Preserved cognitive skills in dementia of the Alzheimer type

Serial reversal learning in an olfactory discrimination task in 3xTg-AD mice

Male and female 3xTg-AD mice between 5 and 24 mo of age and their B6129F2/J wild-type controls were tested on a series of 18 olfactory discrimination and reversal tasks in an operant olfactometer. All mice learned the odor discriminations and reversals to a criterion of 85% correct, but the 3xTg-AD mice made fewer errors than the B6129F2/J mice in the odor discriminations and in the first six reversal learning tasks. Many mice showed evidence of near errorless learning, and on the reversal tasks the 3xTg-AD mice showed more instances of near errorless learning than the B6129F2/J mice. There was no evidence of an age effect on odor discrimination, but there was a decrease in errorless reversal learning in aged B6129F2/J mice. In long-term memory tests, there was an increase in the number of errors made but no genotype difference. The high level of performance indicates that the mice were able to develop a "learning to learn" strategy. The finding that the 3xTg-AD mice outperformed their littermate controls provides an example of paradoxical functional facilitation in these mice.

Sensogenomics of music and Alzheimer's disease: An interdisciplinary view from neuroscience, transcriptomics, and epigenomics

Introduction

The relationship between music and Alzheimer's disease (AD) has been approached by different disciplines, but most of our outstanding comes from neuroscience.

Methods

First, we systematically reviewed the state-of-the-art of neuroscience and cognitive sciences research on music and AD (>100 studies), and the progress made on the therapeutic impact of music stimuli in memory. Next, we meta-analyzed transcriptomic and epigenomic data of AD patients to search for commonalities with genes and pathways previously connected to music in genome association, epigenetic, and gene expression studies.

Results

Our findings indicate that >93% of the neuroscience/ cognitive sciences studies indicate at least one beneficial effect of music on patients with neurodegenerative diseases, being improvements on memory and cognition the most frequent outcomes; other common benefits were on social behavior, mood and emotion, anxiety and agitation, quality of life, and depression. Out of the 334 music-related genes, 127 (38%) were found to be linked to epigenome/transcriptome analysis in AD (vs. healthy controls); some of them (SNCA, SLC6A4, ASCC2, FTH1, PLAUR and ARHGAP26) have been reported to be associated e.g. with musical aptitude and music effect on the transcriptome. Other music-related genes (GMPR, SELENBP1 and ADIPOR1) associated to neuropsychiatric, neurodegenerative diseases and music performance, emerged as hub genes in consensus co-expression modules detected between AD and music estimulated transcriptomes. In addition, we found connections between music, AD and dopamine related genes, with SCNA being the most remarkable - a gene previously associated with learning and memory, and neurodegenerative disorders (e.g., Parkinson's disease and AD).

Discussion

The present study indicate that the vast majority of neuroscientific studies unambiguously show that music has a beneficial effect on health, being the most common benefits relevant to Alzheimer's disease. These findings illuminate a new roadmap for genetic research in neurosciences, and musical interventions in AD and other neurodegenerative conditions.

Assessing music-related memory in people with dementia: a scoping review

OBJECTIVES

There are various type of music-related memory and different aspects of impairment caused by dementia. The purpose of this scoping review was to identify methods and map key concepts in assessing music-related memory in people with dementia.

METHOD

The review was conducted using the five steps in the framework proposed by Arksey and O'Malley. Databases and other sources were searched to identify relevant studies, and data selection and abstraction were performed.

RESULTS

A total of 35 studies that met the selection criteria were finally selected and analysed. We confirmed that the assessment of music-related memory can be systematically classified as assessing short-term or long-term memory, explicit or implicit memory, depending on the type of memory. Regarding the key concept of assessing music-related memory, we mapped a conceptual framework for the interrelationships between music and memory from a person-centered perspective.

CONCLUSION

Comprehensive information on music-related memory obtained through the assessment will be helpful for a holistic understanding of the person with dementia. In addition, it will provide meaningful information for specific planning and application of musical experiences that can be effectively used in music therapy. Further research is needed to establish the reliability and validity of the assessment.

User-centred iterative design of a smartwatch system supporting spontaneous reminiscence therapy for people living with dementia

Reminiscence therapy is beneficial for improving the quality of life for older adults living with dementia. However, it is difficult for caregivers in care homes to make this part of their daily practice because remembering a resident's individual stories is difficult. Proximity-aware technologies can make rapid connections between residents, their histories, and nearby artefacts. Through a user-centred iterative design approach, we designed Memento, a prototype technology system that makes it easy and convenient for caregivers to connect residents with real stories from their past and engage them in meaningful conversations. Memento displays connections between a resident's stories and their surroundings on a caregiver smartphone. Caregivers can then subtly use this information to start spontaneous reminiscences with residents, as they go about their everyday activities. Remembering their histories was highly enjoyable for residents, giving them a renewed sense of self-confidence and well-being.

