Is a plum a memory problem?: Longitudinal study of the reversal of concreteness effect in a patient with semantic dementia

The concreteness effect, which refers to the typically superior performance for concrete concepts compared to abstract ones, is a robust phenomenon that has been observed in normal and brain-damaged subjects in a number of cognitive domains. Reversal of this effect was also reported in a few neuropsychological studies, mainly in patients with semantic dementia (SD). In this article, we report the first longitudinal single-case study of a patient with SD, SC, who performed better for abstract than concrete concepts in various comprehension and production tasks. For concrete concepts, SC showed no category-specific deficit but was impaired in tasks exploring access to stored structural knowledge and semantic perceptual attributes. With the course of the disease, the semantic system progressively declined and the reversal of the concreteness effect, as well as the dissociation between perceptual and non-perceptual knowledge, vanished. We discuss the results and their implications for theoretical propositions of concreteness effect as well as theoretical models of semantic memory. We suggest that the reversal of concreteness in SC is a direct result of the degradation of visual feature knowledge, sustained by anatomical structures affected early in SD. With the time course of the disease, the atrophy extends to adjacent regions and the dissociation between abstract and concrete concepts was no longer observed.     

What happens to personal identity when semantic knowledge degrades? A study of the self and autobiographical memory in semantic dementia

While the self has been extensively explored in amnesic patients with severe episodic but not semantic memory disturbance, little is known about the self in semantic dementia (SD), which generally features the reverse pattern of impairment. In the present study, we investigated the structural (self-representations) and functional (consciousness) dimensions of the self in a group of eight SD patients in the early to moderate stages of the disease. We used two original tasks designed to probe both structural characteristics, namely the strength and the certainty of self-concept and the episodic/semantic nature of self-representations, and functional characteristics, namely autonoetic/noetic level of consciousness, self-evaluation and self-projection into the past, present and future. Results for the structural self showed impairment on the semantic aspects of the self-representations, except for those related to the present. Moreover, SD patients were affected regardless of the episodic or semantic nature of self-representations into the future. As regards the functional self, self-projection and level of consciousness were only impaired for the future. This study confirms the persistence of a feeling of identity in SD over time for the past and present selves. However, it also highlights the loss of the future self in SD patients. These results are discussed in relation to models of long-term memory and future thinking focusing on the interplay of episodic and semantic memory and mental time travel.     

What characterizes the problem psychiatric patient? Results of a study of patient descriptions using the Psychiatric Personnel Order

In recent years, economic pressure on extended and repeated psychiatric hospitalisation have increased dramatically. At the same time, diagnostic approaches, e.g., the new concept of the "young adult chronic patient" have improved. The first part of this article summarises reports and experiences on the chronic mentally ill and the so-called "heavy users" of psychiatric hospitalisation. Although the number of studies evaluating this group is small, several characteristics can be identified. Subsequently, a study is presented that deals with psychiatric problem patients in a special way, namely the A2-categorisation according to the German Psychiatric Personnel Regulation (Psychiatrie-Personalverordnung [Psych-PV]). The study is based on 170 consecutive admissions to the Department of General Psychiatry of a large German state hospital, who are characterised as normal (A1) and intensive patients (A2), respectively. The study aimed at describing difficult-to-treat patients or those whose treatment demands large human resources. Medical histories, sociodemographic and psychopathological data as well as subjective health status data of these patients were analysed by standardised and validated instruments (e.g., BPRS, CGI, SF-36, GAF). Results show that the patients under study suffered mainly from schizophrenic psychosis according to ICD-9. Patients categorised into A2 showed a high degree of psychopathology and little insight into their disease. Further it can be demonstrated that they used more therapeutic help from general practitioners rather than from specialists in psychiatry prior to admission. In conclusion, it is suggested to evaluate concepts, e.g., new treatment methods in respect of motivating schizophrenic patients, new typological methods to better diagnosis and to treat psychiatric problem patients via new treatment modalities such as Case Management or inpatient settings for double diagnoses.     

Verbal learning in semantic dementia: Is repetition priming a useful strategy?

