Demographic Effects on Longitudinal Semantic Processing, Working Memory, and Cognitive Speed

OBJECTIVES

To better understand and compare effects of aging and education across domains of language and cognition, we investigated whether (a) these domains show different associations with age and education, (b) these domains show similar patterns of age-related change over time, and (c) education moderates the rate of decline in these domains.

METHOD

We analyzed data from 306 older adults aged 55-85 at baseline of whom 116 returned for follow-up 4-8 years later. An exploratory factor analysis identified domains of language and cognition across a range of tasks. A confirmatory factor analysis analyzed cross-sectional associations of age and education with these domains. Subsequently, mixed linear models analyzed longitudinal change as a function of age and moderation by education.

RESULTS

We identified 2 language domains, that is, semantic control and semantic memory efficiency, and 2 cognitive domains, that is, working memory and cognitive speed. Older age negatively affected all domains except semantic memory efficiency, and higher education positively affected all domains except cognitive speed at baseline. In language domains, a steeper age-related decline was observed after age 73-74 compared to younger ages, while cognition declined linearly with age. Greater educational attainment did not protect the rate of decline over time in any domain.

DISCUSSION

Separate domains show varying effects of age and education at baseline, language versus cognitive domains show dissimilar patterns of age-related change over time, and education does not moderate the rate of decline in these domains. These findings broaden our understanding of age effects on cognitive and language abilities by placing observed age differences in context.

Efficacy of chemotherapy and atezolizumab in patients with non-small-cell lung cancer receiving antibiotics and proton pump inhibitors: pooled post hoc analyses of the OAK and POPLAR trials

BACKGROUND

Preclinical data have shown that proton pump inhibitors (PPI) can modulate the microbiome, and single-arm studies suggested that antibiotics (ATB) may decrease the efficacy of immune checkpoint inhibitors (ICI), but randomized controlled trial data are lacking. This pooled analysis evaluated the effect of ATB and PPI on outcome in patients randomized between ICI and chemotherapy.

PATIENTS AND METHODS

This retrospective analysis used pooled data from the phase II POPLAR (NCT01903993) and phase III OAK (NCT02008227) trials, which included 1512 patients with previously treated non-small-cell lung cancer (NSCLC) randomly assigned to receive atezolizumab (n = 757) or docetaxel (n = 755). The main objective of this analysis was to assess the impact of ATB and PPI use on overall survival (OS) and progression-free survival (PFS).

RESULTS

A total of 169 (22.3%) patients in the atezolizumab group and 202 (26.8%) in the docetaxel group received ATB, and 234 (30.9%) and 260 (34.4%), respectively, received PPI. Multivariate analysis in all patients revealed that ATB were associated with shorter OS [hazard ratio (HR) 1.20, 95% confidence interval (CI) 1.04-1.39], as was PPI (HR 1.26, 95% CI 1.10-1.44). Within the atezolizumab population, OS was significantly shorter in patients who received ATB (8.5 versus 14.1 months, HR 1.32, 95% CI 1.06-1.63, P = 0.01) or PPI (9.6 versus 14.5 months, HR 1.45, 95% CI 1.20-1.75, P = 0.0001). PPI use was associated with shorter PFS in the atezolizumab population (1.9 versus 2.8 months, HR 1.30, 95% CI 1.10-1.53, P = 0.001). There was no association between ATB and PPI use and PFS or OS within the docetaxel population.

CONCLUSION

In this unplanned analysis from two randomized trials, data suggest that ATB or PPI use in patients with metastatic NSCLC is associated with poor outcome and may influence the efficacy of ICI.

The Role of Executive Functions in Object- and Action-Naming among Older Adults

Background/Study Context: Lexical retrieval abilities and executive function skills decline with age. The extent to which these processes might be interdependent remains unknown. The aim of the current study was to examine whether individual differences in three executive functions (shifting, fluency, and inhibition) predicted naming performance in older adults. Methods: The sample included 264 adults aged 55-84. Six measures of executive functions were combined to make three executive function composites scores. Lexical retrieval performance was measured by accuracy and response time on two tasks: object naming and action naming. We conducted a series of multiple regressions to test whether executive function performance predicts naming abilities in older adults. Results: We found that different executive functions predicted naming speed and accuracy. Shifting predicted naming accuracy for both object and action naming while fluency predicted response times on both tests as well as object naming accuracy, after controlling for education, gender, age, working memory span, and speed of processing in all regressions. Interestingly, inhibition did not contribute to naming accuracy or response times on either task. Conclusion: The findings support the notion that preservation of some executive functions contributes to successful naming in older adults and that different executive functions are associated with naming speed and accuracy.

Lymphocytes are a major source of circulating soluble dipeptidyl peptidase 4

Dipeptidyl peptidase 4 (DPP4, CD26) is a serine protease that is expressed constitutively by many haematopoietic and non-haematopoietic tissues. It exists as a membrane-associated protein, as well as in an active, soluble form (herein called sDPP4), present at high concentrations in bodily fluids. Despite the proposed use of sDPP4 as a biomarker for multiple diseases, its cellular sources are not well defined. Here, we report that individuals with congenital lymphocyte immunodeficiency had markedly lower serum concentrations of sDPP4, which were restored upon successful treatment and restoration of lymphocyte haematopoiesis. Using irradiated lymphopenic mice and wild-type to Dpp4-/- reciprocal bone marrow chimeric animals, we found that haematopoietic cells were a major source of circulating sDPP4. Furthermore, activation of human and mouse T lymphocytes resulted in increased sDPP4, providing a mechanistic link between immune system activation and sDPP4 concentration. Finally, we observed that acute viral infection induced a transient increase in sDPP4, which correlated with the expansion of antigen-specific CD8+ T cell responses. Our study demonstrates that sDPP4 concentrations are determined by the frequency and activation state of lymphocyte populations. Insights from these studies will support the use of sDPP4 concentration as a biomarker for inflammatory and infectious diseases.

