Journal of Clinical and Experimental Neuropsychology 1380-3395/02/2406-745$16.

00
2002, Vol. 24, No. 6, pp. 745±754 # Swets & Zeitlinger

Differences in Executive Functioning Between Alzheimer's

Disease and Subcortical Ischemic Vascular Dementia
Robert L. Yuspeh1, 2, y, Rodney D. Vanderploeg 3, 4, 5, Timothy A. Crowell3, 5, and Michael Mullan 3, 4, 5
1
Department of Psychology, East Carolina University, Greenville, NC, USA, 2 Department of Psychiatry and
Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA,
3
James A. Haley VA Medical Center, Tampa, FL, USA, 4 Roskamp Institute, Tampa, FL, USA, and
5
Memory Disorder Clinic, University of South Florida, Tampa, FL, USA

ABSTRACT

The present study examined the performance of 114 individuals (62 males, 52 females) on a variety of tests
purported to measure executive abilities. Participants were diagnosed with possible or probable Alzheimer's
disease (AD), subcortical ischemic vascular dementia (SVaD), or were normal controls (NoDx). Groups
were matched for age and education, and clinical groups were matched for severity of dementia. Multivariate
and univariate analyses of variance were performed which indicated that the AD and SVaD patients differed
from the NoDx on all measures of executive functioning. Further, the AD group made signi®cantly more
episodic memory errors than the SVaD group. On the other hand, consistent with previous research, the SVaD
group performed signi®cantly better than the AD group on recognition memory, but not on free recall
measures. Present ®ndings suggest that AD patients have more executive self-monitoring problems than
SVaD patients do, but SVaD patients have more retrieval problems (executive memory search), suggesting a
fractionation of executive abilities. Thus, differences between dementia groups depend on the nature of the
executive function assessed.

Alzheimer's disease (AD) and cerebrovascular Studies on the neuropathology of AD indicate

disease are the two most frequent causes of
dementia (Folstein, 1997). In fact, autopsy studies
have indicated that vascular dementia (VaD)
accounts for 17±29% of all dementias, and a
mixed group with the neuropathology of both
AD and VaD accounts for another 10±23%
(Erkinjuntti, Haltia, Palo, Sulkava, & Paetau,
1988; O'Brien, 1988; Tomlinson, Blessed, &
Roth, 1970). Recent advances in neuroimaging
support an even greater spectrum and prevalence
of VaD with the frequent disclosure of periven-
tricular white matter degeneration attributed to
cerebrovascular disease (Hachinski, 1990).
that the pathogenic mechanisms of AD include
the preferential deterioration of medial temporal
lobe or temporal limbic structures and reciprocal
corticolimbic connections (Hyman, Arriagada,
van Hoesen, & Damasio, 1993; Tomlinson et al.,
1970) that are critical in the operation of declarative
memory (Eichenbaum & Otto, 1993). Deteriora-
tion of these brain regions and cognitive processes
result in the hallmark symptom of AD which is
described as poor consolidation of information
into long-term memory, and characterized on
neuropsychological testing as rapid forgetting or
poor delayed memory performance (Hart, Kwentus,