Background: Semantic dementia (SD) is a neurodegenerative disease that impacts long-term conceptual and lexical knowledge (Hodges & Patterson, 1996). Severe naming difficulties are prevalent in SD, yet little is known about the potential for word learning in this population.Aims: We assessed patterns of repetition and implicit learning in patients with moderate to advanced SD via repeated exposure to word lists varied by frequency and imageability. We propose a tentative framework for the language loss incurred in SD and open a dialogue for treatment approaches targeted towards progressive semantic anomia.Methods and Procedures: In two experiments, we examined immediate serial recall and short-term learning in five patients with SD. We predicted reduced semantic effects (imageability), preservation of lexical effects (frequency), and diminished primacy effects in serial recall, consistent with other semantically impaired populations (Martin & Saffran, 1997). We also predicted that severity of semantic impairment would modulate the facilitative effects of repeated exposure (i.e., repetition priming) on word list recall.Outcomes and Results: In immediate serial recall, all participants showed reduced imageability effects, but only one patient showed a significant word frequency advantage. Two patterns of serial position effects emerged: (1) poor recall of initial list items and (2) better recall of initial and final items. All participants showed minimal gains across repeated trials; however, patients who poorly recalled initial items showed the least benefit from repeated exposure.Conclusions: We discuss the usefulness of repetition-based interventions for SD and advocate maintenance of known vocabulary over reacquisition of forgotten words. We provide a theoretical framework for progressive language loss associated with SD; this model reflects an ordered reduction of lexical-semantic support coinciding with dementia severity.     

Longitudinal study of single‐word comprehension in semantic dementia: A comparison with primary progressive aphasia and Alzheimer's disease

Background: Although semantic dementia (SD) is characterised by a multimodal loss of semantic knowledge, it has been demonstrated that lexical‐semantic representations are not equally disrupted in SD and that some categories may be recognised better than others. Little is known, however, about the pattern of the category‐specific comprehension deficits in SD and whether it differs from that of other forms of progressive aphasias.

Aims: This exploratory study aimed to investigate the evolution of category‐specific deficits of single‐word comprehension in progressive aphasias.

Methods & Procedures: A total of 19 patients with a clinical diagnosis of SD, 25 patients with primary progressive aphasia with agrammatic and relatively nonfluent speech (PPA), and 25 patients with Alzheimer's disease (AD) with aphasia were studied longitudinally with the Western Aphasia Battery (WAB). The Auditory Word Recognition subtest of the WAB was utilised to assess comprehension of words derived from different semantic categories.

Outcomes & Results: The analysis revealed that, over time, category‐specific deficits of single‐word comprehension were seen in all three groups of patients. Participants with SD as well as those with PPA and AD were impaired on both pointing to fingers and the right–left orientation task. However, patients with SD were the only group that showed defective recognition of their own body parts. Interestingly, individuals with SD had no difficulties identifying colours, letters, and numbers, even during the follow‐up testing. In addition, in all three groups the extent of category‐specific deficits was associated with the severity of aphasia.

Conclusions: These results indicate that category‐specific deficits of single‐word comprehension are frequently seen not only in patients with SD but also in individuals with PPA or AD, and that the extent of these deficits is associated with the severity of aphasia. However, the pattern of these deficits is often different in these three forms of neurodegenerative conditions and more dissociations between semantic categories are observed as each of these diseases progresses.     

Is dementia with Lewy bodies the second most common cause of dementia?

Lewy bodies were originally described in isolated brainstem nuclei in persons with Parkinson's disease. They have since been recognized as a widespread and common neuropathologic finding in individuals with dementia. Dementia with Lewy bodies (DLB) is the preferred term for the dementia syndrome associated with Lewy bodies. Although DLB is acknowledged as the second most common degenerative dementia, trailing only Alzheimer's disease, its ranking with respect to vascular dementia remains controversial. Large, community-based studies of DLB with postmortem confirmation are lacking. Available data suggest that DLB is more common than pure vascular dementia but not more common than any vascular contribution to dementia.     

Preserved recognition in a case of developmental amnesia: implications for the acquisition of semantic memory?

