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1.  Higher Education is Not Associated with Greater Cortical Thickness in Brain Areas Related to Literacy or Intelligence in Normal Aging or Mild Cognitive Impairment 
Education may reduce risk of dementia through passive reserve, by increasing neural substrate. We tested the hypotheses that education is associated with thicker cortex and reduced rates of atrophy in brain regions related to literacy and intellectual ability. Healthy older adults and those with mild cognitive impairment were categorized into High (≥18 yrs) and Low (≤13 yrs) education groups. Higher education was associated with thinner cortices in several areas, but one-year atrophy rates in these areas did not differ by education group. These results do not support a passive reserve model in which early life education protects against dementia by increasing cortical thickness. Connectivity and synaptic efficiency, or other lifestyle factors may more directly reflect cognitive reserve.
doi:10.1080/13803395.2012.702733
PMCID: PMC3488147  PMID: 22905705
Brain reserve; cortical thickness; education; hippocampal volume; literacy; Mild Cognitive Impairment (MCI); aging
2.  Early Visuospatial Deficits Predict the Occurrence of Visual Hallucinations in Autopsy-Confirmed Dementia with Lewy Bodies 
Objectives
The current study explored the value of visuospatial findings for predicting the occurrence of visual hallucinations (VH) in a sample of patients with Dementia with Lewy bodies (DLB) compared to patients with Alzheimer’s disease (AD).
Participants/Measurements
Retrospective analysis of 55 autopsy-confirmed DLB and 55 demographically-similar, autopsy-confirmed AD cases determined whether severe initial visuospatial deficits on the WISC-R Block Design subtest predicted the development of VH. Visuospatial deficits were considered severe if Block Design z-scores were 2.5 or more standard deviations below the mean of a well-characterized normal control group (Severe-VIS; DLB: n=35, AD: n=26) and otherwise were considered mild (Mild-VIS; DLB: n=20, AD: n=29).
Results
Forty percent of the Severe-VIS DLB group had baseline VH compared to 0% of Mild-VIS DLB patients. Only 8% of the Severe-VIS and 3% Mild-VIS AD patients had baseline VH. During the follow-up period (mean=5.0 years), an additional 61% of the Severe-VIS but only 11% of the Mild-VIS DLB patients developed VH. In that period, 38% of the Severe-VIS and 20% of the Mild-VIS AD patients developed VH. After considering initial MMSE score and rate of decline, logistic regression analyses found that performance on Block Design significantly predicted the presence of VH in the DLB group but not the AD group.
Conclusions
The presence of early, severe deficits on neuropsychological tests of visuospatial skill increases the likelihood that patients with suspected DLB will develop the prototypical DLB syndrome. The presence of such deficits may identify those DLB patients whose syndrome is driven by alpha-synuclein pathology rather than AD pathology and may inform treatment plans as well as future research.
doi:10.1097/JGP.0b013e31823033bc
PMCID: PMC3260388  PMID: 21997600
Lewy body disease; Hallucinations, visual; Alzheimer’s disease; Visuospatial cognition
3.  Are Empirically-Derived Subtypes of Mild Cognitive Impairment Consistent with Conventional Subtypes? 
Given the importance of identifying dementia prodromes for future treatment efforts, we examined two methods of diagnosing mild cognitive impairment (MCI) and determined whether empirically-derived MCI subtypes of these diagnostic methods were consistent with one another as well as with conventional MCI subtypes (i.e., amnestic, non-amnestic, single-domain, multi-domain). Participants were diagnosed with MCI using either conventional Petersen/Winblad criteria (n = 134; >1.5 SDs below normal on one test within a cognitive domain) or comprehensive neuropsychological criteria developed by Jak et al. (2009) (n = 80; >1 SD below normal on two tests within a domain), and the resulting samples were examined via hierarchical cluster and discriminant function analyses. Results showed that neuropsychological profiles varied depending on the criteria used to define MCI. Both criteria revealed an Amnestic subtype, consistent with prodromal Alzheimer’s disease (AD), and a Mixed subtype that may capture individuals in advanced stages of MCI. The comprehensive criteria uniquely yielded Dysexecutive and Visuospatial subtypes, whereas the conventional criteria produced a subtype that performed within normal limits, suggesting its susceptibility to false positive diagnostic errors. Whether these empirically-derived MCI subtypes correspond to dissociable neuropathologic substrates and represent reliable prodromes of dementia will require additional follow-up.
doi:10.1017/S1355617713000313
PMCID: PMC3742806  PMID: 23552486
Mild cognitive impairment; Amnestic MCI; Non-amnestic MCI; Dementia; Cluster analysis; Neuropsychology
4.  Which Neuropsychological Tests Predict Progression to Alzheimer’s Disease in Hispanics? 
Neuropsychology  2013;27(3):343-355.
