Semantic processing of spoken words in Alzheimer's disease: an electrophysiological study

Electrophysiology reveals cognitive-linguistic alterations after concussion

Language deficits and alterations to the N400 ERP are commonly reported in aphasia and moderate-to-severe traumatic brain injury (TBI), but have seldomly been investigated after mild TBI, such as concussion. In the present study, the N400 was recorded from young adults within 1-month after concussion and matched controls during a sentence processing task. The N400 recorded to semantically incongruent sentence-final words was significantly more negative and with a more anterior distribution in the concussion group than control group. Among the concussion group, a weaker N400 was associated with more concussion symptoms, slower response time, and poorer executive functioning. Multiple regression results showed that concussion occurrence and male gender were independently associated with a more negative N400-effect, whereas symptoms were associated with a weaker N400. These findings provide novel evidence that alterations to lexical-semantic networks may occur after concussion and vary based on individual differences in post-concussion symptoms and cognitive function.

Pure Tone Audiometry and Hearing Loss in Alzheimer's Disease: A Meta-Analysis

An association between age-related hearing loss (ARHL) and Alzheimer's Disease (AD) has been widely reported. However, the nature of this relationship remains poorly understood. Quantification of hearing loss as it relates to AD is imperative for the creation of reliable, hearing-related biomarkers for earlier diagnosis and development of ARHL treatments that may slow the progression of AD. Previous studies that have measured the association between peripheral hearing function and AD have yielded mixed results. Most of these studies have been small and underpowered to reveal an association. Therefore, in the current report, we sought to estimate the degree to which AD patients have impaired hearing by performing a meta-analysis to increase statistical power. We reviewed 248 published studies that quantified peripheral hearing function using pure-tone audiometry for subjects with AD. Six studies, with a combined total of 171 subjects with AD compared to 222 age-matched controls, met inclusion criteria. We found a statistically significant increase in hearing threshold as measured by pure tone audiometry for subjects with AD compared to controls. For a three-frequency pure tone average calculated for air conduction thresholds at 500-1,000-2,000 Hz (0.5-2 kHz PTA), an increase of 2.3 decibel hearing level (dB HL) was found in subjects with AD compared to controls (p = 0.001). Likewise, for a four-frequency pure tone average calculated at 500-1,000-2,000-4,000 (0.5-4 kHz PTA), an increase of 4.5 dB HL was measured (p = 0.002), and this increase was significantly greater than that seen for 0.5-2 kHz PTA. There was no difference in the average age of the control and AD subjects. These data confirm the presence of poorer hearing ability in AD subjects, provided a quantitative estimate of the magnitude of hearing loss, and suggest that the magnitude of the effect is greater at higher sound frequencies. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD42021288280.

Investigating Auditory Electrophysiological Measures of Participants with Mild Cognitive Impairment and Alzheimer's Disease: A Systematic Review and Meta-Analysis of Event-Related Potential Studies

BACKGROUND

Objectively measuring auditory functions has been proposed as an avenue in differentiating normal age-related cognitive dysfunction from Alzheimer's disease (AD) and its prodromal states. Previous research has suggested auditory event-related potentials (AERPs) to be non-invasive, cost-effective, and efficient biomarkers for the diagnosis of AD.

OBJECTIVE

The objective of this paper is to review the published literature on AERPs measures in older adults diagnosed with AD and those at higher risk of developing AD, i.e., mild cognitive impairment (MCI) and subjective cognitive decline.

METHODS

The search was performed on six major electronic databases (Ovid MEDLINE, OVID EMBASE, PsycINFO, PubMed, Scopus, and CINAHL Plus). Articles identified prior to 7 May 2019 were considered for this review. A random effects meta-analysis and analysis of between study heterogeneity was conducted using the Comprehensive Meta-Analysis software.

RESULTS

The search identified 1,076 articles; 74 articles met the full inclusion criteria and were included in the systematic review, and 47 articles were included into the analyses. Pooled analysis suggests that AD participants can be differentiated from controls due to significant delays in ABR, N100, P200, N200, and P300 latencies. P300 amplitude was significantly smaller in AD participants compared to controls. P300 latencies differed significantly between MCI participants and controls based on the pooled analysis.

