Verb Naming in Normal Aging

Few studies have examined verb naming in normal aging, although decline in the ability to name nouns has been well documented. In this study, we examined longitudinal performance on the Action Naming Test (ANT), a confrontation naming test for verbs. The purpose of this study was to confirm the verb naming deficit associated with aging, which was previously seen only in cross-sectional studies, and to provide additional normative data on verb naming ability that may prove useful to studies on verb naming in populations with brain dysfunction. Sixty-six healthy men and women aged 30 to 79 were each tested with the ANT 3 times over a 7-year span. ANT performance showed a significant decline over time for all participants except the youngest group. Longitudinal methodology supports the conclusion that this finding of a decline in verb naming ability arises from true age-related changes and not from cohort differences.

Lesions and identification of crystalline precipitates of glycoprotein IIb-IIIa antagonists in the rat kidney

Two glycoprotein IIb-IIIa antagonists (xemilofiban, SC-54684A, and orbofiban, SC-57099B), which are platelet aggregation inhibitors, caused crystalline precipitates in the kidney tubules of rats at high dosages. Dogs were not affected. Depending on the degree of the precipitation, which was dosage dependent, and the location, which differed somewhat between the two compounds, the lesions varied from acute obstruction with tubule cell necrosis, nephron dilation, and sudden death with no inflammation to severe chronic pyogranulomatous inflammation. In order to understand the relevance of the lesions, it was important to identify the precipitates. This was technically challenging because the crystals were water soluble (dissolving in routine fixing and staining techniques) and were present in insufficient quantity to physically isolate. Techniques were devised to evaluate the crystals in situ in unstained frozen sections prepared without directly embedding the tissues in supporting medium, which interfered with the analyses. The crystals were analyzed in situ by infrared and Raman spectroscopy and time-of-flight secondary ion mass spectroscopy (TOF-SIMS). Uroliths found in the renal pelvis of one animal were analyzed by liquid chromatography/mass spectrometry. The resulting spectra showed that the crystals were the de-esterified acids of the parent compounds. This knowledge allowed us to predict that the crystalline precipitates would not be a hazard to humans because of the large multiples of the human dosage at which they occurred and because of differences in renal physiology between rats, dogs, and humans.

Lesion site patterns in severe, nonverbal aphasia to predict outcome with a computer-assisted treatment program

OBJECTIVE

To test whether lesion site patterns in patients with chronic, severe aphasia who have no meaningful spontaneous speech are predictive of outcome following treatment with a nonverbal, icon-based computer-assisted visual communication (C-ViC) program.

DESIGN

Retrospective study in which computed tomographic scans performed 3 months after onset of stroke and aphasia test scores obtained before C-ViC therapy were reviewed for patients after receiving C-ViC treatment.

SETTING

A neurology department and speech pathology service of a Department of Veterans Affairs medical center and a university aphasia research center.

PATIENTS

Seventeen patients with stroke and severe aphasia who began treatment with C-ViC from 3 months to 10 years after onset of stroke.

MAIN OUTCOME MEASURE

Level of ability to use C-ViC on a personal computer to communicate.

RESULTS

All patients with bilateral lesions failed to learn C-ViC. For patients with unilateral left hemisphere lesion sites, statistical analyses accurately discriminated between those who could initiate communication with C-ViC from those who were only able to answer directed questions. The critical lesion areas involved temporal lobe structures (Wernicke cortical area and the subcortical temporal isthmus), supraventricular frontal lobe structures (supplementary motor area or cingulate gyrus 24), and the subcortical medial subcallosal fasciculus, deep to the Broca area. Specific lesion sites were also identified for appropriate candidacy for C-ViC.

CONCLUSIONS

Lesion site patterns on computed tomographic scans are helpful to define candidacy for C-ViC training, and to predict outcome level. A practical method is presented for clinical application of these lesion site results in combination with aphasia test scores.

On the nature of naming errors in aging and dementia: a study of semantic relatedness

This study investigated the nature of naming errors produced on the Boston Naming Test by patients with mild and moderate Alzheimer's disease (AD) and elderly and young controls, using a newly devised scoring system. This new approach involved ratings of error responses on a scale of semantic relatedness to the target name. Error responses of both mild and moderate AD subjects were no less semantically related to target names than were responses of age- and education-matched controls. We conclude that some available evidence of semantic loss in AD may be an artifact of the methodology chosen for evaluating naming errors.

