The impact of semantic impairment on verbal short-term memory in stroke aphasia and semantic dementia: A comparative study.

This study presents the first direct comparison of immediate serial recall in semantic dementia (SD) and transcortical sensory aphasia (TSA). Previous studies of the effect of semantic impairment on verbal short-term memory (STM) have led to important theoretical advances. However, different conclusions have been drawn from these two groups. This research aimed to explain these inconsistencies. We observed (a) qualitative differences between SD and TSA in the nature of the verbal STM impairment and (b) considerable variation within the TSA group. The SD and TSA patients all had poor semantic processing and good phonology. Reflecting this, both groups remained sensitive to phonological similarity and showed a reduced effect of lexicality in immediate serial recall. The SD patients showed normal serial position effects; in contrast, the TSA patients had poor recall of the initial list items and exhibited large recency effects on longer lists. The error patterns of the two groups differed: the SD patients made numerous phoneme migration errors whereas the TSA group were more likely to produce entire words in the wrong order, often initiating recall with terminal list items. The SD cases also showed somewhat larger effects of word frequency and imageability. We propose that these contrasting performance patterns are explicable in terms of the nature of the underlying semantic impairment. SD is associated with anterior lobe atrophy and produces degradation of semantic knowledge - this is more striking for less frequent/imageable items, accentuating the effects of these lexical/semantic variables in STM. SD patients frequently recombine the phonemes of different list items due to the reduced semantic constraint upon phonology (semantic binding: Patterson et al., 1994). In contrast, the semantic impairment in TSA follows frontal or temporoparietal lesions and is associated with poor executive control of semantic processing (deregulated semantic cognition: Jefferies and Lambon Ralph, 2006), explaining why these patients are liable to recall entire words out of serial order.