SEMANTIC DEMENTIA WITH CATEGORY SPECIFICITY:ACOMPARATIVE CASE-SERIES STUDY

Concrete and Abstract Concepts in Primary Progressive Aphasia and Alzheimer's Disease: A Scoping Review

The concreteness effect (CE), namely a better performance with concrete compared to abstract concepts, is a constant feature in healthy people, and it usually increases in persons with aphasia (PWA). However, a reversal of the CE has been reported in patients affected by the semantic variant of Primary Progressive Aphasia (svPPA), a neurodegenerative disease characterized by anterior temporal lobe (ATL) atrophy. The present scoping review aims at identifying the extent of evidence regarding the abstract/concrete contrast in Alzheimer's disease (AD) and svPPA and associated brain atrophy. Five online databases were searched up to January 2023 to identify papers where both concrete and abstract concepts were investigated. Thirty-one papers were selected and showed that while in patients with AD, concrete words were better processes than abstract ones, in most svPPA patients, there was a reversal of the CE, with five studies correlating the size of this effect with ATL atrophy. Furthermore, the reversal of CE was associated with category-specific impairments (living things) and with a selective deficit of social words. Future work is needed to disentangle the role of specific portions of the ATL in concept representation.

Temporopolar regions of the human brain

Following prolonged neglect during the formative decades of behavioural neurology, the temporopolar region has become a site of vibrant research on the neurobiology of cognition and conduct. This turnaround can be attributed to increasing recognition of neurodegenerative diseases that target temporopolar regions for peak destruction. The resultant syndromes include behavioural dementia, associative agnosia, semantic forms of primary progressive aphasia and semantic dementia. Clinicopathological correlations show that object naming and word comprehension are critically dependent on the language-dominant (usually left) temporopolar region, whereas behavioural control and non-verbal object recognition display a more bilateral representation with a rightward bias. Neuroanatomical experiments in macaques and neuroimaging in humans show that the temporoparietal region sits at the confluence of auditory, visual and limbic streams of processing at the downstream (deep) pole of the 'what' pathway. The functional neuroanatomy of this region revolves around three axes, an anterograde horizontal axis from unimodal to heteromodal and paralimbic cortex; a radial axis where visual (ventral), auditory (dorsal) and paralimbic (medial) territories encircle temporopolar cortex and display hemispheric asymmetry; and a vertical depth-of-processing axis for the associative elaboration of words, objects and interoceptive states. One function of this neural matrix is to support the transformation of object and word representations from unimodal percepts to multimodal concepts. The underlying process is likely to start at canonical gateways that successively lead to generic (superordinate), specific (basic) and unique levels of recognition. A first sign of left temporopolar dysfunction takes the form of taxonomic blurring where boundaries among categories are preserved but not boundaries among exemplars of a category. Semantic paraphasias and coordinate errors in word-picture verification tests are consequences of this phenomenon. Eventually, boundaries among categories are also blurred and comprehension impairments become more profound. The medial temporopolar region belongs to the amygdalocentric component of the limbic system and stands to integrate exteroceptive information with interoceptive states underlying social interactions. Review of the pertinent literature shows that word comprehension and conduct impairments caused by temporopolar strokes and temporal lobectomy are far less severe than those seen in temporopolar atrophies. One explanation for this unexpected discrepancy invokes the miswiring of residual temporopolar neurons during the many years of indolently progressive neurodegeneration. According to this hypothesis, the temporopolar regions become not only dysfunctional but also sources of aberrant outputs that interfere with the function of areas elsewhere in the language and paralimbic networks, a juxtaposition not seen in lobectomy or stroke.

A category-selective semantic memory deficit for animate objects in semantic variant primary progressive aphasia

Data are mixed on whether patients with semantic variant primary progressive aphasia exhibit a category-selective semantic deficit for animate objects. Moreover, there is little consensus regarding the neural substrates of this category-selective semantic deficit, though prior literature has suggested that the perirhinal cortex and the lateral posterior fusiform gyrus may support semantic memory functions important for processing animate objects. In this study, we investigated whether patients with semantic variant primary progressive aphasia exhibited a category-selective semantic deficit for animate objects in a word-picture matching task, controlling for psycholinguistic features of the stimuli, including frequency, familiarity, typicality and age of acquisition. We investigated the neural bases of this category selectivity by examining its relationship with cortical atrophy in two primary regions of interest: bilateral perirhinal cortex and lateral posterior fusiform gyri. We analysed data from 20 patients with semantic variant primary progressive aphasia (mean age = 64 years, S.D. = 6.94). For each participant, we calculated an animacy index score to denote the magnitude of the category-selective semantic deficit for animate objects. Multivariate regression analysis revealed a main effect of animacy (β = 0.52, t = 4.03, P < 0.001) even after including all psycholinguistic variables in the model, such that animate objects were less likely to be identified correctly relative to inanimate objects. Inspection of each individual patient's data indicated the presence of a disproportionate impairment in animate objects in most patients. A linear regression analysis revealed a relationship between the right perirhinal cortex thickness and animacy index scores (β = -0.57, t = -2.74, P = 0.015) such that patients who were more disproportionally impaired for animate relative to inanimate objects exhibited thinner right perirhinal cortex. A vertex-wise general linear model analysis restricted to the temporal lobes revealed additional associations between positive animacy index scores (i.e. a disproportionately poorer performance on animate objects) and cortical atrophy in the right perirhinal and entorhinal cortex, superior, middle, and inferior temporal gyri, and the anterior fusiform gyrus, as well as the left anterior fusiform gyrus. Taken together, our results indicate that a category-selective semantic deficit for animate objects is a characteristic feature of semantic variant primary progressive aphasia that is detectable in most individuals. Our imaging findings provide further support for the role of the right perirhinal cortex and other temporal lobe regions in the semantic processing of animate objects.

Different types of abstract concepts: evidence from two neurodegenerative patients

The observation of neurological patients showing selective impairments for specific conceptual categories contributed in the development of semantic memory theories. Here, we studied two patients (P01, P02), affected, respectively, by the semantic variant of Primary Progressive Aphasia (sv-PPA) and Cortico-Basal Syndrome (CBS). An implicit lexical decision task, including concrete (animals, tools) and abstract (emotions, social, quantity) concepts, was administered to patients and healthy controls.P01 and P02 showed an abolished priming effect for social and quantity-related concepts, respectively. This double dissociation suggests a role of different brain areas in representing specific abstract categories, giving insights for current semantic memory theories.

