Language and Aging

Presenter: Sandra Weintraub, Ph.D.

Alzheimer's Disease and Primary Progressive Aphasia: Clues to the Organization of Language

Biography

Dr. Sandra Weintraub is Professor of Psychiatry and Neurology at Northwestern University Medical School and the Director of Neuropsychology in the Cognitive Neurology and Alzheimer's Disease Center (CNADC). She is on the faculty of the Northwestern University Institute for Neuroscience (NUIN) where she is the Associate Director of a training grant recently awarded by the NIA, entitled "Mechanisms of Aging and Dementia." She has been the director of the Clinical Core of the Northwestern Alzheimer's Disease Center (NADC) in Chicago since 1996. Dr. Weintraub has been awarded research grants from the National Institute on Aging and the Illinois Department of Public Health for investigations of visual spatial attention in Alzheimer's disease and aging. She has authored numerous articles and book chapters on the neuropsychology of dementia and the examination of mental state. Currently Dr. Weintraub is one of a group of collaborators at the Northwestern ADC who are studying the clinical, genetic, epidemiological, neuropathological, and anatomical features of primary progressive aphasia. She is a co-author of the most commonly used naming measure in clinical practice and research, the Boston Naming Test. She was one of the two Scientific Honorees recognized at the Rita Hayworth Gala of the National Alzheimer's Association in 1997. She currently serves as the Chair of the Medical/Scientific Advisory Council to the board of directors of the Alzheimer's Association-Greater Illinois Chapter and is a member of the board of directors of the International Neuropsychology Society. Dr. Weintraub is a native of Montreal, Canada, and received her bachelor's degree from McGill University. She received her Ph.D. in Psychology from Boston University in 1978. In 1977 she started the Clinical Neuropsychology program in Behavioral Neurology at the Beth Israel Hospital in Boston. She was Associate Professor of Neurology at Harvard Medical School until 1994 when she joined the faculty of Northwestern University where she is also the director of the graduate Clinical Neuropsychology track in the Division of Psychology at the medical school. She is board certified in Clinical Neuropsychology by the American Board of Professional Psychology and directs the outpatient clinical neuropsychology service at the Northwestern Medical Faculty Foundation.

Abstract

Most of our knowledge about the neurology of language over the past 150 years has been derived from the study of aphasia following acute cerebrovascular lesions. The study of individuals with neurodegenerative dementia for this purpose has only taken on momentum over the past 25 years. This trend has been bolstered by an intensification of research into Alzheimer's disease (AD) which has led to early clinical detection. Thus, individuals with dementia can now be examined very close to the onset of observable symptoms, at a time when the neurodegenerative changes are relatively focal anatomically and manifested in distinctive behavioral and cognitive profiles. Neurodegenerative disease is progressive and the sequence in which additional anatomical areas are involved as the disease progresses is often predictable and governed by principles of neural network connectivity. This contrasts with focal cerebrovascular lesions, the location of which are constrained solely by the cerebral vasculature. Thus, studying the language deficits associated with dementia provides an opportunity to observe a system in dissolution and offers valuable insights into the organization of language. The clinical syndrome of Primary Progressive Aphasia (PPA) was originally defined and has been studied extensively in our laboratory. PPA is a form of dementia characterized by the slow erosion of language in relative isolation from other cognitive deficits for at least two years. It provides a model that supports anatomical and behavioral specificity in neurodegenerative brain disease. Physiological, structural, and pathological abnormalities in the left perisylvian region of the brain have been correlated with this clinical dementia syndrome. Language deficits also accompany progressive amnesia in the most common dementia syndrome designated by the label "Probable AD". The neuropathological changes in this syndrome do not target language areas but instead originate in limbic regions and then successively affect areas contiguous to the language regions in the temporal and parietal lobes. Thus, AD has provided information about the interface between language and semantics. In this presentation, the language alterations associated with AD and PPA will be compared, including examples from work conducted in our laboratory. Related syndromes, such as semantic dementia, will be discussed.

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