Preservation of Musical Memory Throughout the Progression of Alzheimer's Disease? Toward a Reconciliation of Theoretical, Clinical, and Neuroimaging Evidence

Through this review of 25 clinical and experimental works on long-term musical memories in Alzheimer's disease (AD) patients, we attempt to clarify the conceptual understanding of musical memories, identify their evolution across the stages of the pathology, and propose possible explanations concerning the neural and cognitive mechanisms that underpin the preservation and impairment of certain musical memories. After clarifying the different kind of musical memories, we investigated their alterations throughout AD's progression from mild to severe stages. Both procedural and retrograde semantic memory seem relatively spared in AD, while episodic memory appears to be impaired early. Moreover, partial preservation of music encoding in AD can be revealed through paradigms that are especially designed for AD patients (relying on behavioral cues, using adapted settings, etc.). Although seldomly used, they would definitely help understanding the preserved capacities in every stage of AD. However, more research is needed to better understand this phenomenon and assess its specificity to music or other types of supports. These findings could lead to multiple applications in care settings and research designs, bringing more nuanced understanding of how long-term musical memory degrades throughout the course of AD, and should encourage us to prioritize patients' preserved cognitive abilities in current AD recreational and care programs.

Do painters need their whole brain to excel?

Skilled professional artists are sometimes able to maintain their talents while other cognitive functions deteriorate due to brain diseases. The objective of this study is to asses the preserved artistry of a professional painter in spite of the presence of strokes affecting brain areas implicated in art expression. She had a neurologic evaluation and brain imaging after the stroke; painter-curators analyzed and compared the painter's pictorial artwork created before and after the stroke. In spite of cerebellar, visuospatial, motor, cognitive, and functional deficits likely related to strokes affecting bilateral cerebellar, left occipital, and right temporal-occipital areas, the patient was able to maintain most of their artistic painting skills.. After a short period of functional recovery, our patient showed discrepancy among their impaired cerebellar cerebral functions in day activities and their preserved painting abilities.

Music-Based Therapeutic Interventions for People with Dementia: A Mini-Review

The growing population of people with dementia worldwide calls attention to the burdens associated with age-related decline that affects physiology, psychological and cognitive status, and social/emotional wellbeing. The current standards in geriatric care recommend non-pharmacological approaches to these challenges, including safe approaches to managing pain and stress, enhancing symptom relief, and fostering independent lifestyles with the highest quality of life possible. The purpose of this article is to provide definitions of music-based interventions, music therapy applications and clinician qualifications, as well as an umbrella mini-review of meta-analyses regarding music-based interventions for individuals with dementia. Our findings indicate that most descriptions of music therapy protocols in the research lack sufficient detail to enable researchers to compare and replicate studies, and clinicians to apply techniques. Definitions of music therapy and music-based interventions are inconsistent, and practitioners vary in their professional training and preparation for implementing music-based clinical strategies. We recommend that future researchers provide thorough descriptions of music therapy and music-based interventions in their protocols.

Cortical-subcortical production of formulaic language: A review of linguistic, brain disorder, and functional imaging studies leading to a production model

Formulaic language forms about one-fourth of everyday talk. Formulaic (fixed expressions) and novel (grammatical language) differ in important characteristics. The features of idioms, slang, expletives, proverbs, aphorisms, conversational speech formulas, and other fixed expressions include ranges of length, flexible cohesion, memory storage, nonliteral and situation meaning, and affective content. Neurolinguistic observations in persons with focal brain damage or progressive neurological disease suggest that producing formulaic expressions can be achieved by interactions between the right hemisphere and subcortical structures. The known functional characteristics of these structures form a compatible substrate for production of formulaic expressions. Functional imaging using a performance-based analysis supported a right hemisphere involvement in producing conversational speech formulas, while indicating that the pause fillers, uh and um, engage the left hemisphere and function like lexical items. Together these findings support a dual-process model of language, whereby formulaic and grammatical language are modulated by different cerebral structures.

Two new intergenerational interventions for Alzheimer's disease patients and families

Two new intergenerational interventions for Alzheimer's disease (AD) patients (with moderately severe to severe cognitive impairment) and families are being evaluated, with work to date described. Both interventions share the common goals of:

• Introducing a novel long-term care intervention for Alzheimer patients and their families in order to increase the quality of life for both;

• Increasing the incentive of family members, significant others, and volunteers to visit and spend time with AD patients;

• Increasing staff knowledge of the patient as person;

• Effecting a new intergenerational environment at sites providing care for AD patients; and

• Providing a new paradigm for innovative budget neutral programs, requiring no new public monies, building upon and leveraging existing resources to enhance the quality of life of older adults coping with dementing disorders.

The first intervention uses video biographies; the second involves the first game specifically designed for AD patients and their families. In pilot studies both interventions have been shown to increase patient engagement during visits approximately three-fold. Family and staff interest in both projects has been high.

