How Do Verbal Distractors Influence Age-Related Operation Span Performance? A Manipulation of Inhibitory Control Demands
from Experimental Aging Research
This study examined how different verbal distractors influence (age-related) performance in the operation span working memory task. Forty-six older (M = 68 years, SD = 3.82) and 49 younger adults (M = 27 years, SD = 3.02) performed a conventional operation span task version and three versions with non-related, conceptually related, or phonologically related distracting words. Thus, the amount of inhibitory control demands varied across the task versions. Age effects were found for all versions. Furthermore, age effects in the versions with distracting words were even larger than in the conventional version, indicating that a decline in the ability to inhibit irrelevant verbal information can partly explain age effects in working memory performance.
Clustering and switching processes in semantic verbal fluency in the course of Alzheimer’s disease subjects: Results from the PAQUID longitudinal study
from Cortex
Abstract
Reduced semantic fluency performances have been reported in the preclinical phase of Alzheimer’s disease (AD). To investigate the cognitive processes underlying this early deficit, this study analyzed the verbal production of predemented subjects for the animals category with the qualitative parameters related to clustering (i.e. the ability to generate words belonging to semantic subcategories of animals) and switching (i.e. the ability to shift from one subcategory to another) proposed by Troyer.
This qualitative analysis was applied to the PAQUID (Personnes Agées QUID) cohort, a 17-year longitudinal population-based study. The performances on the animal verbal fluency task of 51 incident cases of possible and probable AD were analyzed at the onset of dementia, 2 years and 5 years before dementia onset. Each case was matched for age, sex and education to two control subjects leading to a sample of 153 subjects. The mean cluster size and the raw number of switches were compared in the two samples. The results revealed a significantly lower switching index in the future AD subjects than in the elderly controls including 5 years before dementia incidence. A significant decline in this parameter was evidenced all along the prodromal phase until the clinical diagnosis of dementia. In contrast, the mean cluster size could not discriminate the two groups. Therefore the results support the hypothesis that impaired shifting abilities – rather than semantic memory storage degradation – could explain the early decline in semantic fluency performance occurring in the predementia phase of AD.
The impact of dementia, age and sex on category fluency: Greater deficits in women with Alzheimer’s disease
from Cortex
A category specific effect in naming tasks has been reported in patients with Alzheimer’s dementia. Nonetheless, naming tasks are frequently affected by methodological problems, e.g., ceiling effects for controls and “nuisance variables” that may confound results. Semantic fluency tasks could help to address some of these methodological difficulties, because they are not prone to producing ceiling effects and are less influenced by nuisance variables. One hundred and thirty-three participants (61 patients with probable AD; and 72 controls: 36 young and 36 elderly) were evaluated with semantic fluency tasks in 14 semantic categories. Category fluency was affected both by dementia and by age: while in nonliving-thing categories there were differences among the three groups, in living thing categories larger lexical categories produced bigger differences among groups. Sex differences in fluency emerged, but these were moderated both by age and by pathology. In particular, fluency was smaller in female than male Alzheimer patients for almost every subcategory.
Drug Restores Speech in Alzheimer’s
from Newsmax.com
Alzheimer’s patients given a popular rheumatoid arthritis drug showed seemingly dramatic improvements in a small study, but some doctors worried that the early findings will raise premature hopes in patients and their families.
Are Age Differences in Verbal Learning Related to Interstimulus Interval and Education?
from Experimental Aging Research
Abstract
The present study investigated the effects of a narrow range of interstimulus intervals (ISI; 1, 2, or 3 s) on word-learning performance in relation to age and education. Individuals (N = 338) from four age groups (24 to 76 years) with low or high educational attainment were randomly assigned to one of three ISI conditions. Older age, lower education, and shorter ISI each led to lower performance. However, age differences in performance were not affected by ISI. Furthermore, lower educated individuals needed more time to achieve the same performance level as higher educated individuals.
Collaborative role construction in a conversation with dementia: An application of systemic functional linguistics
from Clinical Linguistics and Phonetics
This study applies the tools provided by Systemic Functional Linguistics (SFL) to the description of patterns in a conversation between a person with dementia and a person without. It shows how, in the presence of, on the one hand, considerable communicative and cognitive deficits, and on the other, a collaborative interlocutor, a person with dementia succeeds in leading and sustaining a lengthy conversation, and of constructing for himself a positive role in the interaction, namely that of the elder advising a much younger man.