Multimodal semantic battery to monitor progressive loss of concepts in the semantic variant of primary progressive aphasia (svPPA): an innovative proposal

Semantic variant primary progressive aphasia (svPPA) is a rare neurodegenerative disease characterized by a progressive loss of semantic knowledge. Patients with svPPA show anomia, impaired word comprehension, poor object recognition, and difficulties in retrieving semantic information. svPPA is also a unique "natural" model that allows clinicians and cognitive neuroscientists to study the organization of semantic memory because only semantic knowledge is affected in the initial period of the disease, with relative sparing of other cognitive domains. In the clinical practice, semantic memory is commonly tested only with verbal tests. The aim of the present study was to preliminary test a new Multimodal Semantic Battery developed in our laboratory, which comprised 11 subtests designed to assess the semantic knowledge of multiple items via all input modalities. The battery was administered twice, over four years, to a patient diagnosed with svPPA. We found that when extensively tested with multiple tests, in some cases, he was still able to recall semantic features of the items that otherwise would not have emerged with standard semantic tests. These results are discussed for the clinical practice: monitoring semantic memory through all modalities in a practical and reliable way could be useful for both clinicians and experimental researchers to better investigate the breakdown of semantic knowledge.

A unified neurocognitive model of semantics language social behaviour and face recognition in semantic dementia

The anterior temporal lobes (ATL) have become a key brain region of interest in cognitive neuroscience founded upon neuropsychological investigations of semantic dementia (SD). The purposes of this investigation are to generate a single unified model that captures the known cognitive-behavioural variations in SD and map these to the patients' distribution of frontotemporal atrophy. Here we show that the degree of generalised semantic impairment is related to the patients' total, bilateral ATL atrophy. Verbal production ability is related to total ATL atrophy as well as to the balance of left > right ATL atrophy. Apathy is found to relate positively to the degree of orbitofrontal atrophy. Disinhibition is related to right ATL and orbitofrontal atrophy, and face recognition to right ATL volumes. Rather than positing mutually-exclusive sub-categories, the data-driven model repositions semantics, language, social behaviour and face recognition into a continuous frontotemporal neurocognitive space.

Representional and connectivity-based accounts of the cognitive consequences of atrophy of the right and left anterior temporal lobes

According to the original "hub-and-spoke" model of conceptual representations, the neural network for semantic memory requires a single convergence zone located in the anterior temporal lobes (ATLs). However, a more recent version of this model acknowledges that a graded specialization of the left and right ATLs might emerge as a consequence of their differential connectivity with language and sensory-motor regions. A recent influential paper maintained that both the format of semantic representations (representational account) and their differential connectivity (connectivity account) could contribute to the cognitive consequences of atrophy to the left versus the right ATL atrophy. That paper, however, also raised questions as to whether the distinction between representational and connectivity accounts is a meaningful question. I argue that an important theoretical difference exists between the representational and the connectivity-based models and that investigations, based on this difference, should allow to choose between these alternative accounts.

Identification of taxonomic and thematic relationships: Do the two semantic systems have the same status in semantic dementia?

Introduction: Disequilibrium between the taxonomic and thematic semantic systems was previously hypothesized in participants with semantic dementia (SD), without rigorously assessing their ability to identify the two types of semantic relationships. Therefore, the aim of the present study was to directly compare the ability of 10 participants with SD, 10 participants with Alzheimer's disease (AD), and 20 controls to identify thematic versus taxonomic relationships. Methods: Participants performed an explicit forced-choice picture-matching task in which they had to determine which of two pictures of choice was semantically related to the target picture. Target pictures could display natural or artifact objects. Each target was presented once with a taxonomically related picture and once with a thematically related picture. Results: Analyses of correct thematic and taxonomic matches as a function of target domain showed that the performance of the two groups of patients differed in the taxonomic conditions but not in the thematic conditions, demonstrating a relative preservation of thematic knowledge in SD. Additional correlation analyses further indicated that the particular status of thematic relationships in SD was even stronger for artifact concepts. Conclusions: Results provide evidence of the heterogeneous nature of semantic knowledge disruption in SD, and could be regarded as being consistent with the existence of two neuroanatomically and functionally distinct semantic systems. Results further stress the relevance of performing a more detailed and complete assessment of semantic performance in participants with SD, in order to capture the impaired but also preserved aspects of their knowledge.

Food knowledge depends upon the integrity of both sensory and functional properties: a VBM, TBSS and DTI tractography study

Food constitutes a fuel of life for human beings. It is therefore of chief importance that their recognition system readily identifies the most relevant properties of food by drawing on semantic memory. One of the most relevant properties to be considered is the level of processing impressed by humans on food. We hypothesized that recognition of raw food capitalizes on sensory properties and that of transformed food on functional properties, consistently with the hypothesis of a sensory-functional organization of semantic knowledge. To test this hypothesis, patients with Alzheimer’s disease, frontotemporal dementia, primary progressive aphasia, and healthy controls performed lexical-semantic tasks with food (raw and transformed) and non-food (living and nonliving) stimuli. Correlations between task performance and local grey matter concentration (VBM) and white matter fractional anisotropy (TBSS) led to two main findings. First, recognition of raw food and living things implicated occipital cortices, typically involved in processing sensory information and, second, recognition of processed food and nonliving things implicated the middle temporal gyrus and surrounding white matter tracts, regions that have been associated with functional properties. In conclusion, the present study confirms and extends the hypothesis of a sensory and a functional organization of semantic knowledge.