We report the performance on recognition memory tests of Jon, who, despite amnesia from early childhood, has developed normal levels of performance on tests of intelligence, language, and general knowledge. Despite impaired recall, he performed within the normal range on each of six recognition tests, but he appears to lack the recollective phenomenological experience normally associated with episodic memory. His recall of previously unfamiliar newsreel events was impaired, but gained substantially from repetition over a 2-day period. Our results are consistent with the hypothesis that the recollective process of episodic memory is not necessary either for recognition or for the acquisition of semantic knowledge.     

Is a sense of community belonging associated with problem gambling in Canada?

Purpose

Despite the increasing demand for public health measures to prevent problem gambling, few studies have examined the association between community characteristics and problem gambling. The aim of this nationally representative cross-sectional study was to investigate the relationship between a sense of community belonging and problem gambling in Canada. We also examined whether this relationship was modified by sex and marital status.

Methods

Canadian Community Health Survey (2013–2014) data from 38,968 residents of Quebec, Saskatchewan, Manitoba, and British Columbia were analyzed. Problem gambling was assessed using the Canadian Problem Gambling Index. We estimated the odds ratios (ORs) and 95% confidence intervals (CIs) for problem gambling.

Results

The prevalence of problem gambling was 1.4% (1.9% among males; 0.9% among females). We observed an inverse dose–response relationship between a sense of community belonging and problem gambling. Compared with those with a very strong sense of community belonging, the adjusted ORs for problem gambling were 1.07 (95% CI 0.65–1.76) for a somewhat strong sense, 1.27 (95% CI 0.77–2.11) for a somewhat weak sense, and 2.32 (95% CI 1.34–4.02) for a very weak sense of community belonging. The association was more prominent among females (except for those widowed/divorced/separated), whereas no clear association was found among males, irrespective of marital status.

Conclusion

When implementing public health measures to reduce problem gambling, it would be useful to account for possible differential impacts of a sense of community belonging by sex and marital status, which may reflect significant social contexts among residents.

     

Visual paralexias in a Spanish-speaking patient with acquired dyslexia: a consequence of visual and semantic impairments?

We report the case of a Spanish patient SC who misread 55 per cent of the single words shown to her. SC's reading accuracy was affected by word imageability and frequency. Nonword reading was very poor. The majority of SC's errors to real-word targets bore a close visual similarity to the items that elicited them, but there was no indication of an effect of serial position on the probability that a letter from a target word would be incorporated into the error made to that word. SC made some visual errors in object naming and also showed evidence of a general semantic impairment. We consider the similarity between SC and patient AB reported by Lambon Ralph and Ellis (1997), and suggest that the very high levels of visual errors shown by these two patients may reflect a combination of visual and semantic impairments.     

Is subjective memory loss correlated with MMSE scores or dementia?

OBJECTIVES: (1) To determine if subjective memory loss (SML) is associated with Mini-Mental State Examination (MMSE) scores, (2) to determine if this association persists after adjustment for other factors, and (3) to determine the sensitivity and specificity of SML for dementia. POPULATION: 1751 seniors sampled from a population registry. MEASURES: Age, sex, education, SML, the MMSE, and the Center for Epidemiologic Studies-Depression (CES-D) scale. Dementia was diagnosed by clinical examination. ANALYSIS: Linear regression models were constructed. The sensitivity and specificity of SML were determined with a diagnosis of dementia being the gold standard. RESULTS: SML was correlated with MMSE scores, even after adjusting for age, sex, education, and depressive symptoms. The sensitivity of SML was 0.58 (95% confidence interval [CI]: 0.45, 0.71), and the specificity was 0.76 (95% CI: 0.74, 0.78) for dementia. CONCLUSIONS: SML is correlated with MMSE score. However, SML is neither sensitive nor specific for dementia.     

Is the immobility of advanced dementia a form of lorazepam-responsive catatonia?

