Six individuals with probable Alzheimer’s disease (AD) participated in a phase 1 study employing a repeated measures, parallel baseline design testing the hypothesis that error-free experience during word production practice combined with an acetyl cholinesterase inhibitor would improve confrontation naming ability. While acetyl cholinesterase inhibitors are safe and delay cognition decline associated with AD, improvement over baseline cognition is less evident; clinically significant cognitive deficits persist and progress. Both animal and clinical research strongly implicate acetylcholine in learning, a form of neuroplasticity. In clinical practice, however, people with AD are given cholinergic medications without concomitant systematic/targeted retraining. In this study six participants with probable AD and taking donepezil participated in targeted word production practice using an errorless learning strategy. Results showed that combining behavioral enrichment training and an acetyl cholinesterase inhibitor resulted in significant improvements in verbal confrontation naming of trained items for three of six participants. Differences in baseline dementia severity, living conditions, and medications may have influenced the training response. Detection of substantial treatment effects in 50% of subjects suggests further language treatment studies in AD in combination with an acetyl cholinesterase inhibitor are warranted and provide useful information on inclusion/exclusion criteria for use in subsequent studies. (JINS, 2009, 15, 311–322.)

In this issue of JINS, Gasparini and her colleagues (2008) report a subject with a right anterior choroidal artery territory stroke that damaged the anterior hippocampus, but likely more importantly, much of the ventral posterior limb of the internal capsule, effectively disconnecting the right thalamus from temporal cortex. Through systematic cognitive neuropsychological detective work, they provide a compelling case that the essential deficit was one of working memory. This is potentially a very important discovery. The thalamus is a phylogenetically ancient structure, and there is considerable evidence that, in human beings, much of its function has been subsumed by cortical mechanisms (Nadeau & Crosson, 1997). Consequently, there are fundamental limits to how much animal studies can inform us about human thalamic functions, and we are particularly reliant on cognitive neuropsychological studies like this one. The work of Gasparini et al. also provides a fine demonstration of the continuing value of cognitive neuropsychology in advancing our understanding of the details of brain function.

Patients with probable Alzheimer's disease (AD) often have difficulties associated with semantic knowledge. Therefore, conceptual apraxia, a defect of action semantics and mechanical knowledge, may be an early sign of this disease. The Florida Action Recall Test (FLART), developed to assess conceptual apraxia, consists of 45 line drawings of objects or scenes. The subject must imagine the proper tool to apply to each pictured object or scene and then pantomime its use. Twelve participants with Alzheimer's disease (NINCDS–ADRDA criteria) and 21 age- and education-matched controls were tested. Nine Alzheimer's disease participants scored below a 2-standarddeviation cutoff on conceptual accuracy, and the three who scored above the cutoff were beyond a 2-standard-deviation cutoff on completion time. The FLART appears to be a sensitive measure of conceptual apraxia in the early stages of Alzheimer's disease. (JINS, 2000, 6, 265–270.)