Mark P. Kelly

The naming disorder of dementia

Naming impairment is a common feature of the language disorder of dementia, yet agreement has not been reached on its mechanisms. In this study, the confrontation naming performance of twelve demented subjects was compared to that of age-matched controls. Naming deficits were studied in relation to overall language and cognitive dysfunction and analysed to assess the importance of both perceptual and linguistic factors. Naming dysfunction occurred even in mild dementia, in patients whose overall language function remained normal, and worsened in proportion to the degree both of language deficit and overall cognitive dysfunction. Perceptual difficulty and word frequency, but not word length, were important determinants of naming performance in demented patients.

Facial Recognition Memory in Dementia

Previous investigations of memory in senile dementia of the Alzheimers type (SDAT) have focused on verbal learning and memory. The aim of the present study was to determine whether the amnesia of SDAT is limited to verbal material. Patients with SDAT (N = 29; mean age = 69.3) and healthy normal controls (N = 41; mean age = 69.3) were given a test of facial perception and two recognition memory tasks, one for words and one for faces. The results indicate that dementia patients show a deficit in the retention of facial information. This deficit cannot be attributed to faculty initial perception or to a response bias. The verbal and facial memory deficits in SDAT appear to differ: performance on tests of verbal and facial memory is relatively independent, and substantial encoding and linguistic defects contribute to the verbal, but not the facial, memory disorder resulting in more severe impairment on tests of verbal memory. The implications of these findings for research on the neuropharmacology and pathophysiology of SDAT are discussed.

Chronic carbon monoxide exposure: a clinical syndrome detected by neuropsychological tests.

Chronic exposure to carbon monoxide produces a clinical syndrome that is often overlooked because of obscure symptomatology, a range of presentations, and lack of awareness of the problem. To help physicians recognize and treat the chronic carbon monoxide exposure syndrome, the authors present its objective symptomatology, an approach to diagnosis emphasizing neuropsychological tests, a treatment protocol, and theoretical considerations for the mechanism of hyperbaric oxygens therapeutic action. For elucidation, eight patients treated in the hyperbaric chamber at a tertiary care facility are described. Diagnosis can be facilitated by recognizing the syndrome based on the patients history, as well as physical and neuropsychological examinations, with emphasis on identifying potential sources of carbon monoxide exposure. The evaluation and treatment protocols presented, though still experimental, show promise for improving functional, cognitive, and psychiatric capacities.

Motivation and Neuropsychological Test Performance Following Mild Head Injury

Effect of motivation on neuropsychological test performance in mild head injury was assessed. Motivation was measured using the Portland Digit Recognition Test. Three groups were compared: (a) mild head injury, financial incentives, good motivation; (b) mild head injury, financial incentives, poor motivation; (c) moderate/severe head injury, good motivation. The neuropsychological battery included measures of sensory function, motor function, attention, intelligence, reasoning, and memory. Mild head injury well motivated patients performed significantly better than the other two groups on some tests. Mild head injury poorly motivated individuals and moderate-severe head injury patients were indistinguishable on many tests. Consistent with previous reports, tactile sensory (finger recognition and Fingertip Number Writing Perception) and recognition memory (Rey Auditory Verbal Learning) tasks were identified as clinically useful measures of poor motivation. On these measures mild head injury well motivated examinees performed no better than moderate-severe patients, with both groups superior to mild head injury poorly motivated examinees. Sensitivity and specificity data are reported. Our measures of tactile sensation and verbal recognition memory were more affected by motivation than by the severity of head injury.

Reversible mental symptoms in temporal arteritis.

Mental symptoms are common in temporal arteritis. Reported here is a case in which a deficit in nonverbal memory documented with psychological testing resolved after a course of steroids. Besides the global confusional states commonly seen in temporal arteritis, focal intellectual impairment may be seen. It seems possible that some patients presenting with dementia as well as focal mental signs may have temporal arteritis. The diagnosis can easily be made by performing an erythrocyte sedimentation rate and temporal artery biopsy.

The amnesia of transient global amnesia

abstract A patient was tested during and following an episode of transient global amnesia. During the episode, the patient displayed a profound anterograde amnesia which spared short-term memory. There was also a retrograde amnesia which was transient and which involved recent material but not memory for events and persons that became famous between 1930 and 1975. The results are discussed in the context of current memory models and some speculative interpretations of the amnesia are offered.

Wechsler adult intelligence scale and wechsler adult intelligence scale-revised in a neurologically impaired population

Compared Verbal, Performance, and Full Scale IQ scores from two groups of neurologically impaired patients (N = 114) similar in age, years of education, occupation, race, sex, and etiology and location of cerebral dysfunction. One group had been given the WAIS and the other the WAIS-R. All three IQ scores were higher for the WAIS group, with Full Scale and Verbal scores significantly (p less than .05) higher. Changes in item content and standardization sample cohort effects are offered as partial possible explanation for the results. The IQ scores from the two tests cannot be considered as interchangeable for neurological patients.

Anomia in cerebral diseases

Naming performance was studied in demented patients, age-matched controls, left-hemisphere stroke patients with aphasia and right-hemisphere stroke patients. The experimental naming test compared four levels of perceptual difficulty and two language variables: word frequency and word length. Naming accuracy and error types were compared among subject groups. Perceptual difficulty influenced naming in the demented and right-hemisphere stroke patients, but not in aphasics and controls. Visual errors, likewise, characterized the former two groups. Semantically-related errors and circumlocutions characterized the naming of aphasic and demented patients, while phonemic errors were common only in aphasics. The results suggested differing patterns of anomia in different patient groups.

Factitial aplastic anemia.

A 29-year-old married nurse with pancytopenia was discovered to be surreptitiously ingesting alkylating agents. Despite her life-threatening behavior, there was no evidence that she was psychotic, depressed, or cognitively impaired. Psychological testing was indicative of a sociopathic personality. The patient and her behavior elicited considerable affect and controversy among members of her health team. It is hypothesized that the patients behavior resulted from longstanding low self-esteem. The production of a dramatic illness gratified dependency needs and fooling physicians gave her a sense of power.