Objective
To investigate which neuropsychological tests predict eventual progression to Alzheimer’s disease (AD) in both Hispanic and non-Hispanic individuals. Although our approach was exploratory, we predicted that tests that underestimate cognitive ability in healthy aging Hispanics might not be sensitive to future cognitive decline in this cultural group.
Method
We compared first-year data of 22 older adults (11 Hispanic) who were diagnosed as cognitively normal but eventually developed AD (decliners), to 60 age- and education-matched controls (27 Hispanic) who remained cognitively normal. To identify tests that may be culturally biased in our sample, we compared Hispanic with non-Hispanic controls on all tests and asked which tests were sensitive to future decline in each cultural group.
Results
Compared to age-, education-, and gender-matched non-Hispanic controls, Hispanic controls obtained lower scores on tests of language, executive function, and some measures of global cognition. Consistent with our predictions, some tests identified non-Hispanic, but not Hispanic, decliners (vocabulary, semantic fluency). Contrary to our predictions, a number of tests on which Hispanics obtained lower scores than non-Hispanics nevertheless predicted eventual progression to AD in both cultural groups (e.g., Boston Naming Test [BNT], Trails A and B).
Conclusions
Cross-cultural variation in test sensitivity to decline may reflect greater resistance of medium difficulty items to decline and bilingual advantages that initially protect Hispanics against some aspects of cognitive decline commonly observed in non-Hispanics with preclinical AD. These findings highlight a need for further consideration of cross-cultural differences in neuropsychological test performance and development of culturally unbiased measures.
doi:10.1037/a0032399
PMCID: PMC3740167  PMID: 23688216
preclinical Alzheimer’s disease; Spanish–English bilingual; Hispanic; verbal fluency; object naming
5.  Temporal Sequence Learning in Healthy Aging and Amnestic Mild Cognitive Impairment 
Experimental aging research  2013;39(4):371-381.
Background/Study Context
Temporal sequence learning is a critical aspect of episodic memory that may be dependent on the temporal and frontal lobes. Since amnestic mild cognitive impairment (aMCI) and normal aging may result in changes within the temporal and frontal lobes, the present study investigated temporal sequence learning in patients with aMCI, cognitively normal older adults, and young adults.
Methods
On each trial of a temporal sequence task, circles appeared one at a time at the end of each arm of a computerized radial 8-arm maze. Participants were asked to reproduce the temporal sequence by placing numbered circles (1-8) on the arms of the 8-arm maze. Participants were presented with the same fixed sequence on each trial until the sequence was replicated without any errors, or until 15 trials were presented.
Results
Individuals with aMCI required significantly more trials to learn the temporal sequence compared to older adults (p <. 05). Older adults required significantly more trials to learn the sequence than young adults (p <. 05). Older adults and individuals with aMCI committed significantly more Trial 1 errors (p <. 05) than young adults; however, there were no significant differences between the aMCI and older adult groups on Trial 1.
Conclusion
The results suggest that temporal sequence learning deficits are detectable in aMCI. These deficits may disrupt a number of cognitive processes, such as episodic memory, that are important for the execution of daily activities. The results suggest that although temporal sequence learning declines with normal aging, this decline is greater in individuals who have a diagnosis of aMCI and are at higher risk for developing AD.
doi:10.1080/0361073X.2013.808122
PMCID: PMC3736698  PMID: 23875836
6.  Effect of mild cognitive impairment and APOE genotype on resting cerebral blood flow and its association with cognition 
Using whole-brain pulsed arterial spin labeling magnetic resonance imaging, resting cerebral blood flow (CBF) was measured in 20 mild cognitive impairment (MCI; 11 ɛ3 and 9 ɛ4) and 40 demographically matched cognitively normal (CN; 27 ɛ3 and 13 ɛ4) participants. An interaction of apolipoprotein (APOE) genotype (ɛ3 and ɛ4) and cognitive status (CN and MCI) on quantified gray-matter CBF corrected for partial volume effects was found in the left parahippocampal and fusiform gyri (PHG/FG), right middle frontal gyrus, and left medial frontal gyrus. In the PHG/FG, CBF was elevated for CN ɛ4 carriers but decreased for MCI ɛ4 carriers. The opposite pattern was seen in frontal regions: CBF was decreased for CN ɛ4 carriers but increased for MCI ɛ4 carriers. Cerebral blood flow in the PHG/FG was positively correlated with verbal memory for CN ɛ4 adults (r=0.67, P=0.01). Cerebral blood flow in the left medial frontal gyrus was positively correlated with verbal memory for MCI ɛ4 adults (r=0.70, P=0.05). Findings support dynamic pathophysiologic processes in the brain associated with Alzheimer's disease risk and indicate that cognitive status and APOE genotype have interactive effects on CBF. Correlations between CBF and verbal memory suggest a differential neurovascular compensatory response in posterior and anterior cortices with cognitive decline in ɛ4 adults.