CONCLUSION

The findings of this review indicate that some AERPs may be valuable biomarkers of AD. In conjunction with currently available clinical and neuropsychological assessments, AERPs can aid in screening and diagnosis of prodromal AD.

Semantic Processing in Healthy Aging and Alzheimer's Disease: A Systematic Review of the N400 Differences

Semantic deficits are common in individuals with Alzheimer’s disease (AD). These deficits notably impact the ability to understand words. In healthy aging, semantic knowledge increases but semantic processing (i.e., the ability to use this knowledge) may be impaired. This systematic review aimed to investigate semantic processing in healthy aging and AD through behavioral responses and the N400 brain event-related potential. The results of the quantitative and qualitative analyses suggested an overall decrease in accuracy and increase in response times in healthy elderly as compared to young adults, as well as in individuals with AD as compared to age-matched controls. The influence of semantic association, as measured by N400 effect amplitudes, appears smaller in healthy aging and even more so in AD patients. Thus, semantic processing differences may occur in both healthy and pathological aging. The establishment of norms of healthy aging for these outcomes that vary between normal and pathological aging could eventually help early detection of AD.

A systematic review of cognitive event-related potentials in mild cognitive impairment and Alzheimer's disease

This systematic review examined whether event-related potentials (ERPs) during higher cognitive processing can detect subtle, early signs of neurodegenerative disease. Original, empirical studies retrieved from PsycINFO and PubMed were reviewed if they analyzed patterns in cognitive ERPs (≥150 ms post-stimulus) differentiating mild cognitive impairment (MCI), Alzheimer's disease (AD), or cognitively intact elders who carry AD risk through the Apolipoprotein-E ε4 allele (ε4+) from healthy older adult controls (HC). The 100 studies meeting inclusion criteria (MCI = 47; AD = 47; ε4+ = 6) analyzed N200, P300, N400, and occasionally, later components. While there was variability across studies, patterns of reduced amplitude and delayed latency were apparent in pathological aging, consistent with AD-related brain atrophy and cognitive impairment. These effects were particularly evident in advanced disease progression (i.e., AD > MCI) and in later ERP components measured during complex tasks. Although ERP studies in intact ε4+ elders are thus far scarce, a similar pattern of delayed latency was notable, along with a contrasting pattern of increased amplitude, consistent with compensatory neural activation. This limited work suggests ERPs might be able to index early neural changes indicative of future cognitive decline in otherwise healthy elders. As ERPs are also accessible and affordable relative to other neuroimaging methods, their addition to cognitive assessment might substantively enhance early identification and characterization of neural dysfunction, allowing opportunity for earlier differential diagnosis and targeting of intervention. To evaluate this possibility there is urgent need for well-powered studies assessing late cognitive ERPs during complex tasks, particularly in healthy elders at risk for cognitive decline.

Altered Neural Activity during Semantic Object Memory Retrieval in Amnestic Mild Cognitive Impairment as Measured by Event-Related Potentials

Deficits in semantic memory in individuals with amnestic mild cognitive impairment (aMCI) have been previously reported, but the underlying neurobiological mechanisms remain to be clarified. We examined event-related potentials (ERPs) associated with semantic memory retrieval in 16 individuals with aMCI as compared to 17 normal controls using the Semantic Object Retrieval Task (EEG SORT). In this task, subjects judged whether pairs of words (object features) elicited retrieval of an object (retrieval trials) or not (non-retrieval trials). Behavioral findings revealed that aMCI subjects had lower accuracy scores and marginally longer reaction time compared to controls. We used a multivariate analytical technique (STAT-PCA) to investigate similarities and differences in ERPs between aMCI and control groups. STAT-PCA revealed a left fronto-temporal component starting at around 750 ms post-stimulus in both groups. However, unlike controls, aMCI subjects showed an increase in the frontal-parietal scalp potential that distinguished retrieval from non-retrieval trials between 950 and 1050 ms post-stimulus negatively correlated with the performance on the logical memory subtest of the Wechsler Memory Scale-III. Thus, individuals with aMCI were not only impaired in their behavioral performance on SORT relative to controls, but also displayed alteration in the corresponding ERPs. The altered neural activity in aMCI compared to controls suggests a more sustained and effortful search during object memory retrieval, which may be a potential marker indicating disease processes at the pre-dementia stage.

