The impact of synaptic depression following brain damage: a connectionist account of "access/refractory" and "degraded-store" semantic impairments

Using lexical semantic cues to mitigate interference effects during real-time sentence processing in aphasia

We examined the auditory sentence processing of neurologically unimpaired listeners and individuals with aphasia on canonical sentence structures in real-time using a visual-world eye-tracking paradigm. The canonical sentence constructions contained multiple noun phrases and an unaccusative verb, the latter of which formed a long-distance dependency link between the unaccusative verb and its single argument (which was base generated in the object position and then displaced to the subject position). To explore the likelihood of similarity-based interference during the real time linking of the verb and the sentence's subject noun, we manipulated the animacy feature of the noun phrases (matched or mismatched). The study's objectives were to examine whether (a) reducing the similarity-based interference by mismatching animacy features would modulate the encoding and retrieval dynamics of noun phrases in real-time; and (b) whether individuals with aphasia would demonstrate on time sensitivity to this lexical-semantic cue. Results revealed a significant effect of this manipulation in individuals both with and without aphasia. In other words, the mismatch in the representational features of the noun phrases increased the distinctiveness of the unaccusative verb's subject target at the time of syntactic retrieval (verb offset) for individuals in both groups. Moreover, individuals with aphasia were shown to be sensitive to the lexical-semantic cue, even though they appeared to process it slower than unimpaired listeners. This study extends to the cue-based retrieval model by providing new insight on the real-time mechanisms underpinning sentence comprehension.

Are they really stronger? Comparing effects of semantic variables in speeded deadline and standard picture naming

Investigations of effects of semantic variables on picture naming have often been inconclusive, with some studies reporting significant and others non-significant effects. One potential explanation may relate to the specific naming tasks used: While most previous studies have used standard picture naming, others have used speeded naming that requires participants to prioritise naming speed over accuracy. Speeded naming has been suggested to cause enhanced effects of item-inherent word characteristics due to disruptions of cognitive control and resulting modulations of responsiveness to input. Consequently, this study investigated whether effects are stronger in speeded compared to standard picture naming, focusing on six feature-based semantic variables: number of semantic features, intercorrelational density, number of near semantic neighbours, semantic similarity, typicality, and distinctiveness. The results showed few differences in the variables' effects between the two naming tasks: In the naming latency analysis, the inhibitory effect of distinctiveness was stronger in the speeded naming task, while in the accuracy analysis the effect of number of semantic features was stronger in the standard naming task. These findings cannot, therefore, be exclusively accounted for by increased responsiveness to input in speeded naming and we discuss possible underlying mechanisms. We conclude that, while some differences in effects of semantic variables between previous studies may have been caused by the specific naming task used, differences between studies more likely depend on statistical power and control of other influential variables in the experiment.

Quantifying the Interplay of Semantics and Phonology During Failures of Word Retrieval by People With Aphasia Using a Multiplex Lexical Network

Investigating instances where lexical selection fails can lead to deeper insights into the cognitive machinery and architecture supporting successful word retrieval and speech production. In this paper, we used a multiplex lexical network approach that combines semantic and phonological similarities among words to model the structure of the mental lexicon. Network measures at different levels of analysis (degree, network distance, and closeness centrality) were used to investigate the influence of network structure on picture naming accuracy and errors by people with Anomic, Broca's, Conduction, and Wernicke's aphasia. Our results reveal that word retrieval is influenced by the multiplex lexical network structure in at least two ways-(a) the accuracy of production and error type on incorrect productions were influenced by the degree and closeness centrality of the target word, and (b) error type also varied in terms of network distance between the target word and produced error word. Taken together, the analyses demonstrate that network science techniques, particularly the use of the multiplex lexical network to simultaneously represent semantic and phonological relationships among words, reveal how the structure of the mental lexicon influences language processes beyond traditionally examined psycholinguistic variables. We propose a framework for how the multiplex lexical network approach allows for understanding the influence of mental lexicon structure on word retrieval processes, with an eye toward a better understanding of the nature of clinical impairments, like aphasia.

On Simulating Neural Damage in Connectionist Networks

A key strength of connectionist modelling is its ability to simulate both intact cognition and the behavioural effects of neural damage. We survey the literature, showing that models have been damaged in a variety of ways, e.g. by removing connections, by adding noise to connection weights, by scaling weights, by removing units and by adding noise to unit activations. While these different implementations of damage have often been assumed to be behaviourally equivalent, some theorists have made aetiological claims that rest on nonequivalence. They suggest that related deficits with different aetiologies might be accounted for by different forms of damage within a single model. We present two case studies that explore the effects of different forms of damage in two influential connectionist models, each of which has been applied to explain neuropsychological deficits. Our results indicate that the effect of simulated damage can indeed be sensitive to the way in which damage is implemented, particularly when the environment comprises subsets of items that differ in their statistical properties, but such effects are sensitive to relatively subtle aspects of the model's training environment. We argue that, as a consequence, substantial methodological care is required if aetiological claims about simulated neural damage are to be justified, and conclude more generally that implementation assumptions, including those concerning simulated damage, must be fully explored when evaluating models of neurological deficits, both to avoid over-extending the explanatory power of specific implementations and to ensure that reported results are replicable.

ELECTRONIC SUPPLEMENTARY MATERIAL

The online version of this article (10.1007/s42113-020-00081-z) contains supplementary material, which is available to authorized users.

White-matter pathways and semantic processing: intrasurgical and lesion-symptom mapping evidence

In the present study, we aimed to test the association between the correct function of the left ventral white matter pathways and semantic processing (dual stream models for language processing, Hickok & Poeppel, 2004), using a new set of language tasks during intraoperative electrical stimulation at white matter level. Additionally, we evaluated brain regions needed for correct performance on the different semantic tasks using lesion-symptom analyses (voxel lesion-symptom mapping and track-wise lesion analysis) in a sample of 62 candidates for the awake brain surgery. We found that electrical stimulation in the vicinity of the inferior longitudinal and inferior fronto-occipital fasciculi disturbed performance on semantic processing tasks. Individuals presented with significantly more semantic paraphasias during brain tumor resection than during the electrical stimulation at the cortex level. Track-wise analyses confirmed the role of these left ventral pathways in semantic processing: a significant relationship was observed between the probability of inferior fronto-occipital fasciculus disconnection/damage and the semantic matching tasks, as well as the number of semantic paraphasias in naming. Importantly, the same analyses for the total score of the Boston Naming Test confirmed significant relationships between this test score and the integrity of the inferior fronto-occipital, inferior longitudinal and uncinate fasciculi. This was further supported by the results of VLSM analyses showing a significant relationship between BNT and the presence of lesion within left middle and inferior temporal gyri. The present findings provide new intraoperative evidence for the role of the white-matter ventral pathways in semantic processing, while at the same time emphasizing the need to include a broader assessment of semantic-conceptual aspects during the awake neurosurgical intervention. This approach will ensure better preservation of functional tissue in the tumoral vicinity and therefore substantially diminish post-surgical language impairments.

