Speech errors in Alzheimer's disease: reevaluating morphosyntactic preservation.

Researchers studying the speech of individuals with probable Alzheimer's disease (PAD) report that morphosyntax is preserved relative to lexical aspects of speech. The current study questions whether dividing all errors into only two categories, morphosyntactic and lexical, is warranted, given the theoretical controversies concerning the production and representation of pronouns and closed-class words in particular. Two experiments compare the speech output of 10 individuals with Alzheimer's disease to that of 15 healthy age- and education-matched speakers. Results of the first experiment indicate that the pattern of errors in the speech of participants with mild PAD reflects an across-the-board increase in the same types of errors made by healthy older speakers, including closed-class and morphosyntactic errors. In the second task, participants produced a grammatical sentence from written stimuli consisting of a transitive verb and two nouns. Only adults with Alzheimer's disease had difficulties with this task, producing many more closed-class word errors than did healthy older adults. Three of the participants with PAD produced nearly agrammatic speech in this task. These 3 people did not differ from the rest of the PAD group in age, education, working memory, or degree of semantic impairment. Further, error rates on the two tasks were highly correlated. We conclude that morphosyntax is not preserved in the speech output of individuals with PAD, but is vulnerable to errors along with all aspects of language that must be generated by the speaker. We suggest that these results best support a model of speech production in which all words are represented by semantic and grammatical features, both of which are vulnerable to failures of activation when there is damage or noise in the system as a result of pathology, trauma, or even divided attention.

Assessing working memory and language comprehension in Alzheimer's disease.

Studies of language impairments in patients with Alzheimer's disease have often assumed that impairments in linguistic working memory underlie comprehension deficits. Assessment of this hypothesis has been hindered both by vagueness of key terms such as "working memory" and by limitations of available working memory tasks, in that many such tasks either seem to have little relationship to language comprehension or are too confusing or difficult for Alzheimer's patients. Four experiments investigated the usefulness of digit ordering, a new task assessing linguistic working memory and/or language processing skill, in normal adults and patients with probable Alzheimer's disease. The digit ordering task was shown to be strongly correlated with the degree of dementia in Alzheimer's patients. The task correlated with measures of language processing on which patients and normal controls performed differently. The results are interpreted as indicating that linguistic representations, linguistic processing, and linguistic working memory are intertwined, such that a deficit of one (e.g., working memory) cannot be said to "cause" a deficit in the other. The implications of this approach are explored in terms of task demands in comprehension and memory measures, and interpretation of previous results in the literature.

Why do Alzheimer patients have difficulty with pronouns? Working memory, semantics, and reference in comprehension and production in Alzheimer's disease.

Three experiments investigated the extent to which semantic and working-memory deficits contribute to Alzheimer patients' impairments in producing and comprehending referring expressions. In Experiment 1, the spontaneous speech of 11 patients with Alzheimer's disease (AD) contained a greater ratio of pronouns to full noun phrases than did the spontaneous speech produced by 9 healthy controls. Experiments 2 and 3 used a cross-modal naming methodology to compare reference comprehension in another group of 10 patients and 10 age-matched controls. In Experiment 2, patients were less sensitive than healthy controls to the grammatical information necessary for processing pronouns. In Experiment 3, patients were better able to remember referent information in short paragraphs when reference was maintained with full noun phrases rather than pronouns, but healthy controls showed the reverse pattern. Performance in all three experiments was linked to working memory performance but not to word finding difficulty. We discuss these findings in terms of a theory of reference processing, the Informational Load Hypothesis, which views referential impairments in AD as the consequence of normal discourse processing in the context of a working memory impairment.

Sentence comprehension deficits in Alzheimer's disease: a comparison of off-line vs. on-line sentence processing.

