Joël Macoir

Psychogenic or neurogenic origin of agrammatism and foreign accent syndrome in a bipolar patient: a case report

BackgroundForeign accent syndrome (FAS) is a rare speech disorder characterized by the appearance of a new accent, different from the speakers native language and perceived as foreign by the speaker and the listener. In most of the reported cases, FAS follows stroke but has also been found following traumatic brain injury, cerebral haemorrhage and multiple sclerosis. In very few cases, FAS was reported in patients presenting with psychiatric disorders but the link between this condition and FAS was confirmed in only one case.Case presentationIn this report, we present the case of FG, a bipolar patient presenting with language disorders characterized by a foreign accent and agrammatism, initially categorized as being of psychogenic origin. The patient had an extensive neuropsychological and language evaluation as well as brain imaging exams. In addition to FAS and agrammatism, FG also showed a working memory deficit and executive dysfunction. Moreover, these clinical signs were related to altered cerebral activity on an FDG-PET scan that showed diffuse hypometabolism in the frontal, parietal and temporal lobes bilaterally as well as a focal deficit in the area of the anterior left temporal lobe. When compared to the MRI, these deficits were related to asymmetric atrophy, which was retrospectively seen in the left temporal and frontal opercular/insular region without a focal lesion.DiscussionTo our knowledge, FG is the first case of FAS imaged with an 18F-FDG-PET scan. The nature and type of neuropsychological and linguistic deficits, supported by neuroimaging data, exclude a neurotoxic or neurodegenerative origin for this patients clinical manifestations. For similar reasons, a psychogenic etiology is also highly improbable.ConclusionTo account for the FAS and agrammatism in FG, various explanations have been ruled out. Because of the focal deficit seen on the brain imaging, involving the left insular and anterior temporal cortex, two brain regions frequently involved in aphasic syndrome but also in FAS, a cerebrovascular origin must be considered the best explanation to account for FGs language deficits.

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.

Known, lost, and recovered: Efficacy of formal‐semantic therapy and spaced retrieval method in a case of semantic dementia

Background: Few studies have addressed rehabilitation in semantic dementia. A potentially promising method is formal‐semantic therapy, which consists of tasks in which the names of concepts and their semantic characteristics are presented. It could also be enhanced by spaced retrieval, a learning method improving retention through recalling information after increasing recall intervals. Aims: This study explores the efficacy of both a formal‐semantic therapy and the spaced retrieval method to restore lost concepts in TBo, a woman with semantic dementia. Methods & Procedures: The formal‐semantic therapy consisted of giving TBo semantic feedback followed by a cueing technique to facilitate naming. Formal‐semantic therapy with simple repetition was compared to formal‐semantic therapy with spaced retrieval. TBos performance was measured throughout the study with picture naming and generation of verbal attributes. Two untrained lists were also measured for generalisation effects. Outcomes & Results: Results indicate that, after therapy, TBo could name 3/8 of the trained items, compared to no items on the untrained lists. She also showed an increase in performance for the evocation of specific semantic attributes of concepts, reaching 6/8 of correct responses. Moreover, she maintained her performance up to 5 weeks after the end of the study. Finally, when compared to simple repeated practice, spaced retrieval did not enhance learning and no generalisation was observed between trained and non‐trained categories. Conclusions: Along with recent results reported in the literature, TBos results confirm that people with semantic dementia can improve their naming performance with training but that this is limited. However, formal‐semantic therapy seems very promising for retraining specific semantic attributes. Instead of focusing on naming, we suggest that therapies used in semantic dementia should aim at restoring specific and functionally relevant concepts to enable the individuals to be more autonomous in daily living. The first author was supported by PhD awards from the Quebec Rehabilitation Research Network, the Canadian Institutes of Health Research, the Interdisciplinary Training in Research on Health and Aging, and the Ordre des ergothérapeutes du Québec. The authors also wish to thank TBo for her enthusiastic participation in this study, as well as Lindsey Nickels, Karen Croot, Kim S. Graham and two anonymous reviewers for their invaluable comments on earlier drafts of this paper.