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Direct electrical stimulation on the ventral white matter disrupts semantic processing.

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Track-wise analyses confirm intraoperative findings.

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Semantic matching a good candidate for monitoring in brain tumor surgeries.

Left frontotemporal effective connectivity during semantic feature judgments in patients with chronic aphasia and age-matched healthy controls

Traditional models of neural reorganization of language skills in patients with chronic stroke-induced aphasia (PWA) propose activation of reperfused or spared left hemisphere tissue results in the most favorable language outcomes. However, these models do not fully explain variable behavioral recovery patterns observed in chronic patients. Instead, investigation of connectivity patterns of critical network nodes may elucidate better-informed recovery models. In the present study, we combined fMRI and dynamic causal modeling (DCM) to examine effective connectivity of a simple three-node left hemisphere network during a semantic feature decision task in 25 PWA and 18 age-matched neurologically intact healthy controls. The DCM model space utilized in Meier, Kapse, & Kiran (2016), which was organized according to exogenous input to one of three regions (i.e., left inferior frontal gyrus, pars triangularis [LIFGtri], left posterior middle temporal gyrus [LpMTG], or left middle frontal gyrus [LMFG]) implicated in various levels of lexical-semantic processing, was interrogated. This model space included all possible combinations of uni- and bidirectional task-modulated connections between LIFGtri, LMFG and LpMTG, resulting in 72 individual models that were partitioned into three separate families (i.e., Family #1: Input to LIFGtri, Family #2: Input to LMFG, Family #3: Input to LpMTG). Family-wise Bayesian model selection revealed Family #2: Input to LMFG best fit both patient and control data at a group level. Both groups relied heavily on LMFG's modulation of the other two model regions. By contrast, between-group differences in task-modulated coupling of LIFGtri and LpMTG were observed. Within the patient group, the strength of activity in LIFGtri and connectivity of LpMTG → LIFGtri were positively associated with lexical-semantic abilities inside and outside of the scanner, whereas greater recruitment of LpMTG was associated with poorer lexical-semantic skills.

GABAergic and cholinergic modulation of repetition suppression in inferior temporal cortex

Neurons in many brain areas of different species reduce their response when a stimulus is repeated. Such adaptation or repetition suppression is prevalent in inferior temporal (IT) cortex. The mechanisms underlying repetition suppression in IT are still poorly understood. Studies in rodents and in-vitro experiments suggest that acetylcholine and GABA can contribute to repetition suppression by interacting with fatigue-related or local adaptation mechanisms. Here, we examined the contribution of cholinergic and GABAergic mechanisms to repetition suppression in macaque IT, using an adaptation paradigm in which familiar images were presented successively with a short interstimulus interval. We found that intracortical local injections of acetylcholine and of the GABA_A receptor antagonist Gabazine both increased repetition suppression in awake macaque IT. The increased repetition suppression was observed for both spiking activity and local field potential power. The latter was present mainly for frequencies below 50 Hz, spectral bands that typically do not show consistent repetition suppression in IT. Although increased with drug application, repetition suppression remained stimulus selective. These findings agree with the hypothesis that repetition suppression of IT neurons mainly results from suppressed input from upstream and other IT neurons but depend less on intrinsic neuronal fatigue.

Incremental learning of perceptual and conceptual representations and the puzzle of neural repetition suppression

Incremental learning models of long-term perceptual and conceptual knowledge hold that neural representations are gradually acquired over many individual experiences via Hebbian-like activity-dependent synaptic plasticity across cortical connections of the brain. In such models, variation in task relevance of information, anatomic constraints, and the statistics of sensory inputs and motor outputs lead to qualitative alterations in the nature of representations that are acquired. Here, the proposal that behavioral repetition priming and neural repetition suppression effects are empirical markers of incremental learning in the cortex is discussed, and research results that both support and challenge this position are reviewed. Discussion is focused on a recent fMRI-adaptation study from our laboratory that shows decoupling of experience-dependent changes in neural tuning, priming, and repetition suppression, with representational changes that appear to work counter to the explicit task demands. Finally, critical experiments that may help to clarify and resolve current challenges are outlined.

A unified model of human semantic knowledge and its disorders

How is knowledge about the meanings of words and objects represented in the human brain? Current theories embrace two radically different proposals: either distinct cortical systems have evolved to represent different kinds of things, or knowledge for all kinds is encoded within a single domain-general network. Neither view explains the full scope of relevant evidence from neuroimaging and neuropsychology. Here we propose that graded category-specificity emerges in some components of the semantic network through joint effects of learning and network connectivity. We test the proposal by measuring connectivity amongst cortical regions implicated in semantic representation, then simulating healthy and disordered semantic processing in a deep neural network whose architecture mirrors this structure. The resulting neuro-computational model explains the full complement of neuroimaging and patient evidence adduced in support of both domain-specific and domain-general approaches, reconciling long-standing disputes about the nature and origins of this uniquely human cognitive faculty.

Behavioral evidence for a differential modulation of semantic processing and lexical production by aging: a full linear mixed-effects modeling approach

The effect of normal aging on lexical production and semantic processing was evaluated in 72 healthy participants. Four tasks were used, picture naming (PN), picture categorization (PC), numerical judgment (NJ), and color judgment (CJ). The dependence of reaction time (RT) and correct responses with age was accounted by mixed-effects models. Participants underwent neuropsychological testing for verbal, executive, and memory functions. The RTs increase significantly with age for all tasks. After parceling out the non-specific cognitive decline, as reflected by the NJ task, the RT for the PN task decreases with age. Behavioral data were interpreted in relation with neuropsychological scores. Our results suggest that (a) naming becomes more automatic and semantic processing slightly more difficult with age, and (b) a non-specific general slowdown of cognitive processing occurs with age. Lexical production remained unaltered, based on compensatory automatic processes. This study also suggests a possible slowdown of semantic processing, even in normal aging.

