The differentiation of semantic dementia and frontal lobe dementia (temporal and frontal variants of frontotemporal dementia) from early Alzheimer's disease: A comparative neuropsychological study.

The authors compared age-matched groups of patients with the frontal and temporal lobe variants of frontotemporal dementia (FTD; dementia of frontal type [DFT] and semantic dementia), early Alzheimer's disease (AD), and normal controls (n?=?9 per group) on a comprehensive neuropsychological battery. A distinct profile emerged for each group: Those with AD showed a severe deficit in episodic memory with more subtle, but significant, impairments in semantic memory and visuospatial skills; patients with semantic dementia showed the previously documented picture of isolated, but profound, semantic memory breakdown with anomia and surface dyslexia but were indistinguishable from the AD group on a test of story recall; and the DFT group were the least impaired and showed mild deficits in episodic memory and verbal fluency but normal semantic memory. The frontal and temporal presentations of FTD are clearly separable from each other and from early AD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Subcortical dementia and the frontal lobe syndrome

Subcortical dementia is a clinical syndrome incorporating disorders of cognitive and affective sphere, which is caused by organic damage to subcortical structures. The syndrome is usually connected with Progressive Supranuclear Palsy, Huntington Disease, Parkinson's Disease. Subcortical dementia is mainly characterized by: slowing down of psychic functions and impairment of their precision, disorders in the ability to use achieved knowledge and personality changes. Most authors stress the fact that similar cognitive and emotional personality defects are observed in cases of frontal cortex damage. Recent research points to the existence of functional subcortical-prefrontal circuits which regulate human behaviour. There is a link between subcortical dementia and functional or structural break of one or more cortical-subcortical connections. Attention is also called to disorders in certain neurotransmitting systems (dopaminergic, acetylcholinergic) as well as to brain hypometabolism in basal ganglia, thalamus and prefrontal cortex.     

Focal cognitive deficits in dementia of the Alzheimer type.

It is widely accepted that the natural history of Alzheimer type-dementia is accurately described by a relatively fixed, invariant sequence of stages of behavioral, cognitive, and neurological symptoms. This stage-wise deterioration model is examined and found wanting. The evidence shows that there is no generalization about the inevitable ordering of symptoms that has not been contradicted by reports in the literature. Two alternatives to the stage-wise model are discussed, both of which reject the notion of a homogeneous disintegration of function and take as a goal the delimitation of a set of symptom domains that define and differentiate patients. Of these 2 alternatives, the subgroups model and the multiple components model, the latter seems to accord best with the available data. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preclinical cognitive markers of dementia of the Alzheimer type.

56 nondemented elderly normal control (NC) Ss were studied at 3 consecutive annual administrations of the California Verbal Learning Test (CVLT). NC Ss with a positive family history for progressive dementia performed significantly worse than individuals with a negative family history for progressive dementia on several quantitative and qualitative indices of the CVLT and were more likely to undergo changes in diagnostic status over time (i.e., develop dementia of the Alzheimer type [DAT]). Stepwise discriminant function analyses of critical CVLT indices of the NC Ss and of 25 patients with mild DAT classified 5 NC Ss as DAT patients 1–2 yrs prior to their eventual changes in diagnostic status. Results suggest that specific memory deficits may serve as preclinical cognitive markers for DAT, especially in individuals with risk factors for DAT such as a positive family history. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A longitudinal study of the course of Alzheimer type dementia