Music and dementia

There is an increasing incidence of dementia in our aging population, and consequently an urgent need to develop treatments and activities that may alleviate the symptoms of dementia. Accumulating evidence shows that persons with dementia enjoy music, and their ability to respond to music is potentially preserved even in the late or severe stages of dementia when verbal communication may have ceased. Media interest in this topic has contributed to the public perception that music abilities are an "island of preservation" in an otherwise cognitively impaired person with dementia. In this chapter, we review the current literature on music cognition in dementia and show that there has been very scarce rigorous scientific investigation of this issue, and that various types of music memory exist and are differentially impaired in the different types of dementia. Furthermore, we discuss the recent development of music activities as a nonpharmacological treatment for dementia and highlight the methodological limitations of the current literature on this topic. While it has been reported that music activities can improve behavior, (particularly agitation), mood, and cognition in persons with dementia, recent large-scale randomized control studies have questioned the specificity of the effect of music and found that it is no more beneficial than other pleasant activities. Nevertheless, music is unique in its powerful ability to elicit both memories and emotions. This can provide an important link to individual's past and a means of nonverbal communication with carers, which make it an ideal stimulus for persons with dementia.

Postmorbid learning of saxophone playing in a patient with frontotemporal dementia

Some patients with frontotemporal dementia (FTD) show an artistic enhancement of musical abilities. However, no patients with FTD, to date, have been reported to be able to learn how to play a musical instrument after disease onset. Herein we describe a patient (J. K.) who had never played any musical instruments premorbidly, but who learned to play the saxophone after being diagnosed with a behavioral variant of FTD. He mastered a repertoire that consisted of 10 pieces of Korean folk songs over a period of three years. Furthermore, his saxophone skills were high enough to outperform other students in his class.

Hearing and music in dementia

Music is a complex acoustic signal that relies on a number of different brain and cognitive processes to create the sensation of hearing. Changes in hearing function are generally not a major focus of concern for persons with a majority of neurodegenerative diseases associated with dementia, such as Alzheimer disease (AD). However, changes in the processing of sounds may be an early, and possibly preclinical, feature of AD and other neurodegenerative diseases. The aim of this chapter is to review the current state of knowledge concerning hearing and music perception in persons who have a dementia as a result of a neurodegenerative disease. The review focuses on both peripheral and central auditory processing in common neurodegenerative diseases, with a particular focus on the processing of music and other non-verbal sounds. The chapter also reviews music interventions used for persons with neurodegenerative diseases.

Formulaic Language in Alzheimer's Disease

BACKGROUND

Studies of productive language in Alzheimer's disease (AD) have focused on formal testing of syntax and semantics but have directed less attention to naturalistic discourse and formulaic language. Clinical observations suggest that individuals with AD retain the ability to produce formulaic language long after other cognitive abilities have deteriorated.

AIMS

This study quantifies production of formulaic expressions in the spontaneous speech of individuals with AD. Persons with early- and late-onset forms of the disease were compared.

METHODS & PROCEDURES

Conversational language samples of individuals with early- (n = 5) and late-onset (n = 6) AD and healthy controls (n = 5) were analyzed to determine whether formulaic language, as measured by the number of words in formulaic expressions, differs between groups.

OUTCOMES & RESULTS

Results indicate that individuals with AD, regardless of age of onset, used significantly more formulaic expressions than healthy controls. The early- and late-onset AD groups did not differ on formulaic language measures.

CONCLUSIONS

These findings contribute to a dual process model of cerebral function, which proposes differing processing principles for formulaic and novel expressions. In this model, subcortical areas, which remain intact into late in the progression of Alzheimer's disease, play an important role in the production of formulaic language. Applications to clinical practice include identifying preserved formulaic language and providing informed counseling to patient and family.

Musical memory in a patient with severe anterograde amnesia

The ability to play a musical instrument represents a unique procedural skill that can be remarkably resilient to disruptions in declarative memory. For example, musicians with severe anterograde amnesia have demonstrated preserved ability to play musical instruments. However, the question of whether amnesic musicians can learn how to play new musical material despite severe memory impairment has not been thoroughly investigated. We capitalized on a rare opportunity to address this question. Patient S.Z., an amateur musician (tenor saxophone), has extensive bilateral damage to his medial temporal lobes following herpes simplex encephalitis, resulting in a severe anterograde amnesia. We tested S.Z.'s capacity to learn new unfamiliar songs by sight-reading following three months of biweekly practices. Performances were recorded and were then evaluated by a professional saxophonist. S.Z. demonstrated significant improvement in his ability to read and play new music, despite his inability to recognize any of the songs at a declarative level. The results suggest that it is possible to learn certain aspects of new music without the assistance of declarative memory.

Palliative care for patients with dementia in long-term care

Seventy percent of people in the United States who have dementia die in the nursing home. This article addresses the following topics on palliative care for patients with dementia in long-term care: (1) transitions of care, (2) infections, other comorbidities, and decisions on hospitalization, (3) prognostication, (4) the evidence for and against tube feeding, (5) discussing goals of care with families/surrogate decision makers, (6) types of palliative care programs, (7) pain assessment and management, and (8) optimizing function and quality of life for residents with advanced dementia.

