Spontaneous speech of healthy adults consists of alternating periods of fluent and hesitant segments, forming temporal cycles in speech fluency. The regularity of these cycles may be related to the functioning of brain networks during speech planning and execution. This paper investigates the theoretical link between human cognitive functioning and temporal cycles in speech production using a quantitative time series analysis to characterize the regularity and frequency of temporal cycles in adults with differing levels and etiology of cognitive decline. We compare spontaneous speech of adults without a neurological diagnosis, both older and younger, to that of adults with frontotemporal lobar degeneration (FTLD). Two measures of temporal cycle frequency (mean and mode) calculated from the power spectrum of speech fluency represented as a time series were found to be associated with subjects’ age, regardless of diagnosis of dementia. Two measures of periodicity (g-statistic and rhythmicity-index), as well as mean frequency, differentiated between adults with and without dementia. Our study confirms the presence of regular temporal cycles in spontaneous speech and suggests that temporal cycle characteristics are affected in different ways by declines in cognitive functioning due to dementia and aging.
from the Journal of Neurolinguistics
The cognition of nonverbal sounds in dementia has been relatively little explored. Here we undertook a systematic study of nonverbal sound processing in patient groups with canonical dementia syndromes comprising clinically diagnosed typical amnestic Alzheimer’s disease (AD; n = 21), progressive nonfluent aphasia (PNFA; n = 5), logopenic progressive aphasia (LPA; n = 7) and aphasia in association with a progranulin gene mutation (GAA; n = 1), and in healthy age-matched controls (n = 20). Based on a cognitive framework treating complex sounds as ‘auditory objects’, we designed a novel neuropsychological battery to probe auditory object cognition at early perceptual (sub-object), object representational (apperceptive) and semantic levels. All patients had assessments of peripheral hearing and general neuropsychological functions in addition to the experimental auditory battery. Whilst a number of aspects of auditory object analysis were impaired across patient groups and were influenced by general executive (working memory) capacity, certain auditory deficits had some specificity for particular dementia syndromes. Patients with AD had a disproportionate deficit of auditory apperception but preserved timbre processing. Patients with PNFA had salient deficits of timbre and auditory semantic processing, but intact auditory size and apperceptive processing. Patients with LPA had a generalised auditory deficit that was influenced by working memory function. In contrast, the patient with GAA showed substantial preservation of auditory function, but a mild deficit of pitch direction processing and a more severe deficit of auditory apperception. The findings provide evidence for separable stages of auditory object analysis and separable profiles of impaired auditory object cognition in different dementia syndromes.
High Specificity of the Word Memory Test and Medical Symptom Validity Test in Groups with Severe Verbal Memory Impairment
By definition, false positives occur when an otherwise very easy symptom validity test (SVT) or effort test is failed because of cognitive impairment and not because of poor effort. Therefore, the highest rate of false positives will be found in those groups with the most severe cognitive impairment. For that reason, it is important to study people with severe impairment when evaluating the specificity of SVTs. Some people with various types of dementia, notably those with Alzheimer’s disease, suffer from severe impairment of memory and other cognitive abilities. In this study, patients with possible or probable dementia were tested with the Word Memory Test (WMT; Green, 2003; Green & Astner, 1995) and the Medical Symptom Validity Test (MSVT; Green, 2004). While some dementia patients failed the easy subtests of these instruments and had severe verbal memory impairment, they showed distinctive profiles of scores that have been reported to be characteristic of people with severe impairment. Using profile analysis, the WMT and MSVT achieved a specificity of 98.4% or higher in the patients of the current study. This suggests that there will be extremely low false positive rates using the same methods in people with relatively minor impairment of the type found in, for example, mild traumatic brain injury or depression.
This study examines the impact of automatic/controlled access processes on the semantic network in 30 patients with Alzheimer’s disease (AD). The AD group was compared with a control group using a battery of neuropsychological tests, a variation of Hodges’s semantic testing battery, designed to assess semantic knowledge. The AD group had markedly lower scores than the normal group on each semantic test, but with a different degree of deterioration depending on the nature of the processes (controlled/automatic) in accessing the semantic network. AD patients had poorer performances on the explicit semantic tasks mainly involving controlled-process access (e.g., the WAIS Similarities Subtest) than those involving mainly automatic-process access (e.g., the Verbal Automatism test). Analyses of confidence intervals allowed a gradient of impaired performances in increasing order to be elaborated: a) the Verbal Automatism test, b) the WAIS Vocabulary Subtest, c) the WAIS Information Subtest, d) the Letter Fluency Task, e) Naming as a Response to Definition, f) the Category Fluency Task, g) the WAIS Similarities Subtest, and h) the Oral Denomination 80 Test. The results of our study suggest that explicit semantic tasks needing passive or automatic processes to access semantic memory would be better preserved in AD.
from the Journal of Alzheimer’s Disease
Mortality and Nursing Care Dependency One Year After First Ischemic Stroke: An Analysis of German Statutory Health Insurance Data
Conclusion: Aphasia has a high impact on mortality and nursing care dependency after ischemic stroke, while dementia and depression are strongly associated with increasing nursing care dependency.
