Archives of Clinical Neuropsychology 20 (2005) 805–950 Abstracts National Academy of Neuropsychology Abstracts from the 25th Annual Meeting, Tampa, Florida October 19–22, 2005 Convention Abstracts Accepted under the Guest Editorship of T. Andrew Zabel (PhD) Kennedy Krieger Institute John Hopkins University School of Medicine Members of the 2005 NAN Poster Program Committee: John Bayless E. Mark Mahone Leigh Beglinger Roy Martin Lynn Blackburn Thomas Martin Jeffrey Browndyke Stephen Moelter Thomas Burns Judith O’Jile Shane Bush Cynthia Salorio Kevin Duff Mark Sandberg David Erlanger Mike Schoenberg Phillip Fastenau Mark Sherer Tania Giovannetti Matthew Thompson Frank Hillary Rodney Vanderploeg Paul Jones Frank Webbe Carrie Kennedy Timothy Wynkoop Gregory Lee Assistant to the Editor Christopher Vaughan 0887-6177/$ – see front matter doi:10.1016/j.acn.2005.06.001 806 Abstracts / Archives of Clinical Neuropsychology 20 (2005) 805–950 ADULT GRAND ROUNDS Moderator: Rick Naugle AGR1 Reversible frontotemporal dementia: verbal fluency content says it all Walker LA, de Meulemeester C A 55-year-old gentleman (M.M.) presented with the cognitive and behavioural profile typically observed in frontotemporal dementia in the context of a diagnosis of spontaneous intracranial hypotension (SIH). Objective: Our goal is to expand upon the only other case report in the literature with this presentation of SIH (Hong et al., 2002), particularly with regard to useful assessment tools, and to illustrate that early diagnosis and treatment can hasten and maximize recovery of cognitive functions. Method: M.M. was healthy until 8 weeks prior to admission to the Neurology in-patient service. Symptoms then included severe orthostatic headache, as well as cognitive and personality changes. Diagnostic investigations included CT, EEG, and MRI (documenting pachymeningitis). He underwent neuropsychological evaluations both prior to, and following, treatment with a tapering dose of corticosteroids. Results: The initial neuropsy- chological evaluation documented significant cognitive impairment with a predominance of executive dysfunction. Following treatment a second evaluation revealed a marked improve- ment in both cognition and behaviour, such that most aspects of functioning reached estimated pre-morbid levels. Conclusions: Discussion highlights the utility of using both quantitative and qualitative measures of executive functioning. Regarding the latter, it is emphasized that process variables (e.g., verbal fluency content) can often be similarly revealing as normative- based comparisons in terms of their ability to reflect underlying dysfunction. The need for rapid diagnosis and treatment of SIH to yield a favourable cognitive and behavioural outcome is also discussed. AGR2 Neuropsychological and neuropsychiatric manifestations of acute and recovered Cush- ing’s disease Sarazin F, Antochi R Objective: Cushing’s disease (CD) has been associated with a variety of neurocognitive and psychiatric manifestations. While gradual improvement occur after treatment and return of cortisol levels to normal, residual cognitive sequelae may remain. Given the dearth of longitu- dinal studies, these have yet to be described. The present case report delineates neurocognitive and neuropsychiatric manifestations during acute CD and following recovery. Method: This is a single case study of a 42-year-old premorbidly high functioning elementary teacher with no prior psychiatric history diagnosed with CD following two years of gradual CD-related changes in health and physical appearance. Despite initial treatment with transphenoidal hypophysectomy, hypercortisolemia with its associated medical and psychiatric complica- tions persisted. She derived limited benefit from psychotropic medication and subsequently underwent bilateral adrenalectomy. Neuropsychological assessments were conducted pre- and post-adrenalectomy. Results: Significant pre-surgical cognitive deficits were documented in complex attention, speed of processing, expressive language, visuoconstruction, visual orga- Abstracts / Archives of Clinical Neuropsychology 20 (2005) 805–950 807 nization, abstraction, problem solving, executive functions, memory, and learning. Verbal and visual abilities were equally affected. Six months post-adrenalectomy, higher mental functions had significantly improved to generally within high average and superior ranges. Residual mild–moderate deficits persisted in visual memory and learning, visual planning and complex visuoconstruction, as well as attention under conditions of interference. Psychotropic medica- tion was no longer required and psychiatric symptoms had completely resolved. Conclusion: Neurocognitive and neuropsychiatric changes associated with sustained hypercortisolemia