Word-finding Problems Research Articles

A - 23 Duration of COVID-19 Predicts Reports of Cognitive Symptoms

Abstract Objective Most individuals recover from COVID-19 within a few weeks; however, some develop chronic symptoms. COVID-19 can affect the brain, and some patients report cognitive issues. Symptom chronicity may be associated with a greater rate of cognitive complaints. This study examined the relationship between COVID-19 symptom duration and reported cognitive problems. Method An archival database was used for this study’s data analyses. United States residents were recruited through Qualtrics and surveyed on their COVID-19 experiences (N = 1918). 173 participants (42% female, 82% Caucasian/White) who reported active COVID-19 symptoms when completing the survey were included in the data analyses. Participants answered how long they had experienced COVID-19 symptoms (ordinal variable with seven levels) and a checklist of the symptoms they experienced, including five cognitive symptoms. Items were “Brain/mind fog,” “Difficulty Concentrating,” “Forgetfulness,” “Word finding problems,” and “Confusion.” Results Five logistic regressions were conducted with symptom duration as the predictor variable and reported cognitive symptoms as the dependent variables. COVID-19 symptom duration significantly predicted all self-reported cognitive issues. Symptom duration most strongly predicted forgetfulness, B = 0.39, SE = 0.11, Wald = 13.71, p < 0.001. The probability of reporting forgetfulness increased by 47% (Exp(B) = 1.47, 95%CI[1.20, 1.81]) per unit increase in symptom duration. Conclusions These results suggest that a longer duration of COVID-19 symptoms predicts cognitive complaints. As this is a cross-sectional database, directionality cannot be determined. Cognitive effects could derive from chronic illness or to other physiological and psychological changes in chronic COVID. Both possibilities imply that healthcare providers should consider cognitive symptoms when evaluating complaints of chronic COVID-19 patients.

B - 11 Alien Limb and Corticobasal Degeneration: a Neuropsychological Case Study

Abstract Objective The patient presented with alien limb, frequently associated with corticobasal degeneration, an atypical parkinsonian syndrome with rigidity, akinesia, dystonia, cortical sensory deficit, and apraxia. Subjective memory complaints are also common. Neuropsychological performance typically includes poor performance on verbal fluency and measures tapping into executive functioning, but confrontation naming and verbal comprehension are initially well-preserved. Method The patient is a right-handed 69-year-old male who developed the sensation of alien limb in his left arm 2 years prior, in which his left hand did not feel “real.” Additionally, the patient presented with memory difficulties, mild word-finding problems, and physical/motor complaints (i.e., limb apraxia, tremor, bradykinesia, occasional limb dystonia, and postural instability) for approximately 2 years. The patient sought neuropsychological assessment to clarify his cognitive functioning in light of his neurologic symptoms. Results Premorbid functioning was in the exceptionally high range, with 18 years of education. Neuropsychologically, immediate memory was generally average, and generally low average delayed memory and recognition abilities. Mild inefficiencies were observed in executive functioning and semantic fluency. Otherwise, the patient performed generally average across other tasks of language, including confrontation naming, and attention. Conclusions In light of the literature, it is expected that corticobasal degeneration will be associated with subjective memory difficulties, executive dysfunction and poor verbal fluency. The patient presented with generally intact memory, mild executive dysfunction, and poor semantic fluency abilities. Given the patient’s high intelligence, he may be more sensitive to cognitive lapses. Neuropsychological results, along with his reported parkinsonian features, are fairly consistent with possible incipient corticobasal degeneration.

"The Invisible Woman" and "In the Rehab Waiting Room"

I have been ruminating lately on the notion of “white space,” “writer’s block,” and selfhood following a traumatic brain injury that caused word-finding problems during the acute phase of my recovery. I have coined the term, “neuropoetics” to denote the attempt to describe in poetry and flash fiction the experience of “drawing a blank” or being silenced by a medical condition.
 Attached you will find three poems for your consideration: “Memory Villanelle,” “The Invisible Woman,” and “In the Rehab Waiting Room.” I was inspired by Laurie Clements Lambeth’s statement regarding the use of formal structure in her poetry about her Multiple Sclerosis, the blurring of bodily boundaries: “I needed the cage of a villanelle—so restrictive, in that very few lines can truly further the poem along, and yet so obsessive a form—to house the poem” (171). I have tried the same technique to describe the connection between memory and identity. “The Invisible Woman” takes as much from the Marvel universe as H.G. Wells; in it, I use the figure of Sue Storm and her dubious gift of being ignored as representative of the experience of an “invisible disability,” or something neurological rather than physically identifiable. Finally, “In the Rehab Waiting Room” was accidentally inspired by Elizabeth Bishop’s famous poem, as per the epigraph. It was an early attempt to capture the feeling of being a “blank slate” or having that post-traumatic “blank stare” that avoids eye contact with others

People with aphasia and their family members proposing joint future activities in everyday conversations: A conversation analytic study.