Cognitive event-related potentials: biomarkers of synaptic dysfunction across the stages of Alzheimer's disease

Cognitive event-related brain potential (ERP) studies of decision-making and attention, language, and memory impairments in Alzheimer's disease (AD) and mild cognitive impairment (MCI) are reviewed. Circumscribed lesions of the medial temporal lobe (MTL), as may be the case in individuals with amnestic MCI, generally produce altered plasticity of the late positive P600 component, with relative sparing of earlier sensory ERP components. However, as the neuropathology of AD extends to neocortical association areas, abnormalities of the P300 and N400 (and perhaps even P50) become more common. Critically, ERP studies of individuals at risk for AD may reveal neurophysiological changes prior to clinical deficits, which could advance the early detection and diagnosis of "presymptomatic AD".

Mass univariate analysis of event-related brain potentials/fields I: a critical tutorial review

Event-related potentials (ERPs) and magnetic fields (ERFs) are typically analyzed via ANOVAs on mean activity in a priori windows. Advances in computing power and statistics have produced an alternative, mass univariate analyses consisting of thousands of statistical tests and powerful corrections for multiple comparisons. Such analyses are most useful when one has little a priori knowledge of effect locations or latencies, and for delineating effect boundaries. Mass univariate analyses complement and, at times, obviate traditional analyses. Here we review this approach as applied to ERP/ERF data and four methods for multiple comparison correction: strong control of the familywise error rate (FWER) via permutation tests, weak control of FWER via cluster-based permutation tests, false discovery rate control, and control of the generalized FWER. We end with recommendations for their use and introduce free MATLAB software for their implementation.

Neural correlates of foreign-language learning in childhood: a 3-year longitudinal ERP study

A foreign language (a language not spoken in one's community) is difficult to master completely. Early introduction of foreign-language (FL) education during childhood is becoming a standard in many countries. However, the neural process of child FL learning still remains largely unknown. We longitudinally followed 322 school-age children with diverse FL proficiency for three consecutive years, and acquired children's ERP responses to FL words that were semantically congruous or incongruous with the preceding picture context. As FL proficiency increased, various ERP components previously reported in mother-tongue (L1) acquisition (such as a broad negativity, an N400, and a late positive component) appeared sequentially, critically in an identical order to L1 acquisition. This finding was supported not only by cross-sectional analyses of children at different proficiency levels but also by longitudinal analyses of the same children over time. Our data are consistent with the hypothesis that FL learning in childhood reproduces identical developmental stages in an identical order to L1 acquisition, suggesting that the nature of the child's brain itself may determine the normal course of FL learning. Future research should test the generalizability of the results in other aspects of language such as syntax.

The phonemic restoration effect reveals pre-N400 effect of supportive sentence context in speech perception

The phonemic restoration effect refers to the tendency for people to hallucinate a phoneme replaced by a non-speech sound (e.g., a tone) in a word. This illusion can be influenced by preceding sentential context providing information about the likelihood of the missing phoneme. The saliency of the illusion suggests that supportive context can affect relatively low (phonemic or lower) levels of speech processing. Indeed, a previous event-related brain potential (ERP) investigation of the phonemic restoration effect found that the processing of coughs replacing high versus low probability phonemes in sentential words differed from each other as early as the auditory N1 (120-180 ms post-stimulus); this result, however, was confounded by physical differences between the high and low probability speech stimuli, thus it could have been caused by factors such as habituation and not by supportive context. We conducted a similar ERP experiment avoiding this confound by using the same auditory stimuli preceded by text that made critical phonemes more or less probable. We too found the robust N400 effect of phoneme/word probability, but did not observe the early N1 effect. We did however observe a left posterior effect of phoneme/word probability around 192-224 ms-clear evidence of a relatively early effect of supportive sentence context in speech comprehension distinct from the N400.

