Download PDF
Semin Speech Lang 2004; 25(4): 335-347
DOI: 10.1055/s-2004-837246
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Verbal Perseveration in Individuals with Alzheimer's Disease

Kathryn A. Bayles1 , Cheryl K. Tomoeda1 , Patrick E. McKnight2 , Nancy Helm-Estabrooks3 , Josh N. Hawley4
  • 1Department of Speech and Hearing Sciences
  • 2Department of Psychology, University of Arizona, Tucson, Arizona
  • 3Department of Neurology, Boston University School of Medicine, Boston, Massachusetts
  • 4ProCare3, Omaha, Nebraska
Further Information

Publication History

Publication Date:
15 December 2004 (online)

    Permissions and Reprints

ABSTRACT

Perseveration has been described as a reliable indicator of disturbed brain function and is a common characteristic of neurological conditions such as Alzheimer's disease (AD). This article will begin with a review of recent theories that account for the phenomenon of perseveration, and data from a National Institute on Deafness and Other Communication Disorders (NIDCD)-supported study further delineate the nature of perseveration among individuals with AD. The study investigated the frequency of verbal perseveration in individuals with AD in relation to task type, mental status, and performance on attention and memory tests. Thirty Alzheimer's patients and 40 healthy elders were given a confrontation naming, generative naming, and picture description test. Perseveration was defined as a proportion of total number of responses. Data analysis revealed that individuals with AD perseverated more than normal elders did, but variability was high. Generative naming elicited more perseveration than either confrontation naming or picture description did. When overall frequency of perseveration was correlated with mental status and performance on attention and memory tests, seemingly paradoxical results were obtained, probably because the unique cognitive demands of each language test affected the probability of perseveration differently. Nonparadoxical, strong positive correlations were obtained, however, between language test scores and performance on tests of attention, memory and mental status.