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.

Musical memory in Alzheimer disease

This study examines musical memory in 12 patients with moderate or severe AD and 12 healthy, older adult controls. Participants were asked to distinguish familiar from novel tunes, to identify distortions in melodies, and to sing familiar tunes. Comparison of the AD and control groups showed significant impairment of the AD participants. However, a more complex picture emerged as we compared each individual case to the control group. Five of the AD group performed within the control group range on most tasks. An additional four participants showed partial sparing in that they performed below the range of control participants, but their scores were above the level of chance. The final three participants showed near complete loss of musical memory, as their performance was consistently at or near the level of chance. These results are discussed in terms of the literature on the heterogeneity of cognitive presentation in AD.

Prosocial capabilities in Alzheimer's patients

OBJECTIVES

To examine the decision making of Alzheimer's patients in a simple, classic game focusing on their capabilities to implement social norms and common social preferences.

METHODS

Patients with Stage I (very mild and mild) Alzheimer's disease (AD) were asked to participate in a dictator game, a type of game in which a subject has to decide how to allocate a certain amount of money between himself and another person.

RESULTS

When we compared the results of treatments involving AD patients (at an early stage) with those of identical treatments involving patients with mild cognitive impairment or healthy elderly controls, with similar ages and social backgrounds, we did not find statistically significant differences.

DISCUSSION

This finding suggests that Stage I AD patients are as capable of making decisions involving basic social norms and preferences as other individuals of their age. Whatever brain structures are affected by the disease, they do not appear to influence, at this early stage, the neural basis for cooperation-enhancing social interactions.

The first therapeutic game specifically designed and evaluated for Alzheimer's disease

The first therapeutic game specifically developed for Alzheimer's disease was evaluated on an NIH grant. It was hypothesized that the game would have a positive influence on factors influencing quality of life (eg, mood, pleasure, interest in activities) and family comfort level in visiting. The study used a single group, within-participants, design, and 2 control conditions including a family visit as usual. The Observed Emotion Rating Scale for assessing individuals with Alzheimer's disease was administered with a questionnaire for the family to provide their own evaluation. Reduction of signs of depression/sadness using the game were statistically significant. An increase in patient pleasure was highly significant (P < .0001). Increases in patient interest, patient satisfaction, and family member satisfaction were all highly significant (P < .0001). The qualitative appeal of the game to family members was very high. The game provides a meaningful one-on-one intervention for individuals with advanced dementia.

Creativity and psychopathology: higher rates of psychosis proneness and nonright-handedness among creative artists compared to same age and gender peers

Creative people have been found to score higher on psychopathologic scales in standardized tests, particularly on the scales that measure traits of psychoticism, and to be more likely to report an excess of nonright handedness compared with controls. However, results are inconsistent across surveys and methodologies, and the contribution of substance abuse has rarely been measured. In this study, 80 creative artists were compared with 80 matched noncreative controls on the Annett Hand Preference Questionnaire (HPQ), the Peters et al. Delusions Inventory, and the General Health Questionnaire. Creative artists were statistically more likely to admit the use of the left hand on the HPQ, with more widespread left hand use reported by artists involved in the creative activities traditionally associated with the right hemisphere (music and painting). They also scored higher on the Peters et al. Delusions Inventory independently from the level of psychopathology (measured with the General Health Questionnaire), from their laterality score (measured with the HPQ), and from their higher use of both licit and illicit drugs.

Relaxing Music at Mealtime in Nursing Homes

Agitation in individuals with severe cognitive impairment is a significant problem that affects care and overall quality of life. Building on research conducted by Goddaer and Abraham (1994), this quasi-experimental study proposed that relaxing music played during meals would exert a calming effect and decrease agitated behaviors among nursing home residents with dementia. Thirty residents residing in a Special Care Unit participated in the 4-week study. The Cohen-Mansfield Agitation Inventory (Cohen-Mansfield, Marx, & Rosenthal, 1989) was used to gather data. Baseline data was obtained in Week 1 (no music). Music was introduced in Week 2, removed in Week 3, and reintroduced in Week 4. At the end of the 4-week study, overall reductions in the cumulative incidence of total agitated behaviors were observed. Reductions in absolute numbers of agitated behaviors were achieved during the weeks with music and a distinct pattern was observed.

Music, memory, and Alzheimer's disease: is music recognition spared in dementia, and how can it be assessed?