ERP generator anomalies in presymptomatic carriers of the Alzheimer's disease E280A PS-1 mutation

Although subtle anatomical anomalies long precede the onset of clinical symptoms in Alzheimer's disease, their impact on the reorganization of brain networks underlying cognitive functions has not been fully explored. A unique window into this reorganization is provided by presymptomatic cases of familial Alzheimer's disease (FAD). Here we studied neural circuitry related to semantic processing in presymptomatic FAD cases by estimating the intracranial sources of the N400 event-related potential (ERP). ERPs were obtained during a semantic-matching task from 24 presymptomatic carriers and 25 symptomatic carriers of the E280A presenilin-1 (PS-1) mutation, as well as 27 noncarriers (from the same families). As expected, the symptomatic-carrier group performed worse in the matching task and had lower N400 amplitudes than both asymptomatic groups, which did not differ from each other on these variables. However, N400 topography differed in mutation carrier groups with respect to the noncarriers. Intracranial source analysis evinced that the presymptomatic-carriers presented a decrease of N400 generator strength in right inferior-temporal and medial cingulate areas and increased generator strength in the left hippocampus and parahippocampus compared to the controls. This represents alterations in neural function without translation into behavioral impairments. Compared to controls, the symptomatic-carriers presented a similar anatomical shift in the distribution of N400 generators to that found in presymptomatic-carriers, albeit with a larger reduction in generator strength. The redistribution of N400 generators in presymptomatic-carriers indicates that early focal degeneration associated with the mutation induces neural reorganization, possibly contributing to a functional compensation that enables normal performance in the semantic task.

Event-related potentials in clinical research: guidelines for eliciting, recording, and quantifying mismatch negativity, P300, and N400

This paper describes recommended methods for the use of event-related brain potentials (ERPs) in clinical research and reviews applications to a variety of psychiatric and neurological disorders. Techniques are presented for eliciting, recording, and quantifying three major cognitive components with confirmed clinical utility: mismatch negativity (MMN), P300, and N400. Also highlighted are applications of each of the components as methods of investigating central nervous system pathology. The guidelines are intended to assist investigators who use ERPs in clinical research, in an effort to provide clear and concise recommendations and thereby to standardize methodology and facilitate comparability of data across laboratories.

Discrimination and reliance on conceptual fluency cues are inversely related in patients with mild Alzheimer's disease

Prior work suggests that patients with mild Alzheimer's disease (AD) often base their recognition memory decisions on familiarity. It has been argued that conceptual fluency may play an important role in the feeling of familiarity. In the present study we measured the effect of conceptual fluency manipulations on recognition judgments of patients with mild AD and older adult controls. "Easy" and "hard" test conditions were created by manipulating encoding depth and list length to yield high and low discrimination, respectively. When the two participant groups performed identical procedures, AD patients displayed lower discrimination and greater reliance on fluency cues than controls. However, when the discrimination of older adult controls was decreased to the level of AD patients by use of a shallow encoding task, we found that controls reliance on fluency did not statistically differ from AD patients. Furthermore, we found that increasing discrimination using shorter study lists resulted in AD patients decreasing their reliance on fluency cues to a similar extent as controls. These findings support the notion that patients with AD are able to attribute conceptual fluency to prior experience. In addition, these findings suggest that discrimination and reliance on fluency cues may be inversely related in both AD patients and older adult controls.