doi:10.1038/jcbfm.2012.58
PMCID: PMC3421098  PMID: 22549621
apolipoprotein E; arterial spin labeling; cognition; mild cognitive impairment
7.  The Influence of Chronic Stress on Dementia-Related Diagnostic Change in Older Adults 
Increased susceptibility of the aging brain to both chronic stress and incipient dementia-related neuropathology may accelerate cognitive decline. We investigated associations between chronic stress and diagnostic change in 62 individuals (mean age=78.7) participating in an Alzheimer’s disease research center longitudinal study. Subjects, diagnosed at baseline as cognitively normal (CN) or Mild Cognitive Impairment (MCI) were followed an average of 2.5 years. Senior neurologists, blind to detailed measures of stress and cognition, assigned diagnoses annually. Logistic regression analyses assessed accuracy with which measures of stress (event-based ratings, cortisol levels) predicted conversion to MCI and dementia. Eleven individuals with MCI at baseline received a dementia diagnosis during follow-up. Sixteen converted from CN to MCI. Prolonged, highly stressful experiences were associated with conversion from MCI to dementia. The cortisol awakening response, with age and education, was associated with diagnostic change to MCI. Cortisol measures were not associated with progression from MCI to dementia, and there was no association between stressful experiences and change to MCI. Mechanisms associated with the transition from normal cognition to MCI may differ from those associated with diagnostic change to dementia. These findings could facilitate identification of interventional strategies to reduce risk of decline at different stages of susceptibility.
doi:10.1097/WAD.0b013e3182389a9c
PMCID: PMC3290680  PMID: 22037597
chronic stress; aging; Alzheimer’s disease; mild cognitive impairment; dementia; diurnal rhythm; cortisol awakening response
8.  Cross-Language Intrusion Errors in Aging Bilinguals Reveal the Link Between Executive Control and Language Selection 
Psychological science  2011;22(9):1155-1164.
Bilinguals outperform monolinguals on measures of executive control, but it is not known how bilingualism introduces these advantages. To address this question, we investigated whether language-control failures increase with aging-related declines in executive control. Eighteen younger and 18 older Spanish-English bilinguals completed a verbal-fluency task, in which they produced words in 18 categories (9 in each language), and a flanker task. Performance on both tasks exhibited robust effects of aging, but cross-language and within-language errors on the verbal-fluency task differed in a number of ways. Within-language errors occurred relatively often and decreased with higher levels of education in both younger and older bilinguals. In contrast, cross-language intrusions (e.g., inadvertently saying an English word on a Spanish-language trial) were rarely produced, were not associated with education level, and were strongly associated with flanker-task errors in older but not younger bilinguals. These results imply that executive control plays a role in maintaining language selection, but they also suggest the presence of independent forces that prevent language-selection errors.
doi:10.1177/0956797611417002
PMCID: PMC3598590  PMID: 21775653
aging; bilingualism; lexical access; attention; frontal lobe
9.  Degree of Bilingualism Predicts Age of Diagnosis of Alzheimer’s Disease in Low-Education but not in Highly-Educated Hispanics 
Neuropsychologia  2011;49(14):3826-3830.
The current study investigated the relationship between bilingual language proficiency and onset of probable Alzheimer’s disease (AD) in 44 Spanish-English bilinguals at the UCSD Alzheimer’s Disease Research Center. Degree of bilingualism along a continuum was measured using Boston Naming Test (BNT) scores in each language. Higher degrees of bilingualism were associated with increasingly later age-of-diagnosis (and age of onset of symptoms), but this effect was driven by participants with low education level (a significant interaction between years of education and bilingualism) most of whom (73%) were also Spanish-dominant. Additionally, only objective measures (i.e., BNT scores), not self-reported degree of bilingualism, predicted age-of-diagnosis even though objective and self-reported measures were significantly correlated. These findings establish a specific connection between knowledge of two languages and delay of AD onset, and demonstrate that bilingual effects can be obscured by interactions between education and bilingualism, and by failure to obtain objective measures of bilingualism. More generally, these data support analogies between the effects of bilingualism and “cognitive reserve” and suggest an upper limit on the extent to which reserve can function to delay dementia.
doi:10.1016/j.neuropsychologia.2011.09.041
PMCID: PMC3223277  PMID: 22001315
10.  Yes/No Versus Forced-Choice Recognition Memory in Mild Cognitive Impairment and Alzheimer’s Disease: Patterns of Impairment and Associations with Dementia Severity 
The Clinical neuropsychologist  2012;26(7):1201-1216.