Language, Culture Barriers Affect Early Alzheimer’s Diagnosis Among Hispanics
from Topix.net
Language and cultural barriers cause a significant number of elderly Hispanics with Alzheimer’s disease to remain undiagnosed and untreated, experts say, the Newark Star-Ledger reports.
Central Auditory Dysfunction in Older Persons With Memory Impairment or Alzheimer Dementia
from Archives of Otolaryngology–Head and Neck Surgery
Objective To assess the effect of memory impairment on central auditory function.
Design Case-control study.
Setting The Virginia Merrill Bloedel Hearing Research Center, Seattle, Washington.
Participants The study cohort of 313 volunteers from a dementia surveillance research program comprised 3 groups: (1) controls without memory loss (n = 232); (2) memory-impaired participants with mild memory impairment but without dementia (n = 64); and (3) memory-impaired participants with a dementia diagnosis (n = 17).
Main Outcome Measures Behavioral central auditory tests were the Synthetic Sentence Identification with Ipsilateral Competing Message test, the Dichotic Sentence Identification test, and the Dichotic Digits Test. Memory impairment was indicated by a total score on the Cognitive Ability Screening Instrument of 86 or less, or a total score of 90 or less with a memory subscale score of 10 or less.
Results The mean score on each central auditory test worsened significantly across the 3 memory groups even after adjustment for age and peripheral hearing status (P<.05); it was poorest in the dementia group and moderately reduced in the memory-impaired group compared with the control group. Heterogeneity of results was noted in all 3 groups.
Conclusions Central auditory function was affected by even mild memory impairment. The Dichotic Sentence Identification test in the free report mode was the most sensitive test for the presence of memory impairment. We recommend that central auditory testing be considered in the evaluation of older persons with hearing complaints as part of a comprehensive, individualized program to assist their needs in both the aural rehabilitative and the cognitive domains.
Rapid improvement in verbal fluency and aphasia following perispinal etanercept in Alzheimer’s disease
from BMC Neurology
Background
Recent clinical studies point to rapid and sustained clinical, cognitive, and behavioral improvement in both Alzheimer’s disease and primary progressive aphasia following weekly perispinal administration of etanercept, a TNF-alpha inhibitor that acts by blocking the binding of this cytokine to its receptors. This outcome is concordant with recent basic science studies suggesting that TNF-alpha functions in vivo as a gliotransmitter that regulates synaptic function in the brain. We hypothesized that perispinal etanercept had the potential to improve verbal function in Alzheimer’s disease, so we included several standarized measures of verbal ability to evaluate language skills in a clinical trial of perispinal etanercept for Alzheimer’s disease.
Methods
This was a prospective, single-center, open-label, pilot study, in which 12 patients with mild-to-severe Alzheimer’s disease were administered etanercept, 25-50 mg, weekly by perispinal administration for six months. Two additional case studies are presented.
Results
Two-tailed, paired t-tests were conducted comparing baseline performance to 6-month performance on all neuropsychological measures. Test batteries included the California Verbal Learning Test-Second Edition, Adult Version; Logical Memory I and II(WMS-LM-II) from the Wechsler Memory Scale-Abbreviated; the Comprehensive Trail Making Test (TMT); Boston Naming Test; and letter(FAS) and category verbal fluency. All measures revealed a significant effect except for the Boston Naming Test and the TMT-4, with WMS-LM-II being marginally significant at p=.05. The FAS test for letter fluency was most highly significant with a p<0.0007. In addition, rapid improvement in verbal fluency and aphasia in two patients with dementia, beginning minutes after perispinal etanercept administration, is documented.
Conclusions
In combination with the previously reported results of perispinal etanercept in Alzheimer’s disease and primary progressive aphasia, these results further argue that larger scale studies of this therapeutic intervention, including Phase 3 trials, are warranted in dementias. In addition, these results may provide insight into the basic pathophysiologic mechanisms underlying Alzheimer’s disease and related forms of dementia, and suggest the existence of novel, rapidly reversible, TNF-mediated pathophysiologic mechanisms in Alzheimer’s disease which are worthy of further investigation.
Central Auditory Dysfunction in Older Persons With Memory Impairment or Alzheimer Dementia
from Archives of Otolaryngology–Head and Neck Surgery
Objective To assess the effect of memory impairment on central auditory function.