Modeling the N400 ERP component as transient semantic over-activation within a neural network model of word comprehension

The study of the N400 event-related brain potential has provided fundamental insights into the nature of real-time comprehension processes, and its amplitude is modulated by a wide variety of stimulus and context factors. It is generally thought to reflect the difficulty of semantic access, but formulating a precise characterization of this process has proved difficult. Laszlo and colleagues (Laszlo & Plaut, 2012; Laszlo & Armstrong, 2014) used physiologically constrained neural networks to model the N400 as transient over-activation within semantic representations, arising as a consequence of the distribution of excitation and inhibition within and between cortical areas. The current work extends this approach to successfully model effects on both N400 amplitudes and behavior of word frequency, semantic richness, repetition, semantic and associative priming, and orthographic neighborhood size. The account is argued to be preferable to one based on "implicit semantic prediction error" (Rabovsky & McRae, 2014) for a number of reasons, the most fundamental of which is that the current model actually produces N400-like waveforms in its real-time activation dynamics.

The ventrolateral prefrontal cortex facilitates processing of sentential context to locate referents

Left ventrolateral prefrontal cortex (VLPFC) has been implicated in both integration and conflict resolution in sentence comprehension. Most evidence in favor of the integration account comes from processing ambiguous or anomalous sentences, which also poses a demand for conflict resolution. In two eye-tracking experiments we studied the role of VLPFC in integration when demands for conflict resolution were minimal. Two closely-matched groups of individuals with chronic post-stroke aphasia were tested: the Anterior group had damage to left VLPFC, whereas the Posterior group had left temporo-parietal damage. In Experiment 1 a semantic cue (e.g., "She will eat the apple") uniquely marked the target (apple) among three distractors that were incompatible with the verb. In Experiment 2 phonological cues (e.g., "She will see an eagle."/"She will see a bear.") uniquely marked the target among three distractors whose onsets were incompatible with the cue (e.g., all consonants when the target started with a vowel). In both experiments, control conditions had a similar format, but contained no semantic or phonological contextual information useful for target integration (e.g., the verb "see", and the determiner "the"). All individuals in the Anterior group were slower in using both types of contextual information to locate the target than were individuals in the Posterior group. These results suggest a role for VLPFC in integration beyond conflict resolution. We discuss a framework that accommodates both integration and conflict resolution.

Different Loci of Semantic Interference in Picture Naming vs. Word-Picture Matching Tasks

Naming pictures and matching words to pictures belonging to the same semantic category impairs performance relative to when stimuli come from different semantic categories (i.e., semantic interference). Despite similar semantic interference phenomena in both picture naming and word-picture matching tasks, the locus of interference has been attributed to different levels of the language system - lexical in naming and semantic in word-picture matching. Although both tasks involve access to shared semantic representations, the extent to which interference originates and/or has its locus at a shared level remains unclear, as these effects are often investigated in isolation. We manipulated semantic context in cyclical picture naming and word-picture matching tasks, and tested whether factors tapping semantic-level (generalization of interference to novel category items) and lexical-level processes (interactions with lexical frequency) affected the magnitude of interference, while also assessing whether interference occurs at a shared processing level(s) (transfer of interference across tasks). We found that semantic interference in naming was sensitive to both semantic- and lexical-level processes (i.e., larger interference for novel vs. old and low- vs. high-frequency stimuli), consistent with a semantically mediated lexical locus. Interference in word-picture matching exhibited stable interference for old and novel stimuli and did not interact with lexical frequency. Further, interference transferred from word-picture matching to naming. Together, these experiments provide evidence to suggest that semantic interference in both tasks originates at a shared processing stage (presumably at the semantic level), but that it exerts its effect at different loci when naming pictures vs. matching words to pictures.

The role of the right hemisphere in semantic control: A case-series comparison of right and left hemisphere stroke

Semantic control processes guide conceptual retrieval so that we are able to focus on non-dominant associations and features when these are required for the task or context, yet the neural basis of semantic control is not fully understood. Neuroimaging studies have emphasised the role of left inferior frontal gyrus (IFG) in controlled retrieval, while neuropsychological investigations of semantic control deficits have almost exclusively focussed on patients with left-sided damage (e.g., patients with semantic aphasia, SA). Nevertheless, activation in fMRI during demanding semantic tasks typically extends to right IFG. To investigate the role of the right hemisphere (RH) in semantic control, we compared nine RH stroke patients with 21 left-hemisphere SA patients, 11 mild SA cases and 12 healthy, aged-matched controls on semantic and executive tasks, plus experimental tasks that manipulated semantic control in paradigms particularly sensitive to RH damage. RH patients had executive deficits to parallel SA patients but they performed well on standard semantic tests. Nevertheless, multimodal semantic control deficits were found in experimental tasks involving facial emotions and the 'summation' of meaning across multiple items. On these tasks, RH patients showed effects similar to those in SA cases - multimodal deficits that were sensitive to distractor strength and cues and miscues, plus increasingly poor performance in cyclical matching tasks which repeatedly probed the same set of concepts. Thus, despite striking differences in single-item comprehension, evidence presented here suggests semantic control is bilateral, and disruption of this component of semantic cognition can be seen following damage to either hemisphere.

Varieties of semantic 'access' deficit in Wernicke's aphasia and semantic aphasia

Comprehension deficits are common in stroke aphasia, including in cases with (i) semantic aphasia, characterized by poor executive control of semantic processing across verbal and non-verbal modalities; and (ii) Wernicke's aphasia, associated with poor auditory-verbal comprehension and repetition, plus fluent speech with jargon. However, the varieties of these comprehension problems, and their underlying causes, are not well understood. Both patient groups exhibit some type of semantic 'access' deficit, as opposed to the 'storage' deficits observed in semantic dementia. Nevertheless, existing descriptions suggest that these patients might have different varieties of 'access' impairment-related to difficulty resolving competition (in semantic aphasia) versus initial activation of concepts from sensory inputs (in Wernicke's aphasia). We used a case series design to compare patients with Wernicke's aphasia and those with semantic aphasia on Warrington's paradigmatic assessment of semantic 'access' deficits. In these verbal and non-verbal matching tasks, a small set of semantically-related items are repeatedly presented over several cycles so that the target on one trial becomes a distractor on another (building up interference and eliciting semantic 'blocking' effects). Patients with Wernicke's aphasia and semantic aphasia were distinguished according to lesion location in the temporal cortex, but in each group, some individuals had additional prefrontal damage. Both of these aspects of lesion variability-one that mapped onto classical 'syndromes' and one that did not-predicted aspects of the semantic 'access' deficit. Both semantic aphasia and Wernicke's aphasia cases showed multimodal semantic impairment, although as expected, the Wernicke's aphasia group showed greater deficits on auditory-verbal than picture judgements. Distribution of damage in the temporal lobe was crucial for predicting the initially 'beneficial' effects of stimulus repetition: cases with Wernicke's aphasia showed initial improvement with repetition of words and pictures, while in semantic aphasia, semantic access was initially good but declined in the face of competition from previous targets. Prefrontal damage predicted the 'harmful' effects of repetition: the ability to reselect both word and picture targets in the face of mounting competition was linked to left prefrontal damage in both groups. Therefore, patients with semantic aphasia and Wernicke's aphasia have partially distinct impairment of semantic 'access' but, across these syndromes, prefrontal lesions produce declining comprehension with repetition in both verbal and non-verbal tasks.

