimental trials of interventions focused on improving academic skills and addressing comorbid conditions. Implications for practice indicate a need to move neuropsychological assessment away from a primary focus on systematic, comprehensive assessment of cognitive skills toward more targeted performance-based assessments of academic achievement, comorbid conditions, and intervention response that lead directly to evidence-based treatment plans. Future research will continue to cross disciplinary boundaries to address questions regarding the interaction of neurobiological and contextual variables, the importance of individual differences in treatment response, and an expanded research base on (a) the most severe cases, (b) older people with LDs, and (c) domains of math problem solving, reading comprehension, and written expression. (JINS, 2017, 23, 930-940).

A neuroscience agenda for counseling psychology research

Recent advances in the field of neuroscience have dramatically changed our understanding of brain-behavior relationships. In this article, we illustrate how neuroscience can provide a conceptual and methodological framework to understand our clients within a transdiagnostic developmental perspective. We provide directions for integrating neuroscience into future process and outcome research. We present examples on how neuroscience can be integrated into researching the effects of contextual counseling interventions. We posit that interpersonal and environmental factors, such as neurotoxic factors (e.g., emotional neglect, stress), positive neurodevelopmental factors (e.g., nurturing and caring, environmental enrichment), and therapeutic interventions influence psychological processes (executive control, behavioral flexibility, reinforcement learning and approach motivation, emotional expression and regulation, self-representation and theory of mind). These psychological processes influence brain networks (attention, motivational, emotional regulation, social cognition), which influence cognitive, social, emotional, identity, and vocational development.

Neuropsychology of migraine: present status and future directions

Migraine is recognized as a primarily neural condition. Changes in neural physiology have been consistently identified in migraineurs. Numerous studies are available that evaluate physical and functional differences between migraineurs and headache-free controls. The most prominent neuroimaging findings reported in migraine sufferers have been white matter changes. However, physical changes on neuroimaging have not been clearly correlated with functional impairment in migraineurs. The current literature addressing the neuropsychologic consequences of migraine has been far from conclusive, and reports of cognitive testing in adult migraineurs and controls has yielded inconsistent results. Neuropsychologic testing suggests that there may be some subtle but possibly significant changes in cognition that occur both during and between migraine episodes. A finding emerging with some consistency is that migraine patients with aura experience more neuropsychologic deficits than migraine patients without aura. The few studies that assess nonmigraine headache suggest that physical changes may not be unique to migraine, although neuropsychologic changes do appear to be limited to migraineurs. An examination of the unmet needs and priorities for future research addressing this important topic is provided.

Spectrum of effectiveness of valproate in neuropsychiatry

Valproate is principally effective in manic aspects of bipolar disorder. Tolerability has been somewhat more favorable for valproate than comparators, with the frequent adverse effects being gastrointestinal disturbances and weight gain. Total cholesterol and low-density lipoproteins are reduced by valproate. Valproate is effective and well tolerated when combined with lithium or antipsychotic drugs. Valproate is efficacious in mixed and euphoric mania. In studies of maintenance versus placebo and active comparators, patients initially treated with divalproex for mania had more robust long-term benefits than in the full sample analyses. In maintenance treatment, patients whose valproate serum levels were between 75 and 99 microg/ml had longer time to discontinuation for any reason or a new mood episode than did patients receiving placebo. The profile of utility in bipolar disorders is principally for core features of manic symptomatology (e.g., impulsivity, hyperactivity and irritability), with little evidence of benefit for anxiety or psychosis. Valproate appears useful in other disorders that have behavioral dimensions inclusive of the domains that valproate benefits in bipolar disorders, such as schizophrenia.

