Stroop Color-Word Test performance in patients with Alzheimer's disease

Brain activity during Stroop task performance at age 74 after exposure to the Dutch famine during early gestation

OBJECTIVE

Poorer performance on the Stroop task has been reported after prenatal famine exposure at age 58, potentially indicating cognitive decline. We investigated whether brain activation during Stroop task performance at age 74 differed between individuals exposed to famine prenatally, individuals born before and individuals conceived after the famine.

METHOD

In the Dutch famine birth cohort, we performed a Stroop task fMRI study of individuals exposed (n = 22) or unexposed (born before (n = 18) or conceived after (n = 25)) to famine in early gestation. We studied group differences in task-related mean activation of the dorsolateral prefrontal cortex (DLPFC), anterior cingulate cortex (ACC) and posterior parietal cortex (PPC). Additionally, we explored potential disconnectivity of the DLPFC using psychophysiological interaction analysis.

RESULTS

We observed similar activation patterns in the DLPFC, ACC and PPC in individuals born before and individuals exposed to famine, while individuals conceived after famine had generally higher activation patterns. However, activation patterns were not significantly different between groups. Task-related decreases in connectivity were observed between left DLPFC-left PPC and right DLPFC-right PPC, but were not significantly different between groups.

CONCLUSIONS

Although not statistically significant, the observed patterns of activation may reflect a combined effect of general brain aging and prenatal famine exposure.

Comparing Stop Signal Reaction Times in Alzheimer's and Parkinson's Disease

BACKGROUND

To investigate the relative contributions of cerebral cortex and basal ganglia to movement stopping, we tested the optimum combination Stop Signal Reaction Time (ocSSRT) and median visual reaction time (RT) in patients with Alzheimer's disease (AD) and Parkinson's disease (PD) and compared values with data from healthy controls.

METHODS

Thirty-five PD patients, 22 AD patients, and 29 healthy controls were recruited to this study. RT and ocSSRT were measured using a hand-held battery-operated electronic box through a stop signal paradigm.

RESULT

The mean ocSSRT was found to be 309 ms, 368 ms, and 265 ms in AD, PD, and healthy controls, respectively, and significantly prolonged in PD compared to healthy controls (p = 0.001). The ocSSRT but not RT could separate AD from PD patients (p = 0.022).

CONCLUSION

Our data suggest that subcortical networks encompassing dopaminergic pathways in the basal ganglia play a more important role than cortical networks in movement-stopping. Combining ocSSRT with other putative indices or biomarkers of AD (and other dementias) could increase the accuracy of early diagnosis.

A Comparison of the Performance between the 60- and 120-Second Conditions of the Korean-Color Word Stroop Test: Color Reading (K-CWST: CR)

Background and Purpose

The Korean-Color Word Stroop Test: Color Reading (K-CWST: CR) included in the Seoul Neuropsychological Screening Battery, 2nd Edition (SNSB-II) examines inhibitory control deficit. It provides normative data for both 60- and 120-second conditions, but the validity of the 60-second condition has not yet been proven. This study examined the validity of the 60-second condition by observing concordance between the performances in cognitively normal, MCI, and mild dementia groups.

Methods

There were 1,336 patients performed the SNSB-II, including the K-CWST: CR. Based on the cognitive test results, activities of daily living, and clinical interview, the patients were assigned to normal cognition (n=104), MCI (n=884), or mild dementia (n=348) groups. Abnormal performance on the K-CWST: CR was operationally defined as 1SD below the normative mean. The receiver operating characteristic curve analyses were conducted to compare the discriminability between the 60- and 120-second conditions.

Results

The percentages of abnormal performance in the MCI group were 41.5% and 42.3%, and those in the mild dementia group were 82.7% and 82.4% for the 60- and 120-second conditions, respectively. The areas under the curve for the 60- and 120-seconds were as follows; 0.80 and 0.81 in differentiating normal from MCI; 0.95 and 0.96 in normal from mild dementia; and 0.77 and 0.77 in MCI from mild dementia.

Conclusions

The 60-second condition of the K-CWST showed very similar results, not statistically different from the 120-second condition. Therefore, the 60-second condition could be used interchangeably with the 120-second condition in a clinical setting.

Effect of desalted Salicornia europaea L. ethanol extract (PM-EE) on the subjects complaining memory dysfunction without dementia: a 12 week, randomized, double-blind, placebo-controlled clinical trial

Desalted Salicornia europaea L. (SE) inhibits acetylcholine esterase, attenuates oxidative stress and inflammatory cytokines, and activates neurotrophic pathway. We performed 12-week, randomized, double-blind, placebo-controlled study to evaluate the efficacy of PhytoMeal(a desalted SE)-ethanol extract (PM-EE), in improving the cognitive performance in patients with subjective memory impairment. 63 participants complaining memory dysfunction without dementia (Korean Mini-Mental State Examination [K-MMSE] score ≥ 23) were assigned to PM-EE 600 mg/day or placebo. The cognitive domain of the Alzheimer's disease assessment scale-Korean version (ADAS-K) was set as the primary outcome. After 12 weeks, there was no differences in the changes in the primary outcome or the frequency of adverse events between the groups. In the subgroup analysis for the 30 subjects with mild cognitive impairment (MCI, baseline K-MMSE scores ≤ 28), PM-EE significantly improved the color-reading score of the Korean color-word stroop test (8.2 ± 25.0 vs. - 4.7 ± 13.2, P = 0.018). Our findings suggest that PM-EE is safe but might not be effective in this setting of this study. However, PM-EE may improve the frontal executive function in the patients with MCI. Further large-sized studies with longer follow-up period is warranted (trial registration number KCT0003418).

