Robyn F. Cruz

Comparing the difficulty of letter, semantic, and name fluency tasks for normal elderly and patients with Parkinson's disease

Research on the effect of Parkinsons disease (PD) on verbal fluency has produced conflicting results. In this study, 88 PD patients with no dementia, 11 PD patients with questionable mental status, 15 PD patients with dementia, and 46 elders free from mental disorder were administered a variety of semantic, letter, and name fluency tasks. The results revealed that, contrary to popular assumption, semantic fluency was not always superior to letter fluency. Rather, verbal fluency was influenced by the nature of the individual categories. Interestingly, the relative difficulty of many categories was fairly stable across groups. The results also indicated that the individual fluency tasks were differentially sensitive to the mental status of the PD patients. Overall, the findings suggest that closer attention to the nature of the tested categories may help clarify the inconsistent effects of PD on verbal fluency.

Frequency of perseveration in normal subjects.

Although perseveration is a recognized sign of disturbed brain function, it also occurs in normal individuals. Determination of the frequency of perseveration in normal subjects would enable clinicians to use perseveration as a marker of possible pathology. The purpose of this study was to document the extent of perseveration in normal young and older subjects. Thirty young normal individuals between the ages of 20 and 35 years and 30 older normal individuals between the ages of 60 and 75 years were given four tasks on which perseveration has been reported in brain-damaged individuals. Four percent of all responses were perseverative. No age or gender effects on frequency were observed. Of the four neuropsychological tasks, the Modified Wisconsin Card Sorting Test elicited the greatest number of perseverations.

Communication abilities of individuals with late-stage Alzheimer disease.

The communication abilities of 49 individuals in the late stage of Alzheimer disease were examined in relation to other markers of late-stage Alzheimer disease (e.g., incontinence and ambulatory ability). Two existing tools used to stage severity of dementia, the Global Deterioration Scale and the Functional Assessment Stages, have represented communication abilities in individuals with late-stage Alzheimer disease to be minimal to nonexistent. The individuals in this sample showed greater communication skills and verbal output than would be predicted by these scales.

Gender differences in language of Alzheimer disease patients revisited.

Results of recent investigations suggest that Alzheimer disease (AD) has a more deleterious effect on language in women than in men. This intriguing finding motivated an analysis of the language performance of probable AD patients, equally divided as to gender, on a variety of language comprehension and production tests. Cross-sectional data were available for 63 probable AD subjects and longitudinal data were available for 26. In addition to analysis of covariance used with the cross-sectional data, effect sizes were calculated. The longitudinal data were analyzed with repeated-measures analyses of covariance. The sum of scores on the orientation items of the Mini-Mental State Examination was used as the covariate in both analyses. No significant differences between the performance scores of male and female subjects were obtained for either the cross-sectional or longitudinal data. All effect sizes of gender were relatively small, with female patients outperforming males on most language tests. Results are discussed in the context of previous findings and comparison of the effect sizes among studies.

Perseverative behaviour in fluent and non-fluent aphasic adults

Perseveration by type (recurrent, continuous, or stuck-in-set) was examined for 30 stroke patients, 20 of whom exhibited fluent aphasia, and 10 with non-fluent aphasia. Comparisons were made between the two aphasic subject groups on two verbal and two non-verbal tasks. Twenty-eight of the patients (93%) produced at least one instance of perseveration. The most commonly occurring type was recurrent perseveration. Instances of continuous perseveration also were common and were produced by 18 patients. Stuck-in-set perseveration was uncommon with only two patients exhibiting this form of perseveration. No differences were observed in the frequency of perseveration across the four tasks between fluent and non-fluent aphasic patients. Perseveration was significantly correlated with aphasia severity, but not with time post-onset.

Hemispheric specialisation for imitation of hand-head positions and finger configurations: a controlled study in patients with complete callosotomy.

Several studies of patients with unilateral brain damage and a patient with spontaneous callosal disconnection [Journal of Neurology, Neurosurgery, and Psychiatry 61 (1996) 176; Neuropsychologia 37 (1999) 559; Neuropsychologia 39 (2001) 1432] suggest that the imitation of positions of the hand relative to the head is a strongly lateralised left hemispheric function. In contrast, the imitation of finger configurations draws on resources of both hemispheres with a predominance of the right hemisphere. While these findings suggest a specific pattern of imitation impairment in split-brain patients, thus far, no imitation deficits have been reported in split-brain patients. Three patients with complete callosotomy and two control groups, four patients with partial callosotomy and 10 healthy subjects, imitated hand-head positions and finger configurations with non-lateralised and tachistoscopic stimulus presentation. In addition, the influence of visual control on the imitation performance was examined. One split-brain patient showed the predicted dissociation as she had severe right hemispheric deficit in imitating hand-head positions, while finger configuration imitation was preserved. The other two split-brain patients had no impairment in hand-head position imitation. Withdrawal of visual control significantly deteriorated imitation of finger configurations in the split-brain group, but not in the controls, demonstrating that the split-brain patients relied heavily on visual control as a compensatory strategy indicating an imitation deficit in the separate hemispheres. The findings question the previously held belief that in split-brain patients both hemispheres are perfectly capable of imitating gestures and that imitation is not dependent on hemispherically specialised functions.