Neural substrates for writing impairments in Japanese patients with mild Alzheimer’s disease: a SPECT study
Language is fairly well preserved in most patients with mild Alzheimer’s disease, but writing ability seems to be impaired even in the early stages of the disease. To investigate the neural bases of writing impairments in Alzheimer’s disease (AD), we examined the correlation between writing ability and regional cerebral blood flow (rCBF) in 52 Japanese patients with mild AD compared to 22 controls, using single photon emission computed tomography (SPECT). We found that, compared with control subjects, Kana writing to dictation and copying Kanji words were preserved in AD patients, but writing to dictating Kanji words was impaired. We classified the errors in the Kanji dictation task into four types to investigate the correlation between rCBF and the error type, as follows: non-response errors, phonologically plausible errors, non-phonologically plausible errors, and peripheral errors. Non-response errors, which indicated difficulty with retrieving Kanji graphic images, were the most frequent. When controlled for confounding factors, the number of non-response errors negatively correlated with rCBF in the left inferior parietal lobule, the posterior middle and inferior temporal gyri, and the posterior middle frontal gyrus. Thus, the impaired recall of Kanji in early Alzheimer’s disease is related to dysfunctional cortical activity, which appears to be predominant in the left frontal, parietal, and temporal regions.
Conclusion: Microstructural integrity of the hippocampus assessed by DTI is related to verbal memory performance in elderly with SVD, also in participants with an intact appearing hippocampus. Changes in hippocampal microstructure may be an early marker of underlying neurodegenerative disease, before macrostructural (i.e., volumetric) changes occur.
from Human Brain Mapping
Alzheimer’s disease (AD) is a slowly progressing form of dementia characterized in its earliest stages as a loss of memory. Individuals with amnestic mild cognitive impairment (aMCI) may be in the earliest stages of the disease and represent an opportunity to identify pathological changes related to the progression of AD. Synaptic loss is one of the hallmarks of AD and associated with cognitive impairment. The inferior temporal gyrus plays an important role in verbal fluency, a cognitive function affected early in the onset of AD. Unbiased stereology coupled with electron microscopy was used to quantify total synaptic numbers in lamina 3 of the inferior temporal gyrus from short postmortem autopsy tissue harvested from subjects who died at different cognitive stages during the progression of AD. Individuals with aMCI had significantly fewer synapses (36%) compared to individuals with no cognitive impairment. Individuals with AD showed a loss of synapses very similar to the aMCI cohort. Synaptic numbers correlated highly with Mini Mental State Examination scores and a test of category verbal fluency. These results demonstrate that the inferior temporal gyrus is affected during the prodromal stage of the disease and may underlie some of the early AD-related clinical dysfunctions.
from the Journal of Alzheimer’s Disease
Behavioural variant frontotemporal dementia is characterized by a change in comportment. It is associated with considerable functional decline over the course of the illness albeit with sometimes dramatic variability among patients. It is unknown whether any baseline features, or combination of features, could predict rate of functional decline in behavioural variant frontotemporal dementia. The aim of this study was to investigate the effects of different baseline clinical, neuropsychological, neuropsychiatric, genetic and anatomic predictors on the rate of functional decline as measured by the Clinical Dementia Rating Sum of Boxes scale. We identified 86 subjects with behavioural variant frontotemporal dementia that had multiple serial Clinical Dementia Rating Sum of Boxes assessments (mean 4, range 2–18). Atlas-based parcellation was used to generate volumes for specific regions of interest at baseline. Volumes were utilized to classify subjects into different anatomical subtypes using the advanced statistical technique of cluster analysis and were assessed as predictor variables. Composite scores were generated for the neuropsychological domains of executive, language, memory and visuospatial function. Behaviours from the brief questionnaire form of the Neuropsychiatric Inventory were assessed. Linear mixed-effects regression modelling was used to determine which baseline features predict rate of future functional decline. Rates of functional decline differed across the anatomical subtypes of behavioural variant frontotemporal dementia, with faster rates observed in the frontal dominant and frontotemporal subtypes. In addition, subjects with poorer performance on neuropsychological tests of executive, language and visuospatial function, less disinhibition, agitation/aggression and night-time behaviours at presentation, and smaller medial, lateral and orbital frontal lobe volumes showed faster rates of decline. In many instances, the effect of the predictor variables observed across all subjects was also preserved within anatomical subtypes. Furthermore, some of the predictor variables improved our prediction of rate of functional decline after anatomical subtype was taken into account. In particular, age at onset was a highly significant predictor but only after adjusting for subtype. We also found that although some predictor variables, for example gender, Mini-Mental State Examination score, and apathy/indifference, did not affect the rate of functional decline; these variables were associated with the actual Clinical Dementia Rating Sum of Boxes score estimated for any given time-point. These findings suggest that in behavioural variant frontotemporal dementia, rate of functional decline is driven by the combination of anatomical pattern of atrophy, age at onset, and neuropsychiatric characteristics of the subject at baseline.