We are saddened to note that Dr. Yuspeh died on January 19th, 2002. Because of that, the corresponding author has
been changed to Dr. Rodney D. Vanderploeg.
Address correspondence to: Dr. Rodney D. Vanderploeg, James A. Haley Veterans Hospital, Psychology Service
(116B), 13000 Bruce B. Downs Blvd., Tampa, FL 33612, USA. Tel.: ‡ 1 813 972 2000 ext. 6728. Fax: ‡ 1 813 903
4814. E-mail: Rodney.Vanderploeg@med.va.gov.
Accepted for publication: August 6, 2001.
746 ROBERT L. YUSPEH ET AL.
Harkins, & Taylor, 1988; Paulsen et al., 1988;
Welsh et al., 1996).
In contrast, VaD preferentially results from
multiple deep strokes or vascular-induced peri-
ventricular white matter changes in frontal-
subcortical regions (Aharon-Peretz, Cummings,
& Hill, 1988; Hachinski, 1990; Ishii, Nishihara, &
Imamura, 1986). Particularly when there is a
minimal history of prior clinical strokes, a
differential diagnosis between AD and VaD is
dif®cult. In addition, the more recently identi®ed
subcategory of subcortical vascular dementia
or ischemic vascular dementia (i.e., individuals
with cognitive de®cits who have no history of
clinical strokes, but who on neuroimaging
studies have multiple white matter lesions
[WMLs]) has complicated the clinical diagnostic
issue. Neuropsychologically, although some
mental slowing has been reported in AD (Gordon
& Carson, 1990; Vrtunski, Patterson, Mack, &
Hill, 1983), a greater decline in mental or
information processing speed and ef®ciency has
been shown to correlate with white matter
involvement in VaD and cerebrovascular disease
(Boone et al., 1992; Junque et al., 1990; Kluger,
Gianututsos, Leon, & George, 1988; Matsubayashi,
Shimada, Kawamoto, & Ozawa, 1992; Ylikoski
et al., 1993).
Other than the aforementioned de®cits in
information processing speed and ef®ciency
associated with WMLs, problems with motor
sequencing (Junque et al., 1990), frontal executive/
self-regulatory abilities (Bernardin, Rao, Haughton,
Yertkin, & Ellington, 1991; Boone et al., 1992),
the emergence of primitive re¯exes (Junque et al.,
1990), and problems with memory retrieval
(Vanderploeg, Yuspeh, & Schinka, 2001) have
been reported. Furthermore, Gupta et al. (1988)
reported that patients with WMLs and mild levels
of cognitive impairment have de®cits limited
to sustained and divided attention; while those
with moderate levels of cognitive impairment
also have problems with general slowing of per-
formance (i.e., bradykinesia and bradyphrenia),
dif®culty in the rate of learning, problems or-
ganizing material to be learned, and poor recall
consistency across learning trials. This speci®c
pattern of de®cits has been described as a frontal-
subcortical dementia. Unfortunately, as pre-
viously mentioned, a number of these symptoms
are also found in AD (Berg, 1988; Pirozzolo,
Christense, Ogl, Hansch, & Thompson, 1981).
A number of research studies have examined
neuropsychological features that differentiate AD
from vascular dementias. Our review of these
studies will focus on aspects of executive function-
ing, and will attempt to differentiate vascular
dementias (an heterogeneous group with and
without clinical strokes, and with varying degrees
of involvement of cortical gray matter, subcortical
gray matter, and subcortical WMLs) from studies
that have a relatively pure subcortical white matter
dementia group (e.g., Binswanger's disease [BD]).
Bernard et al. (1992) evaluated letter and
semantic ¯uency as well as episodic memory in
BD and AD groups and normal controls. Groups
were matched on age and education. In addition,
AD and BD groups also were matched on severity
of dementia using the Mini-Mental State Examina-
tion (MMSE; Folstein, Folstein, & McHugh,
1975). The dementia groups were comparable
on semantic category ¯uency and letter category
¯uency, but were worse than controls on these
measures. On an episodic memory task, although
both dementia groups performed more poorly
than controls, the AD group in turn performed
worse than the BD group.
A number of other studies have compared AD
groups with groups of patients diagnosed with a
VaD (Barr, Benedict, Tune, & Brandt, 1992;
Carew, Lamar, Cloud, Grossman, & Libon, 1997;
Kertesz & Clydesdale, 1994; Lafosse et al., 1997;
Lamar et al., 1997; Libon et al., 1997; Mendez,
Cherrier, & Perryman, 1997; Padovani et al.,
1995). Unfortunately, in all these studies, the VaD
groups are heterogeneous, composed of individ-
uals with and without clinical strokes and having
neuroimaging ®ndings that include cortical and
subcortical lesions (gray and white matter) in
various combinations. In all studies, AD and VaD
