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How to make a spaghetti sauce with a dozen small things I cannot name: A
review of the impact of semantic-memory deficits on everyday actions
Nathalie Bier ab; Joël Macoir ac
a
Centre de Recherche Université Laval Robert-Giffard, Québec, Canada b Faculté de Médecine, École
de Réadaptation, Université de Sherbrooke, Sherbrooke, Canada c Faculté de Médecine, Département
de Réadaptation, Université Laval, Québec, Canada
First published on: 08 June 2009
To cite this Article Bier, Nathalie and Macoir, Joël(2010) 'How to make a spaghetti sauce with a dozen small things I
cannot name: A review of the impact of semantic-memory deficits on everyday actions', Journal of Clinical and
Experimental Neuropsychology, 32: 2, 201 — 211, First published on: 08 June 2009 (iFirst)
To link to this Article: DOI: 10.1080/13803390902927885
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JOURNAL OF CLINICAL AND EXPERIMENTAL NEUROPSYCHOLOGY
2010, 32 (2), 201–211
NCEN
How to make a spaghetti sauce with a dozen small
things I cannot name: A review of the impact of
semantic-memory deficits on everyday actions
Semantic memory and everyday actions
Nathalie Bier1,2 and Joël Macoir1,3
1
Centre de Recherche Université Laval Robert-Giffard, Québec, Canada
Faculté de Médecine, École de Réadaptation, Université de Sherbrooke, Sherbrooke, Canada
3
Faculté de Médecine, Département de Réadaptation, Université Laval, Québec, Canada
Downloaded By: [University of Laval] At: 13:34 28 January 2010
2
The purpose of this article is to present current evidence regarding the role of semantic memory in everyday
actions. First we describe key models of everyday actions. We then discuss current evidence regarding the role of
semantic memory in everyday actions. We reviewed articles reporting on the execution and representation of
everyday actions in populations with semantic-memory deficits and single-object use in patients with semantic
dementia. Although the evidence is sparse, the general conclusion of this review is that semantic memory seems
necessary to support everyday actions. Finally, future challenges and research perspectives are discussed.
Keywords: Semantic memory; Everyday action; Object use; Semantic dementia; Scripts; Schemas.
INTRODUCTION
S.C. is a 54-year-old native speaker of French, righthanded, a psychology professor with a PhD degree, who
presented to us with a 4-year history of cognitive decline
mainly characterized by word-finding problems and
impaired comprehension. He presented with deficits on
all tests requiring semantic processing but performed
normally on tests exploring visual-perceptual abilities,
motor control, and executive functions (Macoir, 2009).
Along with neuroimaging data, these results were suggestive of a clinical diagnosis of possible semantic
dementia (SD). SD is one of the main clinical variants of
frontotemporal dementia (Neary et al., 1998). The clinical syndrome is characterized by a loss of knowledge of
facts, objects, and the meaning of words, along with relative preservation of working memory, episodic memory,
and visuospatial abilities (Hodges, Patterson, Oxbury, &
Funnell, 1992a; Neary et al., 1998). S.C. participated in
an experimental study designed to investigate the nature
of his semantic impairment (Macoir, 2009). During this
period, S.C. lived alone and frequently described how his
semantic-memory deficits disrupted his world. In fact,
everyday activities such as cooking, gardening, shopping,
managing household finances, playing sports, taking
care of the house, and so forth were all disrupted by his
progressive loss of knowledge. However, he could still
perform some activities, such as driving his car and
purchasing clothes, purposefully. Here is one excerpt
(translated from French) from S.C.’s spontaneous written description of the problems he encountered in his
everyday life:
I can prepare and eat all my meals very well. . . .
However, I’ve lost many words related to things that I
eat. For example, when I want to eat spaghetti, I know
how to prepare it: to make the sauce and the whole meal.
Visually, I know what I have to put into it to make it.
However, I don’t remember all of the words that correspond to what I need. . . . The only words I remember
since I made the recipe 4 days ago are: two cans of tomatoes, one can of tomato juice, rice, beef, pepper, and a
dozen other small things I can see in my head. I don’t
remember their names but I know where they are in my
kitchen. . . . It’s when I go to the restaurant that my
symptoms are obvious. When I read the menu, I don’t
understand anymore. It is only what I eat regularly (once
every two weeks), in two restaurants, that I can recognize instantly when I read [the menu]. But if I go back to
a restaurant after many months, I don’t remember the
name of what I ate, even when I read the menu.
Address correspondence to Nathalie Bier, École de réadaptation, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke
(Québec), Canada, J1H 5N4. (E-mail: [email protected]).
© 2009 Psychology Press, an imprint of the Taylor & Francis Group, an Informa business
http://www.psypress.com/jcen
DOI: 10.1080/13803390902927885
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BIER AND MACOIR
Although he presented with substantial naming problems, as is usually the case in SD, S.C. clearly expressed
in spontaneous speech the huge problems he encountered in his daily life. He obviously had some remaining
knowledge but depended on his day-to-day, episodic
memory (memory about events), and on the familiarity
and frequency of the activities, to remember their meaning and how to do them. These observations led us to
question the role of semantic memory in everyday-life
functioning. Semantic memory incorporates concepts
and knowledge in multiple domains, including word and
object meaning. Its integrity appears to be essential to
perform even the simplest everyday activities. For
example, to properly do an activity such as making a cup
of coffee, we must know or have the concepts of “to
drink,” “coffee,” “water,” “cup,” and so on. We also
have to know the kind of social context in which people
drink coffee, and so forth.
The purpose of this article is to provide an up-to-date
review of the current evidence regarding the role of
semantic memory in everyday actions. In the first part,
we briefly describe models of everyday actions. We then
review current evidence regarding the role of semantic
memory in everyday actions. Finally, we summarize
recent findings before highlighting challenges and future
directions in the domain.