Performance of Alzheimer's disease patients in judging word relatedness.

Sixty individuals with probable Alzheimers disease (AD) and 48 normal elders were given a task in which they had to judge the relatedness of concepts as a means of evaluating semantic memory. Very mild AD patients performed similarly to normal elders. Mild AD patients were significantly inferior in performance to normals but the pattern of their performance did not suggest a loss of conceptual knowledge. Moderate AD patients were significantly inferior in performance to mild AD patients, and 8 moderate AD patients (compared to 1 mild AD patient) were unable to do the task. The pattern of performance of moderate patients suggests that conceptual knowledge may degrade and ultimately be lost.

The Relation of Mental Status to Performance on Lexical-Semantic Tasks in Parkinson's Disease

Individuals with Parkinsons disease (PD) can experience changes in mental status and intellectual functioning. Those with dementia are said to exhibit a pattern of intellectual change similar to that experienced by individuals with Alzheimers disease (AD), including deterioration of lexical-semantic knowledge. A popular theory about the dissolution of lexical-semantic knowledge in individuals with AD is that loss of attribute knowledge (knowledge of specific attributes of an object) precedes loss of categorical knowledge (knowledge of the category to which the object belongs). One hundred and one individuals with idiopathic PD, who varied in Mini-Mental State Examination (Folstein, Folstein, & McHugh, 1975) performance, were given three tests of attribute knowledge and three tests of category knowledge. Results indicate that performance on lexical-semantic tests was adversely affected in PD patients whose mental status scores were 26 or lower. However, no evidence was obtained that attribute knowledge was lost before category knowledge.

Test Review Communication and Symbolic Behavior Scales

The CSBS is intended to generate profiles of strengths and weaknesses for a child across communicative, social-affective, and symbolic domains of development for use in diagnostic assessment and intervention planning. Because of the well documented variability in normal development of language, the sensitivity to different rates of growth in children is an important part of the CSBS. In order for abnormal variability to be detected, normal variability must be sufficiently handled by the conversion of raw scores to standard scores. Goodwyn (1995) examined the variability of CSBS standard scores over time in a small sample of normally developing infants using generalizability theory (Cronbach, Gleser, Nanda, & Rajaratnam, 1972). Generally, her findings indicated sensitivity of the instrument to varying rates of development across children, sensitivity to changes in childrens abilities over time, and proper functioning of the normed scores. The relatively small sample size (N = 282) used in the development of the instruments norms is an aspect of the CSBS that could be cause for concern. Yet, Goodwyn (1995) found no evidence for improper functioning of the norms. Some limitations regarding the administration and scoring of the instrument are worth noting. We found a significant disparity in the estimated and actual time required to score the videotaped samples. Even after training and experience with the instrument, we found that scoring took a minimum of one hour and forty-five minutes. Although we have not reveiwed the Scoring Tutorial tapes, it is likely that they will be helpful due to the complexity of the scoring. Applied Symbolix is scheduled to release the CSBS Quick Score in the near future. The Quick Score is designed to reduce the complexity of recording and scoring the instrument. A reordering of the testing procedure during the Language Comprehension portion may be advisable. As the objective is to assess the childs linguistic comprehension, we suggest measuring this while the child is initially focused on the doll prior to presenting the toy sets in the Symbolic Play Probes section of the testing procedure. We have found during testing, that once children have been presented with the toy sets in the Symbolic Play Probes section, they are reluctant to go back to focus only on the doll to identify body parts in the Language Comprehension Probes section. Reordering the testing procedure in this way may cause the norms for the symbolic cluster scale and communication composite score to change slightly. Increased awareness of the need for early detection and intervention of disorders in children was underscored by the inclusion of children under the age of five in the Individuals with Disabilities Education Act. The CSBS has potential to be a useful tool for early identification and intervention planning of language and communication disorders for this age group. The standardized behavior sampling used in the CSBS is unique; with further development, the CSBS may become the instrument of choice for assessing communication and symbolic abilities in very young children.