KEYWORDS

Perseveration - Alzheimer's disease - mental status - memory

REFERENCES

  • 1 Allison R S. Perseveration as a sign of diffuse and focal brain damaged.  BMJ. 1966;  1027-1032
    PubMedGoogle Scholar
  • 2 Jasper H H. Is perseveration a functional unit participating in all behavior processes?.  J Soc Psychol. 1931;  2 28-50
    PubMedGoogle Scholar
  • 3 Goldstein K. Language and Language Disturbances. New York; Grune and Stratton 1948: 916-918
    Google Scholar
  • 4 Buckingham H W, Whitaker H, Whitaker H. On linguistic perseveration. In: Whitaker H, Whitaker H Studies in Neurolinguistics. New York; Academic Press 1979: 324-352
    Google Scholar
  • 5 Santo Pietro M J, Rigrodsky S. Patterns of oral-verbal perseveration in adult aphasics.  Brain Lang. 1986;  29 1-17
    CrossrefPubMedGoogle Scholar
  • 6 Cohen L, Dehaene S. Competition between past and present: assessment and interpretation of verbal perseverations.  Brain. 1998;  121 1641-1659
    CrossrefPubMedGoogle Scholar
  • 7 Hasselmo M E, Bower J M. Cholinergic suppression specific to intrinsic not afferent fiber synapses in rat piriform (olfactory) cortex.  J Neurophysiol. 1992;  67 1222-1229
    PubMedGoogle Scholar
  • 8 Hasselmo M E. Runaway synaptic modification in models of cortex: implications for Alzheimer's disease.  Neural Netw. 1994;  7 13-40
    CrossrefPubMedGoogle Scholar
  • 9 McNamara P, Albert M L. Neuropharmacology of verbal perseveration. Semin Speech Lang 2004 25: 309-322
    Google Scholar
  • 10 Woolf N J. A possible role for cholinergic neurons of the basal forebrain and pontomesencephalon in consciousness.  Conscious Cogn. 1997;  6 574-596
    PubMedGoogle Scholar
  • 11 Perry E K, Walker M, Grace J, Perry R H. Acetylcholine in mind: a neural correlate of consciousness.  Trends Neurosci. 1999;  22 273-280
    PubMedGoogle Scholar
  • 12 Bartus R T, Dean R L, Beer B, Lippa A S. The cholinergic hypothesis of geriatric memory dysfunction.  Science. 1982;  217 408-417
    CrossrefPubMedGoogle Scholar
  • 13 Hasselmo M E, Bradley P, Wyble B P, Wallenstein G V. Encoding and retrieval of episodic memories: role of cholinergic and GABAergic modulation in the hippocampus.  Hippocampus. 1996;  6 693-708
    CrossrefPubMedGoogle Scholar
  • 14 Ghoneim M M, Mewaldt S P. Effects of diazepam and scopolamine on storage, retrieval and organization processes memory.  Psychopharmacologia. 1975;  44 257-262
    PubMedGoogle Scholar
  • 15 Peterson R C. Scopolamine induced learning failures in man.  Psychopharmacology (Berl). 1977;  52 283-289
    CrossrefPubMedGoogle Scholar
  • 16 Ghoneim M M, Mewaldt S P. Studies on human memory; the interactions of diazepan, scopolamine and physostigmine.  Psychopharmacology (Berl). 1977;  52 1-6
    CrossrefPubMedGoogle Scholar
  • 17 Bowen D M, Smith C B, White P, Davison A N. Neurotransmitter related enzymes and indices of hypoxia in senile dementia and other abiotrophies.  Brain. 1976;  99 459-496
    PubMedGoogle Scholar
  • 18 Bowen D M, White P, Spillane J A et al.. Accelerated ageing or selective neuronal loss as an important cause of dementia?.  Lancet. 1979;  i 11-14
    PubMedGoogle Scholar
  • 19 Kasa P, Rakonczah Z, Gulya K. The cholinergic system in Alzheimer's disease.  Prog Neurobiol. 1997;  1 511-535
    PubMedGoogle Scholar
  • 20 Mesulam M M, Geula C. Overlap between acetylcholinesterase-rich and choline acetyltransferase-positive (cholinergic) axons in human cerbral cortex.  Brain Res. 1992;  577 112-120
    CrossrefPubMedGoogle Scholar
  • 21 Mesulam M M, Mufson E J, Levey A I, Wainer B H. Alzheimer's disease and the cholinergic innervation of the neocortex by the nucleus basalis of Meynert. In: Katzman R Banbury Report 15: Biological Aspects of Alzheimer's Disease. New York; Cold Spring Harbor Laboratory 1982: 79-88
    Google Scholar
  • 22 Perry E K, Tomlinson B E, Blessed G et al.. Correlation of cholinergic abnormalities with senile plaques and mental test scores in senile dementia.  BMJ. 1978;  2 1457-1459
    CrossrefPubMedGoogle Scholar
  • 23 Bierer L M, Haroutunian V, Gabriel S et al.. Neurochemical correlates of dementia severity in Alzheimer's disease: relative importance of the cholinergic deficits.  J Neurochem. 1995;  64 749-760
    PubMedGoogle Scholar
  • 24 Cummings J L, Benson D F. Dementia: A Clinical Approach. Boston, MA: Butterworth. 1983
