Drawing perseveration in neglect: Effects of target density

In cancellation tasks, patients with unilateral spatial neglect typically fail to mark targets within the side of the sheet contralateral to the side of the lesion (contralesional). Moreover, they can show a perseverative behaviour, which consists in repeatedly cancelling stimuli, mainly in the side of the display ipsilateral to the side of the lesion (ipsilesional). We investigated in 13 right‐brain‐damaged patients with left spatial neglect and perseverative behaviour whether and how different densities of horizontal targets modulated omission and perseverative errors. We found that the density of targets modulated the patients’ distribution of neglect (area of omission), but not its extent, as indexed by the percentage of omissions. Specifically, the area of omissions tightened when target density increased leftwards. On the other hand, target density did not affect the distribution of perseverative behaviour (area of perseveration), as well as its extent, as indexed by the percentage of perseverations. Correlation analyses showed that both the extent and the distribution of omissions were positively correlated to clinical measures of spatial neglect. Conversely, perseverations did not show such a correlation. These findings support the view that two different pathological mechanisms might be involved in left spatial neglect and in ipsilesional perseverative behaviour.     

Frequency of perseveration in normal subjects

Although perseveration is a recognized sign of disturbed brain function, it also occurs in normal individuals. Determination of the frequency of perseveration in normal subjects would enable clinicians to use perseveration as a marker of possible pathology. The purpose of this study was to document the extent of perseveration in normal young and older subjects. Thirty young normal individuals between the ages of 20 and 35 years and 30 older normal individuals between the ages of 60 and 75 years were given four tasks on which perseveration has been reported in brain-damaged individuals. Four percent of all responses were perseverative. No age or gender effects on frequency were observed. Of the four neuropsychological tasks, the Modified Wisconsin Card Sorting Test elicited the greatest number of perseverations.     

Functional cerebral asymmetry in hostility: a dual task approach with fluency and cardiovascular regulation

The influence of hostility levels on verbal and nonverbal fluency, and the concurrent cerebral regulation of autonomic nervous system functioning was examined in 48 right-handed males, half classified as low-hostile, and half as high-hostile. Recent research has supported inhibitory roles for the anterior right cerebrum in sympathetic regulation, and the anterior left cerebrum in parasympathetic regulation. Two neuropsychological tests purportedly mediated by left and right anterior cerebral systems, respectively, are the Controlled Oral Word Association Test and the Ruff Figural Fluency Test. Fluency and perseverative errors were assessed using these measures. Systolic and diastolic blood pressure, and heart rate were assessed with a digital blood pressure meter. It was predicted that high-hostile men would evidence interference on cardiovascular regulation concurrent with the nonverbal fluency task in comparison to low-hostile males. Further, interference was expected to manifest in the cognitive variable with more perseverative errors on the nonverbal fluency task in high-hostile males than in low-hostile males. The results support a capacity-limited prediction. High-hostile males evidenced significantly heightened systolic blood pressure during the nonverbal fluency task in comparison with low-hostile males. Further, high-hostile males displayed more perseverative errors in nonverbal fluency than did the low-hostile males. These results support the expectation that differences exist between high- and low-hostile males for right frontal functioning. These findings were discussed within the proposed anterior-posterior inhibition model of hostility.     

The spectrum of recurrent thoughts and behaviors in frontotemporal dementia

This article describes the spectrum of recurrent thoughts and behaviors that can result from frontotemporal dementia (FTD) and its variants. Although repetitive behaviors can result from a range of brain disorders, FTD is the most common neurologic cause of new-onset recurrent thoughts and behaviors in middle or late life. Patients with FTD can manifest typical or bizarre compulsions, hoarding, verbal and motor stereotypies and complex tics; self-injurious acts, perseverations; and fixed, obsessional thoughts. The frequency and variability of these repetitive behaviors suggest a common disturbance of orbitofrontal-basal ganglia circuits involved in response inhibition. The amelioration of these recurrent events with the administration of serotonin selective reuptake inhibitors further suggests a serotonergic deficit.     