Vagus nerve stimulation for the treatment of depression and other neuropsychiatric disorders

Vagus nerve stimulation is an interesting new approach to treating neuropsychiatric diseases within the class of brain-stimulation devices sometimes labeled 'neuromodulators'. With vagus nerve stimulation, a battery-powered generator implanted in the chest wall connects to a wire wrapped around the vagus nerve in the neck, and sends intermittent pulses of electricity along the nerve directly into the brain. This mechanism takes advantage of the natural role of the vagus nerve in conveying information into the brain concerning homeostatic information (e.g., hunger, chest pain and respirations). Vagus nerve stimulation therapy is US FDA approved for the adjunctive treatment of epilepsy and has recently been FDA approved for the treatment of medication-resistant depression. Owing to its novel route into the brain, it has no drug-drug interactions or systemic side effects. This treatment also appears to have high long-term tolerability in patients, with low rates of patients relapsing on vagus nerve stimulation or becoming tolerant. However, alongside the excitement and enthusiasm for this new treatment, a lack of Class I evidence of efficacy in treating depression is currently slowing down adoption by psychiatrists. Much more research is needed regarding exactly how to refine and deliver the electrical pulses and how this differentially affects brain function in health and disease.

Developmental disorders: what can be learned from cognitive neuropsychology?

The discipline of cognitive neuropsychology has been important for informing theories of cognition and describing the nature of acquired cognitive disorders, but its applicability in a developmental context has been questioned. Here, we revisit this issue, asking whether the cognitive neuropsychological approach can be helpful for exploring the nature and causes of developmental disorders and, if so, how. We outline the key features of the cognitive neuropsychological approach, and then consider how some of the major challenges to this approach from a developmental perspective might be met. In doing so, we distinguish between challenges to the methods of cognitive neuropsychology and those facing its deeper conceptual underpinnings. We conclude that the detailed investigation of patterns of both associations and dissociations, and across both developmental and acquired cases, can assist in describing the cognitive deficits within developmental disorders and in delineating possible causal pathways to their acquisition.

A new neuropsychology for the XXI century

Regardless of the significant interest in comparing neuropsychological syndromes across cultures, little interest is observed in comparing these syndromes across time. Most of the neuropsychological syndromes were described during the late nineteenth and early twentieth century (e.g., aphasia, alexia, agraphia, acalculia, etc.). However, living conditions have so dramatically changed during the last 100 years that those classical neuropsychological syndromes have to be re-stated and reconsidered; eventually, new syndromes could be proposed. In this paper, an analysis of the impact of the new living conditions in spoken language, written language, numerical abilities, memory, spatial orientation, people recognition, and executive functions is presented. It is concluded that it is time to re-analyze and re-interpret the classical neuropsychological syndromes; and develop new assessment procedures, more in accordance with the twenty-first century living conditions.

[Neuropsychiatry as practised in a highly specialised department of a psychiatric teaching hospital: a successful interdisciplinary approach]

BACKGROUND

Psychiatric disorders can be interpreted as a general dysregulation of the interplay between brain and behaviour. This is why, since the late 1990’s, the terms biological psychiatry and behavioural neurology have been gradually replaced by the term neuropsychiatry. Neuropsychiatry, when practiced in combination with clinical neuropsychology, have given rise to a paradigm that is not based solely on the usual classification models but is directed primarily towards diagnosis and treatment that are based on a functional-dimensional approach.

AIM

To discuss the daily practice and organisation in a specialised department for neuro-psychiatry located in a psychiatric teaching hospital.

METHOD

The interdisciplinary approach is explained and analysed on the basis of 10 case studies.

RESULTS

Most of the patients referred to the specialised department already had a long history of visits to the health care facilities where they had been treated by a variety of specialists in single disciplines. Often, however, this trajectory did not involve periodical re-evaluation and updating of the original diagnosis. If this strategy had been adopted, then a clear diagnosis with simplified treatment programme might have been devised which could have resulted in a patient’s successful reintegration into society.

CONCLUSION

It is essential that the interdisciplinary approach is adopted in specialised centres for neuropsychiatry because it can make an important contribution to individual patient care and to the spread of specialised knowledge that can benefit the entire field of psychiatry.