Two studies explored whether sentence comprehension impairments in Alzheimer's disease (AD) are due to deficits in syntactic processing or memory. Study 1 used a picture-pointing sentence comprehension task to measure the final outcome of comprehension in an off-line fashion. It showed the comprehension of 30 patients with AD to be impaired, but suggested that the deficits could not be attributed solely to syntactic impairments. Study 2 investigated the effects of memory on sentence comprehension by comparing off-line (grammaticality judgment) with on-line (cross-modal naming) language processing in 11 AD and 9 control subjects. The results revealed impaired performance in the off-line task but normal performance in the on-line task using the same sentences. Performance on the off-line task correlated with independent measures of verbal working memory. These data are used to argue that sentence comprehension impairments are related to verbal working memory deficits in AD.

The effects of age, education, and ethnicity on verbal fluency.

A group of 317 healthy participants between 54 and 99 years of age performed a verbal fluency task. The participants included Chinese, Hispanic, and Vietnamese immigrants, as well as White and African American English speakers. They were given 1 min to name as many animals as possible in their native language. The results showed that more animal names were produced by younger people and those with more education. Language background was also an important factor: The Vietnamese produced the most animal names and the Spanish speakers produced the fewest. The exaggerated difference between these two groups is attributed to the fact that Vietnamese animal names are short (predominantly 1 syllable) while the Spanish animal names are longer than any other language in this study (2 and 3 syllables per word). Finally, although the ethnic groups named different animals, and appeared to vary in the variety of animal names they used, these factors did not affect overall verbal fluency performance.

The effect of endodontic medicaments on the sealing ability of provisional restorative materials.

The purpose of this study was to determine the effect of intracanal medicaments on the sealing ability of commonly used provisional filling materials. Ninety extracted, unrestored human molars were prepared. The contents of the pulp chamber were removed, and distal and mesial root canal systems were cleansed to a size 25 file. Group A received a cotton pellet with no medication, group B a cotton pellet with Cresatin, and group C a cotton pellet with 2% iodine potassium iodide (IKI). The prepared teeth from each category were divided into three subgroups of 10 to receive Cavit, IRM, or TERM. After the fillings were placed, the teeth were thermocycled, stained, and sectioned longitudinally. The average dye penetration was greater in the medicated groups (B and C) than in the control group (A) for each provisional material tested. Statistical analysis revealed that sealing ability of all three filling materials was significantly affected by Cresatin and 2% IKI.

Effect of nonvital tooth bleaching on microleakage of resin composite restorations.

Thirty-six extracted, noncarious, nonfractured human incisors were divided into four groups of nine teeth. Endodontic access cavities were prepared, the pulp chamber was debrided, the root canals were cleansed, and root canal treatment was completed. Pulp cavities of teeth in group 1 received a cotton pellet and were sealed with Cavit. Groups 2, 3, and 4 received a mixture of 30% hydrogen peroxide and sodium perborate for 3, 4, and 7 days, respectively, were sealed with Cavit, and were stored in a humidor until used. Cavit and the other materials were removed, and the cavities were rinsed and restored with Scotchbond Multipurpose and Silux. The teeth were thermocycled, stained with 50% silver nitrate, and sectioned longitudinally. Dye penetration was measured. Results indicated that bleaching adversely affected the marginal seal at the tooth-restoration interface, as evidenced by increased microleakage; the highest rate of microleakage was found after the 7-day application of bleaching materials.

Double dissociation of semantic categories in Alzheimer's disease.

Data that demonstrate distinct patterns of semantic impairment in Alzheimer's disease (AD) are presented. Findings suggest that while groups of mild-moderate patients may not display category specific impairments, some individual patients do show selective impairment of either natural kinds or artifacts. We present a model of semantic organization in which category specific impairments arise from damage to distributed features underlying different types of categories. We incorporate the crucial notions of intercorrelations and distinguishing features, allowing us to demonstrate (1) how category specific impairments can result from widespread damage and (2) how selective deficits in AD reflect different points in the progression of impairment. The different patterns of impairment arise from an interaction between the nature of the semantic categories and the progression of damage.

Microleakage of endodontic access cavities restored with composites.

