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Semantic memory in partial epilepsy: verbal and non-verbal deficits and neuroanatomical relationships.

Semantic memory was evaluated in 124 epilepsy patients, including 84 with left (n=44) or right temporal lobe epilepsy (TLE) (n=40) and 40 with left (n=25) or right frontal lobe epilepsy (FLE) (n=15), in order to determine their verbal and visual deficits, and the neuroanatomical relationships between them. The controls were 35 healthy subjects. Semantic memory was assessed by means of Picture Naming, Picture Pointing, the verbal Pyramid and Palm Trees Test (PPTT), the visual PPTT, Object Decision Hard, and Drawing From Memory. Episodic memory was assessed by means of the Short Story, Rey's Complex Figure, the Verbal and Visual Selective Reminding Procedure and Brown-Peterson Procedure. Factor analysis of the epilepsy patients distinguished their semantic memory scores from other neuropsychological domains. The semantic memory factor was significantly related to the side of the epileptic region, with lower scores in the left hemisphere and left TLE patients. In comparison with the controls, the left TLE patients were significantly impaired on Picture Naming, Picture Pointing, and Object Decision Hard. Subsequent analyses showed that, in comparison with the controls and the right TLE patients, the left TLE patients with lateral temporal lobe lesions were impaired in Picture Naming whereas, in comparison with the controls, the left TLE patients with mesial temporal lobe lesions were impaired in Object Decision Hard. On the contrary, the episodic memory factor was not related to the side of the epileptic region, and a few material-specific tests revealed opposite impairments in the left and right hemisphere patients. These results show that left TLE may cause semantic memory deficits involving verbal and visual information. Unlike the material-specific pattern of episodic memory, this pattern of impairment is in line with the view of an amodal semantic store in which all of the information about a thing overlaps. The semantic memory impairment may reflect damage in the lateral and mesial temporal lobe regions that impair neocortical functions in storing and retrieving information or hippocampal functions in processing meaningful stimuli.

Adult↗

Self-ordered pointing in children with autism: failure to use verbal mediation in the service of working memory?

This study tested the hypothesis that children with autism are impaired in using verbal encoding and rehearsal strategies in the service of working memory. Participants were 24 high-ability, school-age children with autism and a comparison group matched on verbal and non-verbal IQ, receptive and expressive vocabulary, and visual memory. Working memory was assessed using verbal and non-verbal variants of a non-spatial, self-ordered pointing test [Petrides, M., & Milner, B. (1982). Deficits on subject-ordered tasks after frontal- and temporal-lobe lesions in man. Neuropsychologia, 20, 249-262] in which children had to point to a new stimulus in a set upon each presentation without repeating a previous choice. In the verbal condition, the stimuli were pictures of concrete, nameable objects, whereas in the non-verbal condition, the stimuli were not easily named or verbally encoded. Participants were also administered a verbal span task to assess non-executive verbal rehearsal skills. Although the two groups were equivalent in verbal rehearsal skills, the autism group performed significantly less well in the verbal, but not the non-verbal, self-ordered pointing test. These findings suggested that children with autism are deficient in the use of verbal mediation strategies to maintain and monitor goal-related information in working memory. The findings are discussed in terms of possible autistic impairments in episodic memory as well as working memory.

Adolescent↗

Verb generation in children and adolescents with acute cerebellar lesions.

The aim of the present study was to examine verb generation in a larger group of children and adolescents with acute focal lesions of the cerebellum. Nine children and adolescents with cerebellar tumours participated. Subjects were tested a few days after tumour surgery. For comparison, a subgroup was tested also 1 or 2 days before surgery. None of the children had received radiation or chemotherapy at or before the time of testing. Eleven age- and education-matched control subjects participated. Subjects had to generate verbs to blocked presentations of photographs of objects. As control condition, the objects had to be named. Furthermore, dysarthria was quantified by means of a sentence production and syllable repetition task. Detailed analysis of individual 3D-MR images revealed that lesions affected cerebellar hemispheres in all children and adolescents. The right cerebellar hemisphere was affected in four and the left hemisphere in five subjects. In the present study, naming and verb generation accuracy were preserved in the majority of subjects with cerebellar lesions. No significant signs of learning deficits were observed, as reduction of reaction times over blocks was not different compared to controls. There was a trend of children and adolescents with right-hemispheric lesions to perform worse compared to controls. In this group, however, significant signs of dysarthria were present. In sum, no significant signs of disordered verb generation were observed in children and adolescents with acute cerebellar lesions. Findings suggest that the role of the cerebellum in verb generation may be less pronounced than previously suggested. Findings need to be confirmed in a larger group of subjects with acute focal lesions.

Acute Disease↗

Impaired decision-making in Parkinson's disease.

