Ing-Mari Tallberg

Swedish norms for word fluency tests: FAS, animals and verbs

Verbal fluency tests are useful measures of acquired language impairment and cognitive decline of various etiologies. The aim of this study was to provide normative data for the Swedish population on the three verbal fluency tests, FAS, Animals and Verbs. A group of 165 healthy participants ranging from 16 to 89 years of age were assessed with the verbal fluency tests and tests of level of intellectual functioning. The sample was stratified by education, age and gender. Level of education had a substantial influence on the performance on verbal fluency, most clearly so in FAS and Verbs. Intellectual level had a positive and significant correlation with all measures of word fluency. Moreover, there was an interaction between age and gender such that women aged between 30 and 64 years outperformed elderly men on FAS and Verbs. Guidelines for instructions and scoring in Swedish are given in the article.

Confabulation and memory in patients with Alzheimer's disease

Confabulation occurs in many brain diseases and concomitant with various cognitive disturbances. The purpose of the present study was to describe semantic features of confabulation and to investigate the relationship between these features and aspects of memory in Alzheimers disease (AD). A group of 15 AD patients were asked questions aiming to evoke confabulations. The answers were analyzed with focus on semantic remoteness to the target answers into four different categories that made it possible to study the genesis of confabulation. Cognitive tests measuring episodic and semantic memory, priming as well as global cognitive functioning were performed, and the results were related to semantic features of confabulation. Results showed that semantic remoteness to the target answers was positively related to poor performance on Mini Mental State Examination but not to item recall, word fluency, or priming. It appears that difficulties with retrieval of recent autobiographical memories may have resulted in substitution of correct information with remote autobiographical memories, that is primary dysdeictic confabulations.

Cognitive decline from estimated premorbid status predicts neurodegeneration in Alzheimer's disease

This study investigated the relationship between premorbid and current cognitive function with respect to the clinical features of patients with various types of neurodegeneration in the form of Alzheimers disease (AD), mild cognitive impairment (MCI), and subjective cognitive impairment (SCI), as compared with a healthy control group (C). Clinical features (MMSE, cognitive and depressive symptoms), genetics (apolipoprotein E; APOE) and measures of neurodegeneration (Abeta(42), t-tau, and p-tau) were examined, as well as present cognitive function. Various methods of assessing premorbid cognitive function were compared, including a Swedish NART-analogous test (Irregularly Spelled Words; ISW), a Swedish lexical decision test (SLDT), a Hold test (Information in WAIS-R), Best current performance test, and combined demographic characteristics. Results showed that cognitive decline (premorbid minus current cognitive function) based on SLDT and ISW was a significant predictor for MMSE and Abeta(42), whereas corresponding associations for present cognitive function and decline measures based on other methods were less powerful. Results also showed that specific verbal abilities (e.g., SLDT and ISW) were insensitive to AD and that these abilities indicated premorbid cognitive function in retrospect. In conclusion, cognitive decline from premorbid status reflects the disease processes.

Lexical and semantic ability in groups of children with cochlear implants, language impairment and autism spectrum disorder

OBJECTIVE Lexical-semantic ability was investigated among children aged 6-9 years with cochlear implants (CI) and compared to clinical groups of children with language impairment (LI) and autism spectrum disorder (ASD) as well as to age-matched children with normal hearing (NH). In addition, the influence of age at implantation on lexical-semantic ability was investigated among children with CI. METHODS 97 children divided into four groups participated, CI (n=34), LI (n=12), ASD (n=12), and NH (n=39). A battery of tests, including picture naming, receptive vocabulary and knowledge of semantic features, was used for assessment. A semantic response analysis of the erroneous responses on the picture-naming test was also performed. RESULTS The group of children with CI exhibited a naming ability comparable to that of the age-matched children with NH, and they also possessed a relevant semantic knowledge of certain words that they were unable to name correctly. Children with CI had a significantly better understanding of words compared to the children with LI and ASD, but a worse understanding than those with NH. The significant differences between groups remained after controlling for age and non-verbal cognitive ability. CONCLUSIONS The children with CI demonstrated lexical-semantic abilities comparable to age-matched children with NH, while children with LI and ASD had a more atypical lexical-semantic profile and poorer sizes of expressive and receptive vocabularies. Dissimilar causes of neurodevelopmental processes seemingly affected lexical-semantic abilities in different ways in the clinical groups.

Cognitive predictors of medical decision-making capacity in mild cognitive impairment and Alzheimer's disease.

Impaired capacity to make decisions in everyday life and situations of medical treatment is an inevitable consequence of the cognitive decline in Alzheimers disease (AD). The objective of this study was to identify the most powerful cognitive component(s) that best predicted medical decision‐making capacity (MDMC) in patients with AD and mild cognitive impairment.

Investigating medical decision-making capacity in patients with cognitive impairment using a protocol based on linguistic features.