Despite intriguing and suggestive clinical observations, no formal research has assessed the possible sparing of musical recognition and memory in Alzheimer's dementia (AD). A case study is presented of an 84-year old woman with severe cognitive impairment implicating AD, but for whom music recognition and memory, according to her caregivers, appeared to be spared. The hypotheses addressed were, first, that memory for familiar music may be spared in dementia, and second, that musical recognition and memory may be reliably assessed with existing tests if behavioral observation is employed to overcome the problem of verbal or written communication. Our hypotheses were stimulated by the patient EN, for whom diagnosis of AD became probable in 2000. With severe problems in memory, language, and cognition, she now has a mini-mental status score of 8 (out of 30) and is unable to understand or recall standard instructions. In order to assess her music recognition abilities, three tests from the previous literature were adapted for behavioral observation. Two tests involved the discrimination of familiar melodies from unfamiliar melodies. The third involved the detection of distortions ("wrong" notes) in familiar melodies and discrimination of distorted melodies from melodies correctly reproduced. Test melodies were presented to EN on a CD player and her responses were observed by two test administrators. EN responded to familiar melodies by singing along, usually with the words, and often continuing to sing after the stimulus had stopped. She never responded to the unfamiliar melodies. She responded to distorted melodies with facial expressions - surprise, laughter, a frown, or an exclamation, "Oh, dear!"; she never responded in this way to the undistorted melodies. Allowing these responses as indicators of detection, the results for EN were in the normal or near normal range of scores for elderly controls. As well, lyrics to familiar melodies, spoken in a conversational voice without rhythmic or pitch clues, often prompted EN to sing the tune that correctly accompanied the lyrics. EN's results provide encouraging support for our hypotheses that sparing of musical memory may be a feature of some forms of dementia and that it may be reliably and quantitatively assessed through behavioral observation. The contrast between EN's response to music and her mini-mental status is dramatic. The article concludes with several considerations why music may be preserved in dementia and suggestions to guide future research.

Contributions of memory circuits to language: the declarative/procedural model

The structure of the brain and the nature of evolution suggest that, despite its uniqueness, language likely depends on brain systems that also subserve other functions. The declarative/procedural (DP) model claims that the mental lexicon of memorized word-specific knowledge depends on the largely temporal-lobe substrates of declarative memory, which underlies the storage and use of knowledge of facts and events. The mental grammar, which subserves the rule-governed combination of lexical items into complex representations, depends on a distinct neural system. This system, which is composed of a network of specific frontal, basal-ganglia, parietal and cerebellar structures, underlies procedural memory, which supports the learning and execution of motor and cognitive skills, especially those involving sequences. The functions of the two brain systems, together with their anatomical, physiological and biochemical substrates, lead to specific claims and predictions regarding their roles in language. These predictions are compared with those of other neurocognitive models of language. Empirical evidence is presented from neuroimaging studies of normal language processing, and from developmental and adult-onset disorders. It is argued that this evidence supports the DP model. It is additionally proposed that "language" disorders, such as specific language impairment and non-fluent and fluent aphasia, may be profitably viewed as impairments primarily affecting one or the other brain system. Overall, the data suggest a new neurocognitive framework for the study of lexicon and grammar.

Ganstigmine and donepezil improve neurodegeneration in AD11 antinerve growth factor transgenic mice

Ganstigmine (CHF2819) is an acetylcholinesterase inhibitor that increases acetylcholine in rat hippocampus and ameliorates scopolamine-induced amnesia. In this article, we examined whether and how ganstigmine might prevent or rescue the neurodegenerative phenotype in AD11 antinerve growth factor (anti-NGF) mice, a transgenic model for Alzheimer's disease. The effects of ganstigmine were compared with those obtained after administration of donepezil. Results demonstrate that intraperitoneal and oral administration of ganstigmine and donepezil can reverse the cholinergic and behavioral deficit in AD11 mice but not the amyloid and phosphotau accumulation, uncovering different mechanisms leading to neurodegeneration in AD11 mice.

The Cognition-Sensitive Approach to DEMENTIA Parallels With the Science of Unitary Human Beings

1. Theory can provide practical guidelines for nursing interventions and research. 2. The Science of Unitary Human Beings, a grand theory, provides input into clarifying the Cognition-Sensitive Approach, a mid-range theory. 3. Cognition in the Alzheimer's disease process can be categorized hierarchically. 4. The Cognition-Sensitive Approach provides a theoretical base for holistic nursing interventions for people with Alzheimer's disease.

Alzheimer's disease and the basal forebrain cholinergic system: relations to beta-amyloid peptides, cognition, and treatment strategies

Alzheimer's disease (AD) is the most common form of degenerative dementia and is characterized by progressive impairment in cognitive function during mid- to late-adult life. Brains from AD patients show several distinct neuropathological features, including extracellular beta-amyloid-containing plaques, intracellular neurofibrillary tangles composed of abnormally phosphorylated tau, and degeneration of cholinergic neurons of the basal forebrain. In this review, we will present evidence implicating involvement of the basal forebrain cholinergic system in AD pathogenesis and its accompanying cognitive deficits. We will initially discuss recent results indicating a link between cholinergic mechanisms and the pathogenic events that characterize AD, notably amyloid-beta peptides. Following this, animal models of dementia will be discussed in light of the relationship between basal forebrain cholinergic hypofunction and cognitive impairments in AD. Finally, past, present, and future treatment strategies aimed at alleviating the cognitive symptomatology of AD by improving basal forebrain cholinergic function will be addressed.

