The semantic category effect increases with worsening anomia in Alzheimer's type dementia

A large number of patients (n=72) with probable Alzheimer's type dementia (DAT) and mild cognitive impairment (MCI) carried out a picture naming task which comprised stimuli from biological and nonbiological categories. The results were stratified into five ranges of overall naming ability. Every group except those with scores within the range of elderly normal individuals demonstrated better nonbiological naming than biological naming, an effect which increased with worsening impairment. In general, patients diagnosed with other dementia (n=15) did not fit well within the pattern of the DAT/MCI participants, except those known to have a significant semantic impairment. A category effect favoring nonbiological items appears to be robust and produce a predictable pattern across progressive levels of impairment in AD.     

Contextual priming in semantic anomia: a case study

The present case continues the series of anomia treatment studies with contextual priming (CP), being the second in-depth treatment study conducted for an individual suffering from semantically based anomia. Our aim was to acquire further evidence of the facilitation and interference effects of the CP treatment on semantic anomia. Based on the results of the study of , our hypothesis before the treatment was that our participant would show short-term interference and at most modest and short-term benefit from treatment. To acquire such evidence would not only be important for the choice of anomia treatment methods in individual patients, but would also prompt further development of the CP method. The CP technique used for our participant included cycles of repeating and naming items in three contextual conditions (semantic, phonological, and unrelated). As predicted, the overall improvement of naming was modest and short-term. Interestingly, the contextual condition that corresponded with the nature of our patient's underlying naming deficit (semantic) elicited immediate interference in the form of contextual naming errors, as well as short-term improvement of naming. Based on this and a recent study by , it appears that despite short-term positive effects, in its current form the CP treatment is not sufficient for those aphasics who have a semantic deficit underlying their anomia. The possible mechanism and directions for future research are discussed.     

Charting the progression in semantic dementia: Implications for the organisation of semantic memory

Abstract

A patient, JL, with the syndrome of semantic dementia was assessed longitudinally over a two-year period. The data presented here address the controversy concerning the hierarchical organisation of semantic memory. On a range of category fluency tests, when first tested JL was just within the normal range on the broadest categories of animals and household items, but was virtually unable to produce any instances of specific categories such as breeds of dog or musical instruments. Longitudinal fluency data for the animal category demonstrate that while JL continued to produce the most prototypical responses (cat, dog, horse), other animal labels dropped out early from his vocabulary. On the picture-sorting tests from our semantic memory test battery, JL's discrimination between living things and man-made objects was preserved for a substantial time in conjunction with a marked decline in his sorting ability for more specific categories, particularly features or attributes (e.g. size, foreign-ness, or ferocity of animals).

An analysis of naming responses to the 260 Snodgrass and Vanderwart pictures on four occasions suggests a progressive loss of the features of semantic representations that enable discrimination between specific category instances. There was a progressive decline in circumlocutory and category co-ordinate responses with a rise in broad superordinate and cross-category errors. The latter are of particular theoretical interest; on session I, all cross-category errors respected the living/man-made distinction, but by session IV almost half of such errors failed to respect this distinction. The emergence of category prototypes was another notable feature, particularly in the living domain: at one stage, land (or four-legged) animals were all named either cat, dog, or horse. By contrast, within the man-made domain, items were frequently described in terms of their broad use or function, until eventually no defining features were produced. These findings are discussed in the context of competing theories of semantic organisation.     

Impaired ranking of semantic attributes in dementia

The present work explored the loss of semantic attributes that is said to occur in dementia. In the first two experiments, subjects had to select attributes that went with concepts like airplane and church. The finding that demented subjects maintained high levels of accuracy when selecting attributes suggested that the semantic content of their concepts was relatively well preserved. The organization of the content was explored in a third experiment by having subjects order attributes according to their relative importance in defining concepts. While demented subjects performed better than chance, they did not rank attributes as well as healthy aged subjects, suggesting a disruption in organization whereby the importance of central attributes is reduced. The hypothesized disruption in organization is viewed in relation to the learning and memory deficit that is the hallmark of the dementias.     

