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      The Anticipatory Proportion as an Indicator of Language Impairment in Early-Stage Cognitive Disorder in the Elderly

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          Abstract

          Background: The anticipatory proportion (AP), the ratio between perseverative and anticipatory speech errors, is reduced in patients with brain injury. However, it is unknown whether the AP is also reduced in elderly speakers with cognitive impairment. Methods: 20 elderly speakers with a Mini Mental State Examination (MMSE) score of 25-27 and 20 elderly speakers with an MMSE score of 28-30 were assessed using a tongue-twister-based speech test, the Regensburg Word Fluency Test (RWT) and an object naming test. Results: The AP in the group of speakers with an MMSE score of 25-27 was significantly lower. Accordingly, the AP and scores in the RWT and the object naming test were higher in persons with an MMSE score of 28-30. Conclusion: Language alterations in mild cognitive dysfunction are detectable with the AP. Further longitudinal studies are needed to evaluate the predictive value of the AP.

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          Most cited references 22

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          The cholinergic hypothesis of geriatric memory dysfunction.

          Biochemical, electrophysiological, and pharmacological evidence supporting a role for cholinergic dysfunction in age-related memory disturbances is critically reviewed. An attempt has been made to identify pseudoissues, resolve certain controversies, and clarify misconceptions that have occurred in the literature. Significant cholinergic dysfunctions occur in the aged and demented central nervous system, relationships between these changes and loss of memory exist, similar memory deficits can be artificially induced by blocking cholinergic mechanisms in young subjects, and under certain tightly controlled conditions reliable memory improvements in aged subjects can be achieved after cholinergic stimulation. Conventional attempts to reduce memory impairments in clinical trials hav not been therapeutically successful, however. Possible explanations for these disappointments are given and directions for future laboratory and clinical studies are suggested.
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            Acetylcholine in mind: a neurotransmitter correlate of consciousness?

            The cholinergic system is one of the most important modulatory neurotransmitter systems in the brain and controls activities that depend on selective attention, which are an essential component of conscious awareness. Psychopharmacological and pathological evidence supports the concept of a 'cholinergic component' of conscious awareness. Drugs that antagonize muscarinic receptors induce hallucinations and reduce the level of consciousness, while the nicotinic receptor is implicated as being involved in the mechanism of action of general (inhalational) anaesthetics. In degenerative diseases of the brain, alterations in consciousness are associated with regional deficits in the cholinergic system. In Alzheimer's disease (AD), there is a loss of explicit (more than implicit) memory and hypoactivity of cholinergic projections to the hippocampus and cortex, while the visual hallucinations experienced by subjects with Dementia with Lewy bodies (DLB) are associated with reductions in neocortical ACh-related activity. In Parkinson's disease, the additional loss of pedunculopontine cholinergic neurones, which control REM (rapid eye movement) sleep or dreaming, is likely to contribute to REM abnormalities, which also occur in DLB. Widespread basal-forebrain and rostral brainstem cholinergic pathways, which include converging projections to the thalamus, appear to be located strategically for generating and integrating conscious awareness. Alleviation of a range of cognitive and non-cognitive symptoms by drugs that modulate the cholinergic system, which are being developed for the treatment of AD and related disorders, could be caused by changes in consciousness.
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              Semantic memory impairment in Alzheimer's disease: failure of access or degraded knowledge?

              A battery of neuropsychological tests designed to assess semantic knowledge about the same items both within and across different modalities was administered to a group of 22 patients with dementia of the Alzheimer type (DAT) and 26 matched controls. The DAT patients were impaired on tests of category fluency, picture naming, spoken word-picture matching, picture sorting and generation of verbal definitions. A relative preservation of superordinate knowledge on the sorting and definition tests, as well as a disproportionate reduction in the generation of exemplars from lower order categories was noted. Analysis of the errors made by each patient across the different tests, revealed a significant correspondence between the individual items. These findings offer compelling evidence that the semantic breakdown in DAT is caused by storage degradation.
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                Author and article information

                Journal
                DEM
                Dement Geriatr Cogn Disord
                10.1159/issn.1420-8008
                Dementia and Geriatric Cognitive Disorders
                S. Karger AG
                1420-8008
                1421-9824
                2013
                December 2013
                06 September 2013
                : 36
                : 5-6
                : 300-309
                Affiliations
                aDepartment of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, and bCharité Research Group on Geriatrics, Evangelisches Geriatriezentrum Berlin, Berlin, Germany
                Author notes
                *Dr. Alexander Wutzler, MD, MA, Department of Internal Medicine, Charité Campus Virchow, Augustenburger Platz 1, DE-13353 Berlin (Germany), E-Mail alexander.wutzler@charite.de
                Article
                350808 Dement Geriatr Cogn Disord 2013;36:300-309
                10.1159/000350808
                24022211
                © 2013 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 2, Tables: 2, Pages: 10
                Categories
                Original Research Article

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