Drawing to communicate: a case report of an adult with global aphasia

Treatment for adults with global aphasia has typically involved the use of verbal treatment methods or alternative communication techniques including communication boards, word lists and notebooks. However, many adults with aphasia are unable to communicate verbally and alternative communication techniques can be limited, as a result of the restricted number and type of concepts that can be adequately depicted and expressed. Another viable means of communication for the globally aphasic adult is drawing. However, few individuals with severe aphasia initiate communication through this modality without specific training. In this case report we present several successful treatment methods that were used to train an adult with global aphasia to communicate more effectively through drawing. Several of his drawings are presented to illustrate the results of training in the use of drawing as an alternative means of communication.

Emotional and non-emotional facial behaviour in patients with unilateral brain damage

Aspects of emotional facial expression (responsivity, appropriateness, intensity) were examined in brain-damaged adults with right or left hemisphere cerebrovascular lesions and in normal controls. Subjects were videotaped during experimental procedures designed to elicit emotional facial expression and non-emotional facial movement (paralysis, mobility, praxis). On tasks of emotional facial expression, patients with right hemisphere pathology were less responsive and less appropriate than patients with left hemisphere pathology or normal controls. These results corroborate other research findings that the right cerebral hemisphere is dominant for the expression of facial emotion. Both brain-damaged groups had substantial facial paralysis and impairment in muscular mobility on the hemiface contralateral to site of lesion, and the left brain-damaged group had bucco-facial apraxia. Performance measures of emotional expression and non-emotional movement were uncorrelated, suggesting a dissociation between these two systems of facial behaviour.

Effect of emotional context on bucco-facial apraxia

Patients with left- and right-hemisphere cerebrovascular pathology and normal adult controls were videotaped while executing tasks of bucco-facial praxis in emotional and nonemotional conditions. Each practic movement was assessed for accuracy and motor execution. Left-brain-damaged patients were significantly impaired on these tasks relative to right-damaged patients and controls. When emotional context was provided, apractic performance improved significantly.

The expression and perception of facial emotion in brain-damaged patients

This study examined the expression and perception of facial emotion in patients with unilateral cerebrovascular pathology. Subjects were 12 right brain-damaged (RBD), 15 left brain-damaged (LBD) aphasic, and 16 normal control (NC) right-handed males. Expressions were elicited during posed and spontaneous conditions. Both positive and negative emotions were studied. RBDs were significantly impaired, relative to LBDs and NCs, in expressing and perceiving facial emotion. There were no group differences as a function of condition, but there were differences as a function of emotional valence. Qualitative performance differences also were observed. There was no evidence that the ability to produce a particular emotion was related to the ability to identify the same emotion. Overall, these findings support the notion that the right cerebral hemisphere is dominant for expressing and perceiving facial emotion.

Lexical retrieval in healthy aging

Lexical retrieval for common nouns and verbs was measured using 2 picture naming tests in 162 healthy female and male subjects aged 30 to 79 years. Responses were scored for correctness, responsivity to cueing, and response type. The ability to name both word types declined with age, especially after age 70 in healthy subjects. More errors were made on object names than action names, especially for older subjects. Subjects of all ages were equally able to utilize phonemic cues. With increasing age subjects produced more circumlocutions and fewer semantic errors. Response type difference need not reflect qualitative differences in lexical retrieval; rather, they reflect the quantitatively greater difficulty of the task for healthy older people as compared to younger adults. The naming difficulty for healthy aging, we conclude, is at the label retrieval stage.

On comprehension across the adult lifespan

To test whether healthy elderly subjects develop language comprehension strategies to compensate for decreases in pure-tone audition, we tested 128 healthy subjects aged 30-79 on two tasks: (1) Comprehension materials from the Boston Diagnostic Aphasia Examination (Goodglass and Kaplan, 1972) presented over babble noise with and without the speaker's face visible; and (2) the Kalikow et al. (1977) Speech Perception in Noise test, which assesses the effect of semantic predictability on sentence-final word intelligibility. Whereas, as predicted, overall performance decreased with advancing age, it appeared, unexpectedly, that older and younger adults were equally affected by the absence of visual input and the absence of semantic predictability.