Concrete versus abstract forms of social concept: an fMRI comparison of knowledge about people versus social terms

The anterior temporal lobes (ATLs) play a key role in conceptual knowledge representation. The hub-and-spoke theory suggests that the contribution of the ATLs to semantic representation is (a) transmodal, i.e. integrating information from multiple sensorimotor and verbal modalities, and (b) pan-categorical, representing concepts from all categories. Another literature, however, suggests that this region's responses are modality- and category-selective; prominent examples include category selectivity for socially relevant concepts and face recognition. The predictions of each approach have never been directly compared. We used data from three studies to compare category-selective responses within the ATLs. Study 1 compared ATL responses to famous people versus another conceptual category (landmarks) from visual versus auditory inputs. Study 2 compared ATL responses to famous people from pictorial and written word inputs. Study 3 compared ATL responses to a different kind of socially relevant stimuli, namely abstract non-person-related words, in order to ascertain whether ATL subregions are engaged for social concepts more generally or only for person-related knowledge. Across all three studies a dominant bilateral ventral ATL cluster responded to all categories in all modalities. Anterior to this ‘pan-category’ transmodal region, a second cluster responded more weakly overall yet selectively for people, but did so equally for spoken names and faces (Study 1). A third region in the anterior superior temporal gyrus responded selectively to abstract socially relevant words (Study 3), but did not respond to concrete socially relevant words (i.e. written names; Study 2). These findings can be accommodated by the graded hub-and-spoke model of concept representation. On this view, the ventral ATL is the centre point of a bilateral ATL hub, which contributes to conceptual representation through transmodal distillation of information arising from multiple modality-specific association cortices. Partial specialization occurs across the graded ATL hub as a consequence of gradedly differential connectivity across the region.

This article is part of the theme issue ‘Varieties of abstract concepts: development, use and representation in the brain’.

The Anatomy of Object Processing: The Role of Anteromedial Temporal Cortex

How objects are represented and processed in the brain remains a key issue in cognitive neuroscience. We have developed a conceptual structure account in which category-specific semantic deficits emerge due to differences in the structure and content of concepts rather than from explicit divisions of conceptual knowledge in separate stores. The primary claim is that concepts associated with particular categories (e.g., animals, tools) differ in the number and type of properties and the extent to which these properties are correlated with each other. In this review, we describe recent neuropsychological and neuroimaging studies in which we have extended our theoretical account by incorporating recent claims about the neuroanatomical basis of feature integration and differentiation that arise from research into hierarchical object processing streams in nonhuman primates and humans. A clear picture has emerged in which the human perirhinal cortex and neighbouring anteromedial temporal structures appear to provide the neural infrastructure for making fine-grained discriminations among objects, suggesting that damage within the perirhinal cortex may underlie the emergence of category-specific semantic deficits in brain-damaged patients.

Cognitive consequences of the left-right asymmetry of atrophy in semantic dementia

Semantic dementia (SD) is a condition in which atrophy to the anterior temporal lobes (ATL) produces a selective deterioration of conceptual knowledge. As this atrophy is always bilateral but usually asymmetrical, differences in performance of the two SD subgroups-with left > right (L > R) versus right > left (R > L) atrophy-constitute a major source of evidence regarding the roles of the left and right sides of this region. We explored this issue using large scale case-series methodology, with a pool of 216 observations of neuropsychological data from 72 patients with SD. Anomia was significantly more severe in the L > R subgroup, even when cases from the two subgroups were matched on severity of comprehension deficits. For subgroups matched on the degree of anomia, we show that asymmetry of atrophy also affected both the nature of the naming errors produced, and the degree of a semantic category effect (living things vs artefacts). A comparison across tasks varying in their loading on verbal and visual processing revealed a greater deficit in object naming for L > R cases and in a picture-based semantic association test for R > L cases; this held true whether severity across subgroups was controlled using pairwise matching or statistically via principal components analysis. Importantly, the size of our sample allowed us to demonstrate considerable individual variation within each of the L > R and R > L subgroups, with consequent overlap between them. Our results paint a clear picture of how asymmetry of atrophy affects cognitive performance in SD, and we discuss the results in terms of two mechanisms that could contribute to these differences: variation in the information involved in semantic representations in the left and right ATL, and preferential connectivity between each ATL and other more modality specific intra-hemispheric regions.

What semantic dementia teaches us about the functional organization of the left posterior fusiform gyrus

After demonstrating the relative preservation of fruit and vegetable knowledge in patients with semantic dementia (SD), we sought to identify the neural substrate of this unusual category effect. Nineteen patients with SD performed a semantic sorting task and underwent a morphometric 3T MRI scan. The grey-matter volumes of five regions within the temporal lobe were bilaterally computed, as well as those of two recently described areas (FG1 and FG2) within the posterior fusiform gyrus. In contrast to the other semantic categories we tested, fruit and vegetable scores were only predicted by left FG1 volume. We therefore found a specific relationship between the volume of a subregion within the left posterior fusiform gyrus and performance on fruits and vegetables in SD. We argue that the left FG1 is a convergence zone for the features that might be critical to successfully sort fruits and vegetables. We also discuss evidence for a functional specialization of the fusiform gyrus along two axes (lateral medial and longitudinal), depending on the nature of the concepts and on the level of processing complexity required by the ongoing task.

The oral spelling profile of posterior cortical atrophy and the nature of the graphemic representation

Spelling is a complex cognitive task where central and peripheral components are involved in engaging resources from many different cognitive processes. The present paper aims to both characterize the oral spelling deficit in a population of patients affected by a neurodegenerative condition and to clarify the nature of the graphemic representation within the currently available spelling models. Indeed, the nature of graphemic representation as a linear or multi-componential structure is still debated. Different hypotheses have been raised about its nature in the orthographic lexicon, with one positing that graphemes are complex objects whereby quantity and identity are separately represented in orthographic representations and can thus be selectively impaired. Posterior cortical atrophy (PCA) is a neurodegenerative condition that mainly affects visuoperceptual and visuospatial functions. Spelling impairments are considered part of the disease. Nonetheless the spelling deficit has received little attention so far and often it has been interpreted in relation to peripheral impairments such as writing difficulties associated with visuoperceptual and visuospatial deficits. In the present study we provide a detailed characterization of the oral spelling profile in PCA. The data suggest that multiple deficits underpin oral spelling problems in PCA, with elements of surface and phonological dysgraphia but also suggesting the involvement of the graphemic buffer. A large phenotypic individual variability is reported. Moreover, the larger proportion and the specific nature of errors involving geminate (i.e., double) as compared to non-geminate (i.e., non-double) letters suggest that a further central impairment might be associated with the abstract graphemic representation of letter numerosity. The present study contributes to the clinical characterization of PCA and to the current debate in the cognitive literature on spelling models; findings, despite not definitive, support the hypothesis that graphemic representations are multidimensional mental objects that separately encode information about grapheme identity and quantity.

