Everyday Language Difficulties in Parkinson's Disease: Caregiver Description and Relationship With Cognition, Activities of Daily Living, and Motor Disability

Purpose Parkinson's disease (PD) impacts language in multiple ways, though important questions remain. The current article explores 2 main issues: what type of everyday language difficulties (ELDs) are noted by care partners and how do ELDs relate to cognition, daily activities, and motor disability in PD. Method Care partner reports of ELD were collected in 42 community-dwelling individuals with PD. Descriptive information of ELD was tallied, and the relationship of cognitive decline, activities of daily living (ADLs), and motor disability with ELD was evaluated. Results Forty-two percent of patients were described by care partners as having at least 1 consistent ELD, and the frequency of ELD increased in the presence of dementia, χ²(2) = 14.37, p = .0008. The most commonly described ELDs by caregivers were related to comprehension of instructions and deriving the point of conversations. ELD was correlated with worse cognition ( r _s = -.524, p < .001), increased difficulty with daily activities ( r _s = .634, p < .001), and increased motor dysfunction ( r _s = .554, p < .001). Mild ADL decline (Functional Assessment Questionnaire score of 4); an area under the curve of .81 ( SE = .07) was highly specific to the presence of ELD (95.4%). Conclusions Care partners note a variety of ELDs in patients with PD, most commonly comprehension difficulties. These difficulties increase with overall cognitive decline but are described in 30%-40% of those without significant cognitive deficits. ADL difficulties correlate with functional, motoric, and cognitive status, with even mild functional declines predictive of the presence of ELD. Implications for research and practice in this population are discussed.

Knowledge of language function and underlying neural networks gained from focal seizures and epilepsy surgery

The effects of epilepsy and its treatments have contributed significantly to language models. The setting of epilepsy surgery, which allows for careful pre- and postsurgical evaluation of patients with cognitive testing and neuroimaging, has produced a wealth of language findings. Moreover, a new wave of surgical interventions, including stereotactic laser ablation and radio frequency ablation, have contributed new insights and corrections to language models as they can make extremely precise, focal lesions. This review covers the common language deficits observed in focal dyscognitive seizure syndromes. It also addresses the effects of surgical interventions on language, and highlights insights gained from unique epilepsy assessment methods (e.g., cortical stimulation mapping, Wada evaluation). Emergent findings are covered including a lack of involvement of the hippocampus in confrontation word retrieval, possible roles for key white matter tracts in language, and the often-overlooked basal temporal language area. The relationship between language and semantic memory networks is also explored, with brief consideration given to the prevailing models of semantic processing, including the amodal Hub and distributed, multi-modal processing models.

Language disorders in victims of domestic violence in children's homes

Studies that deal with child maltreatment have become relevant during these past years. One important aspect to consider is the impact of maltreatment on the cognitive functioning and more precisely on language. Our objective is to analyze the different components in the comprehension and production of language in children victims of domestic abuse in Childreńs Homes.

PARTICIPANTS

The sample consists of 104 participants divided in two groups. A group of children who have just been institutionalized due to domestic abuse (VG) (Age: 8 years 2 months with a standard deviation of 1, 5 years) without previous treatment; a group of comparison (CG) made up by children who have not been victim of domestic violence (Age: 8 years 6 months with a standard deviation of 2 years and a month), with similar characteristics of gender, age and schooling.

MATERIAL

The Child Neuropsychological Assessment by Matute, Rosselli, Ardila and Ostrosky (2007) was applied. This test includes metalinguistic, oral and written comprehension and expression skills.

RESULTS

The VG group showed low scores in all components of the analyzed language with exception to the discourse, syllable and non-word dictation compared to the CG children.

CONCLUSIONS

The alterations of the language observed in these children semantic suggest a lack of consolidation of phonological coding and a low use of code. From our findings an early language evaluation in these children can be of especial interest to apply timely intervention programs with the aim of diminishing the impact caused by domestic violence on school failure which is a frequent trait in these children.