Breathe Easy, Speak Easy: Pulmonary Function and Language Performance in Aging

BACKGROUND

This study explored the association between pulmonary function (PF) and older adults' language performance accuracy. Study rationale was anchored in aging research reporting PF as a reliable risk factor affecting cognition among the elderly.

METHODS

180 adult English native speakers aged 55 to 84 years participated in the study. PF was measured through forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio (FFR). Language performance was assessed with an action naming test and an object naming test, and two tests of sentence comprehension, one manipulating syntactic complexity and the other, semantic negation. Greater PF was predicted to be positively associated with all tasks.

RESULTS

Unadjusted models revealed FVC and FEV1 effects on language performance among older adults. Participants with higher FVC showed better naming on both tasks and those with higher FEV1 had better object naming only. In covariate-adjusted models, only a positive FVC-object naming association remained.

CONCLUSION

Findings were discussed in terms of brain oxygenation mechanisms, whereby good PF may implicate efficient oxygenation, supporting neurotransmitter metabolism that protects against neural effects of cerebrovascular risk. Effects on object naming were linked to putative differential oxygenation demands across language tasks.

How older adults use cognition in sentence-final word recognition

This study examined the effects of executive control and working memory on older adults' sentence-final word recognition. The question we addressed was the importance of executive functions to this process and how it is modulated by the predictability of the speech material. To this end, we tested 173 neurologically intact adult native English speakers aged 55-84 years. Participants were given a sentence-final word recognition test in which sentential context was manipulated and sentences were presented in different levels of babble, and multiple tests of executive functioning assessing inhibition, shifting, and efficient access to long-term memory, as well as working memory. Using a generalized linear mixed model, we found that better inhibition was associated with higher accuracy in word recognition, while increased age and greater hearing loss were associated with poorer performance. Findings are discussed in the framework of semantic control and are interpreted as supporting a theoretical view of executive control which emphasizes functional diversity among executive components.

Baseline sensitivity of T cells to alpha-IFN correlates with sustained virological response to IFN-based triple therapy in HCV infection

Chronic infection with HCV is a public health problem with approximately 170 million people infected worldwide. Interferon alpha (IFNα) sensitivity in liver and IL28B genotype has been identified as important determinants of HCV clearance in the setting of pegylated interferon/ribavirin treatment. Herein, we explored IFNα sensitivity in PBMC from 21 healthy donors and 21 HCV-infected patients treated with pegylated interferon/ribavirin and HCV nonstructural protein-3 inhibitors (i.e. telaprevir/boceprevir). We explored phospho-STAT1 level as read-out for IFN signalling pathway activation in PBMC, T cells and monocytes and correlated results with virological response. We found that PBMC from healthy donors are desensitized to IFNα after priming and challenged with IFNα, with a subsequent decrease of phospho-STAT1 and interferon-stimulated genes. Furthermore, we show that CD3+ T cells, but not monocytes, become desensitized after 4 weeks of treatment, with a significant decrease of phospho-STAT1 after ex vivo IFNα stimulation. Finally, we identified baseline phospho-STAT1 level in CD3+ T cells as a potential biomarker of sustained virological response, regardless of the IL28B genotype. In the upcoming costly era of IFN-sparing regimen, baseline IFNα sensitivity could act as biomarker to define cost-effectiveness strategies of treatment by identifying patients who will or will not respond to IFN-based treatments.

Biomarkers of "Linguistic Anxiety" in aphasia: a proof-of-concept case study

This is a proof-of-concept case study designed to evaluate the presence of "Linguistic Anxiety" in a person with mild aphasia. The participant (aged 68) was tested on linguistic and non-linguistic cognitive tasks administered under conditions that differed in levels of anxiety. A validated anxiety-induction technique rarely used in previous aphasia studies was employed: the participant was instructed to prepare for a public speaking presentation. Measures of linguistic and non-linguistic cognitive performance, and anxiety (self-report and psychophysiologic) were obtained. The participant exhibited increased psychophysiologic stress reactivity (heart rate, skin conductance and self-report ratings) in the high-anxiety condition. In the state of increased anxiety, performance on language tasks, in particular discourse production, declined relative to performance in low-anxiety settings. Even in mild aphasia, language-based anxiety can interfere with language performance. This finding provides a basis for carrying out a study with a larger sample that can open a new path to assessment and treatment of persons with aphasia.

Brain and language: evidence for neural multifunctionality

This review paper presents converging evidence from studies of brain damage and longitudinal studies of language in aging which supports the following thesis: the neural basis of language can best be understood by the concept of neural multifunctionality. In this paper the term "neural multifunctionality" refers to incorporation of nonlinguistic functions into language models of the intact brain, reflecting a multifunctional perspective whereby a constant and dynamic interaction exists among neural networks subserving cognitive, affective, and praxic functions with neural networks specialized for lexical retrieval, sentence comprehension, and discourse processing, giving rise to language as we know it. By way of example, we consider effects of executive system functions on aspects of semantic processing among persons with and without aphasia, as well as the interaction of executive and language functions among older adults. We conclude by indicating how this multifunctional view of brain-language relations extends to the realm of language recovery from aphasia, where evidence of the influence of nonlinguistic factors on the reshaping of neural circuitry for aphasia rehabilitation is clearly emerging.

