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Preserved Cognitive Skills in Dementia of the Alzheimer Type

Preserved Cognitive Skills in Dementia of the Alzheimer Type Abstract Objective: To describe preserved cognitive skills in patients with dementia. Design: Case series. Setting: Community clinic. Patients: Five patients who met National Institute of Neurological and Communicative Disorders and Stroke—Alzheimer's Disease and Related Disorders Association criteria for probable Alzheimer's disease and were claimed to retain a cognitive skill. Interventions: None. Main Outcome Measures: Standard neuropsychological tests and individualized measures of patients' skilled behaviors. For patients who remained skilled at games, performance was compared with that of normal controls in direct competition. For the patient-trombonist, raters compared premorbid and postmorbid recordings of his play. Results: One patient continued to play the trombone in a Dixieland band, although he could not name wellknown numbers that he played. Another continued to solve adult jigsaw puzzles. A third patient retained skill at canasta, the fourth at dominoes. The fifth patient remained a skillful contract bridge player, although he could not name the suits or articulate simple bidding rules. Four patients had impaired performance on standard anterograde and remote memory and naming tests but performed normally on pursuit rotor and letter fluency tests. Mini-Mental State Examination scores for these patients ranged from 10 to 22. One patient refused neuropsychological testing but displayed his skill. Conclusions: Together with previous studies of preserved piano playing or painting skills, our findings indicate that a broad range of complex cognitive abilities may be preserved in patients with dementia of the Alzheimer type who cannot perform simpler actions. References 1. Alajouanine T. Aphasia and artistic realization . Brain . 1948;71:229-241.Crossref 2. Basso A, Capitani E. Spared musical abilities in a conductor with global aphasia and ideomotor apraxia . J Neurol Neurosurg Psychiatry . 1985;48:407-412.Crossref 3. Smith A. Speech and other functions after left (dominant) hemispherectomy . J Neurol Neurosurg Psychiatry . 1966;29:467-471.Crossref 4. Gordon HW, Bogen JE. Hemispheric lateralization of singing after intracarotid sodium amylobarbitone . J Neurol Neurosurg Psychiatry . 1974;37:727-738.Crossref 5. Botez Ml, Wertheim N. Expressive aphasia and amnesia following right frontal lesion in a right-handed man . Brain . 1959;82:186-202.Crossref 6. Milner B. Laterality effects in audition . In: Mountcastle VB, ed. Interhemispheric Relations and Cerebral Dominance . Baltimore, Md: Johns Hopkins Press; 1962:177-195. 7. Cummings JL, Zarit JM. Probable Alzheimer's disease in an artist . JAMA . 1987; 258:2731-2734.Crossref 8. Beatty WW, Zavadil KD, Bailly RC, et al. Preserved musical skill in a severely demented patient . Int J Clin Neuropsychol . 1988;10:158-164. 9. Crystal HA, Grober E, Masur D. Preservation of musical memory in Alzheimer's disease . J Neurol Neurosurg Psychiatry . 1989;52:1415-1416.Crossref 10. Sacks O. The Man Who Mistook His Wife for a Hat and Other Clinical Tales . New York, NY: Summit Books; 1985. 11. Marin OSM. Neurological aspects of music perception and performance . In: Deutsch D, ed. The Psychology of Music . Orlando, Fla: Academic Press Inc; 1982: 453-477. 12. Chavin M. The Lost Chord: Reaching the Person With Dementia Through the Power of Music . Mt Airy, Md: Elder-Song Publications; 1991. 13. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. 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.Crossref 14. Rosen WG, Terry RD, Fuld PA, Katzman R, Peck A. Pathological verfication of ischemic score in differentiation of dementias . Ann Neurol . 1980;7:486-488.Crossref 15. Folstein MF, Folstein SE, McHugh PR. 'Mini-Mental State': a practical method for grading the cognitive state of patients for the clinician . J Psychiatr Res . 1975;12:189-198.Crossref 16. Kiernan RJ, Mueller J, Langston JW, Van Dyke C. The Neurobehavioral Cognitive Status Examination: a brief but differentiated approach to cognitive assessment . Ann Intern Med . 