No negative impact of word retraining on vocabulary use or clarity of communication in semantic dementia

Figures & data

Figure 1. Coronal T1 weighted MRI of the medial temporal lobe for each participant. Note. The left hemisphere is shown on the right. Participants SD-P1 and SD-C1 show greater right sided atrophy.

Table 1. Demographic and clinical profile of study participants.

	S1	J1	S2	P1	B1	G1	J2	C1	T4
Sex	F	M	F	F	M	M	F	M	M
Age (years)	67	75	60	69	67	70	77	55	70
Education (years)	14	15	12	11	13	16	15	12	11
Disease duration (years)	6	5	3	6	5	6	9	8	6
Atrophy pattern	L > R	L > R	L > R	R > L	L > R	L > R	L > R	R > L	L > R
ACE-R^a (100)	80	86	70	79	84	68	56	57	49
Digit Span^b (Age SS)	7	18	11	14	15	10	8	8	7
RCFT Copy^c (36)	28	34	31	32	35	36	35	30	34
RCFT 3-min recall^c (36)	19.5	23	17	11.5	17	22.5	25.5	9	12
Trail Making Test-A^d (s)	39	29	17	31	39	34	35	39	31
Trail Making Test-B^d (s)	73	61	67	58	41	80	111	78	88
SYDBAT Total (120)	98	97	85	85	78	71	68	62	46
Naming^e (30)	16^f	16^f	5^f	14^f	10^f	8^f	8^f	4^f	2^f
Repetition^e (30)	30	29	30	29	30	29	28^f	29	25^f
Comprehension^e (30)	26	27	28	21^f	19^f	17^f	17^f	14^f	12^f
Semantic^e (30)	26	25	22^f	21^f	19^f	17^f	15^f	15^f	7^f

Notes: Participant labels have been retained from Savage et al. (2015a), with the addition of S2 (previously unpublished); L > R, left greater than right temporal lobe atrophy; R > L, right greater than left temporal lobe atrophy; SS, scaled score; s, seconds taken to complete; numbers in parentheses refer to maximum score for that assessment.

^a Addenbrooke’s Cognitive Examination-Revised (Mioshi et al., 2006), where healthy control cut-off is 88 and dementia cut-off score is 82.

^b Total score on Digit Span subtest of the Wechsler Adult Intelligence Scale (Wechsler, 1997).

^c Rey Complex Figure Test (RCFT; Meyers & Meyers, 1995).

^d Trail-Making Test (Strauss et al., 2006).

^e Sydney Language Battery; healthy control means: naming = 26.6; repetition = 29.9; comprehension = 29.1; semantic = 27.7.

^f Performance more than 2 standard deviations below the mean of neurotypical controls.

Table 2. Response coding.

Category	Subcategories	Examples
Correct	Target response	“knife” for picture knife
	Acceptable alternative	“TV” for picture television
	Plurals	“apples” for picture apple
Partially correct response		“cutting pad” for picture cutting board
Semantic errors	Coordinate	“sauce” for picture jam
	Superordinate	“vegetable” for picture potato
	Associate	“salt” for picture peanuts
Semantic descriptions	Semantically based descriptions	“a device for measuring vegetables and things like that” for picture kitchen scales
	Superordinate description	“some sort of insect, but I don’t know which one” for picture fly
Non-semantic descriptions	Episodic memory	“I had two of them this morning” for picture eggs
	Orthographic description	“oh it starts with m” for picture mandarin
Other errors	Unrelated real words	“chickens” for picture strawberry
	Incorrect superordinate	“tool” for picture placemats
	Other descriptions	“little guys” for picture mosquito
	Nonword (phonologically related and unrelated)	“scaptula” for picture spatula
	Morphological neologism	“vacuumer” for picture vacuum cleaner
	Visual error	“snake” for picture belt
Omissions		“I don’t know” or no response within 10 seconds

Table 3. Pre- and post-intervention rates of accuracy, misuse and perseveration by individual at baseline (BL) and post-intervention (number correct or number of misuses/total number of stimuli).