Activation of the posterior cingulate by semantic priming: a co-registered ERP/fMRI study

Although the N400 is the best understood semantically sensitive component of the event-related potential (ERP), others have been observed as well. In an earlier lexical decision study, an N300 ERP was found to be enhanced to unprimed targets, although the effect could also be characterized as a prolonged P2 to primed targets as described in other reports. Because its scalp topography suggested its neural source might be of interest, a source localization was conducted that suggested that this component emanated from the dorsal posterior cingulate cortex (dPCC). In order to confirm this word N300 localization, a functional magnetic resonance imaging (fMRI) study was conducted to replicate the ERP study with a separate sample of 17 participants in an event-related design, using a 3-T scanner. A significant activation in the right dPCC was found corresponding to the N300 localization. The activation was greater on the related prime trials, supporting the characterization of the ERP component as being a P2 rather than an N300. A review is provided which suggests that a number of separate lines of ERP research regarding the word N300, the picture N300, the word P2, the phonological mismatch negativity, and the word midline frontal negativity may be most parsimoniously regarded as dealing with the same ERP component and that they all therefore emanate from the dPCC. It is suggested that this region plays a role in stimulus-response mapping in polymodal fashion. It is also suggested that the ERP component be termed a P2-dPCC.

The mismatch negativity (MMN) in basic research of central auditory processing: a review

In the present article, the basic research using the mismatch negativity (MMN) and analogous results obtained by using the magnetoencephalography (MEG) and other brain-imaging technologies is reviewed. This response is elicited by any discriminable change in auditory stimulation but recent studies extended the notion of the MMN even to higher-order cognitive processes such as those involving grammar and semantic meaning. Moreover, MMN data also show the presence of automatic intelligent processes such as stimulus anticipation at the level of auditory cortex. In addition, the MMN enables one to establish the brain processes underlying the initiation of attention switch to, conscious perception of, sound change in an unattended stimulus stream.

From amnesia to dementia: ERP studies of memory and language

Cognitive event-related potential (ERP) studies of memory and language impairments in amnesia and Alzheimer's disease (AD) are reviewed. Well-circumscribed lesions of the medial temporal lobe (MTL) or diencephalon causing an amnestic syndrome, an inability to encode and retrieve episodic memories beyond the brief duration of working memory, appear to produce altered plasticity of the late positive P600 component, but usually spare P300 and N400 components. The neuropathology of AD affects MTL and extends to neocortical association areas, causing deficits of episodic and semantic memory. In AD dementia, the P300, N400, and P600 all commonly show abnormalities. ERP studies of individuals with mild cognitive impairment may reveal neurophysiological changes prior to the emergence of clinical deficits, which could advance the early detection and diagnosis of AD.

Absent event-related potential (ERP) word repetition effects in mild Alzheimer's disease

OBJECTIVE

We hypothesized that an ERP word repetition paradigm, which reliably elicits and modulates the P600 and N400 components, would be particularly sensitive to the memory deficits and altered synaptic plasticity in mild Alzheimer's disease (AD). The P600 (a late positive component, or 'LPC'), and the N400, are sensitive indices of memory encoding and semantic processing, respectively.

METHODS

We studied 11 patients with mild AD (mean MMSE=22.9) and 11 elderly (mean age=77.1) normal controls (NC) on a paradigm in which semantically 'congruous' category statement/exemplar pairs (50%) and 'incongruous' category statement/non-exemplar pairs (50%) repeat at 10-140 s intervals. A minimum of 19 channels ERP data were recorded and submitted to split-plot ANOVAs.

RESULTS

Normal ERP data showed: (1) a significant word repetition effect for congruous words, with a wide-spread late positivity between approximately 300 and 800 ms post-stimulus (P600) that is larger for New than Old words; (2) a significant N400 repetition effect for incongruous words, with a right posterior negativity that is reduced for Old relative to New words. By contrast, neither of these word repetition effects was reliably present in the mild AD group. Good group discrimination was achieved by requiring that both these repetition effects were > or = the 10th percentile, with 100% sensitivity and 82% specificity.

CONCLUSIONS

We found significant abnormalities of the N400 and P600 in mild AD, with both potentials showing markedly reduced sensitivity to word repetition.

SIGNIFICANCE

The absence of normal N400 and LPC/P600 word repetition effects suggests impaired functioning of their neural generators, several of which are located in medial temporal lobe predilection sites (e.g. anterior fusiform, parahippocampal gyrus, hippocampus) for AD/tau pathology.

