Jennifer Zientz

Discourse changes in early Alzheimer disease, mild cognitive impairment, and normal aging.

The purpose of this study was to determine the sensitivity of discourse gist measures to the early cognitive-linguistic changes in Alzheimer disease (AD) and in the preclinical stages. Differences in discourse abilities were examined in 25 cognitively normal adults, 24 adults with mild probable AD, and 20 adults with mild cognitive impairment (MCI) at gist and detail levels of discourse processing. The authors found that gist and detail levels of discourse processing were significantly impaired in persons with AD and MCI as compared with normal control subjects. Gist-level discourse processing abilities showed minimal overlap between cognitively normal control subjects and those with mild AD. Moreover, the majority of the persons with MCI performed in the range of AD on gist measures. These findings indicate that discourse gist measures hold promise as a diagnostic complement to enhance early detection of AD. Further studies are needed to determine how early the discourse gist deficits arise in AD.

Effects of Traumatic Brain Injury on Working Memory-Related Brain Activation in Adolescents

Eight adolescents (ages 13-18 years) who sustained traumatic brain injury (TBI) and eight gender- and age-matched typically developing (TD) adolescents underwent event-related functional MRI (fMRI) while performing a Sternberg letter recognition task. Encoding, maintenance, and retrieval were examined with memory loads of one or four items during imaging. Both groups performed above a 70% accuracy criterion and did not differ in performance. TD adolescents showed greater increase in frontal and parietal activation during high-load relative to low-load maintenance than the TBI group. The TBI patients showed greater increase in activation during high-load relative to low-load encoding and retrieval than the TD group. Results from this preliminary study suggest that the capability to differentially allocate neural resources according to memory load is disrupted by TBI for the maintenance subcomponent of working memory. The overrecruitment of frontal and extrafrontal regions during encoding and retrieval following TBI may represent a compensatory process.

When nouns and verbs degrade: Facilitating communication in semantic dementia

Background: Little is known about how to maintain communicative effectiveness in semantic dementia as the disease progresses from impairment in word retrieval to a loss of conceptual knowledge. Aim: The purpose of this study is twofold. The first objective is to characterise communicative effectiveness using a modified framework derived from Chapman and Ulatowska (1997) that integrates two components: codification of ideas (falling on a continuum from verbal to nonverbal and generative to automatic forms) and functions of communication (imaginative, heuristic, informative, personal, interactional, regulatory, and instrumental). The second objective is to outline principles of a discourse intervention that focuses on communicative effectiveness. Method & Procedures: The participant was Mr Bobby V, a man with semantic dementia. His communication abilities were characterised at diagnosis and 24 months later using the framework of communicative effectiveness, based on discourse samples, clinical observation, and caregiver report. From the time of diagnosis, Bobby V received discourse intervention, which focused on maintaining his communication abilities using all available communication resources. We outline principles of discourse intervention in semantic dementia based on our experience of delivering individual and group intervention to Bobby V. Outcomes and Results: The communicative effectiveness framework described here could be used to characterise communication skills, set therapy goals, and monitor progress in semantic dementia. Discourse intervention likely facilitated Bobby Vs continued success in maintaining communication despite progressive loss of nouns and verbs. Conclusions: Targeting conversational effectiveness in terms of communicative functions offers a promising and ecologically valuable intervention for people with semantic dementia, as it allows individuals with this form of dementia to connect meaningfully with people in their immediate surroundings well into the later stages of the disease. We deeply appreciate support from the Frank Garrott Fund, Temple Stark Fund, and other private donors to the Center for BrainHealth, as well as professional support from Anne M. Lipton, Katy Milton, and Garen Sparks. We are profoundly grateful for Bobby V and his wife, who have taught us much about optimism and adaptation in the face of difficulty.

Convergence of connected language and SPECT in variants of frontotemporal lobar degeneration.

The characterization of frontotemporal lobar degeneration (FTLD) is complicated and not widely recognized. Connected language measures (ie, discourse) and functional neuroimaging may advance knowledge specifying early distinctions among frontal dementias. The present study examined the correspondence of discourse measures with (1) clinical diagnosis and (2) single photon emission computed tomography (SPECT) imaging. Nineteen subjects were selected from Alzheimers Disease Center (ADC) participants if they were diagnosed with early-stage frontotemporal lobar degeneration and also underwent single photon emission computed tomography and discourse evaluation. First, clinical diagnoses given by specialists at an Alzheimers Disease Center were compared with the discourse-based diagnostic profiles. Secondly, compromised brain regions that were predicted from discourse profiles were compared with SPECT findings. Results revealed a significant correspondence between the ADC diagnosis and the discourse-based diagnoses. Also, the discourse profiles across frontotemporal lobar degeneration subtypes were consistently associated with distinctive patterns of SPECT hypometabolism in the right frontal, left frontal, or left temporal lobes. These findings suggest that discourse methods may be systematized to provide an efficient adjunct measure beyond the traditional word and sentential level measures. Objectifying complex language performance may contribute to early detection and differentiation among frontotemporal lobar degeneration variants because consensus in the literature states that language is a core disturbance of frontotemporal lobar degeneration.

Brain Health Fitness: Beyond Retirement.

The greatest accomplishment of the 20th century—the doubling of the human lifespan—has brought issues related to brain health to the forefront of public health policy. Given that our bodies are outlasting our minds, maximizing brain health is the scientific cause of this millennium. In this paper, we address three major issues related to maintaining and, perhaps, enhancing brain health in seniors. First, we define the construct of brain health fitness. Second, we discuss gist reasoning as a metric of brain health fitness and as a construct of brain health training. Lastly, we propose that healthy brain habits can be practiced by incorporating gist reasoning during complex everyday life and leisure activities to elevate chances for maintaining brain health fitness beyond retirement for a sustainable future.