The Latent Structure and Test-Retest Stability of Connected Language Measures in the Wisconsin Registry for Alzheimer's Prevention (WRAP)

INTRODUCTION

While it is well known that discourse-related language functions are impaired in the dementia phase of Alzheimer's Disease (AD), the presymptomatic temporal course of discourse dysfunction are not known earlier in the course of AD. To conduct discourse-related studies in this phase of AD, validated psychometric instruments are needed. This study investigates the latent structure, validity, and test-retest stability of discourse measures in a late-middle-aged normative group who are relatively free from sporadic AD risk factors.

METHODS

Using a normative sample of 399 participants (mean age = 61), exploratory factor analyses (EFA) and confirmatory factor analyses (CFA) were conducted on 18 measures of connected language derived from picture descriptions. Factor invariance across sex and family history and longitudinal test-retest stability measures were calculated.

RESULTS

The EFA revealed a four-factor solution, consisting of semantic, syntax, fluency, and lexical constructs. The CFA model substantiated the structure, and factors were invariant across sex and parental history of AD status. Test-retest stability measures were within acceptable ranges.

CONCLUSIONS

Results confirm a factor structure that is invariant across sex and parental AD history. The factor structure could be useful in similar cohorts designed to detect early language decline in investigations of preclinical or clinical AD or as outcome measures in clinical prevention trials.

Writing Changes and Perceptions After Traumatic Brain Injury: "Oh, by the way, I can't write"

PURPOSE

Language and cognitive disruptions following traumatic brain injury (TBI) can negatively affect written expression and may result in increased difficulty achieving academic, vocational, social, and personal goals; however, scarce literature exists about TBI's effect on writing abilities. The purpose of this qualitative study was to describe the experiences and perceptions of people with TBI regarding their engagement in writing activities.

METHOD

A transcendental phenomenological design structured the research. Data collection from 11 adults with TBI included gathering demographic and background information, completion of a TBI Symptom Checklist, and engagement in semistructured interviews.

RESULTS

Four major themes and 21 subthemes about postinjury writing recovery and current writing status emerged from the data analysis. Participants reported the extent to which writing difficulties interfered with daily activities and identified support strategies used to address persistent challenges.

CONCLUSION

Understanding the writing experiences and perceptions of people with TBI can guide professionals in designing assessments and interventions to facilitate educational, vocational, social, and personal success following injury.

Chiari Type I Malformation Associated With Verbal Fluency Impairment

PURPOSE

Chiari malformation (CM) Type I is a rare disorder that implies an anomaly in the craniocervical junction, where one or both cerebellar tonsils are displaced below the foramen magnum into the cervical spinal channel. Research carried out regarding cognitive symptoms such as verbal fluency is scarce. The aim of this study was to investigate whether verbal fluency is impaired in a CM clinical group compared to a group of healthy control individuals while controlling for depression and anxiety symptomatology.

METHOD

For this purpose, 101 individuals were enrolled to take part in the study (51 CM, 50 healthy controls). The Controlled Oral Word Association Test (Benton, de Hamsher, & Sivan, 1983) and the Hospital Anxiety and Depression Scale (Zigmond & Snaith, 1983) were administered.

RESULTS

Results showed significantly lower scores for the CM group in verbal fluency compared to the control group (p < .005). After performing an analysis of covariance to eliminate depression and anxiety symptomatology tendencies, it was observed that verbal fluency could not be predicted by this variable (p > .005).

CONCLUSIONS

From the results of this study, it can be concluded that people suffering from CM exhibit less verbal fluency than healthy control individuals and that this difference is not caused by depression or anxiety.

Receptive and expressive language characteristics of school-aged children with non-syndromic cleft lip and/or palate

BACKGROUND

Research investigating language skills in school-aged children with non-syndromic cleft lip and/or palate is sparse. Past studies focus on younger populations, lack key comparisons to demographically matched control cohorts or explore language as a component of broader academic skills. Trends of existing studies suggest that affected children may perform at a lower level compared with typically developing peers.

AIMS

To examine the receptive and expressive language skills of middle-school-aged children with non-syndromic cleft lip and palate (CLP) and cleft palate only (CP). Additionally, to explore the language skills of children with clefts compared with a non-cleft control group.

