The importance of being apt: metaphor comprehension in Alzheimer's disease

Enhancing socio-communicative functions in an MCI patient with intra-nasal insulin: a case report

This report examines extended intra-nasal insulin treatment [INI] for an Insulin Resistant early Mild Cognitive Impairment [MCI] patient. Patient [EJ] also had medial temporal lobe [MTL] damage, poor short-term memory, significant irritability, and social and linguistic withdrawal at treatment start. Compared to baseline, nine months INI treatment increased grey matter volume, lowered beta-amyloid levels, and improved MCI and FAS scores. Patient also increased pragmatic capacities in social conversation and procedural memory. These findings align with results from prior clinical trials on INI and suggest that treatment can slow neurodegenerative disease progression in early MCI patients.

The scope of using pragmatic language tests for early detection of dementia: A systematic review of investigations using figurative language

INTRODUCTION

Dementia cases are expected to rise to 81.1 million in 2040. Efforts are underway to develop diagnostic methods to facilitate early detection of the disease. Herein we review research findings focusing on pragmatic dysfunction in patients with dementia and evaluate the usefulness of assessing dementia and its progress with a battery of tests assessing figurative language skills.

METHODS

A total of 74,778 article titles were identified from EMBASE, PubMed, and Google Scholar databases. After systematic screening, 51 journal articles were selected for the final review.

RESULT

The review suggests that impaired figurative language might be a marker for early cognitive decline. Different forms of figurative language may be impaired at different stages of the disease and in different types of dementia involving different neuropathologies.

CONCLUSION

The use of pragmatic tests in combination with the existing diagnostic protocols might increase the probability of early diagnosis. HIGHLIGHTS Pragmatic impairment could be a marker of early cognitive impairment. Figurative language-an important pragmatic aspect-is disrupted in mild cognitive impairment (MCI) and early Alzheimer's disease (AD). Figurative language impairment might precede literal language impairment. Pragmatic tests could be more sensitive than standard neuropsychological tests. Inclusion of pragmatic tests in diagnostic guidelines might bolster early detection.

Interpretation of familiar metaphors and proverbs by Polish people in middle and late adulthood

BACKGROUND

The ability to understand figurative language, including metaphors and proverbs, decreases with age, although the phenomenon is not universal. Cognitive capacities and education play an important role in the competence connected with figurative language use and comprehension in people during the second half of life.

AIMS

To identify possible similarities and differences in task performance by subjects representing middle adulthood (40-49 and 50-59 years old) and late adulthood (60-69 and 70-92 years old). Additionally, the analyses took into account factors significantly affecting the results, that is, tasks type (metaphors versus proverbs), the way the answer is given (open-ended versus multiple choice) and types of answers (abstract and concrete). This study also aimed to identify some cognitive correlates of task completion.

METHODS & PROCEDURES

A total of 86 Caucasian subjects, aged 40-92 years, participated in this study (M_{whole group} = 62.37, SD = 15.53); the group included 20 subjects aged 40-49 years (M_age = 45.4; SD = 3.05), 20 aged 50-59 years (M_age = 55.50; SD = 2.64), 20 aged 60-69 years (M_age = 64.40; SD = 2.78), and 26 aged 70-92 years (M_age = 79.15; SD = 6.27). A total of 20 well-known Polish metaphors and 20 popular Polish proverbs were used to assess the level of proverb and metaphor comprehension. The Montreal Cognitive Assessment Scale and Vocabulary subtest of the Polish version of WAIS-R were applied to assess the cognitive functions.

OUTCOMES & RESULTS

The results of the analyses suggest that there are differences as well as certain similarities between the groups. At 70+ years of age, the ability to explain and comprehend metaphors and proverbs decreases when compared with younger adults. In the 70+ group, the ability to grasp the meaning of both metaphors and proverbs is similar, unlike in the younger groups which present a better ability to explain and comprehend metaphors than proverbs. The conditions related to the types of tasks, that is, spontaneous interpretation and choice of responses, do not affect scores of the oldest subjects.

