Perseverative errors on the Wisconsin Card Sorting Test and brain perfusion imaging in mild Alzheimer's disease

Cognitive Correlates of Perseverations in Individuals with Memory Impairment

OBJECTIVE

This study examines which cognitive measure best accounts for perseverations in individuals with memory impairment.

METHOD

The sample included 85 individuals, of whom 21 had subjective memory concerns, 27 had mild cognitive impairment, and 37 had Alzheimer's disease. Participants produced responses on a semantic category fluency task and on the ideational fluency (IF) task from the Cambridge Cognitive Examination-Revised. Measures of word finding, working memory, and abstract thinking were also assessed.

RESULTS

Significant group differences in percentage of perseverations emerged on both tasks. No cognitive measure accounted for the percentage of perseverations on the semantic fluency task. A measure of abstract thinking was the best predictor of the percentage of perseverations on the IF task, followed by a measure of working memory.

CONCLUSIONS

The underlying cognitive mechanisms that lead to perseverations differ across tasks, with perseverations on the IF task reflecting both conceptual deficits and working memory limitations.

Attentional Set-Shifting Across Species

Attentional set-shifting, as a measure of executive flexibility, has been a staple of investigations into human cognition for over six decades. Mediated by the frontal cortex in mammals, the cognitive processes involved in forming, maintaining and shifting an attentional set are vulnerable to dysfunction arising from a number of human neurodegenerative diseases (such as Alzheimer's, Parkinson's and Huntington's diseases) and other neurological disorders (such as schizophrenia, depression, and attention deficit/hyperactivity disorder). Our understanding of these diseases and disorders, and the cognitive impairments induced by them, continues to advance, in tandem with an increasing number of tools at our disposal. In this chapter, we review and compare commonly used attentional set-shifting tasks (the Wisconsin Card Sorting Task and Intradimensional/Extradimensional tasks) and their applicability across species. In addition to humans, attentional set-shifting has been observed in a number of other animals, with a substantial body of literature describing performance in monkeys and rodents. We consider the task designs used to investigate attentional set-shifting in these species and the methods used to model human diseases and disorders, and ultimately the comparisons and differences between species-specific tasks, and between performance across species.

The vascular depression hypothesis: mechanisms linking vascular disease with depression

The 'Vascular Depression' hypothesis posits that cerebrovascular disease may predispose, precipitate or perpetuate some geriatric depressive syndromes. This hypothesis stimulated much research that has improved our understanding of the complex relationships between late-life depression (LLD), vascular risk factors, and cognition. Succinctly, there are well-established relationships between LLD, vascular risk factors and cerebral hyperintensities, the radiological hallmark of vascular depression. Cognitive dysfunction is common in LLD, particularly executive dysfunction, a finding predictive of poor antidepressant response. Over time, progression of hyperintensities and cognitive deficits predicts a poor course of depression and may reflect underlying worsening of vascular disease. This work laid the foundation for examining the mechanisms by which vascular disease influences brain circuits and influences the development and course of depression. We review data testing the vascular depression hypothesis with a focus on identifying potential underlying vascular mechanisms. We propose a disconnection hypothesis, wherein focal vascular damage and white matter lesion location is a crucial factor, influencing neural connectivity that contributes to clinical symptomatology. We also propose inflammatory and hypoperfusion hypotheses, concepts that link underlying vascular processes with adverse effects on brain function that influence the development of depression. Testing such hypotheses will not only inform the relationship between vascular disease and depression, but also provide guidance on the potential repurposing of pharmacological agents that may improve LLD outcomes.