Categorization of object descriptions in Alzheimer's disease and frontotemporal dementia: limitation in rule-based processing

Evaluating a Maintenance-Based Treatment Approach to Preventing Lexical Dropout in Progressive Anomia

Purpose Primary progressive aphasia (PPA) and the amnestic variant of Alzheimer's disease (AD) are neurodegenerative conditions characterized by a profound loss of functional communication abilities. Communicative impairment in AD and PPA is especially apparent in the domain of naming common objects and familiar faces. We evaluated the effectiveness of a language intervention targeting maintenance of an individualized core vocabulary in a longitudinal cohort of older adults experiencing either PPA or AD. Method PPA (n = 9) and AD (n = 1) patients were administered a semantically based language treatment for up to 2 years. Patients repeatedly named and generated semantic features for a personalized lexicon consisting of 100 words. We evaluated naming accuracy and off-line neuropsychological measures at four successive timepoints. Naming accuracy was assessed in patients (n = 7) who completed at least three recurrent evaluations. Off-line neuropsychological performance was assessed across timepoints in all patients. Results Patients demonstrated relative preservation of naming trained words relative to a steep decline for untrained (control) words. The greatest decrements were observed for naming people relative to objects. Conclusion These results suggest that consistent training of a finite set of words can protect a core lexicon composed of crucial target concepts (e.g., a spouse's name). We discuss potential benefits and clinical implications of maintenance-based approaches to promoting language functioning in the context of neurodegeneration.

Music models aberrant rule decoding and reward valuation in dementia

Aberrant rule- and reward-based processes underpin abnormalities of socio-emotional behaviour in major dementias. However, these processes remain poorly characterized. Here we used music to probe rule decoding and reward valuation in patients with frontotemporal dementia (FTD) syndromes and Alzheimer's disease (AD) relative to healthy age-matched individuals. We created short melodies that were either harmonically resolved ('finished') or unresolved ('unfinished'); the task was to classify each melody as finished or unfinished (rule processing) and rate its subjective pleasantness (reward valuation). Results were adjusted for elementary pitch and executive processing; neuroanatomical correlates were assessed using voxel-based morphometry. Relative to healthy older controls, patients with behavioural variant FTD showed impairments of both musical rule decoding and reward valuation, while patients with semantic dementia showed impaired reward valuation but intact rule decoding, patients with AD showed impaired rule decoding but intact reward valuation and patients with progressive non-fluent aphasia performed comparably to healthy controls. Grey matter associations with task performance were identified in anterior temporal, medial and lateral orbitofrontal cortices, previously implicated in computing diverse biological and non-biological rules and rewards. The processing of musical rules and reward distils cognitive and neuroanatomical mechanisms relevant to complex socio-emotional dysfunction in major dementias.

Semantic categorisation of novel objects in frontotemporal dementia

Impaired semantic memory is ubiquitous in frontotemporal dementia (FTD), including patients with semantic dementia (SD), progressive nonfluent aphasia (PNFA) and nonaphasic FTD patients with a deficit in executive and social functioning (EXEC/SOC). One hypothesis attributes this to the degradation of specific categories of knowledge in semantic memory. This study explores the alternate hypothesis that impaired semantic memory in FTD can also reflect limitations in the categorisation processes that determine object meaning. Patients were taught a novel semantic category under two conditions: rule-based categorisation, where executive resources support the evaluation of specific features to determine category membership; and similarity-based categorisation, where category membership is determined by the overall resemblance of an item to a prototype or recalled exemplars. In the first experiment, patients learned a novel category composed of highly salient features. For SD patients, we found category membership judgment profiles following rule-based and similarity-based training that resembled the performance of control subjects. Categorisation was impaired following rule-based training in PNFA and EXEC/SOC patients. In the second experiment, we modified the category so that membership was determined by less salient features, thus increasing the burden on executive resources. Under these circumstances, SD patients' categorisation profiles continued to resemble those of control subjects, PNFA patients' category judgments were governed by feature salience, and EXEC/SOC patients' judgments were limited by impaired executive resources. These observations suggest that the semantic memory deficit in SD largely reflects degraded feature knowledge for familiar objects, while impaired semantic memory in PNFA and in EXEC/SOC patients largely reflects a deficit in the processes associated with semantic categorisation.