Verbal Description of Concrete Objects: A Method for Assessing Semantic Circumlocution in Persons With Aphasia

PURPOSE

We investigated from a theoretically motivated perspective what information differentiated sufficient from insufficient descriptions of objects provided by persons with aphasia.

METHOD

Twenty-one adults with aphasia consequent to single left-hemisphere stroke verbally described 9 living and 9 nonliving objects. Responses were scored for accuracy (i.e., sufficiency) and tallied for type and quantity of semantic feature information provided. Main effects and interactions were identified using repeated measures analyses of variance, with significant findings followed up with planned comparisons.

RESULTS

Differences between correct and incorrect descriptions were identified with respect to both feature type and feature distinctiveness for living and nonliving items, in particular highlighting the importance of distinctive features in descriptions of both domains.

CONCLUSIONS

These findings add to the relatively small body of literature investigating semantic feature processing in adults with aphasia. This is a critical gap to close when considered in light of the preponderance of semantically based treatments for word-retrieval impairment in stroke-aphasia. Our findings provide preliminary support for the notion that semantically guided treatments for word-retrieval impairment in stroke-aphasia may be geared toward increasing specificity of semantic circumlocution to increase semantic self-cueing and to improve communication of information to conversation partners.

A Model of Emergent Category-specific Activation in the Posterior Fusiform Gyrus of Sighted and Congenitally Blind Populations

Theories about the neural bases of semantic knowledge tend between two poles, one proposing that distinct brain regions are innately dedicated to different conceptual domains and the other suggesting that all concepts are encoded within a single network. Category-sensitive functional activations in the fusiform cortex of the congenitally blind have been taken to support the former view but also raise several puzzles. We use neural network models to assess a hypothesis that spans the two poles: The interesting functional activation patterns reflect the base connectivity of a domain-general semantic network. Both similarities and differences between sighted and congenitally blind groups can emerge through learning in a neural network, but only in architectures adopting real anatomical constraints. Surprisingly, the same constraints suggest a novel account of a quite different phenomenon: the dyspraxia observed in patients with semantic impairments from anterior temporal pathology. From this work, we suggest that the cortical semantic network is wired not to encode knowledge of distinct conceptual domains but to promote learning about both conceptual and affordance structure in the environment.

Semantic feature degradation and naming performance. Evidence from neurodegenerative disorders

The failure to name an object in Alzheimer's disease (AD) and in the semantic variant of the primary progressive aphasia (sv-PPA) has been generally attributed to semantic memory loss, with a progressive degradation of semantic features. Not all features, however, may have the same relevance in picture naming. We analyzed the relationship between picture naming performance and the loss of semantic features in patients with AD with or without naming impairment, with sv-PPA and in matched controls, assessing the role of distinctiveness, semantic relevance and feature type (sensorial versus non-sensorial) with a sentence verification task. The results showed that distinctive features with high values of semantic relevance were lost only in all patients with naming impairment. The performance on the sensorial distinctive features with high relevance was the best predictor of naming performance only in sv-PPA, while no difference between sensorial and non-sensorial features was found in AD patients.

What matters in semantic feature processing for persons with stroke-aphasia: Evidence from an auditory concept-feature verification task

BACKGROUND

The relationship between object concept domains (living vs. nonliving) and their underlying feature structures is a frequent area of investigation regarding semantic processing in healthy individuals and some individuals with neuropsychological impairment resulting from herpes simplex encephalitis, semantic dementia and Alzheimer's disease. However, this relationship has been less well-investigated in persons with stroke-aphasia (PWA), even though many treatments for anomia following stroke are predicated on the use of semantic feature cues.

AIMS

As part of a larger investigation into the influence of semantic feature processing on naming for PWA, this study examined the ability of PWA to confirm the relations between object concepts and associated semantic features.

METHODS & PROCEDURES

15 native English-speaking, right handed individuals with post-stroke-aphasia responded yes or no via button press to feature-verification questions designed to probe the relationships between concept domain and feature type and distinctiveness.

OUTCOMES & RESULTS

PWA were more accurate and quicker to confirm concept-feature relationships when features contained function/action, rather than visual-perceptual, information about concepts and when features were distinctive to concepts rather than shared. The truthfulness (i.e., veracity) of concept-feature pairings was demonstrated to differentially affect living versus nonliving concepts. Within domain, only nonliving concepts were verified more accurately and more quickly when pairings were true (rather than false). Between domains, true nonliving concept-feature pairings were more accurately and more quickly verified than true living concept-feature pairings. Also with respect to veracity, correlations were observed between aphasia severity and accuracy and speed of response to false concept-feature pairings.

CONCLUSIONS

Findings have implications for the way in which semantic processing is probed with PWA, as well as providing preliminary information regarding responsivity of PWA to differing types of semantic information for living versus nonliving concepts. The fact that PWA demonstrated disproportionate difficulty responding to certain types of semantic information also suggests preliminary implications for the utility of different types of semantic cues in semantically-based treatments for word retrieval impairment.

Beyond the visual word form area: the orthography-semantics interface in spelling and reading

Lexical orthographic information provides the basis for recovering the meanings of words in reading and for generating correct word spellings in writing. Research has provided evidence that an area of the left ventral temporal cortex, a subregion of what is often referred to as the visual word form area (VWFA), plays a significant role specifically in lexical orthographic processing. The current investigation goes beyond this previous work by examining the neurotopography of the interface of lexical orthography with semantics. We apply a novel lesion mapping approach with three individuals with acquired dysgraphia and dyslexia who suffered lesions to left ventral temporal cortex. To map cognitive processes to their neural substrates, this lesion mapping approach applies similar logical constraints to those used in cognitive neuropsychological research. Using this approach, this investigation: (a) identifies a region anterior to the VWFA that is important in the interface of orthographic information with semantics for reading and spelling; (b) determines that, within this orthography-semantics interface region (OSIR), access to orthography from semantics (spelling) is topographically distinct from access to semantics from orthography (reading); (c) provides evidence that, within this region, there is modality-specific access to and from lexical semantics for both spoken and written modalities, in both word production and comprehension. Overall, this study contributes to our understanding of the neural architecture at the lexical orthography-semantic-phonological interface within left ventral temporal cortex.