In everyday conversations, a person with aphasia (PWA) compensates for their language impairment by relying on multimodal and material resources, as well as on their conversation partners. However, some social actions people perform in authentic interaction, proposing a joint future activity, for example, ordinarily rely on a speaker producing a multi-word utterance. Thus, the language impairment connected to aphasia may impede the production of such proposals, consequently hindering the participation of PWAs in the planning of future activities. To investigate (1) how people with post-stroke chronic aphasia construct proposals of joint future activities in everyday conversations compared with their familiar conversation partners (FCPs); and (2) how aphasia severity impacts on such proposals and their uptake. Ten hours of video-recorded everyday conversations from seven persons with mild and severe aphasia of varying subtypes and their FCPs were explored using conversation analysis. We identified 59 instances where either party proposed a joint future activity and grouped such proposals according to their linguistic format and sequential position. Data are in Finnish. People with mild aphasia made about the same number of proposals as their FCPs and used similar linguistic formats to their FCPs when proposing joint future activities. This included comparable patterns associated with producing a time reference, which was routinely used when a proposal initiated a planning activity. Mild aphasia manifested itself as within-turn word searches that were typically self-repaired. In contrast, people with severe aphasia made considerably fewer proposals compared with their FCPs, the proposal formats being linguistically unidentifiable. This resulted in delayed acknowledgement of the PWAs' talk as a proposal. Mild aphasia appears not to impede PWAs' ability to participate in the planning of joint future activities, whereas severe aphasia is a potential limitation. To address this possible participatory barrier, we discuss clinical implications for both therapist-led aphasia treatment and conversation partner training. What is already known on the subject PWAs use multimodal resources to compensate for their language impairment in everyday conversations. However, certain social actions, such as proposing a joint future activity, cannot ordinarily be accomplished without language. What this paper adds to existing knowledge The study demonstrates that proposing joint future activities is a common social action in everyday conversations between PWAs and their family members. People with mild aphasia used typical linguistic proposal formats, and aphasic word-finding problems did not prevent FCPs from understanding the talk as a proposal. People with severe aphasia constructed proposals infrequently using their remaining linguistic resources, a newspaper connecting the talk to the future and the support from FCPs. What are the potential or actual clinical implications of this work? We suggest designing aphasia treatment with reference to the social action of proposing a joint future activity. Therapist-led treatment could model typical linguistic proposal formats, whereas communication partner training could incorporate FCP strategies that scaffold PWAs' opportunities to construct proposals of joint future activities. This would enhance aphasia treatment's ecological validity, promote its generalization and ultimately enable PWAs to participate in everyday planning activities.

Clinical Aspects of Alzheimer Disease

The clinical diagnosis of Alzheimer disease (AD) has been well established, but there is a widespread misunderstanding about the relationship between dementia (a syndrome) and AD (a cause of dementia). AD is the most common etiology that causes dementia in mid- and late life. The prototypical clinical presentation is that of a gradually worsening problem with learning new information, that is, a short-term memory deficit, accompanied by cognitive impairment in other domains, including language, spatial cognition, and executive functioning, as well as changes in personality and behavior. A key element of the diagnosis of dementia is that daily functioning is impaired. The concept of mild cognitive impairment (MCI) as the earliest symptomatic presentation of a dementing illness is now widely accepted. MCI due to AD typically presents with isolated problems with learning and memory without substantial loss of ability to function in daily life. Less common variants of AD are now recognized and include a disorder in which spatial and visual cognitive dysfunction occurs or in which word-finding problems predominate at the onset of symptoms. Although AD as a cause of dementia is the most common among etiologies, AD often co-occurs with other neurodegenerative diseases and with cerebrovascular disease. The presence of multietiology dementia in which AD is a contributor is particularly common in the eighth decade of life and beyond. This review contains 1 figure, 3 tables, and 28 references Keywords: Alzheimer disease, cognitive impairment, dementia, mild cognitive impairment