Error processing in patients with Alzheimer's disease

Patients with dementia are prone to make errors while they perform a task. To evaluate error detection and action monitoring in patients with dementia of the Alzheimer type (DAT) at a relatively early stage of the illness, error negativity (Ne) and error positivity (Pe) of event-related potentials (ERPs) obtained by averages time-locked to error response were studied using a lexical recognition paradigm composed of Japanese 'kanji' ideogram characters. In the DAT patients, reaction times were significantly slower and error rates were higher. Not only in healthy elderly subjects but also in the DAT patients, the Ne component obtained by averages time-locked to error response showed a larger amplitude than negativity for correct response (Nc). The Ne and Pe amplitudes were significantly smaller for the DAT patients than for the healthy elderly subjects, whereas there were no significant differences in the Nc amplitude between the two subject groups. Latencies of the Ne, Pe and positivity for correct response (Pc) were prolonged in the DAT patients. These findings suggest that information processing and error detection are slower and somewhat impaired at a relatively early stage of DAT, although error detection and awareness are still preserved.

Patients with mild Alzheimer's disease attribute conceptual fluency to prior experience

Patients with Alzheimer's disease (AD) have been found to be relatively dependent on familiarity in their recognition memory judgments. Conceptual fluency has been argued to be an important basis of familiarity. This study investigated the extent to which patients with mild AD use conceptual fluency cues in their recognition decisions. While no evidence of recognition memory was found in the patients with AD, enhanced conceptual fluency was associated with a higher rate of "Old" responses (items endorsed as having been studied) compared to when fluency was not enhanced. The magnitude of this effect was similar for patients with AD and healthy control participants. Additionally, ERP recordings time-locked to test item presentation revealed preserved modulations thought critical to the effect of conceptual fluency on test performance (N400 and late frontal components) in the patients with AD, consistent with the behavioral results. These findings suggest that patients with mild AD are able to use conceptual fluency in their recognition judgments and the neural mechanisms supporting such processing is maintained.

Activation in the anterior left auditory cortex associated with phonological analysis of speech input: localization of the phonological mismatch negativity response with MEG

The spatio-temporal dynamics of cortical activation underlying auditory word recognition, particularly its phonological stage, was studied with whole-head magnetoencephalography (MEG). Subjects performed a visuo-auditory priming task known to evoke the phonological mismatch negativity (PMN) response that is elicited by violations of phonological expectancies. Words and non-words were presented in separate conditions. In each of the 318 trials, the subjects first saw a word/non-word (e.g., 'cat') that was soon followed by a prime letter (e.g., 'h'). Their task was to replace mentally the sound of the first letter of the word/non-word with the prime letter, thus resulting in a new word/non-word (e.g., 'hat'). Finally, an auditory word/non-word either matching or mismatching with the anticipated item was presented. In most subjects, a PMNm followed by a later, N400m-like negativity was obtained in the left hemisphere to the mismatching auditory stimuli. A similar response pattern was obtained in the right hemisphere only in a few subjects. Source localization of the N1m, an index of acoustic analysis, and the PMNm and N400m-like responses was performed using L1 minimum-norm estimation. In the left hemisphere, the PMNm source for the words was significantly more anterior than the source of the N400m-like response; for the non-words, the PMNm source was significantly more anterior than the sources of the N1m and the N400m-like response. These results suggest that the left-hemisphere neuronal networks involved in sub-lexical phonological analysis are at least partly different from those responsible for the earlier (acoustic) and later (whole item) processing of speech input.