OBJECTIVE: We carried out a prospective longitudinal study of 41 patients diagnosed as probably having a mild form of Alzheimer's disease according to the data of an investigation of prevalence done in 1991 in the municipality of Habana Vieja. MATERIAL AND METHODS: The research covered two phases, with an interval of one year between them. During both phases the patients were interviewed by the same neurology resident in a door-to-door survey using the Mini-Mental State, Hughes scale (CDR) and Blessed scale, to evaluate higher mental functions. We determined the progress of the disease over the course of two years (1991-1992 and 1992-1993) and the frequency and degree of deterioration of cognitive functions during a period of one year. RESULTS AND CONCLUSIONS: There was evidence of progressive worsening of the illness in 46.4% of the patients. In 34.2% this was to a moderate form and in 12.2% to a severe form. There was no progression in 46.3%. In this group 17.0% continued with a diagnosis of doubtful dementia and 29.3% as having slight dementia. The other 7.3% of the total number of patients (n = 41) were reclassified as normal. Cognitive functions almost always showed a tendency to deteriorate over time, but in a small percentage of patients they did not deteriorate and some even improved. The cognitive functions which deteriorated most were those of orientation, language and copying, with an average deterioration of 28% and 24% respectively with regard to their initial values.     

Bender-Gestalt Test performance in senile dementia of the Alzheimer type.

Bender-Gestalt Test performances of 144 persons with very mild, mild, or moderate senile dementia of the Alzheimer type (SDAT) and 96 healthy older adults ranging in age from 63 to 95 yrs were compared. Total scores and error types according to the modified Hutt-Briskin scoring system are reported. The Bender-Gestalt Test does not appear to be useful in differentiating very mild or mild SDAT from normal aging. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preserved cognitive skills in dementia of the Alzheimer type

OBJECTIVE: To describe preserved cognitive skills in patients with dementia. DESIGN: Case series. SETTING: Community clinic. PATIENTS: Five patients who met National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for probable Alzheimer's disease and were claimed to retain a cognitive skill. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Standard neuropsychological tests and individualized measures of patient's skilled behaviors. For patients who remained skilled at games, performance was compared with that of normal controls in direct competition. For the patient-trombonist, raters compared premorbid and postmorbid recordings of his play. RESULTS: One patient continued to play the trombone in a Dixieland band, although he could not name well-known numbers that he played. Another continued to solve adult jigsaw puzzles. A third patient retained skill at canasta, the fourth at dominoes. The fifth patient remained a skillful contract bridge player, although he could not name the suits or articulate simple bidding rules. Four patients had impaired performance on standard anterograde and remote memory and naming tests but performed normally on pursuit rotor and letter fluency tests. Mini-Mental State Examination scores for these patients ranged from 10 to 22. One patient refused neuropsychological testing but displayed his skill. CONCLUSIONS: Together with previous studies of preserved piano playing or painting skills, our findings indicate that a broad range of complex cognitive abilities may be preserved in patients with dementia of the Alzheimer type who cannot perform simpler actions.     

Serial position effects in dementia of the Alzheimer type

We evaluated the usefulness of an automated hematology analyzer (SE-9000) for the identification and counting of peripheral blood stem cells (PBSCs). The samples tested were from 14 patients with hematological malignancies. Peripheral blood samples were collected from the subjects before and after a course of chemotherapy. From the leukapheresis sample, CD34+ cells, assumed to be hematopoietic stem cells, were obtained with an immunomagnetic cell separator. The CD34+ cells obtained accumulated in the gate corresponding to low recurrent frequencies of the automated hematology analyzer. This gate shows results of the 'immature information' (IMI) channel. Software for detection of only the cells that accumulated in this gate was therefore developed. With this trial program, the regression coefficient between the percentage of leukocytes from the blood samples that were CD34+ and the percentage of such leukocytes that appeared on the IMI channel was 0.79. With this analyzer, the number of PBSC could be counted in about 80 s. The identification and counting of cells picked up by the IMI channel should be clinically useful for the monitoring of changes in PBSC after chemotherapy for mobilization.     

Reading in dementia of the Alzheimer type: A preserved ability?

