VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA 90073, USA.
Neuropsychologia. 2013 Aug;51(9):1726-33. doi: 10.1016/j.neuropsychologia.2013.05.021. Epub 2013 Jun 5.
Neuropsychologists frequently include proverb interpretation as a measure of executive abilities. A concrete interpretation of proverbs, however, may reflect semantic impairments from anterior temporal lobes, rather than executive dysfunction from frontal lobes. The investigation of proverb interpretation among patients with different dementias with varying degrees of temporal and frontal dysfunction may clarify the underlying brain-behavior mechanisms for abstraction from proverbs. We propose that patients with behavioral variant frontotemporal dementia (bvFTD), who are characteristically more impaired on proverb interpretation than those with Alzheimer's disease (AD), are disproportionately impaired because of anterior temporal-mediated semantic deficits.
Eleven patients with bvFTD and 10 with AD completed the Delis-Kaplan Executive Function System (D-KEFS) Proverbs Test and a series of neuropsychological measures of executive and semantic functions. The analysis included both raw and age-adjusted normed data for multiple choice responses on the D-KEFS Proverbs Test using independent samples t-tests. Tensor-based morphometry (TBM) applied to 3D T1-weighted MRI scans mapped the association between regional brain volume and proverb performance. Computations of mean Jacobian values within select regions of interest provided a numeric summary of regional volume, and voxel-wise regression yielded 3D statistical maps of the association between tissue volume and proverb scores.
The patients with bvFTD were significantly worse than those with AD in proverb interpretation. The worse performance of the bvFTD patients involved a greater number of concrete responses to common, familiar proverbs, but not to uncommon, unfamiliar ones. These concrete responses to common proverbs correlated with semantic measures, whereas concrete responses to uncommon proverbs correlated with executive functions. After controlling for dementia diagnosis, TBM analyses indicated significant correlations between impaired proverb interpretation and the anterior temporal lobe region (left>right).
Among two dementia groups, those with bvFTD, demonstrated a greater number of concrete responses to common proverbs compared to those with AD, and this performance correlated with semantic deficits and the volume of the left anterior lobe, the hub of semantic knowledge. The findings of this study suggest that common proverb interpretation is greatly influenced by semantic dysfunction and that the use of proverbs for testing executive functions needs to include the interpretation of unfamiliar proverbs.
神经心理学家经常将谚语解释作为执行能力的衡量标准。然而，具体的谚语解释可能反映了前颞叶的语义损伤，而不是额叶的执行功能障碍。研究不同程度颞叶和额叶功能障碍的痴呆患者的谚语解释，可以阐明谚语抽象的潜在脑-行为机制。我们提出，与阿尔茨海默病（AD）相比，行为变异额颞叶痴呆（bvFTD）患者在谚语解释方面的表现更为受损，这主要是由于前颞叶介导的语义缺陷。
11 名 bvFTD 患者和 10 名 AD 患者完成了 Delis-Kaplan 执行功能系统（D-KEFS）谚语测试和一系列执行和语义功能的神经心理学测试。分析包括 D-KEFS 谚语测试多项选择反应的原始和年龄调整标准化数据，使用独立样本 t 检验。基于张量的形态学（TBM）应用于 3D T1 加权 MRI 扫描，将区域脑体积与谚语表现相关联。在选定的感兴趣区域内计算平均雅可比值，为区域体积提供数值摘要，体素回归产生组织体积与谚语得分之间的 3D 统计图谱。
bvFTD 患者在谚语解释方面明显比 AD 患者差。bvFTD 患者表现更差，涉及到对常见熟悉的谚语做出更多具体的反应，而不是对不常见不熟悉的谚语。这些对常见谚语的具体反应与语义测量相关，而对不常见谚语的具体反应与执行功能相关。在控制痴呆症诊断后，TBM 分析表明，受损的谚语解释与前颞叶区域（左>右）之间存在显著相关性。
在两组痴呆症患者中，与 AD 患者相比，bvFTD 患者对常见谚语做出更多具体反应，并且这种表现与语义缺陷和左侧前叶体积（语义知识的枢纽）相关。这项研究的结果表明，常见谚语的解释受到语义功能障碍的极大影响，并且使用谚语进行执行功能测试需要包括对不熟悉谚语的解释。