groups were matched on age, education, and
severity of dementia (MMSE scores or Mattis
Dementia Rating Scale [MDRS] total scores;
Mattis, 1988). Consistently, no differences were
found between groups on measures of semantic
category ¯uency. However, although not all
studies cited reported statistically signi®cant
differences, with the exception of the Barr et al.
 DIFFERENCES IN EXECUTIVE FUNCTIONING
(1992) study, VaD groups routinely performed
more poorly on letter ¯uency than AD groups. In
discussing poorer letter ¯uency performance in
VaD than AD participants, despite comparable
semantic ¯uency, Carew et al. (1997) concluded
that the reduced letter ¯uency output by the VaD
participants is consistent with search-retrieval
de®cits, whereas the reduced output on semantic
¯uency tasks in AD participants may be second-
ary to degraded semantic knowledge. Consistent
with the conclusions of Carew et al. (1997),
Lafosse et al. (1997) reported that the volume of
WMLs was signi®cantly (inversely) correlated
with letter ¯uency. They hypothesized that
decreased ¯uency was secondary to executive
dysfunction in the ability to organize effective
retrieval strategies due to subcortical dysfunction.
These studies also reported that AD subjects
provided more intrusive responses on free or cued
recall or false positive errors on recognition
episodic memory measures.
Other ®ndings reported in these studies are
mixed. For example, Kertesz et al. (1994) reported
VaD patients performed signi®cantly worse than
AD patients on the Motor Performance subtest of
the MDRS, Wechsler Adult Intelligence Scale±
Revised (WAIS±R; Wechsler, 1981) Picture
Arrangement and Object Assembly subtests, and
the Western Aphasia Battery (Kertesz, 1982)
Writing subtest. Further, Mendez et al. (1997)
reported VaD patients performed signi®cantly
worse than AD patients on Part A of the Trail
Making Test (TMT; Reitan & Wolfson, 1985).
However, although Padovani et al. (1995) reported
VaD patients made signi®cantly more persevera-
tive errors on the Wisconsin Card Sorting Test
(WCST; Heaton, Chelune, Talley, Kay, & Curtiss,
1993), they found no signi®cant differences
between AD and VaD patients on a number of
measures of attention and executive functioning
which included Part A of the TMT. Similarly,
Barr et al. (1992) reported no signi®cant diffe-
rences on either Part A or B of the TMT. It is
important to remember that in the studies
reviewed here, the VaD groups had both cortical
and subcortical vascular lesions on imaging
studies. Thus, the attribution of VaD neuro-
psychological ®ndings to subcortical pathology
cannot be determined with certainty, and may
747
account for some of the discrepant ®ndings
reported here.
Consequently, due to the inconsistent ®ndings
previously cited, as well as the heterogeneity of
the VaD groups employed in the aforementioned
studies, the purpose of the present study is to
attempt to clarify the differential performance on
traditional measures of executive functioning in
groups of AD and SVaD (e.g., VaD where neuro-
imaging reveals only periventricular white
matter alterations), matched on overall severity
of dementia. In addition, aspects of episodic
memory, such as memory errors (i.e., intrusion
and false positive errors) and memory retrieval
ability, will be examined as these facets of
memory rely on intact executive abilities.
METHODS
Participants
Participants consisted of 114 individuals (62 males, 52
females) selected from a larger sample of individuals
referred to a memory disorders clinic for neuropsycho-
logical evaluation. An attempt was made to match the
three groups of participants (AD, SVaD, and controls)
on age, education, gender, and for the clinical groups on
the severity of dementia using the MMSE (Folstein
et al., 1975). Because probable AD participants were
generally more impaired than the SVaD participants, to
match the AD and SVaD samples, the AD group was
composed of some possible AD and some probable AD
participants. Although patients diagnosed with possible
AD have cognitive impairment which may not be as
severe as probable AD patients, these participants were
included in the AD group because in a multidisciplinary
diagnostic consensus meeting it was determined that
their cognitive impairment could not be attributed to
any other medical etiology which could be determined
by serum laboratory values (e.g., thyroid disease) or
medical history (e.g., cardiovascular disease). Further,
patients did not meet criteria for a psychiatric disorder
according to Diagnostic and Statistic Manual of Mental
Disorders-Fourth Edition (DSM-IV) which could
