Symbol Copying Research Articles

Investigating the Relationship Between Local and Global Coherence and Cognitive Processes in Persian-speaking Elderly Population

Objective: Many studies have suggested a relationship between coherence and cognitive processes. This study aims to investigate this hypothesis by assessing the relationship between cognitive variables and coherence in the discourse of 2 groups of Persian-speaking young adults and the elderly. Methods: To evaluate our participants’ cognitive capabilities, we employed the cognitive tests of the mini-mental status test, the Stroop-color task, the digit symbol copy task, the clock-drawing task, and the backward digit span. On the other hand, the specific tasks to evaluate the discourse properties of the participants were the single task of talking and the dual task of talking while walking. Results: The results demonstrated that the dual task did not impact local coherence while global coherence was significantly disrupted in both tasks. However, the global coherence scale was more negatively affected in the dual task compared to the single task. While the relationship between global coherence and cognitive variables was significant in both tasks, the relationship between global coherence and working memory measures was only significant in the dual task. Furthermore, no relationship was observed between the scale of local coherence and either cognitive or working memory measures. Conclusion: Our findings corroborate previous findings that local and global coherence is manipulated by different cognitive processes and the maintenance of global coherence requires more demanding cognitive processes and is disrupted before local coherence occurs.

COGNITIVE TRAINING ATTENUATES AGE-RELATED DECLINE IN PHYSICAL FUNCTION ACROSS 10 YEARS

Poor physical function is associated with negative health and cognitive outcomes. Although nine studies demonstrate that cognitive training reduces age-related declines in physical function, only one has examined effects beyond immediate posttest changes. The current study assessed the impact of three cognitive training programs on physical function measures across 10 years. Using data from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial, older adults randomized to a no-contact control condition (n = 698) were compared to those randomized to processing speed (n = 702), memory (n = 703), or reasoning (n = 694) training. Intention-to-treat and treatment-received analyses were conducted for grip strength, Digit Symbol Copy, and Turn 360. There were no significant effects of being assigned to processing speed, memory, or reasoning training to any physical function outcome (p > .05). Treatment-received models indicated that processing speed training attenuated age-related declines in Digit Symbol Copy (b = -.005, p < .01) and Turn 360 (b = -.011, p < .001), memory training attenuated age-related declines in Digit Symbol Copy (b = -.009, p < .001) and Turn 360 (b = -.011, p < .001), and reasoning training attenuated age-related declines in Digit Symbol Copy (b = -.012, p < .001) and Turn 360 (b = -.012, p < .001). There was no significant transfer to grip strength. This is the first study to demonstrate beneficial effects of cognitive training to some physical functions across 10 years. Future work should examine moderators and mediators of transfer effects.

The Impact of Three Cognitive Training Interventions on Older Adults' Physical Functioning Across 5 Years.

Physical functioning is closely associated with cognition. The current study assessed the impact of three cognitive training programs on objective measures of physical functioning across 5 years. Older adults randomized to a processing speed ( n = 702), reasoning ( n = 694), or memory ( n = 703) training intervention were compared with those randomized to a no-contact control condition ( n = 698). Intention-to-treat (ITT) and treatment-received/dosage (time-varying number of training sessions) analyses were conducted. There were no transfer effects in the ITT analyses. Treatment-received models demonstrated that training sessions (i.e., higher dosage) across all intervention arms transferred to better maintained Digit Symbol Copy and Turn 360 performance relative to the control group. More reasoning training transferred to better grip strength. This is the first study to demonstrate differential longitudinal cognitive training transfer effects to three performance-based physical functioning measures. Future research should investigate mechanisms of far-transfer effects.

Kidney Disease and Cognitive Function: African American-Diabetes Heart Study MIND