Memory tests are sensitive to early identification of Alzheimer’s disease (AD) but less useful as the disease advances. However, assessing particular types of recognition memory may better characterize dementia severity in later stages of AD. We sought to examine patterns of recognition memory deficits in individuals with AD and mild cognitive impairment (MCI). Memory performance and global cognition data were collected from participants with AD (n=37), MCI (n=37), and cognitively intact older adults (normal controls, NC; n=35). One-way analyses of variance (ANOVAs) examined differences between groups on yes/no and forced-choice recognition measures. Individuals with amnestic MCI performed worse than NC and nonamnestic MCI participants on yes/no recognition, but were comparable on forced-choice recognition. AD patients were more impaired across yes/no and forced-choice recognition tasks. Individuals with mild AD (≥120 Dementia Rating Scale, DRS) performed better than those with moderate-to-severe AD (<120 DRS) on forced-choice recognition, but were equally impaired on yes/no recognition. There were differences in the relationships between learning, recall, and recognition performance across groups. Although yes/no recognition testing may be sensitive to MCI, forced-choice procedures may provide utility in assessing severity of anterograde amnesia in later stages of AD. Implications for assessment of insufficient effort and malingering are also discussed.
doi:10.1080/13854046.2012.728626
PMCID: PMC3482270  PMID: 23030301
Recognition memory; Alzheimer’s disease; Mild cognitive impairment; Dementia severity; Neuropsychology
11.  Assessment of Alzheimer’s Disease Risk with Functional Magnetic Resonance Imaging: An Arterial Spin Labeling Study 
Functional magnetic resonance imaging (fMRI) of older adults at risk for Alzheimer’s disease (AD) by virtue of their cognitive (i.e., mild cognitive impairment [MCI]) and/or genetic (i.e., apolipoprotein E [APOE] ε4 allele) status demonstrate divergent brain response patterns during memory encoding across studies. Using arterial spin labeling MRI, we examined the influence of AD risk on resting cerebral blood flow (CBF) as well as the CBF and blood oxygenation level dependent (BOLD) signal response to memory encoding in the medial temporal lobes (MTL) in 45 older adults (29 cognitively normal [14 APOE ε4 carriers and 15 noncarriers]; 16 MCI [8 APOE ε4 carriers, 8 noncarriers]). Risk groups were comparable in terms of mean age, years of education, gender distribution, and vascular risk burden. Individuals at genetic risk for AD by virtue of the APOE ε4 allele demonstrated increased MTL resting state CBF relative to ε4 noncarriers, whereas individuals characterized as MCI showed decreased MTL resting state CBF relative to their cognitively normal peers. For percent change CBF, there was a trend toward a cognitive status by genotype interaction. In the cognitively normal group, there was no difference in percent change CBF based on APOE genotype. In contrast, in the MCI group, APOE ε4 carriers demonstrated significantly greater percent change in CBF relative to ε4 noncarriers. No group differences were found for BOLD response. Findings suggest that abnormal resting state CBF and CBF response to memory encoding may be early indicators of brain dysfunction in individuals at risk for developing AD.
doi:10.3233/JAD-2012-120292
PMCID: PMC3443702  PMID: 22531427
Apolipoprotein E; cerebral blood flow; functional; hippocampus; magnetic resonance imaging; memory; mild cognitive impairment
12.  Distinct cognitive profiles and rates of decline on the Mattis Dementia Rating Scale in autopsy-confirmed frontotemporal dementia and Alzheimer’s disease 
Neuropsychological studies have shown that patients with Frontotemporal dementia (FTD) perform worse than patients with Alzheimer’s disease (AD) on tests of conceptualization and verbal fluency, but better on tests of memory and visuospatial functions. However, it is not known if these distinct cognitive profiles are robust enough to be detected using a relatively brief dementia screening instrument such as the Mattis Dementia Rating Scale (MDRS). To address this issue, the MDRS subscale profiles of patients with autopsy-confirmed FTD (n = 17) or AD (n = 34) were compared. Results showed distinct cognitive profiles in which FTD patients performed worse than AD patients on the Initiation/Perseveration and Conceptualization subscales while performing better on the Memory and Construction subscales. The distinct subscale profiles correctly classified 85% of AD patients and 76% of FTD patients. Profiles were maintained in a subset of mildly-to-moderately demented patients (MDRS ≥ 105) and correctly classified 89% of these patients. In addition, FTD patients (mean = 30.0 points/year) declined faster than AD patients (mean = 14.8 points/year) on MDRS total and specific subscale scores. These results suggest that the MDRS may be a useful adjunct to other clinical measures for distinguishing FTD from AD and tracking the progression of the disorder.