Assessed 45 patients with a probable diagnosis of dementia of the Alzheimer type (DAT), varying from minimal to moderate levels of dementia, on 3 tasks of reading aloud: (1) an extensive list of regular and exception words across a range of word frequencies, (2) the National Adult Reading Test (NART), and (3) a test of nonword reading. On the first test, the patients showed substantial effects of regularity, word frequency, and disease severity. Reading of less common words with atypical spelling-sound correspondences was significantly impaired in the moderately demented subgroup of patients and significantly correlated with measures of semantic memory for the patient group as a whole. This impaired exception word reading was attributed to the breakdown in semantic memory that occurs as the DAT disease process advances. A significant drop in performance on both the NART and nonword reading also accompanied increasing disease severity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Deficits in reading performance in very mild dementia of the Alzheimer type.

Reading of irregular words using the American version of the National Adult Reading Test ([AMNART] E. Grober & M. Sliwinski; see record 1992-16981-001) was examined in 101 healthy older adults and compared with 50 people with very mild and 62 people with mild dementia of the Alzheimer type. Significant deficits were observed in both the very mild and mild dementia groups. Performance on this reading test was substantially correlated with other measures of semantic memory, which are also affected early in the course of the disease. Use of this test as an indicator of premorbid intelligence in people with dementia of the Alzheimer type does not appear wise. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Musical structural determinants of emotional judgments in dementia of the Alzheimer type.

People with dementia of the Alzheimer type (DAT) may well be emotionally soothed by listening to music. However, very few systematic studies have been conducted to support the anecdotal evidence. DAT does damage certain cerebral structures that subsume emotional processing, and some studies have demonstrated deficits affecting emotional judgments of facial expression and prosody in DAT. Accordingly, this study addressed the question of whether DAT might leave musical emotional judgment intact. Twelve early DAT participants and 12 healthy elderly participants took part in this study. Emotional judgments were examined in relation to mode and tempo, two important structural properties that contribute to the happy-sad distinction in music. Their respective contributions were assessed in four different experimental conditions. The DAT participants' responses were similar to those of healthy elderly participants, showing spared ability to employ tempo and mode as cues for emotional interpretation. The DAT participants' performance was not correlated with their global cognitive functioning. These results constitute a preliminary empirical demonstration that, in early DAT, musical emotional judgments appear to be based on normal structural analysis of musical input. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relations between neuropsychological findings and lateral asymmetries of cerebral blood flow measured by SPECT in dementia of Alzheimer type

We studied 16 right-handed patients clinically diagnosed as dementia of Alzheimer type (6 men, 10 women; aged 63-85, mean 72.8 years). The average duration of symptoms was 2.7 years. Dementia ranged from mild to moderately severe. None had clinical or laboratory evidence of cerebrovascular disease (Hachinski ischemic scores for all patients were 4 or below 4). All received the Wechsler Adult Intelligence Scale (WAIS), Mini-mental State Test (MMS) and Western Aphasia Battery (WAB, First Japanese edition, 1986). Regional cerebral blood flow (rCBF) was evaluated by single photon emission CT (SPECT) with 123I-N-isopropyl-p-iodoamphetamine (123I-IMP), using the Matsuda's quantitative method (Am J Physiol Imag 1: 186, 1986). Regional tracer uptake was measured in regions of interests (ROIs) over right and left frontal, temporal, parietal and occipital cortical regions; basal ganglia; and cerebellar hemispheres. The subjects were divided into three groups on the basis of lateral asymmetries in the temporal and parietal cortexes of rCBF (left < right, n = 5; right < left, n = 3; left = right, n = 8). We decided that lateral asymmetry was present when rCBF for each ROI between left and right sides differs by more than 10%. General score (MMS, T-IQ) was not correlated with asymmetry of cerebral blood flow. Verbal IQ in patients with predominant hypoperfusion of left temporal and parietal lobe was significantly lower than other group, while performance IQ and WAB constructive scores were lower in those with right hemispheric hypoperfusion (p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

The experimental investigation of a case of alcohol-induced frontal lobe atrophy.

