October 5, 2005
Effects of Semantic Impairment on List Learning and Serial Recall: Evidence from Semantic Dementia

The temporal lobe variant of frontotemporal dementia (i.e., semantic dementia [SD]) results in a progressive loss of lexical-semantic knowledge with relative preservation of syntax, phonology, and executive functioning until the late stages of the disease. Severe naming difficulties are prevalent in SD. Yet, little is known about the potential for word learning in this population. In an impending era of etiologically driven treatment for neurodegenerative disease, it is increasingly important to tailor behavioral interventions toward specific forms of dementia and progressive aphasia. To this end, we examined the integrity of immediate serial recall and short-term learning via repetition priming in five patients with SD. We predicted reduced semantic effects (imageability), preservation of lexical effects (frequency), and diminished primacy effects in serial recall, consistent with other semantically impaired populations (Martin & Saffran, 1997). We also predicted that severity of semantic impairment would modulate the facilitative effects of repeated exposure (i.e., repetition priming) on word list recall. In immediate serial recall, all participants showed reduced imageability effects, but only one patient showed a significant word frequency advantage. Two patterns of serial position effects emerged: (1) poor recall of initial list items and (2) better recall of initial and final items. All participants showed minimal gains across repeated trials; however, patients who poorly recalled initial items showed the least benefit from repeated exposure. We discuss the usefulness of repetition-based interventions for SD and advocate maintenance of known vocabulary over reacquisition of forgotten words. Furthermore, we propose an anatomically constrained interactive model of the cognitive-linguistic loss incurred in SD. This model reflects a continuous reduction of semantic support, followed by lexical support, extending through phonologic levels of processing, that coincides with the spread of cortical atrophy to medial and superior temporal lobe regions as this disease progresses.