Aims: Albuminuria and reduced estimated glomerular filtration rate (eGFR) are linked with poorer cognitive performance in European-ancestry populations with advanced nephropathy; relationships in African Americans (AAs) with type 2 diabetes (T2D) are less clear. Tests of cognitive performance, urine albumin:creatinine ratio (UACR), and CKD-EPI eGFR were performed in unrelated AAs with T2D to determine relationships. Methods: Cross-sectional analysis of 263 unrelated AAs with T2D recruited in the African American-Diabetes Heart Study (AA-DHS) MIND. Global cognitive function (mini-mental state exam [3MSE] and Montreal Cognitive Assessment [MoCA]), memory (Rey Auditory Verbal Learning Test [RAVLT]), executive function (Stroop, verbal fluency for animals, and Digit Symbol Copy [DSC]), UACR, and eGFR were determined. Relationships between cognitive tests and renal parameters were assessed using multivariate models, adjusted for age, gender, body mass index, hemoglobin A1c, level of education, hypertension, and LDL cholesterol. Results: Participants had a mean ± SD age of 60.2 ± 9.7 years, 62.7% were female, T2D duration was 14.3 ± 8.9 years, eGFR 86.0 ± 23.2 ml/min/1.73 m², and UACR 155.8 ± 542.1 (median 8.1) mg/g. In adjusted models, higher UACR was associated with worse 3MSE (p = 0.014), MoCA (p = 0.0089), DSC (p = 0.0004), Stroop performance time (p = 0.003), Stroop errors (p = 0.032), and Stroop interference (p = 0.026). Higher eGFR was associated with better performance on DSC (p = 0.0071). Conclusions: In AAs with T2D, albuminuria and eGFR were associated with cognitive function, even in mild kidney disease. These data stress the need for interventions to prevent cognitive decline well before the late stages of kidney disease.

Deficits in Processing Speed and Decision Making in Relapsing-Remitting Multiple Sclerosis: The Digit Clock Drawing Test(dCDT)

The current research assessed how digital clock drawing test (dCDT) parameters compliment and convey additional information in conjunction with traditional clock drawing scoring methods in patients with multiple sclerosis (MS). MS and normal control (NC) clock drawing performance was initially scored using a 10-point scale where NC test performance classified MS patients into impaired versus non-impaired clock drawing groups. dCDT variables included intra-component latencies or the time elapsed between clock drawing components (i.e., time between last element drawn followed by the first clock hand); inter-digit latency (i.e., average time between drawing numbers; and quartile drawing time (i.e., total drawing time divided into four equal segments. Subsequent analyses assessed dCDT parameters and other neuropsychological tests related to deficits in processing speed and other neurocognitive functions. In the command condition impaired MS patients produced slower selected intracomponents and slower 3rd and 4th quartile latencies (p<0.032) compared to other groups. In the copy condition impaired MS patients also displayed slower selected intra-components and slower latencies in all four quartiles compared to NCs (p<0.003), but slower latencies only for the 3rd and 4th quartiles compared to non-impaired MS patients (p<0.016). Regression analyses associated slower combined intra-component latencies with reduced processing speed (Symbol Copy, WAIS-R-NI), category (‘animal’) fluency, and CVLT recognition discriminability, and the propensity to endorse selected CVLT list B recognition foils. The dCDT compliments traditional clock scoring methods, captures behavior previously unobtainable, and is related to processing speed and dysexecutive impairment known to be present in MS.

Cognitive Function as a Prospective Predictor of Falls

This study examined speed of processing, executive functioning, and psychomotor speed as independent prospective predictors of falls and recurrent falls across 3 years. The participants were 509 community-dwelling older adults. Measures of speed of processing, executive function, psychomotor speed, and known risk factors of falling were included in correlation and logistic regression analyses. Poor executive function (Trail Making Test), slower speed of processing (Digit Symbol Substitution [DSS] Test), and slower psychomotor speed (Digit Symbol Copy Test) were significantly associated with falls. Poor executive function and speed of processing performance (Stroop Test, Trail Making Test, and DSS Test) as well as slower psychomotor speed were significantly related to recurrent falls. Logistic regression results indicated that only medication use, far visual acuity, and psychomotor speed were significant independent predictors of falls. Regarding recurrent falls, being white, medication use, and balance were significant predictors. Although cognitive measures at baseline were significantly associated with falls and recurrent falls at follow-up, these measures did not predict falling after considering known risk factors of falls and psychomotor speed. Thus, it may be that simple measures of psychomotor speed are more salient predictors of falls than cognitive measures.

APD125, a selective serotonin 5-HT(2A) receptor inverse agonist, significantly improves sleep maintenance in primary insomnia.