METHODS & PROCEDURES

Thirty-seven participants with orofacial clefts (aged 7;1-14;1 years) participated in the study: 19 with CLP (10 males; 9 females) and 18 with CP (8 males; 10 females). A non-cleft comparison group consisted of 129 individuals matched on age, sex and maternal education level. Participants completed formal language (Clinical Evaluation of Language Fundamentals, Fourth Edition) and non-verbal intellectual measurements (Wechsler Abbreviated Scale of Intelligence-WASI). Demographic and developmental information was obtained via parental interview. Further clinical details (e.g., surgery; hearing status) were extracted from patient medical files. Cleft and non-cleft language and non-verbal IQ outcomes were reported separately. Language outcomes were then compared between groups.

OUTCOMES & RESULTS

Participants with clefts achieved core (mean = 103.31, standard deviation (SD) = 10.31), receptive (mean = 102.51, SD = 11.60) and expressive (mean = 102.89, SD = 12.17) language index scores within the normative average range. A total of 14.1% and 17.8% of the cleft and non-cleft groups respectively had impairment (i.e., ≥ 1.25 SD below the mean) in one or more language domains. No significant differences were found in the three language index scores between cleft and non-cleft groups.

CONCLUSIONS & IMPLICATIONS

This study is the first formally to examine language skills alongside non-verbal IQ in school-aged children with clefts compared with a large matched non-cleft population. Results suggest that health professionals should evaluate each child as they present and not assume that a child with non-syndromic CLP or CP will also have co-occurring language difficulties. Where language falls in the average range, these skills can be harnessed to support areas of difficulty often associated with orofacial clefting, such as speech.

Child abuse and neglect re-report rates for young children with developmental delays

The study objective was to examine the likelihood and magnitude of child abuse and neglect (CAN) re-reports for young children (0-71 months) with delays in cognitive, language, and adaptive development, compared to typically developing children. The National Survey of Child and Adolescent Well-Being (NSCAW II), a nationally representative and longitudinal survey, was used to examine CAN re-reports at two follow-up waves, 18- and 36-months post baseline assessments. Logistic regression models were employed to determine the correlation between number of developmental delays and a CAN re-report at waves 2 and 3. Results indicate that children with three or more domains of delays had odds 4.73 times higher than children without developmental delays of re-report to CPS at wave 2 but not at wave 3. In this study, children with multiple developmental delays have elevated rates of CAN re-reports when compared to typically developing children. Allocation of child welfare resources should include strategies for preventing maltreatment risk among children with developmental delays.

Verbal short-term memory and language impairments in Cantonese speakers after stroke

PURPOSE

The study examined the relationship between verbal short-term memory (STM) and language impairment in Cantonese speakers after stroke. It is hypothesised that Cantonese speakers with left-hemisphere (LH) stroke would perform worse than those with right hemisphere (RH) stroke and normal controls. Specific linguistic factors of Cantonese might affect results in the tasks.

METHOD

Fifteen participants with LH stroke, 10 with RH stroke and 25 healthy controls were tested with auditory-verbal immediate serial recall (ISR) tasks and auditory linguistic tasks. All stroke participants were assessed with the Cantonese version of Western Aphasia Battery (CAB).

RESULT

The LH group performed significantly worse than the RH and healthy control groups in the auditory verbal ISR and auditory linguistic tasks. There were significant lexicality, frequency and imageability effects in most tasks. Auditory discrimination and word comprehension tasks, but not the auditory word recognition task had correlations with ISR tasks.

CONCLUSION

Verbal STM and language performance of Cantonese-speakers with history of LH stroke were inferior to RH stroke and healthy controls. The effects of lexicality, word frequency and imageability on verbal STM memory performance were found. Cantonese tones have effects on performance in auditory word recognition task, similar to onset, nucleus and rime.