Categorization of novel tools by patients with Alzheimer's disease: category-specific content and process

We examined the interaction of content and process in categorizing novel semantic material. We taught patients with Alzheimer's disease (AD) and healthy age-matched seniors a category of plausible novel tools by similarity- and rule-based processes, and compared the results with our previous parallel study of categorization of novel animals, in which AD patients were selectively impaired at rule-based categorization. AD patients demonstrated learning in the novel tool study; however, in contrast to the novel animal study, they were impaired in similarity-based as well as rule-based categorization relative to healthy seniors. Healthy seniors' categorization strategies reflected process irrespective of category content; they frequently attended to a single feature following similarity-based training, and always attended to all requisite features following rule-based training. AD patients' categorization strategies, in contrast, reflected category content; they frequently attended to a single feature when categorizing novel animals by either categorization process, but rarely did so when categorizing novel tools. AD patients' ability to categorize novel tools correlated with preserved recognition memory, a pattern not found in the novel animal study. The category-specific role of memory, along with AD patients' performance profile, suggests content-specific distinctions between the categories. We posit that tool features are relatively arbitrary, placing greater demands on memory, while prior knowledge about animals such as constraints on appearance and feature diagnosticity facilitates the assimilation of novel animals into semantic memory. The results suggest that categorization processes are sensitive to category content, which influences AD patients' success at acquiring a new category.

Language performance in Alzheimer's disease and mild cognitive impairment: a comparative review

Mild cognitive impairment (MCI) manifests as memory impairment in the absence of dementia and progresses to Alzheimer's disease (AD) at a rate of around 15% per annum, versus 1-2% in the general population. It thus constitutes a primary target for investigation of early markers of AD. Language deficits occur early in AD, and performance on verbal tasks is an important diagnostic criterion for both AD and MCI. We review language performance in MCI, compare these findings to those seen in AD, and identify the primary issues in understanding language performance in MCI and selecting tasks with diagnostic and prognostic value.

Knowledge of natural kinds in semantic dementia and Alzheimer's disease

We examined the semantic impairment for natural kinds in patients with probable Alzheimer's disease (AD) and semantic dementia (SD) using an inductive reasoning paradigm. To learn about the relationships between natural kind exemplars and how these are distinguished from manufactured artifacts, subjects judged the strength of arguments such as "Humans have a chemical called sebum. Therefore, frogs have a chemical called sebum." These judgments depend on subjects' perception of the similarity between the familiar objects named in the premise and the conclusion. Controls rated arguments generalizing from a natural kind to an artifact as significantly weaker than arguments generalizing from one natural kind to another natural kind. SD patients demonstrated a graded profile of generalization without evidence of a categorical distinction between natural kinds and artifacts. AD patients' judgments also suggested more difficulty than controls at distinguishing between natural kinds and artifacts. Both SD patients and AD patients resembled controls in their judgments of arguments where both objects are from the natural kinds category. Semantic knowledge thus appears to be sufficiently preserved in both AD and SD to support within-category similarity judgments. We suggest that SD patients may be impaired in part at identifying the features critical to diagnosing membership in a semantic category, while AD patients' performance is consistent with their semantic categorization deficit.

Neuropsychological deficits in frontotemporal dementia and Alzheimer's disease: a meta-analytic review

We sought to identify the cognitive tests that best discriminate between Alzheimer's disease (AD) and frontotemporal dementia (FTD). A comprehensive search of all studies examining the cognitive performance of persons diagnosed with AD and FTD, published between 1980 and 2006, was conducted. Ninety-four studies were identified, comprising 2936 AD participants and 1748 FTD participants. Weighted Cohen's d effect sizes, percentage overlap statistics, confidence intervals and fail-safe Ns were calculated for each cognitive test that was used by two or more studies. The most discriminating cognitive tests were measures of orientation, memory, language, visuomotor function and general cognitive ability. Although there were large and significant differences between groups on these measures, there was substantial overlap in the scores of the AD and FTD groups. Age, education, years since diagnosis and diagnostic criteria did not significantly contribute to the group differences. Given the large overlap in the test performance of persons diagnosed with AD and FTD, cognitive tests should be used cautiously and in conjunction with a medical history, behavioural observations, imaging and information from relatives when making differential diagnoses.

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.