MODELLING EVERYDAY ACTIONS
Few researchers have studied disorders of everyday life
from a cognitive perspective, perhaps because they are
complex and difficult to measure, or because the cognitive skills necessary to carry them out are not fully
understood (Forde & Humphreys, 2000). A few theories
of everyday actions have been proposed in the literature,
in which a specific role is attributed to our knowledge
about the world, or to semantic memory, although this
role is not well specified. Two main categories of theories
emerge from the literature: (a) theories of high-level
everyday actions, or scripts, and (b) theories of routine,
well-learned actions, or schemas.
Script theories regarding high-level everyday
actions
More than 30 years ago, Schank and Abelson (1977)
introduced the term “scripts” to conceptualize how
people represent their knowledge about familiar events
and experiences encountered in their everyday life. More
specifically, scripts are defined as general knowledge
representations, abstracted from a class of similar events
experienced hundreds of times, such as going to the restaurant, taking a course, or going to the doctor’s office.
Scripts are conceptualized as goal-directed behaviors,
hierarchically organized in subgoals and specifying
actions (or plans) required to achieve the main goal.
These actions are organized temporally and causally, as
some of them have to be performed before others. For
example, the script “going to the restaurant,” a classic
example used by Schank and Abelson (1977), specifies
that we must first get to the restaurant, then sit down,
order, eat, pay, and so forth. According to this conception, the scripts remain general and do not refer to specific details (e.g., the very good spaghetti eaten at Da
Giovanni, the unpleasant waitress), though we can associate specific details with a general script. Scripts help
people to understand, plan, organize and execute
actions, according to what is expected in a particular
situation. Thus scripts are considered the core basis of
human social interactions and goal-directed behavior.
The concept of script was further developed by Grafman
(1995, 2002). According to this author, the role of the
cortex is to encode representations in long-term memory,
corresponding to different types of information, such as
lexico-semantic and people knowledge, but also goaloriented activities. Everyday-life, goal-oriented activities
comprise a series of events structured in a particular
sequence, called “structured event complex” (SEC). For
example, “to take a taxi,” “to order at the restaurant,”
“to eat the meal,” and “to pay the bill” constitute different SECs, which can be combined with other SECs and
encoded and retrieved in a unique episode. Therefore,
they allow the elaboration of a representation for the
complex activity “to eat at the restaurant” and to fulfill
the goal “having a nice dinner with friends” (Grafman,
2002). Although not well specified in Grafman’s theory,
SECs seem to be at a higher level than scripts. For
example, an event in an SEC such as “eating dinner”
could comprise the scripts “cooking a particular recipe,”
“using an electric kitchen appliance,” and so on. However, in the following sections, the term “script” is used
to refer to high-level everyday-life activities.
Grafman specifies that SECs may be conceptualized
as memory units, belonging to domains of knowledge
(e.g., sexual behavior, social behavior, mechanical knowledge), whose particular structure depend on the individual’s culture and personal preferences (Grafman, 1995).
Similarities with other kinds of knowledge also characterize the organization of the SEC, such as frequency,
familiarity, associative relations, and so forth (Grafman,
1995). Grafman’s proposition (2002) is not clear about
the specific relationship between semantic knowledge
and scripts.
Other theoretical propositions have been put forward
to account for scripts of everyday actions that are routinely executed, well learned, and object bounded, like
brushing one’s teeth or preparing coffee (e.g., Botvinick &
Plaut, 2004; Cooper & Shallice, 2000; Humphreys &
Forde, 1998). These types of low-level scripts are referred
to as “schemas.” Schema theories are discussed in the
next section.
Schema theories regarding low-level everyday
actions
According to Cooper and Shallice (2000), schemas
depend on the environment and require specific timing in
the execution of the different actions that compose the
routine. In this respect, they differ from scripts, which
are considered high-level actions, independent of the
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SEMANTIC MEMORY AND EVERYDAY ACTIONS
environment (e.g., going to any restaurant), which can
be combined with other activities (e.g., reading at the
restaurant) and are of a more general nature regarding
the descriptions of the subactions (e.g., going to the
restaurant by car or in a taxi).
Interesting models have been proposed to conceptualize
the concept of schemas (for a review of these models, see
Cooper, 2002). Among these models, Cooper and
Shallice’s contention scheduling (CS) theory (Cooper,
2002, 2007; Cooper, Schwartz, Yule, & Shallice, 2005;
Cooper & Shallice, 2000, 2006), based on the original
work by Norman and Shallice (1986), has sparked a lot
of interest in the last 20 years. In this model, CS is a relatively automatic system that is responsible for control in
routine, well-learned, everyday actions. The CS model
comprises the following three networks: the schema network, the object network, and the resource network.
The schema network contains hierarchically stored,
standardized schemas for routine actions. Schemas are
ways or methods to achieve a goal. In this model, goals
and schemas are closely related and are both represented
in the schema network. For example, “making a cup of
coffee” is a goal but is also a schema—that is, a way to
achieve this goal. Each schema can be represented as an
ordered set of subgoals, like “put sugar in coffee,” “put
milk in coffee,” which also correspond to a schema that
can be subdivided into subgoals/subschemas. As can be
seen from this example, the schemas are assumed to have
various levels of complexity. High-level schemas (or
goals) such as “making coffee” or “putting sugar in
coffee” can be broken down into low-level component
schemas, which are discrete actions like “pick up.” The
object network corresponds to the internal representation of objects. Finally, the resource network represents
effectors required to execute a schema (e.g., language,
hands). The object and resource networks interact with
the schema network bidirectionally. Thus an object in
the environment or a resource may trigger a schema,
which in turn will activate appropriate objects/resources
to be used. When a schema exceeds its selection threshold, following different activation mechanisms (e.g.,
environment, resources, other schemas), a selection process selects the schema and sends the output to the motor
system in order to execute the action and achieve the
goal. Thus specific deficits in object knowledge should
have an impact on the triggering of schemas and their
correct execution. CS may operate automatically or be
monitored by intentional control (the supervisor attentional system, or SAS).
