Memory impairment at initial clinical presentation in posterior cortical atrophy

Posterior cortical atrophy (PCA) is characterized by core visuospatial and visuoperceptual deficits, and predominant atrophy in the parieto-occipital cortex. The most common underlying pathology is Alzheimer's disease (AD). Existing diagnostic criteria suggest that episodic memory is relatively preserved. The aim of this study was to examine memory performance at initial clinical presentation in PCA, compared to early-onset AD patients (EOAD). 15 PCA patients and 32 EOAD patients, and 34 healthy controls were entered into the study. Patients were tested on the Addenbrooke's Cognitive Examination (ACE-R), consisting of subscales in memory and visuospatial skills. PCA and EOAD patients were significantly impaired compared to controls on the ACE total score (p <  0.001), visuospatial skills (p <  0.001), and memory (p <  0.001). Consistent with the salient diagnostic deficits, PCA patients were significantly more impaired on visuospatial skills compared to EOAD patients (p <  0.001). However, there was no significant difference between patient groups in memory. Further analysis of learning, recall, and recognition components of the memory subscale showed that EOAD and PCA patients were significantly impaired compared to controls on all three components (p <  0.001), however, there was no significant difference between EOAD and PCA patients. The results of this study show that memory is impaired in the majority of PCA patients at clinical presentation. The findings suggest that memory impairment must be considered in assessment and management of PCA and second. Further study into memory in PCA is warranted, since the ACE-R is a brief screening tool and is likely to underestimate the presence of memory impairment

Where words meet numbers:Comprehension of measurement unit terms in posterior cortical atrophy

Units of measurement (e.g., metre, week, gram) are critically important concepts in everyday life. Little is known about how knowledge of units is represented in the brain or how this relates to other forms of semantic knowledge. As unit terms are intimately connected with numerical quantity, we might expect knowledge for these concepts to be supported by parietally-mediated representations of space, time and magnitude. We investigated knowledge for measurement units in patients with posterior cortical atrophy (PCA), who display profound impairments of spatial and numerical cognition associated with occipital and parietal lobe atrophy. Relative to healthy controls, PCA patients displayed impairments for a range of unit-based knowledge, including the ability to specify the dimension which a unit refers to (e.g., grams measure mass), to select the appropriate units to measure everyday quantities (grams for sugar) and to determine the relative magnitudes of different unit terms (gram is smaller than kilogram). In most cases, their performance was also significantly poorer than a patient control group diagnosed with typical Alzheimer's disease. Our results suggest that impairment to systems that code numerical and spatial magnitudes has an effect on non-numerical verbal knowledge for measurement units. Units of measurement appear to lie at the intersection of the brain's verbal and numerical semantic systems, making them a critical class of concepts in which to investigate how magnitude-based codes contribute to verbal semantic representation

Facilitating text reading in posterior cortical atrophy

Objective We report 1) the first quantitative investigation of text reading in posterior cortical atrophy (PCA); and 2) the effects of two novel software-based reading aids that result in dramatic improvements in PCA patients' reading ability. Methods Reading performance, eye movements and fixations were assessed in PCA and typical Alzheimer’s disease (tAD) patients and healthy controls (Experiment 1). Two reading aids (single- and double-word) were evaluated based on the notion that reducing the spatial and oculomotor demands of text reading might support reading in PCA (Experiment 2). Results PCA patients’ mean reading accuracy was significantly worse (57%) compared to both tAD patients (98%) and healthy controls (99%); spatial aspects of passages were the primary determinants of text reading ability in PCA. Both aids led to considerable gains in reading accuracy (PCA mean reading accuracy: single-word reading aid = 96%; individual patient improvement range: 6%-270%) and self-rated measures of reading. Data suggest a greater efficiency of PCA patients’ fixations and eye movements under the single-word reading aid. Conclusions These findings demonstrate how neurological characterisation of a neurodegenerative syndrome (PCA) and detailed cognitive analysis of an important everyday skill (reading) can combine to yield aids capable of supporting important everyday functional abilities. Classification of evidence This study provides Class III evidence that for patients with posterior cortical atrophy, two software-based reading aids (single-word and double-word) improve reading accuracy

Abstract conceptual feature ratings: the role of emotion, magnitude, and other cognitive domains in the organization of abstract conceptual knowledge.

This study harnessed control ratings of the contribution of different types of information (sensation, action, emotion, thought, social interaction, morality, time, space, quantity, and polarity) to 400 individual abstract and concrete verbal concepts. These abstract conceptual feature (ACF) ratings were used to generate a high dimensional semantic space, from which Euclidean distance measurements between individual concepts were extracted as a metric of the semantic relatedness of those words. The validity of these distances as a marker of semantic relatedness was then tested by evaluating whether they could predict the comprehension performance of a patient with global aphasia on two verbal comprehension tasks. It was hypothesized that if the high-dimensional space generated from ACF control ratings approximates the organization of abstract conceptual space, then words separated by small distances should be more semantically related than words separated by greater distances, and should therefore be more difficult to distinguish for the comprehension-impaired patient, SKO. SKO was significantly worse at identifying targets presented within word pairs with low ACF distances. Response accuracy was not predicted by Latent Semantic Analysis (LSA) cosines, any of the individual feature ratings, or any of the background variables. It is argued that this novel rating procedure provides a window on the semantic attributes of individual abstract concepts, and that multiple cognitive systems may influence the acquisition and organization of abstract conceptual knowledge. More broadly, it is suggested that cognitive models of abstract conceptual knowledge must account for the representation not only of the relationships between abstract concepts but also of the attributes which constitute those individual concepts

