Objective Hoarding disorder (HD) is an often incapacitating psychiatric illness associated with a wide range of neurocognitive abnormalities. Some prior neuropsychological studies have found executive dysfunction in HD, but no clear pattern has emerged. One potential reason for discrepant results in previous studies might be the inclusion of patients on psychotropic and other medications that can affect neurocognitive performance. Therefore, we examined neurocognitive functioning in medication-free HD patients. We also added a novel investigation of implicit learning, which has been found to be abnormal in obsessive-compulsive disorder (OCD) and related disorders. Method 26 participants meeting DSM-5 diagnostic criteria for HD and 23 normal controls were administered a battery of neuropsychological tests and symptom rating scales. All participants were free of psychotropic medications for at least six weeks prior to the study. Results HD participants showed no significant differences from normal controls on measures of verbal memory, attention, or executive functioning, including response inhibition, planning, organization, and decision-making. However, HD participants demonstrated a trend toward less implicit learning and greater use of explicit learning strategies during perceptual categorization, compared to normal controls. HD participants who used an implicit strategy performed significantly worse than controls who used an implicit strategy. Hoarding symptom severity was not associated with neurocognitive performance. Conclusions HD patients may have a tendency to use explicit rather than implicit learning strategies for perceptual categorization but perform as well as normal controls on many other neurocognitive measures. Future studies should assess unmedicated participants and examine test strategies, not just outcomes.

This study investigated whether subgroups of AD patients exhibit different patterns of impairment in analyzing global (configural) and local (detail) features of complex visual stimuli. A High Spatial AD subgroup (i.e., patients with better block constructions than naming) and a High Verbal AD subgroup (i.e., patients with better naming than block constructions) were impaired in analyzing both global and local forms. As predicted, however, the High Spatial AD patients exhibited greater impairment in analyzing the local forms than the High Verbal AD patients and normal controls. In contrast, the High Verbal AD patients exhibited greater impairment in analyzing the global forms than the High Spatial AD patients and normal controls. There was a striking separation of the subgroups: Using the local-global difference score, the hit rate for classifying these patients into the two subgroups was 91%. Robust correlations were found between the AD patients' ability to construct global and local forms and their scores on traditional visuospatial and verbal tests, respectively. The findings suggest that it may be misleading to subdivide AD patients using a verbal/spatial dichotomy, because even those AD patients who appear to have relative strengths on traditional visuospatial tests are likely to exhibit a primary impairment in analyzing local features of complex visual stimuli. The results underscore the importance of a process (qualitative) approach to neuropsychological assessment for a more valid understanding of the behavioral subtypes of Alzheimer's disease.

Thirty-nine patients with Parkinson's disease (PD) were categorized into one of three subgroups using discriminant function analysis and three key indices from the California Verbal Learning Test (CVLT). Patients were classified as having one of three memory profiles: (a) a normal memory profile; (b) a memory profile often observed in patients with Huntington's disease (HD); or (c) a memory profile often observed in patients with Alzheimer's disease (AD). Twenty of the patients with PD were classified as having a normal profile, 10 as having an HD profile, and 9 as having an AD profile. The three subgroups did not differ on measures of global cognitive functioning, letter fluency, confrontation naming, or visuo-construction, suggesting that the patients with PD with an AD memory profile were not experiencing AD, per se. These results demonstrate that the memory deficits associated with PD can be similar to those found in patients with either HD or AD, and argues against the notion that the behavioral manifestations of PD are homogeneous.

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