The neural networks of music

Recent neuropsychological, transcranial Doppler sonographic, positron emission tomographic and functional nuclear magnetic resonance studies have indicated that musical perception is not dependent on the right hemisphere but on neural networks corresponding to the fundamental components of music in both hemispheres. In the brain there is no centre for music. Musicians have cerebral characteristics, anatomical as well as functional, which are correlated with the age at which they began their musical studies. This argues for cortical reorganization as a result of musical training. Whether these characteristics are to be ascribed to cortical plasticity alone, or to an innate structural property, or to both, remains an open question, however. Investigation of chromosomal defects, biochemical abnormalities and morphological features of congenital and degenerative brain diseases can provide further insight into the cerebral substrate of musicality.

Musical creativity and suicide

The different abilities involved in artistic creativity may be mirrored by differences among mental disorders prevalent in each artistic profession, taking poets, painters, and composers as examples. Using suicide rates as a proxy for the prevalence of mental disorders in groups of artists, we investigated the percentage of deaths by suicide in a sample of 4,564 eminent artists who died in the 19th and 20th centuries. Of the sample, 2,259 were primarily involved in activities of a linguistic nature, e.g., poets and writers; 834 were primarily visual artists, such as painters and sculptors; and 1,471 were musicians (composers and instrumentalists). There were 63 suicides in the sample (1.3% of total deaths). Musicians as a group had lower suicide rates than literary and visual artists. Beyond socioeconomic reasons, which might favour interpretations based on effects of health selection, the lower rate of suicides among musicians may reflect some protective effect arising from music.

A neurocognitive perspective on language: the declarative/procedural model

What are the psychological, computational and neural underpinnings of language? Are these neurocognitive correlates dedicated to language? Do different parts of language depend on distinct neurocognitive systems? Here I address these and other issues that are crucial for our understanding of two fundamental language capacities: the memorization of words in the mental lexicon, and the rule-governed combination of words by the mental grammar. According to the declarative/procedural model, the mental lexicon depends on declarative memory and is rooted in the temporal lobe, whereas the mental grammar involves procedural memory and is rooted in the frontal cortex and basal ganglia. I argue that the declarative/procedural model provides a new framework for the study of lexicon and grammar.

Preservation of golf skills in a case of severe left lobar frontotemporal degeneration

The authors report the longitudinal study of a 53-year-old man with severe lobar atrophy confined to the left frontal and temporal lobes, including the left hippocampus, but sparing other cortical regions. He experienced profound cognitive deterioration, sparing only visuospatial memory. Despite these deficits, he could play golf at a high level of competence, following rules and etiquette as well as monitoring the ongoing game. The patient's golf performance may have been supported by residual visuospatial declarative memory and complex flexible implicit memory programs.

A critique of research on the use of activities with persons with Alzheimer's disease: a systematic literature review

TOPIC

The topic of this paper concerns the use of therapeutic activities with persons with Alzheimer's disease (AD).

PURPOSE

The purpose is to present a critique of the research on these activities, with an emphasis on methodology. ORGANIZING CONSTRUCT AND SCOPE: Nursing literature identifies a number of purposes for activities for persons with AD. Activities should be therapeutic, enhance quality of life, arrest mental decline, and generate and maintain self-esteem. Other purposes of activities for this population are to create immediate pleasure, re-establish dignity, provide meaningful tasks, restore roles, and enable friendships. Activities may be more important to the psychological state of well-being of persons with dementia than the general physical and social environments in which they live.

SOURCES

The literature reviewed was identified with the use of computer data bases (Medline - 1991-March 2001; Cumulative Index of Nursing and Allied Health Literature (CINAHL) - 1991-March 2001; and PsychLit - 1988-March 1999). In addition, data bases of Science Citation Index and Social Science Citation Indexes as they appear in the computer base, Web of Science, were searched for 1992-2001. The time period for each search was determined by the manner in which the literature was grouped for inclusion in the particular database. Hand searches of 11 selected journals included the years 1993-2001. The search dates were selected to reflect the time period when the largest number of studies on activities and AD have appeared in the professional literature. We critique a total of 33 studies.

CONCLUSIONS

While researchers have demonstrated interest in the use of activities with persons with AD, theoretical and methodological difficulties, unclear findings and gaps exist, including a lack of emphasis on gender, ethnic, racial or cultural differences. Sampling issues involving diagnosis and staging complicate the research on individuals with AD. Case studies, single subject experimental designs, and tightly controlled quasi-experimental and experimental designs are needed to advance knowledge in this important area.

Functional correlates of musical and visual ability in frontotemporal dementia

BACKGROUND

The emergence of new skills in the setting of dementia suggests that loss of function in one brain area can release new functions elsewhere.

AIMS

To characterise 12 patients with frontotemporal dementia (FTD) who acquired, or sustained, new musical or visual abilities despite progression of their dementia.

METHOD

Twelve patients with FTD who acquired or maintained musical or artistic ability were compared with 46 patients with FTD in whom new or sustained ability was absent.