The present study demonstrated that individuals with Parkinson's disease display impairments in making profitable decisions, as evidenced by poorer performance on the Iowa Gambling Task relative to matched controls. The ability to make beneficial judgments solely correlates with ability to appropriately attribute internal mental-state to other people, as shown in a mind-reading task. However, decision-making ability for individuals with Parkinson's disease is not associated with effective execution, intellectual function or depressed mood. These findings offer a new perspective on the cognitive impairments that affect social living and adaptive decisions for individuals with Parkinson's disease.

Affect↗

Assessing a minimal executive operation in schizophrenia.

The minimal cognitive operation of thinking of a just-seen stimulus (refreshing) was studied in 24 patients with schizophrenia and 24 normal controls. Verbal response times were measured when participants read a word, read a word immediately again, or refreshed a word just after it was no longer present. Patients showed equal priming as controls in reading a word for the second time and were slower than controls to say a word only in the refresh condition. On a surprise test, participants were asked to recognize the words they had seen previously and to give Remember, Know, or Guess responses according to whether they recognized words on the basis of conscious recollection, familiarity, or guessing. Although patients showed overall poorer recognition memory, the beneficial effect of refreshing on long-term memory accuracy and Remember responses was preserved, whereas they derived less benefit in familiarity from seeing an item twice than from refreshing it. These results suggest that although patients may have some difficulty engaging the refresh process, they show significant long-term memory benefits when induced to do so.

Adult↗

What is measured by verbal fluency tests in schizophrenia?

INTRODUCTION: Schizophrenia patients perform below the norm on verbal fluency tests. The causes for this are unknown, but defective memory, executive functioning and psychomotor speed may play a role. METHOD: We examined 50 patients with schizophrenia and related disorders, and 25 healthy controls with a cognitive test battery containing tests for verbal memory, executive functioning and psychomotor speed, and a categorical fluency test. RESULTS: Patients obtained significantly lower test results than the controls on most cognitive measures including the verbal fluency test. During the fluency test, they formed as many clusters, and switched as often between clusters as the controls did, but they generated fewer words per cluster. Interestingly, in the control group, fluency performance was predicted by memory and executive functioning, but not by psychomotor speed. In patients, verbal fluency was predicted by psychomotor speed, but not by memory or executive functioning. DISCUSSION: We conclude that psychomotor speed could be a crucial factor in cognition, and its influence on cognitive test performance should be considered in schizophrenia research. Furthermore, these data illustrate the importance of qualitative analysis of cognitive impairments in schizophrenia patients, as traditional cognitive tests often only provide quantitative information.

Adult↗

Effects of ketamine on thought disorder, working memory, and semantic memory in healthy volunteers.

BACKGROUND: The N-methyl-D-aspartate receptor antagonist, ketamine, produces a clinical syndrome of thought disorder, perceptual distortion, and cognitive impairment. METHODS: We have administered ketamine to healthy volunteers to characterize the formal thought disorder and specific memory dysfunction associated with ketamine. Ten healthy volunteers underwent a double-blind, placebo-controlled, ketamine infusion (0.12 mg/kg bolus and 0.65 mg/kg/hour). Thought disorder was evaluated with the Scale for the Assessment of Thought, Language and Communication. Cognitive testing involved working and semantic memory tasks. RESULTS: Ketamine produced a formal thought disorder, as well as impairments in working and semantic memory. The degree of ketamine-induced thought disorder significantly correlated with ketamine-induced decreases in working memory and did not correlate with ketamine-induced impairments in semantic memory. CONCLUSIONS: This study characterizes the formal thought disorder associated with ketamine and may suggest that ketamine-induced deficits in working memory are associated with ketamine-induced thought disorder.

Adult↗

More is not always better: a response to Roelofs, Meyer, and Levelt.

In a series of papers we have argued that the distinction between lemma and lexeme levels of representation in lexical access may be unnecessary. We pointed out that the evidence cited in support of this view is not incompatible with alternative accounts that do not assume a lemma level of representation. Furthermore, we argued that there are neuropsychological observations and results from tip-of-the-tongue (TOT) experiments that appear to be problematic for the lemma/lexeme distinction. Roelofs et al. [Roelofs, A., Meyer, A.S., Levelt, W.J.M., 1998. A case for the lemma/lexeme distinction in models of speaking: comment on Caramazza and Miozzo (1997). Cognition 69, 219-230.] have challenged our conclusions by attempting to demonstrate that (1) a model that incorporates the lemma/lexeme distinction can account for the putatively problematic neuropsychological and TOT data; (2) there are other data that appear to be problematic for a type of model that does not include a lemma level of representation. In the present paper we respond to these criticisms by showing (1) that the neuropsychological and TOT data still represent a challenge for the lemma/lexeme distinction, and (2) that the other evidence cited by Roelofs et al. is not incompatible with lexical theories that assume only one lexical layer.