Effects of raloxifene on cognition in postmenopausal women with schizophrenia: a 24-week double-blind, randomized, parallel, placebo-controlled trial

We assessed the utility of raloxifene (60 mg/day) as an adjuvant treatment for cognitive symptoms in postmenopausal women with schizophrenia in a 24-week, double-blind, randomized, placebo-controlled study. Patients were recruited from the inpatient and outpatient services of Parc Sanitari Sant Joan de Déu, Hospital Universitari Institut Pere Mata, and Corporació Sanitària Parc Taulí. Seventy eight postmenopausal women with schizophrenia were randomized to either adjunctive raloxifene or placebo. Sixty-eight began the clinical trial (37 women on raloxifene adjunct) and 31 on placebo adjunct. The outcome measures were: memory, attention and executive function. Assessment was conducted at baseline and at week 24. Between groups homogeneity was tested with the Student's t test for continuous variables and/or the Mann-Whitney U test for ordinal variables and the χ² test or Fisher's exact test for categorical variables. The differences between the two groups in neuropsychological test scores were compared using the Student's t test. The sample was homogenous with respect to age, formal education, illness duration and previous pharmacological treatment. The addition of raloxifene to antipsychotic treatment as usual showed no differences in cognitive function. The daily use of 60 mg raloxifene as an adjuvant treatment in postmenopausal women with schizophrenia has no appreciable effect.ClinicalTrials.gov Identifier: NCT01573637.

Changes in Plasma Amyloid and Tau in a Longitudinal Study of Normal Aging, Mild Cognitive Impairment, and Alzheimer's Disease

BACKGROUND

Changes in cerebrospinal fluid, neuroimaging, and cognitive functions have been used as diagnostic biomarkers of Alzheimer's disease (AD). This study aimed to investigate the temporal trajectories of plasma biomarkers in subjects with mild cognitive impairment (MCI) and patients with AD relative to healthy controls (HCs).

METHODS

In this longitudinal study, 82 participants (31 HCs, 33 MCI patients, and 18 AD patients) were enrolled. After 3 years, 7 HCs had transitioned to MCI and 10 subjects with MCI had converted to AD. We analyzed plasma amyloid beta (Aβ) and tau proteins at baseline and annually to correlate with biochemical data and neuropsychological scores.

RESULTS

Longitudinal data analysis showed an evolution of Aβ-related biomarkers over time within patients, whereas tau-related biomarkers differed primarily across diagnostic classifications. An initial steady increase in Aβ42 in the MCI stage was followed by a decrease just prior to clinical AD onset. Hyperphosphorylated tau protein levels correlated with cognitive decline in the MCI stage, but not in the AD stage.

CONCLUSION

Plasma Aβ and tau levels change in a dynamic, nonlinear, nonparallel manner over the AD continuum. Changes in plasma Aβ concentration are time-dependent, whereas changes in hyperphosphorylated tau protein levels paralleled the clinical progression of MCI. It remains to be clarified whether diagnostic efficiency can be improved by combining multiple plasma markers or combining plasma markers with other diagnostic biomarkers.

Executive Functions in Alzheimer Disease: A Systematic Review

Alzheimer's disease is a severe irreversible syndrome, characterized by a slow and progressive cognitive decline that interferes with the standard instrumental and essential functions of daily life. Promptly identifying the impairment of particular cognitive functions could be a fundamental condition to limit, through preventive or therapeutic interventions, the functional damages found in this degenerative dementia. This study aims to analyse, through a systematic review of the studies, the sensitivity of four experimental paradigms (Wisconsin Card Sorting Test, Stroop Task, Go/No-Go Task, and Flanker Task) considered as golden standard instruments for executive functions assessment in elderly subjects affected by Alzheimer dementia. This review was carried out according to the PRISMA method. Forty-five studies comparing the executive performance of patients with Alzheimer's dementia (diagnosed according to different classification criteria for dementia) and healthy elderly patients both over the age of sixty, were selected. For the research, PubMed, PsycINFO, PsycArticles databases were used. The study highlighted the importance of using standard protocols to evaluate executive dysfunction in Alzheimer's disease. The Stroop task allows discriminating better between healthy and pathological aging.

Investigating Multimodal Diagnostic Eye Biomarkers of Cognitive Impairment by Measuring Vascular and Neurogenic Changes in the Retina