Design Case-control study.
Setting The Virginia Merrill Bloedel Hearing Research Center, Seattle, Washington.
Participants The study cohort of 313 volunteers from a dementia surveillance research program comprised 3 groups: (1) controls without memory loss (n = 232); (2) memory-impaired participants with mild memory impairment but without dementia (n = 64); and (3) memory-impaired participants with a dementia diagnosis (n = 17).
Main Outcome Measures Behavioral central auditory tests were the Synthetic Sentence Identification with Ipsilateral Competing Message test, the Dichotic Sentence Identification test, and the Dichotic Digits Test. Memory impairment was indicated by a total score on the Cognitive Ability Screening Instrument of 86 or less, or a total score of 90 or less with a memory subscale score of 10 or less.
Results The mean score on each central auditory test worsened significantly across the 3 memory groups even after adjustment for age and peripheral hearing status (P<.05); it was poorest in the dementia group and moderately reduced in the memory-impaired group compared with the control group. Heterogeneity of results was noted in all 3 groups.
Conclusions Central auditory function was affected by even mild memory impairment. The Dichotic Sentence Identification test in the free report mode was the most sensitive test for the presence of memory impairment. We recommend that central auditory testing be considered in the evaluation of older persons with hearing complaints as part of a comprehensive, individualized program to assist their needs in both the aural rehabilitative and the cognitive domains.
Rapid improvement in verbal fluency and aphasia following perispinal etanercept in Alzheimer’s disease
from BMC Neurology
Background
Recent clinical studies point to rapid and sustained clinical, cognitive, and behavioral improvement in both Alzheimer’s disease and primary progressive aphasia following weekly perispinal administration of etanercept, a TNF-alpha inhibitor that acts by blocking the binding of this cytokine to its receptors. This outcome is concordant with recent basic science studies suggesting that TNF-alpha functions in vivo as a gliotransmitter that regulates synaptic function in the brain. We hypothesized that perispinal etanercept had the potential to improve verbal function in Alzheimer’s disease, so we included several standarized measures of verbal ability to evaluate language skills in a clinical trial of perispinal etanercept for Alzheimer’s disease.
Methods
This was a prospective, single-center, open-label, pilot study, in which 12 patients with mild-to-severe Alzheimer’s disease were administered etanercept, 25-50 mg, weekly by perispinal administration for six months. Two additional case studies are presented.
Results
Two-tailed, paired t-tests were conducted comparing baseline performance to 6-month performance on all neuropsychological measures. Test batteries included the California Verbal Learning Test-Second Edition, Adult Version; Logical Memory I and II(WMS-LM-II) from the Wechsler Memory Scale-Abbreviated; the Comprehensive Trail Making Test (TMT); Boston Naming Test; and letter(FAS) and category verbal fluency. All measures revealed a significant effect except for the Boston Naming Test and the TMT-4, with WMS-LM-II being marginally significant at p=.05. The FAS test for letter fluency was most highly significant with a p<0.0007. In addition, rapid improvement in verbal fluency and aphasia in two patients with dementia, beginning minutes after perispinal etanercept administration, is documented.
Conclusions
In combination with the previously reported results of perispinal etanercept in Alzheimer’s disease and primary progressive aphasia, these results further argue that larger scale studies of this therapeutic intervention, including Phase 3 trials, are warranted in dementias. In addition, these results may provide insight into the basic pathophysiologic mechanisms underlying Alzheimer’s disease and related forms of dementia, and suggest the existence of novel, rapidly reversible, TNF-mediated pathophysiologic mechanisms in Alzheimer’s disease which are worthy of further investigation.
Video released of rapid Alzheimer’s improvement after new immune-based treatment
from EurekAlert.org
New research into the treatment of Alzheimer’s disease reports improvement in language abilities using a novel immune-based approach. A video accompanying the research, published today in the open access journal BMC Neurology, documents rapid language improvement within minutes of using this new treatment.
Alzheimer’s Australia Vic Announces Dementia Awareness Week 2008
Alzheimer’s Australia’s major annual awareness campaign, Dementia Awareness Week, will kick off this year on Friday 19 September and conclude on Friday 26 September. The theme this year is ‘Mind your Mind, and reduce the risk of dementia’.