Patients with end-stage dementia typically are very immobilized. Could this state actually be a form of lorazepam-responsive catatonia? Catatonia has been documented following cerebrovascular accidents, head injury, HIV encephalitis, brain tumors, and multiple sclerosis. Identified anatomical substrates include frontal lobes, parietal lobes, limbic system, diencephalon, and basal ganglia. Given that Alzheimer's disease, vascular dementia, Lewy body dementia, corticobasal degeneration, frontotemporal dementia, and Parkinsonian dementia often have degeneration in some of the same areas, dramatic awakenings might be possible by giving lorazepam challenges to locked-in dementia patients. If even a small percentage were lorazepam responders, the impact worldwide would be tremendous. Serious consideration should be given to undertaking large-scale clinical trials.     

Is dementia reversible in patients with neurocysticercosis?

OBJECTIVE: To determine the correlates and outcome of dementia in patients with neurocysticercosis (NCC). METHODS: Ninety consecutive patients with untreated NCC underwent a cognitive assessment (Mini-mental State Examination, Neurobehavioral Cognitive Status Examination, and IQCODE) and were classified as having or not having dementia according to DSM-IV criteria. Imaging and cerebrospinal fluid examination data were recorded. The cognitive measures were repeated six months after treatment with albendazole and steroids. RESULTS: At the initial evaluation 15.5% (n = 14) of the patients were classified as having dementia. Dementia was associated with older age, lower education level, increased number of parasitic lesions in the brain (mostly in the frontal, temporal, and parietal lobes). After six months, 21.5% of the patients from the dementia group continued to have a full dementia disorder and 78.5% no longer fulfilled the DSM-IV criteria for dementia, although some of these patients still showed mild cognitive decline. CONCLUSIONS: The results of this study suggest that dementia occurs frequently in patients with untreated NCC, and it is reversible in most cases.     

A horse of a different colour: do patients with semantic dementia recognise different versions of the same object as the same?

Ten patients with semantic dementia resulting from bilateral anterior temporal lobe atrophy, and 10 matched controls, were tested on an object recognition task in which they were invited to choose (from a four-item array) the picture representing "the same thing" as an object picture that they had just inspected and attempted to name. The target in the response array was never physically identical to the studied picture but differed from it - in the various conditions - in size, angle of view, colour or exemplar (e.g. a different breed of dog). In one test block for each patient, the response array was presented immediately after the studied picture was removed; in another block, a 2 min filled delay was inserted between study and test. The patients performed relatively well when the studied object and target response differed only in the size of the picture on the page, but were significantly impaired as a group in the other three type-of-change conditions, even with no delay between study and test. The five patients whose structural brain imaging revealed major right-temporal atrophy were more impaired overall, and also more affected by the 2 min delay, than the five patients with an asymmetric pattern characterised by predominant left-sided atrophy. These results are interpreted in terms of a hypothesis that successful classification of an object token as an object type is not a pre-semantic ability but rather results from interaction of perceptual and conceptual processing.     

Efficacy of semantic–phonological treatment combined with tDCS for verb retrieval in a patient with aphasia

Recent studies reported enhanced performance on language tasks induced by transcranial direct current stimulation (tDCS) in patients with aphasia. One chronic patient with non-fluent aphasia received 20 sessions of a verb anomia training combined with off-line bihemispheric tDCS applied to the dorsolateral prefrontal cortex (DLPFC) – anodal tDCS over left DLPFC plus cathodal tDCS over right DLPFC. A significant improvement in verb naming was observed at all testing times (4, 12, 24, and 48 weeks from post-entry/baseline testing) for treated and untreated verbs. Our findings show beneficial effects of verb anomia training in combination with tDCS in chronic aphasic patient, suggesting a long-lasting effect of this treatment.     

Living with dementia from the perspective of older people: Is it a positive story?