Measuring physiological responses to the arts in people with dementia

The dementias are a group of progressive symptoms that have multiple causes, usually caused by disease or injury of the brain, affecting higher brain functions such as language, perception, memory, reasoning and mood; they can also be associated with changes in personality. Arts interventions and interaction with the arts can create meaningful, positive experiences for people with a dementia, as well as improve quality of life. Qualitative research in particular, has been able to describe the emotional responses the arts can produce, but quantifiable changes have not been well documented. Physiological measurements such as stress hormone levels and galvanic skin response show promise in being able to quantify such responses. When taken together, these can give a picture of the kinds of physiological outcomes that are associated with positive affect and improvements in mental wellbeing in the context of arts interventions. This review provides a critical overview of the studies which measure some form of physiological outcome in response to the arts or an arts intervention in people with dementia, and indicates how future research in this area can help to broaden our understanding of the effects of the arts in dementia research and care

Defining a Conceptual Topography of Word Concreteness: Clustering Properties of Emotion, Sensation, and Magnitude among 750 English Words

Cognitive science has a longstanding interest in the ways that people acquire and use abstract vs. concrete words (e.g., truth vs. piano). One dominant theory holds that abstract and concrete words are subserved by two parallel semantic systems. We recently proposed an alternative account of abstract-concrete word representation premised upon a unitary, high dimensional semantic space wherein word meaning is nested. We hypothesize that a range of cognitive and perceptual dimensions (e.g., emotion, time, space, color, size, visual form) bound this space, forming a conceptual topography. Here we report a normative study where we examined the clustering properties of a sample of English words (N = 750) spanning a spectrum of concreteness in a continuous manner from highly abstract to highly concrete. Participants (N = 328) rated each target word on a range of 14 cognitive dimensions (e.g., color, emotion, valence, polarity, motion, space). The dimensions reduced to three factors: Endogenous factor, Exogenous factor, and Magnitude factor. Concepts were plotted in a unified, multimodal space with concrete and abstract concepts along a continuous continuum. We discuss theoretical implications and practical applications of this dataset. These word norms are freely available for download and use at http://www.reilly-coglab.com/data/

Looking but Not Seeing: Recent Perspectives on Posterior Cortical Atrophy

Posterior cortical atrophy (PCA) is the canonical “visual dementia,” with affected individuals experiencing a progressive disintegration of their visual world owing to dysfunction and atrophy at the back of the brain. The syndrome, which also affects literacy, numeracy, and gesture, is typically caused by Alzheimer’s disease, but is distinguished from more common amnestic presentations by virtue of relatively preserved episodic memory and insight. Although problems with object and space perception are the most widely reported and investigated symptoms, these higher-order perceptual difficulties are often underpinned by an array of changes in more basic visual and oculomotor processes. Here we review recent studies providing insights into these more elementary aspects of vision in PCA, including fixation stability, saccade generation, point localization, excessive crowding, and factors affecting the effective field of vision. We argue that a more detailed appreciation of these fundamental changes in the early visual system not only will improve the characterization and understanding of this rare clinico-radiological syndrome but will also guide the design of visual aids and strategies aimed at maintaining everyday abilities in individuals with PCA

The cognitive organization of music knowledge: a clinical analysis

Despite much recent interest in the clinical neuroscience of music processing, the cognitive organization of music as a domain of non-verbal knowledge has been little studied. Here we addressed this issue systematically in two expert musicians with clinical diagnoses of semantic dementia and Alzheimer’s disease, in comparison with a control group of healthy expert musicians. In a series of neuropsychological experiments, we investigated associative knowledge of musical compositions (musical objects), musical emotions, musical instruments (musical sources) and music notation (musical symbols). These aspects of music knowledge were assessed in relation to musical perceptual abilities and extra-musical neuropsychological functions. The patient with semantic dementia showed relatively preserved recognition of musical compositions and musical symbols despite severely impaired recognition of musical emotions and musical instruments from sound. In contrast, the patient with Alzheimer’s disease showed impaired recognition of compositions, with somewhat better recognition of composer and musical era, and impaired comprehension of musical symbols, but normal recognition of musical emotions and musical instruments from sound. The findings suggest that music knowledge is fractionated, and superordinate musical knowledge is relatively more robust than knowledge of particular music. We propose that music constitutes a distinct domain of non-verbal knowledge but shares certain cognitive organizational features with other brain knowledge systems. Within the domain of music knowledge, dissociable cognitive mechanisms process knowledge derived from physical sources and the knowledge of abstract musical entities