Object alternation and orbitofrontal system dysfunction in Alzheimer's and Parkinson's disease

Previous performance on measures of frontal system function have suggested prominent orbitofrontal system damage in Alzheimer's disease, but not in Parkinson's dementia. Object alternation (OA), a task sensitive to orbitofrontal system dysfunction in non-human animals, was therefore administered to determine whether this measure would distinguish Alzheimer's from Parkinson's dementia. OA was significantly impaired in Alzheimer's disease compared to Parkinson's dementia, even though both groups were equated for severity of dementia. Although the patients with Parkinson's dementia also showed impairment on OA compared to normals, an error analysis revealed that the performance of the Alzheimer's patients, but not the Parkinson's patients, was characterized by abnormal response perseveration. The marked perseverative deficit in Alzheimer's disease may reflect orbitofrontal system dysfunction whereas the milder, and qualitatively different, deficits in Parkinson's disease may reflect dorsolateral frontal system involvement.     

When actions speak louder than words: improving children's flexibility in a card-sorting task

People often perseverate, or repeat habitual behaviors when they are no longer appropriate. For example, after sorting cards by one rule, children will reliably perseverate with this rule even when they are clearly and repeatedly instructed to switch to a new rule. Such perseveration may result from limitations in working memory abilities for holding instructions actively in mind. If so, children may switch more readily to a new rule following experiences that are less demanding on working memory, such as guided practice with the new rule. In a study testing this prediction, 3-year-old children received direct instructions to switch to a new rule, guided practice with the new rule, or both. Providing children with guided practice was much more effective than telling them what to do. These findings support theories of perseveration based on competing memory systems, challenge alternative theories, and suggest effective methods for countering prepotent behaviors.     

Response perseveration in psychopathic women.

Recent attempts to validate the Psychopathy Checklist-Revised (PCL-R) as a measure of psychopathy in female offenders have been limited by a failure to examine laboratory correlates of the syndrome. We assessed 112 incarcerated women by using the PCL-R and examined their performance on a card perseveration task that has been used to demonstrate response perseveration in psychopathic men. Contrary to prediction, psychopathic women did not perseverate responding when the PCL-R was used either dimensionally or categorically. The authors discuss the implications of the results for the PCL-R and for female psychopathy more generally.     

Two types of perseveration in the Dimension Change Card Sort task

In the Dimension Change Card Sort (DCCS) task, 3-year-olds can sort cards well by one dimension but have difficulty in switching to sort the same cards by another dimension when asked; that is, they perseverate on the first relevant information. What is the information that children perseverate on? Using a new version of the DCCS, the experiments in this article reveal that there are two types of perseverators: those who perseverate at the level of dimensions and those who perseverate at the level of values (stimulus features). This novel finding has implications for theories of perseveration.     

Intrusions and perseverations

Twenty-two subjects with presumed senile dementia of the Alzheimer's type (SDAT), twenty-two with dementia other than SDAT, twenty with aphasia, and seventeen healthy controls over 50 years of age were examined for intrusions and perseverations. Perseverations were defined as the immediate inappropriate repetition of a prior response whereas intrusions were defined as the inappropriate repetition of prior responses after intervening stimuli. Intrusions and perseverations occurred in demented and aphasic subjects, but were rare in controls. Intrusions occurred most often in SDAT or Wernicke aphasia, but also in dementia other than SDAT. Intrusions were not correlated with dementia severity. Intrusions are a useful sign of dementia, but they cannot be considered pathognomonic of SDAT. They appear to arise when subjects are unable to access correct responses from long-term memory and instead substitute erroneous responses selected from short-term memory. Perseverations were most common in the Wernicke aphasics and subjects with dementia due to communicating hydrocephalus. Although frontal lobe dysfunction is prominent in communicating hydrocephalus, it is absent in cases of Wernicke aphasia. Thus, we have confirmed prior suggestions that perseveration can occur in the absence of frontal lobe injury. Failure to self-monitor speech as well as an inability to change mental set probably plays an important role in the genesis of perseverations. There was no statistically significant correlation between dementia severity and number of perseverations. Low correlations were found between intrusions and perseverations suggesting that these seemingly similar behaviors are distinct and are probably produced by separate neuropsychological mechanisms.     

Memory in sub-clinical obsessive-compulsive checkers

In a series of experiments we extended the research on possible memory deficits in subclinical obsessive-compulsive Ss who reported excessive checking. Using a variety of memory tests we compared 20 subclinical checkers to 20 Ss without obsessive-compulsive symptomatology. Contrary to hypothesis, checkers remembered self-generated words better than read words just as much as did normals, but they were more likely than normals to report thinking they had studied words that, in fact, had not been on the study list. Further, they more often confused whether they read or generated the words at study. Checkers did not appear to perseverate on already-recalled words on repeated free recall tests any more than did normals. However, checkers remembered fewer actions overall and more often misremembered whether they had performed, observed, or written these actions. Such memory deficits may contribute to the development of excessive checking.     