Previous studies have demonstrated that cognitive impairment (CI) is not limited to the brain but also affects the retina. In this pilot study, we investigated the correlation between the retinal vascular complexity and neurodegenerative changes in patients with CI using a low-cost multimodal approach. Quantification of the retinal structure and function were conducted for every subject (n = 69) using advanced retinal imaging, full-field electroretinogram (ERG) and visual performance exams. The retinal vascular parameters were calculated using the Singapore Institute Vessel Assessment software. The Montreal Cognitive Assessment was used to measure CI. Pearson product moment correlation was performed between variables. Of the 69 participants, 32 had CI (46%). We found significantly altered microvascular network in individuals with CI (larger venular-asymmetry factor: 0.7 ± 0.2) compared with controls (0.6 ± 0.2). The vascular fractal dimension was lower in individuals with CI (capacity, information and correlation dimensions: D₀, D_1, and D₂ (mean ± SD): 1.57 ± 0.06; 1.56 ± 0.06; 1.55 ± 0.06; age 81 ± 6years) vs. controls (1.61 ± 0.03; 1.59 ± 0.03; 1.58 ± 0.03; age: 80 ± 7 years). Also, drusen-like regions in the peripheral retina along with pigment dispersion were noted in subjects with mild CI. Functional loss in color vision as well as smaller ERG amplitudes and larger peak times were observed in the subjects with CI. Pearson product moment correlation showed significant associations between the vascular parameters (artery-vein ratio, total length-diameter ratio, D₀, D₁, D₂ and the implicit time (IT) of the flicker response but these associations were not significant in the partial correlations. This study illustrates that there are multimodal retinal markers that may be sensitive to CI decline, and adds to the evidence that there is a statistical trend pointing to the correlation between retinal neuronal dysfunction and microvasculature changes suggesting that retinal geometric vascular and functional parameters might be associated with physiological changes in the retina due to CI. We suspect our analysis of combined structural-functional parameters, instead of individual biomarkers, may provide a useful clinical marker of CI that could also provide increased sensitivity and specificity for the differential diagnosis of CI. However, because of our study sample was small, the full extent of clinical applicability of our approach is provocative and still to be determined.

Psychometric Properties of a Flanker Task in a Sample of Patients with Dementia: A Pilot Study

Background/Aims

Reliable and valid neuropsychological tests for patients with dementia are scarce. To improve the assessment of attention and inhibitory control in dementia, we determined the feasibility, test-retest reliability, and validity of a Flanker task.

Methods

Participants with all-cause diagnosed dementia (n = 22, mean age 84 years; mean Mini-Mental State Examination [MMSE] score = 19.4) performed a computerized Flanker task twice within 7 days. The Flanker task required participants to indicate the direction of target arrows flanked by congruent or incongruent arrows. Number of completed trials, accuracy, and reaction times (RTs) were recorded, and interference scores were calculated from basic scores. We examined the psychometric properties of the Flanker task and its relationship with the MMSE and Stroop test.

Results

The Flanker task was feasible. Test-retest reliability was good for number of correct answers and RTs, and fair to poor for accuracy and the interference scores. The correlation of the Flanker task with Stroop and MMSE performance was fair to poor.

Conclusion

The Flanker task appears to be feasible, and a reliable and valid measure of selective attention. Although the test-retest reliability for the Flanker RT interference measure was fair, future studies need to confirm its validity to measure inhibitory control in patients with dementia.

Speed and Lateral Inhibition of Stimulus Processing Contribute to Individual Differences in Stroop-Task Performance

The Stroop task is a popular neuropsychological test that measures executive control. Strong Stroop interference is commonly interpreted in neuropsychology as a diagnostic marker of impairment in executive control, possibly reflecting executive dysfunction. However, popular models of the Stroop task indicate that several other aspects of color and word processing may also account for individual differences in the Stroop task, independent of executive control. Here we use new approaches to investigate the degree to which individual differences in Stroop interference correlate with the relative processing speed of word and color stimuli, and the lateral inhibition between visual stimuli. We conducted an electrophysiological and behavioral experiment to measure (1) how quickly an individual’s brain processes words and colors presented in isolation (P3 latency), and (2) the strength of an individual’s lateral inhibition between visual representations with a visual illusion. Both measures explained at least 40% of the variance in Stroop interference across individuals. As these measures were obtained in contexts not requiring any executive control, we conclude that the Stroop effect also measures an individual’s pre-set way of processing visual features such as words and colors. This study highlights the important contributions of stimulus processing speed and lateral inhibition to individual differences in Stroop interference, and challenges the general view that the Stroop task primarily assesses executive control.

Are There Any Connections between Language Deficits and Cognitive Slowing in Alzheimer's Disease?

Background

Speech disorders already occur in the early phases of Alzheimer's disease (AD). As a possible cause, problems of executive processes are discussed. Cognitive slowing is also repeatedly addressed.

Aims

Are there any connections between cognitive slowing and speech disorders in AD? And is there a relationship between cognitive slowing and executive processes?

Methods

The data of 72 healthy controls and 52 AD patients were examined with regard to their language performance and their response times in a computerized Stroop paradigm.

Results

The AD patients showed significantly worse results in all language tests as well as much longer reaction times in all Stroop conditions, especially in the interference condition (Stroop 3). Speech errors and response times correlated with severity (MMSE), and the speech errors correlated with the reaction times in Stroop 3 (interference condition, which reflects the processing time of executive processes).

Conclusion

The most interesting question now is: How are language processing and executive processing time (Stroop 3) related?