Insomnia is a condition affecting 10% to 15% of the adult population and is characterized by difficulty falling asleep, difficulty staying asleep, or nonrestorative sleep, accompanied by daytime impairment or distress. This study evaluates APD125, a selective inverse agonist of the 5-HT(2A) receptor, for treatment of chronic insomnia, with particular emphasis on sleep maintenance. In phase 1 studies, APD125 improved sleep maintenance and was well tolerated. Adult subjects (n=173) with DSM-IV defined primary insomnia were randomized into a multicenter, double-blind, placebo-controlled, 3-way crossover study to compare 2 doses of APD125 (10 mg and 40 mg) with placebo. Each treatment period was 7 days with a 7- to 9-day washout period between treatments. Polysomnographic recordings were performed at the initial 2 screening nights and at nights (N) 1/2 and N 6/7 of each treatment period. APD125 was associated with significant improvements in key sleep maintenance parameters measured by PSG. Wake time after sleep onset decreased (SEM) by 52.5 (3.2) min (10 mg) and 53.5 (3.5) min (40 mg) from baseline to N 1/2 vs. 37.8 (3.4) min for placebo, (P < 0.0001 for both doses vs. placebo), and by 51.7 (3.4) min (P = 0.01) and 48.0 (3.6) min (P = 0.2) at N 6/7 vs. 44.0 (3.8) min for placebo. Significant APD125 effects on wake time during sleep were also seen (P < 0.0001 N 1/2, P < 0.001 N 6/7). The number of arousals and number of awakenings decreased significantly with APD125 treatment compared to placebo. Slow wave sleep showed a statistically significant dose-dependent increase. There was no significant decrease in latency to persistent sleep. No serious adverse events were reported, and no meaningful differences in adverse event profiles were observed between either dose of APD125 and placebo. APD125 was not associated with next-day psychomotor impairment as measured by Digit Span, Digit Symbol Copy, and Digit Symbol Coding Tests. APD125 produced statistically significant improvements in objective parameters of sleep maintenance and sleep consolidation and was well tolerated in adults with primary chronic insomnia.

Post-bedtime dosing with indiplon in adults and the elderly: results from two placebo-controlled, active comparator crossover studies in healthy volunteers

ABSTRACTObjective: To assess the effects of post-bedtime dosing with indiplon on next-day function in adults and the elderly.Research design and methods: Two randomized, double-blind, placebo-controlled crossover studies were conducted in two groups of healthy volunteers: an adult study (18–45 years) and an elderly study (65–80 years). In adults, a single post-bedtime dose of indiplon 10 mg and 20 mg was compared to placebo, with zolpidem 10 mg and zopiclone 7.5 mg included as controls. In the elderly, a single post-bedtime dose of indiplon 5 mg and 10 mg was compared to placebo, with zopiclone 3.75 mg included as a control. Next-day residual effects were evaluated in the morning at 4 and 6 h post-dose in adults, and 4, 6, and 8 h in the elderly, by a Visual Analog Scale of sleepiness (VAS-sleepiness), Digit Symbol Substitution Test (DSST), and the Symbol Copying Test (SCT).Results: In adults, there were no statistically significant differences between indiplon and placebo on the VAS-sleepiness, DSST, or SCT at any timepoint for either dose. In contrast, a significant increase versus placebo in VAS-sleepiness was observed for both zopiclone (at 4 and 6 h post-dose; p < 0.0001 and p = 0.002, respectively) and zolpidem (at 4 h post-dose; p = 0.042). In the elderly, there were no statistically significant differences between indiplon 5 mg and placebo on the VAS-sleepiness, DSST, or SCT at any timepoint. DSST was significantly reduced for indiplon 10 mg versus placebo at 4 h only ( p = 0.022), compared with a significant reduction in DSST for zopiclone at both 4 and 8 h post-dose ( p = 0.002 and p = 0.003, respectively). In adults, the overall incidence of adverse events was higher on zopiclone compared to indiplon, zolpidem, and placebo. In the elderly, the incidence of adverse events was similar for indiplon, zopiclone, and placebo. Potential limitations of the current study include recruitment of healthy volunteers and the use of a limited pharmacodynamic battery.Conclusions: Indiplon, at doses of 10 mg in adults and 5 mg in the elderly, was not associated with next day residual sedation or impairment in simple cognitive and psychomotor tasks when administered during the night 4 h prior to awakening.