Clinical Aspects of Alzheimer Disease

The clinical diagnosis of Alzheimer disease (AD) has been well established, but there is a widespread misunderstanding about the relationship between dementia (a syndrome) and AD (a cause of dementia). AD is the most common etiology that causes dementia in mid- and late life. The prototypical clinical presentation is that of a gradually worsening problem with learning new information, that is, a short-term memory deficit, accompanied by cognitive impairment in other domains, including language, spatial cognition, and executive functioning, as well as changes in personality and behavior. A key element of the diagnosis of dementia is that daily functioning is impaired. The concept of mild cognitive impairment (MCI) as the earliest symptomatic presentation of a dementing illness is now widely accepted. MCI due to AD typically presents with isolated problems with learning and memory without substantial loss of ability to function in daily life. Less common variants of AD are now recognized and include a disorder in which spatial and visual cognitive dysfunction occurs or in which word-finding problems predominate at the onset of symptoms. Although AD as a cause of dementia is the most common among etiologies, AD often co-occurs with other neurodegenerative diseases and with cerebrovascular disease. The presence of multietiology dementia in which AD is a contributor is particularly common in the eighth decade of life and beyond. This review contains 1 figure, 3 tables, and 28 references Keywords: Alzheimer disease, cognitive impairment, dementia, mild cognitive impairment

Longitudinal Neurocognitive and Pulmonological Profile of Long COVID-19: Protocol for the COVIMMUNE-Clin Study

BackgroundThere is a dearth of information about “brain fog,” characterized by concentration, word-finding, or memory problems, which has been listed in the new World Health Organization provisional classification “U09.9 Post-COVID-19 Condition.” Moreover, the extent to which these symptoms may be associated with neurological, pulmonary, or psychiatric difficulties is unclear.ObjectiveThis ongoing cohort study aims to carefully assess neurocognitive function in the context of the neurological, psychiatric, and pulmonary sequelae of SARS-CoV-2 infection among patients with asymptomatic/mild and severe cases of COVID-19 after remission, including actively recruited healthy controls.MethodsA total of 150 participants will be included in this pilot study. The cohort will comprise patients who tested positive for SARS-CoV-2 infection with either an asymptomatic course or a mild course defined as no symptoms except for olfactory and taste dysfunction (n=50), patients who tested positive for SARS-CoV-2 infection with a severe disease course (n=50), and a healthy control group (n=50) with similar age and sex distribution based on frequency matching. A comprehensive neuropsychological assessment will be performed comprising nuanced aspects of complex attention, including language, executive function, verbal and visual learning, and memory. Psychiatric, personality, social and lifestyle factors, sleep, and fatigue will be evaluated. Brain magnetic resonance imaging, neurological and physical assessment, and pulmonological and lung function examinations (including body plethysmography, diffusion capacity, clinical assessments, and questionnaires) will also be performed. Three visits are planned with comprehensive testing at the baseline and 12-month visits, along with brief neurological and neuropsychological examinations at the 6-month assessment. Blood-based biomarkers of neurodegeneration will be quantified at baseline and 12-month follow-up.ResultsAt the time of submission, the study had begun recruitment through telephone and in-person screenings. The first patient was enrolled in the study at the beginning of April 2021. Interim data analysis of baseline information is expected to be complete by December 2021 and study completion is expected at the end of December 2022. Preliminary group comparisons indicate worse word list learning, short- and long-delayed verbal recall, and verbal recognition in both patient cohorts compared with those of the healthy control group, adjusted for age and sex. Initial volumetric comparisons show smaller grey matter, frontal, and temporal brain volumes in both patient groups compared with those of healthy controls. These results are quite robust but are neither final nor placed in the needed context intended at study completion.ConclusionsTo the best of our knowledge, this is the first study to include objective and comprehensive longitudinal analyses of neurocognitive sequelae of COVID-19 in an extreme group comparison stratified by disease severity with healthy controls actively recruited during the pandemic. Results from this study will contribute to the nascent literature on the prolonged effects of COVID-19 on neurocognitive performance via our coassessment of neuroradiological, neurological, pulmonary, psychiatric, and lifestyle factors.Trial RegistrationInternational Clinical Trials Registry Platform DRKS00023806; https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00023806International Registered Report Identifier (IRRID)DERR1-10.2196/30259

Language processing in glioma patients: speed or accuracy as a sensitive measure?