Psycholinguistics of Aphasia Pharmacotherapy: Asking the Right Questions

BACKGROUND

Among the obstacles to demonstrating efficacy of pharmacological intervention for aphasia is quantifying patients' responses to treatment in a statistically valid and reliable manner. In many of the review papers on this topic (e.g., Berthier et al., 2011; de Boissezon, Peran, de Boysson, & Démonet, 2007; Small & Llano, 2009), detailed discussions of various methodological problems are highlighted, with some suggestions on how these shortcomings should be addressed. Given this deep understanding of caveats associated with the experimental design of aphasia pharmacotherapy studies (e.g., Berthier et al., 2011), investigations continue to produce inconsistent results.

AIM

In this review paper we suggest that inclusion of theory-driven linguistic measures in aphasia pharmacotherapy studies would add an important step toward elucidating precise patterns of improvement in language performance resulting from pharmacotherapeutic intervention.

MAIN CONTRIBUTION

We provide a brief review of the clinical approaches currently used in pharmacotherapy studies of aphasia, which often lack psycholinguistic grounding. We then present ways in which psycholinguistic models can complement this approach, offering a rationale for task selection, and as a result, lead to a better understanding of treatment effects. We then follow with an example of how such an integrative approach can be implemented in studies targeting stress reduction in people with aphasia, via beta-blocking agents, as a means to augment language performance, using the psycholinguistic framework of "linguistic anxiety" outlined in Cahana-Amitay et al, 2011 as our guideline.

CONCLUSION

We conclude that the incorporation of psycholinguistic models into aphasia pharmacotherapy studies can increase the resolution with which we can identify functional changes.

From infection to immunotherapy: host immune responses to bacteria at the bladder mucosa

The pathogenesis of urinary tract infection and mechanisms of the protective effect of Bacillus Calmette-Guerin (BCG) therapy for bladder cancer highlight the importance of studying the bladder as a unique mucosal surface. Innate responses to bacteria are reviewed, and although our collective knowledge remains incomplete, we discuss how adaptive immunity may be generated following bacterial challenge in the bladder microenvironment. Interestingly, the widely held belief that the bladder is sterile has been challenged recently, indicating the need for further study of the impact of commensal microorganisms on the immune response to uropathogen infection or intentional instillation of BCG. This review addresses the aspects of bladder biology that have been well explored and defines what still must be discovered about the immunobiology of this understudied organ.

Effects of hypertension and diabetes on sentence comprehension in aging

OBJECTIVES

To assess the impact of hypertension and diabetes mellitus on sentence comprehension in older adults.

METHOD

Two hundred and ninety-five adults aged 55 to 84 (52% men) participated in this study. Self-report mail survey combined with medical evaluations were used to determine eligibility. Multiple sources were used to determine whether hypertension and diabetes were present or absent and controlled or uncontrolled. Sentence comprehension was evaluated with two tasks: embedded sentences (ES) and sentences with multiple negatives (MN). Outcome measures were percent accuracy and mean reaction time of correct responses on each task.

RESULTS

Regression models adjusted for age, gender, and education showed that the presence of hypertension impaired comprehension on the multiple negatives task (p < .01), whereas the presence of diabetes impaired the comprehension of embedded sentences (p < .05). Uncontrolled diabetes significantly impaired accurate comprehension of sentences with multiple negatives (p < .05). No significant patterns were found for reaction time.

DISCUSSION

The presence of hypertension and diabetes adversely affected sentence comprehension, but the relative contribution of each was different. These findings support the researchers' earlier speculations on the neurobiological mechanisms underlying the effects of hypertension and diabetes on language and cognition in aging. Uncontrolled disease status demonstrated more complicated age-related effects on sentence processing, highlighting the clinical importance for cognitive aging of identifying and managing vascular risk factors.

The contribution of set switching and working memory to sentence processing in older adults

This study evaluates the involvement of switching skills and working-memory capacity in auditory sentence processing in older adults. The authors examined 241 healthy participants, aged 55 to 88 years, who completed four neuropsychological tasks and two sentence-processing tasks. In addition to age and the expected contribution of working memory, switching ability, as measured by the number of perseverative errors on the Wisconsin Card Sorting Test, emerged as a strong predictor of performance on both sentence-processing tasks. Individuals with both low working-memory spans and more perseverative errors achieved the lowest accuracy scores. These findings are consistent with compensatory accounts of successful performance in older age.

Discrimination of agonist and antagonist forms of CXCL10 in biological samples

The ready access to commercially available multiplex assays and the importance of inflammation in disease pathogenesis has resulted in an abundance of studies aimed at identifying surrogate biomarkers for different clinically important questions. Establishing a link between a biomarker and disease pathogenesis, however, is quite complex, and in some instances this complexity is compounded by post-translational modifications and the use of immunoassays that do not always discriminate between the different forms of the same protein. Herein, we provide a detailed description of an assay system that has been established to discriminate the agonist form of CXCL10 from the NH(2) -terminal truncated form of the molecule generated by dipeptidylpeptidase IV (DPP4) cleavage. We demonstrate the utility of this assay system for monitoring agonist and antagonist forms of CXCL10 in culture supernatant, patient plasma and urine samples. Given the important role of CXCL10 in chronic inflammatory diseases and its suggested role as a predictive marker in managing patients with chronic hepatitis C, asthma, atopic dermatitis, transplantation, tuberculosis, kidney injury, cancer and other diseases, we believe that our method will be of general interest to the research and medical community.