Effects of raloxifene on cognition in postmenopausal women with schizophrenia: a double-blind, randomized, placebo-controlled trial

Studies of estrogen therapy in postmenopausal women provide evidence of an effect of sex hormones on cognitive function. Estrogen has demonstrated some utility in the prevention of normal, age-related decline in cognitive functions, especially in memory. The potential therapeutic utility of estrogens in schizophrenia is increasingly being recognized. Raloxifene, a selective estrogen receptor modulator (SERM), appears to act similarly to conjugated estrogens on dopamine and serotonin brain systems, and may be a better option since it lacks the possible negative effects of estrogen on breast and uterine tissue. We assessed the utility of raloxifene as an adjuvant treatment for cognitive symptoms in postmenopausal women with schizophrenia in a 12-week, double-blind, randomized, placebo-controlled study. Patients were recruited from both the inpatient and outpatient departments. Thirty-three postmenopausal women with schizophrenia (DSM-IV) were randomized to receive either adjuvant raloxifene (16 women) or adjuvant placebo (17 women) for three months. The main outcome measures were: Memory, attention and executive functions. Assessment was conducted at baseline and week 12. The total sample is homogenous with respect to: age, years of schooling, illness duration, baseline symptomatology and pharmacological treatment. The addition of raloxifene (60 mg) to regular antipsychotic treatment showed: we found significant differences in some aspects of memory and executive function in patients treated with raloxifene. This improvement does not correlate with clinical improvement. The use of raloxifene as an adjuvant treatment in postmenopausal women with schizophrenia seems to be useful in improving cognitive symptoms.

Cognitive profiles of three clusters of patients with a first-episode psychosis

OBJECTIVE

The primary objective was to identify specific groups of patients with a first-episode psychosis based on family history, obstetric complications, neurological soft signs, and premorbid functioning. The secondary objective was to relate these groups with cognitive variables.

METHOD

A total of 62 first-episode psychoses were recruited from adult and child and adolescent mental health services. The inclusion criteria were patients between 7 and 65 years old (real range of the samples was 13-35 years old), two or more psychotic symptoms and less than one year from the onset of the symptoms. Premorbid functioning (PAS), soft signs (NES), obstetric complications and a neuropsychological battery (CPT, TMTA/TMTB, TAVEC/TAVECI, Stroop, specific subtest of WAIS-III/WISC-IV) were administered.

RESULTS

We found three clusters: 1) higher neurodevelopment contribution (N=14), 2) higher genetic contribution (N=30), and 3) lower neurodevelopment contribution (N=18). Statistical differences were found between groups in TMTB, learning curve of the TAVEC, digits of the WAIS and premorbid estimated IQ, the cluster 1 being the most impaired.

CONCLUSIONS

A cluster approach could differentiate several groups of patients with different cognitive performance. Neuropsychological interventions, as cognitive remediation, should be addressed specifically to patients with more impaired results.

Neural correlates of saccadic inhibition in healthy elderly and patients with amnestic mild cognitive impairment

Performance on tasks that require saccadic inhibition declines with age and altered inhibitory functioning has also been reported in patients with Alzheimer's disease. Although mild cognitive impairment (MCI) is assumed to be a high-risk factor for conversion to AD, little is known about changes in saccadic inhibition and its neural correlates in this condition. Our study determined whether the neural activation associated with saccadic inhibition is altered in persons with amnestic mild cognitive impairment (aMCI). Functional magnetic resonance imaging (fMRI) revealed decreased activation in parietal lobe in healthy elderly persons compared to young persons and decreased activation in frontal eye fields in aMCI patients compared to healthy elderly persons during the execution of anti-saccades. These results illustrate that the decline in inhibitory functions is associated with impaired frontal activation in aMCI. This alteration in function might reflect early manifestations of AD and provide new insights in the neural activation changes that occur in pathological ageing.

An effective environmental intervention for management of the 'mirror sign' in a case of probable Lewy body dementia

The term 'mirror sign' refers to the inability to recognize the reflection of oneself in a mirror, while the ability to recognize others' faces often remains intact. In this article, we present a case of an 85-year-old woman, with probable Lewy body dementia, who stably exhibited a delusional 'mirror sign' for a period of 9 months. Following a straightforward, ecological, non-pharmacological intervention, her 'mirror sign' delusion was no longer present.

Inhibition impairments in Alzheimer's disease, mild cognitive impairment and healthy aging: effect of congruency proportion in a Stroop task

The goal of this study was to assess inhibition and goal maintenance in persons with Alzheimer's disease, mild cognitive impairment, healthy older adults and younger adults. This was done by using a task that compared the Stroop effect in pure blocks, that comprised only incongruent trials, with the Stroop effect in mixed blocks, in which 25% of trials were incongruent and 75% were congruent (Kane & Engle, 2003). Those conditions were administered to 20 healthy younger and 20 older control participants, and to 20 participants meeting criteria for MCI and 11 for AD. Results show reduced resistance to interference as a consequence of healthy aging and only partially impaired goal-maintenance capacities. Interference and goal maintenance are also impaired when comparing MCI and AD to healthy older adults, with AD suffering from a more severe impairment than MCI. In addition, there is a partial preservation of goal-maintenance capacities in MCI because reducing response speed allows them to maintain a level of error rate similar to that of healthy older adults. In contrast, AD persons suffer from a complete breakdown of goal-maintenance capacities, as is suggested by deficits on both response time and error rates.