Disorders of representation and control in semantic cognition: Effects of familiarity, typicality, and specificity

We present a case-series comparison of patients with cross-modal semantic impairments consequent on either (a) bilateral anterior temporal lobe atrophy in semantic dementia (SD) or (b) left-hemisphere fronto-parietal and/or posterior temporal stroke in semantic aphasia (SA). Both groups were assessed on a new test battery designed to measure how performance is influenced by concept familiarity, typicality and specificity. In line with previous findings, performance in SD was strongly modulated by all of these factors, with better performance for more familiar items (regardless of typicality), for more typical items (regardless of familiarity) and for tasks that did not require very specific classification, consistent with the gradual degradation of conceptual knowledge in SD. The SA group showed significant impairments on all tasks but their sensitivity to familiarity, typicality and specificity was more variable and governed by task-specific effects of these factors on controlled semantic processing. The results are discussed with reference to theories about the complementary roles of representation and manipulation of semantic knowledge.

What we talk about when we talk about access deficits

Semantic impairments have been divided into storage deficits, in which the semantic representations themselves are damaged, and access deficits, in which the representations are intact but access to them is impaired. The behavioural phenomena that have been associated with access deficits include sensitivity to cueing, sensitivity to presentation rate, performance inconsistency, negative serial position effects, sensitivity to number and strength of competitors, semantic blocking effects, disordered selection between strong and weak competitors, correlation between semantic deficits and executive function deficits and reduced word frequency effects. Four general accounts have been proposed for different subsets of these phenomena: abnormal refractoriness, too much activation, impaired competitive selection and deficits of semantic control. A combination of abnormal refractoriness and impaired competitive selection can account for most of the behavioural phenomena, but there remain several open questions. In particular, it remains unclear whether access deficits represent a single syndrome, a syndrome with multiple subtypes or a variable collection of phenomena, whether the underlying deficit is domain-general or domain-specific, whether it is owing to disorders of inhibition, activation or selection, and the nature of the connection (if any) between access phenomena in aphasia and in neurologically intact controls. Computational models offer a promising approach to answering these questions.

Effects of phonological and semantic deficits on facilitative and inhibitory consequences of item repetition in spoken word comprehension

Repeating a word can have both facilitative and inhibitory effects on subsequent processing. The present study investigated these dynamics by examining the facilitative and inhibitory consequences of different kinds of item repetition in two individuals with aphasia and a group of neurologically intact control participants. The two individuals with aphasia were matched on overall aphasia severity, but had deficits at different levels of processing: one with a phonological deficit and spared semantic processing, the other with a semantic deficit and spared phonological processing. Participants completed a spoken word-to-picture matching task in which they had to pick which of four object images matched the spoken word. The trials were grouped into pairs such that exactly two objects from the first trial in a pair were present on screen during the second trial in the pair. When the second trial's target was the same as the first trial's target, compared to control participants, both participants with aphasia exhibited equally larger repetition priming effects. When the second trial's target was one of the new items, the participant with a phonological deficit exhibited a significantly more negative effect (i.e., second trial response slower than first trial response) than the control participants and the participant with a semantic deficit. Simulations of a computational model confirmed that this pattern of results could arise from (1) normal residual activation being functionally more significant when overall lexical processing is slower and (2) residual phonological activation of the previous trial's target having a particularly strong inhibitory effect specifically when phonological processing is impaired because the task was phonologically-driven (the spoken input specified the target). These results provide new insights into perseveration errors and lexical access deficits in aphasia.

Refractory semantic access dysphasia resulting from resection of a left frontal glioma

The existence of semantic access disorders is now well established, however the precise cognitive and anatomical underpinnings are still debated. Here we describe the case of a patient that became aphasic after the resection of a left frontal glioma. Detailed lesion reconstruction indicates that the lesion was mostly restricted to the left dorsal and ventral prefrontal cortices and the underlying white matter, but sparing temporal lobes. Critically, the patient showed all the signs of refractory semantic access dysphasia, supporting the association between this syndrome and damage to left prefrontal areas likely to subserve retrieval and selection mechanisms for verbal material.

Auditory cortical function during verbal episodic memory encoding in Alzheimer's disease

OBJECTIVE

Episodic memory encoding of a verbal message depends upon initial registration, which requires sustained auditory attention followed by deep semantic processing of the message. Motivated by previous data demonstrating modulation of auditory cortical activity during sustained attention to auditory stimuli, we investigated the response of the human auditory cortex during encoding of sentences to episodic memory. Subsequently, we investigated this response in patients with mild cognitive impairment (MCI) and probable Alzheimer's disease (pAD).

METHODS

Using functional magnetic resonance imaging, 31 healthy participants were studied. The response in 18 MCI and 18 pAD patients was then determined, and compared to 18 matched healthy controls. Subjects heard factual sentences, and subsequent retrieval performance indicated successful registration and episodic encoding.

RESULTS

The healthy subjects demonstrated that suppression of auditory cortical responses was related to greater success in encoding heard sentences; and that this was also associated with greater activity in the semantic system. In contrast, there was reduced auditory cortical suppression in patients with MCI, and absence of suppression in pAD. Administration of a central cholinesterase inhibitor (ChI) partially restored the suppression in patients with pAD, and this was associated with an improvement in verbal memory.

INTERPRETATION

Verbal episodic memory impairment in AD is associated with altered auditory cortical function, reversible with a ChI. Although these results may indicate the direct influence of pathology in auditory cortex, they are also likely to indicate a partially reversible impairment of feedback from neocortical systems responsible for sustained attention and semantic processing.

Types of case series--the anatomically based approach: commentary on M. F. Schwartz & G. S. Dell: case series investigations in cognitive neuropsychology

The paper addresses a weakness in the Schwartz and Dell paper (2010)-namely, its discussion of the inclusion criteria for case series. The paper distinguishes the different types that exist and how they constrain the theoretical conclusions that one can draw about the organization of the normal cognitive system. Four different types of inclusion criteria are considered. Two are those treated by Schwartz and Dell-namely, theoretically derived clinical criteria, such as the example of semantic dementia, and broad clinical criteria such as the presence of aphasia. In addition, in the present paper two different types of anatomically based criteria are assessed-those using anatomical regions selected a priori and also regions selected as a result of an anatomical group study analysis. Putative functional syndromes are argued to be the empirical building blocks for cognitive neuropsychology. Anatomically based case series can aid in their construction or in their fractionation.