Predictive Value of Rapid Decline in Mini Mental State Examination in Clinical Practice for Prognosis in Alzheimer’s Disease
from Dementia and Geriatric Cognitive Disorders
Background: Given the poorer prognosis of Alzheimer’s disease (AD) patients with rapid cognitive decline (RCD), there is a need for a clinical assessment tool to detect these patients. Objective: To investigate if there is a Mini Mental State Examination (MMSE) threshold of decline during 6 months of follow-up which predicts a worse disease progression at the 2-year follow-up. Then, to propose a feasible definition of RCD for routine clinical practice. Methods: Data from 565 community-dwelling AD patients recruited in a multi-centre prospective observational study were assessed. All patients had MMSE scores between 10 and 26 at inclusion and were followed up 6-monthly using a standardised clinical assessment. Patients were classified as rapid and non-rapid decliners according to 2 MMSE decline thresholds tested: 3 points and 4 points for decline over the first 6 months of the study. Worse disease outcome was defined as attainment of 1 of 4 clinical end points 18 months later: institutionalisation, death, increased physical dependence or worsening of behavioural and psychological symptoms. Results: 135 patients (23.9%) lost 3 points during the first 6 months of follow-up in the MMSE score and 77 patients (13.6%) lost 4 points. Patients with moderate disease and a loss of 4 points showed a significantly increased risk of mortality (HR = 5.6, 95% CI 2.0-15.9) and institutionalisation (HR = 3.8, 95% CI 1.8-8.1) at the 2-year follow-up. The same MMSE threshold was associated with a higher risk of physical decline (HR = 1.6, 95% CI 1.2-2.3). Conclusion: The loss of 4 points in MMSE during the first 6 months of follow-up seems to be a predictor of worse clinical course, and thus it could be used to define the category of AD patients presenting a RCD.
Foveal crowding in posterior cortical atrophy: A specific early-visual-processing deficit affecting word reading
from Cognitive Neuropsychology
Visual crowding is a form of masking in which single-letter identification is compromised by the presence of additional letters or other simple visual forms in close proximity. This behavioural phenomenon has been studied most frequently in the context of amblyopic and normal peripheral vision. In the current study, we investigate this phenomenon in the context of two patients with peripheral dyslexia and a third with visual disorientation consequent to bilateral posterior cortical atrophy. In one case, reading showed the effects of word length typical of letter-by-letter reading, whereas the second case was unable to read any whole words. In a series of letter identification tasks, recognition accuracy was shown to decrease significantly in the presence of a range of flanking stimuli (e.g., letters, digits, letter fragments). Compatible with previous reports of the crowding phenomenon, the flanking effect was strengthened by increasing flanker proximity but was unaffected by target or flank size, flank contrast, target-flank lexicality, or flank category. One patient also showed amelioration of the flanking effect when the target and flankers were of opposite contrast polarity. To the best of our knowledge, this is the first demonstration of visual crowding in individuals with posterior cortical atrophy. We consider the relevance of these empirical findings to accounts of the letter-by-letter reading form of peripheral dyslexia. In particular, we suggest that crowding constitutes one specific form of early-visual-processing deficit, which impairs the reading process.
The Effects of Contextual Strength on Phonetic Identification in Younger and Older Listeners
from Experimental Aging Research
Subjects: Behavioral Medicine; Psychiatry: Dementia; Gerontology/Ageing: Dementia; Dementia & Abstract
It has often been reported that older listeners have difficulty discriminating between phonetically similar items, but may rely on contextual cues as a compensatory mechanism. The present study examined the effects of different degrees of semantic bias on speech perception in groups of younger and older listeners. Stimuli from two /g/-/k/ voice onset time (VOT) continua were presented at the end of biasing and neutral sentences. Results indicated that context strongly influenced phonetic identification in older listeners; this was true for younger listeners only in the case of less-than-ideal stimuli. Findings are discussed in relation to theories concerning age-related changes in speech processing.
Alzheimer and frontotemporal pathology in subsets of primary progressive aphasia
from Annals of Neurology
Objective
To identify predictors of Alzheimer’s disease (AD) versus frontotemporal lobar degeneration pathology in primary progressive aphasia (PPA), and determine whether the AD pathology is atypically distributed to fit the aphasic phenotype.