An ERP investigation of the Stroop task: the role of the cingulate in attentional allocation and conflict resolution

The majority of studies support a role of the anterior cingulate cortex (ACC) in the attentional control necessary for conflict resolution in the Stroop task; however, the time course of activation and the neural substrates underlying the Stroop task remain contentious. We used high-density EEG to record visual-evoked potentials from 16 healthy subjects while performing a manual version of the traditional Stroop colour-word task. Difference waveforms for congruent-control and incongruent-control conditions were similar in amplitude and had a similar spatial distribution in the time window of 260-430 ms post stimulus onset. Source estimation indicated particularly middle cingulate involvement in congruent-control and incongruent-control difference waveforms. In contrast, the difference waveform for the incongruent-congruent contrast was observed later (in the time window of 370-480 ms), had a different spatial distribution, and source estimation indicated that the anterior cingulate underlies this difference waveform. As congruent-control and incongruent-control differences have a similar timeframe and cingulate source, we propose that this indicates early attentional allocation processes. That is, the identification of two sources of information (the word and the colour it is printed in) and the selective attention to one. The later peak in the incongruent-congruent difference wave, originating in anterior cingulate, likely reflects identification (and subsequent resolution) of conflict in the two sources of information.

Metaphor comprehension in Alzheimer's disease: novelty matters

The comprehension of non-literal language was investigated in 20 probable Alzheimer's disease (pAD) patients by comparing their performance to that of 20 matched control subjects. pAD patients were unimpaired in the comprehension of conventional metaphors and idioms. However, their performance was significantly lower in the case of non-conventional (novel) metaphor comprehension. This ability was not related to global cognitive deterioration or to deficits in the cognitive domains of attention, memory and language comprehension. On the other hand, the impairment in verbal reasoning appeared to be relevant for both novel and conventional metaphor comprehension. The relationship between novel metaphor comprehension and performance in the visual-spatial planning task of the Behavioral Assessment of the Dysexecutive Syndrome (BADS) suggests that executive impairment, possibly related to prefrontal dysfunction, may be responsible for the pAD patients' poor performance in novel metaphor comprehension. The present findings suggest a role of the prefrontal cortex in novel metaphor comprehension.

Normative study of the Stroop Color and Word Test in an educationally diverse elderly population

OBJECTIVE

The purpose of this study was to explore the effects of demographic variables on Stroop Color and Word Test (SCWT) performance in an educationally diverse elderly population and to provide normative information.

METHODS

SCWT was administered to 564 community-dwelling volunteers aged 60-90 years with an educational history of from zero to 25 years of full-time education. People with serious neurological, medical and psychiatric disorders (including dementia) were excluded.

RESULTS

Age, education and gender were found to be significantly associated with performance on all three pages of the SCWT. Based on the results obtained, SCWT norms were stratified by age (four overlapping tables), education (three strata), and gender.

CONCLUSIONS

In the present study, normative information on SCWT was obtained from an educationally diverse elderly population. SCWT would appear to be more useful in poorly educated elderly, and could be used in future cross-cultural comparisons of geriatric populations.

Comparison of inhibitory functioning in mild Alzheimer's disease and frontotemporal dementia

Executive dysfunction is frequently reported in Alzheimer's disease (AD) and the frontal variant of frontotemporal dementia (FTD). More specifically, inhibitory dysfunction is observed early in AD and inhibitory deficits are also prominent in patients with FTD. However, few studies have simultaneously explored and compared inhibitory abilities in both degenerative diseases. Consequently, the aim of this study was to compare verbal and motor inhibitory processes in the initial stages of AD and the frontal variant of FTD. Stroop and Go/No-go tasks were administered. The results demonstrate that, on the Go/No-go task, AD and FTD patients do not produce more errors than control subjects. However, both groups are impaired on the Stroop task (mainly with regard to the error score) but do not differ from each other. These results indicate that AD and FTD patients do not present a general impairment of their inhibitory abilities. Moreover, these two kinds of dementia present similar quantitative and qualitative inhibitory impairments on the two tasks, although their patterns of structural and functional cerebral impairments are known to be different. The presence of similar inhibitory deficits despite very different patterns of brain damage is in agreement with the hypothesis that inhibitory dysfunction in the two groups of patients depends on a disconnection process between anterior and posterior cerebral areas, rather than on the presence of focal metabolism decreases in different regions.

Inefficient response inhibition in individuals with mild cognitive impairment

Individuals diagnosed with mild cognitive impairment (MCI) show primary deficits in memory and are at increased risk for developing Alzheimer's disease (AD). In light of recent evidence that executive cognitive deficits are common in AD and may be detectable in individuals diagnosed with MCI, we extend these findings to the investigation of response inhibition, an essential aspect of executive cognitive control. Twenty MCI patients and 20 healthy controls (HC) completed an arrow version of the flanker task [Eriksen, B. A., & Eriksen, C. W. (1974). Effects of noise letters upon the identification of target letters in a non-search task. Perception & Psychophysics, 16, 143-149] in which participants responded to a target arrow surrounded by distractors (i.e., flankers) that signaled a same (congruent) or a conflicting (incongruent) response. Reaction time (RT) increased in both groups when flankers signaled an incongruent response, but more so among MCI patients. MCI patients taking a cholinesterase inhibitor showed smaller flanker interference effects than those not taking this medication. Analysis of the flanker effect as a function of the entire RT distribution indicated that MCI patients show increasing interference at the slowest segments of the distribution, a finding that implicates deficient inhibition of the incongruent response [Ridderinkhof, K. R. (2002). Activation and suppression in conflict tasks: Empirical clarification through distributional analyses. In W. Prinz & B. Hommel (Eds.), Common mechanisms in perception and action. Attention & performance, Vol. XIX (pp. 494-519). Oxford: Oxford University Press]. These results suggest that deficits in response inhibition are detectable in MCI patients and merit further investigation as to whether these changes aid prediction of which MCI patients convert to AD.