ABSTRACT Background Glioma (brain tumour) patients can suffer from mild linguistic and non-linguistic cognitive problems when the glioma is localised in an eloquent brain area. Word-finding problems are among the most frequently reported complaints. However, mild problems are difficult to measure with standard language tests because they are generally designed for more severe aphasic patients. Aims The aim of the present study was to investigate whether word-finding problems reported by patients with a glioma can be objectified with a standard object naming test, and a linguistic processing speed test. In addition, we examined whether word-finding problems and linguistic processing speed are related to non-verbal cognitive abilities. Methods & Procedures We tested glioma patients (N=36) as part of their standard pre-treatment clinical work-up. Word-finding problems were identified by a clinical linguist during the anamnesis. Linguistic processing speed was assessed with a newly designed sentence judgment test (SJT) as part of the Diagnostic Instrument for Mild Aphasia (DIMA), lexical retrieval with the Boston Naming Test (BNT), presence of aphasia with a Token Test (TT), and non-verbal processing with the Trail Making Test A and B (TMT). Test performances of glioma patients were compared to those of healthy control participants (N=35). Outcomes & Results The results show that many glioma patients (58%) report word-finding problems; these complaints were in only half of the cases supported by deviant scores on the BNT. Moreover, the presence of reported word-finding problems did not correlate with the BNT scores. However, word-finding problems were significantly correlated with reaction times on the SJT and the TMT. Although there were no significant differences between the patient and control group on the SJT, a subgroup of patients with a glioma in the frontal lobe of the language-dominant hemisphere was slower on the SJT. Finally, performance on the SJT and TMT were significantly correlated in the patient group but not in the control group. Conclusions Linguistic processing speed appears to be an important factor in explaining reported word-finding problems. Moreover, the overlap between speed of language processing and non-verbal processing indicates that patients may rely on more domain-general cognitive abilities as compared to healthy participants. The variability observed between patients emphasises the need for tailored neuro-linguistic assessments including an extensive anamnesis regarding language problems in clinical work-up.

ERPS AS AN INDEX OF IMPAIRED COGNITIVE CONTROL IN AN ISCHEMIC BRAIN STROKE APHASIC PATIENT

Stroke is a sudden-onset neurological deficit resulting from focal vascular lesions. This is either due to a clot-induced obstruction of a vessel (ischemic stroke) or a rupture of a vessel causing haemorrhage (hemorrhagic stroke). The appropriate diagnosis of brain stroke aphasic patients is a major public health problem one so important for effective rehabilitation. Here an important role is played by the diagnosis of impaired cognitive processes. The aim of the research was to find the index of impaired cognitive control with the use of ERPs in a patient following an ischemic stroke with aphasia. A male patient, aged 69, after an ischemic brain stroke experienced 4 months previously with resulting naming problem, was admitted to the Reintegrative and Teaching Center of the Polish Neuropsychological Society. In the neuropsychological evaluation three neuropsychological tests were employed: (a) the Boston Naming Test-Polish version, to evaluate the naming and word finding problem; (b) the nonverbal Bell test to ascertain a selective, visuospatial and strategic attentional evaluation; (c) the Digit Memory test to evaluate working memory capabilities; (d) ERPs as a neurophys- iological index of impaired cognitive control. Significant changes were observed in testing. All cognitive functions including naming, non- verbal, visuospatial and strategic attention, along with the digit memory deviate substantially from the norm. The patient obtained a lo wer score, compared to the norm (p <0.05). Boston Naming Test (patient = 21< Mean-Norm = 57.29; SD= 0.52). Bell test (patient = 23 < Mean-Norm = 31.29; SD= 2.52). Digit Memory Test scores: Forward digit span (patient = 3 < Mean-Norm = 7.65, SD = 0.49). Backward digit span (patient = 2 <Mean-Norm = 6.51, SD = 0.7). Significant changes were observed also in neurophysiological testing: behavioral parameters (except RT) deviate substantially from the reference. EEG spectra show clear abnormalities on the left side within the left Rolandic fis- sure. The deviations include excessive mu-rhythm and beta activity, which means that this area is inhibited. The ERPs show no difference between GO and NOGO conditions in the patient in comparison to the norm from HBI database indicating poor cognitive control. ERPs could be treated as an index of impaired cognitive control in the ischemic stroke aphasic patient.