doi:10.1017/S135561770808051X
PMCID: PMC2864090  PMID: 18419836
Frontotemporal dementia; Alzheimer’s disease; Mattis Dementia Rating Scale; Rate of progression; Cognitive profile; Functional impairment
13.  Antemortem Pulse Pressure Elevation Predicts Cerebrovascular Disease in Autopsy-Confirmed Alzheimer’s Disease 
Journal of Alzheimer's Disease  2012;30(3):595-603.
Elevated pulse pressure (PP) is associated with cognitive decline and increased risk of Alzheimer’s disease (AD) in older adults, although the mechanisms behind these associations remain unclear. To address this question, we examined whether antemortem late-life PP elevation predicted vascular or AD pathology in autopsy-confirmed AD patients. Sixty-five elderly patients (mean age 74.2 years) clinically diagnosed with possible or probable AD underwent neuropsychological testing and blood pressure examinations. Postmortem histopathological measures of cerebrovascular disease (CVD) and AD neuropathology were later obtained on these same patients. We expected that antemortem PP elevation, but not standard blood pressure measures such as systolic or diastolic blood pressure, would predict the autopsy-based presence of CVD, and possibly AD pathology, in elderly AD patients. Results demonstrated that antemortem PP elevation was associated with the presence and severity of CVD at autopsy. For every 5 mmHg increase in antemortem PP there was an estimated 36% increase in the odds of having CVD at autopsy. Additionally, PP accounted for 12% of variance in CVD severity. No significant associations were present for cerebral amyloid angiopathy or Braak and Braak staging of the severity of AD pathology. Other standard blood pressure measures also did not significantly predict neuropathology. The association between antemortem PP and CVD at autopsy suggests that in older adults with AD, PP elevation may increase the risk of CVD. These findings may have treatment implications since some antihypertensive medications specifically address the pulsatile component of blood pressure (e.g., renin-angiotensin system inhibitors, calcium channel blockers).
doi:10.3233/JAD-2012-111697
PMCID: PMC3370943  PMID: 22451309
Alzheimer’s disease; blood pressure; cerebrovascular disease; pulse pressure
14.  The Neuropsychological Profile of Alzheimer Disease 
Neuropsychological assessment has featured prominently over the past 30 years in the characterization of dementia associated with Alzheimer disease (AD). Clinical neuropsychological methods have identified the earliest, most definitive cognitive and behavioral symptoms of illness, contributing to the identification, staging, and tracking of disease. With increasing public awareness of dementia, disease detection has moved to earlier stages of illness, at a time when deficits are both behaviorally and pathologically selective. For reasons that are not well understood, early AD pathology frequently targets large-scale neuroanatomical networks for episodic memory before other networks that subserve language, attention, executive functions, and visuospatial abilities. This chapter reviews the pathognomonic neuropsychological features of AD dementia and how these differ from “normal,” age-related cognitive decline and from other neurodegenerative diseases that cause dementia, including cortical Lewy body disease, frontotemporal lobar degeneration, and cerebrovascular disease.
Alzheimer disease (AD) targets neuroanatomical networks for episodic memory before those for language, executive functions, and visuospatial abilities. Therefore, amnestic dementia is strongly associated with early AD pathology.
doi:10.1101/cshperspect.a006171
PMCID: PMC3312395  PMID: 22474609
15.  Specific Measures of Executive Function Predict Cognitive Decline in Older Adults 
Decline in executive function has been noted in the prodromal stage of Alzheimer’s disease (AD) and may presage more global cognitive declines. In this prospective longitudinal study, five measures of executive function were used to predict subsequent global cognitive decline in initially nondemented older adults. Of 71 participants, 15 demonstrated significant decline over a 1-year period on the Dementia Rating Scale (Mattis, 1988) and the remaining participants remained stable. In the year before decline, the decline group performed significantly worse than the no-decline group on two measures of executive function: the Color-Word Interference Test (CWIT; inhibition/switching condition) and Verbal Fluency (VF; switching condition). In contrast, decliners and non-decliners performed similarly on measures of spatial fluency (Design Fluency switching condition), spatial planning (Tower Test), and number-letter switching (Trail Making Test switching condition). Furthermore, the CWIT inhibition-switching measure significantly improved the prediction of decline and no-decline group classification beyond that of learning and memory measures. These findings suggest that some executive function measures requiring inhibition and switching provide predictive utility of subsequent global cognitive decline independent of episodic memory and may further facilitate early detection of dementia.
doi:10.1017/S1355617711001524
PMCID: PMC3314335  PMID: 22115028
Executive functions; Global cognition; Switching; Prodromal Alzheimer’s disease; Mild cognitive impairment; Prediction
16.  Altered brain response for semantic knowledge in Alzheimer’s disease 
Neuropsychologia  2010;49(3):392-404.
