Abstract
Most research, clinical and behavioral, has focused on cognitive degeneration, disease progression and related difficulties in Alzheimer’s disease. Additionally, most therapeutic approaches have as their goal the improvement of cognitive capacities in general. This paper discusses the case of two patients under intra-nasal insulin therapy (cf. Craft S, Baker L, Montine T, Minoshima S, Watson S, Claxton A, Arbuckle M, Callaghan M, Tsai E, Plymate S, Green P, Leverenz J, Cross D, Gerton B, Arch Neurol 69(1):29–38, 2012; de la Monte, 2012; Freiherr J, Hallschmid M, Frey II WH, Brünner YF, Chapman CD, Hölscher C, Craft S, De Felice FG, Benedict C, CNS Drugs 27:505–514, 2013; Schatz, González-Rivera, Pragmat Cognit 23(2), 2016; a.o.): an 86 year old male with moderate Alzheimer’s disease and a 67 year old male with early on-set Alzheimer’s who have both shown significant improvement of certain cognitive functions, mostly related to executive functioning and visuo-spatial skills while the elder patient exhibited severe deterioration in other capacities related to episodic memory. Selective cognitive improvement, even if partial, can have a significant impact on the quality of life of a patient and the ability to interact with others in a functional way; ameliorating some of the most devastating interactional and behavioral aspects of the disease.
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Notes
- 1.
Some examples of such correct conversational responses include the following: In reacting to his 14-year-old teenage granddaughter’s loud, dramatic negative emotional expression of fatigue after a long car ride, he said to his daughter: “She just lets it all go, doesn’t she”. On another occasion outside in his front yard he corrected his daughter who was understating the problem of the overgrown trees and plants when she said of the yard:“It needs a little trimming” by stating “It needs a lot of trimming”. On another occasion, the patient, in responding on the phone to his girlfriend who was on vacation and accidently walked into a clear plate glass window and hurt her nose, he said “Are you okay now? Did you get it taken care of?” Another example occurred after his daughter told him the long, complex story of having tried, but failed to make a profit on renting out an old family cabin, and how she might try again but did not trust one prospective renter who refused the idea of anybody checking on the property. The patient remarked to her, “No, you don’t want anybody like that renting because if they are trouble now, they will only cause problems down the road”.
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His neurologist reported that patient two, by January 2016, had “become more childlike and will tend to spend money that he does not have. The analysis is not done before making a spending decision. He does not go out at night”.
- 3.
Both patients retained the capacity to use and to respond affectively to humor in conversations. Yet, typically, the capacity to detect, understand and respond to humor deteriorates significantly in the progression of AD (Clark et al., 2015). Scholarship on the neural basis of humor processing suggests that humor engages a core network of cortical and subcortical structures, including temporo-occipito-parietal areas involved in detecting and resolving incongruity, i.e. mismatch between expected and presented stimuli and the mesocorticolimbic dopaminergic system and the amygdale, which are both key structures for reward and salience (Vrticka et al. 2013). The temporo-parietal junction incorporates information from the thalamus, among other systems. In addition, Clark and Warren (2014) specifically note that in the cognitive neurology of humor processing, the insular cortex is engaged in an affective response to a joke.
- 4.
BNT (2014) Spontaneous 5/15, w/Phonemic 4, w/Multiple Choice 5; BNT (2015) Spontaneous 2/15, w/Phonemic 3, w/Multiple Choice 9. Silagi, Bertolucci, Ferreira & Ortiz (2015:426) report Boston Naming Scores for patients with moderate AD at 58% total correct with significant “no response” errors and 81% total correct for patients with mild AD. In contrast, this patient was still able to score 93% total correct on the BNT (14/15with multiple attempts, 2015) even after three years into AD disease progression. WRAT scores are: (2014), comprehension 5/5; agility 6/6; repetition 5/5. WRAT (2015). irregular −2/6; verbal −2/6; sentence 4/5, repetition −2/5; Verbal Fluency: Category correct (4) with no Reps or RV; Verbal Fluency Phonemic D- Correct −2; Rep −2; RV -2. PPVT scores are: (2014) verbs 3/4; descriptives 3/4, animate 2/4, inanimate 3/4. PPVT-R (2015): Verbs 3/4, Descriptive 2/4, Animate 1/4; Inanimate 3/4. In 2015, there was included a Similarities (−5/3) and Proverbs (−5/3) test.
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Schatz, S., González-Rivera, M. (2019). Executive Functioning, Visuo-Spatial and Inter-Personal Skill Preservation in Alzheimer’s and Mild Cognitive Impairment. In: Capone, A., Carapezza, M., Lo Piparo, F. (eds) Further Advances in Pragmatics and Philosophy: Part 2 Theories and Applications. Perspectives in Pragmatics, Philosophy & Psychology, vol 20. Springer, Cham. https://doi.org/10.1007/978-3-030-00973-1_21
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