Revisiting domain-general accounts of category specificity in mind and brain

Theories about the neural basis of semantic knowledge have been strongly influenced by reports that particular semantic categories can be differentially impaired by neuropathology and can differentially activate particular regions of cortex in brain imaging studies. One well-known interpretation of these data is that the brain has evolved distinct functional and anatomical modules for storing and retrieving knowledge about different kinds of things. We review the evidence supporting an alternative view: that category specificity arises from many heterogeneous factors and so tells us little directly about the cognitive and neural architecture of semantic memory. We consider four general hypotheses about domain-general causes of category-specific patterns, their roots in early work, and their reemergence in contemporary research. We argue that there is compelling evidence supporting each hypothesis, and that the different hypotheses together can explain most of the interesting data. We further suggest that such a multifactor domain-general approach to category specificity is appealing partly because it explains the important findings with reference to theoretical claims that are already widely accepted, and partly because it resolves several puzzles that arise under the alternative view. For further resources related to this article, please visit the WIREs website.

CONFLICT OF INTEREST

The authors have declared no conflicts of interest for this article.

Neurocognitive insights on conceptual knowledge and its breakdown

Conceptual knowledge reflects our multi-modal 'semantic database'. As such, it brings meaning to all verbal and non-verbal stimuli, is the foundation for verbal and non-verbal expression and provides the basis for computing appropriate semantic generalizations. Multiple disciplines (e.g. philosophy, cognitive science, cognitive neuroscience and behavioural neurology) have striven to answer the questions of how concepts are formed, how they are represented in the brain and how they break down differentially in various neurological patient groups. A long-standing and prominent hypothesis is that concepts are distilled from our multi-modal verbal and non-verbal experience such that sensation in one modality (e.g. the smell of an apple) not only activates the intramodality long-term knowledge, but also reactivates the relevant intermodality information about that item (i.e. all the things you know about and can do with an apple). This multi-modal view of conceptualization fits with contemporary functional neuroimaging studies that observe systematic variation of activation across different modality-specific association regions dependent on the conceptual category or type of information. A second vein of interdisciplinary work argues, however, that even a smorgasbord of multi-modal features is insufficient to build coherent, generalizable concepts. Instead, an additional process or intermediate representation is required. Recent multidisciplinary work, which combines neuropsychology, neuroscience and computational models, offers evidence that conceptualization follows from a combination of modality-specific sources of information plus a transmodal 'hub' representational system that is supported primarily by regions within the anterior temporal lobe, bilaterally.

Comparative semantic profiles in semantic dementia and Alzheimer's disease

Patients with the semantic variant of primary progressive aphasia, also known as semantic dementia, and Alzheimer's disease have deficits in semantic memory. However, few comparative studies have been performed to determine whether these patient groups have distinct semantic memory impairments. We asked 15 patients with semantic variant primary progressive aphasia and 57 patients with Alzheimer's disease to judge semantic category membership of coloured photos and printed words that are members of familiar natural and manufactured categories, and we related performance to grey matter atrophy. We found that both semantic variant primary progressive aphasia and Alzheimer's disease are significantly impaired on this task. Moreover, patients with semantic variant primary progressive aphasia had a significantly more prominent deficit for natural objects than their own deficit judging manufactured objects. Both semantic variant primary progressive aphasia and Alzheimer's disease had atrophy that included portions of the left temporal lobe. Regression analyses related performance in semantic variant primary progressive aphasia to ventral and medial portions of the left temporal lobe, while regression analyses in Alzheimer's disease related performance to these ventral and medial temporal areas as well as lateral temporal-parietal regions in the left hemisphere. We conclude that both semantic variant primary progressive aphasia and Alzheimer's disease are significantly impaired in a simple category membership judgement task and the selective impairment for natural kinds in semantic variant primary progressive aphasia is related in part to disease in visual association cortex in ventral-medial portions of the left temporal lobe. We discuss factors that may contribute to the semantic memory deficit in semantic variant primary progressive aphasia.

Relative category-specific preservation in semantic dementia? Evidence from 35 cases

Category-specific deficits have rarely been reported in semantic dementia (SD). To our knowledge, only four previous studies have documented category-specific deficits, and these have focused on the living versus non-living things contrast rather than on more fine-grained semantic categories. This study aimed to determine whether a category-specific effect could be highlighted by a semantic sorting task administered to 35 SD patients once at baseline and again after 2 years and to 10 Alzheimer's disease patients (AD). We found a relative preservation of fruit and vegetables only in SD. This relative preservation of fruit and vegetables could be considered with regard to the importance of color knowledge in their discrimination. Indeed, color knowledge retrieval is known to depend on the left posterior fusiform gyrus which is relatively spared in SD. Finally, according to predictions of semantic memory models, our findings best fitted the Devlin and Gonnerman's computational account.

The degraded concept representation system in semantic dementia: damage to pan-modal hub, then visual spoke

The core clinical feature of semantic dementia is a progressive yet selective degradation of conceptual knowledge. Understanding the cognitive and neuroanatomical basis for this deficit is a key challenge for both clinical and basic science. Some researchers attribute the deficit to damage to pan-modal conceptual representations that are independent of any particular sensory-motor modality and are represented in the ventrolateral anterior temporal lobes. Others claim that damage to modality-specific visual feature representations in the occipitotemporal 'ventral stream' is responsible. In the present study, we tested the hypothesis that concept degradation in semantic dementia involves a combination of these pan-modal and modality-specific elements. We investigated factors influencing knowledge of object concepts by analysing 43 sets of picture-naming data from patients with semantic dementia. We found a strong influence of two pan-modal factors: highly familiar and typical items were named more accurately than less familiar/atypical items at all stages of the disorder. Items associated with rich sensory-motor information were also named more successfully at all stages, and this effect was present for sound/motion knowledge and tactile/action knowledge when these modalities were studied separately. However, there was no advantage for items rich in visual colour/form characteristics; instead, this factor had an increasingly negative impact in the later stages of the disorder. We propose that these results are best explained by a combination of (i) degradation of modality-independent conceptual representations, which is present throughout the disorder and is a consequence of atrophy focused on the ventrolateral anterior temporal lobes; and (ii) a later additional deficit for concepts that depend heavily on visual colour/form information, caused by the spreading of atrophy to posterior ventral temporal regions specialized for representing this information. This explanation is consistent with a graded hub-and-spoke model of conceptual knowledge, in which there is a gradual convergence of information along the temporal lobes, with visual attributes represented in the posterior cortex giving way to pan-modal representations in the anterior areas.