Language as a Stressor in Aphasia

BACKGROUND: Persons with aphasia often report feeling anxious when using language while communicating. While many patients, caregivers, clinicians and researchers would agree that language may be a stressor for persons with aphasia, systematic empirical studies of stress and/or anxiety in aphasia remain scarce. AIM: The aim of this paper is to review the existing literature discussing language as a stressor in aphasia, identify key issues, highlight important gaps, and propose a program for future study. In doing so, we hope to underscore the importance of understanding aspects of the emotional aftermath of aphasia, which plays a critical role in the process of recovery and rehabilitation. MAIN CONTRIBUTION: Post stroke emotional dysregulation in persons with chronic aphasia clearly has adverse effects for language performance and prospects of recovery. However, the specific role anxiety might play in aphasia has yet to be determined. As a starting point, we propose to view language in aphasia as a stressor, linked to an emotional state we term "linguistic anxiety." Specifically, a person with linguistic anxiety is one in whom the deliberate, effortful production of language involves anticipation of an error, with the imminence of linguistic failure serving as the threat. Since anticipation is psychologically linked to anxiety and also plays an important role in the allostatic system, we suggest that examining physiologic stress responses in persons with aphasia when they are asked to perform a linguistic task would be a productive tool for assessing the potential relation of stress to "linguistic anxiety." CONCLUSION: Exploring the putative relationship between anxiety and language in aphasia, through the study of physiologic stress responses, could establish a platform for investigating language changes in the brain in other clinical populations, such as in individuals with Alzheimer's disease or persons with post traumatic stress disorder, or even with healthy aging persons, in whom "linguistic anxiety" might be at work when they have trouble finding words.

Bilateral brain regions associated with naming in older adults

To determine structural brain correlates of naming abilities in older adults, we tested 24 individuals aged 56-79 on two confrontation-naming tests (the Boston Naming Test (BNT) and the Action Naming Test (ANT)), then collected from these individuals structural Magnetic-Resonance Imaging (MRI) and Diffusion Tensor Imaging (DTI) data. Overall, several regions showed that greater gray and white matter volume/integrity measures were associated with better task performance. Left peri-Sylvian language regions and their right-hemisphere counterparts, plus left mid-frontal gyrus correlated with accuracy and/or negatively with response time (RT) on the naming tests. Fractional anisotropy maps derived from DTI showed robust positive correlations with ANT accuracy bilaterally in the temporal lobe and in right middle frontal lobe, as well as negative correlations with BNT RT, bilaterally, in the white matter within middle and inferior temporal lobes. We conclude that those older adults with relatively better naming skills can rely on right-hemisphere peri-Sylvian and mid-frontal regions and pathways, in conjunction with left-hemisphere peri-Sylvian and mid-frontal regions, to achieve their success.

Effects of health status on word finding in aging

OBJECTIVES

To evaluate effects of health status on word-finding difficulty in aging, adjusting for the known contributors of education, sex, and ethnicity.

DESIGN

Cross-sectional.

SETTING

Community.

PARTICIPANTS

Two hundred eighty-four adults aged 55 to 85 (48.6% female) participating in an ongoing longitudinal study of language in aging.

MEASUREMENTS

Medical, neurological, and laboratory evaluations to determine health status and presence or absence of hypertension and diabetes mellitus. Lexical retrieval evaluated with the Boston Naming Test (BNT) and Action Naming Test.

RESULTS

Unadjusted regression models showed that presence of diabetes mellitus was not related to naming. Presence of hypertension was associated with significantly lower accuracy on both tasks (P<.02). Adjustment for demographics attenuated the effect of hypertension (P<.08). For the BNT, a variable combining presence, treatment, and control of hypertension was marginally significant (P<.10), with subjects with uncontrolled hypertension being least accurate (91.4%). Previously observed findings regarding the effects of age, education, sex, and ethnicity were confirmed.

CONCLUSION

In this sample of older adults, hypertension contributed to the word-finding difficulty of normal aging, but diabetes mellitus did not.

Effects of health status on word finding in aging

OBJECTIVES

To evaluate effects of health status on word-finding difficulty in aging, adjusting for the known contributors of education, sex, and ethnicity.

DESIGN

Cross-sectional.

SETTING

Community.

PARTICIPANTS

Two hundred eighty-four adults aged 55 to 85 (48.6% female) participating in an ongoing longitudinal study of language in aging.

MEASUREMENTS

Medical, neurological, and laboratory evaluations to determine health status and presence or absence of hypertension and diabetes mellitus. Lexical retrieval evaluated with the Boston Naming Test (BNT) and Action Naming Test.

RESULTS

Unadjusted regression models showed that presence of diabetes mellitus was not related to naming. Presence of hypertension was associated with significantly lower accuracy on both tasks (P<.02). Adjustment for demographics attenuated the effect of hypertension (P<.08). For the BNT, a variable combining presence, treatment, and control of hypertension was marginally significant (P<.10), with subjects with uncontrolled hypertension being least accurate (91.4%). Previously observed findings regarding the effects of age, education, sex, and ethnicity were confirmed.

CONCLUSION

In this sample of older adults, hypertension contributed to the word-finding difficulty of normal aging, but diabetes mellitus did not.