A proper seal of restorative composites in endodontic access cavities is mandatory to prevent ingress of microorganisms and debris into the tooth-restoration interface. Chemically cured composites tend to have less polymerization shrinkage than photopolymerization composites. This study compared in vitro sealing performance of a chemically cured and a photopolymerization composite for access cavity restorations in endodontically treated teeth. In addition, the effects of four dentin pretreatments on the seal were evaluated. One hundred twenty-eight roots of extracted human incisors were cleansed, shaped and obturated with gutta percha and Grossman's sealer. The endodontic access cavities were later treated by Scotchbond Multipurpose, All-Bond 2, Vitrebond and Ketac-Bond. Half the access cavities within each group were filled by Coltene Microhybrid H.P., a chemically cured microhybrid composite. The other half were filled with Aelitfil, a photopolymerized composite. The filled teeth were thermocycled, submerged in silver nitrate solution, sectioned longitudinally, and their dye penetration measured and statistically analyzed by two-way ANOVA at 95 percent confidence level. The results show that the chemically cured composite allowed less dye penetration than the photopolymerized composite. As for the dentin pretreatments, the Scotchbond Multipurpose and All-Bond 2 exhibited less microleakage than Vitrebond and Ketac-Bond for both chemical and photopolymerized composite. Ketac-Bond allowed the highest amount of dye penetration, followed by Vitrebond, Scotchbond Multipurpose, then All-Bond, which had the least depth of microleakage. Chemically cured composites bonded with All-Bond 2 and Scotchbond Multipurpose may exhibit less microleakage than photopolymerized composites in endodontic access cavity restoration.

Temporoparietal cortex in aphasia. Evidence from positron emission tomography.

Forty-four aphasic patients were examined with (F18)-fluorodeoxyglucose positron emission tomography in a resting state to determine whether consistent glucose metabolic abnormalities were present. Ninety-seven percent of subjects showed metabolic abnormalities in the angular gyrus, 89% in the supramarginal gyrus, and 87% in the lateral and transverse superior temporal gyrus. Pearson product moment correlations were calculated between regional metabolic measures and performance on the Western Aphasia Battery. No significant correlations were found between the Western Aphasia Battery scores and right hemisphere metabolic measures. Most left hemisphere regions correlated with more than one score from the Western Aphasia Battery. Temporal but not frontal regions had significant correlations to the comprehension score. The left temporoparietal region was consistently affected in these subjects, suggesting that common features in the aphasias were caused by left temporoparietal dysfunction, while behavioral differences resulted from (1) the extent of temporoparietal changes, and (2) dysfunction elsewhere in the brain, particularly the left frontal and subcortical areas.

Slowly progressive aphasia: three cases with language, memory, CT and PET data.

Three cases of slowly progressive speech and language disturbance were studied at various points post onset (three, five and 15 years respectively). Language, neuropsychological and brain imaging (computer tomography and positron emission tomography) evaluations were completed on all three patients. The data suggest that the syndrome of "progressive aphasia": 1) does not involve a uniform symptom complex; 2) does not necessarily develop into a full blown dementia syndrome; 3) varies greatly in rate of progression from case to case; 4) is associated with normal brain structure (on computer tomography); and 5) is associated with abnormal left temporal lobe metabolism as measured by fluorodeoxyglucose (FDG) positron emission tomography (PET). One patient had histological findings consistent with Alzheimer's disease at necropsy.

Naming consistency in Alzheimer's disease.

Although lexical semantic deficits are postulated to play a prominent role in the anomia of Alzheimer's disease, it is unclear whether the primary disturbance is one of lexical access or one of lexical semantic loss. Response consistency on a naming task is one means of evaluating the underlying source of naming impairment. Access dysfunction usually implies variable word-finding difficulty, while a theory of lexical loss predicts that many word names would be consistently unavailable. Nineteen Alzheimer's disease patients were administered a visual confrontation naming task (the Boston Naming Test) on two occasions 6 months apart. Eighty percent of errors occurred consistently at both times; only 20% of errors occurred on only one occasion. Response consistency occurred significantly more often than expected under the assumption of no response consistency. Findings support the hypothesis that anomia in Alzheimer's disease is in part due to a loss of lexical semantic information.