Knowledge of natural kinds in semantic dementia and Alzheimer's disease

We examined the semantic impairment for natural kinds in patients with probable Alzheimer's disease (AD) and semantic dementia (SD) using an inductive reasoning paradigm. To learn about the relationships between natural kind exemplars and how these are distinguished from manufactured artifacts, subjects judged the strength of arguments such as "Humans have a chemical called sebum. Therefore, frogs have a chemical called sebum." These judgments depend on subjects' perception of the similarity between the familiar objects named in the premise and the conclusion. Controls rated arguments generalizing from a natural kind to an artifact as significantly weaker than arguments generalizing from one natural kind to another natural kind. SD patients demonstrated a graded profile of generalization without evidence of a categorical distinction between natural kinds and artifacts. AD patients' judgments also suggested more difficulty than controls at distinguishing between natural kinds and artifacts. Both SD patients and AD patients resembled controls in their judgments of arguments where both objects are from the natural kinds category. Semantic knowledge thus appears to be sufficiently preserved in both AD and SD to support within-category similarity judgments. We suggest that SD patients may be impaired in part at identifying the features critical to diagnosing membership in a semantic category, while AD patients' performance is consistent with their semantic categorization deficit.     

Pattern of semantic memory impairment in dementia of Alzheimer's type

The specific pattern of semantic memory impairment in patients with dementia of Alzheimer's type (DAT) remains unclear. Specifically, the presence of a category-specific deficit for biological concepts (reflected in anomia for these concepts) has been questioned. We studied 9 DAT patients using a semantic association judgement test in which they had to decide which of the two given words was most like a target word (e.g., lamb: goat, sheep). The 150 target words were drawn from 6 categories: animals, clothing and furniture, fruits and vegetables, tools, action verbs, and abstract nouns. Age- and education-matched control subjects performed equivalently (between 86 and 90% correct) in all categories. Compared to control subjects, DAT patients made significantly more errors in abstract and biological nouns, but not in verbs and man-made artifacts. This pattern of semantic memory impairment--a sparing of verbs and a selective deficit of nouns in the biological category--has been documented in patients with temporal lobe damage, suggesting a critical dysfunction in the temporal lobes of DAT.     

Memory for internally generated words in Alzheimer-type dementia: breakdown in encoding and semantic memory

The "generation effect" is a phenomenon in which words that are generated by the subject are remembered better than words which are read. The present experiments examined this effect in patients with mild-to-moderate dementia of the Alzheimer type (DAT), healthy elderly adults, and young adults under a variety of different encoding and retrieval conditions. Experiment 1 employed an intentional learning task with multiple study/test trials using the same list of words. While both the young and elderly adults exhibited higher recall for internally generated words than read words, the DAT patients failed to demonstrate the effect even after repeated exposures to the same stimulus list. Experiment 2 replicated this same pattern of results using an incidental learning paradigm with both recall and recognition tests. Various explanations as to why the DAT patients failed to show the generation effect were discussed with particular emphasis placed on the role of semantic memory and encoding failure.     

Simulating episodic memory deficits in semantic dementia with the TraceLink model

Although semantic dementia is primarily characterised by deficits in semantic memory, episodic memory is also impaired. Patients show poor recall of old autobiographical and semantic memories, with better retrieval of recent experiences; they can form new memories, and normal performance on pictorial recognition memory has been demonstrated. As these abnormalities in episodic memory are virtually a mirror image of those seen in the amnesic syndromes, semantic dementia poses a challenge to extant models of remote memory and amnesia. Here, we show that one such model, TraceLink, can reproduce some of the principal findings on episodic memory in semantic dementia. A loss of nodes and connections within the trace system, which can be identified with the temporal neocortical memory storage sites implicated in semantic dementia, simulates without further assumptions the findings reported above.     

Empathy and emotion recognition in semantic dementia: A case report

Recent studies have demonstrated that patients suffering from frontotemporal lobar degeneration (FTLD) show impairments in empathy and emotional processing. In this study, we examined two different aspects of these abilities in a patient with semantic dementia (SD), a variant of FTLD. The first aspect was the assessment of the cognitive and emotional components of empathy through the Interpersonal Reactivity Index. The second was the naming and comprehension of emotions using the Ekman 60 Faces Test. The patient’s emotion word knowledge was spared and the emotional aspects of empathy preserved. Conversely, the patient performed below average for all of the basic emotions when an emotion word had to be matched with a picture. When picture-to-picture matching was tested, however, the patient was able to recognize happiness. This case is a good example of a dissociation of covert and overt emotional functioning in SD. Results are discussed in terms of the impaired empathic behavior and emotional functioning in FTLD.     

Simulating episodic memory deficits in semantic dementia with the TraceLink model

Although semantic dementia is primarily characterised by deficits in semantic memory, episodic memory is also impaired. Patients show poor recall of old autobiographical and semantic memories, with better retrieval of recent experiences; they can form new memories, and normal performance on pictorial recognition memory has been demonstrated. As these abnormalities in episodic memory are virtually a mirror image of those seen in the amnesic syndromes, semantic dementia poses a challenge to extant models of remote memory and amnesia. Here, we show that one such model, TraceLink, can reproduce some of the principal findings on episodic memory in semantic dementia. A loss of nodes and connections within the trace system, which can be identified with the temporal neocortical memory storage sites implicated in semantic dementia, simulates without further assumptions the findings reported above.     