Semantic verbal fluency in two contrasting languages

This cross-linguistic study investigated Semantic Verbal Fluency (SVF) performance in 30 American English-speaking and 30 Finnish-speaking healthy elderly adults with different cultural and linguistic backgrounds. Despite the different backgrounds of the participant groups, remarkable similarities were found between the groups in the overall SVF performance in two semantic categories (animals and clothes), in the proportions of words produced within the first half (30 seconds) of the SVF tasks, and in the variety of words produced for the categories. These similarities emerged despite the difference in the mean length of words produced in the two languages (with Finnish words being significantly longer than English words). The few differences found between the groups concerned the types and frequencies of the 10 most common words generated for the categories. It was concluded that culture and language differences do not contribute significantly to variability in SVF performance in healthy elderly people.

Perseveration in Alzheimer's disease

BACKGROUND/AIMS AND METHODS

Perseveration is common in Alzheimer's disease (AD). We document the type and quantitative burden of perseveration as cognitive decline progresses from normal aging (n = 30) through mild AD (n = 20) to moderate AD (n = 20) by administering a semantic verbal fluency task.

RESULTS

We found perseveration to increase significantly with increasing severity of AD and different types of perseveration that distinguish the subject groups in a statistically significant manner. Recurrent and continuous perseverations appear early in AD. As the disease progresses in severity into moderate stage, the number of recurrent and continuous perseverations increases, and stuck-in-set perseverations emerge.

CONCLUSION

The different types of perseveration are likely to reflect the progressive deterioration of different brain regions in AD.

Assessing the potential role of photopheresis in hematopoietic stem cell transplant

The First International Symposium on Photopheresis in Hematopoietic Stem Cell Transplantation was held in Vienna, Austria with an educational grant from Therakos Inc. from 25 May to 27 May 2005. Three general issues were addressed: (1) pathophysiology of graft-versus-host disease (GvHD), (2) induction of immune tolerance and the immunology of phototherapy and (3) current standard treatment and prevention strategies of acute and chronic GvHD and the use of extracorporeal photopheresis (ECP). The objectives of the meeting were to open a dialogue among leading researchers in photobiology, immunology, and hematopoietic stem cell transplantation; foster discussions and suggestions for future studies of the mechanism of action of ECP in acute and chronic GvHD; and promote collaboration between basic scientists and clinicians. As can be seen from the summaries of the individual presentations, important advances have been made in our understanding of GvHD, including the use of photoimmunology interventions and the development of robust model systems. It is our expectation that data from photoimmunology studies can be used to generate hypotheses in animal models that can further define the mechanism of action of ECP and help translate the findings to clinical trials of ECP for the prophylaxis and treatment of both chronic and acute GvHD.

Cognitive neuroscience of delusions in aging

Assessments and clinical understanding of late-onset delusions in the elderly are inconsistent and often incomplete. In this review, we consider the prevalence, neurobehavioral features, and neuroanatomic correlations of delusions in elderly persons - those with documented cognitive decline and those with no evidence of cognitive decline. Both groups exhibit a common phenotype: delusions are either of persecution or of misidentification. Late-onset delusions show a nearly complete absence of the grandiose, mystical, or erotomanic content typical of early onset psychoses. Absent also from both elderly populations are formal thought disorders, thought insertions, and delusions of external control. Neuroimaging and behavioral studies suggest a frontotemporal localization of delusions in the elderly, with right hemispheric lateralization in delusional misidentification and left lateralization in delusions of persecution. We propose that delusions in the elderly reflect a common neuroanatomic and functional phenotype, and we discuss applications of our proposal to diagnosis and treatment.

Modes of remembering in patients with chronic pain: relation to current pain

The objective of our study was to assess the relation of current pain ratings to observer versus field modes of memory retrieval in patients with chronic pain. Memories from an observer perspective involve seeing oneself in the original event as if from an external point of view; memories from a field perspective involve recalling the event as if viewing it through one's own eyes. Sixty-one patients with chronic pain were asked to (1) recall a painful memory, (2) indicate whether they saw themselves in the memory (observer mode) or re-experienced events of the memory from the first-person perspective (field mode), and (3) rate various phenomenologic properties of the memory. Twenty of these pain patients were also given two frontal lobe tests to examine potential neuropsychologic correlates of memory retrieval preferences. Memory retrieval in the field mode was associated with (a) significantly higher self-reported pain scores on the McGill Pain Questionnaire, (b) nonright-handedness, and (c) poorer performance on the tests of frontal function. Patients with chronic pain who adopt the field mode of memory retrieval when recalling painful memories experience greater current pain severity than chronic pain patients who adopt observer retrieval strategies. Those adopting field retrieval strategies may also evidence frontal system neuropsychologic anomalies.

Neuropharmacology of Verbal Perseveration

In this article we will review available evidence concerning the effects of forebrain catecholaminergic and cholinergic activity on verbal perseveration. The anatomy and physiology of these two major neuropharmacological systems make it likely that they influence speech and language functioning directly as well as the cognitive systems that have an indirect impact on speech and language functions. Both catecholaminergic and cholinergic agents have been shown to influence executive cognitive functions (ECFs) such as "resistance to interference" and "attentional switching" as well as mnemonic encoding and retrieval processes. The ECF effects are most likely mediated by prefrontal cortex; mnemonic processes are mediated by both prefrontal and temporal lobes. Although no full-scale clinical trials on the effects of pharmacological agents on verbal perseveration have been conducted as yet, existing preclinical trials suggest that both presynaptic and postsynaptic dopaminergic agents can reduce perseverative responding by increasing inhibitory control processes. Cholinesterase inhibitors and other cholinergic agents can reduce perseverative responding by reducing verbal intrusions.