[Clinical neuropsychology in perspective: future challenges based on current developments]

INTRODUCTION

New lines of translational, interdisciplinary research are emerging among different fields of the neurosciences, which often point at clinical neuropsychology as the hinge discipline capable of linking the basic findings with their clinical implications and thereby endow them with some meaning for phenomenological experience.

AIM

To establish the great lines of progress made in the fields of neuroscience and neuropsychology in recent years, so as to be able to foresee the strategic lines and priorities of neuroscience in the near future.

DEVELOPMENT

To achieve this aim, the first step will be to identify the changes of paradigm that have taken place in the areas of neuroscience and psychology in the last two decades. The next step will be to propose new topics and fields of application that these changes in paradigm offer and demand from neuroscience.

CONCLUSIONS

The false dichotomies of genes versus environment, mind versus brain, and reason versus emotion are considered, as are the new applications of neuropsychology to the understanding of psychopathological disorders, from the neurodegenerative to neurodevelopment, from 'dirty' drugs to cognitive and affective enhancers.

Neurocognition in schizophrenia: a study of the productivity and visibility of Spanish authors

This paper provides a map of the scientific productivity of authors affiliated to a Spanish institution and who have addressed one of the most important current topics in schizophrenia: The study of cognitive performance. A search of the Web of Science yielded 125 articles that met the inclusion criteria. In order to provide a comprehensive overview of scientific productivity, we examine several bibliometric indicators, concerning both productivity and impact or visibility. The analysis also focuses on qualitative aspects of key theoretical importance, such as the kinds of cognitive functions that are most often assessed and the tests most widely used to evaluate them in clinical practice. The study shows that interest in the subject of cognitive function in schizophrenia has increased considerably in Spain since the beginning of this century. The results also highlight the need to standardize the type of tests to be used in the cognitive assessment of patients with schizophrenia.

Future directions in the neuropsychology of epilepsy

Two important themes for future clinical research in the neuropsychology of epilepsy are proposed: (1) the neurobiological abnormalities that underlie neuropsychological impairment in people with epilepsy, and (2) neuropsychological status of persons with new-onset epilepsy.

Interview with Michael Gazzaniga

Widely considered the father of the field of cognitive neuroscience, Professor Michael S. Gazzaniga is one of the world's premier neuroscientists. He founded the Center for Neuroscience at the University of California, Davis; the Center for Cognitive Neuroscience at Dartmouth College; the Cognitive Neuroscience Institute; Journal of Cognitive Neuroscience; and the Cognitive Neuroscience Society. He is currently the director of the Sage Center for the Study of the Mind at the University of California, Santa Barbara. Born on December 12, 1939 in Los Angeles and educated at Dartmouth College, he received his Ph.D. in psychobiology at the California Institute of Technology under the tutelage of Roger Sperry. As a graduate student, Professor Gazzaniga initiated the first lateralized testing of human split-brain patients, leading to a fundamental shift in our understanding of functional lateralization in the brain and how the cerebral hemispheres communicate with one another. His many scholarly publications and pioneering work during the last 50 years have produced significant contributions to our understanding of how the brain enables the mind. His landmark 1995 book for MIT Press, The Cognitive Neurosciences, now in its fourth edition, is recognized as the sourcebook for the field. He has also published many books accessible to a lay audience, including Mind Matters, Nature's Mind, and The Ethical Brain.

The emerging architecture of neuropsychological impairment in epilepsy

A new literature is now under way, one linking cognitive abnormalities directly to indices of structural, functional, metabolic, and other neurobiologic markers of cerebral integrity, independent of their association with clinical epilepsy characteristics. These trends are reviewed in this article. The focus is on temporal lobe epilepsy (TLE) as a model with which to address the core points because this form of localization-related epilepsy has been very carefully studied from both a cognitive and imaging standpoint. Some pertinent historical issues are touched on first, followed by more detailed reviews of the cognitive and neuroimaging abnormalities that have been found in TLE, followed by an overview of studies examining direct structure-function relationships in TLE and other epilepsies.