account for their cognitive impairment (e.g., depres-
sion). Both probable and possible AD subjects had no
history of clinical strokes and had MRI studies that
revealed only very mild WMLs, that is, no more WMLs
than might be expected for their age. AD participants
(n ˆ 47) met NINCDS/ADRDA criteria for either
possible (n ˆ 25) or probable (n ˆ 22) AD (McKhann
et al., 1984). Participants in the SVaD group (n ˆ 29)
met the NINDS/AIREN criteria for VaD (Roman et al.,
748 ROBERT L. YUSPEH ET AL.
Table 1. Characteristics of the Matched AD, SVaD, and NoDx Groups.
AD (n ˆ 47)
Characteristic M SD
Age (years) 76.3 5.2
Educ. (years) 12.9 2.5
MMSE 1 24.2 2.0
Gender 2 (% male) 40.4%
1
Note. NoDx > SVaD ˆAD.
2
NoDx ˆ SVaD > AD.
1993). Further, SVaD subjects had neuroimaging data
that revealed extensive WMLs, with no indication of
cortical lesions. The normal control group (NoDx;
n ˆ 38) was composed of individuals who showed no
indication of cognitive problems on clinical examina-
tion or on neuropsychological testing and did not meet
diagnostic criteria for any neurological, psychiatric, or
alcohol/drug abuse diagnosis based on criteria in the
DSM-IV; (American Psychiatric Association, 1994).
The overall evaluation suggested a tendency to over-
attend to normal cognitive aging issues (i.e., the normal
controls might best be described as `worried well').
Table 1 shows the demographic characteristics and
MMSE performance of these three groups of partici-
pants. Groups did not differ in age or education. Groups
did differ in MMSE performance [F(2, 111) ˆ 62.82,
p < .0001]; however, Tukey's HSD post hoc analyses
revealed that the AD and SVaD participants did not
differ on MMSE performance. The three groups
differed somewhat on gender composition [X2(2,
N ˆ 114) ˆ 6.32, p < .05], with the AD group having a
higher proportion of females than the other two groups.
Procedure
Subjects were administered an expanded Consortium
to Establish a Registry for Alzheimer's Disease
neuropsychological test battery (CERAD; Morris
et al., 1989). Executive functioning was assessed with
a variety of traditional executive measures including:
the Controlled Oral Word Association Test (COWA;
Benton, Hamsher, & Sivan, 1983), the CERAD 60 s
Animal word list generation task, the Color-Word score
from the Stroop Color-Word test (Golden, 1978), the
Symbol-Digit Modalities Test (Smith, 1991), and Parts
A and B of the TMT, (Reitan & Wolfson, 1985).
Aspects of episodic memory were also assessed
with the 10-item 3-trial CERAD word list learning test
(Morris et al., 1989). Amount of learning was assessed
by Trial 3 performance. Total words learned was
assessed with the sum of Trials 1 to 3 score. Rate of
learning or learning slope was assessed by a computed
SVaD (n ˆ 29) NoDx (n ˆ 38)
M SD M SD
74.1 8.2 73.6 7.6
13.2 4.4 13.8 2.8
25.2 2.7 28.9 1.1
65.5% 63.2%
score of Trial 3 minus Trial 1 performance. Memory
retention was evaluated by examining the delayed
recall score. Episodic memory retrieval was evaluated
by the CERAD list learning recognition score de®ned
as Correct Yes responses minus any false positive
responses. More speci®cally, this recognition test
consists of the 10 words of the CERAD word list
learning test presented among 10 distractor words
(Morris et al., 1989) which are not semantically related
to the targets. Memory retrieval is seen as re¯ecting an
executive memory search process, and recent positron
emission tomography research suggests that memory
search or a `retrieval attempt' is associated with frontal
functioning (Kapur et al., 1995). Finally, episodic
memory errors were evaluated by comparing groups
on the sum of intrusive responses on the CERAD list
learning and recall trials and false positive errors on the
recognition trial. This memory errors score is seen as a
measure of an executive memory self-monitoring
ability.
RESULTS
Two multivariate analyses of variance (MANOVA)
comparing the AD, SVaD, and NoDx groups were
conducted to assess the overall between-group
effects and to reduce Type I error rate. The ®rst
compared groups on the traditional executive
measures: COWA, Animal Fluency, Color-Word
Stroop score, Symbol Digit Modalities, Trails A,
and Trails B. The second MANOVA compared
groups on the memory measures, including the
memory executive measures: recognition memory
score and memory errors.
The MANOVA on six traditional executive
measures was signi®cant, Wilks' Lambdaˆ 0.362,
[F (12, 212) ˆ 11.37, p < .001]. With the ®nding of
a signi®cant overall multivariate effect, planned
 DIFFERENCES IN EXECUTIVE FUNCTIONING 749