RESULTS

The group with musical or visual ability performed better on visual, but worse on verbal tasks than did the other patients with FTD. Nine had asymmetrical left anterior dysfunction. Nine showed the temporal lobe variant of FTD.

CONCLUSION

Loss of function in the left anterior temporal lobe may lead to facilitation of artistic or musical skills. Patients with the left-sided temporal lobe variant of FTD offer an unexpected window into the neurological mediation of visual and musical talents.

Words without mind

A woman (LR), unconscious for 20 years, spontaneously produces infrequent, isolated words unrelated to any environmental context. Fluorodeoxy-glucose-positron emission tomography (FDG-PET) imaging coregistered with magnetic resonance imaging (MRI) revealed a mean brain metabolism equivalent to deep anesthesia. Nevertheless, PET imaging demonstrated islands of modestly higher metabolism that included Broca's and Wernicke's areas. Functional brain imaging with magnetoencephalographic (MEG) imaging, a technique providing a temporal resolution of better than 1 msec, identified preserved dynamic patterns of spontaneous and evoked brain activity in response to sensory stimulation. Specifically, we examined spontaneous gamma-band activity (near 40 Hz) and its reset or modification during early auditory processing, a measure that correlated with human perception of sensory stimuli (Joliot, Ribary, & Llinás, 1994). Evidence of abnormal and incomplete gamma-band responses appeared in the left hemisphere only in response to auditory or somatosensory stimulation. MEG single-dipole reconstructions localized to the auditory cortex in the left hemisphere and overlapped with metabolically active regions identified by FDG-PET. The observation demonstrates that isolated neuronal groups may express well-defined fragments of activity in a severely damaged, unconscious brain. The motor fixed-action pattern character of her expressed words supports the notion of brain modularity in word generation.

Representations of knowledge about dominoes in demented and normal elderly players

1. Dementia patients who retain musical and game-playing skills exhibit impaired performance on explicit memory tests of knowledge about their retained skill. 2. Dementia patients who retain skill at playing dominoes can answer complex questions about the play of the game almost as well as normal elderly domino players when the questions are presented with real dominoes. 3. The aim of this study was to determine if skilled dementia patients could answer questions about domino play when the stimuli were two-dimensional drawings of dominoes. 4. Seventeen dementia patients and eight normal elderly domino players were tested on two forms of the Domino Quiz: first with real dominoes, then with two-dimensional drawings; other neuropsychological tests were given at the same time. 5. Fourteen of the 17 patients and all of the controls showed no decline in answering questions about domino play when two-dimensional drawings were used. These patients showed retained symbolic processing of information about dominoes despite declines in overall mental status, generation of words from specific semantic categories, and recognition memory for domino terminology. 6. Because the 14 patients with retained domino skill performed as accurately as controls on both administrations of a letter cancellation task, the ability to process familiar symbols may be important to their game-playing skill.

Present imperfect: a critical review of animal models of the mnemonic impairments in Alzheimer's disease

This paper reviews the current literature on animal models of the memory impairments of Alzheimer's disease (AD). The authors suggest that modeling of the mnemonic deficits in AD be limited to the amnesia observed early in the course of the disease, to eliminate the influence of impairments in non-mnemonic processes. Tasks should be chosen for their specificity and selectivity to the behavioral phenomena observed in early-stage AD and not for their relevance to hypothetical mnemonic processes. Tasks that manipulate the delay between learning and remembering are better able to differentiate Alzheimer patients from persons with other disorders, and better able to differentiate effects of manipulations in animals. The most commonly used manipulations that attempt to model the amnesia of AD are reviewed within these constraints. The authors conclude that of the models examined, lesions of the medial septal nucleus produce behavioral deficits that are most similar to the mnemonic impairments in the earliest stage of AD. However, the parallel is not definitive and more work is needed to clarify the relationship between neurobiology and behavior in AD.

Literatuuronderzoek naar intacte cognitieve vaardigheden bij patiënten met dementie van het Alzheimer-type

De onlangs overleden Willem de Kooning wordt alom beschouwd als één der grootste beeidende kunstenaars van de 20e eeuw. Hij werd in 1904 in Nederland geboren en emigreerde in 1926 naar de Verenigde Staten. Daar ontwikkelde de Kooning eind jaren veertig, samen met Jackson Pollock, Franz Kline en Mark Rotko, een nieuwe stroming binnen de schilderskunst: het abstract expressionisme. Het waren vooral zijn opzienbarende, semi-abstracte schilderijen over vrouwen die destijds veel stof deden opwaaien. Op 78-jarige leeftijd werd bij hem de ziekte van Alzheimer vastgesteld. Een jaar eerder, in 1981, was de Kooning, na enkele jaren zo goed als gestopt te zijn, wederom begonnen met schilderen. Tussen 1981 en 1986 produceerde hij zo'n 250 abstracte doeken.