Research in paediatric neuropsychology—past, present and future

Reviews of the research literature in a range of neurodevelopmental disorders and acquired brain injury reveal a remarkably consistent historical transition through three phases, here termed structural, theoretical and dynamic neuropsychology. Of course, any attempt to summarize such a complex and rich history using a simplistic heuristic will inevitably fail to capture the wide diversity of the research effort. Nevertheless, it is argued that looking at three distinct phases in the history of research helps to organize the field and points to possible future directions for applied research. Using examples from an eclectic range of disorders including childhood obsessive compulsive disorder, congenital hemiplegia and disorders implicating mutation of neurodevelopmental control genes, the implications for future efforts in paediatric neurorehabilitation are considered.

Cultural neuroscience and psychopathology: prospects for cultural psychiatry

There is a long tradition that seeks to understand the impact of culture on the causes, form, treatment, and outcome of psychiatric disorders. An early, colonialist literature attributed cultural characteristics and variations in psychopathology and behavior to deficiencies in the brains of colonized peoples. Contemporary research in social and cultural neuroscience holds the promise of moving beyond these invidious comparisons to a more sophisticated understanding of cultural variations in brain function relevant to psychiatry. To achieve this, however, we need better models of the nature of psychopathology and of culture itself. Culture is not simply a set of traits or characteristics shared by people with a common geographic, historical, or ethnic background. Current anthropology understands culture as fluid, flexible systems of discourse, institutions, and practices, which individuals actively use for self-fashioning and social positioning. Globalization introduces new cultural dynamics and demands that we rethink culture in relation to a wider domain of evolving identities, knowledge, and practice. Psychopathology is not reducible to brain dysfunction in either its causes, mechanisms, or expression. In addition to neuropsychiatric disorders, the problems that people bring to psychiatrists may result from disorders in cognition, the personal and social meanings of experience, and the dynamics of interpersonal interactions or social systems and institutions. The shifting meanings of culture and psychopathology have implications for efforts to apply cultural neuroscience to psychiatry. We consider how cultural neuroscience can refine use of culture and its role in psychopathology using the example of adolescent aggression as a symptom of conduct disorder.

Culture and social support: neural bases and biological impact

Social support is an effective means by which people cope with stressful events, and consequently, it beneficially affects health and well-being. Yet there are profound cultural differences in the effectiveness of different types of support and how people use their support networks. In this paper, we examine research on the impact of culture on social support, the neural underpinnings of social support, and how cultural differences in social support seeking are manifested biologically. We focus on cultural factors that may affect individuals' decisions to seek or not to seek social support and how culture moderates the impact of support seeking on biological and psychological health outcomes. We also examine recent research on the interaction between genes and culture in social support use. Discussion centers on the importance of developing an overarching framework of social support that integrates health psychology, cultural psychology, social neuroscience, and genetics.

Science of the conscious mind

Human beings have direct access to their own mental states, but can only indirectly observe cosmic radiation and enzyme kinetics. Why then can we measure the temperature of far away galaxies and the activation constant of kinases to the third digit, yet we only gauge our happiness on a scale from 1 to 7? Here we propose a radical research paradigm shift to embrace the subjective conscious mind into the realm of objective empirical science. Key steps are the axiomatic acceptance of first-person experiences as scientific observables; the definition of a quantitative, reliable metric system based on natural language; and the careful distinction of subjective mental states (e.g., interpretation and intent) from physically measurable sensory and motor behaviors (input and output). Using this approach, we propose a series of reproducible experiments that may help define a still largely unexplored branch of science. We speculate that the development of this new discipline will be initially parallel to, and eventually converging with, neurobiology and physics.