Table 2. Performance of AD, SVaD, and NoDx Groups on Traditional Executive Measures.
AD (n ˆ 47) SVaD (n ˆ 29) NoDx (n ˆ 38)

Characteristic M SD M SD M SD
COWA 22.76 11.03 21.14 8.49 34.87 12.33
Animal Naming 7.49 3.35 8.57 3.20 16.39 4.77
Stroop Color-Word 14.09 8.38 13.25 9.83 24.78 10.79
SDMT 22.84 9.84 19.01 6.17 38.42 10.60
Trails A 80.40 48.71 79.92 64.37 45.47 18.87
Trails B 314.42 182.33 304.27 177.61 128.68 81.18
Trails BÿTrials A 239.42 161.44 221.64 151.39 83.21 68.64
Note. COWA ˆControlled Oral Word Association Test; SDMT ˆ Symbol Digit Modalities Test; Trails A ˆTrail
Making Test, Part A; Trails B ˆ Trail Making Test, Part B; Controls > AD ˆ SVaD on all measures.

univariate comparisons (one-way ANOVAs)
were completed to assess group differences for
individual measures (Tabachnick & Fidell, 1989).
Subsequent univariate ANOVAs were also all
signi®cantly different between groups. Table 2
summarizes the ®ndings. Tukey's HSD indicated
that the AD and SVaD groups differed from the
NoDx group, but not from each other on all
executive measures. To emphasize the executive
nature of the Trail Making task, Trails B minus
Trails A, a computed measure of cognitive ¯exibil-
ity controlling for the motor speed component, was
also examined in a one-way ANOVA. The
ANOVA was signi®cant [F(2, 111) ˆ 15.58,
p < .001] and post hoc Tukey's HSD indicated
that the AD and SVaD groups differed from the
NoDx group, but not from each other.
The MANOVA on memory measures also was
signi®cant, Wilks' Lambdaˆ 0.303, [F (14, 210)ˆ
12.27, p < .001). With the ®nding of a signi®cant
overall multivariate effect, planned univariate
comparisons (one-way ANOVAs) were com-
pleted to assess group differences for individual
measures. Subsequent univariate ANOVAs were
also all signi®cantly different between groups.
Table 3 summarizes the ®ndings. Tukey's HSD
indicated that the NoDx group outperformed both
the AD and the SVaD groups on all episodic
memory measures except two. The AD group had
more memory errors (Sum of intrusion and false

Table 3. Performance of AD, SVaD, and NoDx Groups on Episodic Memory and Memory-Based Executive
Measures.
AD (n ˆ 47) SVaD (n ˆ 29) NoDx (n ˆ 38)