A combination of thematic and similarity-based semantic processes confers resistance to deficit following left hemisphere stroke

Semantic knowledge may be organized in terms of similarity relations based on shared features and/or complementary relations based on co-occurrence in events. Thus, relationships between manipulable objects such as tools may be defined by their functional properties (what the objects are used for) or thematic properties (e.g., what the objects are used with or on). A recent study from our laboratory used eye-tracking to examine incidental activation of semantic relations in a word–picture matching task and found relatively early activation of thematic relations (e.g., broom–dustpan), later activation of general functional relations (e.g., broom–sponge), and an intermediate pattern for specific functional relations (e.g., broom–vacuum cleaner). Combined with other recent studies, these results suggest that there are distinct semantic systems for thematic and similarity-based knowledge and that the “specific function” condition drew on both systems. This predicts that left hemisphere stroke that damages either system (but not both) may spare specific function processing. The present experiment tested these hypotheses using the same experimental paradigm with participants with left hemisphere lesions (N = 17). The results revealed that, compared to neurologically intact controls (N = 12), stroke participants showed later activation of thematic and general function relations, but activation of specific function relations was spared and was significantly earlier for stroke participants than controls. Across the stroke participants, activation of thematic and general function relations was negatively correlated, further suggesting that damage tended to affect either one semantic system or the other. These results support the distinction between similarity-based and complementarity-based semantic relations and suggest that relations that draw on both systems are relatively more robust to damage.

The differential contributions of pFC and temporo-parietal cortex to multimodal semantic control: exploring refractory effects in semantic aphasia

Aphasic patients with multimodal semantic impairment following pFC or temporo-parietal (TP) cortex damage (semantic aphasia [SA]) have deficits characterized by poor control of semantic activation/retrieval, as opposed to loss of semantic knowledge per se. In line with this, SA patients show "refractory effects"; that is, declining accuracy in cyclical word-picture matching tasks when semantically related sets are presented rapidly and repeatedly. This is argued to follow a build-up of competition between targets and distractors. However, the link between poor semantic control and refractory effects is still controversial for two reasons. (1) Some theories propose that refractory effects are specific to verbal or auditory tasks, yet SA patients show poor control over semantic processing in both word and picture semantic tasks. (2) SA can result from lesions to either the left pFC or TP cortex, yet previous work suggests that refractory effects are specifically linked to the left inferior frontal cortex. For the first time, verbal, visual, and nonverbal auditory refractory effects were explored in nine SA patients who had pFC (pFC+) or TP cortex (TP-only) lesions. In all modalities, patient accuracy declined significantly over repetitions. This refractory effect at the group level was driven by pFC+ patients and was not shown by individuals with TP-only lesions. These findings support the theory that SA patients have reduced control over multimodal semantic retrieval and, additionally, suggest there may be functional specialization within the posterior versus pFC elements of the semantic control network.

Multifractal dynamics in the emergence of cognitive structure

The complex-systems approach to cognitive science seeks to move beyond the formalism of information exchange and to situate cognition within the broader formalism of energy flow. Changes in cognitive performance exhibit a fractal (i.e., power-law) relationship between size and time scale. These fractal fluctuations reflect the flow of energy at all scales governing cognition. Information transfer, as traditionally understood in the cognitive sciences, may be a subset of this multiscale energy flow. The cognitive system exhibits not just a single power-law relationship between fluctuation size and time scale but actually exhibits many power-law relationships, whether over time or space. This change in fractal scaling, that is, multifractality, provides new insights into changes in energy flow through the cognitive system. We survey recent findings demonstrating the role of multifractality in (a) understanding atypical developmental outcomes, and (b) predicting cognitive change. We propose that multifractality provides insights into energy flows driving the emergence of cognitive structure.

Theories of spoken word recognition deficits in aphasia: evidence from eye-tracking and computational modeling

We used eye-tracking to investigate lexical processing in aphasic participants by examining the fixation time course for rhyme (e.g., carrot-parrot) and cohort (e.g., beaker-beetle) competitors. Broca's aphasic participants exhibited larger rhyme competition effects than age-matched controls. A re-analysis of previously reported data (Yee, Blumstein, & Sedivy, 2008) confirmed that Wernicke's aphasic participants exhibited larger cohort competition effects. Individual-level analyses revealed a negative correlation between rhyme and cohort competition effect size across both groups of aphasic participants. Computational model simulations were performed to examine which of several accounts of lexical processing deficits in aphasia might account for the observed effects. Simulation results revealed that slower deactivation of lexical competitors could account for increased cohort competition in Wernicke's aphasic participants; auditory perceptual impairment could account for increased rhyme competition in Broca's aphasic participants; and a perturbation of a parameter controlling selection among competing alternatives could account for both patterns, as well as the correlation between the effects. In light of these simulation results, we discuss theoretical accounts that have the potential to explain the dynamics of spoken word recognition in aphasia and the possible roles of anterior and posterior brain regions in lexical processing and cognitive control.

Remembering 'zeal' but not 'thing': reverse frequency effects as a consequence of deregulated semantic processing

More efficient processing of high frequency (HF) words is a ubiquitous finding in healthy individuals, yet frequency effects are often small or absent in stroke aphasia. We propose that some patients fail to show the expected frequency effect because processing of HF words places strong demands on semantic control and regulation processes, counteracting the usual effect. This may occur because HF words appear in a wide range of linguistic contexts, each associated with distinct semantic information. This theory predicts that in extreme circumstances, patients with impaired semantic control should show an outright reversal of the normal frequency effect. To test this prediction, we tested two patients with impaired semantic control with a delayed repetition task that emphasised activation of semantic representations. By alternating HF and low frequency (LF) trials, we demonstrated a significant repetition advantage for LF words, principally because of perseverative errors in which patients produced the previous LF response in place of the HF target. These errors indicated that HF words were more weakly activated than LF words. We suggest that when presented with no contextual information, patients generate a weak and unstable pattern of semantic activation for HF words because information relating to many possible contexts and interpretations is activated. In contrast, LF words are associated with more stable patterns of activation because similar semantic information is activated whenever they are encountered.