[Renewed interest in neuropsychiatry within child and adolescent psychiatry]

Child and adolescent psychiatry has existed as a subspecialty since the 1920s. In the early days its practitioners regarded observation as their main source of knowledge. In the period after 1970 the anti-psychiatric movement gained momentum, presenting a threat to child and adolescent psychiatrists. Later on, however, it was realised that the influence of the anti-psychiatry movement had been fairly limited and that the most important changes had occurred as a result of the introduction of the empirical method, which in turn has led to renewed interest in neuropsychiatry.

Geriatric neuropsychology: implications for front line clinicians

Consistent with the aging population, neuropsychologists are being asked with increased frequency to evaluate older adults. These assessments are often complicated by medical and psychiatric co-morbidities, polypharmacy, and complex psychosocial and legal issues that are frequently encountered in this population. The aim of this review article is to address the challenges neuropsychologists and other frontline clinicians often confront when evaluating older individuals. Specifically, we review psychiatric and medical co-morbidities, testing accommodations, diagnostic versus descriptive testing approaches, normative issues, polypharmacy, and reimbursement rates. Finally, future implications are discussed for advancing the neuropsychologist's role in evaluating and treating older individuals.

[On the reunion between neurology and psychiatry. An old neuropsychiatrist's reflections]

What appears in this article is nothing more than a series of reflections on psychiatry and neurology based on my own experience as an educator, practitioner and scholar of both disciplines. It is not, therefore, a piece of research work in the usual sense of the word. Such has been my commitment to Revista de Neurologia that I was asked to analyse the current situation of neurology and psychiatry and the possible relations between them, and the editors have accepted this way of studying the matter.

An Internet-based symptom questionnaire that is reliable, valid, and available to psychiatrists, neurologists, and psychologists

The Neuropsych Questionnaire (NPQ) addresses 2 important clinical issues: how to screen patients for a wide range of neuropsychiatric disorders quickly and efficiently, and how to acquire independent verification of a patient's complaints. The NPQ is available over the Internet in adult and pediatric versions. The adult version of the NPQ consists of 207 simple questions about common symptoms of neuropsychiatric disorders. The NPQ scores patient and/or observer responses in terms of 20 symptom clusters: inattention, hyperactivity-impulsivity, learning problems, memory, anxiety, panic, agoraphobia, obsessions and compulsions, social anxiety, depression, mood instability, mania, aggression, psychosis, somatization, fatigue, sleep, suicide, pain, and substance abuse. The NPQ is reliable (patients tested twice, patient-observer pairs, 2 observers) and discriminates patients with different diagnoses. Scores generated by the NPQ correlate reasonably well with commonly used rating scales, and the test is sensitive to the effects of treatment. The NPQ is suitable for initial patient evaluations, and a short form is appropriate for follow-up assessment. The availability of a comprehensive computerized symptom checklist can help to make the day-to-day practice of psychiatry, neurology, and neuropsychology more objective.

Neuropsychology: traditional and new methods of investigation

The neuropsychological assessment is an integral part of the clinical investigation of patients suffering from epilepsy. The aim of the evaluation is to determine disease-related and treatment-related effects on cognition and behavior in order to orient therapeutic interventions, by taking into account the compensatory mechanisms that are available to the patient. Examples of the tests best illustrating the classical neuropsychological protocol are presented. Neuropsychology also plays an important role in the assessment of language lateralization in patients slated for epilepsy surgery. Traditionally, this has been achieved by means of the rather invasive Wada procedure. However, with the advent of new neuroimaging techniques, this procedure is gradually being replaced by minimally invasive or noninvasive methods, such as functional magnetic resonance imaging, positron emission tomography, and optical imaging. In the present paper, we discuss some of the newer techniques that are available to the neuropsychologist for the study of the impact of epilepsy on cerebral functioning.

