Priming and semantic memory loss in Alzheimer's disease

Semantic memory (SM) was investigated in six patients with probable Alzheimer's disease (AD) by on-line measurement of semantic priming in a lexical decision task, and off-line tests of comprehension. Detailed assessment was carried out on naming, name comprehension, and probes of semantic knowledge with a battery of 150 items. The patients performed normally on perceptual tests and displayed an item-specific loss of knowledge on the semantic tests. In a primed lexical decision task, greater semantic priming was found relative to age-matched normals. The priming was substantially greater for items with "degraded" representations as determined by the off-line tests. Lexical decision was also performed more slowly on these items. These unexpected results demand a reevaluation of the concepts of the lexicon and semantic memory structure and their possible alteration in dementia.     

Alzheimer disease and the "then" self

The authority of the intact self over the future severely demented self is based on notions of integrity and precedent autonomy. Despite criticism of this authority, the principle of precedent autonomy in the care of people with Alzheimer disease or other progressive and irreversible dementias retains its moral significance.     

Bodily self and schizophrenia: The loss of implicit self-body knowledge

Schizophrenia spectrum has been associated with a disruption of the basic sense of self, which pertains, among others, the representation of one's own body. We investigated the impact of either implicit or explicit access to the representation of one's own body-effectors on bodily self-awareness, in first-episode schizophrenia (FES) patients and healthy controls (HCs). We contrasted their performance in an implicit self-recognition task (visual matching) and in an explicit self/other discrimination task. Both tasks employed participant's own and others' body-effectors. Concerning the implicit task, HCs were more accurate with their own than with others' body-effectors, whereas patients did not show such self-advantage. Regarding the explicit task, both groups did not exhibit a self-advantage, and patients showed a higher percentage of self-misattribution errors. Neither self/other nor implicit/explicit effects were found in both groups when processing inanimate-objects. We propose that FES patients suffer of a disturbed implicit sense of bodily self.     

CT scan and neuropsychological correlates of Alzheimer's disease and Huntington's disease

"Cortical" and "subcortical" dementia syndromes differ in areas of primary neuropathology and clinical characteristics. Conventional CT scan interpretation, visual inspection of pictures, has not been useful in studying dementia. Recent studies of the digitally stored CT attenuation values have found systematic variations with normal aging and aphasia subtypes. In this study of numerical CT scan information in four Alzheimer's Disease and two Huntington's Disease patients, a double dissociation of frontal and temporal lobe density values was found, and a significant correlation was found between left temporal lobe density and verbal ability measures in the Alzheimer's Disease patients.     

Current concepts in the prevention of Alzheimer's disease

Alzheimer's disease represents a significant challenge to the aging population. Since most estimates suggest that AD has a multifactorial etiology, the challenge to find preventative approaches is particularly great. With the aging of the population and the very high incidence from the eighth decade on, the challenge is further enhanced by the need to think of relatively safe interventions given the relative frailty of this elderly population. The need to find safe treatments, or ones with well-understood safety profiles, has led to the examination of known agents for potential dementia-preventing properties. Data supporting these interventions comes from observational studies, laboratory analyses, and clinical trials. Potential mechanisms for prevention of AD include anti-inflammatory and antioxidant approaches. Modulation of risk factors associated with cardiac disease may also reduce the risk of AD. Known agents have been examined for their potential to modify amyloid pathology. Trial designs to address prevention of AD include both primary and secondary prevention studies as well designs to assess slowing disease progression. Information can also be gathered when dementia evaluation is added to ongoing studies. As results from these studies becoming available, we will be able to refine our approach to managing this disease.     

Semantic memory in Alzheimer's disease

Patients with Alzheimer's disease have been suggested to have a semantic memory impairment not present in the normal old. This article reviews the performance of Alzheimer patients on tests of various aspects of semantic memory, including word finding, knowledge of the semantic attributes, and associates of concepts, as well as their category membership. The effect that semantic context has on cognitive processes such as lexical and semantic priming and memory encoding is also reviewed. Finally, the ability of theoretical constructs such as implicit memory and automaticity to explain intertask variability in Alzheimer patients' semantic performance is discussed.     

Maze learning in Alzheimer's disease

Alzheimer's disease (AD) patients and normal elderly controls performed a block of 10 trials on a finger maze, followed by a 45-min period during which verbal learning measures were administered. Subjects then performed an additional 10 trials on the original maze, followed by 10 trials on a new maze. The AD patients and a subset of control subjects decreased mean completion time across Blocks 1 and 2, suggesting skill acquisition. Mean time on Block 3 was significantly less than mean time on Block 1, suggesting skill generalization. A subset of controls did not show the above pattern. The results of this study suggest that AD patients are able to acquire and generalize a cognitively mediated perceptual-motor skill.     