To recap, everyday actions, from scripts to schemas,
are conceptualized from a cognitive perspective as
abstract knowledge units that integrate the sequential
ordering of actions. Although not well specified in theoretical models, scripts and schemas appeared to be linked
to object representations and to more general types of
knowledge. Considering the possible importance of knowledge in everyday actions, actual evidence of disorders in
everyday actions in patients with semantic-memory deficits is of particular interest. In fact, disorders in scripts
or schemas have been mainly studied in relation to the
prefrontal cortex, in a population with frontal lobe or
203
diffuse brain damage (Allain et al., 2008; Chevignard et
al., 2000; Forde & Humphreys, 2000, 2002a; Forde,
Humphreys, & Remoundou, 2004; Godbout & Doyon,
1995; Rumiati, Zanini, Vorano, & Shallice, 2001;
Schwartz et al., 1995, 1998, 1999; Sirigu et al., 1995;
Zanini, 2008; Zanini, Rumiati, & Shallice, 2002). However, few neuropsychological studies have specifically
addressed the role of conceptual knowledge in everyday
actions, from tasks consisting of verbally accessing
scripts and schemas (e.g., verbal generation or categorization) to tasks oriented toward their effective execution.
CURRENT EVIDENCE REGARDING
THE ROLE OF SEMANTIC MEMORY
IN EVERYDAY ACTIONS
Disorders in script representation in patients with
semantic-memory deficits
According to Grafman and colleagues’ position (Sirigu
et al., 1995), a lesion of the prefrontal cortex could lead
to a deficit affecting the organization of scripts, whilst a
lesion of the temporal lobe could lead to an impairment
of the access to scripts or of the scripts themselves. Neuropsychological studies have shown that patients with
prefrontal lobe dysfunction generally present with difficulties in organizing and prioritizing the sequential
actions of scripts (Allain et al., 2008; Chevignard et al.,
2000; Godbout & Doyon, 1995; Rumiati et al., 2001;
Sirigu et al., 1995; Zanini, 2008; Zanini et al., 2002). For
example, compared to normal subjects, patients with
frontal lobe lesions make more sequential errors when
asked to sort cards describing actions belonging to different scripts (e.g., taking the train, going to the restaurant; Allain et al., 2008). However, these patients showed
normal performance when asked to identify the actions
which are central to or distinctive of a particular script
(Sirigu et al., 1995). Patients with focal lesions of the left
temporal cortex were also observed in studies on script
deficits but none of them showed impairment on the
semantic dimension of script representation (Armus,
Brookshire, & Nicholas, 1989; Godbout & Doyon, 1995;
Lojek-Osiejuk, 1996; Sirigu et al., 1995). However, precise location of the cerebral lesion is not always specified
in these studies, with the exception of one patient
reported by Godbout and Doyon (1995), patient D.B.,
who had a left focal anterior temporal lobe lesion, a
region that plays a critical role in semantic memory
(Patterson, Nestor, & Rogers, 2007). Though their aim
was to measure the contribution of script knowledge in
script representation, these studies present no extensive
assessment of semantic memory, and thus the relationship between the script deficits and the possible semantic
impairment cannot be posited.
Some studies have explored the semantic content of
scripts with populations known to present semanticmemory impairments. For example, Allain et al. (2008)
studied patients with Alzheimer’s disease (AD), who are
recognized to have semantic memory (Hodges & Patterson,
1995; Hodges, Salmon, & Butters, 1992b) and executive
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function deficits (Binetti et al., 1996; Collette, Van der
Linden, & Salmon, 1999); executive functions refer to
high-level processes that facilitate adaptation to new or
complex situations (Collette et al., 1999). The authors
showed that patients with AD also presented with deficits in the organizational aspects of scripts and made
many sequencing errors when asked to rearrange actions
pertaining to a script. Furthermore, when patients with
AD were asked to categorize actions according to the
script to which they belong, they produced numerous
sorting errors, a pattern consistent with the difficulties
they encountered in sorting other kinds of semantic
knowledge, as documented in other studies (Hodges
et al., 1992b; Montanes, Goldblum, & Boller, 1996).
Allain and his colleagues (2008) concluded that AD
affects the syntactic and semantic aspects of scripts.
In order to better discriminate between the respective
roles of executive functions and semantic memory in
scripts, Cosentino and collaborators (Cosentino, Chute,
Libon, Moore, & Grosman, 2006) compared the performance of patients with AD, frontotemporal dementia
(FTD), and SD on a semantic-judgment task. This task
consisted in presenting a script written on a sheet of
paper, like doing laundry or washing the dishes, along
with four events that were in the correct order or an
incorrect order (i.e., presence of sequential errors) or
that comprised semantic errors (i.e., inappropriate object
use, or action error). The patients had to decide whether
the activity made sense or not. Patients with FTD performed worse than the other participants and showed
significant deficits in the organizational component of
the scripts. Patients with SD and AD were equally
impaired in both the organizational and semantic components of the scripts. However, the verbal nature of the
task may have compromised the performance of the
patients with SD, and, as mentioned by the authors, no
clear conclusion can be drawn from their results.
To recap, results of studies that explored script
generation in patients with potential semantic-memory
deficits show impairment in the specific content of the
scripts, although some studies on script deficits in
patients with focal lesions of the left temporal lobe did
not report similar results. However, in none of these
studies did the investigators use a comprehensive evaluation of semantic memory, covering the conceptual knowledge assessed in the script tasks. Thus the specific
contribution of semantic memory in script representation is not well established.