Methods
Neuropsychological and neuropathological analyses of 23 consecutive PPA autopsies. All had qualitative determination of neurofibrillary tangle (NFT) density. Additional quantitation was done in four of the PPA/AD cases and four AD cases with the typical amnestic dementia of the Alzheimer type.
Results
The sample contained mostly logopenic, agrammatic, and mixed forms of PPA. All six agrammatics had frontotemporal lobar degeneration (five of six with tauopathy). Seven of the 11 logopenics had AD. In logopenics, lower memory scores increased the probability of AD, but there were exceptions. The PPA/AD group showed predominance of entorhinal NFT typical of the amnestic dementia of the Alzheimer type. In the small subgroup examined quantitatively, neocortical NFTs were more numerous in the left hemisphere of PPA/AD. However, the asymmetry was low and inconsistent. Neuritic plaques did not display consistent asymmetry. Apolipoprotein E4, a major risk factor for typical AD, did not predict AD pathology in PPA.
Interpretation
Subtyping PPA helps to predict AD versus frontotemporal lobar degeneration pathology at the group level. However, our results and the literature also indicate that no clinical predictor is completely reliable in individual patients. The inconsistent concordance of NFT distribution with the asymmetric atrophy and the nonamnestic phenotype also raises the possibility that the AD markers encountered at autopsy in PPA may not always reflect the nature of the initiating neurodegenerative process. Ann Neurol 2008
Reduced short-term memory capacity in Alzheimer’s disease: The role of phonological, lexical, and semantic processing
from Memory
Individuals with Alzheimer’s disease (AD) are often reported to have reduced verbal short-term memory capacity, typically attributed to their attention/executive deficits. However, these individuals also tend to show progressive impairment of semantic, lexical, and phonological processing which may underlie their low short-term memory capacity. The goals of this study were to assess the contribution of each level of representation (phonological, lexical, and semantic) to immediate serial recall performance in 18 individuals with AD, and to examine how these linguistic effects on short-term memory were modulated by their reduced capacity to manipulate information in short-term memory associated with executive dysfunction. Results showed that individuals with AD had difficulty recalling items that relied on phonological representations, which led to increased lexicality effects relative to the control group. This finding suggests that patients have a greater reliance on lexical/semantic information than controls, possibly to make up for deficits in retention and processing of phonological material. This lexical/semantic effect was not found to be significantly correlated with patients’ capacity to manipulate verbal material in short-term memory, indicating that language processing and executive deficits may independently contribute to reducing verbal short-term memory capacity in AD.
Chapter 25 Cognitive neuroscience studies of semantic memory in Alzheimer’s disease
from Progress in Brain Research
Semantic memory is the component of long-term memory that stores our concepts about the world. The disruption of semantic memory as a result of brain damage may have profound negative consequences on an individual’s ability to name objects and process concepts. This can be disrupted as a result of many forms of brain damage, particularly Alzheimer’s disease (AD). The current paper reviews research demonstrating that semantics deteriorates early in AD, particularly on effortful semantic tasks. There is a “category effect”, meaning that AD preferentially affects concepts dealing with living things and abstract concepts compared to non-living objects and verbs/actions. While this pattern of deterioration, specific for AD, may reflect a breakdown within a distributed semantic system (where living things are distinguished by a high rate of inter-correlations between concepts or by a particular mode of being learned), it is equally possible that there is a regional distribution of semantic knowledge, with living things preferentially involving left temporal regions which become damaged early on in AD. Evidence from patients with strokes and semantic dementia, as well as activation studies in normal individuals, implicates the left posterior temporal region in semantic processing for pictures, abstract words, and concrete words. AD individuals, who are impaired in a variety of semantic tasks, show functional deficits in this area, and fail to activate it normally.
Longitudinal study of single-word comprehension in semantic dementia: A comparison with primary progressive aphasia and Alzheimer’s disease
from Aphasiology
Background: Although semantic dementia (SD) is characterised by a multimodal loss of semantic knowledge, it has been demonstrated that lexical-semantic representations are not equally disrupted in SD and that some categories may be recognised better than others. Little is known, however, about the pattern of the category-specific comprehension deficits in SD and whether it differs from that of other forms of progressive aphasias.
Aims: This exploratory study aimed to investigate the evolution of category-specific deficits of single-word comprehension in progressive aphasias.