A critical question is whether cognitively impaired patients have the competence for autonomous decisions regarding participation in clinical trials. The present study aimed to investigate medical decision-making capacity by use of a Swedish linguistic instrument for medical decision-making (LIMD) in hypothetical clinical trials in patients with Alzheimers disease (AD) and mild cognitive impairment (MCI). Three comparable groups (age, education) participated in the study: AD (n = 20; MMSE: 24.1 ± 3.3) and MCI (n = 22; MMSE: 26.7 ± 2.4) patients and healthy controls (n = 37; MMSE: 29.1 ± 1.0). Medical decision-making capacity was operationalized as answers to questions regarding participation in three hypothetical clinical trials. Answers were scored regarding comprehension, evaluation and intelligibility of decisions, and a total LIMD score was used as the measure of medical decision-making ability. Groups differed significantly in LIMD with AD patients performing worst and MCI poorer than the control group. A strong association was found between all LIMD scores and diagnosis which supported the assertion that LIMD as it is designed is a one-dimensional instrument of medical decision-making capacity (MDMC). The results indicate that a fundamental communicative ability has an impact on the competence for autonomous decisions in cognitive impairment.

Word fluency performance and strategies in children with cochlear implants : Age-dependent effects?

Word fluency was examined in 73 Swedish children aged 6-9 years divided into two age groups, 6-7 and 8-9 years; 34 deaf children with cochlear implants (CI) (15 girls/19 boys) and 39 age-matched children with normal hearing (NH) (20 girls/19 boys). One purpose was to compare the ability to retrieve words in two different word fluency tasks; one phonemically based (FAS letter fluency) and one semantically based (animal fluency). A second purpose was to examine retrieval strategies in the two tasks by conducting an analysis of clustering and switching of word sequences. In general we found that age was an important factor for word fluency ability, in both the CI and the NH groups. It was also demonstrated that children with CI aged 8-9 years retrieved significantly fewer words and used less efficient strategies in the retrieval process, especially on the phonemically based task compared to children with NH of the same ages, whereas children 6-7 years performed similarly in both groups regarding number of retrieved words and use of strategies. The results are discussed with respect to factors such as age differences in performance for children with CI, especially for the phonemically based task.

The Boston Naming Test and Swedish children: Normative Data and response analysis

The present study concerns responses to the Boston Naming Test (BNT) in a sample of native Swedish-speaking children between the ages of 6 and 15. Normative data are presented not only for the number of correct responses but also for the frequency of types of substitutive responses on the BNT. The study involved 152 children and adolescents from four different grades (kindergarten, third grade, sixth grade, and ninth grade). For the sample, a normal distribution of test subjects was sought, including both linguistically weaker and stronger students from school classes in representative areas. The results for the Swedish children and adolescents were slightly lower than the American norms for the BNT. A classification was undertaken of the non-target-word responses, which showed that there were significant differences in the use of the various semantic response categories among the grades. As expected, the younger children gave more unspecific responses and also omitted more responses than the older children. Based on the results of this study, it can be maintained that despite cultural and linguistic differences, the BNT is applicable for examining the vocabulary and word retrieval abilities of native Swedish-speaking children and adolescents.

Deictic disturbances after right hemisphere stroke

Confabulation is a symptom of a cognitive disorder with consequences for communication. Linguistic investigations based on the speech of confabulating individuals are rare, especially when the focus is on semantic-pragmatic aspects. This study is based on material collected from conversations with an elderly, previously non-demented woman suffering from a stroke in the right posterior hemisphere. Sections with confabulate speech were analyzed from a semantic-pragmatic point of view. A method for line-by-line investigation of the confabulate construction was developed. The analysis focuses on semantic projections and on the linguistic cueing of cognitive structures. The results indicate that confabulation is a semantic-pragmatic disorder originating in the lack of a deictic center. Deictic spaces resulting in projections of old, semantic structures provided answers when appropriate structures were not available. The confabulations were created in interaction and were determined by the context. Finally, the results reveal how the confabulating individual projected an image of herself by the use of deixis.

How Do Patients with Cognitive Impairment Communicate During Discharge Meetings? Evaluation of Participation Using Talking Mats

Objective: Individuals with dementia experience a declining capacity for communication, negatively affecting their ability to participate in discharge meetings. Communication problems might be obvious. Nevertheless patients often lack a structuralized support. The aim of this study was to investigate if communication could be facilitated by preparing patients for their discharge meetings using Talking Mats (TM), a visual communication-supporting device. Methods: A pilot study was conducted, in which twenty patients participated, randomized to use TM prior their discharge meeting (Talking Mats Group, TMG) or to follow the ward’s usual procedure (Control Group, CG). Persons attending discharge meetings (patients, close acquaintances, nurses, and social care workers) at a geriatric ward rated on Visual analogue scale how well they perceived the patient participated in communication. They also rated to which extent utilizing TM had helped them. Results: Our main finding was an interaction effect regarding how the four groups of persons attending the meeting (patients, close acquaintances, nurses, and social care workers) rated the three different statements regarding communication and participation; knowing the patient before the meeting affected the ratings of the patient’s communicative participation. A majority using TM rated that it had been beneficial during the discharge meetings. Comparison between groups yielded the contradicting result that in CG communication was rated as more well-functioning than in TMG. Conclusion: Understanding each other is not a given in discharge meetings, especially when a patient has cognitive impairment, but the use of TM was rated as a communication facilitator by the persons attending. Having knowledge of a patient affected ratings of communication, and we conclude it is desirable to have the person utilizing the mat with the patient also attending the discharge meeting.