Deregulated semantic cognition contributes to object‐use deficits in Alzheimer's disease: A comparison with semantic aphasia and semantic dementia

Executive control is impaired from the early stages of Alzheimer's Disease (AD) and this produces deregulated semantic cognition (Corbett, Jefferies, Burns, & Lambon Ralph, 2012 ; Perry, Watson, & Hodges, 2000 ). While control deficits should affect semantic retrieval across all modalities, previous studies have typically focused on verbal semantic tasks. Even when non‐verbal semantic tasks have been used, these have typically employed simple picture‐matching tasks, which may be influenced by abnormalities in covert naming. Therefore, in the present study, we examined 10 patients with AD on a battery of object‐use tasks, in order to advance our understanding of the origins of non‐verbal semantic deficits in this population. The AD patients’ deficits were contrasted with previously published performance on the same tasks within two additional groups of patients, displaying either semantic degradation (semantic dementia) or deregulation of semantic retrieval (semantic aphasia; Corbett, Jefferies, Ehsan, & Lambon Ralph, 2009 ). While overall accuracy was comparable to the scores in both other groups, the AD patients’ object‐use impairment most closely resembled that observed in SA; they exhibited poorer performance on comprehension tasks that placed strong demands on executive control. A similar pattern was observed in the expressive domain: the AD and SA groups were relatively good at straightforward object use compared to executively demanding, mechanical puzzles. Error types also differed: while all patients omitted essential actions, the SA and AD groups’ demonstrations also featured unrelated intrusions. An association between AD patients’ object use and their scores on standard executive measures suggested that control deficits contributed to their non‐verbal semantic deficits. Moreover, in a task specifically designed to manipulate executive demand, patients with AD (and SA) exhibited difficulty in thinking flexibly about the non‐canonical uses of everyday objects, especially when distracted by semantically related objects. This study provides converging evidence for the notion that a failure of regulatory control contributes to multimodal semantic impairment in AD and uniquely demonstrates this pattern for the highly non‐verbal domain of object use.     

Phoneme-based rehabilitation of anomia in aphasia

This study investigated the effects of phonologic treatment for anomia in aphasia. We proposed that if treatment were directed at the level of the phonologic processor, opportunities for naming via a phonological route, as opposed to a strictly whole word route, would be enhanced, thereby improving naming. The participants, ten people with anomia and aphasia due to left hemisphere stroke, received 96 h of phoneme based treatment in 12 weeks. To learn if treatment improved naming, a single-subject, repeated probe design with replication was employed. The primary outcome measure was confrontation naming. Secondary outcome measures included phonologic production, nonword repetition and discourse production. Results suggest a positive treatment effect (confrontation naming), improvements in phonologic production and nonword repetition, and generalization to discourse production. When tested 3 months after the completion of treatment the effects appeared to be maintained.     

Exploring classical conditioning for strengthening the links between semantic and lexical representations in pure anomia: Preliminary findings from a single case study

The same language symptom might arise at different functional loci in people with aphasia. Therefore, it is plausible that different therapeutic interventions should be adopted to approach the same difficulties in different patients. Although this point of view is still widely accepted, recently the focus has shifted from the functional locus of a rehabilitative intervention to the mechanisms of action underlying the relearning process. We maintain that both aspects should be taken into account when programming a rehabilitative intervention; furthermore, investigating relearning mechanisms might shed new light on the functional architecture of the disrupted processes. Here, we investigated, in a single case study, whether classical conditioning was a suitable relearning paradigm for targeting word‐finding difficulties in pure anomia, that is in a patient with an impairment in accessing intact output lexical representations from a spared semantic system. Using a word‐repetition task on picture presentation, we contrasted a condition in which the stimulus onset asynchrony between word and picture stimuli was well suited to produce classical conditioning with a condition in which repetition training could not benefit from this learning mechanism. Only classical conditioning training exerted a significant, long‐lasting effect on our patient's naming skill. Tentative implications of our results for the functional architecture of single‐word processing are discussed.     