Separating phonological and semantic processing in auditory sentence processing: a high-resolution event-related brain potential study

Phonological and semantic processing was studied using high-resolution event-related brain potentials (ERPs) during a sentence-matching task to investigate the spatial distribution of the phonological mismatch negativity (PMN) and the N400 response. It was hypothesized that the two components were spatially separable and that the activity matched prior localization knowledge. Participants examined visual-auditory sentence pairs that related within a semantic hierarchy (e.g., visual: "The man is teaching in the classroom"; Auditory: "The man is in the em leader school/barn"). Semantic congruency was varied for the final words of the spoken sentences. Incongruent words mismatched expectation in terms of both the initial phonological features (unexpected sound) and semantic features (unexpected meaning). In addition, the category-exemplar probability of the final words was either high or low, with low probability words being more difficult to anticipate. Low probability words were predicted to selectively affect PMN activity. We found that incongruent words elicited a PMN (287 msec) and a N400 (424 msec), for both the high and low probability words. As expected, low probability congruent words elicited a small PMN but no N400. In contrast, high probability congruent words elicited neither a detectible PMN nor a N400. The primary PMN sources were in left inferior frontal and inferior parietal lobes. The primary N400 source activation occurred along the left perisylvian cortex, consistent with prior N400 source localization work. From these results, it was concluded that the PMN and N400 were localized to separate cortical language (and memory) regions and had different source activation patterns.

Clinical applications of cognitive event-related potentials in Alzheimer's disease

This article has reviewed several abnormalities in the cognitive ERPs of AD patients. These abnormalities are prominent from latencies of approximately 200 msec and later. In contrast, sensory-dependent evoked potentials, such as N100, are generally normal in AD. This finding is as one familiar with the neuropathology of AD would predict. Predilection sites in early AD include the medial temporal lobe, other limbic areas, and multimodal association cortices with sparing of primary sensory areas. Unimodal association cortex is involved in AD, but not as heavily as multimodal cortex. Particular advantages of studying a given ERP paradigm or component depend largely on the specific application or hypothesis being tested. A P300 paradigm can be useful in detecting a disorder of attention or in quantifying the effects of drugs that improve attention, such as the cholinesterase inhibitors. For the early diagnosis of AD or other memory disorders, a word-repetition paradigm with an explicit recognition task or one that fosters associative learning would be recommended. This article has discussed potential use of N400 in tracking disease progression. ERPs provide a flexible and powerful technique, with superb temporal resolution, which can be used as a probe into subtle "subclinical" abnormalities of cognitive processes. Despite being applied to AD for about 25 years since the early P300 studies, the full potential of ERPs in helping diagnose and treat AD patients has yet to be realized. In this era of rapidly evolving brain-imaging techniques, electrophysiologic data are important in advancing understanding of cognition. Brain-mapping techniques that can inform where and when key cognitive processes occur are finally emerging. A final example of potential clinical application of cognitive ERPs is in the development of rational combinational treatment of cognitive enhancing drugs. Along these lines, P300 investigations in epilepsy proved helpful in ranking the cognitive side effects of anticonvulsant drugs. Drug studies that use 2 x 2 combinational designs, which compare the effects of drug A, drug B, with A + B, are currently prohibitively expensive for full-scale clinical trials in AD. It is likely that precise ERP measures could hasten drug development in several ways. Smaller samples could be used, at lower cost, to test the cognitive effects of each specific drug combination. Optimal doses of combinational therapy perhaps could be identified by repeated within-subject ERP measures. Longitudinal changes in the ERP hold promise as a marker of individual responsivity to a particular agent, which could have diagnostic utility (eg, testing response to cholinergic or dopaminergic therapy). This horizon and many others remain wide open for well-planned explorations.

Electrophysiological analysis of context effects in Alzheimer's disease

Event-related potentials elicited by semantically associated and unassociated word pairs embedded in congruous and semantically anomalous spoken sentences were recorded from patients with Alzheimer's disease (AD) and healthy older and young controls as a means of examining the nature, time course, and relation between word and sentence context effects. All groups demonstrated lexical priming in nonsensical sentences, but it was earlier in the young (200-600 ms) than in the older controls (600-800 ms), and even later in the probable AD patients (800-1,000 ms). Moreover, processing in both the elderly and AD groups benefited disproportionately from a meaningful sentence context. The results do not accord well with either a strictly structural or a strictly functional account of the semantic impairments in AD.