Disorders in script execution in patients
with semantic-memory deficits
Some indications of impairment in script execution following semantic-memory deficits come from a few group
studies conducted with patients with SD. From a general
perspective, Mioshi and collaborators (Mioshi et al.,
2007) showed that patients with SD present deficits in
activities of daily living (ADL) measured using the
Disability Assessment for Dementia (DAD) (Gélinas,
Gauthier, McIntyre, & Gauthier, 1999). The DAD is an
informant-based questionnaire, originally developed for
assessing functional impairments in AD, which includes
questions on basic activities of daily living (BADL; dayto-day core survival abilities) and instrumental activities
of daily living (IADL; activities with a high level of complexity, reflecting the subject’s ability to live independently in the community). ADL questionnaires may be
considered a general measure of “script execution” in the
person’s daily living. Mioshi et al. (2007) reported that
almost half of the 15 patients with SD whom they
studied showed deficits in BADL, with around 5 to 10%
showing moderate to severe deficits. “Dressing” was
identified as a difficult activity for some patients, who
had problems with “choosing clothes appropriate to the
weather and occasion.” Also, more than 90% of the
patients with SD showed a deficit in IALD. Patients
were more dependent in language-based activities, such
as using the phone and managing finances/correspondence, whilst they showed mild dependence in outings
(shopping), leisure, and household chores. Meal preparation required supervision in some patients. Finally,
patients with SD had difficulties in initiating, planning,
and executing BADL and IADL.
In their study on the behavioral profiles of frontotemporal dementia, Snowden et al. (2001) more specifically
explored a group of 11 patients with SD. The authors
did not explicitly measure ADL but some of their observations are relevant to this subject. With respect to
BADL, 64% patients neglected hygiene, and 55% were
more selective in their choice of food. Patients with SD
pursued their daily-life activities purposefully but
showed a narrowed repertoire of activities on which they
spent excessive time, like doing jigsaws or painting. They
also adhered to fixed routines and carried out tasks in
the same way. Clinical observations of patients with SD
also support these results (Bozeat, Lambon Ralph,
Patterson, & Hodges, 2002a; Funnell, 2001; Hodges
et al., 1992a; Lauro-Grotto, Piccini, & Shallice, 1997;
Snowden, Griffiths, & Neary, 1996; Snowden & Neary,
2002). For example, Bozeat et al. (2002a) observed that,
even if patients with SD can participate in some activities
efficiently, like cooking, their repertoire is limited and
stereotyped.
These results suggest, as proposed by Snowden et al.
(1996), that since patients have a progressively shrinking
world view, they engage in activities for which they have
remaining knowledge or that they encountered frequently in their everyday experiences. In other words,
semantic-memory deficits may lead to abandoning some
activities for which the individual has incomplete or no
knowledge and thus to a limited range of ADL and leisure activities.
To recap, patients with circumscribed semanticmemory impairments show difficulties in BADL (e.g.,
dressing appropriately), IADL (cooking, outings, and
language-based activities), and leisure activities (which
can be considered as the execution of scripts), although
these difficulties are not described in detail. However,
the severity of dementia is not well specified in these
studies, which makes it impossible to establish the parallels between the severity of semantic-memory deficits
SEMANTIC MEMORY AND EVERYDAY ACTIONS
and functional deficits. In addition, it is difficult to interpret the results presented in these studies due to the possible occurrence of other deficits in individuals whose
disease is at a very advanced stage. Thus the specific
nature of ADL difficulties in semantic dementia remains
unknown. However, some observations suggest that
ADL and leisure deficits are expressed by a narrowing of
the patients’ repertoire of activities and their rigid and
stereotyped execution.
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Disorders in schema representation
in patients with semantic-memory deficits
To our knowledge, only one study has explored the nature
of schema representations in the context of semanticmemory deficits. Buxbaum, Schwartz, and Carew (1997)
measured D.M.’s knowledge of the sequential organization of everyday tasks (schemas) by asking him to organize
photographs depicting the steps in six simple actions
(e.g., lighting a candle, making a pot of coffee). D.M.,
suffering from SD, failed on one out of the six sequential
organizations of actions, a performance that is suggestive of a deficit in schema representation since normal
participants perform at ceiling on this task. However,
Buxbaum et al. (1997) do not specify whether D.M.’s
results were due to an organizational deficit or to a deficit in content knowledge.
Disorders in schema execution in patients with
semantic-memory deficits
Group studies
Some group studies explored, albeit indirectly, the role
of semantic memory in ADL. More specifically, they
assessed the ability of patients with left brain damage
(LBD) and right brain damage (RBD) to perform simulated everyday routine actions (Buxbaum, Schwartz, &
Montgomery, 1998; Hartmann, Goldenberg, Daumuller, &
Hermsdorfer, 2005; Schwartz et al., 1998, 1999). Traditionally, the left hemisphere has been associated with
semantic memory and language while the right hemisphere has been associated with attentional and spatial
abilities (Gazzaniga, 1995). Accordingly, specific difficulties due to a loss of knowledge are more expected
in LBD.
Buxbaum et al. (1998) conducted a group study on
16 patients with LBD and tested their ability to execute
routine actions derived from the Multi-Level Action
Test (MLAT)—namely, spreading butter and jam on
toast, wrapping a present, and packing a lunchbox. All
the objects required to perform the task were placed on a
table, and patients were asked to carry out the task. The
patients with LBD made a total of 213 errors on the
MLAT whereas only 29 errors were observed in the control group. Buxbaum et al. (1998) then compared these
results with previous studies on patients with RBD
(Schwartz et al., 1999) and closed head injury (Schwartz
et al., 1998). They found that all types of patients had
problems with simulated everyday tasks and showed the
205
same types of errors, with omission of a step being the
most frequent type of mistake. However, patients with
RBD were more affected than the other two groups.