Semantic diversity accounts for the "missing" word frequency effect in stroke aphasia: insights using a novel method to quantify contextual variability in meaning

Word frequency is a powerful predictor of language processing efficiency in healthy individuals and in computational models. Puzzlingly, frequency effects are often absent in stroke aphasia, challenging the assumption that word frequency influences the behavior of any computational system. To address this conundrum, we investigated divergent effects of frequency in two comprehension-impaired patient groups. Patients with semantic dementia have degraded conceptual knowledge as a consequence of anterior temporal lobe atrophy and show strong frequency effects. Patients with multimodal semantic impairments following stroke (semantic aphasia [SA]), in contrast, show little or no frequency effect. Their deficits arise from impaired control processes that bias activation toward task-relevant aspects of knowledge. We hypothesized that high-frequency words exert greater demands on cognitive control because they are more semantically diverse--they tend to appear in a broader range of linguistic contexts and have more variable meanings. Using latent semantic analysis, we developed a new measure of semantic diversity that reflected the variability of a word's meaning across different context. Frequency, but not diversity, was a significant predictor of comprehension in semantic dementia, whereas diversity was the best predictor of performance in SA. Most importantly, SA patients did show typical frequency effects but only when the influence of diversity was taken into account. These results are consistent with the view that higher-frequency words place higher demands on control processes, so that when control processes are damaged the intrinsic processing advantages associated with higher-frequency words are masked.

Refractoriness and the healthy brain: a behavioural study on semantic access

While many behavioural studies on refractory phenomena in lexical/semantic access have focused on the mechanisms involved in the oral production of names, comprehension tasks have been almost exclusively used in neuropsychological studies on brain damaged patients. We report the results of two experiments on healthy participants conducted by means of speeded word to picture matching tasks. They assess the effects of the same variables examined in the study of refractory access dysphasic patients: semantic distance and word frequency (experiment 1) and presentation rate and serial position effects (experiment 2). Semantic access patients usually show little effect of word frequency but a large semantic distance effect. However, critical in characterising the syndrome as 'refractory', effects of presentation rate and serial position should also be present. The experiments involved the use of a deadline response procedure. The critical manipulation was the absence of a Response Stimulus Interval (RSI) in the fast presentation rate conditions; slower presentation rates involved 1 s RSI. With these manipulations the typical behavioural pattern of performance provided by semantic access dysphasic patients was reproduced. Semantic distance effects were more powerful than word frequency effects (experiment1). Presentation rate effects were found and, most important for a "refractory" account of the effects, a serial position effect was obtained (experiment 2). These results provide the first evidence of such a broad range of refractory effects at the same time in comprehension tasks in healthy subjects and support a purely semantic account for the locus of refractoriness. Moreover, error analysis showed a predominance of perseverative errors with subsequent representations of the same target, supporting a failure of cognitive control mechanisms as the cause of refractory behaviour. The findings are discussed in the light of current models of lexical and semantic processing.

Manipulability and object recognition: is manipulability a semantic feature?

Several lines of evidence exist, coming from neuropsychology, neuroimaging and behavioural investigations on healthy subjects, suggesting that an interaction might exist between the systems devoted to object identification and those devoted to online object-directed actions and that the way an object is acted upon (manipulability) might indeed influence object recognition. In this series of experiments on speeded word-to-picture-matching tasks, it is shown how the presentation of pairs of objects sharing similar manipulation causes greater interference with respect to objects sharing only visual similarity (experiment 1). Moreover, (experiment 2) it is shown how the repeated presentation of pairs of objects sharing a similar type of manipulation leads to a 'negative' serial position effect, with the number of errors increasing across presentations, a behaviour that is typically found in patients with access deficits to semantic representations. By contrast, the repeated presentation of pairs of objects sharing only visual similarity leads to an opposite 'positive' serial position effect, with errors decreasing across presentations. It is argued that a negative serial position effect is linked to interference occurring within the semantic system, and therefore that the way an object is manipulated is indeed a semantic feature, critical in defining manipulable object properties at a semantic level. To our knowledge, this constitutes the first direct evidence of manipulability being a semantic dimension. The results are discussed in the light of current models of semantic memory organization.

Case series investigations in cognitive neuropsychology

Case series methodology involves the systematic assessment of a sample of related patients, with the goal of understanding how and why they differ from one another. This method has become increasingly important in cognitive neuropsychology, which has long been identified with single-subject research. We review case series studies dealing with impaired semantic memory, reading, and language production and draw attention to the affinity of this methodology for testing theories that are expressed as computational models and for addressing questions about neuroanatomy. It is concluded that case series methods usefully complement single-subject techniques.

Elucidating the Nature of Deregulated Semantic Cognition in Semantic Aphasia: Evidence for the Roles of Prefrontal and Temporo-parietal Cortices

Semantic cognition—semantically driven verbal and nonverbal behavior—is composed of at least two interactive principal components: conceptual representations and executive control processes that regulate and shape activation within the semantic system. Previous studies indicate that semantic dementia follows from a progressive yet specific degradation of conceptual knowledge. In contrast, multimodal semantic impairment in aphasic patients (semantic aphasia [SA]) reflects damage to the control component of semantic cognition [Jefferies, E., & Lambon Ralph, M. A. Semantic impairment in stroke aphasia versus semantic dementia: A case-series comparison. Brain, 129, 2132–2147, 2006]. The purpose of the present study was to examine the nature of the semantic control deficits in SA in detail for the first time. Seven patients with SA were tested on four comprehension and naming tasks that directly manipulated the requirement for executive control in different ways. In line with many theories of cognitive control, the SA patients demonstrated three core features of impaired control: (i) they exhibited poor on-line manipulation and exploration of semantic knowledge; (ii) they exhibited poor inhibition of strongly associated distractors; and (iii) they exhibited reduced ability to focus on or augment less dominant aspects of semantic information, although the knowledge itself remained and could be successfully cued by external constraints provided by the examiner. Our findings are consistent with the notion that the anterior temporal lobes are crucial for conceptual knowledge whereas the left prefrontal and temporo-parietal cortices, damaged in patients with SA, play a critical role in regulating semantic activation in a task-appropriate fashion.

Spatially coded semantic information about geographical terms

The cognitive representations supporting our conceptual knowledge of geographical terms such as country and city names have rarely been explored. It has been hypothesised that semantic information about geographical terms is spatially coded (Crutch & Warrington, 2003). The aim of the current study was to assess whether the findings from this previous single case study generalise to other patients and to different classes of geographical terms. Two globally aphasic stroke patients were administered a series of spoken word to written word matching tasks in which they had to repeatedly identify places from the same geographical area (e.g. Norway, Sweden, Denmark, Finland) or different geographical areas (e.g. Norway, India, Spain, Brazil). The patients replicated previous findings by showing that response accuracy was significantly affected by the real-world geographical proximity of the places being examined. Error rates were significantly higher when identifying geographically close as compared with geographically distant countries and cities. They were also significantly less accurate identifying the names of towns in Greater London drawn from the same geographical area (e.g. northwest, northeast, southwest, southeast) than from different geographical areas. Furthermore, it was found that geographical proximity effects occurred even between different types of geographical terms (e.g. England, London, Surrey, Thames). These results suggest that the comprehension of spoken and written geographical terms is directly influenced by their real-world location.