Change in object naming ability during adulthood

Using longitudinal data on the Boston Naming Test ( Kaplan, Goodglass, & Weintraub, 1983) collected over 20 years from healthy individuals aged 30 to 94, we examined change in lexical retrieval with age, gender, education, and their interactions. We compared results between random-effects longitudinal and traditional cross-sectional models. Random-effects modeling revealed significant linear and quadratic change in lexical retrieval with age; it also showed a Gender x Education interaction, indicating poorest performance for women with less education. Cross-sectional analyses produced greater estimates of change with age than did longitudinal analyses.

Can Drug Therapies Improve Language Functions of Individuals with Aphasia? A Review of the Evidence

The neurochemistry of language and the neuropharmacology of aphasia are two domains of cognitive neuroscience still in their infancy. In this article we review what is known about these two domains, especially with regard to treating aphasia with drugs. Selected neurotransmitters can improve language function in certain patients with aphasia. We discuss which neurotransmitters work for which language functions in which patients, and why.

Amnestic MCI or prodromal Alzheimer's disease?

The concept of mild cognitive impairment (MCI) draws attention to cognitive changes not severe enough to warrant the diagnosis of dementia. As used today, it covers many pathological disorders and characterises a diverse population of patients who attend memory clinics. Our concern is the underlying heterogeneity. We suggest that it will soon be possible (if it is not already) to identify the underlying pathological disorders before the affected patients meet the criteria of dementia, thanks to specific neuropsychological assessments, neuroimaging, and biomarkers. In particular, patients with Alzheimer's disease (AD), the most important subgroup of patients with MCI, can already be identified before appearance of the fully developed clinical dementia syndrome. Accordingly, this paper proposes diagnostic criteria for "prodromal AD".

Effective antigen cross-presentation by prostate cancer patients' dendritic cells: implications for prostate cancer immunotherapy

Despite the potency with which dendritic cells (DCs) are able to utilize the exogenous MHC I antigen cross-presentation pathway to cross-present antigen for the activation of killer T cells in model systems, concern about defects in immune function in cancer patients has led to uncertainty regarding whether immune cells derived from patients can effectively be used to generate tumor vaccines. We have undertaken a careful analysis of the potency of using DCs obtained from prostate cancer patients to cross-present antigen derived from human prostate tumor cells for the activation of antigen-specific T cells. Such DCs can be matured ex vivo into functionally active cells and are capable of cross-presenting influenza antigen derived from internalized apoptotic prostate tumor cells. Importantly, we demonstrate effective stimulation of both CD4+ and CD8+ T cells, as evident by production of IFN-gamma, and the ability of CD8+ T cells to differentiate into effector CTLs. These results, defining conditions in which prostate cancer patient DCs can efficiently utilize the cross-presentation pathway and in which apoptotic tumor can serve as a source of antigen for DCs to activate T cells, demonstrate that this system warrants clinical study as a potential immunotherapy.

Noun and verb retrieval in healthy aging

This study tests the hypothesis that retrieval of object and action names declines at different rates with age. Uncued and cued performance on the Boston Naming Test (BNT) and the Action Naming Test (ANT) were examined for 171 individuals from 50 to 88 years old. To control for differences in item difficulty, a subset of items from each of the two tests was selected for which uncued performance was equivalent in individuals in their 50s. With this matched set of items, differences in action and object naming were tested in the 60s and 70+ age groups. Although age-related decline in name retrieval was observed for both the BNT and the ANT subsets, no differences between object and action retrieval were found. Our results, thus, do not confirm previous studies reporting that object names and action names are differentially retrieved with aging. We discuss these new findings in relation to evidence of dissociations in object and action naming in brain-damaged individuals.

Dendritic cell maturation is required for the cross-tolerization of CD8+ T cells

In vivo models have shown that tissue-restricted antigen may be captured by bone marrow-derived cells and cross-presented for the tolerization of CD8+ T cells. Although these studies have shown peripheral tolerization of CD8+ T cells, the mechanism of antigen transfer and the nature of the antigen-presenting cell (APC) remain undefined. We report here the establishment of an in vitro system for the study of cross-tolerance and show that dendritic cells (DCs) phagocytose apoptotic cells and tolerize antigen-specific CD8+ T cells when cognate CD4+ T helper cells are absent. Using this system, we directly tested the "two-signal" hypothesis for the regulation of priming versus tolerance. We found that the same CD83+ myeloid-derived DCs were required for both cross-priming and cross-tolerance. These data suggested that the current model for peripheral T cell tolerance, "signal 1 in the absence of signal 2", requires refinement: the critical checkpoint is not DC maturation, but instead the presence of a third signal, which is active at the DC-CD4+ T cell interface.

Effect of socioeconomic status on aphasia severity and recovery

Low levels of educational attainment and low socioeconomic status have been significantly linked to poor health and increased incidence of disease, including Alzheimer's disease and diseases of the cardiovascular, pulmonary, renal, and gastrointestinal systems. Our goal in the present study was to determine the degree to which educational level and socioeconomic status influence initial severity of aphasia and subsequent recovery. We evaluated the records of 39 persons with aphasia twice: at about 4 months and 103 months postonset. We found early severity of aphasia to be significantly greater for subjects in the lower educational and occupational groups. However, rate of recovery (the slope of the recovery curve) was the same regardless of educational or occupational status.