Word retrieval deficits are common in Alzheimer’s disease (AD) and are thought to reflect a degradation of semantic memory. Yet, the nature of semantic deterioration in AD and the underlying neural correlates of these semantic memory changes remain largely unknown. We examined the semantic memory impairment in AD by investigating the neural correlates of category knowledge (e.g., living vs. nonliving) and featural processing (global vs. local visual information). During event-related fMRI, 10 adults diagnosed with mild AD and 22 cognitively normal older adults named aloud items from three categories for which processing of specific visual features has previously been dissociated from categorical features. Results showed widespread group differences in the categorical representation of semantic knowledge in several language-related brain areas. For example, the right inferior frontal gyrus showed selective brain response for nonliving items in the CN group but living items in the AD group. Additionally, the AD group showed increased brain response for word retrieval irrespective of category in Broca’s homologue in the right hemisphere and rostral cingulate cortex bilaterally, which suggests greater recruitment of frontally-mediated neural compensatory mechanisms in the face of semantic alteration.
doi:10.1016/j.neuropsychologia.2010.12.011
PMCID: PMC3058793  PMID: 21163275
dementia; semantic memory; language; fMRI; word retrieval; category-specific deficit
17.  Neuropathology of Dementia with Lewy Bodies in Advanced Age: a comparison with Alzheimer Disease 
Neuroscience letters  2010;485(3):222-227.
Dementia with Lewy Bodies (DLB) is a common neurodegenerative disorder of the aging population characterized by α–synuclein accumulation in cortical and subcortical regions. Although neuropathology in advanced age has been investigated in dementias such as Alzheimer Disease (AD), severity of the neuropathology in the oldest old with DLB remains uncharacterized. For this purpose we compared characteristics of DLB cases divided into three age groups 70–79, 80–89 and ≥90 years (oldest old). Neuropathological indicators and levels of synaptophysin were assessed and correlated with clinical measurements of cognition and dementia severity. These studies showed that frequency and severity of DLB was lower in 80–89 and ≥90 year cases compared to 70–79 year old group but cognitive impairment did not vary with age. The extent of AD neuropathology correlated with dementia severity only in the 70–79 year group, while synaptophysin immunoreactivity more strongly associated with dementia severity in the older age group in both DLB and AD. Taken together these results suggest that the oldest old with DLB might represent a distinct group.
doi:10.1016/j.neulet.2010.09.016
PMCID: PMC2987680  PMID: 20849919
Cognition; Neuropsychological assessment
18.  Stroke Risk Modifies Regional White Matter Differences in Mild Cognitive Impairment 
Neurobiology of aging  2008;31(10):1721-1731.
Forty nondemented older adults who were divided into two groups on the basis of their cognitive status (MCI: n=20; Normal Control: n=20) underwent diffusion tensor imaging, and estimates of fractional anisotropy (FA) and mean diffusivity (MD) were obtained for the genu and splenium of the corpus callosum. Results demonstrated the following: (1) group comparisons revealed that splenium FA was significantly lower in MCI participants than in NC participants, despite no differences in gross morphometry or hippocampal volumes; (2) in the overall sample, higher stroke risk was associated with lower white matter integrity, particularly in the genu; (3) increased stroke risk was more strongly associated with poorer splenium FA in those with MCI than in normal elderly; and (4) splenium FA significantly predicted performance on verbal memory (adjusting for the effects of age, education, and whole brain volume). Findings demonstrate a relationship between increased vascular burden and white matter changes, and they support the possibility that posterior white matter pathology may contribute to the development of MCI-related cognitive changes.
doi:10.1016/j.neurobiolaging.2008.09.013
PMCID: PMC2946939  PMID: 19004528
MCI; mild cognitive impairment; stroke risk; Framingham; aging; white matter; diffusion tensor imaging; DTI
19.  Increased functional brain response during word retrieval in cognitively intact older adults at genetic risk for Alzheimer’s disease 
NeuroImage  2010;51(3):1222-1233.