Different impairments of semantic cognition in semantic dementia and semantic aphasia: evidence from the non-verbal domain

Disorders of semantic cognition in different neuropsychological conditions result from diverse areas of brain damage and may have different underlying causes. This study used a comparative case-series design to examine the hypothesis that relatively circumscribed bilateral atrophy of the anterior temporal lobe in semantic dementia (SD) produces a gradual degradation of core semantic representations, whilst a deficit of cognitive control produces multi-modal semantic impairment in a subset of patients with stroke aphasia following damage involving the left prefrontal cortex or regions in and around the temporoparietal area; this condition, which transcends traditional aphasia classifications, is referred to as 'semantic aphasia' (SA). There have been very few direct comparisons of these patient groups to date and these previous studies have focussed on verbal comprehension. This study used a battery of object-use tasks to extend this line of enquiry into the non-verbal domain for the first time. A group of seven SA patients were identified who failed both word and picture versions of a semantic association task. These patients were compared with eight SD cases. Both groups showed significant deficits in object use but these impairments were qualitatively different. Item familiarity correlated with performance on object-use tasks for the SD group, consistent with the view that core semantic representations are degrading in this condition. In contrast, the SA participants were insensitive to the familiarity of the objects. Further, while the SD patients performed consistently across tasks that tapped different aspects of knowledge and object use for the same items, the performance of the SA participants reflected the control requirements of the tasks. Single object use was relatively preserved in SA but performance on complex mechanical puzzles was substantially impaired. Similarly, the SA patients were able to complete straightforward item matching tasks, such as word-picture matching, but performed more poorly on associative picture-matching tasks, even when the tests involved the same items. The two groups of patients also showed a different pattern of errors in object use. SA patients made substantial numbers of erroneous intrusions in their demonstrations, such as inappropriate object movements. In contrast, response omissions were more common in SD. This study provides converging evidence for qualitatively different impairments of semantic cognition in SD and SA, and uniquely demonstrates this pattern in a non-verbal expressive domain-object use.

Temporal characteristics of semantic perseverations induced by blocked-cyclic picture naming

When unimpaired participants name pictures quickly, they produce many perseverations that bear a semantic relation to the target, especially when the pictures are blocked by category. Evidence suggests that the temporal properties of these "semantic perseverations" may differ from typical lexical perseverations in aphasia. To explore this, we studied semantic perseverations generated by participants with aphasia on a naming task with semantic blocking [Schnur, T. T., Schwartz, M. F., Brecher, A., & Hodgson, C. (2006). Semantic interference during blocked-cyclic naming: Evidence from aphasia. Journal of Memory and Language, 54, 199-227]. The properties of these perseverations were investigated by analyzing how often they occurred at each lag (distance from prior occurrence) and how time (response-stimulus interval) influenced the lag function. Chance data sets were created by re-shuffling stimulus-response pairs in a manner that preserved unique features of the blocking design. We found that the semantic blocking manipulation did not eliminate the expected bias for short-lag perseverations (recency bias). However, immediate (lag 1) perseverations were not invariably the most frequent, which hints at a source of inconsistency within and across studies. Importantly, there was not a reliable difference between the lag functions for perseverations generated with a 5s, compared to 1s, response-stimulus interval. The combination of recency bias and insensitivity to elapsed time indicates that the perseveratory impetus in a named response does not passively decay with time but rather is diminished by interference from related trials. We offer an incremental learning account of these findings.

Semantic access dysphasia resulting from left temporal lobe tumours

Unlike semantic degradation disorders, the mechanisms and the anatomical underpinnings of semantic access disorders are still unclear. We report the results of a case series study on the effects of temporal lobe gliomas on semantic access abilities of a group of 20 patients. Patients were tested 1–2 days before and 4–6 days after the removal of the tumour. Their semantic access skills were assessed with two spoken word-to-picture matching tasks, which aimed to separately control for rate of presentation, consistency and serial position effects (Experiment 1) and for word frequency and semantic distance effects (Experiment 2). These variables have been held to be critical in characterizing access in contrast to degraded-store semantic deficits, with access deficits characterized by inconsistency of response, better performance with slower presentation rates and with semantically distant stimuli, in the absence of frequency effects. Degradation deficits show the opposite pattern. Our results showed that low-grade slowly growing tumours tend not to produce signs of access problems. However, high-grade tumours especially within the left hemisphere consistently produce strong semantic deficits of a clear access type: response inconsistency and strong semantic distance effects in the absence of word frequency effects were detected. However, effects of presentation rate and serial position were very weak, suggesting non-refractory behaviour in the tumour patients tested. This evidence, together with the results of lesion overlapping, suggests the presence of a type of non-refractory semantic access deficit. We suggest that this deficit could be caused by the disconnection of posterior temporal lexical input areas from semantic system.

Translational research in aphasia: from neuroscience to neurorehabilitation

PURPOSE

In this article, the authors encapsulate discussions of the Language Work Group that took place as part of the Workshop in Plasticity/NeuroRehabilitation Research at the University of Florida in April 2005.

METHOD

In this narrative review, they define neuroplasticity and review studies that demonstrate neural changes associated with aphasia recovery and treatment. The authors then summarize basic science evidence from animals, human cognition, and computational neuroscience that is relevant to aphasia treatment research. They then turn to the aphasia treatment literature in which evidence exists to support several of the neuroscience principles.

CONCLUSION

Despite the extant aphasia treatment literature, many questions remain regarding how neuroscience principles can be manipulated to maximize aphasia recovery and treatment. They propose a framework, incorporating some of these principles, that may serve as a potential roadmap for future investigations of aphasia treatment and recovery. In addition to translational investigations from basic to clinical science, the authors propose several areas in which translation can occur from clinical to basic science to contribute to the fundamental knowledge base of neurorehabilitation. This article is intended to reinvigorate interest in delineating the factors influencing successful recovery from aphasia through basic, translational, and clinical research.

The Influence of refractoriness upon comprehension of non-verbal auditory stimuli

An investigation of non-verbal auditory comprehension in two patients with global aphasia following stroke is reported. The primary aim of the investigation was to establish whether refractory access disorders can affect non-verbal input modalities. All previous reports of refractoriness, a cognitive syndrome characterized by response inconsistency, sensitivity to temporal factors and insensitivity to item frequency, have involved comprehension tasks which have a verbal component. Two main experiments are described. The first consists of a novel sound-to-picture and sound-to-word matching task in which comprehension of environmental sounds is probed under conditions of semantic relatedness and semantic unrelatedness. In addition to the two stroke patients, the performance of a group of 10 control patients with non-vascular pathology is reported, along with evidence of semantic relatedness effects in sound comprehension. The second experiment examines environmental sound comprehension within a repetitive probing paradigm which affords assessment of the effects of semantic relatedness, response consistency and presentation rate. It is demonstrated that the two stroke patients show a significant increase in error rate across multiple probes of the same set of sound stimuli, indicating the presence of refractoriness within this non-verbal domain. The implications of the results are discussed with reference to our current understanding of the mechanisms of refractoriness.

