The problem of naming in SDAT: a relative deficit

Pragmatic assessment of communication in dementia (PAC-D)

This study evaluates the pragmatic communicative abilities ofpatients with dementia, primarily of the Alzheimer's type. A special screening test andfour other tests were utilized along with video recordings of selected subjects' test performances. Results revealed significant correlation among scores of the various tests as well as some communication skills which appear to be robustfor progression of dementia.

Noninfarct vascular dementia and Alzheimer dementia spectrum

Vascular dementia is an overarching superordinate category of which multiinfarct vascular dementia is only one subtype. To contribute to the definition of vascular dementia, method involved investigation of mental status, oral language and comprehension in 81 consecutive vascular patients comprising two vascular samples: cerebral infarct sample (n=43) and cerebral noninfarct sample (n=38). To determine baseline, method also involved investigation of 36 demographically equivalent normal elderly. Results indicate both vascular samples performed significantly worse than normal elderly. Results further indicate there were no robust, reliable, significant differences between cerebral infarct and cerebral noninfarct patients. The lack of significant differences between cerebral infarct and cerebral noninfarct vascular samples brings into focus the ambiguous transition between diffuse, generalized disease and the multifocality underlying the vascular dementia-Alzheimer dementia spectrum. Cross-cutting infarct and noninfarct vascular populations were vascular factors of arteriosclerosis, abnormal blood pressure, diabetes mellitus, abnormal electrocardiogram, peripheral vascular disease, and other variables implicated in the distal causality of both infarct and noninfarct vascular dementias. Results indicate cerebral infarction is not the only path to the final common phenotype of vascular dementia. Vascular dementia is reconceptualized so as to include noninfarct vascular dementia: vascular dementia caused by underlying vascular factors other than cerebral infarction. It is suggested that one form of the subtype of noninfarct vascular dementia is Alzheimer-type vascular dementia.

Language impairment in dementia of the Alzheimer type: a hierarchical decline?

OBJECTIVE

Progressive memory impairment is the primary cognitive feature of Alzheimer's disease. Systematic attention to progressive language impairment is under-appreciated. The purpose of this article is to apply the semiotic language framework to organize the disparate findings on language impairment in DAT.

METHOD

The semiotic system is hierarchical, going from simple to more complex units of language, with the hierarchical ranks of phonology, morphology, syntax, semantics. This language hierarchy is used as an organizing tool to provide a context for the discrete data on language decline in DAT. Studies relating to language impairment in DAT were identified through an exhaustive computerized search (Medline and Psych Info Database) of available literature spanning the last forty years in which 615 references were examined. Papers were selected for review if reference were made to any one or more of the language parameters of phonology, morphology, syntax, semantics, or to any components or indicators of these parameters, such as sound production, naming, grammar, sentence processing, verbal comprehension in Alzheimer patients.

RESULTS

There appears to be an overall relation between language decline and complexity of language both across and within the hierarchical ranks. There also appears to be an associated negative relation between sequence in language development and language decline. Language forms learned last in the sequence of language development are the most complex and appear to be first to deteriorate.

CONCLUSIONS

The decline of language in DAT appears to be hierarchical in nature. Further understanding of this hierarchical language decline depends in part on nosologic clarification and subtyping of DAT.

Phonological and articulatory impairment in Alzheimer's disease: a case series

We demonstrate that phonological and articulatory impairments may occur at presentation or early in the course of Alzheimer's disease, contrary to claims that these aspects of language production are relatively preserved until the final stages of this disease. Six patients with pathologically confirmed Alzheimer's disease (AD) and four patients with clinically diagnosed dementia of the Alzheimer's type (DAT) presented with one of five different clinical profiles: nonfluent progressive aphasia, mixed progressive aphasia, progressive aphasia diagnosed as DAT from neuropsychological assessment, initial amnestic syndrome with prominent phonological errors, and biparietal syndrome. Analysis of their conversational speech, single-word production, and performance of highly familiar series speech tasks such as counting revealed false start errors, phonological paraphasias, and/or articulatory difficulty. Neuropathological changes were located in left perisylvian regions consistent with speech and language impairment but atypical for Alzheimer's disease.

Interface between vascular dementia and Alzheimer syndrome. Nosologic redefinition

Vascular dementia is redefined so as to include noninfarct vascular dementia: vascular dementia caused by underlying vascular factors other than cerebral infarction. Data are presented that bring into focus the interface between vascular dementia and Alzheimer syndrome, and the ambiguous transition between multifocality and diffuse or generalized disease. By cross-cutting both stroke and nonstroke vascular groups, arteriosclerosis, abnormal blood pressure, abnormal electrocardiogram, and other vascular factors are implicated in the distal causality of both infarct and noninfarct vascular dementia.

Semantic organization and verbal episodic memory in patients with mild and moderate Alzheimer's disease

The objective of the present research was to investigate the relationship between semantic organization and cue utilization in mildly and moderately demented patients with Alzheimer's disease (AD). In Experiment 1, subjects were presented with two lists of words: a list with semantically unrelated words and a list with words from four semantic categories presented randomly intermixed. Free recall was assessed and following the organizable list, subjects received a cued recall test. Normal controls, as opposed to mildly and moderately demented patients, showed higher performance in the organizable list as compared to the random list. In addition, normal controls and mildly demented patients benefited from semantic cues in the organizable list and performed at a higher level in total recall as compared to free recall. In Experiment 2, subjects were presented with two lists of words: a list with words from four semantic categories presented randomly intermixed and a list with words from four semantic categories presented clustered, together with information about the organization of the list. Free recall and cued recall, with the category names serving as cues, were assessed. Free recall performance of normal controls was higher in the clustered than in the organizable list, whereas no such effect was observed for the AD patients. Normal controls and mildly demented patients performed at a higher level in total as compared to free recall in both lists, whereas this effect was present only in the clustered list for the moderately demented patients. The overall pattern of results indicates that there are conditions under which memory facilitation from semantic organization may be obtained in AD.