When the zebra loses its stripes: Semantic priming in early Alzheimer’s disease and semantic dementia
Patients suffering from Alzheimer’s disease (AD) or semantic dementia (SD) both exhibit deficits on explicit tasks of semantic memory. Semantic priming (SP) paradigms provide a very pure and precise implicit measurement of semantic memory impairment, and a previous study of AD (Giffard et al., 2002) using one such paradigm revealed that AD patients in the initial stages of semantic deterioration presented an abnormally large priming effect (hyperpriming) in a category-coordinate condition, compared with controls. This astonishing phenomenon could stem from the specific loss of distinctive attributes that make it possible to distinguish between semantically close concepts, while attributes shared by different concepts belonging to a given category remain intact. To test this hypothesis and compare the degradation of semantic memory in AD and SD, we devised an SP paradigm in which word pairs had either a category-coordinate or an attribute relationship. In accordance with our hypothesis, we distinguished between shared (duck–feathers) versus distinctive attributes (zebra–stripes) and close (tiger–lion) versus distant (elephant–crocodile) category-coordinate relationships. This paradigm, together with two explicit semantic memory tasks (picture-naming and categorization), was administered to 16 AD and 8 SD patients and 30 elderly control subjects. The AD patients, at the very beginning of semantic deterioration, only displayed impaired SP effects in the distinctive attribute condition, whereas in the SD patients, who had more severe semantic deterioration, we observed an extinction of SP effects in both attribute conditions. In SD patients, we also report hyperpriming effects in both category-coordinate conditions. Our results suggest that semantic memory impairment follows the same course in both AD and SD, affecting distinctive attributes first and then shared ones. In accordance with distributed models of semantic memory, the loss of distinctive attributes leads to a confusion between close concepts and it is this which causes the transient hyperpriming phenomenon.
This study examined trajectories of cognitive change in psychometrically matched measures of episodic memory, semantic memory, and executive function in an ethnically, demographically, and cognitively diverse sample of older persons. Individual rates of change showed considerable heterogeneity in each domain. Baseline clinical diagnosis predicted differential change in semantic memory and executive function, dementia > mild cognitive impairment (MCI) > normal, but average decline in verbal episodic memory was similar across all 3 diagnostic groups. There was substantial overlap of distributions of cognitive change across baseline diagnostic groups for all 3 measures. Cognitive change was strongly related to change in clinical diagnosis. Rapid and similar change was present for all 3 cognitive measures in patients with dementia and in those with normal cognition and those with MCI who progressed clinically. In cognitively normal patients, verbal episodic memory change was greater than change in the other two domains. Global status, measured by the Clinical Dementia Rating scale (Morris, 1993), predicted change in semantic memory and executive function, whereas APOE genotype predicted change in verbal episodic memory, and age had no effect on rates of change in any domain independent of global status and APOE. Results show important limitations in using cross-sectional diagnosis to predict prognosis and suggest that research to identify robust predictors of cognitive change across the full spectrum from normal to dementia is needed for better early identification of diseases that cause progressive decline.
from Psychology and Aging
Conclusions: Implications are discussed regarding impaired emotional prosody in DAT, and the utility of objective acoustic measures in revealing subtle deficits and overcoming methodological inconsistencies is emphasized. Further research is critical in advancing our understanding of this pervasive disorder and is important, clinically, in the provision of specific interventions.
Despite the numerous studies focused on priming performances in Alzheimer’s disease (AD), the question of whether word-stem completion priming persists in AD is still prone to controversy. Methodological variations, such as encoding instructions, have been proposed to explain the discrepancy of word-stem completion priming results in AD. We conducted a meta-analysis on 678 AD patients and 640 controls to assess whether word-stem completion priming in AD differs according to instructions provided at encoding. When the data across the different encoding instructions were combined, the results showed that AD patients manifest significant completion priming, even though the magnitude of priming is reduced. Taking into account the different encoding conditions, the results suggested that whereas completion priming is impaired in AD when encoding conditions consist in reading or rating words, priming is equivalent to that of controls when encoding conditions require semantic judgments or generating words. In this latter condition in particular, self-generating a word at encoding may provide an aid to partially overcome conceptual deficits of the patients and increase the degree of adequacy between cognitive operations employed at encoding phase and those triggering implicit retrieval.
CONCLUSION: Environmental, cognitive and behavioral factors related to feeding were significantly present among the subjects of the study, putting deglutition at risk. Other specific deglutition difficulties were also identified. Managing these difficulties is important, in order to avoid health complications for elderly women