Writing fluency in patients with low-grade glioma before and after surgery

BACKGROUND

Low-grade glioma (LGG) is a type of brain tumour often situated in or near areas involved in language, sensory or motor functions. Depending on localization and tumour characteristics, language or cognitive impairments due to tumour growth and/or surgical resection are obvious risks. One task that may be at risk is writing, both because it requires intact language and memory function and because it is a very complex and cognitively demanding task. The most commonly reported language deficit in LGG patients is oral lexical-retrieval difficulties, and poor lexical retrieval would be expected to affect writing fluency.

AIMS

To explore whether writing fluency is affected in LGG patients before and after surgery and whether it is related to performance on tasks of oral lexical retrieval.

METHODS & PROCEDURES

Twenty consecutive patients with presumed LGG wrote a narrative and performed a copy task before undergoing surgery and at 3-month follow-up using keystroke-logging software. The same tasks were performed by a reference group (N = 31). The patients were also tested using the Boston Naming Test (BNT) and word-fluency tests before and after surgery. Writing fluency was compared between the patients and the reference group, and between the patients before and after surgery. Relationships between performance on tests of oral lexical retrieval and writing fluency were investigated both before and after surgery.

OUTCOME & RESULTS

Different aspects of writing fluency were affected in the LGG patients both before and after surgery. However, when controlling for the effect of typing speed, the LGG group differed significantly from the reference group only in the proportion of pauses within words. After surgery, a significant decline was seen in production rate and typing speed in the narrative task, and a significant increase was seen in pauses before words. Strong positive relationships were found between oral lexical retrieval and writing fluency both before and after surgery.

CONCLUSIONS & IMPLICATIONS

Although aspects of writing fluency were affected both before and after surgery, the results indicate that typing speed is an important factor behind the pre-surgery differences. However, the decline in overall productivity and the increase in pauses before words after surgery could be related to a lexical deficit. This is supported by the finding that oral lexical-retrieval scores were strongly correlated with writing fluency. However, further exploration is needed to identify the language and cognitive abilities affecting writing processes in LGG patients.

Effects of Epilepsy on Language Functions: Scoping Review and Data Mining Findings

PURPOSE

This study involved a scoping review to identify possible gaps in the empirical description of language functioning in epilepsy in adults. With access to social network data, data mining was used to determine if individuals with epilepsy are expressing language-related concerns.

METHOD

For the scoping review, scientific databases were explored to identify pertinent articles. Findings regarding the nature of epilepsy etiologies, patient characteristics, tested language modalities, and language measures were compiled. Data mining focused on social network databases to obtain a set of relevant language-related posts.

RESULTS

The search yielded 66 articles. Epilepsy etiologies except temporal lobe epilepsy and older adults were underrepresented. Most studies utilized aphasia tests and primarily assessed single-word productions; few studies included healthy control groups. Data mining revealed several posts regarding epilepsy-related language problems, including word retrieval, reading, writing, verbal memory difficulties, and negative effects of epilepsy treatment on language.

CONCLUSION

Our findings underscore the need for future specification of the integrity of language in epilepsy, particularly with respect to discourse and high-level language abilities. Increased awareness of epilepsy-related language issues and understanding the patients' perspectives about their language concerns will allow researchers and speech-language pathologists to utilize appropriate assessments and improve quality of care.

Contributions of Neuroimaging to Understanding Language Deficits in Acute Stroke

Advances in structural and functional imaging techniques have provided new insights into our understanding of brain and language relationships. In this article, we review the various structural and functional imaging methods currently used to study language deficits in acute stroke. We also discuss the advantages and the limitations of each imaging modality and the applications of each modality in the clinical and research settings in the study of language deficits.

Overdiagnosis and Medication for Attention-Deficit Hyperactivity Disorder in Children with Cleft: Diagnostic Examination and Follow-Up

Objective

To examine the diagnosis of attention-deficit hyperactivity disorder (ADHD) in children with cleft to determine whether language-learning characteristics are taken into account when making this diagnosis.

Design

Prospective examination of 177 consecutive patients. Objective behavioral ratings, cognitive assessments, and attention/impulsivity testing of 32 of the 177 children with nonsyndromic cleft lip and palate (CLP) who had previously been diagnosed as ADHD and were receiving medication were performed. the prospective 6- to 9-month follow-up examination was examined to determine the accuracy of prior and posttest diagnoses.