Examined the performance of a nonamnesic male chronic alcoholic (aged 70 yrs) with significant frontal cortical atrophy on 3 memory tests (decay from immediate memory, release from proactive interference, and word completion). Results were compared with those from a male (aged 58 yrs) with alcoholic dementia and manifestations of Wernicke-Korsakoff syndrome and 2 nonalcoholic controls (aged 68 and 74 yrs). All Ss were evaluated using computerized tomography (CT) scans. Frontal atrophy alone was not related to impairment of verbal retention. Findings are important for the proposed neuropathology of some memory deficits of alcoholic Korsakoff patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Autonomic dysfunction in patients with dementia of the Alzheimer type

Abnormalities of the noradrenergic system have been documented in the central nervous system of patients with dementia of the Alzheimer's type (DAT). To evaluate the autonomic sympathetic system in DAT, we measured lying and standing blood pressure (BP), pulse, and plasma epinephrine (E) and norepinephrine (NE) in 60 DAT patients (mean age +/- SD = 65 +/- 8 years), and 20 normal elderly controls. DAT patients had normal baseline findings (BP, pulse, NE, and E). Upon standing, plasma NE and E significantly increased in both DAT patients and controls, without group differences. However, the systolic BP response to standing was reduced in DAT patients compared with the normal controls (repeated measures ANOVA, p < 0.01). This impaired response of the systolic BP on standing was particularly evident in DAT patients with symptoms of depression. Severely impaired DAT patients did not differ in E, NE, BP, pulse, or in orthostatic changes from mild-to-moderately impaired patients. These results suggest that the sympathetic response to the stress of standing is functionally impaired in DAT. This deficit was especially evident when DAT was accompanied by depression, consistent with prior studies in non-demented depressed patients.     

An analysis of confrontation naming errors in senile dementia of the Alzheimer type.

Examined confrontation naming performance as reflected by the Boston Naming Test (BNT) in 25 healthy elderly adults (aged 63–83 yrs), 25 age-matched adults with very mild senile dementia of the Alzheimer type (DAT), and 24 age-matched adults with mild DAT. Errors were classified within 17 different categories that differentially reflected perceptual, lexical, and semantic mechanisms. Early in DAT, there was a loss of lexical information and some loss in specific semantic attributes. As the disease progressed, there was increasing involvement of core semantic structures. These observations were supported by analyses of linguistically related errors, 4-alternative forced-choice recognition performance, and correlational analyses between performance on the BNT and 12 standard psychometric tests. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Repetition priming with nonverbal stimuli in patients with dementia of the Alzheimer type.

Perceptual repetition priming was examined in patients with dementia of the Alzheimer type (DAT) and normal control (NC) participants using a task involving the discrimination of geometric designs that had either a continuous ("closed") or discontinuous ('open") perimeter. With the open stimuli, the groups displayed significant and equivalent levels of priming after immediate repetition of the stimuli, whereas only the NC group primed significantly over a delay of three intervening items. Neither group demonstrated significant priming with the closed stimuli. Results indicate that under some conditions DAT patients can exhibit normal repetition priming with stimuli that do not have pre-existing representations but that (due possibly to a deficiency in the level of steady-state cortical activation) this priming dissipates more rapidly in DAT patients than in NC participants. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Event understanding and memory in healthy aging and dementia of the Alzheimer type.

Segmenting ongoing activity into events is important for later memory of those activities. In the experiments reported in this article, older adults' segmentation of activity into events was less consistent with group norms than younger adults' segmentation, particularly for older adults diagnosed with mild dementia of the Alzheimer type. Among older adults, poor agreement with others' event segmentation was associated with deficits in recognition memory for pictures taken from the activity and memory for the temporal order of events. Impaired semantic knowledge about events also was associated with memory deficits. The data suggest that semantic knowledge about events guides encoding, facilitating later memory. To the extent that such knowledge or the ability to use it is impaired in aging and dementia, memory suffers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)