CONCLUSIONS

The analysis of response types, that is, abstract versus concrete, shows that, compared with younger groups, people aged 70+ years tend to less frequently provide abstract explanations and more often give concrete (but correct) responses, referring to situational data or examples from everyday life. Moreover, attention, short-term/delayed memory and lexical reserve influence the ability to use and comprehend figurative language to a varied degree.

WHAT THIS PAPER ADDS

What is already known on the subject Studies focusing on metaphor and proverb interpretation by people in middle and late adulthood are rather scarce, and what is more, they provide inconclusive results. Research has shown that the capacities related to attention and memory, as well as language resources and executive functions, all deteriorate in older people, which negatively affects their ability to understand metaphors and proverbs. However, varied methods are applied to assess these skills, which may explain why the related findings are inconsistent. What this paper adds to existing knowledge The novelty of this study lies in the fact that the analyses took into account the type of task (metaphors versus proverbs), the method of responding (open-ended versus multiple-choice) and the nature of the answer (abstract versus concrete). This allowed us to highlight intergroup differences and to show specific characteristics of proverb and metaphor spontaneous interpretation and choice of correct answers. The results were compared among the participants representing relatively narrow age ranges classified as middle and late adulthood. What are the potential or actual clinical implications of this work? Analysis of how people in middle and late adulthood interpret metaphors and proverbs might constitute an element of preliminary screening assessment showing whether a decrease in this capacity is in the normal range or if it reflects a serious cognitive decline. It would be worthwhile if the diagnostic process included varied task designs, that is, both metaphors and proverbs, as well as spontaneous interpretation and multiple-choice, as well as varied types of responses.

The Neural Basis of Metaphor Comprehension: Evidence from Left Hemisphere Degeneration

Despite the ubiquity of metaphor in cognition and communication, it is absent from standard clinical assessments of language, and the neural systems that support metaphor processing are debated. Previous research shows that patients with focal brain lesions can display selective impairments in processing metaphor, suggesting that figurative language abilities may be disproportionately vulnerable to brain injury. We hypothesized that metaphor processing is especially vulnerable to neurodegenerative disease, and that the left hemisphere is critical for normal metaphor processing. To evaluate these hypotheses, we tested metaphor comprehension in patients with left-hemisphere neurodegeneration, and in demographically matched healthy comparison participants. Stimuli consisted of moderately familiar metaphors and closely matched literal sentences sharing the same source term (e.g., The interview was a painful crawl / The infant's motion was a crawl). Written sentences were presented, followed by four modifier-noun answer choices (one target and three foils). Healthy controls, though reliably better at literal than metaphor trials, comprehended both sentence conditions well. By contrast, participants with left-hemisphere neurodegeneration performed disproportionately poorly on metaphor comprehension. Anatomical analyses show relationships between metaphor accuracy and patient atrophy in the left middle and superior temporal gyri, and the left inferior frontal gyrus, areas that have been implicated in supporting metaphor comprehension in previous imaging research. The behavioral results also suggest deficits of metaphor comprehension may be a sensitive measure of cognitive dysfunction in some forms of neurodegenerative disease.

Non-literal understanding and psychosis: Metaphor comprehension in individuals with a diagnosis of schizophrenia

Previous studies suggest that understanding of non-literal expressions, and in particular metaphors, can be impaired in people with schizophrenia; although it is not clear why. We explored metaphor comprehension capacity using a novel picture selection paradigm; we compared task performance between people with schizophrenia and healthy comparator subjects and we further examined the relationships between the ability to interpret figurative expressions non-literally and performance on a number of other cognitive tasks. Eye-tracking was used to examine task strategy. We showed that even when IQ, years of education, and capacities for theory of mind and associative learning are factored in as covariates, patients are significantly more likely to interpret metaphorical expressions literally, despite eye-tracking findings suggesting that patients are following the same interpretation strategy as healthy controls. Inhibitory control deficits are likely to be one of multiple factors contributing to the poorer performance of our schizophrenia group on the metaphor trials of the picture selection task.