Setting

University hospital-based cleft palate clinic.

Main Outcome Measures

Pretest/posttest design to determine accuracy of DSM-IV psychiatric diagnosis.

Results and Conclusions

The results show that the proportion of children originally diagnosed with ADHD (18%) was significantly higher than posttest diagnosis of ADHD (6% p < .001). Also, the frequency of pretest diagnosis of learning disorder (LD; 31%) was significantly different from posttest diagnosis (66% p < .01). The overdiagnosis of ADHD and underdiagnosis of LD in this sample of children with nonsyndromic unilateral cleft lip and palate appears to be due to lack of language-learning assessment.

The Changing View of Input in the Treatment of Children With Grammatical Deficits

PURPOSE

The purpose of this article is to present 3 approaches that emphasize the role that input plays in the treatment of grammatical deficits in children with language impairments.

METHOD

These approaches-input informativeness, competing sources of input, and high variability-were selected because they go beyond issues of token frequency and emphasize instead type frequency, relative frequency, and frequency at an abstract as well as a concrete level of grammar. Each of these approaches can be applied to the grammatical deficits seen in children with specific language impairment and can be readily used with well-established procedures, such as focused stimulation and recasting.

RESULTS

Each approach is supported by a body of laboratory research with children with typical language skills, and the feasibility of each has been tested in studies with a treatment design. Furthermore, the assumptions of the 3 approaches are largely compatible, permitting application of combinations of these approaches without violating any of their principles.

CONCLUSION

The positive findings from each of these approaches should serve as a basis for further clinical research.

Deficit in feature-based attention following a left thalamic lesion

Selective attention enables us to prioritise the processing of relevant over irrelevant information. The model of priority maps with stored attention weights provides a conceptual framework that accounts for the visual prioritisation mechanism of selective attention. According to this model, high attention weights can be assigned to spatial locations, features, or objects. Converging evidence from neuroimaging and neuropsychological studies propose the involvement of thalamic and frontoparietal areas in selective attention. However, it is unclear whether the thalamus is critically involved in generating different types of modulatory signals for attentional selection. The aim of the current study was to investigate feature- and spatial-based selection in stroke survivors with subcortical thalamic and non-thalamic lesions. A single case with a left-hemispheric lesion extending into the thalamus, five cases with right-hemispheric lesions sparing the thalamus and 34 healthy, age-matched controls participated in the study. Participants performed a go/no-go task on task-relevant stimuli, while ignoring simultaneously presented task-irrelevant stimuli. Stimulus relevance was determined by colour or spatial location. The thalamic lesion case was specifically impaired in feature-based selection but not in spatial-based selection, whereas performance of non-thalamic lesion patients was similar to controls' performance in both types of selective attention. In summary, our thalamic lesion case showed difficulties in computing differential attention weights based on features, but not based on spatial locations. The results suggest that different modulatory signals are generated mediating attentional selection for features versus space in the thalamus.

[Communicative and social-adaptive profile in children with autism spectrum disorder: a new approach based on the DSM-5 criteria]

INTRODUCTION

Following the adoption of the new international diagnosis classification from the Diagnostic and Statistical Manual (DSM-5), autism spectrum disorder (ASD) has been established as a dimensional category that includes other disorders that were previously considered as separate entities. Previous research has shown that some people with this disorder exhibit different communicative and linguistic profiles. Therefore, contradictory results could be found among people who receive the same diagnosis.

AIM

To distinguish structural language aspects (expression and comprehension), interactive aspects (pragmatics), and social adaptation between children with an ASD-level 1 of support and children with typical development.

SUBJECTS AND METHODS

Seventeen children with Asperger syndrome (according to the DSM-IV-TR), and 20 children with typical development between 7 and 12 years old. We have equated diagnosis of Asperger syndrome with ASD-level 1 of support. We have evaluated intelligence quotient, communication, and social adaptation with direct and indirect standardized parental scales.