Case-based teaching and learning experiences

Case-based teaching and learning strategies can be utilized to assist advanced practice psychiatric nursing students in both obtaining requisite knowledge and enhancing clinical reasoning skills. We discuss the benefits of case-based learning in terms of how it (1) contributes to students' appropriate organization of information to be recalled later for use in clinical reasoning situations; (2) generates experiences that students would not otherwise have; (3) increases the visibility of students' clinical reasoning processes; and (4) enhances students' confidence. This article also explores three examples of case-based teaching and learning: use of written cases in a seminar; use of standardized patients in an assessment course; and utilization of web-based cases for learning assessment and intervention skills. Finally, we compare and contrast each of these methods in terms of their relative effectiveness in achieving each of the benefits.

alphavbeta5 integrin recruits the CrkII-Dock180-rac1 complex for phagocytosis of apoptotic cells

Integrin receptors are important for the phagocytosis of apoptotic cells. However, little is known about their function in mediating internalization, as previous studies used blocking antibodies for the inhibition of binding. Here we show that the alphavbeta5 receptor mediates both binding and internalization of apoptotic cells. Internalization is dependent upon signalling through the beta5 cytoplasmic tail, and engagement of the alphavbeta5 heterodimer results in recruitment of the p130cas-CrkII-Dock180 molecular complex, which in turn triggers Rac1 activation and phagosome formation. In addition to defining integrin-receptor signalling as critical for the internalization of apoptotic material, our results also constitute the first evidence in human cells that the CED-2-CED-5-CED-10 complex defined in Caenorhabditis elegans is functionally analagous to the CrkII-Dock180-Rac1 molecular complex in mammalian cells. By linking the alphavbeta 5 receptor to this molecular switch, we reveal an evolutionarily conserved signalling pathway that is responsible for the recognition and internalization of apoptotic cells by both professional and non-professional phagocytes.

Cdr2, a target antigen of naturally occuring human tumor immunity, is widely expressed in gynecological tumors

The paraneoplastic neurological disorders provide perhaps the best known example of naturally occurring tumor immunity in humans. For example, patients with paraneoplastic cerebellar degeneration (PCD) appear to suppress the growth of occult breast or ovarian tumors that express a neuronal antigen termed cdr2. PCD patients harbor cdr2-specific CTLs in their peripheral blood, and these cells are likely mediators of the tumor suppression. Whereas cdr2 therefore appears to be the target of an effective immune response in patients with PCD, the general relevance to cancer patients has been unclear, due in part to reports indicating that cdr2 is not expressed in tumors obtained from neurologically normal patients. We have reexamined this question, and we find that cdr2 is widely expressed in such tumors, indicating that cdr2 is in fact an important tumor antigen in the general population of breast and ovarian cancer patients.

Forced hyperphasia and environmental dependency syndrome

A distinctive, language related fragment of the environmental dependency syndrome is described: compulsive, involuntary, environmentally dependent speaking. Because this syndrome represents the observe of aphasia, it is named forced hyperphasia. An 84 year old woman with acute left frontal infarction was admitted to hospital with gait disturbance, forced grasp reflex, and striking imitation behaviour. After 2 weeks her imitation behaviour disappeared, but an equally striking new behaviour emerged. In the presence of others she would call out the names of objects in the room, and also call out the actions and gestures of people in the room, even though she was not asked to do so, and even though she was asked to stop. For example, if the doctor scratched his nose, she said, "The doctor is scratching his nose." Brain CT, MRI, and SPECT showed cerebral atrophy and a left superior frontal subcortical infarct. It is suggested that "forced hyperphasia" is a clinical fragment of the environmental dependency syndrome and that her compulsive, impulsive, involuntary release of spoken language resulted from the release of frontal inhibition of the complex reflex linking environmental cues to the set of motor, limbic, spatial, and linguistic associations underlying spoken language.

Detection and treatment of activated T cells in the cerebrospinal fluid of patients with paraneoplastic cerebellar degeneration

Patients with paraneoplastic cerebellar degeneration (PCD) offer the opportunity to explore the mechanisms underlying tumor immunity and immune-mediated neuronal degeneration. Cytotoxic T lymphocytes (CTLs) specific for the PCD onconeural antigen cdr2 found in the blood of patients with PCD are likely to be effectors of PCD tumor immunity. Here, we suggest a role for CTLs in the autoimmune destruction of Purkinje neurons. More than 75% of the cells obtained from the cerebrospinal fluid (CSF) of PCD patients were CD3+ alphabeta T cells. In patients with active/progressive disease, 20% to 40% of CSF cells were activated T cells, and the CD4+ helper cells were Th1-type cells. Three PCD patients were given tacrolimus, a specific inhibitor of activated T cells, which markedly reduced these cells in the CSF. Tacrolimus also reduced the number of activated cdr2-specific CTLs in the peripheral blood, but did not lead to tumor recurrence. We suggest that activated cdr2-specific CTLs in the CSF contribute to Purkinje degeneration in PCD, and that tacrolimus therapy may benefit patients with paraneoplastic neurological disease and other T cell-mediated autoimmune neurological disorders.

Incorporating standardized patients into a psychosocial nurse practitioner program

Interactions with standardized patients (SPs) provide customized, immediate clinical learning for graduate nursing students. SPs are lay persons trained to portray a role in a faculty-designed health care scenario for a series of students. Student learning results from the experience of the encounter, performance feedback from the SP, subsequent classroom discussion with peers, faculty critique, and review of the videotaped interaction. Design and implementation of an SP experience involves clarification of goals for the encounter, development of the clinical scenario, recruitment and training of SPs, preparation of students, and management of the logistics of the exercise. Although the process is labor-intensive, we have found SP experiences versatile, valuable, and popular with students.