Cognitive rehabilitation in the elderly: overview and future directions

This study provides an overview of the papers emanating from the experimental trial that evaluated a new cognitive rehabilitation program in older adults who were experiencing normal cognitive decline. The main features of the design are summarized, along with evidence that the training produced long-lasting improvement in memory performance, goal management, and psychosocial status. The benefits were attributed to several factors, including the program's emphasis on techniques that promoted efficient strategic processing. Limitations of the program and directions for future research are discussed.

Glycosylated neuropeptides: a new vista for neuropsychopharmacology?

The application of endogenous neuropeptides (e.g., enkephalins) as analgesics has been retarded by their poor stability in vivo and by their inability to effectively penetrate the blood-brain barrier (BBB). Effective BBB transport of glycosylated enkephalins has been demonstrated in several labs now. Analgesia (antinociception) levels greater than morphine, and with reduced side effects have been observed for several glycopeptides related to enkephalin. Somewhat paradoxically, enhanced BBB transport across this lipophilic barrier is achieved by attaching water-soluble carbohydrate groups to the peptide moieties to produce biousian glycopeptides that can be either water-soluble or membrane bound. Transport is believed to rely on an endocytotic mechanism (transcytosis), and allows for systemic delivery and transport of the water-soluble glycopeptides. Much larger endorphin/dynorphin glycopeptide analogs bearing amphipathic helix address regions also have been shown to penetrate the BBB in mice. This holds forth the possibility of transporting much larger neuropeptides across the BBB, which may encompass a wide variety of receptors beyond the opioid receptors.

Coalescence of psychiatry, neurology, and neuropsychology: from theory to practice

In a climate of renewed interest in the synergy between neurology and psychiatry, practitioners are increasingly recognizing the importance of exchange and collaboration between these two disciplines. However, there are few working models of interdisciplinary teams that freely share expertise in real time, while providing clinical and academic training to future physicians who specialize in the central nervous system. Over the past 11 years, the McLean Hospital Neuropsychiatry and Behavioral Neurology service has provided proof-of-principle for such collaboration, demonstrating that a team comprising psychiatrists, neurologists, and neuropsychologists can function effectively as a unit while maintaining the autonomy of these three disciplines and also synthesizing their combined knowledge. In addition to delivering enhanced patient care and promoting medical research, this clinical service has provided enriched cross-specialty training for fellows, residents, and medical students. The practical functioning of the team is described, and case vignettes are presented to illustrate the team's collaborative synergism in practice.

Cortical control of motor sequences

The neural substrate of sequence learning is well known. However, we lack a clear understanding of the detailed functional properties of many of the areas involved. The reason for this discrepancy lies, in part, in the fact that two types of processes, implicit and explicit, subserve motor sequence learning, and these often interact with each other. The most significant recent advances have been the elucidation of the very complex relationships between medial motor areas and the temporal and ordinal control of sequences, and the demonstration that motor cortex is an important site for sequence storage and production. The challenge for the future will be to develop a coherent and internally consistent theory of sequence control.

The multi-component model of working memory: Explorations in experimental cognitive psychology

There are a number of ways one can hope to describe and explain cognitive abilities, each of them contributing a unique and valuable perspective. Cognitive psychology tries to develop and test functional accounts of cognitive systems that explain the capacities and properties of cognitive abilities as revealed by empirical data gathered by a range of behavioral experimental paradigms. Much of the research in the cognitive psychology of working memory has been strongly influenced by the multi-component model of working memory [Baddeley AD, Hitch GJ (1974) Working memory. In: Recent advances in learning and motivation, Vol. 8 (Bower GA, ed), pp 47-90. New York: Academic Press; Baddeley AD (1986) Working memory. Oxford, UK: Clarendon Press; Baddeley A. Working memory: Thought and action. Oxford: Oxford University Press, in press]. By expanding the notion of a passive short-term memory to an active system that provides the basis for complex cognitive abilities, the model has opened up numerous questions and new lines of research. In this paper we present the current revision of the multi-component model that encompasses a central executive, two unimodal storage systems: a phonological loop and a visuospatial sketchpad, and a further component, a multimodal store capable of integrating information into unitary episodic representations, termed episodic buffer. We review recent empirical data within experimental cognitive psychology that has shaped the development of the multicomponent model and the understanding of the capacities and properties of working memory. Research based largely on dual-task experimental designs and on neuropsychological evidence has yielded valuable information about the fractionation of working memory into independent stores and processes, the nature of representations in individual stores, the mechanisms of their maintenance and manipulation, the way the components of working memory relate to each other, and the role they play in other cognitive abilities. With many questions still open and new issues emerging, we believe that the multicomponent model will continue to stimulate research while providing a comprehensive functional description of working memory.