Hartmann and colleagues (2005) also contrasted the
performance of patients with LBD (n = 25) and RBD
(n = 16) on simple routine tasks. These patients were
asked to execute two tasks, making coffee and using a
tape recorder, with the items necessary to perform each
activity placed on a table. Both groups of patients were
equally impaired on the two tasks. However, according
to the authors the LBD and RBD impairments originate
from different mechanisms. In patients with LBD, making coffee was strongly correlated with tests of language
and functional knowledge of objects. Hartmann et al.
(2005) hypothesized that the coffee-making task may
imply the retrieval of schema-like instructions in semantic memory, which may be compromised in patients with
LBD. Comparatively, patients with RBD showed difficulties with the multistep sequencing aspects of the tasks
caused by a general reduction in attentional resources. In
these patients, the tape recorder task correlated with
mechanical problem-solving tests, involving trial and
error, and was thus probably carried out by patients
using this strategy.
To recap, group studies on patients with LBD and
RBD indicate that deficits in both populations are not
different from a quantitative point of view. Both populations produce high rates of errors, which predominantly
consist in the omission of steps required to perform the
tasks. However, some observations suggest that patients
with LBD have specific difficulties in retrieving schemalike instructions from semantic memory in certain types
of everyday actions (e.g., making coffee but not using a
tape recorder). In spite of these interesting results, these
studies do not elucidate the specific role of semantic
memory in everyday actions since semantic memory for
the objects used in the simulated tasks was not tested and
associated with task execution.
Case studies
Some indications regarding the possible role of semantic memory in everyday routine actions come from case
studies of patients with LBD and SD. For example,
Buxbaum et al. (1998) reported the case of G.L., a
patient with predominant LBD following a closed head
injury. G.L. showed language and semantic-memory
impairments as well as ideational apraxia, whilst other
cognitive functions were well preserved. G.L. also
showed substantial difficulties in executing the MLAT
(e.g., interchanging objects: spatula for knife, juice for
mustard), a performance that could suggest the impact
of a semantic-memory impairment on simulated routine
actions. However, G.L.’s performance on the MLAT
was highly comparable to the performances of two
patients with RBD, who presumably had no semanticmemory impairment. Therefore, a semantic origin for
G.L.’s errors in everyday action tasks is doubtful unless
deficits in everyday routine actions always manifest
identically regardless of the functional origin of the
impairment.
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In 1997, Buxbaum et al. reported on the case of D.M.,
a patient with SD who had a substantial semanticmemory deficit, as measured by an extensive semantic
battery. He also failed on one of the six sequential
organizations of everyday tasks (see description in the
previous section). However, he could pantomime singleobject use and execute simulated everyday routine tasks
almost normally, as measured by the MLAT. D.M.
made few mistakes in the MLAT, without predominance
for semantic substitutions. Buxbaum et al. concluded that
intact semantic memory for single-object use is not necessary to ensure appropriate object utilization, although they
did not specifically test D.M.’s remaining knowledge on
these particular objects. More specifically, they suggested
that D.M. may have used a direct route based on sensorimotor capacities, recruited directly from perception, to
perform single-object tasks. To explain the preservation of
D.M.’s performance in the more complex, multiple-object
activities the authors proposed a hypothesis consisting in
the summation of this direct route with an indirect, semantic route, relying on the remaining functional semantic
knowledge. Thus semantic memory appears to be important for the execution of complex tasks.
The single-case study conducted by Lauro-Grotto
et al. (1997) also supports this hypothesis. R.M., a
patient with SD, showed well-preserved abilities related
to cooking despite a profound verbal semantic-memory
deficit. She was able to cook 8 different types of foods
and could mimic in detail the cooking procedure for 16
other foods that she could no longer name. Moreover,
she showed no comprehension of the verbal instructions
if asked to cook a specific food. On the other hand, she
could gesture and rapidly execute the detailed cooking
procedure (e.g., washing, preparing, and cooking) when
presented with the actual food. For Lauro-Grotto et al.,
these results point towards a multimodal account of the
organization of semantic memory comprising independent action semantic, visual semantic, and verbal semantic stores. In this model, R.M.’s pattern of performance
could be explained by preserved access to the action
semantic store from visual semantic representations,
along with impaired access to this store from verbal
semantic representations. This hypothesis supports the
view that, in this patient, remaining complex knowledge
about everyday tasks was still accessible and could support the patient’s performance in everyday life.
To recap, even though the specific overlap between the
semantic testing and the complex activities measures is not
always specified, these case studies showed that some
patients with a profound semantic deficit can perform everyday actions. However, the results also suggest that these
patients rely on their remaining semantic knowledge,
accessible from visual or functional input, and thus that
semantic memory supports their actions, at least in part.
Object use in patients with semantic-memory
deficits
Single-object use represents only part of the knowledge
required to perform complex ADL. However, considering
the interactions between objects and schemas or scripts,
a review of the studies in this field seemed relevant.
Many studies on object use in patients with SD have
been motivated by the clinical observation of their normal
or near-normal use of objects in daily life. Some studies
explored single-object use and semantic-memory knowledge without measuring the same concepts in the two
testing situations, and these studies are not discussed
further (Buxbaum et al., 1997; Dumont, Ska, & Joanette,
2000; Lauro-Grotto et al., 1997). However, good matching was done in other studies, and results point toward the
importance of semantic-memory knowledge in object use.