Cognitive Neuropsychology Has Been, Is, And Will Be Significant To Aphasiology

BACKGROUND: In recent years, some critical voices have been raised in regard to the significance of cognitive neuropsychology (CNP) to the study of brain and mind. Given the central role of language disorders in CNP research, it is time to consider the relevance of this research approach in aphasiology. AIMS: We analyze the main points of criticism raised against the CNP research approach, evaluate the significance of this approach to the study of acquired language disorders, and make some suggestions concerning further development of the field. MAIN CONTRIBUTION: The main points of criticism against CNP (reliance on single-case studies; single-minded hunt for dissociations; emptiness of theorizing) have been important long-term concerns but do not take into account the fact that during its history of circa four decades, the CNP approach has diversified. There are thus CNP studies that rely on case series analyses, focus on error analyses rather than mere dissociations, or employ computational modeling rather than the "boxes-and-arrows" models of the mental architecture. The CNP approach to cognition and its disorders is thus applicable to different research questions and theoretical stances, providing experimental rigor to single-case patient studies. With regard to clinical applications in aphasia diagnostics and treatment, the CNP approach provides a richer view on the strengths and weaknesses of a patient's cognitive-linguistic abilities. CONCLUSIONS: We believe that CNP case studies continue to be an important source of information for generating hypotheses and providing converging evidence for research on the mind and on the brain. There is however a need for further research development especially in computational modeling of language processes, their impairments, and recovery. This research is expected to provide further benefit to clinical diagnostics and treatment of aphasia.

Motor knowledge is one dimension for concept organization: further evidence from a Chinese semantic dementia case

Neuropsychological and neuroimaging studies have indicated that motor knowledge is one potential dimension along which concepts are organized. Here we present further direct evidence for the effects of motor knowledge in accounting for categorical patterns across object domains (living vs. nonliving) and grammatical domains (nouns vs. verbs), as well as the integrity of other modality-specific knowledge (e.g., visual). We present a Chinese case, XRK, who suffered from semantic dementia with left temporal lobe atrophy. In naming and comprehension tasks, he performed better at nonliving items than at living items, and better at verbs than at nouns. Critically, multiple regression method revealed that these two categorical effects could be both accounted for by the charade rating, a continuous measurement of the significance of motor knowledge for a concept or a semantic feature. Furthermore, charade rating also predicted his performances on the generation frequency of semantic features of various modalities. These findings consolidate the significance of motor knowledge in conceptual organization and further highlights the interactions between different types of semantic knowledge.

Premorbid expertise produces category-specific impairment in a domain-general semantic disorder

For decades, category-specific semantic impairment - i.e., better comprehension of items from one semantic category than another - has been the driving force behind many claims about the organisation of conceptual knowledge in the brain. Double dissociations between patients with category-specific disorders are widely interpreted as showing that different conceptual domains are necessarily supported by functionally independent systems. We show that, to the contrary, even strong or classical dissociations can also arise from individual differences in premorbid expertise. We examined two patients with global and progressive semantic degradation who, unusually, had known areas of premorbid expertise. Patient 1, a former automotive worker, showed selective preservation of car knowledge, whereas Patient 2, a former botanist, showed selective preservation of information about plants. In non-expert domains, these patients showed the typical pattern: i.e., an inability to differentiate between highly similar concepts (e.g., rose and daisy), but retention of broader distinctions (e.g., between rose and cat). Parallel distributed processing (PDP) models of semantic cognition show that expertise in a particular domain increases the differentiation of specific-level concepts, such that the semantic distance between these items resembles non-expert basic-level distinctions. We propose that these structural changes interact with global semantic degradation, particularly when expert knowledge is acquired early and when exposure to expert concepts continues during disease progression. Therefore, category-specific semantic impairment can arise from at least two distinct mechanisms: damage to representations that are critical for a particular category (e.g., knowledge of hand shape and action for the category 'tools') and differences in premorbid experience.

Primary progressive aphasias and their contribution to the contemporary knowledge about the brain-language relationship

Primary progressive aphasia (PPA), typically resulting from a neurodegenerative disease such as frontotemporal dementia/Pick Complex or Alzheimer's disease, is a heterogeneous clinical condition characterized by a progressive loss of specific language functions with initial sparing of other cognitive domains. Based on the constellation of symptoms, PPA has been classified into a nonfluent, semantic, or logopenic variant. This review of the literature aims to characterize the speech and language impairment, cognition, neuroimaging, pathology, genetics, and epidemiology associated with each of these variants. Some therapeutic recommendations, theoretical implications, and directions for future research have been also provided.

Anomia as a marker of distinct semantic memory impairments in Alzheimer's disease and semantic dementia

OBJECTIVE

Many neurologically constrained models of semantic memory have been informed by two primary temporal lobe pathologies: Alzheimer's disease (AD) and Semantic Dementia (SD). However, controversy persists regarding the nature of the semantic impairment associated with these patient populations. Some argue that AD presents as a disconnection syndrome in which linguistic impairment reflects difficulties in lexical or perceptual means of semantic access. In contrast, there is a wider consensus that SD reflects loss of core knowledge that underlies word and object meaning. Object naming provides a window into the integrity of semantic knowledge in these two populations.

METHOD

We examined naming accuracy, errors and the correlation of naming ability with neuropsychological measures (semantic ability, executive functioning, and working memory) in a large sample of patients with AD (n = 36) and SD (n = 21).

RESULTS

Naming ability and naming errors differed between groups, as did neuropsychological predictors of naming ability. Despite a similar extent of baseline cognitive impairment, SD patients were more anomic than AD patients.

CONCLUSIONS

These results add to a growing body of literature supporting a dual impairment to semantic content and active semantic processing in AD, and confirm the fundamental deficit in semantic content in SD. We interpret these findings as supporting of a model of semantic memory premised upon dynamic interactivity between the process and content of conceptual knowledge.