RESULTS

We have found significant differences in comprehension (p = 0.025), interaction (p = 0.001), and social adaptation (p = 0.001) between the two groups.

CONCLUSIONS

Subjects with ASD-level 1 of support demonstrate an average intelligence quotient, and good expressive structure (syntax and semantic level), which may be different from other children who receive the same diagnosis, due to the wide heterogeneity of the disorder. Nevertheless, our subjects have problems related to comprehension of grammar structure, pragmatics, and social adaptation. These difficulties could be related to emotional and social problems.

Association between speech-language, general cognitive functioning and behaviour problems in individuals with Williams syndrome

BACKGROUND

Williams syndrome (WS) phenotype is described as unique and intriguing. The aim of this study was to investigate the associations between speech-language abilities, general cognitive functioning and behavioural problems in individuals with WS, considering age effects and speech-language characteristics of WS sub-groups.

METHODS

The study's participants were 26 individuals with WS and their parents. General cognitive functioning was assessed with the Wechsler Intelligence Scale. Peabody Picture Vocabulary Test, Token Test and the Cookie Theft Picture test were used as speech-language measures. Five speech-language characteristics were evaluated from a 30-min conversation (clichés, echolalia, perseverative speech, exaggerated prosody and monotone intonation). The Child Behaviour Checklist (CBCL 6-18) was used to assess behavioural problems.

RESULTS

Higher single-word receptive vocabulary and narrative vocabulary were negatively associated with CBCL T-scores for Social Problems, Aggressive Behaviour and Total Problems. Speech rate was negatively associated with the CBCL Withdrawn/Depressed T-score. Monotone intonation was associated with shy behaviour, as well as exaggerated prosody with talkative behaviour. WS with perseverative speech and exaggerated prosody presented higher scores on Thought Problems. Echolalia was significantly associated with lower Verbal IQ. No significant association was found between IQ and behaviour problems. Age-associated effects were observed only for the Aggressive Behaviour scale.

CONCLUSIONS

Associations reported in the present study may represent an insightful background for future predictive studies of speech-language, cognition and behaviour problems in WS.

Domain-general subregions of the medial prefrontal cortex contribute to recovery of language after stroke

We hypothesized that the recovery of speech production after left hemisphere stroke not only depends on the integrity of language-specialized brain systems, but also on 'domain-general' brain systems that have much broader functional roles. The presupplementary motor area/dorsal anterior cingulate forms part of the cingular-opercular network, which has a broad role in cognition and learning. Consequently, we have previously suggested that variability in the recovery of speech production after aphasic stroke may relate in part to differences in patients' abilities to engage this domain-general brain region. To test our hypothesis, 27 patients (aged 59 ± 11 years) with a left hemisphere stroke performed behavioural assessments and event-related functional magnetic resonance imaging tasks at two time points; first in the early phase (∼2 weeks) and then ∼4 months after the ictus. The functional magnetic resonance imaging tasks were designed to differentiate between activation related to language production (sentential overt speech production-Speech task) and activation related to cognitive processing (non-verbal decision making). Simple rest and counting conditions were also included in the design. Task-evoked regional brain activations during the early and late phases were compared with a longitudinal measure of recovery of language production. In accordance with a role in cognitive processing, substantial activity was observed within the presupplementary motor area/dorsal anterior cingulate during the decision-making task. Critically, the level of activation within this region during speech production correlated positively with the longitudinal recovery of speech production across the two time points (as measured by the in-scanner performance in the Speech task). This relationship was observed for activation in both the early phase (r = 0.363, P = 0.03 one-tailed) and the late phase (r = 0.538, P = 0.004). Furthermore, presupplementary motor area/dorsal anterior cingulate activity was a predictor of both language recovery over time and language outcome at ∼4 months, over and above that predicted by lesion volume, age and the initial language impairment (general linear model overall significant at P < 0.0001; ExpB 1.01, P = 0.02). The particularly prominent relationship of the presupplementary motor area/dorsal anterior cingulate region with recovery of language was confirmed in voxel-wise correlation analysis, conducted unconstrained for the whole brain volume. These results accord with the hypothesis that the functionality of the presupplementary motor area/dorsal anterior cingulate contributes to language recovery after stroke. Given that this brain region is often spared in aphasic stroke, we propose that it is a sensible target for future research into rehabilitative treatments. More broadly, baseline assessment of domain-general systems could help provide a better prediction of language recovery.