Case	Accuracy: Trained words naming accuracy			Accuracy: Untrained words naming accuracy			Misuse: Trained targets to name other trained words			Misuse: Trained targets to name untrained words			Perseveration: Repetition errors per testing session
	BL	Post	Pre-post change (exact p)	BL	Post	Pre-post change (exact p)	BL	Post	Pre-post change (exact p)	BL	Post	Pre-post change (exact p)	BL	Post	Pre-post change (exact p)
S1	15/32	31/32	<.001	36/64	33/64	.607	0/32	0/32	NA	2/64	3/64	1.0	5/96	2/96	.250
J1	13/30	30/30	<.001	28/57	26/57	.625	2/30	0/30	.50	1/57	3/57	.50	2/87	1/87	1.0
S2	11/31	29/31	<.001	20/66	31/66	.013	0/31	0/31	NA	1/66	1/66	1.0	1/97	0/97	1.0
P1	10/32	31/32	<.001	26/65	26/65	1.0	0/32	0/32	NA	4/65	3/65	1.0	2/97	1/97	1.0
B1	14/30	30/30	<.001	28/65	29/65	1.0	0/30	0/30	NA	1/65	1/65	1.0	3/95	1/95	.500
G1	17/31	28 /31	.003	30/62	33/62	.375	0/31	1 /31	1.0	1/62	2/62	1.0	2/93	2/93	1.0
J2	14/25	25/25	.001	19/39 ^a	20/39 ^a	1.0	0/25	0/25	NA	0/39	0/39	NA	0/64	0/64	NA
C1	16/38	34/38	<.001	32/72	41/72	.064	1/38	1/38	1.0	3/72	2/72	1.0	4/110	1/110	.375
T4	8/29	27/29	<.001	22/71	19/71	.375	1/29	0/29	1.0	0/71	5/71	.063	2/100	5/100	.453
ALL	118/278	265/278	.008	241/561	258/561	.401	4/278^b	2/278	.285	13/561^b	20/561	.116	21/839	13/839	.176

^a Although J2’s word lists comprised 32 items each, given problems with sound recording, only those items with clear and complete responses were included in the analysis, reducing the total number.

^b Note that the proportions of misuse at baseline are equivalent, with no significant difference in misuse of (to-be) trained targets when naming other (to-be) trained words versus when naming untrained words prior to intervention (χ² (1) = .35, p = .555, Pearson’s Chi-square test with Yates’ continuity correction).

Figure 2. Individual error profiles at baseline and post-intervention for (a) trained items and (b) untrained item.

Table 4. Percentage of errors of each type for trained and untrained items at baseline and post-intervention combined across participants (n = 9).

Error type	Trained items		Untrained items
	Baseline (n = 160)	Post-intervention (n = 13)	Baseline (n = 320)	Post-intervention (n = 303)
% partially correct	4	23	3	4
% semantic error (total)	21	31	23	19
Coordinate	14	31	16	15
Superordinate	6	0	6	4
Associative	1	0	1	0
% semantic description	19	15	21	15
% non-semantic description	4	0	3	1
% omissions	44	15	42	50
% other	8	15	9	11

Table 5. Wilcoxon tests for each participant and for all participants as a group.

Case	Trained items			Untrained items
	Clarity Score		Pre-post change (Wilcoxon), p	Clarity Score		Pre-post change (Wilcoxon), p
	BL	Post		BL	Post
S1	0.578	0.984	< .001	0.680	0.539	.071
J1	0.483	1.000	< .001	0.544	0.430	.029
S2	0.339	0.935	< .001	0.295	0.462	.010
P1	0.297	0.953	< .001	0.308	0.346	.272
B1	0.583	1.000	< .001	0.469	0.508	.475
G1	0.468	0.839	.029	0.371	0.548	.013
J2	0.540	1.000	.002	0.474	0.526	.595
C1	0.461	0.921	< .001	0.597	0.611	.839
T4	0.276	0.948	< .001	0.197	0.148	.449
ALL	0.446	0.951	.008	0.433	0.453	.515

Note: BL denotes baseline assessment.

