Emotion perception, but not affect perception, is impaired with semantic
memory loss
Supplementary Online Materials
Additional Patient Data
Patients were tested in the neurology clinic at a local Boston hospital. We
report the neuropsychological tests that were administered as part of a battery
performed by a trained neuropsychologist.
Case 1
Case history and presentation
EG is a 70-year-old male high school graduate who worked for most of his
adult life as an engineer at a construction company. He presented in 2006 with
gradually progressive symptoms of difficulty with “memory” and word finding in
speech. At the time of presentation, his family reported that he was having difficulty
remembering words and had stopped reading books. He was still doing the family
finances without difficulty. His family did not report changes in mood or personality.
On his first evaluation in 2006, he demonstrated word-finding difficulties and
anomia but normal affect and comportment. Structural MRI demonstrated focal
atrophy of the left temporal pole and he was diagnosed with Primary Progressive
Aphasia-Semantic variant (PPA-S; Gorno-Tempini et al., 2011a) of semantic
dementia. Findings from a full neuropsychological battery performed in 2006 are as
follows.
Intellectual abilities. This patient had normal intellectual abilities. He had
an average estimated intelligence score on the Weschler Test of Adult Reading and
performed superiorly on the Raven’s Progressive Matrices.
Attention and Executive function. This patient had normal attention and
executive function. Performance was in the average range on an auditory attention
span test and on the Mental Control subtest of the Weschler Memory Scale III. He
was in the superior range for Part A of the Trail Making Test (19 sec). He had one
sequencing error and one set-shifting error on Part B of the Trail Making Test, but
time to completion was 73 sec.
Memory. This patient had normal recognition memory, but consistent with
the semantic dementia diagnosis, had poor performance on the word recall portion
of the Consortium to Establish a Registry for Alzheimer’s Disease memory task.
Visuospatial performance. This patient had normal visuospatial skills. He
performed well with no omissions on the letter cancellation task, had intact
performance on the Visual Organization Test, and performed flawlessly on the
Benton Visual Form Discrimination Task.
Language. Consistent with the diagnosis of semantic dementia, this patient
had impaired performance on language tests. Lexical verbal fluency was impaired
(total FAS = 21), as was semantic verbal fluency (animals = 11). Performance on the
Boston Naming Task was also impaired (32/60 spontaneously plus 4 additional
items with phonemic cues).
Profile at time of emotion testing
By 2008, when EG completed the present experimental tasks, he had
undergone progressive impairment in the domain of language and semantic
memory. He was exhibiting anomia and semantic memory impairment with fluent
and articulate speech. Performance on confrontational naming (8/15 on
abbreviated Boston Naming Test) and verbal fluency tasks was severely impaired (3
F words and 7 animals in one minute each) although he was still able to repeat
lengthy sentences. He had severe impairments in both immediate and delayed
verbal memory and was no longer able to use cues to increase his memory
performance (no words recalled after a brief delay). His Mini Mental State Exam
score of 19/30 was impaired only as a result of his word retrieval impairment.
Amidst these language deficits, EG demonstrated normal memory for visual
material and normal visual construction (e.g., he was able to draw a clock and place
the hands correctly to 10 minutes after 11). His calculational abilities remained
normal: he was able to perform simple addition and subtraction. His mood was
judged clinically to be normal and he demonstrated appropriate affect during
clinical and research visits. His son reported no significant behavioral problems at
home.
Case 2
Case history and presentation
FZ is a 64-year old male with a Masters of Business Administration and
Certified Public Accountant degree, who worked as an accountant. He presented in
2009 with gradually progressive word finding difficulties. In particular, he forgot
names of people he had known for many years. Once an avid reader, he began
having difficulties following newspaper articles. He reported mild depression and
anxiety as a result of his symptoms, but was not diagnosable with a formal mood
disorder. He had no behavioral symptoms or personality change. On his first
evaluation, he demonstrated significant word finding difficulties and semantic
paraphasic errors during casual conversation. Structural MRI demonstrated
bilateral temporal pole atrophy with more prominent atrophy in the left temporal
pole. He was diagnosed with PPA-S (semantic dementia). Findings from a full
neuropsychological battery performed in 2009 are as follows.
Intellectual abilities. This patient had normal intellectual abilities. He had
average Perceptual Reasoning and Working Memory on the Weschler Adult
Intelligence Scale-IV. He performed in the high range on Matrix Reasoning (91st
percentile).
Attention and Executive function. This patient had normal attention and
executive function. His digit span was high average (7 forward and 5 in reverse), as
was his visual attention (forward span= 6, backward span = 4-5). He had no
difficulty on a graphomotor sequencing task (alternating M and N). Performance on
the DKEFS Trail Making Test was borderline (Trails A, 43 seconds, 4th percentile;
Trails B, 101 seconds, 2nd percentile). He demonstrated no difficulty on a go/no-go
task. His was able to quickly learn a serial hand movement sequence with his right
hand and was able to transfer learning to his left hand. Concept formation and
cognitive flexibility was preserved (WCST, 6/6 categories).
Memory. This patient had normal recognition memory, but consistent with
the semantic dementia diagnosis, had poor performance on the word retrieval. On
the CERAD 10-word list, his immediate recall was normal (5, 8, and 8 words; Total
Learning = 21, 47th percentile). After 8 minutes, he only recalled 3 words (1st
percentile). Delayed recognition was in-line with encoding, (10/10 words, 1 false
positive). On the Free and Cued Selective Reminding Test, he had mild difficulty
retrieving new material across the three learning trials (Free Recall = 22), but
benefited from the provision of cues paired with the items at the time of learning
(Free and Cued Total = 44).