Methods & Procedures: A total of 19 patients with a clinical diagnosis of SD, 25 patients with primary progressive aphasia with agrammatic and relatively nonfluent speech (PPA), and 25 patients with Alzheimer’s disease (AD) with aphasia were studied longitudinally with the Western Aphasia Battery (WAB). The Auditory Word Recognition subtest of the WAB was utilised to assess comprehension of words derived from different semantic categories.
Outcomes & Results: The analysis revealed that, over time, category-specific deficits of single-word comprehension were seen in all three groups of patients. Participants with SD as well as those with PPA and AD were impaired on both pointing to fingers and the right-left orientation task. However, patients with SD were the only group that showed defective recognition of their own body parts. Interestingly, individuals with SD had no difficulties identifying colours, letters, and numbers, even during the follow-up testing. In addition, in all three groups the extent of category-specific deficits was associated with the severity of aphasia.
Conclusions: These results indicate that category-specific deficits of single-word comprehension are frequently seen not only in patients with SD but also in individuals with PPA or AD, and that the extent of these deficits is associated with the severity of aphasia. However, the pattern of these deficits is often different in these three forms of neurodegenerative conditions and more dissociations between semantic categories are observed as each of these diseases progresses.
In Search of Meaning: Reading and Writing in Alzheimer’s Disease
from Seminars in Speech and Language
Decline in semantic memory is a key feature of Alzheimer’s disease, and reading and writing performance reflects this loss. The article presents an overview of theoretical reading and spelling models, including definitions of key terminology and controversies surrounding the interaction of semantics and the orthographic lexicon. We review literature supporting a direct lexical nonsemantic route in reading and writing. The reading and writing deficits of Alzheimer’s disease are contrasted with those of semantic dementia. Methods of assessing semantic memory in reading and writing are outlined, including administering published tests, word lists, homophones, written confrontation naming, verbal fluency, and written narrative analysis.
Effects of Semantic Impairment on Language Use in Alzheimer’s Disease
from Seminars in Speech and Language
Many studies present apparently conflicting results and conclusions about the effects of Alzheimer’s disease (AD) on language use. This review attempts to reconcile these apparently conflicting results regarding the language impairments in AD by discussing how the slow deterioration of the semantic system at the feature level interacts with the task demands of tests used to evaluate performance. In particular, performance is impaired on tasks that require relatively complete, elaborate semantic representations but is preserved when the task requires only partial semantic representations consisting largely of shared features. The variety of language impairments reported in complex, multiword tasks are likely attributable to a combination of the deterioration of semantic representations and reduced working memory resources. The few available treatment studies for language impairments in AD suggest that treatments designed for adults with other language impairments, such as aphasia, may also be effective in AD.
Self-awareness and self-monitoring of cognitive and behavioral deficits in behavioral variant frontotemporal dementia, primary progressive aphasia and probable Alzheimer’s disease
from Brain and Cognition
Lack of insight is a core diagnostic criterion for behavioral variant frontotemporal dementia (bvFTD), and is believed to be intact in the early stages of primary progressive aphasia (PPA). In other neurological conditions, symptom-specific insight has been noted, with behavioral symptoms appearing especially vulnerable to reduced insight. Different components of insight, self-awareness and self-monitoring, are also often considered separate phenomena. The current study compared insight in patients with PPA, bvFTD, and probable Alzheimer’s disease (PrAD) and a group of cognitively intact control subjects. Additionally, differences in insight for the domains primarily affected by the three types of dementia, namely, Behavior, Naming, and Memory, were assessed, and self-awareness and self-monitoring were compared. A total of 55 participants were enrolled. Participants were asked to complete self-estimate scales demonstrating their perceived ability immediately prior to, and immediately following a test in each domain of interest. Results indicated that PPA and normal control groups performed very similarly on control (Weight and Eyesight) and cognitive domains, whereas bvFTD and PrAD patients were unable to accurately assess Memory. All three diagnostic groups failed to accurately assess their behavioral symptoms, suggesting that this domain is vulnerable to loss of insight across diagnoses. Naming ability, in contrast, was either accurately assessed or underestimated in all groups. Finally, there were no notable differences between self-awareness and self-monitoring, potential explanations for this are examined.