The role of testimony in young children's solution of a gravity-driven invisible displacement task

Previous research has shown that young children make a perseverative, gravity-oriented, error when asked to predict the final location of a ball dropped down an S-shaped opaque tube (Hood, 1995). We asked if providing children with verbal information concerning the role that the tubes play, in determining the ball's trajectory would improve their performance. Experiment 1 showed that performance of 3.5-year-olds improved after hearing testimony about the movement of the ball. Experiment 2 showed that the specific content of the testimony – rather than any accompanying non-verbal cues – helped children improve. These findings suggest that other people's testimony can be a valuable source of information when young children learn about the physical world. Indeed, under some circumstances children seem to benefit more from verbal than visual information. An educational implication is that it may sometimes be ineffective to focus on the impact of first-hand experience while marginalizing the role of verbal information.     

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.     

I'm sitting here feeling aphasic! A study of recurrent perseverative errors elicited in unimpaired speakers

In this study, the recurrent perseverative errors produced by 44 speakers without impairment were examined in picture naming and reading aloud tasks under a fast response deadline. The proportion of perseverative relative to non-perseverative errors was greater in picture naming, the more error-prone task, than in reading aloud. Additionally, although perseverative errors were less likely to be related to the target than non-perseverative errors, the overall distribution of perseverative and non-perseverative errors in each task was similar. It is concluded that the perseverative errors produced by the participants reflected both the degree and level at which language processing efficiency was reduced in each task. This is consistent with a more recent account of perseveration as a result of normally existing persistent activation overcoming weakened activation of a target at any level of language processing. These results are compared with recent studies of recurrent perseverative errors produced by people with aphasia in light of the cognitive neuropsychological assumption that speakers with and without impairment utilise a common language processing system.     

Emotional inertia contributes to depressive symptoms beyond perseverative thinking

The autocorrelation or inertia of negative affect reflects how much negative emotions carry over from moment to moment and has been associated with increased depressive symptoms. In this study, we posed three challenges to this association by examining: (1) whether emotional inertia is relevant for depressive symptoms when assessed on a longer timescale than usual; (2) whether inertia is uniquely related to depressive symptoms after controlling for perseverative thoughts; and (3) whether inertia is related to depressive symptoms over and above the within-person association between affect and perseverative thoughts. Participants (N = 101) provided ratings of affect and perseverative thoughts for 100 days; depressive symptoms were reported before and after the study, and again after 2.5 years. Day-to-day emotional inertia was related to depressive symptoms over and above trait and state perseverative thoughts. Moreover, inertia predicted depressive symptoms when adjusting for its association with perseverative thoughts. These findings establish the relevance of emotional inertia in depressive symptoms independent of perseverative thoughts.     

Frontal deficits differentiate progressive supranuclear palsy from Parkinson's disease

The clinical differentiation of progressive supranuclear palsy from Parkinson's disease can be challenging, due to overlapping clinical features and a lack of diagnostic markers. Abnormalities in cognitive function form part of the clinical spectrums of these diseases and distinctive cognitive profiles may be helpful in differentiating these diseases in the diagnostic period. A comprehensive neuropsychological test battery was administered to 12 patients with clinically diagnosed progressive supranuclear palsy and 12 patients with Parkinson's disease matched for age and disease duration. Effect size (Cohen's d) was calculated for cognitive tests that were significantly different between groups. Patients with progressive supranuclear palsy performed significantly worse than those with Parkinson's disease on measures of processing speed, verbal fluency, planning, verbal abstract reasoning, verbal memory, and made more perseverative responses on a set shifting task. Measures of executive function, manual dexterity and processing speed were most diagnostically useful (Cohen's d > 2.0) in differentiating between progressive supranuclear palsy and Parkinson's disease. These findings suggest that more severe and prominent ‘frontal’ cognitive deficits in patients with progressive parkinsonism would be helpful in predicting progressive supranuclear palsy rather than Parkinson's disease and these findings may contribute to the development of diagnostic criteria.     

Augmented input reveals word deafness in a man with frontotemporal dementia

We describe a 57 year old, right handed, English speaking man initially diagnosed with progressive aphasia. Language assessment revealed inconsistent performance in key areas. Expressive language was reduced to a few short, perseverative phrases. Speech was severely apraxic. Primary modes of communication included gesture, pointing, gaze, physical touch and leading. Responses were 100% accurate when he was provided with written words, with random or inaccurate responses for strictly auditory/verbal input. When instructions to subsequent neuropsychological tests were written instead of spoken, performance improved markedly. A comprehensive audiology assessment revealed no hearing impairment. Neuroimaging was unremarkable. Neurobehavioral evaluation utilizing written input led to diagnoses of word deafness and frontotemporal dementia, resulting in very different management. We highlight the need for alternative modes of language input for assessment and treatment of patients with language comprehension symptoms.     