Recent language studies in aging and dementia provide two complementary lines of evidence that: (1) measures of semantic knowledge and word-finding ability show declines comparable to those of episodic memory, and greater impairment than executive function measures, during the prodromal period of Alzheimer’s disease and (2) cognitively intact older adult carriers of the apolipoprotein E (APOE) ε4 allele also demonstrate poorer object naming than their low-risk peers. Given that possible changes in the neural substrates of word retrieval (e.g., Broca’s area and fusiform gyrus) in at-risk adults may signal impending cognitive decline and serve as a prodromal marker of AD, we examined whether APOE ε4 carriers exhibit changes in brain response in regions subserving word retrieval and semantic knowledge. Eleven cognitively intact APOE ε4 older adults and 11 age, education, and family history of AD-matched APOE ε3 adults named aloud photographs of animals, tools, and vehicles during event-related fMRI. Results showed that, in the face of equivalent naming accuracy, APOE ε4 adults demonstrated more widespread brain response with greater signal change in the left fusiform gyrus, bilateral medial prefrontal cortex, and right perisylvian cortex. Findings are discussed in the context of possible compensatory mechanisms invoked to maintain performance in those at genetic risk for AD.
doi:10.1016/j.neuroimage.2010.03.021
PMCID: PMC2862794  PMID: 20298792
apolipoprotein E; language; fMRI; word retrieval; confrontation naming
20.  APOE genotype is associated with left-handedness and visuospatial skills in children 
Neurobiology of aging  2008;31(5):787-795.
We sought to investigate whether APOE genotype is associated with unique profiles of cognitive functioning during early life. School-aged children (N = 147) received standardized achievement tests, the Rey-Osterrieth Complex Figure Test (Copy Condition; RCFT-CC), assessment of hand dominance for writing, and buccal swab testing to determine their APOE genotype. Significant differences were found on the RCFT-CC, with ε2-positive children performing worse on this measure relative to both ε3/3 (p = .032) and ε4-positive children (p = .018). Further, a higher prevalence of left-hand dominance for writing was observed among ε2-positive children (29.2%) relative to ε3/3 (8.9%) and ε4-positive children (6.1%; p = .012), although this finding did not account for the observed group differences on the RCFT-CC. Findings raise the possibility that in childhood, the ε2 allele may be associated with (a) decreased functioning in certain cognitive domains; and (b) factors associated with atypical hemispheric dominance. Results may be consistent with the theory of antagonistic pleiotropy, which suggests that APOE may have different protective effects at different developmental stages.
doi:10.1016/j.neurobiolaging.2008.05.021
PMCID: PMC2865468  PMID: 18606479
Cognitive aging; neurodevelopment; apolipoprotein E; developmental neuropsychology; dementia; Alzheimer’s disease
21.  COMPARISON OF THE TRADITIONAL RECALL-BASED VERSUS A NEW LIST-BASED METHOD FOR COMPUTING SEMANTIC CLUSTERING ON THE CALIFORNIA VERBAL LEARNING TEST: EVIDENCE FROM ALZHEIMER’S DISEASE 
The Clinical neuropsychologist  2009;24(1):70-79.
For over 50 years, cognitive psychologists and neuropsychologists have relied almost exclusively on a method for computing semantic clustering on list-learning tasks (recall-based formula) that was derived from an outdated assumption about how learning occurs. A new procedure for computing semantic clustering (list-based formula) was developed for the CVLT-II to correct the shortcomings of the traditional method. In the present study we compared the clinical utility of the traditional recall-based method versus the new list-based method using results from the original CVLT administered to 87 patients with Alzheimer’s disease and 86 matched normal control participants. Logistic regression and score distribution analyses indicated that the new list-based method enhances the detection of differences in semantic-clustering ability between the groups.
doi:10.1080/13854040903002232
PMCID: PMC3084534  PMID: 19894184
Learning; Memory; Neuropsychology; CVLT
22.  Asymmetry in Auditory and Spatial Attention Span in Normal Elderly Genetically At Risk for Alzheimer's Disease 
Some studies of elderly individuals with the ApoE-e4 genotype noted subtle deficits on tests of attention such as the WAIS-R Digit Span subtest, but these findings have not been consistently reported. One possible explanation for the inconsistent results could be the presence of subgroups of e4+ individuals with asymmetric cognitive profiles (i.e., significant discrepancies between verbal and visuospatial skills). Comparing genotype groups with individual, modality-specific tests might obscure subtle differences between verbal and visuospatial attention in these asymmetric subgroups. In this study, we administered the WAIS-R Digit Span and WMS-R Visual Memory Span subtests to 21 nondemented elderly e4+ individuals and 21 elderly e4- individuals matched on age, education, and overall cognitive ability. We hypothesized that a) the e4+ group would show a higher incidence of asymmetric cognitive profiles when comparing Digit Span/Visual Memory Span performance relative to the e4- group; and (b) an analysis of individual test performance would fail to reveal differences between the two subject groups. Although the groups’ performances were comparable on the individual attention span tests, the e4+ group showed a significantly larger discrepancy between digit span and spatial span scores compared to the e4- group. These findings suggest that contrast measures of modality-specific attentional skills may be more sensitive to subtle group differences in at-risk groups, even when the groups do not differ on individual comparisons of standardized test means. The increased discrepancy between verbal and visuospatial attention may reflect the presence of “subgroups” within the ApoE-e4 group that are qualitatively similar to asymmetric subgroups commonly associated with the earliest stages of AD.