Accessing semantic knowledge in dementia: evidence from a word definition task

We examine production of word definitions by people with probable Alzheimer's disease (pAD). In the first experiment, healthy young adults defined concrete, imageable nouns to provide a baseline of definitional ability. Analysis of these definitions identified the key defining features of each target item. In the second experiment, pAD participants and elderly controls produced definitions of the same items. In the third experiment, healthy young participants rated the adequacies of these definitions. Although as expected the pAD participants produced fewer good definitions than the other two groups, most of their responses still contained some relevant information. pAD definitions contained fewer pieces of information and the information they produced was more tangential to the primary concept than that provided by the young or elderly participants. We identify two possible explanations in semantic loss and metalinguistic impairment. We consider metalinguistic impairment to provide the more plausible explanation of pAD patients' definitional performance.     

Semantic impairment and anomia in Alzheimer''s disease

Impairment in naming visually presented objects was investigated in patients with a clinical diagnosis of Alzheimer's disease. Impaired object naming correlated with difficulty listing the names of objects from a specified semantic category and with erroneous selection of words semantically related to the correct names for objects in a name recognition test. These results suggest that patients with Alzheimer's disease have a semantic impairment characterized by inability to distinguish among objects that are members of the same semantic category, and that this impairment is associated with difficulty producing the names for objects. Semantic impairment was present in patients with normal ability to discriminate visually presented shapes, indicating that the semantic deficit in Alzheimer's disease occurs independently of abnormalities of visuospatial function. Patients tended to make errors on the same items in both confrontation naming and name recognition tests, suggesting that the semantic impairment in Alzheimer's disease involves loss of information about specific objects and their names.     

SD-squared: on the association between semantic dementia and surface dyslexia

Within the connectionist triangle model of reading aloud, interaction between semantic and phonological representations occurs for all words but is particularly important for correct pronunciation of lower frequency exception words. This framework therefore predicts that (a) semantic dementia, which compromises semantic knowledge, should be accompanied by surface dyslexia, a frequency-modulated deficit in exception word reading, and (b) there should be a significant relationship between the severity of semantic degradation and the severity of surface dyslexia. The authors evaluated these claims with reference to 100 observations of reading data from 51 cases of semantic dementia. Surface dyslexia was rampant, and a simple composite semantic measure accounted for half of the variance in low-frequency exception word reading. Although in 3 cases initial testing revealed a moderate semantic impairment but normal exception word reading, all of these became surface dyslexic as their semantic knowledge deteriorated further. The connectionist account attributes such cases to premorbid individual variation in semantic reliance for accurate exception word reading. These results provide a striking demonstration of the association between semantic dementia and surface dyslexia, a phenomenon that the authors have dubbed SD-squared.     

The role of context in remembering familar persons: insights from semantic dementia

Semantic dementia (SD) is a progressive condition characterized by an insidious and gradual breakdown in semantic knowledge. Patients suffering from this condition gradually lose their knowledge of objects and their attributes, concepts, famous persons, and public events. In contrast, these patients maintain a striking preservation of autobiographical memory. The aim of the present study was to examine in a patient suffering from SD the role of context in the ability to recall knowledge of familiar persons. In an experiment, patient J.M. was asked to name and identify familiar persons that appeared on family photographs from recent and remote periods of her life. In the first experimental condition, the pictures represented personally familiar persons present in a specific spatial and temporal context. In a second experimental condition, the pictures showed personally familiar persons who were presented without any specific episodic context. Results indicate that the patient was able to name and identify familiar persons irrespective of the context of presentation (with/without context) and of the time period (recent/remote). No temporal gradient was found using family photographs. Finally, in contrast with familiar persons, J.M. presented a severe anomia for celebrities. Results are discussed in light of recent research in the field.     

Verbal mediation of number knowledge: evidence from semantic dementia and corticobasal degeneration

Patients with corticobasal degeneration (CBD) appear to have impaired number knowledge. We examined the nature of their number deficit while we tested the hypothesis that comprehension of larger numbers depends in part on verbal mediation. We evaluated magnitude judgments and performance on number conservation measures rooted in Piagetian theory in nonaphasic patients with CBD (n=13) and patients with a fluent form of progressive aphasia known as semantic dementia (SD; n=15). We manipulated the numbers of the arrays and the visual-spatial properties of the stimuli being compared during magnitude judgments and Piagetian conservation measures. CBD patients were consistently impaired judging the magnitudes of larger numbers (4-9), while they had minimal difficulty with smaller numbers (magnitudes < or = 3). By comparison, SD patients performed all measures of number knowledge at a ceiling level regardless of number magnitude. Neither patient group was significantly impacted by manipulations of the spatial properties of the stimuli. CBD patients' impairment with larger numbers despite minimal aphasia, and SD patients' intact performance despite an aphasia, challenge the proposal that understanding larger numbers depends on verbal mediation.