Channels of emotional expression in patients with unilateral brain damage

The contribution of facial, intonational, and speech channels to spontaneous emotional expression was examined in right brain-damaged (RBD), left brain-damaged (LBD), and normal control (NC) subjects. Subjects were videotaped while viewing and responding to a series of emotionally laden slides; the videotapes were then rated for the three channels of communication. Overall, RBDs used facial expression and intonation less frequently than the other two groups. When the speech output channel was analyzed, oral expression of feelings in the RBDs, relative to the LBDs and NCs, was less appropriate, more propositional than prosodic, and more descriptive than affective. When the ratings for the three channels of communication were examined, facial expression and intonation were significantly correlated for all subjects.

Non-consultant peripheral clinics: a new approach to diabetic care

A system of non-consultant peripheral clinics (NCPCs) established on the Isle of Wight is described. For the first phase of the study 182 diabetics attending the consultant clinic were allocated to the appropriate peripheral clinic (group 1). In the second phase, 152 new referrals were prospectively allocated between the consultant and appropriate peripheral clinics (group 2). Evaluation was made of the patients' random blood sugar and glycosylated haemoglobin. The savings in cost and time to patients resulted in over 90% of patients preferring the peripheral clinics. NCPCs are discussed in relation to hospital-based clinics and to other alternative systems of care. It is concluded that NCPCs could be incorporated into the diabetic service in other regions in the United Kingdom with advantages to diabetics and hospital services alike. These peripheral clinics are suited to all types of diabetics and perhaps the only clinical restriction is the desirability for metabolic deterioration to be managed by a consultant clinic until the patient is satisfactory.

Is there a bias in size measurements taken from mirror-reversed photographs of body parts?

This study compared measurements of hands, feet, and hemifaces taken from original and mirror-reversed photographs to determine whether a hemispace-bias exists in size measurements. Posers were adult right- and left-handers (50% female). In 80% of the measurement comparisons (total N = 84), there was complete agreement; there were no instances of right-left reversals among the discrepant comparisons. The side of the body measured as larger was independent of the side of space in which it appeared. The lack of such bias in physical measurements is discrepant with data suggesting a left-hemispace preference in psychological judgments of visual material.

Asymmetries in body part size, mobility, and usage. Relationship between structure and function

Asymmetries in structure (size) and function (usage or mobility) for the upper and lower face, hands, and feet were investigated in 42 left- and right-handed male and female college students. Size measurements were taken from photographs, mobility was rated from videotapes, and usage was assessed by questionnaire. Size asymmetries were typical, and independent of handedness, but were not consistent across body parts; usage asymmetries varied as a function of handedness. No systematic relationships were found between structure and function.

Two decades of change: Glenside Hospital population surveys 1960-80

Results of the fifth quinquennial survey of the patients of Glenside Hospital, Bristol, when compared with five yearly surveys over the past 20 years, show that the "run-down" of the hospital continues. There is still an accumulation of long-stay patients, mainly for non-medical reasons. They remain in hospital because of the failure to provide community facilities adequate to their needs. It is suggested that local authorities will never be able to cope with them and that the NHS should be enabled to extend their hospital services into "nursing homes" in the community.

'Dissolution of the mental hospital': fifteen years on

The pattern of decline of a mental hospital population over fifteen years is described. Continuing problems are commented on, particularly the presence of 'old' long-stay patients and the accumulation of 'new chronic patients'. The number of beds required for each of these categories is estimated. The dissolution of the mental hospital service by degradation is deplored, and a suggestion is made that some of the good points of the old service might be salvaged before it is too late.

The rehabilitation of long-stay schizophrenic patients who have had a leucotomy

Leucotomy has been used to treat many patients with schizophrenia. Although some patients seem to have derived considerable benefit from the operation, a number have shown little or no improvement (Board of Control, 1947, Tooth et al., 1961). An appreciable number of schizophrenic patients who have had a leucotomy remain long-stay patients in mental hospitals. In the last few years there has been an increased emphasis on the rehabilitation of chronically disabled psychiatric patients and the purpose of this paper is to assess the response to rehabilitation of long-stay schizophrenic patients several years after a leucotomy operation.

The rehabilitation of long-stay schizophrenic patients

An appreciable number of chronic schizophrenic patients otherwise destined to remain long-stay patients in mental hospitals, are able to live in the community if they undergo active rehabilitation. In this paper, an attempt is made to correlate the post-rehabilitation progress of long-stay schizophrenic patients with observations made during their rehabilitation.