Efficacy and Tolerability of Indiplon in Transient Insomnia

The efficacy of indiplon was evaluated by polysomnography (PSG) in an experimental model of transient insomnia consisting of the first night effect combined with a 2-hour phase advance. Healthy volunteers age 21-64 years (N=593; 62% female; mean +/- SEM) years, 32 +/- 0.39) were randomized to double-blind treatment with a single nighttime dose of indiplon (10 mg or 20 mg) or placebo. PSG assessments included latency to persistent sleep (LPS, primary endpoint) and total sleep time (TST); self-report assessments included sleep quality (SQ); next day residual effects were evaluated by the Digit Symbol Substitution Test (DSST), Symbol Copying Test (SCT), and a Visual Analog Scale of sleepiness (VAS). LPS mean (+/- SEM) values were significantly reduced on indiplon 10 mg (21.2 +/- 1.5 minutes) and indiplon 20 mg (16.8 +/- 1.1 minutes) compared to placebo (33.1 +/- 2.5 minutes; p < 0.0001 for both comparisons to placebo). TST mean (+/- SEM) values were significantly increased on indiplon 10 mg (414.5 +/- 3.9 minutes) and indiplon 20 mg (423.5 +/- 3.1 minutes) compared to placebo (402.9 +/- 3.9 minutes; p <0.005 for the 10 mg dose; p < 0.0001 for the 20 mg dose). SQ was also significantly improved on both doses. There were no differences between indiplon and placebo on next day DSST, SCT, or VAS. Indiplon was effective in inducing sleep, increasing sleep duration, and improving overall sleep quality without next day residual effects in healthy volunteers in a model of transient insomnia.

Speed and memory in the WAIS-III Digit Symbol—Coding subtest across the adult lifespan

The primary role of speed in determining Digit Symbol scores is well established. Among the important questions that remain to be resolved are: (1) whether speed accounts for all of the age-related decline in Digit Symbol scores, and (2) whether memory ability makes any significant contribution to Digit Symbol performance, especially after controlling for speed. We analyzed data from the WAIS-III/WMS-III standardization sample to resolve these issues. As expected, speed (Digit Symbol—Copy) correlated very strongly with Digit Symbol—Coding. Memory (Digit Symbol—Incidental Learning or WMS-III index scores) correlated more moderately with Digit Symbol—Coding. Even after controlling for variance in Coding explained by Copying, a statistically significant proportion of the residual variance was explicable in terms of memory functions. The contribution of memory to Digit Symbol—Coding, while relatively small, is real. In addition, a small portion of the age-associated decline in Coding scores cannot be accounted for by Copying scores.

Decoding digit symbol: speed, memory, and visual scanning.

The authors evaluated the relative contributions of speed, memory, and visual scanning to Digit Symbol score in a sample of young adults (N = 87). Speed (Symbol Copy) explained 35% of Digit Symbol variance; only half of this was attributable to graphomotor speed (Name Printing), implying a role for perceptual speed. Visual-scanning tests (e.g., Symbol Scan) explained (on average) 34% of Digit Symbol variance, much of which was independent of perceptual-motor speed, establishing an important role for visual-scanning efficiency in Digit Symbol performance. By contrast, memory tests (on average) explained only 4% to 5% of Digit Symbol variance: statistically significant but clearly subsidiary, although a visual memory composite correlated more strongly with Digit Symbol. The Digit Symbol incidental learning procedures did, however, correlate moderately with other memory measures, suggesting that they are valid memory screening devices.

Effects of zaleplon or triazolam with or without ethanol on human performance

Objectives and background: Given that non-selective γ-aminobutyric acid (GABA) agonist hypnotics impair performance and potentiate the disruptive effects of ethanol, this study was done to determine the performance-impairing and ethanol-potentiating effects of zaleplon, a new selective GABA agonist hypnotic. Methods: Eighteen healthy men (12) and women (six), 31.5±5.6 years old, were studied. Each underwent six treatments of 2 days in duration, presented in a Latin square design with 2–12 recovery days between. The treatments were: placebo–placebo; placebo–ethanol; triazolam–placebo; triazolam–ethanol; zaleplon–placebo; and zaleplon–ethanol; with triazolam (0.25 mg) or placebo administered at 08:30 h, zaleplon (10 mg) or placebo at 09:00 h, and ethanol (0.75 g/kg) or placebo consumed from 09:30 h. Performance tests were completed each day at 10:30, 12:00 and 14:30 h. Results: Breath ethanol concentration (BrEC), tested 0.5, 2.0, 4.5 and 6 h post consumption, did not differ among treatments and peaked at 0.052%, declining to 0.037, 0.009 and 0.001%. Triazolam with and without ethanol impaired digit symbol substitution, symbol copying, simple and complex reaction times and divided attention performance relative to placebo–placebo treatment. It did so consistently at 10:30 and 12:00 h, and less consistently at 14:30 h. Zaleplon without ethanol impaired only digit symbol substitution and divided attention tracking, and only at 10:30 h. Zaleplon with ethanol impaired most measures at 10:30 and 12:00 h, but not at 14:30 h. Zaleplon without ethanol consistently differed from triazolam without ethanol in the extent of performance impairment. Zaleplon with ethanol began to differ from triazolam with ethanol in performance impairment on the 12:00 and 14:30 h test sessions. Ethanol itself impaired most measures at 10:30 h, fewer at 12:00 h and none at 14:30 h. All active drug treatments increased self-rated sleepiness compared with placebo–placebo. Triazolam without ethanol produced greater self-rated sleepiness than zaleplon without ethanol. The addition of ethanol to both drugs generally produced comparable levels of self-rated sleepiness. Conclusions: In an absolute sense, zaleplon produced less performance impairment and a shorter period of ethanol potentiation than triazolam.

