Is a Perseveration a Perseveration? An Evaluation of Cognitive Error Types in Patients with Subcortical Pathology

Abstract

This study investigated several constructs of executive functioning in a group of 77 patients with subcortical pathology. Specifically, we examined the validity of categorizing perseverative errors as "recurrent," "stuck-in-set," or "continuous," as proposed by Sandson and Albert (1984). A principal components analysis of 2 measures of recurrent perseveration, 2 measures of stuck-in-set perseveration, and 2 measures of intrusive errors yielded a 2 component solution with stuck-in-set perseverations and intrusive errors loading on Component 1, and recurrent perseverations loading on Component 2. Presence of a continuous perseveration on a graphomotor test was significantly associated with higher factor scores on Component 1, but not Component 2. The stuck-in-set perseveration and intrusion component was associated with the majority of the other neuropsychological tests administered, including tests of executive function and memory. The recurrent perseveration component was not associated with the other measures of cognitive functioning. Presence of a continuous perseveration was associated with executive function but not memory measures. This study provides evidence that recurrent perseverations are distinct from the other types of perseverative and intrusive errors, and that stuck-in-set and intrusive errors are good indicators of general cognitive functioning in patients with subcortical pathology.

Exploration of verbal repetition in people with dementia using an online symptom-tracking tool

“…In relation to executive functioning, recurrent verbal perseverations occur early in the course of AD and has been held to imply frontal lobe involvement rather than memory dysfunction – as demonstrated by the lack of significant association with general memory measures (Bayles et al , 2004; Possin et al , 2005; Pekkala et al , 2007). At the neuropharmacological level, recurrent perseveration and deficits in attentional switching have been attributed to resistance of catecholaminergic and cholinergic activity in the prefrontal cortex (McNamara and Albert, 2004).…”

Verbal perseveration as the initial symptom in a case of Creutzfeldt‐Jakob disease

“…In these studies, the frequency of occurrence of perseverative responses in selected language and cognitive tasks, the differential diagnostic power of the various types of perseveration in differentiating among dementia types, and the possible underlying mechanisms have been investigated (see, for example, Bayles, Tomoeda, Kasniak, Stern, & Eagans, 1985;Nagahama, Okina, Nabatome, & Matsuda, 2006;Possin et al, 2005;Shindler, Caplan, & Hier, 1984). The results from these group studies with mixed clinical populations are not conclusive and they diverge in terms of correlations with types of dementia, neuroanatomical data, and degree of severity of the dementing illness.…”

Perseveration in Alzheimer’s Disease

“…One of these, championed by Goldberg and colleagues [16][17][18][19][20] , states that perseverations are produced by a single neurocognitive mechanism, the 'pathological inertia' of cognitive processes, which manifests itself as an inability to complete the previous activity and to switch from one cognitive or behavioral activity to another, and is linked primarily to frontal system dysfunction. The other, originally proposed by Sandson and Albert [1,2] , further developed by Helm-Estabrooks and colleagues [14,[21][22][23] and recently supported by Possin et al [24] , suggests that there are 3 different forms of perseveration, recurrent, stuck-in set and continuous, each linked to a specific neuroanatomical network and each influenced by a different neurochemical profile.…”