Babbling in children with neurodevelopmental disability and validity of a simplified way of measuring canonical babbling ratio

Babbling is an important precursor to speech, but has not yet been thoroughly investigated in children with neurodevelopmental disabilities. Canonical babbling ratio (CBR) is a commonly used but time-consuming measure for quantifying babbling. The aim of this study was twofold: to validate a simplified version of the CBR (CBR^UTTER), and to use this measure to determine if early precursors to speech and language development could be detected in children with different neurodevelopmental disabilities. Two different data sets were used. In Part I, CBR^UTTER was compared to two other CBR measures using previously obtained phonetic transcriptions of 3571 utterances from 38 audio recordings of 12-18 month old children with and without cleft palate. In CBR^UTTER, number of canonical utterances was divided by total number of utterances. In CBR^syl, number of canonical syllables was divided by total number of syllables. In CBR^utt, number of canonical syllables was divided by total number of utterances. High agreement was seen between CBR^UTTER and CBR^syl, suggesting CBR^UTTER as an alternative. In Part II, babbling in children with neurodevelopmental disability was examined. Eighteen children aged 12-22 months with Down syndrome, cerebral palsy or developmental delay were audio-video recorded during interaction with a parent. Recordings were analysed by observation of babbling, consonant production, calculation of CBR^UTTER, and compared to data from controls. The study group showed significantly lower occurrence of all variables, except for of plosives. The long-term relevance of the findings for the speech and language development of the children needs to be investigated.

[Are language disorders in Alzheimer's disease simply aphasia?]

Alzheimer's disease is accompanied by gradual aphasia, becoming more severe when the cognitive disorders are more marked. However, the quality of care provided to the patient can modulate the evolution of these language difficulties. Aphasia is linked to a human communication deficiency and can be limited by taking into account the phatic function of language to keep the channels of communication open.

Damage to white matter bottlenecks contributes to language impairments after left hemispheric stroke

Damage to the white matter underlying the left posterior temporal lobe leads to deficits in multiple language functions. The posterior temporal white matter may correspond to a bottleneck where both dorsal and ventral language pathways are vulnerable to simultaneous damage. Damage to a second putative white matter bottleneck in the left deep prefrontal white matter involving projections associated with ventral language pathways and thalamo-cortical projections has recently been proposed as a source of semantic deficits after stroke. Here, we first used white matter atlases to identify the previously described white matter bottlenecks in the posterior temporal and deep prefrontal white matter. We then assessed the effects of damage to each region on measures of verbal fluency, picture naming, and auditory semantic decision-making in 43 chronic left hemispheric stroke patients. Damage to the posterior temporal bottleneck predicted deficits on all tasks, while damage to the anterior bottleneck only significantly predicted deficits in verbal fluency. Importantly, the effects of damage to the bottleneck regions were not attributable to lesion volume, lesion loads on the tracts traversing the bottlenecks, or damage to nearby cortical language areas. Multivariate lesion-symptom mapping revealed additional lesion predictors of deficits. Post-hoc fiber tracking of the peak white matter lesion predictors using a publicly available tractography atlas revealed evidence consistent with the results of the bottleneck analyses. Together, our results provide support for the proposal that spatially specific white matter damage affecting bottleneck regions, particularly in the posterior temporal lobe, contributes to chronic language deficits after left hemispheric stroke. This may reflect the simultaneous disruption of signaling in dorsal and ventral language processing streams.