Production of narrative and procedural discourse in aphasia

The study described the abilities of a group of 10 aphasics and 10 normals to produce narrative and procedural discourse. The experimental tasks included telling stories, producing summaries, giving morals to the stories, and producing procedures. The variables examined in the investigation included features of sentential grammars, such as amount of embedding, and features of discourse grammars, such as occurrence of elements of superstructure in narrative. Additionally, raters assessed the content and clarity of the discourses. The results showed that aphasics produced well-structured narrative and procedural discourse. Aphasics' discourse errors differed only in degree, not qualitatively, from those of normals. The language of the aphasics' discourses was reduced in both complexity and amount. It was found that the aphasics had difficulties in producing summaries and giving morals for the stories when compared with the normals. Both the content and clarity of the discourses produced by the aphasics were rated lower than those produced by the normals.     

What is perseverated in schizophrenia? Evidence of abnormal response plasticity in the saccadic system

Although perseveration is sometimes attributed to defective set switching, the authors have recently shown that set-switching is normal in schizophrenia. In this article, the authors tested for persistent states of the saccadic response system, rather than set perseveration. Schizophrenic and healthy subjects performed antisaccades and prosaccades. The authors analyzed for 3 carry-over effects. First, whereas the latency of the current saccade correlated with that of the prior saccade in both groups, the correlations under mixed-task conditions declined in healthy but not in schizophrenic subjects. Second, antisaccades in penultimate trials delayed upcoming saccades in schizophrenic but not in healthy subjects. Third, schizophrenic subjects were more likely to erroneously perseverate the direction of a prior antisaccade but not a prior prosaccade. The authors concluded that, in schizophrenia, the effects of correct antisaccades are persistent not weak. Saccades in schizophrenia are characterized by perseveration of antisaccade-induced changes in the saccadic response system rather than failures to switch task set.     

Young infants reach correctly in A-not-B tasks: on the development of stability and perseveration

This paper examines the development of perseverative reaching in the A-not-B task. We describe two recent models that view perseveration as a sign of developmental progress toward stability. In Experiment 1, we test the novel prediction from both models that very young infants should not perseverate in the A-not-B task whereas older infants should. We tracked infants' behavior monthly on the A-not-B task and found that infants reached correctly at 5 months, and only perseverated at 7 and 8 months of age. Experiment 2 provides further evidence on the role of motor development in the emergence of perseveration by exploring the connection between perseveration and detailed changes in reach kinematics in two infants across the first year. These data together suggest that perseveration is a sign of developmental achievement on the path to stable and flexible behavior.     

Production of narrative discourse in aphasia

The study described the abilities of a group of 15 moderately impaired aphasics and 15 normals to produce narrative discourse. The experimental tasks included telling stories, summarizing stories, and giving morals to stories. The data were analyzed in terms of sentential grammar, discourse grammar, and subjective ratings of content and clarity of language. The results showed that aphasics produced well-structured discourse. The language of the aphasics' discourse was reduced in both complexity and amount, as compared to that produced by normals. The reduction of language reflected selective reduction of hierarchically organized information. The findings of the study confirm the results of previous research on mildly impaired aphasics, which also showed preservation of discourse structure with selective reduction of information.     

The Simple Copy Task: Detecting Higher Order Visual Processing Deficits in Schizophrenia,Dementia, and Movement Disorder Groups

The Simple Copy Task (SCT) is a figure copying test with inherent appeal due to its short administration time, graded task difficulty, varied stimuli, and potential to eliminate floor effects. Despite this, there is a lack of data regarding its construct validity and diagnostic utility. The present study compared SCT performance of schizophrenia (n = 29), dementia (n = 64), and movement disorder (n = 12) groups with that of unmatched healthy control participants (n = 49). Movement disorder patients committed a high degree of misplacement errors, whereas dementia patients tended to omit items, add extraneous detail, and perseverate. The schizophrenia group was most similar to the dementia group in their performance on the SCT, committing primarily omission and perseveration errors. The SCT was most closely related to the Rey Complex Figure Task (r = 0.68, p < .01) and the Block Design Task (r = 0.62, p < .01). Age (r = ?0.14, p < .01) and education (r = 0.35, p < .01) effects were present; however, there was no impact of gender and handedness. Taken together, these findings provide support for the utility of the task and directions for clinical interpretation.     