How the speed of word finding depends on ventral tract integrity in primary progressive aphasia

Primary progressive aphasia (PPA) is a clinical neurodegenerative syndrome with word finding problems as a core clinical symptom. Many aspects of word finding have been clarified in psycholinguistics using picture naming and a picture-word interference (PWI) paradigm, which emulates naming under contextual noise. However, little is known about how word finding depends on white-matter tract integrity, in particular, the atrophy of tracts located ventrally to the Sylvian fissure. To elucidate this question, we examined word finding in individuals with PPA and healthy controls employing PWI, tractography, and computer simulations using the WEAVER++ model of word finding. Twenty-three individuals with PPA and twenty healthy controls named pictures in two noise conditions. Mixed-effects modelling was performed on naming accuracy and reaction time (RT) and fixel-based tractography analyses were conducted to assess the relation between ventral white-matter integrity and naming performance. Naming RTs were longer for individuals with PPA compared to controls and, critically, individuals with PPA showed a larger noise effect compared to controls. Moreover, this difference in noise effect was differentially related to tract integrity. Whereas the noise effect did not depend much on tract integrity in controls, a lower tract integrity was related to a smaller noise effect in individuals with PPA. Computer simulations supported an explanation of this paradoxical finding in terms of reduced propagation of noise when tract integrity is low. By using multimodal analyses, our study indicates the significance of the ventral pathway for naming and the importance of RT measurement in the clinical assessment of PPA.

Stimulation-induced side effects after deep brain stimulation - a systematic review.

Deep brain stimulation (DBS) was approved by Food and Drug Administration for Parkinson's disease, essential tremor, primary generalised or segmental dystonia and obsessive-compulsive disorder (OCD) treatment. The exact mechanism of DBS remains unclear which causes side effects. The aim of this review was to assess variables causing stimulation-induced chronic psychiatric/personality-changing side effects. The analysis of scientific database (PubMed, Cochrane Library, EMBASE) was conducted. The included articles had to be research study or case report and DBS to be conducted in therapeutic purposes. The researches with mental disorders in patients' medical histories were excluded. Seventeen articles were used in the review. In the group of movement disorders the characteristic of side effects was strongly related to the placement of the electrode implantation. Tiredness/fatigue was correlated with DBS in thalamus. Implantations in subthalamic nucleus were mostly followed by affective side effects such as depression or suicide. The higher voltage of electrode was connected with more severe depression after implantation. The analysis of affective disorder contained only three articles - two about OCD and one about depression. Forgetfulness and word-finding problems as activities connected with cognition may be an inevitable side effect if obsessive thoughts are to be inhibited. DBS of subthalamic nucleus should be seen as the most hazardous place of implantation. As a result there is a strong need of 'gold standards' based on the connectivity research and closer cooperation of scientists and clinicians.

What are the most common memory complaints following stroke? A frequency and exploratory factor analysis of items from the Everyday Memory Questionnaire-Revised

Objective: Memory problems are commonly reported following stroke; however, the specific nature and frequency of memory complaints experienced by stroke survivors has not been sufficiently investigated. We aimed to investigate the factor structure of the Everyday Memory Questionnaire-Revised (EMQ-R) in stroke survivors with memory complaints, and identify the most commonly endorsed items.Method: A total of 91 stroke survivors completed the EMQ-R prior to participation in a memory rehabilitation trial. A principal components analysis was carried out on the EMQ-R data and reliability analyses were conducted on the resulting subscales. We described the average frequency of occurrence of specific memory complaints in one month, as reported by stroke survivors.Results: The factor analysis yielded a two-component solution which accounted for 60.12% of the variance, suggesting that two subscales termed Forgetting and Attention would be most appropriate for clinical use with stroke survivors. These subscales demonstrated strong internal reliability. A total of 87.9% of the participants reported having word-finding difficulties more than once monthly. Of all EMQ-R items, participants rated word-finding problems as occurring at the highest frequency (once or more daily).Conclusions: Stroke survivors’ everyday memory complaints fall into two distinct categories relating to memory and attentional processes. Calculating scores on the two EMQ-R subscales separately may assist clinicians to understand the nature of memory complaints reported by stroke survivors who participate in memory rehabilitation programs, and may enable more targeted outcome measurement in research trials.

