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Verbal working memory and the role of the phonological loop in Alzheimer’s Disease Introduction In the last few years, the nature of neuropsychological deficits in Alzheimer's Disease (AD) has been intensly researched. There have been a few investigations of verbal working memory in AD, wich reported more difficulties in verbal fluency test (e.g. Martin, A., Fedio, P. 1983; Martin, A., Brouwers, P., Cox, Ch., Fedio P. 1985; Tröster, A. I., Salmon, D. P., McCullough, D., Butters, N., 1989; Diaz, M., Sailor, K., Cheung, D., Kuslansky, G. 2004; Astell, A. J., Arlene J. Astell, Bucks, R. S., 2006; Marczinski, C. A., Kertesz, A. 2006), the role of the central executive (Papagno, C., Allegra, A., Cardaci, M. 2004) and auditory verbal working memory (Karrasch, M., Laine, M., Rinne, J. O., Rapinoja, P., Sinervä, E., Krause, Ch. M. 2006). The main purpose of this research is to study verbal working memory and the role of phonological loop in different stages of Alzheimer's Disease (mild, moderate, severe) compared to age-matched healthy controls. We would like to map the neuropsychological profile of the participants. We used Baddeley's model (Baddeley 1998, 2003). Materials and methods In total, 50 participants participated in this study. AD persons (n=30) were sub-grouped according to the severity of the dementia syndrome: they were midly to moderately demented as gauged by Mini Mental State Examination (Folstein, Folstein, & McHugh, 1975; Addenbrook Cognitive Examination, Dudas et al. 2005). All AD participants met the DSM-IV and ICD-10 criteria for probable Alzheimer's Disease (American Psychiatric Association, 2000). The following neuropsychological tests were used to map the verbal working memory of native Hungarian speaking participants: digit span (forward, phonological loop), nonword repetition (phonological loop), complex listening and reading span (complex working memory), verbal fluency (phonemic and semantic). Results The result of the verbal working memory tests are summarized in Table 1.
2,36 0,92 0-3 0,8 1,03 0-2 0,00 0,00 0 2,45 0,68 2-3
4,9 0,53 4-6
4,7 0,94 3-6
3,77 0,44 3-4 4,7 0,8 4-6
8,63 3,41 5-15 6,3 3,12 2-11 3,44 1,74 0-6 12,75 2,78 9-20
11,72 3,34 7-17 8,5 2,99 4-13 6,40 3,43 2-12 15,9 3,55 11-25
4,72 0,70 3-7
4,6 1,34 3-7 3,00 1,41 0-5 4,65 0,98 3-7
The results of the verbal working memory tasks revealed that the AD persons performance in the complex listening and reading span tasks (mild 2.36, moderate 0.80, severe 0.00 vs. 2.45±0.68), phonemic fluency (mild 8.63, moderate 6.30, severe 3.44 vs. 12.75±2.78) and semantic fluency (mild 11.72, moderate 8.50, severe 6.40 vs. 15.9±3.55) was lower than in the controls, while in the nonword repetition task (mild 4.72, moderate 4.6, severe 3.00 vs.4.65±0.98) was close to that of the controls and in the digit span (mild 4.90, moderate 4.7, severe 3.77 vs. 4.7±0.8) task in mild AD was better than in the controls.
Conclusions Verbal working memory has been different disordered in the different stages of Alzheimer's Disease. In the nonword repetition task results of AD persons were close to that of the controls and in the digit span task in mild AD was better than in the controls. In the mild and moderate stage of the disease phonological loop is intact. In the nonword repetition task results of mild and moderate AD persons were close to that of the controls and in the digit span task in mild AD was better than in the controls (but not significant). Central executive is from early stage disordered. References American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders (4th ed., text. rev.) Washington, DC: Author. Astell, A. J., Bucks R. S. (2006) Strategy prompts increase verbal fluency in people with Alzheimer’s disease. Brain and Language, 99/1-2, 141-142. Baddeley, A. D. (1998) The central executive: A concept and some misconceptions. Journal of the International Neuropsychological Society, 4/5, 523-526. Diaz, M., Sailor, K., Cheung, D. & Kuslansky, G. (2004) Category size effects in semantic and letter fluency in Alzheimer’s patients. Brain and Language, 89/1, 108-114. Folstein, M. F., Folstein, S. E., McHugh, P. R. (1975) "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician". Journal of psychiatric research, 12/3, 189-98. Karrasch, M., Laine, M., Rinne, J. O., Rapinoja, P., Sinervä, E. & Krause, Ch. M. (2006) Brain oscillatory responses to an auditory-verbal working memory task in mild cognitive impairment and Alzheimer's disease. International Journal of Psychophysiology, 59/2, 168-178. Marczinski, C. A. & Kertesz, A. (2006) Category and letter fluency in semantic dementia, primary progressive aphasia, and Alzheimer’s disease. Brain and Language, 97/3, 258-265. Martin, A., Brouwers, P., Cox, Ch. & Fedio, P. (1985) On the nature of the verbal memory deficit in Alzheimer's disease. Brain and Language, 25/2, 323-341. Martin, A. & Fedio, P. (1983) Word production and comprehension in Alzheimer's disease: The breakdown of semantic knowledge. Brain and Language, 19/1, 124-141. Papagno, C., Allegra, A. & Cardaci, M. (2004) Time estimation in Alzheimer’s disease and the role of the central executive. Brain and Cognition, 54/1, 18-23. Tröster, A. I., Salmon, D. P., McCullough, D. & Butters, N. (1989) A comparison of the category fluency deficits associated with Alzheimer's and Huntington's disease. Brain and Language, 37/3, 500-513.
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