PMCID: PMC3080769  PMID: 15903153
23.  Accessibility of the nondominant language in picture naming: A counterintuitive effect of dementia on bilingual language production 
Neuropsychologia  2009;48(5):1356-1366.
The current study tested the assumption that bilinguals with dementia regress to using primarily the dominant language. Spanish-English bilinguals with probable Alzheimer's disease (AD; n=29), and matched bilingual controls (n=42) named Boston Naming Test pictures in their dominant and nondominant languages. Surprisingly, differences between patients and controls were larger using dominant-language than nondominant-language naming scores, and bilinguals with AD were either more likely than controls (in English-dominant bilinguals), or equally likely (in Spanish-dominant bilinguals), to name some pictures in the nondominant language that they could not produce in their dominant language. These findings suggest that dominant language testing may provide the best assessment of language deficits in bilingual AD, and argue against the common notion that the nondominant language is particularly susceptible to dementia. The greater vulnerability of the dominant language may reflect the increased probability of AD affecting richer semantic representations associated with dominant compared to nondominant language names.
doi:10.1016/j.neuropsychologia.2009.12.038
PMCID: PMC2843816  PMID: 20036679
24.  Cognitive Discrepancies Versus APOE Genotype as Predictors of Cognitive Decline in Normal-Functioning Elderly Individuals: A Longitudinal Study 
Objectives
Cognitive-discrepancy analysis has been shown to be a useful technique for detecting subtle cognitive deficits in normal-functioning elderly individuals who are genetically at-risk for Alzheimer disease (AD). However, studies that have used cognitive-discrepancy measures to date have used retrospective or cross-sectional designs, and the utility of this approach to predict cognitive decline has not been examined in a prospective investigation.
Design
Longitudinal study.
Setting
San Diego, CA, Veterans Administration Hospital.
Participants
Twenty-four normal-functioning elderly individuals participated in the study, with 16 subjects exhibiting no change in their Dementia Rating Scale (DRS) scores over an 1-year period (Stable Group), and 8 subjects exhibiting a decline in DRS scores over the 1-year period (Decline group).
Measurements
A cognitive-discrepancy measure isolating cognitive switching was computed that contrasted performance on a new higher-level task of executive functioning (a Stroop/Switching measure) relative to a composite measure of lower-level Stroop conditions.
Results
a) In the year before their cognitive changes, the Decline group exhibited a significantly larger cognitive-discrepancy (Stroop/Switching versus lower-level Stroop conditions) score compared with a control (Stable) group; and b) the cognitive-discrepancy measure was superior to APOE genotype in predicting DRS decline.
Conclusion
Cognitive-discrepancy analysis isolating a component executive function ability not only seems to be a useful tool for identifying individuals at risk for cognitive deficits, but also shows promise in predicting individuals who may show subtle cognitive decline over time.
doi:10.1097/JGP.0b013e3181629957
PMCID: PMC3050584  PMID: 18448849
Cognitive discrepancies; aging; Alzheimer disease; executive functioning
25.  Hierarchical cognitive and psychosocial predictors of amnestic mild cognitive impairment 
To identify neuropsychological and psychosocial factors predictive of amnestic Mild Cognitive Impairment (aMCI) among a group of 94 nondemented older adults, we employed a novel nonlinear multivariate classification statistical method called Optimal Data Analysis (ODA) in a dataset collected annually for 3 years. Performance on measures of memory and visuomotor processing speed or symptoms of depression in year 1 predicted aMCI status by year 2. Performance on a measure of learning at year 1 predicted aMCI status at year 3. No other measures significantly predicted incidence of aMCI at years 2 and 3. Results support the utility of multiple neuropsychological and psychosocial measures in the diagnosis of aMCI, and the present model may serve as a testable hypothesis for prospective investigations of the development of aMCI.
doi:10.1017/S1355617710000512
PMCID: PMC3005198  PMID: 20561399
Amnestic mild cognitive impairment; aMCI; MCI; Neuropsychology; Memory; Visuomotor processing speed; D-KEFS; Depression; Optimal data analysis

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