A brief intervention for chemobrain: Results from a pilot study.

171 Background: Up to 75 percent of breast cancer survivors (BCS) who were treated with chemotherapy report difficulty with cognition, including word finding problems and an inability to attend or multitask. The phenomenon of chemotherapy-related cognitive impairment is often referred to as “Chemobrain.” Chemobrain negatively affects one’s family and social and professional lives. In addition, anxiety and depression – commonly found in breast cancer survivors –negatively affect one’s cognition. An intervention for chemobrain needs to also address these psychological disorders in order to increase the quality of life of BCS. Methods: BCS who completed chemotherapy in the past 5 years and complained of subsequent cognitive decline were recruited for an intervention that included mindfulness and cognitive rehabilitation. Mindfulness has been shown to help with attention and to decrease depression and anxiety. The intervention was given in a class setting and met once/week for 1.5 hours for 6 weeks. Participants completed a brief neuropsychological battery pre- and post-intervention. Results: Immediately post-intervention, all participants (n = 11, mean age = 53.7 years, 100% female) reported increased cognitive functioning as measured by FACT-Cognitive Function, with a mean increase of 27.7 points (p < 0.01, d= 1.82). Ninety-one percent of participants reported decreased depression as measured by PHQ-9, with a mean decrease of 4.7 points (p = 0.02, d= 0.82). These improvements were sustained 3 months post-intervention in cognitive functioning (p < 0.01, d= 2.04) and depression (p < 0.01, d = 1.39). Improved performance was also found in verbal fluency (p = 0.02, d= 0.87) and executive functioning as measured by Trail Making Test B (p = 0.02, d= 0.82). No improvement was detected in verbal learning or processing speed. Conclusions: Breast cancer survivors with chemobrain can recover cognitive functioning and decrease levels of depression relatively quickly with an intervention that combines mindfulness and cognitive rehabilitation. This recovery can be sustained for at least 3 months post-intervention. Additional research is needed to investigate how long recovery can be maintained and if the same intervention can help other cancer survivors.

Lexical access in a bilingual speaker with dementia: Changes over time

ABSTRACTIn this article, we explore the naming skills of a bilingual English-Norwegian speaker diagnosed with Primary Progressive Aphasia, in each of his languages across three different speech contexts: confrontation naming, semi-spontaneous narrative (picture description), and conversation, and at two points in time: 12 and 30 months post diagnosis, respectively. The results are discussed in light of two main theories of lexical retrieval in healthy, elderly speakers: the Transmission Deficit Hypothesis and the Inhibitory Deficit Theory. Our data show that, consistent with the participant’s premorbid use of and proficiency in the two languages, his performance in his L2 is lower than in his L1, but this difference diminishes as the disease progresses. This is the case across the three speech contexts; however, the difference is smaller in the narrative task, where his performance is very low in both languages already at the first measurement point. Despite his word finding problems, he is able to take active part in conversation, particularly in his L1 and more so at the first measurement point. In addition to the task effect, we find effects of word class, frequency, and cognateness on his naming skills. His performance seems to support the Transmission Deficit Hypothesis. By combining different tools and methods of analysis, we get a more comprehensive picture of the impact of the dementia on the speaker’s languages from an intra-individual as well as an inter-individual perspective, which may be useful in research as well as in clinical practice.

Assessing the Believability of Standardized Patients Trained to Portray Communication Disorders.

The purpose of this study was to evaluate the believability of standardized patients portraying individuals with communication disorders as part of a larger study in which standardized patients help train medical and allied health students about communication disorders. Two women portrayed persons with aphasia, and 2 men depicted persons with dysarthria associated with Parkinson's disease. Two stakeholder groups rated believability. Speech-language pathologists rated believability of videos online. Persons with aphasia rated aphasia videos during in-person sessions with the researchers. Targeted believability was 80 or higher (0-100 scale; 0 = not at all believable, 100 = very believable). For speech-language pathologist raters, average ratings met the target for the portrayals of the aphasia characteristics of word-finding problems, agrammaticism, nonverbal communication, and overall portrayal but not for auditory comprehension problems. Targets for the portrayals were met for the dysarthria characteristics of reduced speech movements, reduced loudness, reduced intonation, flat affect, and overall portrayal but not for speech rate. Ratings for different standardized patients portraying the same case were not significantly different from each other on most characteristics. Ratings from persons with aphasia were highly variable. Standardized patients who do not have communication disorders can portray disorder characteristics in a believable manner.