The neural basis for novel semantic categorization

We monitored regional cerebral activity with BOLD fMRI during acquisition of a novel semantic category and subsequent categorization of test stimuli by a rule-based strategy or a similarity-based strategy. We observed different patterns of activation in direct comparisons of rule- and similarity-based categorization. During rule-based category acquisition, subjects recruited anterior cingulate, thalamic, and parietal regions to support selective attention to perceptual features, and left inferior frontal cortex to helps maintain rules in working memory. Subsequent rule-based categorization revealed anterior cingulate and parietal activation while judging stimuli whose conformity with the rules was readily apparent, and left inferior frontal recruitment during judgments of stimuli whose conformity was less apparent. By comparison, similarity-based category acquisition showed recruitment of anterior prefrontal and posterior cingulate regions, presumably to support successful retrieval of previously encountered exemplars from long-term memory, and bilateral temporal-parietal activation for perceptual feature integration. Subsequent similarity-based categorization revealed temporal-parietal, posterior cingulate, and anterior prefrontal activation. These findings suggest that large-scale networks support relatively distinct categorization processes during the acquisition and judgment of semantic category knowledge.

Inhibitory functioning in Alzheimer’s disease

We present a comprehensive review of studies assessing inhibitory functioning in Alzheimer's disease. The objectives of this review are: (i) to establish whether Alzheimer's disease affects all inhibitory mechanisms equally, and (ii) where possible, to assess whether any effects of Alzheimer's disease on inhibition tasks might be caused by other cognitive deficits, such as slowed processing. We review inhibitory mechanisms considered to play a crucial role in various domains of cognition, such as inhibition involved in working memory, selective attention and shifting abilities, and the inhibition of motor and verbal responses. It was found that whilst most inhibitory mechanisms are affected by the disorder, some are relatively preserved, suggesting that inhibitory deficits in Alzheimer's disease may not be the result of a general inhibitory breakdown. In particular, the experimental results reviewed showed that Alzheimer's disease has a strong effect on tasks requiring controlled inhibition processes, such as the Stroop task. However, the presence of the disease appears to have relatively little effect on tasks requiring more automatic inhibition, such as the inhibition of return task. Thus, the distinction between automatic, reflexive inhibitory mechanisms and controlled inhibitory mechanisms may be critical when predicting the integrity of inhibitory mechanisms in Alzheimer's disease. Substantial effects of Alzheimer's disease on tasks such as negative priming, which are not cognitively complex but do require some degree of controlled inhibition, support this hypothesis. A meta-analytic review of seven studies on the Stroop paradigm revealed substantially larger effects of Alzheimer's disease on the inhibition condition relative to the baseline condition, suggesting that these deficits do not simply reflect general slowing.

Selective Attention Impairments in Alzheimer's Disease: Evidence for Dissociable Components

Tasks emphasizing 3 different aspects of selective attention-inhibition, visuospatial selective attention, and decision making-were administered to subjects with mild Alzheimer's disease (AD) and to healthy elderly control (HEC) subjects to determine which components of selective attention were impaired in AD subjects and whether selective attention could be dissociated into different components. The tasks were administered with easy versus hard levels of difficulty to assess proportional slowing as the key variable across tasks. The results indicated that the inhibitory and visual search tasks showed greater proportional slowing in subjects with AD than in HEC subjects, and that the task involving inhibition was significantly more affected in subjects with AD. Furthermore, there were no significant intertask correlations, and the results cannot be explained simply in terms of generalized cognitive slowing. These results provide evidence that inhibition is the most strikingly affected aspect of selective attention that is observed to be impaired in early stages of AD.

Categorization of object descriptions in Alzheimer's disease and frontotemporal dementia: limitation in rule-based processing

Studies of semantic memory in probable Alzheimer's disease (AD) have focused on the degradation of semantic knowledge, but other work in AD suggests an impairment in the semantic categorization processes that operate on this knowledge. We examined the categorization of object descriptions, where semantic category membership judgments were based on rule-based or similarity-based categorization processes. We found that AD patients were selectively limited in their semantic categorization under conditions requiring a rule-based approach. However, AD patients did not differ from healthy seniors under conditions based on judgments of overall similarity. We showed that this was not due to nonspecific or overall task-related difficulty associated with the rule condition by asking the subjects to use similarity-based judgments of perceptually degraded versions of the stimuli. The results of this condition did not differ from other similarity-based judgments but did differ from the rule-based condition in AD. Rule-based judgments of semantic category membership correlated with executive measures of inhibitory control and mental search, but not with measures of episodic memory or overall dementia severity, suggesting a contribution of executive resources to rule-based semantic categorization. Moreover, the pattern of limited rule-based categorization in AD closely resembled the performance profile of patients with frontotemporal dementia, further implying that executive resource limitations underlie AD patients' limited rule-based semantic categorization. These findings suggest that semantic memory difficulty in AD is due in part to a deficit in executive processes that are central to rule-based categorization in semantic memory.