Alpha level for Bonferroni corrected p-value: p < .025.

Table A1. Number of items in each list by participant.

Participant	Trained items	Untrained items		Total
	List 1	List 2	List 3
S1	32	32	32	96
J1	30	27	30	87
S2	31	32	34	97
P1	32	32	33	97
B1	30	32	33	95
G1	31	32	30	93
J2*	25	17	22	64
C1	38	37	35	110
T4	29	31	40	100

Note: * Original lists for J2 comprised 32 items each, however, due to technical issues in sound files, items that were incomplete or unclear were not included in the analysis.

Table A2. Example list items (as for participant B1).

Semantic category	Trained list	Untrained list
Food – fruit & vegetables	grapes, nectarines, onion, cucumber, broccoli, carrot	raisins, passionfruit, kiwi fruit, lemon, strawberries, watermelon, mandarin, tomatoes, avocado, capsicum, asparagus, cauliflower, corn, lettuce, mushrooms
Food – other	sausages, chocolate, tomato sauce, teabag, peanuts	steak, chicken, yoghurt, jam, mayonnaise, salt and pepper, juice, sugar, pasta,
Kitchen items	placemats, kitchen scales, can opener, whisk, colander, clingwrap, teapot, wine glass	coasters, chopping board, grater, peeler, potato masher, spatula, tongs, ladle, dish cloth, paper towel, serviettes, pot or saucepan, frying pan, wok
Household appliances	oven, kettle, sink, vacuum cleaner, air conditioner, fan	microwave, cooktop or stove, barbecue, toaster, refrigerator or fridge, dishwasher, washing machine, heater, iron, power point, remote control, telephone or phone, computer
Insects and reptiles	bees, spider, dragonfly, mosquito, termite	wasp, beetle, centipede, cicada, butterfly, moth, fly, cockroach, grasshopper, praying mantis, bull ant, silverfish, snake, lizard

Table B1. Detailed error coding.

Error category	Subcategories	Details
Correct	Target response
	Acceptable alternative
	Plurals	correct plurals: “apples” for picture apple, but not “corns” for picture corn
Partially correct response		- for compound nouns: response had to contain one of the two nouns: “cutting pad” for picture cutting board, “paper peeler” for picture potato peeler or “chopping” for picture chopping board - for single word items: the response had to contain the target word but in combination with unnecessary additional words: “baking oven” for picture oven
Semantic errors	Coordinate	words belonging to the same semantic category: “sauce” for picture jam or “mosquito” for picture fly
	Superordinate	category name for the item: “vegetable” for picture potato or “insect” for picture cockroach
	Associate	related words as found in the Nelson et al. (2004) association norms: “salt” for picture peanuts or “birthday” for picture cake
Semantic descriptions	Semantically based descriptions	responses which provide some correct semantic information regarding the item, including - descriptions of major use: “a device for measuring vegetables and things like that” for picture kitchen scale - description of how the item is used/words which describe the main action carried out with the item: “scraper” for picture rake, “ironing” for picture iron - description of what it is similar to: “little kitchen towel” for picture dish cloth - description of kind/consistency: “creamy item” for picture mayonnaise, “little crunchy things” for picture peanuts
	Superordinate description	any multi-word response that includes a superordinate as the keyword: “some sort of insect, but I don’t know which one” for picture fly, “another vegetable” for picture carrot, “cooking item” for picture wok
Non-semantic descriptions	Episodic memory
	Orthographic description
Other errors	Unrelated real words
	Incorrect superordinate
	Other descriptions	- visual description: “top of oven” for picture stove - neutral (vague or non-specific information): “little guys” for picture mosquito, “in the kitchen” for picture bowl - neologistic or incorrect with target relationship: “baking parts of baking table” for picture stove, “for boiling water” for picture teapot - incorrect without target relationship: “you can use it for striking” for picture peeler
	Nonword (phonologically related and unrelated)	phonologically related nonword: “scaptula” for picture spatula
	Morphological neologism
	Visual error	no semantic connection between item and response: “snake” for picture belt
Omissions		- “I don’t know” or “not sure about that one” note the exception: in response “I don't know … maybe a cat”, “maybe a cat” is coded as the response and the initial “I don't know” disregarded as a comment - null responses: no response or “um … ” - time out: no response within 10 seconds

Table B2. Clarity of response scoring.