With the specific aim of assessing object use in SD,
Hodges and collaborators (Hodges, Spatt, & Patterson,
1999) compared the performance of two patients with
SD, D.J.E. and I.F., to the performance of F.L., a
patient with apraxia and corticobasal degeneration. The
assessment battery comprised 20 familiar ADL objects
that patients were asked to name and manipulate.
Patients were then asked to match colored pictures of the
same 20 objects to: (a) the typical recipient of the action
(i.e., the object on which the action is performed); (b)
their typical location (e.g., bathroom, kitchen, or study);
and (c) another object with a similar use (matching
objects for shared purpose). Finally, the assessment
battery also included a task designed to evaluate the ability to solve mechanical problems without resorting to
semantic-memory knowledge: the novel tool task. In this
task, patients were presented with 6 different wooden
cylinders and were asked to select, among a selection of
novel tools, the one best suited to lift the cylinder out of
its base. First, results showed that correct object use was
partially linked to remaining semantic knowledge in
patients with SD. D.J.E. correctly used 6 of the 7 objects
for which he had residual knowledge. However, I.F. correctly used 9 objects although he showed residual semantic knowledge for only 2 of them. The authors suggested
that in this patient, object use could be explained by a
“trial-and-error” process. This position is explained
below. Second, results from the novel tool experiment
showed that both patients with SD had no difficulty
inferring object use through a mechanical problemsolving process. Comparatively, F.L., the patient with
apraxia, could not correctly use 12 of the 20 ADL
objects whilst she showed no problem with identifying
them. Moreover, her performance did not differ from
chance in the novel tool experiment.
In a later study, Hodges and collaborators (Hodges,
Bozeat, Lambon Ralph, Patterson, & Spatt, 2000)
obtained similar results in 9 patients with SD. In this
particular study, the patients’ performance on object use
was highly correlated to semantic-memory tests and,
more specifically, to semantic-knowledge tasks performed with the same objects. Furthermore, patients
with SD did not differ from controls on the mechanical
problem solving. Similar results were also observed in
8 patients with SD reported by Bozeat and colleagues
(Bozeat, Lambon Ralph, Patterson, & Hodges, 2002b),
in 2 patients with SD studied by Hamanaka et al. (1996),
as well as in Elvezio and Dirce, 2 patients with SD studied over a period of 4 years by Coccia and colleagues
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SEMANTIC MEMORY AND EVERYDAY ACTIONS
(Coccia, Bartolini, Luzzi, Provinciali, & Lambon Ralph,
2004). Elvezio and Dirce showed parallel and longitudinal decline in object use and object knowledge, in tasks
of visual and tactile naming as well as in tasks of demonstrating and describing the function of objects from
visual and verbal input.
Hodges et al. (2000; Hodges et al., 1999) suggested that
the performance of these patients could be explained by
the combined effect of two mechanisms: The patients
may use object-specific remaining knowledge, which is
supplemented by a combination of visual affordances
and mechanical problem solving. Affordances refer to
characteristics of the object (visual and/or tactile) that
automatically trigger how to manipulate the object
online. This hypothesis is in accordance with the positions of Buxbaum et al. (1997) and Riddoch et al.
(Riddoch, Humphreys, Heslop, & Castermans, 2002).
Although the results of Hodges et al. (2000; Hodges
et al., 1999) point toward the necessary role of semantic
memory in single-object use, preservation of object use
in cases of severe semantic-memory deficits on these particular objects has also been reported (Negri, Lunardelli,
Reverberi, Gigli, & Rumiati, 2007). The apparent contradiction between studies can be interpreted by taking
into account some factors that may have a significant
effect on the performance of SD patients with single
objects. First, premorbid familiarity with the tested
objects influences the interaction with them (Bozeat
et al., 2002a, 2002b; Giovannetti et al., 2006). Second,
the presence of a personally relevant schema within specific contexts may influence the patients’ performance
(Graham, Lambon Ralph, & Hodges, 1999a; Hodges
et al., 2000; Snowden, Griffiths, & Neary, 1994, 1999).
According to this hypothesis, patients with SD come to
build a memory of an object usage through frequent or
even daily use of this object in everyday life (Bozeat
et al., 2002a). In that case, the “knowledge” of the
object’s function is limited to this precise use in that specific context. Thus, although they performed poorly on
formal semantic-memory testing, patients performed
well when using objects that are part of their everyday
routine and that are supported by their episodic memory
(Bozeat et al., 2002a; Funnell, 2001). Therefore, repeated
experiences with objects could strengthen the patients’
degraded conceptual representations or help to maintain
a very specific form of representation. For Hodges et al.
(2000), the importance of episodic memory of object use
(personal references) might explain the performance of
patients with SD who performed well in using objects in
specific situations. They suggest that R.M., the patient
with SD who was remarkably able to cook and prepare
food (Lauro-Grotto et al., 1997), could rely on such memories or references to perform during testing. Likewise,
familiarity and personal references may also have contributed to the performances of patients A.M. (with AD) and
D.L. (with SD), who could use objects for which they had
no remaining knowledge (Negri et al., 2007).
To recap, results on single-object use in SD indicate the
importance of semantic memory in object use. Patients
may be able to manipulate objects by supplementing their
remaining semantic knowledge by a combination of
207
visual affordances and mechanical problem solving. Furthermore, they may also rely on their episodic memory
of how an object is used in a particular context, without
actual conceptual knowledge of this object.
SUMMARY AND FUTURE DIRECTIONS
The objective of this literature review was to shed light
on the specific role of semantic memory in everyday
actions by reviewing studies on representation and execution of scripts and schemas in patients with semanticmemory deficits. In Table 1 we summarize and classify
the evidence from the different studies containing
enough details to infer the role of semantic memory in
everyday actions. As can be seen, there is little rigorous
evidence regarding the ability or inability of persons with
semantic-memory deficits to perform everyday activities
normally. Many studies presented methodological flaws or
did not specifically intend to measure semantic-memory
contribution to everyday actions. However, the following
conclusions can be derived from the available data.