Verb Naming in Normal Aging

Few studies have examined verb naming in normal aging, although decline in the ability to name nouns has been well documented. In this study, we examined longitudinal performance on the Action Naming Test (ANT), a confrontation naming test for verbs. The purpose of this study was to confirm the verb naming deficit associated with aging, which was previously seen only in cross-sectional studies, and to provide additional normative data on verb naming ability that may prove useful to studies on verb naming in populations with brain dysfunction. Sixty-six healthy men and women aged 30 to 79 were each tested with the ANT 3 times over a 7-year span. ANT performance showed a significant decline over time for all participants except the youngest group. Longitudinal methodology supports the conclusion that this finding of a decline in verb naming ability arises from true age-related changes and not from cohort differences.

Tumor-specific killer cells in paraneoplastic cerebellar degeneration

Models for immune-mediated tumor regression in mice have defined an essential role for cytotoxic T lymphocytes (CTLs); however, naturally occurring tumor immunity in humans is poorly understood. Patients with paraneoplastic cerebellar degeneration (PCD) provide an opportunity to explore the mechanisms underlying tumor immunity to breast and ovarian cancer. Although tumor immunity and autoimmune neuronal degeneration in PCD correlates with a specific antibody response to the tumor and brain antigen cdr2, this humoral response has not been shown to be pathogenic. Here we present evidence for a specific cellular immune response in PCD patients. We have detected expanded populations of MHC class I-restricted cdr2-specific CTLs in the blood of 3/3 HLA-A2.1+ PCD patients, providing the first description, to our knowledge, of tumor-specific CTLs using primary human cells in a simple recall assay. Cross-presentation of apoptotic cells by dendritic cells also led to a potent CTL response. These results indicate a model whereby immature dendritic cells that engulf apoptotic tumor cells can mature and migrate to draining lymph organs where they could induce a CTL response to tissue-restricted antigens. In PCD, peripheral activation of cdr2-specific CTLs is likely to contribute to the subsequent development of the autoimmune neuronal degeneration.

Treatment of aphasia

Approximately 1 million people have aphasia in the United States today, yet with properly targeted therapy in selected patients effective communication can be restored. Current approaches to treatment of aphasia include psycholinguistic theory-driven therapy, cognitive neurorehabilitation, computer-aided techniques, psychosocial management, and (still on an experimental basis) pharmacotherapy.

Immature dendritic cells phagocytose apoptotic cells via alphavbeta5 and CD36, and cross-present antigens to cytotoxic T lymphocytes

Dendritic cells, but not macrophages, efficiently phagocytose apoptotic cells and cross-present viral, tumor, and self-antigens to CD8(+) T cells. This in vitro pathway corresponds to the in vivo phenomena of cross-priming and cross-tolerance. Here, we demonstrate that phagocytosis of apoptotic cells is restricted to the immature stage of dendritic cell (DC) development, and that this process is accompanied by the expression of a unique profile of receptors, in particular the alphavbeta5 integrin and CD36. Upon maturation, these receptors and, in turn, the phagocytic capacity of DCs, are downmodulated. Macrophages engulf apoptotic cells more efficiently than DCs, and although they express many receptors that mediate this uptake, they lack the alphavbeta5 integrin. Furthermore, in contrast to DCs, macrophages fail to cross-present antigenic material contained within the engulfed apoptotic cells. Thus, DCs use unique pathways for the phagocytosis, processing, and presentation of antigen derived from apoptotic cells on class I major histocompatibility complex. We suggest that the alphavbeta5 integrin plays a critical role in the trafficking of exogenous antigen by immature DCs in this cross-priming pathway.

Dendritic cells acquire antigen from apoptotic cells and induce class I-restricted CTLs

CD8+ cytotoxic T lymphocytes (CTLs) mediate resistance to infectious agents and tumours. Classically, CTLs recognize antigens that are localized in the cytoplasm of target cells, processed and presented as peptide complexes with class I molecules of the major histocompatibility complex (MHC). However, there is evidence for an exogenous pathway whereby antigens that are not expected to gain access to the cytoplasm are presented on MHC class I molecules. The most dramatic example is the in vivo phenomenon of cross-priming: antigens from donor cells are acquired by bone-marrow-derived host antigen-presenting cells (APCs) and presented on MHC class I molecules. Two unanswered questions concern the identity of this bone-marrow-derived cell and how such antigens are acquired. Here we show that human dendritic cells, but not macrophages, efficiently present antigen derived from apoptotic cells, stimulating class I-restricted CD8+ CTLs. Our findings suggest a mechanism by which potent APCs acquire antigens from tumours, transplants, infected cells, or even self-tissue, for stimulation or tolerization of CTLs.

Visible changes in lesion borders on CT scan after five years poststroke, and long-term recovery in aphasia

This study examined 12 aphasia patients at approximately 1 year poststroke (Time 1) and again at 5-12 years poststroke (Time 2) with language testing and CT scan. Significant increases in naming scores, and phrase length in nonfluent speech were observed after 5 years poststroke. Significant expansion in visible lesion borders (lesion size) was observed after 5 years poststroke; an increase in lesion size of > 1% was present in 9/12 cases (75%). Not one case had a second stroke. Thus, it appears that even though lesion expansion may occur after 5 years poststroke, as long as this expansion is unilateral and gradual, it has no adverse effect on language, and in fact, continued recovery in naming and nonfluent speech may also occur. Long-term recovery patterns in aphasia which may be associated with brain reorganization deserve further study, especially with functional brain imaging techniques.