Numeric score	Response type
1	correct name is given
	- target response
	- acceptable alternatives
	- plurals
0.5	correct and non-conflicting information is given but not the correct label
	- partially correct response
	- superordinate
	- semantically based description
	superordinate description
	- orthographic description – if correct information provided
	- visual description – if correct and specific
	- morphological neologism
0	non-specific responses
	- episodic memory
	- omission
	- other description – neutral content (neither clearly correct nor incorrect, including a mix of content)
−0.5	associated, but incorrect information is provided
	- associate
	- coordinate
	- other description – neologistic or incorrect content but with a close relationship to the target
−1	incorrect and unrelated or misleading information is provided
	- incorrect superordinate
	- unrelated real word
	- other description – incorrect content (description is clearly unrelated or misleading)
	- orthographic description –incorrect content without target relationship
	- nonword (phonologically related and unrelated)
	- visual error

Table C1. Instances of misuse of list items pre- and post-intervention by participant.

	Trained targets named using other trained words		Untrained targets named using trained words		Repetition errors across all lists
	BL Target word → response given	Post	BL	Post	BL (lag in items in parenthesis)	Post (lag in items in parenthesis)
S1			Clarinet → trumpet Coriander → parsley	Cockroach → spider Coriander → parsley Saxophone → trumpet	Cello → big violin (63) Clarinet → trumpet (2) Cockroach → beetle (30) Coriander → parsley (22) Ladybird → beetle (47)	Cockroach → spider (23) Coriander → parsley (33)
J1	Ladybird → beetle Mosquito → spider		Killer whale → dolphin	Killer whale → dolphin Kookaburra → cockatoo Noisy miner → Indian myna	Killer whale → dolphin (51) Pigeon → dove (62)	Kookaburra → cockatoo (43)
S2			Polo shirt → t-shirt	Polo shirt → t-shirt	Polo shirt → t-shirt (4)
P1			Cockroach → bee (→ DK) Goose → duck Noisy miner → pigeon Silverfish → mosquito	Noisy miner → pigeon Goose → duck Tuba → trumpet	Cello, violin → guitar (−31; −36) Goose → duck (2)	Goose → duck (35)
B1			Wasp → mosquito (→ “another insect”)	Fly → bee	Beetle → cockroach (88) Grasshopper → cocky (47) Frying pan → pot (34)	Frying pan → saucepan (59)
G1		Steak → silver beet [self-corrected “no”] (silver beet→ blue …)	Dishwasher → washing machine	Teapot →tea jug Toaster → milk	Dishwasher → washing machine (23) Teapot, coaster → cup (−54; −44)	Teapot → jug (51) Toaster → milk (41)
J2
C1	Tea towel → towel (“another towel”)	Rubber band → button	Dish cloth → towel (“another towel”) Dishwasher → washing machine Teapot → kettle (→ description of use)	Dish cloth → towel Peas → button	Dish cloth → towel (6) Frying pan → pot (46) Polo shirt → shirt (18) Tea towel → towel (52)	Peas → buttons (3)
T4	Serviettes → paper towel			Microwave → mandarin Peanuts → potatoes Shower → sink Strawberries → chicken Tea towel → paper towel	Dishwasher → washing machine (51) Singlet, t-shirt → shirt (−42; −23)	Banana → apple (24) Microwave → mandarin (9) Shower → sink (2) Strawberries → chicken (10) [error acknowledged: “not chicken”] Socks, trousers → shirt (−79; −16)
Grand Total	4	2	13	20	21	13

Note: Words that are written in bold were named correctly when they appeared as target words.

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