1. Semantic memory and script representation. Results
in patients with AD suggest that semantic-memory deficits affect the semantic content of scripts. However,
studies did not include comprehensive semantic-memory
testing, and thus no firm conclusions can be drawn from
the existing results.
2. Semantic memory and script execution. Results from
questionnaires and clinical observations suggest that
semantic-memory deficits have an impact on patients’
script execution. The deficit may be expressed by a narrowing of the repertoire of activities of patients with SD
and their rigid and stereotyped execution. However,
further studies, such as case descriptions or longitudinal
group studies, are needed in order to better describe deficits in script execution.
3. Semantic memory and schema representation. Results
from one patient with SD suggest that a deficit in schema
representation may be found in cases of semanticmemory deficits. However, the specific relationship
between the schema executions and the semantic impairment cannot be posited. This research area needs more
studies and is a very promising avenue in the domain of
semantic memory and everyday actions.
4. Semantic memory and schema execution. Results
suggest that patients with LBD may have specific
difficulties in retrieving schema-like instructions from
semantic memory in certain types of everyday routine
actions (execution of schemas). The performance in routine action testing (schemas) suggests that some patients
with SD are able to execute everyday tasks almost normally. However, in many case studies (Buxbaum et al.,
1997; Funnell, 2001; Lauro-Grotto et al., 1997), a central
semantic-memory deficit is questionable, and results
point toward the necessary role of remaining knowledge
accessible from visual or functional input and the role of
208
BIER AND MACOIR
TABLE 1
Semantic-memory deficits and everyday actions
Preserved
a. Script/schema representation
—
Deficits
—
Patients with AD
D.M.
b. Script/schema execution
D.M.
R.M.
E.P.
M.C.
a,b
Buxbaum et al., 1997
Lauro-Grotto et al., 1997a,b
Funnell, 2001
Riddoch et al., 2002b
Patients with LBD
G.L.
Patients with SD
Allain et al., 2008
Cosentino et al., 2006
Grafman et al., 1991
Buxbaum et al., 1997a,b
Hartmann et al., 2005
Buxbaum et al., 1998c
Buxbaum et al., 1998c
Mioshi et al., 2007
Snowden
2001c
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c. Object use
D.M.
R.M.
J.H. and B.W.
A.M. and D.L.
Buxbaum et al., 1997a,b
Lauro-Grotto et al., 1997a,b
Bozeat et al., 2002a
Negri et al., 2007
S.T. and M.K.
D.J.E. and I.F.
9 patients with SD
10 patients with AD
E.P.
8 patients with SD
Elvezio and Dirce
et
al.,
Hamanaka et al., 1996
Hodges et al., 1999
Hodges et al., 2000
Dumont et al., 2000a
Funnell, 2001a
Bozeat et al., 2002b
Coccia et al., 2004
Note. AD = Alzheimer’s disease. SD = semantic dementia. LBD = left brain damage. Other abbreviations are patients’ initials. Note
that the table does not include studies regarding the execution of routine actions and single-object use or script/schema evaluation in
the context of semantic-memory preservation. Thus the table does not report double dissociations. Also, the table does not include
single case studies in which other important cognitive deficits were reported in conjunction with semantic-memory deficits and in which
the contribution of semantic memory in simulated everyday routine actions cannot be isolated (e.g., patient F.K. in Forde &
Humphreys, 2002b).
aNo parallel between object use and semantic-memory testing or parallel not specified by the authors. bSemantic memory partially
preserved. cNo detailed analysis of deficits in semantic memory or no evaluation of semantic memory.
a direct, sensorimotor route to support their performance. However, more studies are needed on this aspect—
for example, studies with patients presenting a clear
central semantic-memory deficit.
5. Semantic memory and single-object use. Results on
single-object use are more equivocal than those in script
or schema execution. Generally, studies in SD showed
that object use is disrupted following semantic-memory
deficits. However, when patients are able to use objects,
their performance may be supported by remaining conceptual knowledge, preserved motor components of
object use, familiarity, and personal references regarding
how an object is used in a particular context. Further
studies with rigorous semantic testing could corroborate
these results.
Since the study of semantic-memory contribution to
ADL is still in its infancy, greater clarification
concerning these statements could come from three main
research areas: cognitive neuropsychology, real-life
observations of everyday activities, and optical imagery.
First, elaborated theories about everyday actions in
which the contribution of semantic memory is more specified are needed in order to formulate testable hypotheses
regarding the role of semantic memory in scripts and
schemas. For example, in the model proposed by Grafman (2002), knowledge about scripts would be encoded
in posterior areas of the brain. However, the specific
nature of this knowledge remains far from precise. Moreover, the connections between knowledge of objects and
knowledge of complex everyday actions, as well as their
interactions with action representation and execution,
remain unspecified. In order to better understand the
nature of the script content, more direct parallels
between theories concerning everyday actions and
semantic-memory models (e.g., Caramazza & Shelton,
1998; Warrington & Shallice, 1984) should be established. Similarly, the central role of semantic memory in
language processing (Caramazza, 1997), object recognition (Humphreys & Riddoch, 2006), and object use
(Rothi, Ochipa, & Heilman, 1991) is generally recognized. Theoretical models of semantic memory should be
more explicit with regard to the role of semantic representations in human cognition and, considering the
scope of this paper, in the representation and execution
of everyday actions. Longitudinal studies, in which the
severity of the SD is specified and precisely documented,
would also help assess the impact of semantic memory
on everyday actions (representation and execution)
throughout the evolution of the disease. Finally, the role
of goals in object use and everyday action should also be
studied. Patients with SD may no longer understand the
external goal of the action they have to perform in a testing situation. Normal participants can understand the
action requested by the experimenter by generalizing
from their knowledge of what is generally done (or
expected) in a similar everyday situation. Thus, even
without a specific internal goal, they can perform the
action. For example, if the participant is asked to use a
hammer, even without a personal plan to use it in a
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SEMANTIC MEMORY AND EVERYDAY ACTIONS
specific context, a normal participant can execute what
he or she would normally do in an everyday situation.