Visuospatial skills. This patient had normal visuospatial skills. His
performance on the Rey-O figure copy was fully intact although the design was
drawn in a segmented fashion.
Language. Consistent with the diagnosis of semantic dementia, this patient
had impaired performance on language tests. Visual confrontation naming was
impaired on two measures (Boston Naming Test, 33/60, Multilingual Aphasia Exam:
Visual Naming, 21/30). Phonemic cueing was only minimally helpful, with an
additional 3 items named. He had mild difficulty on an auditory word picture
matching task, selecting the correct picture (out of 2 choices) for 29/32 concrete
words (5th percentile). He also had difficulty comprehending abstract words, where
accuracy in choosing which of two words matched a target word's meaning (e.g.,
does naïve mean innocent or stupid?) fell in the impaired range. In contrast, his
ability to access other aspects spoken language, including phonological,
morphological and syntactic information was intact. He was able to distinguish
words from non-words, to distinguish word meaning based on morphology (e.g.,
employer vs. employee, bus vs. busses), and was able to appreciate the syntactic
form of sentences as assessed on a sentence-picture matching task, however, and all
scores fell in the average range. Basic comprehension using the token test was
preserved.
Profile at time of emotion testing
By 2012, when FZ completed the present experimental tasks, he had
undergone progressive impairment in the domain of language and semantic
memory. He was exhibiting anomia and semantic memory impairment with fluent
and articulate speech. Performance verbal fluency tasks was impaired (Verbal
fluency for animals = 8; vegetables = 2). His Mini Mental State Exam was 25/30.
Verbal memory encoding was impaired but he retained what he learned after a 20-
minute delay (Wechsler Logical Memory Immediate = 4; Delayed = 4).
Amidst these language deficits, FZ displayed normal visuospatial function (he
was able to copy a picture of a pentagon on the Mini Mental State Exam and
accurately draw a clock with the instructed time). Although some aspects of
executive function demonstrated progressive impairment from 2009 (Trail Making
Test A 50s; Trail Making Test B 123 s), others remained relatively intact (e.g., digit
span forward 7, backward, 6). His mood was judged clinically to be normal and he
demonstrated appropriate affect during clinical and research visits. His wife
reported no behavioral problems at home.
Case 3
Case history and presentation
CP is a 53-year-old female with a Master’s Degree in Education who worked
as an administrator at a bank before retiring. She presented in 2008 with gradually
progressive word finding difficulties. At the time of presentation, her family
reported that she had been struggling to find words (mostly nouns) and had
experienced some minor difficulties with memory retrieval for conversations. They
denied any changes in mood or personality. On her first evaluation, she
demonstrated word-finding difficulty with anomia and pauses during spontaneous
speech but normal affect and comportment. Structural MRI demonstrated left
temporal pole atrophy. She was diagnosed with PPA-S (semantic dementia).
Findings from a full neuropsychological battery performed in 2008 are as follows.
Intellectual abilities. This patient had normal intellectual abilities. She had
a high average estimated intelligence score on the Weschler Test of Adult Reading.
Attention and Executive function. This patient had normal attention and
executive function. Performance was in the superior range on an auditory attention
span test and average on the Mental Control subtest of the Weschler Memory Scale
III. Digit span was 7 forward and 6 in reverse. Performance on a number-letter
sequencing task was in the average range. Wisconsin Card Sort was performed at an
average level with no perseverative errors and 6 categories obtained. Performance
on DKEFS Trail Making Test was in the high average to superior range. Color word
interference was in the average to high average range.
Memory. This patient had normal memory. Performance on the Weschler
Memory Scale III Logical Memory was in the high average range for immediate
recall (75th percentile), with 30 minute delayed recall in the high average range (84th
percentile). One hundred percent of encoded material was retained after the delay.
Visual memory was in the high average range (20-minute delayed recall of Rey-O
figure = 86th percentile).
Visuospatial skills. This patient had normal visuospatial skills. Her
visuospatial attention was high average on the Weschler Adult Intelligence Scale III.
Rey-O figure copy was 95th percentile.
Language. Consistent with the semantic dementia diagnosis, this patient had
impaired performance on language tests. Performance on the Boston Naming Task
was impaired (17/32 spontaneously; 1 additional correct response was obtained
with phonemic cues; semantically correct descriptions were often obtained (e.g.,
“you throw it” for dart). Semantic access from pictures was relatively maintained on
the Pyramids and Palm Trees test (49/52). Lexical verbal fluency was average (total
FAS = 29) but semantic verbal fluency was borderline (DKEFS category total = 25).
Profile at time of emotion testing
By 2011, when CP completed the present experimental tasks, she had
undergone progressive impairment in the domain of language and semantic
memory. She was exhibiting severe anomia and semantic memory impairment with
fluent and articulate speech. Her Mini Mental State Exam was 27/30, with errors
due to language deficits. Amidst these language deficits, her basic calculational skills
(addition and subtraction), visuospatial skills (e.g., she was able to copy a picture of
a pentagon on the Mini Mental State Exam and accurately draw a clock with the
instructed time) and attention remained intact. Her mood was judged clinically to be
normal and she demonstrated appropriate affect and comportment during clinical
and research visits. Her husband reported no behavioral problems at home.
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