Multiple systems of category learning

We review neuropsychological and neuroimaging evidence for the existence of three qualitatively different categorization systems. These categorization systems are themselves based on three distinct memory systems: working memory (WM), explicit long-term memory (explicit LTM), and implicit long-term memory (implicit LTM). We first contrast categorization based on WM with that based on explicit LTM, where the former typically involves applying rules to a test item and the latter involves determining the similarity between stored exemplars or prototypes and a test item. Neuroimaging studies show differences between brain activity in normal participants as a function of whether they are instructed to categorize novel test items by rule or by similarity to known category members. Rule instructions typically lead to more activation in frontal or parietal areas, associated with WM and selective attention, whereas similarity instructions may activate parietal areas associated with the integration of perceptual features. Studies with neurological patients in the same paradigms provide converging evidence, e.g., patients with Alzheimer's disease, who have damage in prefrontal regions, are more impaired with rule than similarity instructions. Our second contrast is between categorization based on explicit LTM with that based on implicit LTM. Neuropsychological studies with patients with medial-temporal lobe damage show that patients are impaired on tasks requiring explicit LTM, but perform relatively normally on an implicit categorization task. Neuroimaging studies provide converging evidence: whereas explicit categorization is mediated by activation in numerous frontal and parietal areas, implicit categorization is mediated by a deactivation in posterior cortex.

Verb acquisition and representation in Alzheimer's disease

We examined the implicit acquisition and mental representation of a novel verb in patients with probable Alzheimer's disease (AD). Patients were exposed to the new verb in a naturalistic manner as part of a simple picture story. We probed grammatical, semantic and thematic matrix knowledge of the verb soon after presentation and again 1 week later. We found partial verb acquisition that was retained over 1 week. AD patients did not differ from controls in their acquisition and retention of a new verb's major grammatical subcategory, although they acquired little of its semantic properties and displayed minimal acquisition of the new word's thematic matrix. Moreover, AD patients appeared to maintain their acquired grammatical knowledge over 1 week. We discuss the implications of these findings from several perspectives, including the modularity of the language processing system, the relationship between episodic memory and semantic memory, and the role of the preserved implicit memory system in AD patients' partially successful lexical acquisition.

The neural basis for novel semantic categorization

We monitored regional cerebral activity with BOLD fMRI during acquisition of a novel semantic category and subsequent categorization of test stimuli by a rule-based strategy or a similarity-based strategy. We observed different patterns of activation in direct comparisons of rule- and similarity-based categorization. During rule-based category acquisition, subjects recruited anterior cingulate, thalamic, and parietal regions to support selective attention to perceptual features, and left inferior frontal cortex to helps maintain rules in working memory. Subsequent rule-based categorization revealed anterior cingulate and parietal activation while judging stimuli whose conformity with the rules was readily apparent, and left inferior frontal recruitment during judgments of stimuli whose conformity was less apparent. By comparison, similarity-based category acquisition showed recruitment of anterior prefrontal and posterior cingulate regions, presumably to support successful retrieval of previously encountered exemplars from long-term memory, and bilateral temporal-parietal activation for perceptual feature integration. Subsequent similarity-based categorization revealed temporal-parietal, posterior cingulate, and anterior prefrontal activation. These findings suggest that large-scale networks support relatively distinct categorization processes during the acquisition and judgment of semantic category knowledge.

The neural basis for categorization in semantic memory

We asked young adults to categorize written object descriptions into one of two categories, based on a rule or on overall similarity, while we monitored regional brain activity with functional magnetic resonance imaging (fMRI). We found significantly greater recruitment of left dorsolateral prefrontal cortex for rule-based categorization in direct comparison with similarity-based categorization. Recruitment of right ventral frontal cortex and thalamus was uniquely associated with rule-based categorization as well. These observations lend support to the claim that executive functions such as working memory, inhibitory control, and selective attention contribute to rule-based categorization. Right inferior parietal activation was uniquely associated with similarity-based categorization. This region may play an important role in overall feature configuration that is important for this form of categorization. We found other brain regions recruited for both rule-based and similarity-based categorization: Anterior cingulate cortex may support the implementation of executive functions during situations with competing response alternatives; and left inferior parietal cortex may be related to the integration of feature knowledge about objects represented in modality-specific association cortices. We also administered a degraded-similarity condition where the task of categorizing a written object description was made more difficult by perceptually degrading the stimulus materials. The degraded condition and the rule-based condition, but not the similarity-based condition, were associated with caudate activation. The caudate may support resource demands that are not specific for a particular categorization process. These findings associate partially distinct large-scale neural networks with different forms of categorization in semantic memory.