Uniquely human social cognition

Recent data identify distinct components of social cognition associated with five brain regions. In posterior temporal cortex, the extrastriate body area is associated with perceiving the form of other human bodies. A nearby region in the posterior superior temporal sulcus is involved in interpreting the motions of a human body in terms of goals. A distinct region at the temporo-parietal junction supports the uniquely human ability to reason about the contents of mental states. Medial prefrontal cortex is divided into at least two subregions. Ventral medial prefrontal cortex is implicated in emotional empathy, whereas dorsal medial prefrontal cortex is implicated in the uniquely human representation of triadic relations between two minds and an object, supporting shared attention and collaborative goals.

Motor Development and Neuropsychological Patterns in Persons with Down Syndrome

Neuropsychological research has permitted defining specific cognitive profiles among individuals with mental retardation (MR) of different etiology. Namely, the cognitive profile of people with Down syndrome (DS) is often reported to be characterized by a deficit in language abilities that usually exceed impairments in visual-spatial capacities. However, recent studies have demonstrated a more complex neuropsychological profile in this population, with atypical development in the cognitive and in the linguistic domain. This paper is dedicated to reviewing literature regarding motor, linguistic and cognitive abilities in DS. Our aim is to present evidences supporting the hypothesis that individuals with these syndrome exhibit a peculiar motor development and neuropsychological profile with some abilities more preserved and others more impaired. This finding may have theoretical and practical implications. In fact, a better definition of the cognitive pattern in DS may contribute to understand the nature of MR in general and, also, it may suggests individualized rehabilitation treatment protocols.

[Novel advances in neuropsychology--forward to the "deconstruction" of psychiatry]

Neuropsychology has recently become a science which deals not only with instrumental disorders (e.g., aphasia, apraxia, and agnosia), but also with impairments of interpersonal relationships (e.g., emotional cognitions, social decision making, and understanding others), and many important paradigms are already provided. We could enumerate several representative instances: (1)application of the "theory of mind" to autistic or related disorders (-->"reasoning of psychological state of others"), (2) neuropsychological studies on the "social brain" concerning emotional recognition or social recognition (-->"amygdale, orbitofrontal cortex, and medial ventral frontal cortex"), (3) identifying related cerebral areas (-->"superior temporal sulcus") to detect eye or body movements of others, (4) discovering the mirror neuron and mirror systems in monkeys and humans (-->"imitation of the behavior of others in the brain"), and (5) intracerebral processes which may occur precedent to conscious intention (-->"consciousness as post-hoc phenomena"). These novel paradigms might lead us to the "deconstruction" of psychiatry. We believe that the fundamental assignments of neuropsychology should inquire into "cognitive representation", "conscious representation", and "cerebral representation" about the inner processes of human activities. As these assignments would be almost the same for the psychiatric symptoms, we do not have any necessity to fundamentally distinguish psychiatric and neuropsychologial symptoms. These two kinds of signs will be attributed finally to the same dimension. The specificity of psychiatry resides in "conscious representation" and its cerebral foundations. We reconsidered the "Theory of Neural Group Selection" proposed by Edelman and the excellent experimental results on the relationship between intention and movements reported by Libet, et al.. All these results strongly indicate the absolute necessity to reconsider conscious causality and psychogenesis. Finally, we have presented two main neuropsychological hypotheses on the manifestation mechanism of Capgras syndrome. These are the "mirror impairment of prosopagnosia" hypothesis and the "self-other confusion resulting from right hemisphere dysfunction" hypothesis. We insisted on the importance of the right cerebral predominance hypothesis about self-other understanding processes and also the absolute necessity to shake ourselves free from language dependent consciousness theory. Common specificity in neuropsychology and psychiatry should be converged to, and symbolized by the novel concept of sociality, which is characterized for instance by emotional cognition or social decision making supported by the social brain and by shared cerebral representations for self-other understanding and consciousness processes.