Identification of diagnostic evoked response potential segments in Alzheimer's disease

Evoked response potentials (ERPs) to brief flashes of light were analyzed for constituent features that could be used to distinguish individuals with Alzheimer's disease (AD, n = 15) from matched control subjects (n = 17). Statistical k nearest-neighbor methods distinguished AD from control with a maximum sensitivity of 29% and false alarm rate of 12%. The comparable sensitivity/false-alarm values for a statistical projection pursuit method and an extended projection pursuit method, which selectively identify discriminative features for classification, were 75%/18% and 100%/6%, respectively. The results demonstrate that combinations of selected ERP time segments across different electrodes contain signal features that discriminate AD from control subjects with high sensitivity and specificity.

Neurophysiological efficiency in male and female alcoholics

Chronic alcoholics often exhibit impairment in behavioral indicators of cognitive efficiency. However, potential neurophysiological correlates of this deficit are understudied. To examine this function, semantic expectancy was measured by recording the N400 component of the event-related potential (ERP), which is elicited by incongruent semantic information. Abstinent alcoholics, 21-45 days sober (n = 26; 12 males, 14 females), as well as age and education equated community controls (n = 26; 12 males, 14 females), were instructed to read silently 218 sentences ending with either congruent, related/incongruent, or unrelated/incongruent terminal words. Difference waveforms to the terminal word were derived, and amplitude and latency measures of the most negative peak between 300 and 600 ms were obtained. Electrode sites included the midline sites, Fz, Cz, and Pz; the temporal sites T3 and T4; and parietal sites P3 and P4. Significant group effects in amplitude were observed for the difference waveform under the unrelated/incongruent condition at T3, T4, and P4 (P < or = .05). Measures at P3, Pz, Fz, and Cz approached significance (P < or = .15). Although the overall pattern did not change when regression techniques were used to control for age, only the T4 site retained significance (P < or = .05). Across all electrode sites, alcoholics produced reduced N400 amplitudes relative to community controls. Latency was unaffected. There were no group effects for amplitude or latency measures in the related/incongruent condition. These data are consistent with the hypothesis that alcoholics suffer from a subtle deficiency in neurophysiologically based cognitive efficiency which renders them less likely to respond appropriately to irrelevant information.

Evidence for a selective deficit in automatic activation of positive information in patients with Alzheimer's disease in an affective priming paradigm

Using an affective priming paradigm, we studied the automatic and unconscious activation of emotional information in long-term memory. Participants had to judge target words preceded by various primes as positive or negative. The primes were masked and the SOA between the onset of primes and the onset of targets was 50 ms. Our results showed that in patients with dementia of the Alzheimer type (DAT), the negativity bias was preserved and the emotional priming effect was perturbed with positive targets. In control participants, this priming effect was restricted to negative targets. These findings are discussed in terms of preserved automatic activation of emotional information in Alzheimer's disease (AD) and in terms of an early deficit of the left hemisphere in AD making positive information more vulnerable to disease.

Phonological aspects of word recognition as revealed by high-resolution spatio-temporal brain mapping

We describe, for the first time, the use of high-resolution event-related brain potentials (hrERP) to identify the spatio-temporal characteristics of neural systems involved in phonological analysis. Subjects studied a visual word/non-word that was followed by the brief presentation of a prime letter (e.g. House, M) with the instruction to anticipate the word/non-word formed by replacing the word's first letter with the prime letter. After the prime letter, an auditory target word/non-word was presented that either matched/mismatched expectations (e.g., Mouse/Barn). ERPs were recorded to the onset of the auditory targets and scalp topographical maps were derived for the phonological mismatch negativity (PMN). The PMN reflected phonological analysis and examination of the peak topography revealed that the response was characterized by a prominent frontal, right-asymmetrical distribution. Spatial de-blurring (using current source density maps) indicated that the PMN scalp topography resulted primarily from an active left anterior source. The current results provide the initial evidence for the localization of the intra-cranial generator(s) involved in phonological analysis.