Semantic dementia: a specific network-opathy

Semantic dementia (SD) is a unique syndrome in the frontotemporal lobar degeneration spectrum. Typically presenting as a progressive, fluent anomic aphasia, SD is the paradigmatic disorder of semantic memory with a characteristic anatomical profile of asymmetric, selective antero-inferior temporal lobe atrophy. Histopathologically, most cases show a specific pattern of abnormal deposition of protein TDP-43. This relatively close clinical, anatomical and pathological correspondence suggests SD as a promising target for future therapeutic trials. Here, we discuss outstanding nosological and neurobiological challenges posed by the syndrome and propose a pathophysiological model of SD based on sequential, regionally determined disintegration of a vulnerable neural network.

Verb production during action naming in semantic dementia

In contrast with widely documented deficits of semantic knowledge relating to object concepts and the corresponding nouns in semantic dementia (SD), little is known about action semantics and verb production in SD. The degradation of action semantic knowledge was studied in 5 patients with SD compared with 17 matched control participants in an action naming task based on video clips. The pattern of errors, involving a huge proportion of generic verbs (e.g. "to remove" versus "to peel") relative to responses in control subjects, suggested a hierarchical, bottom-up deficit of action knowledge in SD patients. In addition, abnormal responses in patients consisted of verbs that were semantically related to the expected verbs produced by control subjects (e.g. "to undress" versus "to peel" for the action [To peel_orange]). This study suggests that, in SD, non-canonical responses to action naming reflect lack of both specificity and semantic relatedness relative to the expected responses.

LEARNING OUTCOMES

As a result of this activity, readers will recognize that semantic word knowledge disappears in semantic dementia using video clips of object-related actions. As a result of this activity, readers will discover that this semantic impairment followed a hierarchical pattern with the more specific verbs vanishing first.

Patterns of brain reorganization subsequent to left fusiform damage: fMRI evidence from visual processing of words and pseudowords, faces and objects

Little is known about the neural reorganization that takes place subsequent to lesions that affect orthographic processing (reading and/or spelling). We report on an fMRI investigation of an individual with a left mid-fusiform resection that affected both reading and spelling (Tsapkini & Rapp, 2010). To investigate possible patterns of functional reorganization, we compared the behavioral and neural activation patterns of this individual with those of a group of control participants for the tasks of silent reading of words and pseudowords and the passive viewing of faces and objects, all tasks that typically recruit the inferior temporal lobes. This comparison was carried out with methods that included a novel application of Mahalanobis distance statistics, and revealed: (1) normal behavioral and neural responses for face and object processing, (2) evidence of neural reorganization bilaterally in the posterior fusiform that supported normal performance in pseudoword reading and which contributed to word reading (3) evidence of abnormal recruitment of the bilateral anterior temporal lobes indicating compensatory (albeit insufficient) recruitment of mechanisms for circumventing the word reading deficit.

Progress in the last decade in our understanding of primary progressive aphasia

Primary progressive aphasia (PPA) is a focal neurodegeneration of the brain affecting the language network. Patients can have isolated language impairment for years without impairment in other areas. PPA is classified as primary progressive nonfluent aphasia (PNFA), semantic dementia (SD), and logopenic aphasia, which have distinct patterns of atrophy on neuroimaging. PNFA and SD are included under frontotemporal lobar degenerations. PNFA patients have effortful speech with agrammatism, which is frequently associated with apraxia of speech and demonstrate atrophy in the left Broca’s area and surrounding region on neuroimaging. Patients with SD have dysnomia with loss of word and object (or face) meaning with asymmetric anterior temporal lobe atrophy. Logopenic aphasics have word finding difficulties with frequent pauses in conversation, intact grammar, and word comprehension but impaired repetition for sentences. The atrophy is predominantly in the left posterior temporal and inferior parietal regions. Recent studies have described several progranulin mutations on chromosome 17 in PNFA. The three clinical syndromes have a less robust relationship to the underlying pathology, which is heterogeneous and includes tauopathy, ubiquitinopathy, Pick’s disease, corticobasal degeneration, progressive supranuclear palsy, and Alzheimer’s disease. Recent studies, however, seem to indicate that a better characterization of the clinical phenotype (apraxic, agrammatic, semantic, logopenic, jargon) increases the predictive value of the underlying pathology. Substantial advances have been made in our understanding of PPAs but developing new biomarkers is essential in making accurate causative diagnoses in individual patients. This is critically important in the development and evaluation of disease-modifying drugs.

The organization and dissolution of semantic-conceptual knowledge: is the 'amodal hub' the only plausible model?

In recent years, the anatomical and functional bases of conceptual activity have attracted a growing interest. In particular, Patterson and Lambon-Ralph have proposed the existence, in the anterior parts of the temporal lobes, of a mechanism (the 'amodal semantic hub') supporting the interactive activation of semantic representations in all modalities and for all semantic categories. The aim of then present paper is to discuss this model, arguing against the notion of an 'amodal' semantic hub, because we maintain, in agreement with the Damasio's construct of 'higher-order convergence zone', that a continuum exists between perceptual information and conceptual representations, whereas the 'amodal' account views perceptual informations only as a channel through which abstract semantic knowledge can be activated. According to our model, semantic organization can be better explained by two orthogonal higher-order convergence systems, concerning, on one hand, the right vs. left hemisphere and, on the other hand, the ventral vs. dorsal processing pathways. This model posits that conceptual representations may be mainly based upon perceptual activities in the right hemisphere and upon verbal mediation in the left side of the brain. It also assumes that conceptual knowledge based on the convergence of highly processed visual information with other perceptual data (and mainly concerning living categories) may be bilaterally represented in the anterior parts of the temporal lobes, whereas knowledge based on the integration of visual data with action schemata (namely knowledge of actions, body parts and artefacts) may be more represented in the left fronto-temporo-parietal areas.