Oculomotor programming disturbances in the dementia syndrome

Three types of oculomotor programming disturbances are described in patients with the dementia syndrome. This report describes two of these abnormalities, poorly regulated gaze patterns and a programming type of gaze perseveration. All patients showed poorly regulated gaze patterns in contrast to the normal controls, whereas on the whole only the moderately affected patients showed the programming type of gaze perseveration. The third type of oculomotor programming disturbance is efferent perseveration of gaze (a hypokinetic, "staring" type of gaze pattern) and can be seen with severe dementia. The possible significance of these findings is discussed.     

Inhibition versus switching deficits in different forms of rumination

Individuals who depressively ruminate about their current dysphoria tend to perseverate more than nonruminators. The goal of the current study was to determine whether such perseverative tendencies are associated with an inability to switch attention away from old to new information or with an inability to effectively inhibit the processing of previously relevant information. We used a task-switching paradigm that can distinguish between these two processes. Two experiments showed that depressive rumination is associated with a deficit in inhibiting prior mental sets. The second experiment also demonstrated that, in contrast to depressive rumination, angry and intellectual rumination are associated with difficulties in switching to a new task set, but not with inhibition of a prior task set. This study suggests that different forms of rumination are associated with different cognitive mechanisms and that both deficits may contribute to the perseveration that is associated with ruminative tendencies.     

The neurological substrates for prosodic aspects of speech

The ability to comprehend and produce the stress contrast between noun compounds and noun phrases (e.g., greenhouse vs. green house) was examined for 8 nonfluent aphasics, 7 fluent aphasics, 7 right hemisphere damaged (RHD) patients, and 22 normal controls. The aphasics performed worse than normal controls on the comprehension task, and the RHD group performed as well as normals. The ability to produce stress contrasts was tested with a sentence-reading task; acoustic measurements revealed that no nonfluent aphasic used pitch to distinguish noun compounds from phrases, but two used duration. All but one of the RHD patients and all but one of the normals produced pitch and/or duration cues. These results suggest that linguistic prosody is processed by the left hemisphere and that with brain damage the ability to produce pitch and duration cues may be dissociated at the lexical level.     

Implications of memory and language dysfunction in the naming deficit of senile dementia

Young normals, elderly normals, and patients with either mild-to-moderate or severe senile dementia of the Alzheimer type (SDAT) were administered several tests of language function and remote memory. On all of the language tests examined, elderly normals exhibited a mild, nonsignificant performance decrement relative to the young normals. Advanced SDAT patients were markedly impaired on all of the tests. Early dementia patients were most impaired, relative to aged normals, on tests of object naming, category instance fluency, and remote memory. The deficit was smaller on the WAIS vocabulary subtest, on selecting the name of a visually presented object, and on recalling the function of an object. Early SDAT patients were least impaired in selecting the picture of an object after its name had been provided and in selecting objects that belong to a specified functional category. The results are consistent with the notion that the language dysfunction in early SDAT is due to a deficit in semantic memory function in which general, categorical information remains available whereas information about specific attributes becomes less accessible. The object naming test might be useful in the assessment of treatment effects upon SDAT because of its sensitivity and specificity to dementia, its high face validity, and its independence of recent memory.     

Comprehension of contrastive stress by Broca's aphasics.

Comprehension of stress as a determiner of reference for pronouns was compared in eight patients with Broca's aphasia (BA) and five age-matched control subjects. The subjects were asked to listen to sentences in which the stressed or unstressed condition of the pronoun was a critical criterion for the establishment of reference. For each sentence, subjects were shown three pictures and asked to point to the correct referent of the pronoun. While the controls were nearly perfect in both the stressed and unstressed conditions, BA patients were significantly worse than normals, showing chance performance in both cases. However, a significant disparity was found in the BA patients' selection of the object NP as the referent under stressed and unstressed conditions, indicating that BA subjects are, indeed, sensitive to the stress patterns of pronouns. It was thus hypothesized that the BA patients' chance performance was the result of an inability to implement their knowledge of stress during the processing of sentences involving discourse-related linguistic operations, such as the establishment of pronoun reference (Grodzinsky, Wexler, Chien, Marakovitz, & Solomon, 1993). To test this hypothesis, a second experiment was conducted in which discourse-related operations were eliminated. In this second experiment, comprehension of stress by the same two groups was compared in tasks involving purely morphosyntactic processes. The contrastive stress patterns of otherwise homophonous compound nouns and adjectival phrases (e.g., BLACKboard, black BOARD), rather than those of pronouns, were examined. In this grammatically "simpler" experiment (i.e., without discourse-related operations), BA subjects scored significantly above chance in their comprehension of sentences involving compound nouns; unexpectedly, however, these same subjects did not show significantly above-chance performance in their comprehension of sentences containing adjectival phrases. Nevertheless, the results obtained in these two experiments seem to support the view that aphasic patients may have a lack of processing capacity, resulting in more errors during the processing of discourse-related linguistic constructions.