The heterogeneity of cognitive symptoms in Parkinson's disease: a meta-analysis

Several studies have reported heterogeneity in cognitive symptoms associated with specific characteristics of patients with Parkinsons disease (PD). Indeed, researchers have characterised subtypes of patients suffering from PD according to various criteria. Those most frequently used are the type of predominant motor symptoms (tremors or non-tremor symptoms), age at onset and presence of depression. Some characteristics, like the predominant motor subtypes, as well as the presence of depression, are more widely used to categorise cognitive differences between patients. The goal of this study was to analyse the impact of the type of predominant motor symptoms and depression on cognition in PD. A meta-analysis of 27 studies (from 1989 to 2012) was carried out to calculate the average effect size of these factors on the most often used cognitive test during those past years to evaluate cognitive skills, the Mini-Mental State Examination. The studies analysed showed significant mean weighted effect sizes on cognition for the type of motor symptoms (d=0.42; 95% CI 0.30 to 0.54) and for depression (d=0.52; 95% CI 0.38 to 0.66). These results suggested that PD participants with non-tremor predominant motor symptoms or with depression had more or more severe cognitive impairments. Identification of different subtypes in PD is important for a better understanding of the cognitive symptoms associated with this disease. Better knowing the impact of different features of PD subgroups could help to design more appropriate treatments for patients with PD.

Comprehension of concrete and abstract words in patients with selective anterior temporal lobe resection and in patients with selective amygdalo-hippocampectomy.

The role of the anterior temporal lobe (ATL) in semantic memory is now firmly established. There is still controversy, however, regarding the specific role of this region in processing various types of concepts. There have been reports of patients suffering from semantic dementia (SD), a neurodegenerative condition in which the ATL is damaged bilaterally, who present with greater semantic impairment for concrete concepts than for abstract concepts, an effect known as reversal of the concreteness effect. This effect has previously been interpreted as reflecting degraded visual-perceptual features of objects due to damage to the inferior temporal lobes such as is observed in SD. Temporal lobe atrophy in SD, however, is bilateral even if it usually predominates to the left ATL, and it has been found to extend beyond the ATL, throughout the temporal lobes including medial and posterior temporal lobe regions. The question therefore remains whether greater impairment for concrete concepts results from damage to the ATL or from damage to the visual association cortex, and if unilateral damage can produce such a deficit. The aim of the present study was to investigate the processing of concrete and abstract words in rare patients who underwent a selective ATL surgical resection, and to compare their performance with that of patients with selective medial temporal lobe damage sparing the ATL region. Seven patients with a selective unilateral anterior temporal resection (ATL), 15 patients with a selective unilateral amygdalo-hippocampectomy (SeAH), and 15 healthy age- and education-matched controls underwent detailed neuropsychological assessment and carried out a semantic similarity judgment task evaluating their comprehension of concrete and abstract words. Results showed that both ATL and SeAH groups were significantly impaired on the semantic task relative to the control group. Within the patient groups, however, comprehension of concrete words was significantly more impaired than that of abstract words in the ATL group, while comprehension of abstract and concrete words was equally affected in the SeAH group. Results of this study suggest that the ATL region may play a critical role in processing concrete concepts, and that the reversal of the concreteness effect observed in ATL patients may result from damage to a categorical organization underlying the representation of concrete concepts.

Cooking “Shrimp à la Créole”: A pilot study of an ecological rehabilitation in semantic dementia

New learning in semantic dementia (SD) seems to be tied to a specific temporal and spatial context. Thus, cognitive rehabilitation could capitalise upon preserved episodic memory and focus on everyday activities which, once learned, will have an impact in everyday life. This pilot study thus explores the effectiveness of an ecological approach in one patient suffering from SD. EC, a 68-year-old woman with SD, stopped cooking complex meals due to a substantial loss of knowledge related to all food types. The therapy consisted of preparing a target recipe. She was asked to generate semantic attributes of ingredients found in one target, one control and two no-therapy recipes. The number of recipes cooked by EC between therapy sessions was computed. She was also asked to prepare a generalisation recipe combining ingredients from the target and control recipes. ECs generated semantic attributes (GSA) of ingredients pertaining to the target and control recipes increased significantly (p < .001), compared to the no-therapy recipes (ps > .79). The proportion of meals cooked also increased significantly (p = .021). For the generalisation recipe, she could not succeed without assistance. Frequent food preparation may have provided EC with new memories about the context, usage and appearance of some concepts. These memories seem very context-bound, but EC nonetheless re-introduced some recipes into her day-to-day life. The impact of these results on the relationship between semantic, episodic and procedural memory is discussed, as well as the relevance of an ecological approach in SD.