Clinical Aspects of Alzheimer Disease

The clinical diagnosis of Alzheimer disease (AD) has been well established, but there is a widespread misunderstanding about the relationship between dementia (a syndrome) and AD (a cause of dementia). AD is the most common etiology that causes dementia in mid- and late life. The prototypical clinical presentation is that of a gradually worsening problem with learning new information, that is, a short-term memory deficit, accompanied by cognitive impairment in other domains, including language, spatial cognition, and executive functioning, as well as changes in personality and behavior. A key element of the diagnosis of dementia is that daily functioning is impaired. The concept of mild cognitive impairment (MCI) as the earliest symptomatic presentation of a dementing illness is now widely accepted. MCI due to AD typically presents with isolated problems with learning and memory without substantial loss of ability to function in daily life. Less common variants of AD are now recognized and include a disorder in which spatial and visual cognitive dysfunction occurs or in which word-finding problems predominate at the onset of symptoms. Although AD as a cause of dementia is the most common among etiologies, AD often co-occurs with other neurodegenerative diseases and with cerebrovascular disease. The presence of multietiology dementia in which AD is a contributor is particularly common in the eighth decade of life and beyond. Key words: Alzheimer disease, cognitive impairment, dementia, mild cognitive impairment

Estimating risk of word-finding problems in adults undergoing epilepsy surgery.

This retrospective, observational study examined the frequency and magnitude of change in naming ability as a function of side/site of epilepsy surgery and identified predictive factors to assist clinicians in identifying patients at low, moderate, or high risk of postoperative naming decline. A total of 875 adults with pharmacoresistant epilepsy (454 left/421 right; 763 temporal/87 frontal/25 posterior quadrant) met inclusion criteria and completed the Boston Naming Test before and after surgery. Clinically meaningful change in naming ability was assessed using reliable change indices for epilepsy. Demographic, cognitive, and seizure variables were examined to determine factors most predictive of naming decline and to develop a decision tree to assist with clinical decision-making. Naming decline was rare in right-sided resections and did not exceed the level expected by chance (5% overall; 90% confidence interval [CI] ± 2%). Naming decline occurred in 41% (CI ± 5%) of patients after left temporal resection (TLR) compared to 10%-12% (CI ± 10%-19%) in other left-sided surgical groups. A sizable proportion of left TLR patients (17%; CI ± 4%) showed substantial declines in naming (>11 points). Decline following left TLR was related to later age at seizure onset, older age at surgery, and higher preoperative naming ability. These factors correctly predicted naming decline in 68% of patients and were associated with degree of decline following left TLR. A decision tree is provided to assist clinicians in identifying patients at low, moderate, or high risk for postoperative naming declines. In addition to discussions regarding risk for memory decline following left TLR, patients should be counseled about potential decline in word-finding ability.

NCOG-06. USABILITY AND VALIDITY OF A PHONE BATTERY TO ASSESS LANGUAGE FUNCTIONS IN BRAIN TUMOR PATIENTS UNDERGOING AWAKE SURGERY

Introduction: A wake surgery in eloquent brain regions is performed to preserve language functions. Although in general no major permanent language deficits are found after awake brain surgery, clinically relevant impairments are detected (Satoer et al., 2014). Unfortunately, follow-up of tumor patients in the San Francisco area is difficult since most patients are not local and come from far. Therefore, we developed a short language phone battery for pre- and postoperative language assessments. Methods: Phase 1: task and item selection of the phone battery. The development of the phone battery was based on the Dutch Linguistic Intraoperative Protocol (De Witte et al., 2015) and existing standardized English batteries. Two parallel versions were composed and tested in healthy native English speakers. The test items were controlled for linguistic variables (e.g. frequency). Phase 2: clinical use of the phone battery in tumor patients. The phone battery was administered in a group of 15 tumor patients before surgery and at 1 week after surgery. Follow-up test moments at 1 month and 3 months postsurgery are planned. These patient data will be compared with language data collected in a group of 15 matched controls. Results: Phase 1: The phone test battery includes auditory comprehension, repetition, semantic selection, sentence/story completion, verbal naming and fluency tests. It takes less than 20 minutes to administer. The healthy participants had no difficulty performing any of the seven language tests via the phone, attesting to the feasibility of a phone assessment. Phase 2: In the tumor group wordfinding, phonological and fluency problems were found at 1 week postsurgery. Longer follow-up data will be analysed and discussed. Discussion: The use of telephone batteries to conduct language assessments from afar can provide convenience, reduce costs (for traveling), and optimize patient care as assessment services might be unavailable locally.