1987;107:481-485.Crossref 17. Schwamm LH, Van Dyke C, Kiernan RJ, Merrin EL, Mueller J. The Neurobehavioral Cognitive Status Examination: comparison with the Cognitive Capacity Screening Examination and the Mini-Mental State Examination in a neurosurgical population . Ann Intern Med . 1987;107:486-491.Crossref 18. Kaplan E, Fein D, Morris R, Delis DC. WAIS-R as a Neuropsychological Instrument . San Antonio, Tex: Psychological Corp; 1991. 19. Benton AL, de Hamsher KS. Multilingual Aphasia Examination . 2nd ed. Iowa City, Iowa: AJA Associates Inc; 1978. 20. Kaplan E, Goodglass H, Weintraub S. Boston Naming Test . Philadelphia, Pa: Lea & Febiger; 1983. 21. Warrington EK. Recognition Memory Test . Windsor, England: NFER-Nelson; 1984. 22. Lezak M. Neuropsychological Assessment . 2nd ed. New York, NY: Oxford University Press; 1983. 23. Heilman KM, Gonzalez-Rothi LJ. Apraxia. In: Heilman KM, Valenstein E, eds. Clinical Neuropsychology . 2nd ed. New York, NY: Oxford University Press; 1985: 131-150. 24. Beatty WW, Monson N. Picture and motor sequencing in Parkinson's disease . J Geriatr Psychiatry Neurol . 1990;3:192-197.Crossref 25. Beatty WW, Goodkin DE, Monson N, Beatty PA, Hertsgaard D. Anterograde and retrograde amnesia in patients with chronic progressive multiple sclerosis . Arch Neurol . 1988;45:611-619.Crossref 26. Eslinger PJ, Damasio AR. Preserved motor learning in Alzheimer's disease: implications for anatomy and behavior . J Neurosci . 1986;6:3006-3009. 27. Albert MS, Heaton RK. Intelligence testing . In: Albert MS, Moss MB, eds. Geriatric Neuropsychology . New York, NY: Guilford Press; 1988:13-32. 28. Albert MS. Cognitive function . In: Albert MS, Moss MB, eds. Geriatric Neuropsychology . New York, NY: Guilford Press; 1988:33-56. 29. Denney NW, Pearce KA. A developmental study of practical problem solving in adults . Psychol Aging . 1989;4:438-442.Crossref 30. Zhang MY, Katzman R, Salmon D, et al. The prevalence of dementia and Alzheimer's disease in Shanghai, China: impact of age, gender, and education . Ann Neurol . 1990;27:428-437.Crossref 31. Berkman LF. The association between educational attainment and mental status examinations: of etiologic significance for senile dementia or not? J Chronic Dis . 1986;39:171-174.Crossref 32. Stern Y, Alexander GE, Prohovnik I, Mayeaux R. Inverse relationships between education and parietotemporal perfusion deficit in Alzheimer's disease . Ann Neurol . 1992;32:371-375.Crossref 33. Dick MB. Motor and procedural memory in Alzheimer's disease . In: Bäckman L, ed. Memory Functioning in Dementia . Amsterdam, the Netherlands: North-Holland; 1992;89:135-150. Advances in Psychology. 34. Haxby JV, Duava R, Grady CL, Cutler NR, Rapoport SI. Relations between neuropsychological and cerebral metabolic asymmetries in early Alzheimer's disease . J Cereb Blood Flow Metab . 1985;5:193-200.Crossref 35. Rapoport SI. Positron emission tomography in Alzheimer's disease in relation to disease pathogenesis: a critical review . Cerebrovasc Brain Metab Rev . 1991; 3:297-335. 36. Martin A. Semantic knowledge in patients with Alzheimer's disease: evidence for degraded representations . In: Bäckman L, ed. Memory Functioning in Dementia . Amsterdam, the Netherlands: North-Holland; 1992;89:119-134. Advances in Psychology. 37. Salmon DP, Heindel WC, Butters N. Semantic memory, priming, and skill learning in Alzheimer's disease . In: Bäckman L, ed. Memory Functioning in Dementia . Amsterdam, the Netherlands: North-Holland; 1992;89:99-118. Advances in Psychology. 38. Nebes RD. Semantic memory dysfunction in Alzheimer's disease: disruption of semantic knowledge on information-processing limitation . In: Squire LR, Butters N, eds. Neuropsychology of Memory . 2nd ed. New York, NY: Guilford Press; 1992:233-240. 39. Kemper S, LaBarge E, Ferraro FR, Cheung H, Storandt M. On the preservation of syntax in Alzheimer's disease: evidence from written sentences . Arch Neurol . 1993;50:81-86.Crossref 40. Monsch AU, Bondi MW, Butters N, Salmon DP, Katzman R, Thal LJ. Comparisons of verbal fluency tasks in the detection of dementia of the Alzheimer type . Arch Neurol . 1992;49:1253-1258.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Preserved Cognitive Skills in Dementia of the Alzheimer Type