Technical note: antimicrobial action of glass-ionomer lining cement on S. sanguis and S. mutans.

There are a number of glass-ionomer lining cements available to the profession. It is generally agreed that the glass-ionomer cements demonstrate reasonably good biocompatibility. The purpose of this study was to evaluate the antimicrobial activity of six glass-ionomer cements on S. sanguis and S. mutans. Forty-eight plates of TSA-SRBC (10%), each with 3.0-mm-diam. wells, were divided into two groups (1 and 2) of 24 each. Group 1 was inoculated with S. sanguis (10558) and Group 2 with S. mutans (6715-13 w.t.). Each well was filled with 4.0 mg of one of the following liners: Glassic (A), Shofu lining cement (B), GC lining cement (C), Ever Bond (D), Gingiva Seal (E), and Ketac Bond (F); the empty wells served as control. Plates were incubated under microaerophilic conditions at 37 degrees C, and checked daily over seven days for inhibition zones. Average inhibition zones (mm) at 7 days were as follows: Group 1-1A = 10.00, 1B = 7.83, 1C = 18.50, 1D = 13.00, 1E = 8.67, and 1F = 9.33; Group 2-2A = 3.08, 2B = 10.25, 2C = 12.75, 2D = 15.58, 2E = 8.83, and 2F = 3.20. All control wells were 0.0 GC liner and Ever Bond showed significantly greater overall inhibition of microbial growth than did other tested liners (p less than 0.5). A one-way ANOVA and SNK test showed that all tested liners were significantly more toxic toward S. sanguis than toward S. mutans (p less than 0.05).

Antimicrobial activity of calcium hydroxide liners on Streptococcus sanguis and S. mutans.

The antimicrobial activity of 10 calcium hydroxide liners on Streptococcus sanguis and S. mutans was studied. One hundred plates of tryticose soy agar-sheep red blood cells (10%), each with four distinct 3 mm diameter wells, were divided into two groups of 50. One group was inoculated with S. sanguis and the second group with S. mutans. A 4 mg liner was placed in each of three wells; the fourth well was left empty as a control. Plates were incubated at 37 degrees C and observed at 24 hours, 48 hours, and 7 days. All liners inhibited growth of both organisms. The inhibitory zones for S. mutans were larger than inhibitory zones for S. sanguis for all tested liners. Life Fast Set material had significantly less inhibitory effect on S. mutans. VLC Dycal, Life, and Life Fast Set materials had significantly less inhibitory effect on S. sanguis at p = 0.05.

Cerebral glucose metabolism in Wernicke's, Broca's, and conduction aphasia.

Cerebral glucose metabolism was evaluated in patients with either Wernicke's (N = 7), Broca's (N = 11), or conduction (N = 10) aphasia using 18F-2-fluoro-2-deoxy-D-glucose with positron emission tomography. The three aphasic syndromes differed in the degree of left-to-right frontal metabolic asymmetry, with Broca's aphasia showing severe asymmetry and Wernicke's aphasia mild-to-moderate metabolic asymmetry, while patients with conduction aphasia were metabolically symmetric. On the other hand, the three syndromes showed the same degree of metabolic decline in the left temporal region. The parietal region appeared to separate conduction aphasia from both Broca's and Wernicke's aphasias. Common aphasic features in the three syndromes appear to be due to common changes in the temporal region, while unique features were associated with frontal and parietal metabolic differences.

Subcortical structures in aphasia. An analysis based on (F-18)-fluorodeoxyglucose, positron emission tomography, and computed tomography.