Method matters: an empirical study of impact in cognitive neuroscience

A major thrust of cognitive neuroscience is the elucidation of structure-function relationships in the human brain. Over the last several years, functional neuroimaging has risen in prominence relative to the lesion studies that formed the historical core of work in this field. These two methods have different strengths and weaknesses. Among these is a crucial difference in the nature of evidence each can provide. Lesion studies can provide evidence for necessity claims, whereas functional neuroimaging studies do not. We hypothesized that lesion studies will continue to have greater scientific impact even as the relative proportion of such studies in the cognitive neuroscience literature declines. Using methods drawn from systematic literature review, we identified a set of original cognitive neuroscience articles that employed either functional imaging or lesion techniques, published at one of two time points in the 1990s, and assessed the effect of the method used on each article's impact across the decade. Functional neuroimaging studies were cited three times more often than lesion studies throughout the time span we examined. This effect was in large part due to differences in the influence of the journals publishing the two methods; functional neuroimaging studies appeared disproportionately more often in higher impact journals. There were also differences in the degree to which articles using one method cited articles using the other method. Functional neuroimaging articles were less likely to include such cross-method citations.

Pushing the frames of reference in traumatic brain injury rehabilitation

Cognitive rehabilitation is an empirically based field driven by multiple sources of activities and knowledge bases. Drawing on frames of reference provided by rehabilitation, neuropsychology, and rehabilitation psychology, cognitive rehabilitation has evolved to a point where studies have been generated to qualify for consideration in tables of evidence. At the center of cognitive rehabilitation is the effort to teach people to overcome or adapt to limitations. While rehabilitation has traditionally been focused on activity, a recent trend in the literature is to incorporate the individuals experience into a frame of reference for rehabilitation. Emphasizing the experience of the person in the situation fits into cognitive rehabilitation and raises the bar for rehabilitation not only in viewing rehabilitation as an activity to relieve burdens but also in terms of how rehabilitants come to grips with limitations. Dealing with limitations is an important indicator of mental health.

Current trends in the reimbursement of professional neuropsychological services

Professional members of the National Academy of Neuropsychology (NAN) completed a survey focusing on clinicians' time requirements for activities, number of yearly claims to funding sources, average reimbursement rates, reimbursement rates associated with specific current procedural terminology (CPT) codes, managed care tolerance, hourly reimbursement rates, and other relevant practice issues such as incident-to. Clinicians continue to offer neuropsychological services through traditional assessment and evaluation activities, receive referrals from other healthcare professionals (i.e., neurologists, other medical specialists), and answer traditional referral questions related to patient diagnoses and determination of neuropsychological deficits. Two-thirds of respondents disapprove of managed care, and clinicians engage in activities which appear to minimize the ongoing changes in, and detrimental effects of, managed-care-based funding, in the form of dropping managed care panels, opting for fee-for-service, requiring self-pay patients, or spending more time in clinical activities for which there is a higher percentage of time approved such as forensic evaluations and evaluations for private practice. Clinicians continue to rely on managed care for their referrals even though they are only being reimbursed at about 50%. Overall, across service providers, clinicians are only receiving 60% of their hourly rate, and only 22% report receiving full compensation for their hourly rate. These results suggest that the effects of managed care have, for better or worse, altered the practice of clinical neuropsychology.