Speed and memory in WAIS-R-NI Digit Symbol performance among healthy older adults.

Although roles have been proposed for both graphomotor speed and learning in the execution of Digit Symbol, few data have been available concerning performance across the adult lifespan on the Symbol Copy, paired associates, or free recall measures derived from Digit Symbol and recommended in the WAIS-R-NI. We report findings on 177 healthy older adults (ages 50-90), providing normative data by age group, education level, and gender. As previously reported, Digit Symbol scores decline steeply with age (r = -.64). Symbol Copy speed declines almost as steeply (r = -.58). Incidental learning, however, declines only modestly (r = -.26 on both measures). Symbol Copy is a far stronger correlate of Digit Symbol (r = .72) than are paired associates or free recall (r = .26 and r = .28, respectively). The 2 incidental learning measures do, however, offer valuable supplementary information as part of a comprehensive individual assessment. When low Digit Symbol scores are produced by slowing on Symbol Copy, further evaluation of perceptual and motor speed and dexterity are indicated. When low incidental learning scores are obtained, further evaluation of memory is warranted. Qualitative analysis of errors (e.g., rotations) made on the incidental learning procedures may also be valuable.

Limited memory impairment after temazepam

In order to examine the effects of temazepam on memory, a battery of cognitive tests and analogue mood ratings were given to healthy volunteers after oral administration of 5, 10 and 30 mg. The lowest dose had no effect and 10 mg only significantly increased self-ratings of well-being. Temazepam (30 mg) significantly improved recall of items learned prior to drug administration, but impaired recall and recognition of word lists acquired after drug administration. However, when retrieval was assessed indirectly using a backwards reading task there was no impairment, indicating that automatic information processing was unaffected. Temazepam (30 mg) significantly reduced self-ratings of anxiety and increased those of sedation. It also significantly impaired performance in symbol copying, digit-symbol substitution and number cancellation tasks. It is striking that, at a dose that was sedative and impaired many aspects of performance, temazepam nonetheless improved retrieval of items learned prior to drug administration. (C) 1998 John Wiley & Sons, Ltd.

Comparison of the Residual Effects and Efficacy of Short Term Zolpidem, Flurazepam and Placebo in Patients with Chronic Insomnia

This multicentre, double-blind, randomised, placebo-controlled, parallel-group study compared the next-day residual effects, hypnotic efficacy and sleep staging effects of zolpidem 10 and 20mg with those of placebo in patients with chronic insomnia. Flurazepam 30mg was used as a positive control for residual effects. Patients completed written and computerised performance tests [Digital Symbol Substitution Test (DSST) was the primary outcome measure], and their sleep was evaluated polysomnographically and subjectively. After treatment with zolpidem for 3 consecutive nights, the change from baseline in number of correct responses on the next-morning DSST or Symbol Copying Test (SCT) was not different to that recorded in placebo-treated patients. Next-day performance was impaired every day after treatment with flurazepam. As measured by objective and subjective criteria, both zolpidem and flurazepam were effective hypnotics. Sleep stages were affected more by flurazepam than by zolpidem. The incidence of treatment-emergent adverse events was approximately the same for zolpidem 10mg, flurazepam and placebo. The 20mg dose of zolpidem (twice the therapeutic dose) was associated with a higher incidence of adverse events. It was concluded that no next-day residual effects are associated with nightly intake (3 nights) of the recommended dose of zolpidem. At this dose, zolpidem was an effective and safe hypnotic.