A Neural Dissociation within Language: Evidence that the Mental Dictionary Is Part of Declarative Memory, and that Grammatical Rules Are Processed by the Procedural System

Language comprises a lexicon for storing words and a grammar for generating rule-governed forms. Evidence is presented that the lexicon is part of a temporal-parietalhnedial-temporal “declarative memory” system and that granlmatical rules are processed by a frontamasal-ganglia “procedural” system. Patients produced past tenses of regular and novel verbs (looked and plagged), which require an -ed-suffixation rule, and irregular verbs (dug), which are retrieved from memory. Word-finding difficulties in posterior aphasia, and the general declarative memory impairment in Alzheimer's disease, led to more errors with irregular than regular and novel verbs. Grammatical difficulties in anterior aphasia, and the general impairment of procedures in Parkinson's disease, led to the opposite pattern. In contrast to the Parkinson's patients, who showed sup pressed motor activity and rule use, Huntington's disease patients showed excess motor activity and rule use, underscoring a role for the basal ganglia in grammatical processing.

Memory disorders in Alzheimer's disease and the organization of human memory

The Squire and Zola-Morgan parallel organization model of the memory and the Tulving hierarchical model were developed mainly through the study of amnesic patients. The predictions of these two models are different, the first being more open to double dissociations and less restrictive than the second. Alzheimer's Disease is characterized by a differential impairment of the memory systems and by an interindividual variability which may take the form of dissociations between preserved and disturbed abilities in some patients. The objective of this study was to use the memory dysfunctions of patients with AD to test the validity of the two models. Analysis of the group data provided an average profile of memory disturbance consistent both with much of the data given in AD literature and with the two models. Using a multiple single-case strategy, we demonstrated several simple dissociations which are for the greater part compatible with the two models. Two of the dissociations underline the limits of the Tulving model, which otherwise accounts for a lot of results. The study supports the relevance of AD for the understanding of the cognitive architecture of the human memory.

Neuropsychological features of early Alzheimer's disease: preclinical and clinical stages

In the preclinical stage of Alzheimer's disease (AD), studies of asymptomatic mutation carriers have identified impairments in episodic memory. Other cognitive functions show no or slight impairment suggesting that preclinical AD is a unifunctional cognitive syndrome; the brain is affected selectively and predominantly in the medial temporal structures. In the early clinical stage, deficits occur in episodic memory, verbal abilities, visuospatial functions, attention, and executive functions. AD becomes a multifunctional cognitive syndrome and the brain's association cortices are affected. Nevertheless, sensory-motor performance and procedural memory seem to be intact and only slight impairment may be seen in primary memory. In advanced AD, cognitive dysfunction including deficits is global in primary memory, although sensory-motor performance may be well preserved. The brain's association cortices are severely affected. The sequence of cognitive decline; from unifunctional to global deficits, conforms to the three-stage development of neurofibrillary tangles described by Braak and Braak.

Memory deficits in a demented patient with probable corticobasal degeneration

Anterograde and retrograde amnesia in a patient with probable corticobasal degeneration (pCBD) and dementia were studied in a university medical center setting. The patient with pCBD and four comparison patients of comparable global mental status (Mini-Mental State Exam) who met NINCDS-ADRDA criteria for Alzheimer's disease (AD) were included. Standard neuropsychological tests of naming, intelligence, achievement, verbal fluency, anterograde and remote verbal and visuospatial memory, and motor skill learning were given. The pCBD patient exhibited a progressive asymmetric akinetic-rigid syndrome, which was unresponsive to Sinemet. His initially mild, intellectual deficits consisted of apraxia, slowed speech, and word-finding and memory difficulties. Over a 2-year period, a dementia syndrome developed, which involved more-serious deficits in praxis and naming, as well as impairments in spelling, calculation, verbal fluency, IQ, anterograde verbal and visuospatial memory, and motor skill learning. When tested by recall methods, the pCBD patient exhibited marked deficits on several tests of remote memory; however, on recognition testing, he performed normally on the Famous Faces Test and on a test of geographical knowledge, which measures remote visuospatial memory. By contrast, the four AD patients, who showed equivalent naming difficulties, less-severe fluency deficits, and normal motor skill learning, showed severe impairments in recalling and recognizing the names of famous people from photographs. A magnetic resonance imaging (MRI) scan of the pCBD patient showed marked frontal and parietal lobe atrophy and central atrophy, with ventriculomegaly that was greater on the left side of the brain. The temporal lobes were relatively spared, and the amygdalae, hippocampi, and temporal horns were of normal size.(ABSTRACT TRUNCATED AT 250 WORDS)

Neurobiology of skill and habit learning

Recent evidence indicates that the basal ganglia are critical brain structures for motor-skill and habit learning, and may be important for the acquisition of some perceptual and cognitive skills. The cerebellum appears to contribute importantly only to motor-skill learning. Transitory cortical changes occur during motor-skill learning, but perceptual-skill learning may involve a semi-permanent change in neuronal sensitivity in the primary sensory cortex.