Humans↗

Persistent cognitive deficits associated with lithium intoxication: a neuropsychological case description.

We present the case of a 51-year-old patient with an acute lithium intoxication associated with several cognitive deficits. During the acute phase of intoxication the patient displayed general psychomotor slowing, dysarthric speech, mood changes, and incoherent discourse. Neuropsychological assessment revealed ideomotor apraxia, profound deficits of visuospatial processing, an impairment of memory and of frontal-executive functions. Other cognitive abilities, such as orientation, spontaneous speech, comprehension, naming, reading, writing, and working memory remained intact. An electroencephalogram revealed diffuse slowing with rhythmic trains, whereas MRI showed no cerebral abnormality. Follow-up examinations at 4 and 14 weeks with lithium levels in the normal range showed substantial recovery of memory abilities and executive functions, whereas praxis and visuoperceptual functions remained impaired, despite the fact that lithium was immediately withdrawn after the intoxication became manifest. We conclude that lithium intoxication may be associated with variable behavioural and cognitive impairments, some of them potentially persistent. Different from other case studies our findings suggest that lithium intoxication may cause a combined, multifocal functional impairment of subcortical and cortical neural mechanisms in both hemispheres.

Antimanic Agents↗

Metaphor comprehension in right brain-damaged patients with visuo-verbal and verbal material: a dissociation (re)considered.

Metaphor comprehension was investigated in 50 right-hemisphere damaged (RHD) patients and 38 control subjects in two experimental conditions: a visuo-verbal and a verbal test. In the visuo-verbal test, subjects had to match a metaphorical sentence with one of four pictures representing the correct metaphorical meaning, the literal meaning, a control metaphor and a control literal meaning. In the verbal test, a metaphorical sentence had to be matched to a correct written metaphorical interpretation, a literal or a control interpretation. On both tests, the number of correct metaphorical responses in the RHD group was lower than in the control group. However, RHD patients performed more poorly in the visuo-verbal than in the verbal condition. Interestingly, when they selected the wrong response, the RHD patients tended to select the literal one only in the visuo-verbal condition. Context does not seem to be responsible for the dissociation between the two tests. The influence of the RHD patients' major visuo-spatial deficits was also checked, to exclude their role in the tendency to be literal with visuo-verbal material. Results are discussed in the perspective of an integration deficit.

Aged↗

Word finding in the damaged brain: probing Marshall's caveat.

Marshall (1977) constructed a plausible simulation of "anomic" speech out of the 100 most common words in the English language. He suggested that impaired access to lower frequency vocabulary might underlie anomic word finding difficulties. But he also noted that another factor, age of acquisition, may exert an influence, with anomic patients experiencing particular difficulty with later acquired vocabulary. A review of research on word-finding in aphasia and other neuropsychological conditions suggests that Marshall (1977) may have been right on both counts, and that in many patients both frequency of use and age of acquisition influence the likelihood that a given word will be able to be accessed and used. Theoretical accounts of why the age of acquisition of words might affect their retention or loss following brain injury in adulthood are considered.

Age Factors↗

Comprehension of spatial language terms in Williams syndrome: evidence for an interaction between domains of strength and weakness.

Individuals with Williams syndrome show an unusual neuropsychological profile, with relatively strong language abilities and impoverished visual and spatial abilities. Two studies are reported that examine the interaction between these two domains in Williams syndrome by assessing individuals' comprehension of spoken language with a spatial component. In a first study, the Test for Reception of Grammar (Bishop, 1983) was given to 32 individuals with Williams syndrome and to controls matched individually for total number of errors on the task. Individuals with Williams syndrome had particular problems when asked to comprehend sentences containing spatial prepositions, making significantly more errors on these items than control groups. A second study examined in more detail comprehension of sentences with spatial and non-spatial components, comparing the performance of 15 individuals with Williams syndrome and control groups matched for vocabulary ability. Individuals with Williams syndrome again showed impaired comprehension of spoken spatial terms. In contrast, they were unimpaired in comprehending utterances without a spatial component, with the exception of descriptions testing comprehension of non-spatial comparatives (lighter than and darker than). These results suggest that the spatial difficulties experienced by individuals with Williams syndrome may constrain language comprehension in certain circumstances. They also shed light on the ways in which spatial cognition may interact with language comprehension more generally.

Adolescent↗

Different components in word-list forgetting of pure amnesics, degenerative demented and healthy subjects.