Decline in verbal memory in non-demented older adults
from the Journal of Clinical and Experimental Neuropsychology
Decline in memory function was detected in 30% of healthy community-dwelling elderly over 6 years using a task assessing delayed word list recall. Individuals with memory decline over time also demonstrated relative deficits on additional tasks of memory and learning, a task of working memory and executive function, and on a verbal (category) fluency task at their most recent assessment. These relative deficits in the performance of individuals with memory decline cannot be explained by age-related changes, education, intelligence, mood, health-related factors, or the individuals’ APOE ε 4 status. Decline in memory performance did not result in greater complaints of cognitive difficulties when compared with normal elderly, nor did it limit overall participation in life activities. Although the significance of memory decline in the current study was not determined quantitatively, memory decline is consistent with the early deterioration characteristic of mild cognitive impairment and preclinical Alzheimer’s disease and confirms the need to monitor individuals with objective memory decline, even when these individuals fall within normal limits for a given neuropsychological task.
Progressive aphasia secondary to Alzheimer disease vs FTLD pathology
from Neurology
Background: The pathology causing progressive aphasia is typically a variant of frontotemporal lobar degeneration, especially with ubiquitin-positive inclusions (FTLD-U). Less commonly the underlying pathology is Alzheimer disease (AD).
Objective: To compare clinicopathologic and MRI features of subjects with progressive aphasia and AD pathology to subjects with aphasia and FTLD-U pathology and subjects with typical AD.
Methods: We identified 5 subjects with aphasia and AD pathology and 5 with aphasia and FTLD-U pathology with an MRI from a total of 216 aphasia subjects. Ten subjects with typical AD clinical features and AD pathology were also identified. All subjects with AD pathology underwent pathologic reanalysis with TDP-43 immunohistochemistry. Voxel-based morphometry (VBM) was used to assess patterns of gray matter atrophy in the aphasia cases with AD pathology, aphasia cases with FTLD-U, and typical AD cases with AD pathology, compared with a normal control group.
Results: All aphasic subjects had fluent speech output. However, those with AD pathology had better processing speed than those with FTLD-U pathology. Immunohistochemistry with TDP-43 antibodies was negative. VBM revealed gray matter atrophy predominantly in the temporoparietal cortices, with notable sparing of the hippocampus in the aphasia with AD subjects. In comparison, the aphasic subjects with FTLD-U showed sparing of the parietal lobe. Typical AD subjects showed temporoparietal and hippocampal atrophy.
Conclusions: A temporoparietal pattern of atrophy on MRI in patients with progressive fluent aphasia and relatively preserved processing speed is suggestive of underlying Alzheimer disease pathology rather than frontotemporal lobar degeneration with ubiquitin-only immunoreactive changes.
Early Detection of Risk of Onset for Dementia of the Alzheimer Type and Subtle Executive Dysfunction after TBI Using the Test of Verbal Conceptualization and Fluency During Clinical Neuropsychological Assessment: Two Case Studies
Two case reports are presented that illustrate the use of a new assessment instrument of executive skills, the Test of Verbal Conceptualization and Fluency (TVCF), as a component of a clinical neuropsychological assessment. The cases presented include the assessment of a patient at risk of developing Alzheimer’s disease and a patient with subtle signs of executive dysfunction subsequent to a mild head injury. Both patients had high levels of education and occupational status. The TVCF demonstrated clinical sensitivity to central nervous system (CNS) insult and results similar to those obtained with other established measures of executive functioning.
Reduced Prefrontal Oxygenation in Alzheimer Disease During Verbal Fluency Tasks
from the American Journal of Geriatric Psychiatry
Objective:Near-infrared spectroscopy (NIRS) is an optical method to measure changes in the concentration of oxygenated hemoglobin (O2Hb) and deoxygenated hemoglobin (HHb) in the vascular system of the brain tissue. Because NIRS is easy to assess and does not have any side effects, it seems perfectly suitable for functional measurements in psychiatric patients or fragile subjects. As previous research suggested changes in functional brain activation in prefrontal brain areas of patients with dementia, the aim of this study was to replicate these findings by means of multichannel NIRS. Methods:In the present study, the authors investigated 16 patients with Alzheimer disease and 16 healthy subjects (similar in age and sex) during performance of a verbal fluency task. Results:The results clearly showed an activation pattern during active phase as compared to baseline phase in the form of decreases in HHb and increases in O2Hb, with a reduced increase of O2Hb for patients. Conclusion: These results indicate a diminished activation of the dorsolateral prefrontal cortex in patients with Alzheimer disease. Future research has to show whether this decreased activation pattern might be a suitable predictor for the effectiveness of treatment in dementias.