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References (43)

Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1994.00540220088018
Publisher site
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Abstract

Abstract Objective: To describe preserved cognitive skills in patients with dementia. Design: Case series. Setting: Community clinic. Patients: Five patients who met National Institute of Neurological and Communicative Disorders and Stroke—Alzheimer's Disease and Related Disorders Association criteria for probable Alzheimer's disease and were claimed to retain a cognitive skill. Interventions: None. Main Outcome Measures: Standard neuropsychological tests and individualized measures of patients' skilled behaviors. For patients who remained skilled at games, performance was compared with that of normal controls in direct competition. For the patient-trombonist, raters compared premorbid and postmorbid recordings of his play. Results: One patient continued to play the trombone in a Dixieland band, although he could not name wellknown numbers that he played. Another continued to solve adult jigsaw puzzles. A third patient retained skill at canasta, the fourth at dominoes. The fifth patient remained a skillful contract bridge player, although he could not name the suits or articulate simple bidding rules. Four patients had impaired performance on standard anterograde and remote memory and naming tests but performed normally on pursuit rotor and letter fluency tests. Mini-Mental State Examination scores for these patients ranged from 10 to 22. One patient refused neuropsychological testing but displayed his skill. Conclusions: Together with previous studies of preserved piano playing or painting skills, our findings indicate that a broad range of complex cognitive abilities may be preserved in patients with dementia of the Alzheimer type who cannot perform simpler actions. References 1. Alajouanine T. Aphasia and artistic realization . Brain . 1948;71:229-241.Crossref 2. Basso A, Capitani E. Spared musical abilities in a conductor with global aphasia and ideomotor apraxia . J Neurol Neurosurg Psychiatry . 1985;48:407-412.Crossref 3. Smith A. Speech and other functions after left (dominant) hemispherectomy . J Neurol Neurosurg Psychiatry . 1966;29:467-471.Crossref 4. Gordon HW, Bogen JE. Hemispheric lateralization of singing after intracarotid sodium amylobarbitone . J Neurol Neurosurg Psychiatry . 1974;37:727-738.Crossref 5. Botez Ml, Wertheim N. Expressive aphasia and amnesia following right frontal lesion in a right-handed man . Brain . 1959;82:186-202.Crossref 6. Milner B. Laterality effects in audition . In: Mountcastle VB, ed. Interhemispheric Relations and Cerebral Dominance . Baltimore, Md: Johns Hopkins Press; 1962:177-195. 7. Cummings JL, Zarit JM. Probable Alzheimer's disease in an artist . JAMA . 1987; 258:2731-2734.Crossref 8. Beatty WW, Zavadil KD, Bailly RC, et al. Preserved musical skill in a severely demented patient . Int J Clin Neuropsychol . 1988;10:158-164. 9. Crystal HA, Grober E, Masur D. Preservation of musical memory in Alzheimer's disease . J Neurol Neurosurg Psychiatry . 1989;52:1415-1416.Crossref 10. Sacks O. The Man Who Mistook His Wife for a Hat and Other Clinical Tales . New York, NY: Summit Books; 1985. 11. Marin OSM. Neurological aspects of music perception and performance . In: Deutsch D, ed. The Psychology of Music . Orlando, Fla: Academic Press Inc; 1982: 453-477. 12. Chavin M. The Lost Chord: Reaching the Person With Dementia Through the Power of Music . Mt Airy, Md: Elder-Song Publications; 1991. 13. McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. 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.Crossref 14. Rosen WG, Terry RD, Fuld PA, Katzman R, Peck A. Pathological verfication of ischemic score in differentiation of dementias . Ann Neurol . 1980;7:486-488.Crossref 15. Folstein MF, Folstein SE, McHugh PR. 'Mini-Mental State': a practical method for grading the cognitive state of patients for the clinician . J Psychiatr Res . 1975;12:189-198.Crossref 16. Kiernan RJ, Mueller J, Langston JW, Van Dyke C. The Neurobehavioral Cognitive Status Examination: a brief but differentiated approach to cognitive assessment . Ann Intern Med . 