Cognitive and neuropathologic correlates of Stroop Color-Word Test performance in Alzheimer's disease

The Stroop Color-Word Test (SCWT; C. Golden, 1978) was examined in 59 patients with probable Alzheimer's disease (AD) and in 51 demographically comparable normal control (NC) participants. AD patients produced significantly larger Stroop interference effects than NC participants, and level of dementia severity significantly influenced SCWT performance. Principal-components analyses demonstrated a dissociation in the factor structure of the Stroop trials between NC participants and AD patients, suggesting that disruption of semantic knowledge and speeded verbal processing in AD may be a major contributor to impairment on the incongruent trial. Results of clinicopathologic correlations in an autopsy-confirmed AD subgroup further suggest the invocation of a broad network of integrated cortical regions and executive and language processes underlying successful SCWT performance.

Cognitive resources during sentence processing in Alzheimer's disease

This study assessed sentence comprehension in Alzheimer's disease (AD) while minimizing executive resource demands. AD patients (n=17) and healthy elderly control subjects (n=17) were asked to detect a word in a sentence. Unbeknownst to subjects, the target word at times followed an incorrect grammatical or semantic agreement. Control subjects took significantly longer to respond to a target word when it immediately followed an agreement violation compared to a coherent agreement, a difference that was not evident when the target word followed the agreement by several syllables. AD patients did not demonstrate a discrepancy between a violation and a coherent agreement in the immediate vicinity of the agreement, but demonstrated a significant delay in their response to a target word when it followed an agreement violation--particularly a violation of a grammatical agreement--by several syllables. Analyses of individual patient performance profiles revealed the pattern of delayed sensitivity to agreements in a majority of AD patients. Correlation and regression analyses associated AD patients' sensitivity to agreement violations over an abnormally delayed time course with a measure of inhibitory control, although weaker associations were also evident with measures of planning and short-term memory. We hypothesize that difficulty understanding grammatically complex sentences in AD is related to slowed information processing speed that restricts the timely construction of a sentence's structure and limits inhibition of canonical sentence interpretations such as first-noun-is-subject.

Inductive reasoning in Alzheimer's disease

We evaluated knowledge of basic level and superordinate semantic relations and the role of cognitive resources during inductive reasoning in probable Alzheimer's disease (AD). Nineteen mildly demented AD patients and 17 healthy control subjects judged the truthfulness of arguments with a premise and a conclusion that contain familiar concepts coupled with "blank" predicates, such as "Spiders contain phosphatidylcholine; therefore all insects contain phosphatidylcholine." Like healthy control subjects, AD patients were relatively insensitive to the typicality of the premise category when judging the strength of arguments with a conclusion containing a basic-level concept, but were relatively sensitive to typicality during judgments of arguments containing a superordinate in the conclusion. Moreover, AD patients resembled control subjects in judging arguments with an immediate superordinate in the conclusion compared to arguments with a distant superordinate. AD patients differed from control subjects because they could not take advantage of two premises in an argument containing basic-level concepts. We conclude that semantic knowledge is sufficiently preserved in AD to support inductive reasoning, but that limited cognitive resources may interfere with AD patients' ability to consider the entire spectrum of information available during semantic challenges.

A rule-based categorization deficit in Alzheimer's disease?

This study examined the categorization processes that Alzheimer's disease (AD) patients use during assessments of semantic memory. Rule-based categorization involves the careful, analytic processing of strict criteria to determine category membership, particularly for items from graded categories with ambiguous category membership; similarity-based categorization requires an overall comparison of a test stimulus with a prototype or remembered exemplar of the category and is relatively effective for the rapid categorization of items with unambiguous category membership. To assess these processes in AD, patients were asked to decide the category membership of test stimuli for categories with poorly defined or fuzzy boundaries (e.g., VEGETABLE) and for categories with well-defined boundaries (e.g., FEMALE) and then to judge the representativeness of the test stimulus for its chosen category. A subgroup of AD patients demonstrated a typical pattern of impaired semantic memory compared to healthy control subjects; that is, difficulty deciding the category membership of test items from fuzzy categories. Among these patients, we found no deficit in category membership decisions about items taken from well-defined categories. We also found that AD patients and healthy controls do not differ in their representativeness judgments of items within a correctly judged category. These findings are most consistent with the hypothesis that rule-based categorization difficulty limits semantic memory in AD.

Differential diagnosis of the major progressive dementias and depression in middle and late adulthood: a summary of the literature of the early 1990s

There is a preponderance of research on the neuropsychology of the various dementias. There are also direct comparisons between two or more dementias available in the literature. This paper sought to summarize the most recent literature, primarily from 1990 through mid-1996, including recent reviews of the literature from previous decades. The purpose was to provide, in one location, a summary of neuropsychological (i.e., cognitive, motor, and psychiatric) characteristics of major noninfectious, progressive dementias and depression of middle and late adulthood. It is hoped that this review, particularly a summary table provided, will serve as a guide in the differential diagnosis of the dementias by clinicians. In addition to Alzheimer's disease, vascular dementias, Parkinson's disease, Lewy body dementia, Huntington's disease, and frontal lobe dementia, the impact of depression on cognitive functioning is covered given the frequency with which neuropsychologists are asked to differentiate depression from primary dementia.

Sentence comprehension in Alzheimer's disease

We asked 22 patients with Alzheimer's disease (AD) to respond to simple probes of sentences where we manipulated grammatical factors, semantic factors, and cognitive resource demands associated with a sentence. The results demonstrated limitations in the cognitive resources needed to appreciate atypical syntactic-thematic mapping relations and difficulty processing selection restrictions associated with a verb. By comparison, comprehension in AD was not influenced by the active or passive voice of a sentence. These findings are consistent with the hypothesis that impaired sentence comprehension in AD is multifactorial in nature, including difficulty processing cognitive resource and semantic aspects of sentences.