Characteristic M SD M SD M SD
Trial 3 1 4.96 1.82 4.86 1.16 7.74 1.25
Total Words 1 12.53 3.98 11.66 3.20 18.87 3.39
Slope 1 1.89 1.49 2.28 1.16 3.16 1.13
Delayed Words1 2.11 1.70 2.41 1.92 5.82 1.80
Recognition 2 7.99 1.16 9.29 0.71 9.66 0.48
Memory Errors 3 3.47 3.03 1.79 1.68 1.21 1.91
Note. Trial 3 ˆ Total words recalled on Trial 3; Total Words ˆ Sum of Words Recalled on Trials 1 to 3; Slope ± Trial
3 minus Trial 1 raw score difference; Delayed Words ˆ Words Recalled after a Delay; Recognition ˆ Total
correct Yes responses minus False Positive responses on the Recognition Trial; Memory Errors ˆ total
number of intrusive responses on the learning and recall trials plus false positive responses on the recognition
memory trial. Memory Errors can be seen as an executive dysfunction in the self-monitoring of memory.
1
Controls > AD ˆ SVaD.
750 ROBERT L. YUSPEH ET AL.
positive errors) than either the NoDx or the SVaD
groups (p < .05).1 Similarly, the AD group
performed more poorly on recognition memory
than either the NoDx or the SVaD groups
(p < .05), although the two patient groups were
comparable on delayed recall performance.2 This
pattern of memory performance indicates memory
retrieval problems in the SVaD group and
impaired consolidation abilities in the AD group.
DISCUSSION
The primary objective of the present study was to
compare individuals diagnosed with possible or
probable AD with those diagnosed with a SVaD
predominantly affecting subcortical white matter.
When these subjects are matched on age, educa-
tion, and degree of overall dementia severity,
traditional measures of executive functioning
did not differentiate dementia groups, although
both patient groups had more dif®culty than a
demographically matched control group (NoDx).
Although previous studies have reported differ-
ences between AD and VaD on COWA, that was
only the case in studies where the VaD group
contained both cortical and subcortical lesions
1
We combined Intrusions on free recall and false positive
errors on recognition recall as both re¯ect the same type
of memory monitoring problem. We also looked
separately at intrusions and false positive errors and
found that the pattern of memory error ®ndings is similar
across the three diagnostic groups for both intrusions and
false positives. The AD group made more intrusion and
false positive errors than the control group, while the
SVaD group fell at an intermediate level. When the two
types of memory errors are combined the pattern is
identical, but then the AD group produces more
combined errors than both the SVaD and control groups,
who do not differ from each other.
2
We used an adjusted recognition score (adjusting the
overall number of correct yes responses by subtracting
the number of false positive responses) because otherwise
a good recognition hit score could simply re¯ect an
individual with memory impairment af®rming all
recognition items. However, the AD group performed
more poorly than both SVaD and control groups on both
the adjusted recognition score and on the unadjusted
number of correct yes (i.e., recognition hits).
(Carew et al., 1997; Lafosse et al., 1997; Lamar
et al., 1997; Libon et al., 1997; Mendez et al.,
1997; Padovani et al., 1995). In the one study of
BD (a pure SVaD) versus AD (Bernard et al.,
1992), no differences were found on either
COWA or semantic ¯uency.
In contrast to the ®ndings on more traditional
executive measures, within memory measures
indicative of aspects of executive functioning,
two patterns emerge between dementia subtypes.
First, the AD group made more episodic memory
errors (intrusions and false positive errors)
suggesting that individuals with AD have more
executive self-monitoring problems than either
control subjects or those diagnosed with SVaD.
These ®ndings are consistent with previous
research (Almkvist, 1994; Gainotti & Marra,
1994; Helkala, Luluman, Soininen, & Riekkinen,
1989; Vanderploeg, Yuspeh, & Schinka, 2001).
Helkala et al. (1989) suggest that AD patients
make these types of episodic memory errors as
a result of an inability to inhibit irrelevant
information and because of increased sensitivity
to interference. An alternative explanation, that
memory errors are made simply because of poor
memory functioning, seems unlikely. If memory
is poor and executive self-monitoring is intact,
there is no reason for an individual to provide
intrusions or false positive errors. With a pure
memory de®cit, only the amount of correct
information recalled or recognized should be