1987;107:481-485.Crossref 17. Schwamm LH, Van Dyke C, Kiernan RJ, Merrin EL, Mueller J. The Neurobehavioral Cognitive Status Examination: comparison with the Cognitive Capacity Screening Examination and the Mini-Mental State Examination in a neurosurgical population . Ann Intern Med . 1987;107:486-491.Crossref 18. Kaplan E, Fein D, Morris R, Delis DC. WAIS-R as a Neuropsychological Instrument . San Antonio, Tex: Psychological Corp; 1991. 19. Benton AL, de Hamsher KS. Multilingual Aphasia Examination . 2nd ed. Iowa City, Iowa: AJA Associates Inc; 1978. 20. Kaplan E, Goodglass H, Weintraub S. Boston Naming Test . Philadelphia, Pa: Lea & Febiger; 1983. 21. Warrington EK. Recognition Memory Test . Windsor, England: NFER-Nelson; 1984. 22. Lezak M. Neuropsychological Assessment . 2nd ed. New York, NY: Oxford University Press; 1983. 23. Heilman KM, Gonzalez-Rothi LJ. Apraxia. In: Heilman KM, Valenstein E, eds. Clinical Neuropsychology . 2nd ed. New York, NY: Oxford University Press; 1985: 131-150. 24. Beatty WW, Monson N. Picture and motor sequencing in Parkinson's disease . J Geriatr Psychiatry Neurol . 1990;3:192-197.Crossref 25. Beatty WW, Goodkin DE, Monson N, Beatty PA, Hertsgaard D. Anterograde and retrograde amnesia in patients with chronic progressive multiple sclerosis . Arch Neurol . 1988;45:611-619.Crossref 26. Eslinger PJ, Damasio AR. Preserved motor learning in Alzheimer's disease: implications for anatomy and behavior . J Neurosci . 1986;6:3006-3009. 27. Albert MS, Heaton RK. Intelligence testing . In: Albert MS, Moss MB, eds. Geriatric Neuropsychology . New York, NY: Guilford Press; 1988:13-32. 28. Albert MS. Cognitive function . In: Albert MS, Moss MB, eds. Geriatric Neuropsychology . New York, NY: Guilford Press; 1988:33-56. 29. Denney NW, Pearce KA. A developmental study of practical problem solving in adults . Psychol Aging . 1989;4:438-442.Crossref 30. Zhang MY, Katzman R, Salmon D, et al. The prevalence of dementia and Alzheimer's disease in Shanghai, China: impact of age, gender, and education . Ann Neurol . 1990;27:428-437.Crossref 31. Berkman LF. The association between educational attainment and mental status examinations: of etiologic significance for senile dementia or not? J Chronic Dis . 1986;39:171-174.Crossref 32. Stern Y, Alexander GE, Prohovnik I, Mayeaux R. Inverse relationships between education and parietotemporal perfusion deficit in Alzheimer's disease . Ann Neurol . 1992;32:371-375.Crossref 33. Dick MB. Motor and procedural memory in Alzheimer's disease . In: Bäckman L, ed. Memory Functioning in Dementia . Amsterdam, the Netherlands: North-Holland; 1992;89:135-150. Advances in Psychology. 34. Haxby JV, Duava R, Grady CL, Cutler NR, Rapoport SI. Relations between neuropsychological and cerebral metabolic asymmetries in early Alzheimer's disease . J Cereb Blood Flow Metab . 1985;5:193-200.Crossref 35. Rapoport SI. Positron emission tomography in Alzheimer's disease in relation to disease pathogenesis: a critical review . Cerebrovasc Brain Metab Rev . 1991; 3:297-335. 36. Martin A. Semantic knowledge in patients with Alzheimer's disease: evidence for degraded representations . In: Bäckman L, ed. Memory Functioning in Dementia . Amsterdam, the Netherlands: North-Holland; 1992;89:119-134. Advances in Psychology. 37. Salmon DP, Heindel WC, Butters N. Semantic memory, priming, and skill learning in Alzheimer's disease . In: Bäckman L, ed. Memory Functioning in Dementia . Amsterdam, the Netherlands: North-Holland; 1992;89:99-118. Advances in Psychology. 38. Nebes RD. Semantic memory dysfunction in Alzheimer's disease: disruption of semantic knowledge on information-processing limitation . In: Squire LR, Butters N, eds. Neuropsychology of Memory . 2nd ed. New York, NY: Guilford Press; 1992:233-240. 39. Kemper S, LaBarge E, Ferraro FR, Cheung H, Storandt M. On the preservation of syntax in Alzheimer's disease: evidence from written sentences . Arch Neurol . 1993;50:81-86.Crossref 40. Monsch AU, Bondi MW, Butters N, Salmon DP, Katzman R, Thal LJ. Comparisons of verbal fluency tasks in the detection of dementia of the Alzheimer type . Arch Neurol . 1992;49:1253-1258.Crossref

Journal

Archives of Neurology – American Medical Association

Published: Oct 1, 1994

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