Simulated in-home teletreatment for anomia

This pilot study explored the feasibility of in-home teletreatment for patients with post-stroke anomia. Three participants over 65 years of age suffering from post-stroke anomia were treated in this pre/post-intervention case study. They received 12 speech therapy teletreatments (two sessions/week for 6 weeks) aimed at improving confrontation naming skills. Half of the failed items from a set of 120 preselected stimuli were trained during treatment (Block A-trained stimuli) while the other half served as controls (Block B-untrained stimuli). Variables measured were: 1) efficacy of treatment (performance on Block-A vs. Block B Stimuli), and 2) participants’ satisfaction with teletreatment (using a French adaptation of the Telemedicine satisfaction questionnaire). All participants showed a clinically relevant improvement on confrontation naming of trained items and less improvement for untrained items. The researchers also obtained high satisfaction scores on the questionnaire (above 57/60). This pilot study supports the feasibility of speech therapy teletreatments applied to neurological language disorders.

The Relation Between Depressive Symptoms and Semantic Memory in Amnestic Mild Cognitive Impairment and in Late-Life Depression

Semantic deficits have been documented in the prodromal phase of Alzheimers disease, but it is unclear whether these deficits are associated with non-cognitive manifestations. For instance, recent evidence indicates that cognitive deficits in elders with amnestic mild cognitive impairment (aMCI) are modulated by concomitant depressive symptoms. The purposes of this study were to (i) investigate if semantic memory impairment in aMCI is modulated according to the presence (aMCI-D group) or absence (aMCI group) of depressive symptoms, and (ii) compare semantic memory performance of aMCI and aMCI-D groups to that of patients with late-life depression (LLD). Seventeen aMCI, 16 aMCI-D, 15 LLD, and 26 healthy control participants were administered a semantic questionnaire assessing famous person knowledge. Results showed that performance of aMCI-D patients was impaired compared to the control and LLD groups. However, in the aMCI group performance was comparable to that of all other groups. Overall, these findings suggest that semantic deficits in aMCI are somewhat associated with the presence of concomitant depressive symptoms. However, depression alone cannot account solely for the semantic deficits since LLD patients showed no semantic memory impairment in this study. Future studies should aim at clarifying the association between depression and semantic deficits in older adults meeting aMCI criteria. (JINS, 2011, 17, 865-874).

Normative Data for the Rappel libre/Rappel indicé à 16 items (16-item Free and Cued Recall) in the Elderly Quebec-French Population

Performance on verbal memory tests is generally associated with socio-demographic variables such as age, sex, and education level. Performance also varies between different cultural groups. The present study aimed to establish normative data for the Rappel libre/Rappel indicé à 16 items (16-item Free and Cued Recall; RL/RI-16), a French adaptation of the Free and Cued Selective Reminding Test (Buschke, 1984; Grober, Buschke, Crystal, Bang, & Dresner, 1988). The sample consisted of 566 healthy French-speaking older adults (50–88 years old) from the province of Quebec, Canada. Normative data for the RL/RI-16 were derived from 80% of the total sample (normative sample) and cross-validated using the remaining participants (20%; validation sample). The effects of participants’ age, sex, and education level were assessed on different indices of memory performance. Results indicated that these variables were independently associated with performance. Normative data are presented as regression equations with standard deviations (symmetric distributions) and percentiles (asymmetric distributions).

The impact of semantic dementia on everyday actions: evidence from an ecological study.

In theory, semantic memory may trigger and support the execution of everyday activities. This study explored this question by comparing three patients with semantic dementia to 40 normal controls performing different everyday activities. Participants were tested in their home using the Instrumental Activities of Daily Living Profile, an ecological measure of everyday functioning. Participants were informed that they had unknowingly invited two guests for lunch and should prepare accordingly. With these instructions, they dress to go outdoors, go to the grocery store, shop for food, prepare a hot meal, have the meal with the guests, and clean up after the meal. Performance was analyzed on the basis of four operations related to problem solving: formulate a goal, plan, execute, and verify attainment of the goal. Results indicate that compared to normal controls, two patients had significant difficulties and needed assistance with all operations of problem-solving, particularly while preparing a meal and cleaning up after the meal. One patient showed no difficulties despite severe semantic deficits. These results suggest that semantic deficits alone cannot explain the difficulties observed, but may contribute to some aspects of everyday actions such as those involved in everyday problem-solving.