Handedness in children at school entry: does the 'Mesker test' provide a valid method for testing writing handedness?

The 'Mesker test', an experiment devised after the psycho-motor dominance test described by the Dutch paediatrician Mesker, was evaluated as a method for testing writing handedness in 145 children at school entry in Crewe Health Authority. Also included in the assessment was if, and how these children know their laterality. Positive outcome was measured as Mesker test result corresponding to spontaneous hand-preference in symbol copying. The correct indication of right arm or leg was evaluated in relation to the outcome by chance. The Mesker test could not confirm hand-preference in children at school entry. There was no significant relation to the child's maturity and no significant consistency in test performance. The sub-group of right-handed writers who confirmed their handedness showed an almost significant level of consistency. No more children who thought they knew the right side indicated the correct limb then could have been arrived at by chance. This was not significantly related to having been taught, writing handedness or maturity. It is concluded therefore, that at school entry age children don't have a good knowledge of their body's laterality. Although the Mesker test does not confirm writing handedness at school entry, it may be useful in older children with inconsistent laterality.

Efficacy of Zopiclone in Middle Age

Effects of zopiclone (5.0, 7.5, and 10 mg) on sleep and on performance were studied in middle-aged subjects. Zopiclone (5.0-10.0 mg) reduced awake activity and the number of awakenings, and increased the duration of stage 2 sleep. The appearance of REM sleep was delayed, but this effect was without reduction over the whole night. There were no impairments in the digit symbol substitution test when zopiclone was compared with placebo, although there were less substitutions with 10.0 mg than with 5.0 mg. Symbol copying and choice reaction time were unaltered. Zopiclone would appear to be a useful hypnotic for those involved in skilled work. Based on the results obtained in healthy volunteers, the 5.0 mg dose would be appropriate for many; if in insomniac patients, 7.5 mg was needed, then it is likely to be free of undue impairment of performance the next day.

Sex-Related Differences on Fine-Motor Tasks at Grade One

This study attempted qualitatively and quantitatively to assess sex-related differences on fine motor tasks performed by 132 first-grade students, 56.8% boys and 43.2% girls. The results of two criterion-referenced probes, involving accuracy and rate, were analyzed with the SPSS programs oneway and anova. Both sexes performed equally well on a task involving dotting a circle but boys performed significantly worse on a task involving symbol copying. It was hypothesized that the difference might reflect a difference in information processing of symbols.

Dose tolerance to lorazepam develop with once weekly dosing?

The effect of once weekly administration of lorazepam (2.5 mg) to benzodiazepine-naive student volunteers was assessed in a number of performance tests and on self-ratings. Tolerance developed to the effects of lorazepam on finger-tapping and on self-ratings of dizziness. No tolerance was observed to the drug-induced impairment in a nonsense-syllable paired associate learning test or to the effects on self-ratings of sedation or on heart rate. It is suggested that the reduced impairment in the digit-symbol substitution test observed in weeks 2 and 3 of lorazepam treatment was due to a 'masked' practice effect rather than to tolerance. Test-retest correlation coefficients were calculated for all the tests used. The effect of lorazepam in each test was also correlated with its effect in the other tests. There were significant correlations in performance on placebo in the finger-tapping (r = 0.66), digit-symbol substitution (r = 0.94), symbol copying (r = 0.96) and nonsense-syllable learning (r = 0.74) tests. It is suggested that benzodiazepine experience should be given to drug-naive subjects before they are used in cross-over experiments that involve this class of compound, since the major change in impairment occurred between the first and second exposure to lorazepam.

Interaction Between Effects of Caffeine and Lorazepam in Performance Tests and Self-Ratings

In 18 normal volunteers, lorazepam (2.5 mg) compared with placebo significantly impaired performance in a verbal learning task, in the digit-symbol substitution test, and in symbol copying and number cancellation tasks. These impairments were found equally in subjects with high and low state anxiety and in subjects with high and low trait anxiety. Caffeine citrate (125 to 500 mg) significantly improved performance on the digit-symbol substitution test when given alone and reduced the lorazepam impairment. In the symbol copying test caffeine counteracted the lorazepam impairment. Lorazepam produced a significant loss of appetite and made the subjects feel significantly more dizzy, physically and mentally tired, withdrawn and tranquil, and significantly less anxious. Caffeine citrate (500 mg) counteracted the lorazepam effect of reducing anxiety and making the subjects feel more relaxed.