Dementia, even at an early stage, may pose problems and challenge one's quality of life. Having accurate knowledge of what one experiences when living with dementia is important for developing proactive care for individuals with dementia and their families. The aim of our Grounded Theory study was to explore what it means for elderly people to live with early-stage dementia. We interviewed 20 elderly people with probable mild dementia and their family members. Living with dementia was often presented as a positive narrative, one that told of only minor problems and which stressed abilities and contentment with life. Being valued, rather than losing one's cognition or identity was central in their experience. More in-depth analyses of participants' narratives revealed, however, that they were constantly balancing their feelings of value and worthlessness, struggling to remain someone of value. This struggle was prompted by threats posed by dementia and by the persons' interactions with others. Superficially, a positive narrative may be understood as a lack of awareness or as denial due to cognitive loss. Our findings suggest, however, that we should look beyond this superficial view and seek to understand the narrative as an expression of one's attempt to counterbalance devaluation.     

Is there a delay in the antidepressant effect? A meta-analysis

OBJECTIVES: It has long been thought that there is a delay of several weeks before a true antidepressant effect occurs, although this theory has increasingly come into question. The goals of this meta-analysis were to determine whether significant drug-placebo separation occurs during the first 2 weeks of treatment and to ascertain whether the timing of response to antidepressant medication and placebo is distinct. DATA SOURCES: Seventy-six double-blind, placebo-controlled trials conducted between 1981 and 2000, included in a recently published meta-analysis that evaluated placebo response rates in depressed outpatients, were reviewed. In addition, each issue of 6 psychiatric journals from January 1992 through December 2001 was reviewed. STUDY SELECTION: Forty-seven studies that evaluated antidepressant medications with established efficacy, performed weekly or biweekly (every other week) evaluations, and presented the time course of improvement as measured by the Hamilton Rating Scale for Depression were included in our meta-analysis. DATA SYNTHESIS: The time course of improvement on active medication and placebo was nearly identical, as 60.2% and 61.6% of the improvement that occurred on active medication and placebo, respectively, took place during the first 2 weeks of treatment. Drug-placebo differences were not only present but were most pronounced during the first 2 weeks of treatment and diminished in a stepwise fashion thereafter. A series of subanalyses confirmed that this early drug-placebo separation was clinically observable and represented a true drug effect. CONCLUSION: These results challenge the notion that a delay exists before a true antidepressant effect occurs.     

Is dopamine a limiting factor of the antidepressant-like effect in the mouse forced swimming test?

To study the role of dopamine (DA) in antidepressant-like effect in the forced swimming test (FST), the relationship between the magnitude of the antidepressant-like effect of drugs [citalopram, fluoxetine, paroxetine (selective serotonin reuptake inhibitors), desipramine (tricyclic antidepressant), maprotiline (tetracyclic antidepressant), bupropion (DA reuptake inhibitor), and tranylcypromine (inhibitor of monoamine oxidase)] and the corresponding concentration of DA in the whole brain of mice was investigated. A trend for an inversely proportional linear relationship [(magnitude of the antidepressant-like effect)=−0.0145×(concentration of DA in the whole brain)+34.773 (r=0.276)] was observed between the magnitude of the antidepressant-like effect and the concentrations of DA in the whole brain, but this correlation was not significant. This result suggests that the high concentration of DA in the whole brain could be a limiting factor for the antidepressant-like effect of antidepressants such as tranylcypromine and seems to play a minor role in the antidepressant-like activity of another antidepressant such as bupropion in the FST.     

Is there a role for uridine and pyrimidine nucleosides in the treatment of vascular dementia?

In the 70s, the discovery of a constant loss of acetylcholine (Ach) in the brains of people suffering from dementia led to the development, in order to improve cognitive functions, of drugs that increased Ach levels. The possibility that loss of a given neurotransmitter might be associated with the onset of a specific neurological syndrome led to suggestions that, as had already been found in Parkinson's disease, replacement therapy might drastically improve the course of the syndrome. We are now aware of the limits of this therapeutic approach. In this review, we analyse potential factors contributing to the partial failure of Ach replacement therapy, contrasting common beliefs regarding the Ach synapse with the difficulties in restoring its activity through replacement drugs. Considering the search for alternative strategies, in the second part of the review, we overview progress of research into pyrimidine compounds, now emerging as a new modulatory system acting through specific pyrimidino-receptors involved in various steps of cell signalling. Pyrimidine nucleosides might be useful in the chronic treatment of cognitive deficits resulting from vascular dementia.