Posture recognition in Alzheimer's disease

BACKGROUND: Apraxia is neurologically induced deficit in the ability perform purposeful skilled movements. One of the most common forms is ideomotor apraxia (IMA) where spatial and temporal production errors are most prevalent. IMA can be associated Alzheimer's disease (AD), even early in its course, but is often not identified possibly because the evaluation of IMA by inexperienced judges using performance tests is unreliable. The purpose of this study, therefore, is to learn if the Postural Knowledge Test (PKT), a praxis discrimination test that assesses knowledge of transitive (PKT-T subtest) and intransitive (PKT-I subtest) postures and does not require extensive training, is as sensitive and specific as the praxis performance tests. METHODS: We studied 15 subjects with probable AD as well as 18 age-matched controls by having them perform transitive and intransitive gestures to command and imitation, as well as having them discriminate between correct and incorrect transitive and intransitive postures. RESULTS: Overall on all tests, the control subjects performed better than those with AD. In addition all subjects had more trouble with transitive than intransitive gestures. Using a stepwise discriminative analysis, 81.8% of the subjects could be classified according to Group (94.4% of Controls, 66.7% of AD subjects). In this analysis, the PKT-T (transitive posture subtest) was the only measure that contributed to the discrimination of subjects. CONCLUSION: We found that having subjects select the correct transitive hand postures in this "booklet test" was more sensitive than grading their praxis performances even when using judges with extensive training. This suggests that this discrimination test might be an excellent means for diagnosing and screening patients for AD. The reason why recognition of transitive postures is relatively more difficult for our AD subjects is not known. Two possibilities are that the representations for intransitive movements are stronger than those for transitive movements, and hence, more resistant to degradation, or that intransitive acts are stored in parts of the brain not affected by AD.     

Confabulation in Alzheimer's disease.

Confabulation is present when memory is disturbed, but does it occur in Alzheimer's disease (AD) where memory abnormalities are often severe? In this study, confabulation was assessed prospectively in 26 AD patients and 15 normal elderly (NE) controls using a neuropsychological battery specifically designed to assess different types of memory errors. The results indicated that the AD group made significantly more verbal intrusions than the NE group. These findings provide evidence for the feasibility of eliciting confabulatory-type behavior during clinical assessment and support previous reports which have documented verbal intrusions as a common accompaniment of the memory impairment manifested by AD patients.     

Functional decline in the early stages of Alzheimer's disease

At present most reports of functional decline in patients with Alzheimer's Disease (AD) are anecdotal, and few studies have objectively documented the course of the disease. This is a report of a 2-year follow-up of 15 AD patients characterized by mild functional impairment, and 22 age-, sex-, and education-matched control subjects. In a previous cross-sectional study of these 37 subjects and 16 AD patients with moderate functional impairment, we found that measures of memory and attention deficits accounted for much of the impairment observed in functional competence. The current longitudinal study found that these same initial assessments could be used to predict functional decline in the 15 mildly impaired patients. These patients were observed to decline to levels similar to those of the 16 moderate patients. In contrast, the control subjects exhibited little decline during the same period. These results both affirm that it is possible to diagnose AD in its mild form and demonstrate the validity of the initial diagnosis.     

Proper names in the early stages of Alzheimer's disease

A short proper name retrieval test was found to discriminate between unselected subjects and age- and education- matched patients affected by Alzheimer's type dementia at a stage where the Mini-Mental State Examination could not detect a difference between these groups. The proper name retrieval task also compared favorably with the 3MS, a more sensitive, modified version of the MMSE. These findings suggest that proper name retrieval could be used to an advantage and become a routine component of short batteries for the early detection of Alzheimer's disease.     

Time estimation in Alzheimer's disease and the role of the central executive

The aim of this study was to evaluate the role of short-term memory and attention in time estimation. For this purpose we studied prospective time verbal estimation in 21 patients with Alzheimer's disease (AD), and compared their performance with that of 21 matched normal controls in two different conditions: during a digit span task and during an attentional task. Results showed that the performance of AD patients was significantly worse than that of the controls; the interaction between group and condition was significant. We suggest a role of attentional-executive functions in prospective time estimation.     

Sleep in Alzheimer's disease and other dementing disorders

It is estimated that up to 10% of the elderly population have clinically significant cognitive deficits. The neuronal pathologies that underlie the dementing disorders cause both cognitive dysfunction and disturbances in normal sleep/wake patterns. Here we report the changes in sleep/wake patterns seen with increasing severity of Alzheimer's disease, probably the most common dementing disorder. In addition, studies examining sleep/wake patterns in a number of other dementing disorders are reviewed.     

Sentence repetition and processing resources in Alzheimer's disease

Sentence processing in Alzheimer's disease (AD) has been found to be influenced by several grammatical and extragrammatical factors, including phrase structure and verb-argument relations, number of propositions/verbs, and processing resource capacity. This study examines the effects of these variables on sentence production in AD. Normal control and AD subjects were asked to repeat six types of sentences varying along the above dimensions of complexity. Subjects' processing resource capacity was measured using several verbal working memory tests. AD subjects' sentence-repetition performance was impaired compared to the normal control group. Significant effects were observed for branching direction of phrase structure, canonicity of verb-argument relations, and serial position of errors. Sentence-repetition performance significantly correlated with working memory scores. The findings are interpreted within a resource capacity theory of sentence processing.     

Visual identification and spatial location in Alzheimer's disease

Twelve patients with Alzheimer's disease (AD) and 15 healthy elderly control subjects were shown sets of luminance-defined letters, texture-defined letters, luminance-defined squares, and texture-defined squares. They were asked to name the letters or point to the target square on each page. The stimuli were graded into four levels of difficulty based on the amount of contrast between the figure and the background. Performance was measured in terms of the maximum level of difficulty at which the participant correctly identified or located the three figures. Contrary to expectations, no significant difference was found between the performance of AD patients and control subjects on texture discrimination tasks vs. luminance discrimination tasks. However, results indicate that AD patients are impaired in performing a task requiring them to locate a texture-defined target of known shape in a noisy background field. By contrast, AD patients show no significant deficit in a task requiring them to locate a texture-defined shape in a known location. This argues that the observed deficit in the location task is not due to a failure in the system that discriminates target texture from background texture (since both location and identification tasks require the same textural discriminations), but rather to an impairment of the system responsible for "finding things" (i.e., locating known targets at unknown locations). This observation suggests that AD patients may suffer selective damage to the dorsal "Where" pathway, which is responsible for localizing objects in space.