Refractory access disorders and the organization of concrete and abstract semantics: do they differ?

Patients with 'refractory semantic access deficits' demonstrate several unique features that make them important sources of insight into the organization of semantic representations. Here we attempt to replicate several novel findings from single-case studies reported in the literature. Patient UM-103 displays the cardinal features of a 'refractory semantic access deficit' and showed many of the same effects of semantic relatedness reported in the literature. However, when probing concrete and abstract words, this patient revealed very different patterns of performance compared to two previously reported patients. We discuss the implications of our data for models of semantic organization of abstract and concrete words.

Word-finding difficulty: a clinical analysis of the progressive aphasias

The patient with word-finding difficulty presents a common and challenging clinical problem. The complaint of 'word-finding difficulty' covers a wide range of clinical phenomena and may signify any of a number of distinct pathophysiological processes. Although it occurs in a variety of clinical contexts, word-finding difficulty generally presents a diagnostic conundrum when it occurs as a leading or apparently isolated symptom, most often as the harbinger of degenerative disease: the progressive aphasias. Recent advances in the neurobiology of the focal, language-based dementias have transformed our understanding of these processes and the ways in which they breakdown in different diseases, but translation of this knowledge to the bedside is far from straightforward. Speech and language disturbances in the dementias present unique diagnostic and conceptual problems that are not fully captured by classical models derived from the study of vascular and other acute focal brain lesions. This has led to a reformulation of our understanding of how language is organized in the brain. In this review we seek to provide the clinical neurologist with a practical and theoretical bridge between the patient presenting with word-finding difficulty in the clinic and the evidence of the brain sciences. We delineate key illustrative speech and language syndromes in the degenerative dementias, compare these syndromes with the syndromes of acute brain damage, and indicate how the clinical syndromes relate to emerging neurolinguistic, neuroanatomical and neurobiological insights. We propose a conceptual framework for the analysis of word-finding difficulty, in order both better to define the patient's complaint and its differential diagnosis for the clinician and to identify unresolved issues as a stimulus to future work.

Neural substrates of semantic memory

Semantic memory is described as the storage of knowledge, concepts, and information that is common and relatively consistent across individuals (e.g., memory of what is a cup). These memories are stored in multiple sensorimotor modalities and cognitive systems throughout the brain (e.g., how a cup is held and manipulated, the texture of a cup's surface, its shape, its function, that is related to beverages such as coffee, and so on). Our ability to engage in purposeful interactions with our environment is dependent on the ability to understand the meaning and significance of the objects and actions around us that are stored in semantic memory. Theories of the neural basis of the semantic memory of objects have produced sophisticated models that have incorporated to varying degrees the results of cognitive and neural investigations. The models are grouped into those that are (1) cognitive models, where the neural data are used to reveal dissociations in semantic memory after a brain lesion occurs; (2) models that incorporate both cognitive and neuroanatomical information; and (3) models that use cognitive, neuroanatomic, and neurophysiological data. This review highlights the advances and issues that have emerged from these models and points to future directions that provide opportunities to extend these models. The models of object memory generally describe how category and/or feature representations encode for object memory, and the semantic operations engaged in object processing. The incorporation of data derived from multiple modalities of investigation can lead to detailed neural specifications of semantic memory organization. The addition of neurophysiological data can potentially provide further elaboration of models to include semantic neural mechanisms. Future directions should incorporate available and newly developed techniques to better inform the neural underpinning of semantic memory models.

Refractory effects in stroke aphasia: A consequence of poor semantic control

This study examined the full range of effects associated with "semantic access impairment" - namely, refractory variables (semantic relatedness, speed of presentation and item repetition), inconsistency, the absence of frequency effects and facilitation by cues - in a series of stroke patients with multimodal semantically impairment. By investigating all of these factors in a group of patients who were not specifically selected to show "access" effects, we were able to establish (1) whether this pattern is a common consequence of infarcts that produce semantic impairment and (2) if these symptoms co-occur. All of the patients showed effects of cueing and an absence of frequency effects in comprehension. Patients whose brain damage included the left inferior prefrontal cortex (LIPC) also showed marked effects of refractory variables; in contrast, two patients with temporal-parietal but not frontal lesions were less sensitive to these variables. Parallel results were obtained for cyclical naming and word-picture matching tasks suggesting that the LIPC plays a role in semantic selection as well as lexical retrieval. Rapid presentation and item repetition is likely to have increased the selection demands in both of these tasks in a similar fashion. Unlike patients with classical "semantic access impairment", our semantically impaired stroke patients showed significant test-retest consistency, indicating that their difficulties did not result from an unpredictable failure of semantic access--instead, their deficits were interpreted as arising from failures of semantic control.

Semantic impairment in stroke aphasia versus semantic dementia: a case-series comparison

Different neuropsychological populations implicate diverse cortical regions in semantic memory: semantic dementia (SD) is characterized by atrophy of the anterior temporal lobes whilst poor comprehension in stroke aphasia is associated with prefrontal or temporal-parietal infarcts. This study employed a case-series design to compare SD and comprehension-impaired stroke aphasic patients directly on the same battery of semantic tests. Although the two groups obtained broadly equivalent scores, they showed qualitatively different semantic deficits. The SD group showed strong correlations between different semantic tasks--regardless of input/output modality--and substantial consistency when a set of items was assessed several times. They were also highly sensitive to frequency/familiarity and made coordinate and superordinate semantic errors in picture naming. These findings support the notion that amodal semantic representations degrade in SD. The stroke aphasia group also showed multimodal deficits and consistency across different input modalities, but inconsistent performance on tasks requiring different types of semantic processing. They were insensitive to familiarity/frequency--instead, tests of semantic association were influenced by the ease with which relevant semantic relationships could be identified and distractors rejected. In addition, the aphasic patients made associative semantic errors in picture naming that SD patients did not make. The aphasic patients' picture naming performance improved considerably with phonemic cues suggesting that these patients retained knowledge that could not be accessed without contextual support. We propose that semantic cognition is supported by two interacting principal components: (i) a set of amodal representations (which progressively degrade in SD) and (ii) executive processes that help to direct and control semantic activation in a task-appropriate fashion (which are dysfunctional in comprehension-impaired stroke aphasic patients).