Patients with SD, on the other hand, could have lost this
capacity to generalize and thus to execute the requested
task without having a personal, relevant, and specific
goal for the object or the action. Their poor performance
in object use could thus be the consequence of a misunderstanding of the external goal and/or a misunderstanding
of the significance of the objects presented during testing.
To our knowledge, this important aspect of task execution
has not been studied in semantic-memory deficits.
Studies aiming at the execution of scripts and schemas
as well as studies focusing on the relationship between
execution and representations are also needed. Table 2
describes examples of methods of investigation that
could be used to better understand the nature of everyday action representations. As shown in this table, a
semantic-ADL questionnaire could be a promising way
to assess the functional impact of semantic memory. For
example, does the patient have difficulty in preparing a
meal? If so, can he or she recognize and use different
kinds of foods or utensils? Are these difficulties consistent with the semantic-memory evaluation? In the same
vein, real-life standardized observations of the patients’
engagement and level of independence in daily living
should also be done in order to measure the functional
impact of semantic-memory impairments. Simulated
real-life situations in the researchers’ laboratory are
practical and easy to use in the research context but are
far from being representative of real-life situations
(Bottari, Dutil, Dassa, & Rainville, 2006). The Instrumental Activities of Daily Living Profile (Bottari, Dassa,
Rainville, & Dutil, 2009) is a promising instrument in
this regard. It consists in observing a patient’s performance and rating his or her level of independence when
executing a routine of actions in which some novel
elements are introduced. The evaluation is done in the
patient’s community and home living environment. The
patient is asked to prepare a hot meal for two unexpected guests with $20, which is about the only information given to the patient. With these instructions, it is
expected that the participant will think of buying food,
then put on outdoor clothing, go to the grocery store,
209
buy food, prepare a hot meal for guests, have the meal
with the guests, and clean up afterwards. Thus, the
patient has to formulate a goal, to plan and organize a
solution, to execute this plan, and to verify the achievement of the goal. The evaluation provides a vast amount
of information regarding the person’s difficulties and
strengths. Furthermore, as is done in other protocols
(see Brennan, Giovannetti, Libon, Bettcher, & Duey, in
press), patients are videotaped, which helps with further
analysis of their performance and interrater reliability.
With respect to activities the patients still engage in, it
is important to assess the actual semantic or “semanticlike” nature of the remaining knowledge. According to
Graham and colleagues (Graham, Patterson, & Hodges,
1999b), patients with SD may rely on their preserved episodic memory of day-to-day activities to remember how
to do things and how to name objects. More specifically,
their episodic memories would allow them to infer object
use from their day-to-day experiences, a strategy that
leads to a highly abnormal, limited, and sometimes
incorrect “knowledge” about things and their usage.
Future research should thus try to better assess the interaction between semantic and episodic memories in everyday actions.
Finally, optical imaging techniques are a promising
way to study the role of semantic memory in everyday
tasks. For example, functional near-infrared spectroscopy (fNIRS), which relies on optical techniques to
detect changes in the hemodynamic response within the
cortex (Arenth, Ricker, & Schultheis, 2007), requires
compact experimental equipment and can be potentially
used in any setting (lab, clinic, home). The technique is
portable and is not sensitive to movement during data
acquisition. Arenth et al. (2007) highlight the potential
of this technique to monitor brain activity while individuals are engaged in actual, real-life functional activities.
The possibility of monitoring the brain “in action”
would expand our understanding of the cognitive abilities involved in everyday actions—for example, by pointing up the importance of temporal lobe activation
during execution of scripts or schemas. However, this
technique also has significant limitations. For example,
the lack of standardization in its use across different
TABLE 2
Examples of measures to assess representation and execution of scripts and schemas
Measures
Representation
Associative matching between everyday activities and object matching (e.g., patient asked to associate a relevant
object (coffee, hammer) to a picture/video depicting an action (e.g., someone getting out of bed)
Matching everyday activities presented on video according to their similarities or associative content (e.g., videos
of someone getting out of bed, eating breakfast, and eating at a restaurant)
Judgment regarding the quality of the execution of everyday activities presented on video (e.g., patient asked to
identify execution errors, such as added actions or misused objects)
Familiarity judgment on everyday activities (e.g., patient asked to state whether he/she is familiar with an activity
presented on video, such as shopping or doing financial tasks)
Execution
Functional evaluation—execution of scripts (e.g., making dinner for two) or schemas (e.g., brushing one’s teeth)—in
real-life settings (home–community)
Semantic-ADL (activities of daily living) questionnaire measuring the specific contribution of semantic memory in
everyday life (patient’s and caregiver’s point of view)
210
BIER AND MACOIR
studies (particularly for the parameters of cognitive
function measures) limits the ability to establish its validity. Although these limitations will have to be overcome,
fNRIS appears to be a promising and exciting way to
study everyday actions from a neurological perspective.
In conclusion, a combination of these investigation
methods and a rigorous semantic evaluation of everyday
actions will definitely expand our understanding of the
role of semantic memory in everyday life and enable us
to construct an integrated model of cognition and everyday action.
Original manuscript received 7 October 2008
Revised manuscript accepted 25 March 2009
First published online 8 June 2009
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