The Word Processing Deficit in Semantic Dementia: All Categories Are Equal, but Some Categories Are More Equal than Others

It has been claimed that semantic dementia (SD), the temporal variant of fronto-temporal dementia, is characterized by an across-the-board deficit affecting all types of conceptual knowledge. We here confirm this generalized deficit but also report differential degrees of impairment in processing specific semantic word categories in a case series of SD patients (N = 11). Within the domain of words with strong visually grounded meaning, the patients' lexical decision accuracy was more impaired for color-related than for form-related words. Likewise, within the domain of action verbs, the patients' performance was worse for words referring to face movements and speech acts than for words semantically linked to actions performed with the hand and arm. Psycholinguistic properties were matched between the stimulus groups entering these contrasts; an explanation for the differential degrees of impairment must therefore involve semantic features of the words in the different conditions. Furthermore, this specific pattern of deficits cannot be captured by classic category distinctions such as nouns versus verbs or living versus nonliving things. Evidence from previous neuroimaging research indicates that color- and face/speech-related words, respectively, draw most heavily on anterior-temporal and inferior-frontal areas, the structures most affected in SD. Our account combines (a) the notion of an anterior-temporal amodal semantic “hub” to explain the profound across-the-board deficit in SD word processing, with (b) a semantic topography model of category-specific circuits whose cortical distributions reflect semantic features of the words and concepts represented.

Visual and semantic processing of living things and artifacts: an FMRI study

We carried out an fMRI study with a twofold purpose: to investigate the relationship between networks dedicated to semantic and visual processing and to address the issue of whether semantic memory is subserved by a unique network or by different subsystems, according to semantic category or feature type. To achieve our goals, we administered a word-picture matching task, with within-category foils, to 15 healthy subjects during scanning. Semantic distance between the target and the foil and semantic domain of the target-foil pairs were varied orthogonally. Our results suggest that an amodal, undifferentiated network for the semantic processing of living things and artifacts is located in the anterolateral aspects of the temporal lobes; in fact, activity in this substrate was driven by semantic distance, not by semantic category. By contrast, activity in ventral occipito-temporal cortex was driven by category, not by semantic distance. We interpret the latter finding as the effect exerted by systematic differences between living things and artifacts at the level of their structural representations and possibly of their lower-level visual features. Finally, we attempt to reconcile contrasting data in the neuropsychological and functional imaging literature on semantic substrate and category specificity.

The orthography-specific functions of the left fusiform gyrus: evidence of modality and category specificity

We report on an investigation of the cognitive functions of an individual with a resection of the left fusiform gyrus. This individual and a group of control participants underwent testing to examine the question of whether or not there are neural substrates within the left fusiform gyrus that are dedicated to orthographic processing. We evaluated the modality specificity (written vs spoken language) and the category specificity (written language vs other visual categories) of this individual's impairments. The results clearly reveal deficits affecting lexical processes in both reading and spelling. Specifically, we find disruption of normal, rapid access to meaning from print in reading and of accurate retrieval of the spellings of words from their meaning in writing. These deficits stand in striking contrast with intact processing of spoken language and categories of visual stimuli such as line drawings of objects and faces. The modality and category specificity of the deficits provide clear evidence of neural substrates within the left-mid-fusiform gyrus that are specialized and necessary for normal orthographic processing.

Comprehension of concrete and abstract words in semantic dementia

The vast majority of brain-injured patients with semantic impairment have better comprehension of concrete than abstract words. In contrast, several patients with semantic dementia (SD), who show circumscribed atrophy of the anterior temporal lobes bilaterally, have been reported to show reverse imageability effects, that is, relative preservation of abstract knowledge. Although these reports largely concern individual patients, some researchers have recently proposed that superior comprehension of abstract concepts is a characteristic feature of SD. This would imply that the anterior temporal lobes are particularly crucial for processing sensory aspects of semantic knowledge, which are associated with concrete not abstract concepts. However, functional neuroimaging studies of healthy participants do not unequivocally predict reverse imageability effects in SD because the temporal poles sometimes show greater activation for more abstract concepts. The authors examined a case-series of 11 SD patients on a synonym judgment test that orthogonally varied the frequency and imageability of the items. All patients had higher success rates for more imageable as well as more frequent words, suggesting that (1) the anterior temporal lobes underpin semantic knowledge for both concrete and abstract concepts, (2) more imageable items--perhaps because of their richer multimodal representations--are typically more robust in the face of global semantic degradation and (3) reverse imageability effects are not a characteristic feature of SD.

Further lesion evidence for the neural basis of conceptual knowledge for persons and other concrete entities

The neural underpinnings of conceptual knowledge have been studied intensively, but many unanswered questions remain. In a previous study examining recognition of persons, animals, and tools in 116 participants with unilateral brain lesions, we found no instance of a patient who manifested defective recognition in all three categories. We reasoned that the spatial distribution of the lesion loci critical for the appearance of recognition defects for these different categories explained why this 'three-way' defect could not be found in patients with unilateral lesions, and we proposed that only a suitable bilateral lesion would be likely to produce such a combined defect. In the study reported here, we tested this hypothesis by investigating recognition performances in 55 participants with bilateral cortical lesions. In support of the hypothesis, nine patients, all of whose lesions included bilateral occipitotemporal and/or temporal cortices, had a three-way recognition impairment (persons, M = 18.3%; animals, M = 35.7%; tools, M = 71.3%; all scores >2 SDs below normal). As expected, bilateral lesions to other neural sectors, for example prefrontal cortices, did not lead to recognition impairments. These findings provide further support for the notion that retrieval of knowledge for concrete entities from different conceptual categories depends on partially segregated neural systems, located in different sectors of occipitotemporal and temporal regions in right and left hemisphere.

Is a plum a memory problem? Longitudinal study of the reversal of concreteness effect in a patient with semantic dementia

The concreteness effect, which refers to the typically superior performance for concrete concepts compared to abstract ones, is a robust phenomenon that has been observed in normal and brain-damaged subjects in a number of cognitive domains. Reversal of this effect was also reported in a few neuropsychological studies, mainly in patients with semantic dementia (SD). In this article, we report the first longitudinal single-case study of a patient with SD, SC, who performed better for abstract than concrete concepts in various comprehension and production tasks. For concrete concepts, SC showed no category-specific deficit but was impaired in tasks exploring access to stored structural knowledge and semantic perceptual attributes. With the course of the disease, the semantic system progressively declined and the reversal of the concreteness effect, as well as the dissociation between perceptual and non-perceptual knowledge, vanished. We discuss the results and their implications for theoretical propositions of concreteness effect as well as theoretical models of semantic memory. We suggest that the reversal of concreteness in SC is a direct result of the degradation of visual feature knowledge, sustained by anatomical structures affected early in SD. With the time course of the disease, the atrophy extends to adjacent regions and the dissociation between abstract and concrete concepts was no longer observed.