    Google Scholar
  • 25 Albert M L, Sandson J. Perseveration in aphasia.  Cortex. 1986;  22 103-115
    PubMedGoogle Scholar
  • 26 Fuld P A, Katzman R, Davies P, Terry R D. Intrusions as a sign of Alzheimer dementia: chemical and pathological verification.  Ann Neurol. 1982;  11 155-159
    CrossrefPubMedGoogle Scholar
  • 27 Wilson R S, Rosenbaum G, Brown G. The problem of premorbid intelligence in neuropsychological assessment.  J Clin Neuropsychol. 1979;  1 49-53
    PubMedGoogle Scholar
  • 28 McKhann G, Drachman D, Folstein M et al.. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease.  Neurology. 1984;  34 939-944
    CrossrefPubMedGoogle Scholar
  • 29 Hachinski V C, Iliff L D, Zihka E et al.. Cerebral blood flow in dementia.  Arch Neurol. 1975;  32 632-637
    CrossrefPubMedGoogle Scholar
  • 30 National Institute of Mental Health .The Diagnostic Interview Schedule. Washington, DC; NIMH Center for Epidemiological Studies 1979
    Google Scholar
  • 31 Folstein M F, Folstein S E, McHugh P R. Mini-mental state: a practical method for grading cognitive state of patients for clinician.  J Psychiatr Res. 1975;  12 189-198
    CrossrefPubMedGoogle Scholar
  • 32 Tombaugh T N, McIntyre N J. The mini-mental state examination: a comprehensive review.  J Am Geriatr Soc. 1992;  40 922-935
    PubMedGoogle Scholar
  • 33 Farber J F, Schmitt F A, Logue P E. Predicting intellectual level from the Mini-Mental State Examination.  J Am Geriatr Soc. 1988;  36 509-510
    PubMedGoogle Scholar
  • 34 Wechsler D. Manual: Wechsler Adult Intelligence Scale-Revised. New York; Psychological Corporation 1981
    Google Scholar
  • 35 Nelson H E. A modified Wisconsin card sorting test sensitive to frontal lobe defects.  Cortex. 1976;  12 313-324
    CrossrefPubMedGoogle Scholar
  • 36 Wechsler D. Manual: Wechsler Memory Scale-Revised. New York; Psychological Corporation 1987
    Google Scholar
  • 37 Bayles K A, Tomoeda C K. Arizona Battery for Communication Disorders of Dementia. Austin, TX; Pro-Ed 1993
    Google Scholar
  • 38 Goodglass H, Kaplan E. Assessment of aphasia and related disorders, 2nd ed. Philadelphia; Lea & Febiger 1983
    Google Scholar
  • 39 Helm-Estabrooks N, Emery P, Albert M L. Treatment of aphasic perseveration (TAP) program.  Arch Neurol. 1987;  44 1253-1255
    PubMedGoogle Scholar
  • 40 Tomoeda C K, Bayles K A. Longitudinal effects of Alzheimer disease on discourse production.  Alzheimer Dis Assoc Disord. 1993;  7 223-236
    PubMedGoogle Scholar
  • 41 Tomoeda C K, Bayles K A, Trosset M W, Azuma T, McGeagh A. Cross sectional analysis of Alzheimer's disease effects on oral discourse in a picture description task.  Alzheimer Dis Assoc Disord. 1996;  10 204-215
    PubMedGoogle Scholar
  • 42 Cohen J. Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ; Lawrence Erlbaum 1988
    Google Scholar
  • 43 Bayles K A, Tomoeda C K, Kaszniak A W, Sterm L Z, Eagans K K. Verbal perseveration of dementia patients.  Brain Lang. 1985;  25 102-116
    CrossrefPubMedGoogle Scholar
  • 44 Ramage A, Bayles K, Helm-Estabrooks N, Cruz R. Frequency of perseveration in normal subjects.  Brain Lang. 1999;  66 329-340
    CrossrefPubMedGoogle Scholar
  • 45 Bayles K A, Salmon D P, Tomoeda C K et al.. Semantic and letter category naming in Alzheimer's patients: a predictable difference.  Dev Neuropsychol. 1989;  5 335-347
    PubMedGoogle Scholar
  • 46 Azuma T A, Bayles K A, Cruz R F et al.. Comparing the difficulty of letter, semantic, and name fluency tasks for normal elderly and patients with Parkinson's disease.  Neuropsychology. 1997;  11 1-10
    PubMedGoogle Scholar
  • 47 Rosen W G. Verbal fluency in aging and dementia.  J Clin Neuropsychol. 1980;  2 135-146
    PubMedGoogle Scholar
  • 48 Ober B A, Dronkers N F, Koss E, Delis D C, Friedland R P. Retrieval from sementic memory in Alzheimer-type dementia.  J Clin Exp Neuropsychol. 1986;  8 75-92
    PubMedGoogle Scholar
  • 49 Bayles K A, Tomoeda C K, Trosset M W. Relation of linguistic communication abilities of Alzheimer's patients to stage of disease.  Brain Lang. 1992;  42 454-472
    CrossrefPubMedGoogle Scholar

Kathryn A BaylesPh.D. 

Department of Speech and Hearing Sciences, University of Arizona

P.O. Box 210071, Tucson

AZ 85721-0071

Email: bayles@email.arizona.edu

      >