Functional analysis and intervention of perseverative speech in students with high-functioning autism and related neurodevelopmental disabilities

Although perseverative speech is a common characteristic of individuals with high-functioning neurodevelopmental disabilities, little is known about the operant functions of these verbalizations. We conducted analogue functional analyses of perseverative speech for 2 students using reinforcement contingencies that included alone, attention, control, escape, and tangible conditions. Results showed the following patterns: attention only (Charlotte) or multiply determined including an attention function (Paul). We then tested an intervention for perseverative speech maintained by social positive reinforcement that included differential reinforcement of alternative behavior and extinction of perseverative speech for 1 participant. The intervention reduced perseverative speech, but did not increase appropriate speech until we added a prompting component. We then replicated this three-component intervention with Paul. The results showed moderate to high decreases in levels of perseverative speech and increased appropriate verbalizations in both cases. The results systematically replicated the interventions of previous studies by adding a prompting component to the intervention.     

认知固执导致持续应激的认知与神经机制

认知固执(Perseverative Cognition, PC)是一种重复或长期的消极认知表征,既能够使用量表测量,也可以通过实验诱发。认知固执会导致持续应激反应,进而影响个体的身心健康。其导致持续应激反应的认知机制体现在个体难以识别安全信号,高认知固执个体会表现出低心率变异性的显著特征;在脑机制方面主要表现为前额叶的抑制控制功能失调、杏仁核与前扣带回的病理性改变以及前额叶-杏仁核的连接减弱。未来研究应深入探讨认知固执的影响因素以及干预措施,同时需要进一步分析内隐认知固执的测量方式及其对个体的影响。     

Error Types in Ideomotor Apraxia: A Qualitative Analysis

Seventeen brain-damaged subjects with dominant hemisphere pathology and 24 matched control subjects were asked to perform simple familiar gestures under four conditions: (1) verbal command (pantomime), (2) imitation, (3) with the actual object, and (4) verbal command a second time. The subjects subsequently watched a video of an actor performing simple movements and decided whether or not these were performed accurately. The gestural production task was videoed and analyzed for error type. Error type remained consistent over the four task conditions, although subgroups of patients made different types of errors. One group of patients with Ideomotor Apraxia (IMA) made more errors but of the same type as the controls, i.e., movement-related errors and the use of "body part as object" (BPO). The second group made mainly substituted (i.e. unrelated) movements and perseverative errors. The second group of subjects was also poorer at discriminating incorrectly performed movements in the recognition task. BPO errors were commonly made by the control group and they were also chosen as correct in the recognition task. This indicated that use of BPO may reflect a convention in symbolising gestures rather than pathology. The performance of the IMA subjects was discussed in relation to current theories of the mechanisms underlying apraxia.     

Memory and attention in combat-related post-traumatic stress disorder (PTSD)

Vietnam combat veterans assigned diagnoses of PTSD were compared on measures of attention/concentration, new learning, and memory with Army National Guard enlistees who reported no unusual traumatic events or stress-related symptoms. Results showed that PTSD veterans performed more poorly than the comparison sample on a measure of verbal learning, exhibiting less proficient cumulative acquisition across repeated exposures, greater sensitivity to proactive interference, and more perseverative errors. Veterans with PTSD diagnoses also evidenced impairments in word fluency and visual attention/tracking abilities. These preliminary findings suggest that diagnoses of chronic PTSD in combat veterans are associated with cognitive performance deficits, when comparisons are made with military troops judged to be free of stress-related psychopathology. Results are consistent with self-reported complaints of concentration and memory impairments among PTSD-diagnosed clinical samples, thus highlighting the need for continued investigation of the neuropsychologlcal sequelae of prolonged stress exposure.     