NEUROPATHOLOGY OF FAMILIAL ALZHEIMER'S DISEASE ASSOCIATED WITH A PRESENILIN 1 A396T MUTATION REVEALS THE COEXISTENCE OF Aβ, TAU, AND A-SYNUCLEIN PROTEINOPATHIES

In the course of a published, large molecular study of Alzheimer disease in Turkey, the Presenilin 1 (PSEN1) variant GCC to ACC was identified at c.1186 in the coding region of Exon 11. The same DNA change was found by analyzing archival brain tissue obtained by the National Cell Repository for Alzheimer’s Disease. A re-examination of the brain was carried out and available clinical records reviewed. DNA was isolated from frozen brain tissue and the APP and PSEN1 genes were sequenced. For histology, the following methods were used: Hematoxylin Eosin, Woelcke-Heidenhain, and Bielschowsky; for immunohistochemistry, antibodies against tau (ALZ-50), amyloid β (10D5), and α-synuclein were used. A 58 year old male complained of problems of concentration. At age 60, he noted word finding problems. An MRI, at age 61, showed atrophy and white matter changes more pronounced in the right occipital lobe; a SPECT scan at age 62 showed decreased perfusion in the right parietal lobe. The subject died at age 66. The subject’s father developed a dementing illness after age 65. The fresh brain weighed 1200 grams. The left hemibrain was examined neuropathologically, while the right hemibrain was frozen for molecular studies. Histologic and immuno-histochemical studies revealed numerous Lewy bodies and neurites in cingulate, frontal, insular, temporal, parietal and occipital cortices, in hippocampus, caudate nucleus, putamen, substantia innominata, amygdala, thalamus, substantia nigra, ocular motor nerve nucleus, locus coeruleus, and nucleus ambiguus. Numerous neurofibrillary tangles and neuritic plaques, tau immuno-positive neurons and neuropril threads, as well as Aβ immuno-positive plaques were also present in the above mentioned anatomical regions. Aβ angiopathy was noted. DNA analysis revealed a GCC>ACC point mutation predicting an amino acid substitution of Alanine (A) to Threonine (T) at residue 396 in Presenilin 1. This is the first study of the neuropathologic features associated with the PSEN1 A396T mutation. The neuropathologic diagnoses established prior to molecular analysis were: 1) Lewy body disease and 2) Alzheimer disease. The reexamination forces us to reconsider the neuropathologic diagnosis and potential pathogenetic mechanisms operating in the presence of PSEN1 mutations. Acknowledgements: P30 AG 010133; U24 AG 21886.

Age-Related Increases in Verbal Knowledge Are Not Associated With Word Finding Problems in the Cam-CAN Cohort: What You Know Won't Hurt You.

Objective: We tested the claim that age-related increases in knowledge interfere with word retrieval, leading to word finding failures. We did this by relating a measure of crystallized intelligence to tip-of-the-tongue (TOT) states and picture naming accuracy.Method: Participants were from a large (N = 708), cross-sectional (aged 18–88 years), population-based sample from the Cambridge Centre for Ageing and Neuroscience cohort (Cam-CAN; www.cam-can.com). They completed (a) the Spot-the-Word Test (STW), a measure of crystallized intelligence in which participants circled the real word in word/nonword pairs, (b) a TOT-inducing task, and (c) a picture naming task.Results: Age and STW independently predicted TOTs, with higher TOTs for older adults and for participants with lower STW scores. Tests of a moderator model examining interactions between STW and age indicated that STW was a significant negative predictor of TOTs in younger adults, but with increasing age, the effect size gradually approached zero. Results using picture naming accuracy replicated these findings.Discussion: These results do not support the hypothesis that lifelong knowledge acquisition leads to interference that causes an age-related increase in TOTs. Instead, crystallized intelligence supports successful word retrieval, although this relationship weakens across adulthood.