are reversible with stabilization of cortisol. In this single case report, residual cognitive sequelae were highly circumscribed, self-limiting, and reflected greater visual processing deficits. AGR3 TBA FORENSIC GRAND ROUNDS Moderator: Robert L. Denney FGR1 Competency assessment guideline based on a case of someone found permanently incom- petent from dementia who was later found not to have dementia Stewart R, Vega J Objective: To suggest evaluation guideline based on a case of someone found permanently incompetent due to dementia (with charges dropped) who, two years later following another charge, was found not to have dementia. Method: Mr B was charged with drug and driving vio- lations in January of 2000 after a traffic accident. He had four evaluations in 2000 and 2001, and was found permanently incompetent in 2002. After new charge in 2004 he was found incompetent based on previous evaluations. Previous and current evaluations are compared. Results: The previous evaluators (MDs, PhD) performed outpatient evaluations without sig- nificant other interview and with some, but not comprehensive, cognitive or effort assessment. While scores were poor (such as a Mini Mental State of 16), some were so poor as to suggest effort problems (2 of 50 on the CAST-MR). Effort/malingering tests were not given. In 2004 he was admitted to a forensic hospital. Effort tests showed good effort, he had a Mini Mental State of 30, and some minor cognitive problems. In the state where this evaluation was done (Colorado) funding for competency evaluations is limited. Conclusion: Results would suggest that (a) significant other interviews be incorporated for outpatient evaluations; (b) atypical patterns prompt a recommendation for more thorough and/or inpatient assessment including a standard neuropsychological test battery; (c) effort tests be given when cognitive problems are a cause of the incompetency. FGR2 Chronic fatigue syndrome and alexithymia: a multiplicative interaction Schutz LE, Schutz JA Objective: Chronic fatigue syndrome, once regarded as a dubious taxon, is accepted by NIH and addressed by a growing neuropsychological literaure. British neurologists call it myalgic 808 Abstracts / Archives of Clinical Neuropsychology 20 (2005) 805–950 encephalomyelitis. It is a diagnosis of exclusion of, among others, affective and somatoform disorders. Because the condition creates unusual vulnerability to exertion and stimulation, valid behavioral presentations can include a wide range of unusual symptom patterns. Method: A full neuropsychological IME was conducted at the patient’s home at the carrier’s request. Results: This case met CDC criteria, with disabling fatigue, weakness, irritability, headache, photophobia, and marked loss of recent memory and attention shown on alternate forms read- ministered late in sessions. This attorney had been receiving disabilty benefits for 15 years, while home-schooling two young, disabled daughters. She showed striking symptom variabil- ity, progressing to and then recovering fully from marked, dramatic symptomatology across 4-h sessions, contradicting her self-report. Her inconsistency, in context of potential secondary gains, raised concerns about symptom validity. Conclusions: The CARB, TOMM, MMPI-2, and close observations instead depict a markedly driven, lifelong alexithymic coping style of investing extreme effort whenever possible. This pattern is known to aggravate chronic pain disorders, and in this case aggravated her fatigue and consequent cognitive impairment and physical disability. Self-insight was virtually nil. The insurer’s in-house neuropsychologist concurred, describing the behavior as “a fascinating pattern I have never seen in many years and thousands of cases.” FGR3 Forensic evaluation of a mold (repeated water intrusions) neurotoxicity case Singer RM Objective: The scientific literature supports the possibility of neurotoxicity with extended exposure to repeated indoor water intrusions and mold development. This case expands the existing literature and demonstrates a method for presenting forensic neuropsychological data. Method: A 54-year-old woman, with two children and 14 years of marriage, divorced after the onset of her illness, had successfully owned and managed two businesses, and was actively self-employed at the time of examination, albeit at a reduced level of function. After relocation to a domicile subject to repeated water intrusions from a poorly designed roof and periodic ground flooding, she developed pain, difficulty with concentration and memory, headaches, light sensitivity, sleep disorder, depression, and weight gain. Visible mold, and mold counts elevated more than three times the recommended limit at more than one site in the domicile were found, including