Attentional control in OCD and GAD: specificity and associations with core cognitive symptoms

Obsessive–compulsive disorder (OCD) and generalized anxiety disorder (GAD) are both defined by excessive negatively-valenced cognitions. Although obsessional thoughts are considered essential to OCD and perseverative worry is considered essential to GAD, these excessive cognitions have been found to co-occur in both disorders. Accordingly, a common diathesis may influence the emergence of excessive thoughts in both disorders. The present study examined deficits in attentional control as a cognitive vulnerability that may contribute to both obsessional thought and perseverative worry. Patients with OCD (n = 30), GAD (n = 29), and non-clinical controls (NCC; n = 29) completed measures of obsessional thoughts, perseverative worry, and attentional control. Deficits in self-reported attentional control were found in both OCD and GAD relative to the NCC. However, attentional control was only related to excessive cognition in the GAD patient group, where deficits were associated with increased perseverative worry. Mediational modeling suggested that trait anxiety mediated the relationship between attentional control and perseverative worry in GAD. Implications of these findings for conceptualizing the role of attentional control in the genesis of excessive cognitions in OCD and GAD are discussed.     

Effects of verb complexity on speech errors

Two experiments examined whether semantically related verbs that contrast with respect to the absence versus the presence of an additional semantic feature differentially compete for selection during the encoding of a sentence for production. In both experiments, a speech error induction task was used to elicit contextual (misordering) errors involving semantically related verbs that contrasted only in their semantic complexity or in both their semantic and morphophonological complexity. The prediction was that an asymmetry in contextual errors would be observed in which the more complex verbs would replace the simpler verbs more often than the reverse. This prediction was confirmed in both experiments, with more perseverations and anticipations involving the semantically more complex verb of antonym pairs in Experiment 1, and more perseverations and anticipations involving the semantically more-specified verb of a heavy-light pair in Experiment 2. The implications of the results for spreading-activation theories of language production are discussed.     

Linguistic markers of decision processes in a problem solving task

Two distinct decision processes, involved in the construction of chunks, were characterized from the cognitive interpretation of Culioli’s enunciative operations in 80 thinking aloud verbal reports for the Tower of Hanoi puzzle. The instructions presented the tower to 20 participants, 10 years old, during four consecutive trials, with two distinct verbal labels, either as a collection or as a class, i.e. as Tower vs. Disks. Two studies analysed the repartition of linguistic markers: enunciative Locations between consecutive moves, interpreted as markers of automatic entailments and of attentional focusing; and Starting Terms, as markers of a categorizing process, reconstructing external occurrences at a higher level of control, and regulating the access to abstraction. In the first study sections were demarcated on every solution path by the achievement of subgoals, and by points of obligatory passage, and, in the second one, two distinct batches of moves were distinguished. Results allowed to characterize micro-processes involved in the interaction between internal and external spaces. A process of internalization and externalization, entailing perseverations, was observed in the case of holistic structure, at the beginning in condition Tower, and later in condition Disks where the emergence of this structure was attested. A third study analyzed individual differences in performance, showing two mechanisms of generalization, one in interactive processing, the other along the optimal strategy in the external space. These exploratory results open the way to a number of issues going far beyond the case of the Tower of Hanoi puzzle.     

Reduction of perseverative errors in patients with schizophrenia using monetary feedback.

The influence of monetary feedback on Wisconsin Card Sort Test (WCST) performance of 14 male schizophrenics was investigated. Patients were administered the test under standard instructions and with monetary feedback in counterbalanced order. Monetary reinforcement reduced perseverative errors and increased correct responses (p less than .05). These findings suggest that the WCST perseverative errors of schizophrenics reflect motivational as well as cognitive factors.     

Young children's difficulty with inhibitory control in a social context1

Abstract: The authors’ prior research has documented that young children's behaviors in the Dimensional Change Card Sorting (DCCS) task can be influenced by their observation of another person performing the task and has suggested that young children committed perseverative errors in a social context. The present study explored whether children who committed perseverative errors in the social context also committed perseverative errors in the standard DCCS task. Three‐ and 4‐year‐old children were given the standard DCCS and the observation version of the DCCS, and the relationship between them was examined. The results showed that the correlation between these two tasks was significant. Furthermore, 4‐year‐old children displayed more difficulty in the observation version than in the standard DCCS, whereas 3‐year‐olds did not. The results are discussed in terms of the development of inhibitory control and social cognition.