Subcortical structural damage that includes the anterior and posterior internal capsule, caudate, thalamus, lenticular nuclei, and insula has been shown to cause aphasias. A critical question that has not been resolved is whether the role of these structures on behavior is a direct one or whether it is indirect through the cortex. We have used pathway analysis to evaluate computed tomography, glucose metabolic, and language data from 47 aphasic patients to answer this question. For fluency (from the Western Aphasia Battery), subcortical structural damage had direct and indirect (through frontal lobe) effects on the behavior. For a comprehension task (sequential commands), subcortical damage had no direct effect and only a slight indirect effect through the temporal lobe. Thus, both direct and indirect effects of subcortical damage can be demonstrated for specific behavioral measures.

A comparison between xeroradiography and conventional radiography in the diagnosis of endodontic lesions.

Detection of periapical bone pathosis is an important part of the diagnostic process in dentistry. Xeroradiographs and E-speed films were taken to evaluate and to compare the diagnostic value for the radiographic interpretation of periapical lesions. Thirty-four patients undergoing endodontic treatment were chosen. Simultaneous exposures of the radiographic film and the xeroradiographic plates were made. The samples were viewed and categorized by the examiners using the following scores: 0 = unacceptably poor, 1 = poor but diagnostic, 2 = adequate for diagnostic information, and 3 = optimal for diagnostic information. A paired sample t test was performed on the result of the evaluation by the two examiners, and both showed that there were no significant difference at p less than 0.05 between xeroradiography and conventional radiography. A two-sample t test was performed on the means of the two examiner's evaluation, and there was no significant difference at p less than 0.05 between the means.

Xeroradiography in root fracture diagnosis.

Root fracture is a clinical problem that often is difficult to diagnose. The purpose of this study was to compare diagnostic value of conventional radiographic and xeroradiographic images of experimentally fractured teeth. Forty-five extracted human single-rooted teeth were used. The roots of the teeth were coated with wax to simulate periodontal ligament and invested in acrylic to the cementoenamel junction. An access cavity was prepared and para-post, size 4 to 12 mm, was placed into the root canal. Each tooth with post was placed on the load cell table of an Instron testing machine. The Instron continuously recorded load on a moving graph paper. The load was increased until the tooth fractured. Determination of fracture was made by the sound of a sharp "crack" and by a sudden release of load on the post, as seen on the Instron recording graph. After fracture, conventional radiograph and xeroradiograph were obtained for each tooth by use of the paralleling technique. The x-ray beam angle, film distance, and tooth placement were held constant in both techniques by use of a Rinn instrument. All films were evaluated by use of light from a masked viewbox, while all of the xeroradiographs were viewed in reflected light. A magnifying glass was used to aid in the examination process. The samples were examined and categorized for root fracture by the examiners with the use of the following scores: 0 = unacceptably poor, 1 = poor but diagnostic, 2 = adequate for diagnostic information, and 3 = optimal for diagnostic information.(ABSTRACT TRUNCATED AT 250 WORDS)

Disconnection and cerebral metabolism. The case of conduction aphasia.

Ten patients with conduction aphasia were studied with computed tomography and 18-F-fluorodeoxyglucose positron emission tomography to examine glucose metabolism. Computed tomographic results identified a postrolandic structural locus for conduction aphasia. All patients demonstrated resting glucose hypometabolism throughout the parietal and temporal regions, and half of the patients also demonstrated reduced metabolic rates in the posterior, inferior, frontal (Broca's) regions. These data suggest that disconnection between posterior and anterior language areas may not be the best anatomical explanation for conduction aphasia.

Mesiodistal root fracture. Three case reports.

Vertical root fractures present a complex diagnostic problem. Three cases of vertical root fractures are presented. In the first case, there was a mesiodistal vertical fracture with an almost intact tooth structure. In the second case, there was a mesiodistal vertical fracture with an extensive amalgam restoration and improper root canal treatment. The third case showed extensive root caries with proper root canal therapy. All of the cases resulted in periodontal defects with subsequent loss of the tooth. Diagnosis was obtained with the use of clinical, fiberoptic, and disclosing solution examinations. Histologic examination revealed pulpal canals devoid of vital tissue and filled with necrotic material, debris, neutrophils, and bacterial colonies.