impaired. If the information is not in memory,
it cannot be recalled or recognized; but there
would be no reason to produce inaccurate or
false information unless executive monitoring is
de®cient as well. Although we believe this
explanation accounts for the memory errors, it is
possible that if subjects with memory dif®culties
adopt a moderate or liberal recognition response
criterion, they may have an elevated number of
false positive errors while still failing to identify a
normal number of correct targets.
The second difference in performance was that
the SVaD group performed better than the AD
group on recognition memory, although the two
patient groups were comparable on delayed recall
performance. This pattern of memory performance
indicates that some new episodic information
was stored within the LTM of the SVaD subjects
 DIFFERENCES IN EXECUTIVE FUNCTIONING
that could not be retrieved without retrieval cues
(i.e., recognition testing). The memory retrieval
problems in the SVaD group stand in contrast
to apparent memory consolidation/storage pro-
blems in the AD group ± where minimal informa-
tion could be detected in LTM on either delayed
recall or recognition testing. The memory retrieval
de®cit noted in the SVaD group is consistent with
retrieval problems associated with VaD (Kershaw,
Yuspeh, Vanderploeg, Gold, & Cohen, 1997;
Vanderploeg, Yuspeh, Dupree, Schinka, & Cohen,
1997; Vanderploeg, Yuspeh, & Schinka, 2001;
Yuspeh, Vanderploeg, & Schinka, 1999), and
other subcortically based dementias such as
Huntington's disease (Massman, Delis, Butters,
Levin, & Salmon, 1990; Paulsen et al., 1995;
Randolph, Braun, Goldberg, & Chase, 1993), and
Parkinson's disease (Jacobs et al., 1995; Stern,
Richards, Sano, & Mayeaux, 1993).
Although AD subjects may also have some
dif®culty with memory retrieval in that traces
of information may be present in LTM but be
insuf®ciently strong to support recall or recogni-
tion, the SVaD group would appear to have more
severe retrieval problems than the AD subjects.
The SVaD subjects have comparable performance
to the AD subjects on other measures of executive
functioning including measures of processing
speed and ef®ciency that would be important in
encoding. In addition, the SVaD group's rate of
learning (an aspect of encoding) was comparable
to the AD group, while both patient groups had
an impaired learning slope compared to the
controls. Therefore, the SVaD participants are
likely to have comparably weak memory traces
in LTM. However, unlike the AD subjects, for
the SVaD group the recognition paradigm pro-
vided suf®cient support to retrieve these memory
traces.
The memory retrieval problems experienced
by SVaD patients are likely the result of dif®culties
with executive memory search, as opposed to the
executive problems with self-monitoring seen
with the AD group. Recent positron emission
tomography research suggests that there are two
components to successful memory retrieval: (a) a
prefrontally mediated memory searching process
(retrieval attempt), and (b) successful reactivation
of memory information from posterior cortical
751
LTM stores (retrieval success; Kapur et al., 1995).
Medial temporal activity is associated with retrieval
success, rather than retrieval attempt, likely re¯ect-
ing a role in reactivation of previously stored
information (Nyberg, McIntosh, Houle, Nilsson,
& Tulving, 1996). In contrast, retrieval search is
frontally mediated and may be somewhat later-
alized: (a) right frontal for episodic information,
and (b) left prefrontal for semantic information
(Buckner et al., 1995; Tulving, Kapur, Craik,
Moscovitch, & Houle, 1994).
Future research with larger sample sizes will
be needed to con®rm the pattern of differences in
executive functioning exhibited between these
two dementia groups. Furthermore, future studies
should sample a wider range of both traditional
and nontraditional executive measures, employ-
ing functional neuroimaging information if
possible, and include the types of dementias
employed in the present study, in addition to other
dementias such as vascular dementia of a more
cortical etiology, Huntington's disease, Parkin-
son's disease, Lewy body dementia, and fronto-
temporal dementia. Nevertheless, taken together,
the present ®ndings suggest a fractionation of
executive abilities. Thus, executive functioning
differences between dementia groups depend
on the nature of the executive ability being
assessed.
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