The aim of this study was to compare the performances on each item of the Mini-Mental State Examination (MMSE) of patients with Alzheimer's disease (AD) and multi-infarct dementia (MID). In order to identify the items that could better distinguish the two groups of patients, 70 AD and 31 MID patients matched for disease severity, age, and education were evaluated. The scores of the 101 patients on each of the MMSE items were entered into a principal component factor analysis using varimax rotation, and two main components were derived. Component 1 was probably representative of recently acquired information, whereas component 2 represented educational level. A score summing the items that loaded on component 1 and the recall item was calculated to generate a measure of episodic memory. Performing analysis of variance and covarying for age and education revealed that this score was statistically different in the two groups, with AD patients having lower values. The data suggest that the MMSE may demonstrate a pattern of impairment of memory that differs between AD and MID. Possible explanations of this finding should take into account the different neuroanatomical impairments and the different degrees of motivation, due to depression or attentional deficits, toward external stimuli.

Three types of problems are raised in this commentary: On the linguistic side, we emphasize the importance of an appropriate definition of the different domains of linguistics. This is needed to define the domains (lexicon-syntax-semantics) to which transformational relations apply. We then question the concept of Broca's aphasia as a “functional” syndrome, associated with a specific lesion. Finally, we discuss evidence from functional brain imaging. The breadth and potential impact of such evidence has grown considerably in the last few years, expanding our knowledge of the multiple contributions of the “Broca's region” to phonological, lexical-semantic, and syntactic processing. “Lumping” under diagnostic labels, such as Broca's aphasia, should be replaced by more detailed linguistic and neurological descriptions of the clinical cases.

Functional neuroimaging, used in conjunction with experimental cognitive tasks, has been extremely successful in establishing functional specialization as a principle of brain organization in man. Positron emission tomography activation techniques and functional magnetic resonance imaging assess localized increases in cerebral blood flow associated with mental processes. The advent of these noninvasive neuroimaging techniques opened a “new era” in the investigation of language organization in healthy individuals. Neuroimaging studies of bilinguals and polyglots have highlighted the potential role of variables, such as age of acquisition, degree of proficiency, level of exposure, dominance/maternality on functional brain mapping of multiple languages. Consistent results indicate that attained proficiency, and maybe language exposure, are more important than the age of acquisition as a determinant of the cerebral representation of languages in bilinguals/polyglots. Indeed, increasing language proficiency appears to be associated at the neural level with the engagement of a common network within the dedicated language areas. Here we have reviewed the functional imaging literature on bilingualism.