Freehand drawing impairments in probable Alzheimer's disease

We evaluated freehand picture production of familiar objects in patients with probable Alzheimer's disease. The overall recognizability of their drawings was significantly compromised. Error analyses revealed the production of category violations and the frequent inclusion of incorrect features in a picture that were borrowed from semantically related objects, suggesting difficulty distinguishing between items with overlapping features sets in semantic memory. Analyses of individual patient drawing profiles also revealed that some patients are disproportionately compromised in expressing a particular perceptual feature, implicating difficulty at the level of perceptual processing. Regression analyses demonstrated the contribution of limited visual attentional resources. We conclude that impaired freehand drawing in probable Alzheimer's disease is multifactorial in nature.

Color- and picture-word Stroop tests: performance changes in old age

The Stroop test comes in different variations, but all of them index performance on a basic task, like color or picture naming, when it is carried out by itself versus when it is performed in the presence of conflicting or incongruent stimuli. The present study examined the hypothesis that Stroop interference--the cost of performing one task in the presence of another--is a general as opposed to a test-specific index of cognitive flexibility. A second goal was to examine changes in Stroop test performance in old age. A group of 129 healthy older adults (> or = 65 years of age) were assessed on the color- and picture-word Stroop test, as well as on a battery of neuropsychological tests. Subjects' performance on each card of both Stroop tests, and various derived (differences and ratios) scores, were used to prepare age-group norms. The use of the norms is illustrated with findings from previous studies. Regression analyses showed age-changes in several aspects of Stroop test performance. Hierarchical multiple regression analyses, and causal modeling showed an age effect on Stroop interference only on the picture-word test but not on the color-word test. Exploratory factor analysis of the Stroop data and the neuropsychological test data revealed different factor loadings for the color- and picture-word test. The combined findings suggest that the color- and picture-word Stroop test measure different cognitive functions, at least in old age.

Incomplete achromatopsia in Alzheimer's disease

We report that patients with Alzheimer's disease (AD) have a selective deficit in blue hue discrimination, as assessed with three clinical measures of color vision. The Farnsworth D-15 Test, the Lanthony New Color Test, and the City University Color Vision Test were administered to 32 patients with AD (ranging in dementia severity from mild to severe) and 32 age-matched normal control subjects (NCS). Of the AD patients, 11 who were representative of the larger group for age, education level, and dementia severity received a complete neuro-ophthalmological examination that ruled out obvious disorders of the anterior visual structures. AD patients made significantly more tritan (blue) errors than NCS on all three color vision tests but did not make more protan (red) or deutan (green) errors on two of the three tests. The results support the conclusion that there is a deficit in color discrimination in AD that is specific to blue hues, and oppose the hypothesis that AD does not deleteriously affect the color-opponent visual channel. In the absence of obvious damage to anterior visual structures, the likely substrates for the observed deficit are peristriate and inferotemporal visual cortices, which are subject to significant neuropathology in AD.

Activation of cerebral blood flow during a visuoperceptual task in patients with Alzheimer-type dementia

Changes in regional cerebral blood flow (rCBF) associated with a face-matching task were examined using positron emission tomography (PET) and H2(15)O in 7 patients with mild-moderate dementia of the Alzheimer type (DAT) and in 8 healthy age-matched controls. rCBF was normalized to whole brain flow and pixel-by-pixel difference images were computed by contrasting flow during a control task to flow during face matching. Both patients and controls showed bilateral rCBF increases in occipitotemporal extrastriate cortex during face matching. The magnitude of these increases was not significantly different between the groups. In addition, the patients showed greater rCBF activation in regions of occipital and frontal cortex. These results show that early in the course of DAT, patients utilize extrastriate cortex to perform a visuoperceptual task, as do control subjects but also show rCBF increases in additional cortical areas. Activation of these additional areas of cortex in the patients may reflect an increased attentional load during face matching due to their reduced cognitive capacity.

Visual dysfunction in Alzheimer's disease: relation to normal aging

In patients with Alzheimer's disease (AD), compared with age-matched and young healthy control subjects, visual deficits in the following functions were observed: color, stereoacuity, contrast sensitivity, and backward masking (homogeneous and pattern). Critical flicker fusion thresholds were normal, relative to age-matched healthy subjects. For color, the majority of the errors were tritanomalous (blue axis). Color and stereoacuity deficits were unrelated to severity of dementia, in accordance with models of vision that describe these functions as modular rather than diffuse for cortical localization. Although contrast sensitivity was depressed throughout the frequency range in AD, more patients were impaired at low than at high spatial frequencies, contrasting with the observed normal aging pattern of high-frequency loss. Healthy elderly subjects showed depressed critical flicker fusion thresholds and reduced contrast sensitivity at high frequencies, relative to the young group; differences between these groups were not found for the other vision tests. A subset of the AD group received detailed neuro-ophthalmological examination, and no abnormalities were found. This finding, taken together with normal thresholds for critical flicker fusion, suggests that the widespread visual dysfunction reported here is more likely to be related to known pathological changes in primary visual and association cortex in AD than to changes in the retina or optic nerve.