This study investigated the contribution of different components of the serial position curve to the accelerated forgetting rate displayed by amnesic and degenerative demented patients in word-list recall. For this purpose, we analyzed immediate and 15 min delayed recall performances on Rey's 15-word learning task of 16 pure amnesic, 15 Alzheimer's demented and 81 healthy subjects. Results documented that in all groups most forgetting occurred at the expense of terminal items of the word list. Nevertheless, both amnesic and demented patients showed a disproportionately larger memory loss on the recent part of the serial position curve than healthy subjects. Finally, amnesics (but not AD patients) suffered from a significantly larger forgetting rate for primacy items than normal controls. These data demonstrate that a critical deficit in memory disordered patients is represented by a failure in transferring information from a transitory memory status to a more durable storing condition. At least in amnesic patients, our results also suggest "true" long-term forgetting, presumably due to decay or to the intervening inaccessibility of previously stored memory representations.

Adult↗

Dissociations of language functions in aphasics with speech automatisms (recurring utterances).

The linguistic performance of 27 aphasics with frequent production of non-lexical speech automatisms (recurrent utterances; e.g. do-do-do...) in spontaneous speech was investigated. Of the 26 patients examined with the Aachen aphasia test (AAT), 24 cases suffered from global aphasia, one from Broca's aphasia, and one was not classifiable but most resembled the fluent types as Wernicke's or conduction aphasia. While most patients were severely impaired in language comprehension, a subgroup showed impairments on a moderate level. In four cases clear dissociations between oral and written output performance were found. Only one patient, and very rarely so, interspersed his written output with his speech automatism. Analysis of written output within the theoretical framework of the logogen model provided evidence for the possibility of a partially intact phonological system in patients with speech automatisms. Results are interpreted as supporting a sub-phonemic hypothesis of the generation of non-lexical speech automatisms.

Adult↗

Case studies in working memory: a case for single cases?

Patterns of cognitive deficit in single neuropsychological cases are common sources of evidence for theories of normal cognition. In particular, the working memory model has benefited from data obtained from a number of contrasting patients, in some cases resulting in modifications of the working memory model. In this paper, patterns of data from short-term memory patients and anarthric patients are compared with patterns of data from normal subjects. The patterns of patient data that were unlike those patterns typically found for groups of normal subjects, could be incorporated within a modified version of the articulatory loop component of the working memory model. However a small number of individual normal subjects also did not show the pattern that is reported on the basis of average performance of groups of normal subjects. This causes some difficulty in interpreting those data from such 'aberrant normal' patterns, and those data from single patients with functional cognitive deficits. The implications of these findings for the interpretation of neuropsychological data are discussed in the context of the working memory model, but with the intention of making a general point pertaining to the development of functional models of cognition. It is argued that single case studies should continue to provide a useful source of evidence, providing that care is exercised in considering the implications of such data for models of normal cognition.

Adult↗

Spontaneous recovery of impaired memory span: does comprehension recover?

We have previously described a patient, T.B., who had a memory span of two digits and a sentence span of three words. He showed no evidence of effects of either phonological similarity or word length on span and his deficit was interpreted as reflecting the impaired functioning of the phonological loop component of working memory. Analysis of his language comprehension indicated normal processing of short sentences, together with a marked deficit in understanding long sentences, whether these were presented visually or auditorily (Baddeley and Wilson, 1988). When re-tested after several years, T.B.'s memory span had increased to nine digits, and showed clear effects of phonological similarity and word length. His performance on a series of language comprehension tests indicated a complete recovery, although he continued to show impairment on two tests of phonological awareness. These results are consistent with the proposed link between phonological working memory and language comprehension. In addition, they indicate a dissociation between short-term phonological memory and phonological awareness.

Awareness↗

Spared and impaired cognitive abilities after bilateral frontal damage.

We report on a patient (PG) with a severe behavioural disorder following massive bilateral prefrontal damage due to herpetic encephalitis. The lesion involves also the mesial and polar regions of the temporal lobes; the frontal dorso-lateral cortices were relatively spared. The patient's inattentiveness and alternating impulsive and apathetic behaviour led to her social alienation. The only self-motivated activities we observed were those initiated to satisfy her enhanced urge to eat and play games. She did not react to surprise stimuli that consistently elicit a reaction of surprise in healthy people. She also presented "adynamic aphasia" associated with anomia and episodic amnesia. A striking feature of the syndrome was the patient's consistent "utilization behaviour". Her motor behaviour was marked by constant akathisia. She performed surprisingly well on intelligence, "frontal", and visuo-spatial tests. This non-demented patient exhibited a clear dissociation between her relatively spared cognitive abilities and grossly impaired behaviour. In the discussion we explore the extent to which a defect of the supervisory control may be held responsible for the inconsistencies in the patient's coping skill performances.

Adolescent↗