Cognitive-Behavioral Profiles of Neurodegenerative Dementias: Beyond Alzheimer’s Disease
from the Journal of Geriatric Psychiatry and Neurology
The neurocognitive and behavioral profiles of vascular dementia and vascular cognitive impairment, dementia with Lewy bodies and Parkinson’s disease with dementia, and dementia syndromes associated with frontotemporal lobar degenerations are compared and contrasted with Alzheimer’s dementia (AD). Vascular dementia/vascular cognitive impairment is characterized by better verbal memory performance, worse quantitative executive functioning, and prominent depressed mood. Dementia with Lewy bodies and Parkinson’s disease with dementia are equally contrasted with AD by defective processing of visual information, better performance on executively supported verbal learning tasks, greater attentional variability, poorer qualitative executive functioning, and the presence of mood-congruent visual hallucinations. The frontal variant of frontotemporal lobar degeneration (frontotemporal dementia) differs from AD by better multimodal retention on learning tasks, different patterns of generative word fluency, defective qualitative executive functioning, and by markedly impairment of comportment. For temporal variants of frontotemporal lobar degenerations, progressive aphasia and semantic dementia, worse language performance relative to AD is typically characteristic. (J Geriatr Psychiatry Neurol 2007;20:227-238)
Screening for Frontotemporal Dementias and Alzheimer’s Disease with the Philadelphia Brief Assessment of Cognition: A Preliminary Analysis
from Dementia and Geriatric Cognitive Disorders
Background: A neuropsychological screening instrument sensitive to neuropsychological deficits associated with Alzheimer’s disease (AD) and patients with frontotemporal dementia (FTD) would be valuable for diagnostic evaluation. Methods: The Philadelphia Brief Assessment of Cognition (PBAC) assesses working memory/executive control, language, visuospatial operations, verbal/visual episodic memory, and behavior/social comportment and can be administered and scored in 15-20 min. Participants included 149 patients with AD and four groups of FTD patients - i.e., patients with a decline in social comportment, personality, and executive functioning (SOC/EXEC), semantic dementia (SemD), progressive nonfluent aphasia (PNFA), and corticobasal syndrome (CBS). Results: The total PBAC score correlated with the Mini-Mental State Examination. Between-group analysis of PBAC subscales and the results of logistic regression analyses produced substantial between-group differences, emphasizing the sensitivity of the test to differentiate dementia subtypes. AD patients were impaired on tests of episodic memory, SOC/EXEC patients were impaired on a measure of social comportment/behavioral disturbance, PNFA patients obtained low scores on tests of working memory/executive control, SemD patients obtained lower scores on language-mediated measures, and CBS patients were impaired on visuospatial/visual memory tests. Conclusion: These data support the usefulness of the PBAC as a relatively brief screening test of overall dementia severity across a wide range of dementia patients.
Voice onset time production in speakers with Alzheimer’s disease
from Clinical Linguistics and Phonetics
In the present study, voice onset time (VOT) measurements were compared between a group of individuals with moderate Alzheimer’s disease (AD) and a group of healthy age- and gender-matched peers. Participants read a list of consonant-vowel-consonant (CVC) words, which included the six stop consonants. The VOT measurements were made from oscillographic displays obtained from the Brown Laboratory Interactive Speech System (BLISS) implemented on an IBM-compatible computer. VOT measures for the participants’ six stop consonant productions were subjected to statistical analysis. The results indicated that VOT values in speakers with Alzheimer’s disease were not statistically different from those for the normal control speakers.
About the Callier Library
Callier Library is a satellite facility of The University of Texas at Dallas, McDermott Library. It is located at the Dallas, Texas campus of the Callier Center for Communication Disorders. The library supports the graduate-level programs and faculty in communications sciences which are located at the center. It also supports the work of clinicians in hearing and speech disorders who work at both campuses of the Callier Center. One of the missions of Callier Library is to be a useful source of information to the international community of researchers and clinicians in communication disorders. To that end, this web log of citations and news in the field has been built and maintained by Allen Clayton, the Callier Center Librarian.
Note: These news items are gleaned from over 400 sources on the Internet and are provided as a service to our patrons. The University of Texas at Dallas does not guarantee the veracity, reliability or completeness of any information provided on this page, or in any hyperlink appearing on this page