Language context processing deficits in schizophrenia: The role of attentional engagement

Individuals with schizophrenia exhibit problems in language comprehension that are most evident during discourse processing. We hypothesized that deficits in cognitive control contribute to these comprehension deficits during discourse processing, and investigated the underlying cognitive-neural mechanisms using EEG (alpha power) and ERPs (N400). N400 amplitudes to globally supported or unsupported target words near the end of stories were used to index sensitivity to previous context. ERPs showed reduced sensitivity to context in patients versus controls. EEG alpha-band activity was used to index attentional engagement while participants listened to the stories. We found that context effects varied with attentional engagement in both groups, as well as with negative symptom severity in patients. Both groups demonstrated trial-to-trial fluctuations in alpha. Relatively high alpha power was associated with compromised discourse processing in participants with schizophrenia when it occurred during any early portion of the story. In contrast, discourse processing was only compromised in controls when alpha was relatively high for longer segments of the stories. Our results indicate that shifts in attention from the story context may be more detrimental to discourse processing for participants with schizophrenia than for controls, most likely due to an impaired ability to benefit from global context.

The Profiles of Students With Significant Cognitive Disabilities and Known Hearing Loss

The present study describes the characteristics of students in Grades 3-12 with significant cognitive disabilities (SCD) and known hearing loss. The study analyzed results of a survey of teachers of students with SCD (n = 38,367) who were slated to participate in an alternate assessment based on alternate achievement standards in 14 states in the United States. Analysis revealed similar profiles in academic achievement and symbolic language use combined with an increased incidence of additional sensory impairments among students with SCD and known hearing loss compared to their peers without known hearing loss. Results suggest that hearing loss may be underidentified and underserved among students with SCD and point to the need for improved hearing screenings and evaluations combined with services delivered by teams that follow a model of interprofessional practice.

Mild Cognitive Impairments Moderate the Effect of Time on Verbal Fluency Performance

OBJECTIVES

Mild cognitive impairments (MCI) is a transitional state in aging associated with increased risk of incident dementia. The current study investigated whether MCI status moderated the effect of time on word generation during verbal fluency tasks. Specifically, the objective was to determine whether MCI status had differential effects on initial automatic or latter more effortful retrieval processes of fluency tasks.

METHODS

Participants were community residing older adults enrolled in a longitudinal cohort study. Of the 408 participants, 353 were normal (age=76.06±6.61; %female=57.8) and 55 were diagnosed with MCI (age=78.62±7.00; %female=52.7). Phonemic and category fluency were each administered for 60 s, but performance was recorded at three consecutive 20-s intervals (0-20 s [T1], 21-40 s [T2], 41-60 s [T3]. Separate linear mixed effects models for each fluency task were used to determine the effects of group, time, and their interaction on word generation.

RESULTS

In both fluency tasks, word generation declined as a function of time. Individuals with MCI generated fewer words compared to controls during the first 20 s of phonemic (beta=-1.56; p<.001; d=0.28) and category fluency (beta=-1.85; p<.001; d=0.37). Group by time interactions revealed that individuals with MCI demonstrated attenuated declines in word generation from the first to the second and third time intervals of both phonemic ([T1 vs. T2] beta=2.17, p=.001; d=0.41; [T1 vs. T3]beta=2.28, p=.001; d=0.45) and category ([T1 vs. T2] beta= 2.22, p=.002; d=0.50; [T1 vs. T3]beta=3.16, p<.001; d=0.71) fluency.

CONCLUSIONS

Early automatic retrieval processes in verbal fluency tasks are compromised in MCI. (JINS, 2017, 23, 44-55).

The Mental Status Examination in Patients With Suspected Dementia

PURPOSE OF REVIEW

This article describes a comprehensive approach to the mental status examination and diagnostic workup of patients suspected of having an emerging neurodegenerative dementia. Key strategies for obtaining a history and bedside examination techniques are highlighted.

RECENT FINDINGS

Classic descriptions of behavioral neurology syndromes were largely based on clinicopathologic correlations of strategic lesions in stroke patients. While still very important, advances in neuroimaging have expanded our armamentarium of cognitive evaluations to include assessments of findings in nonstroke anatomic distributions of disease. These efforts support comprehensive assessments of large-scale cerebral networks in cognitive neurology.

SUMMARY

A thorough and focused mental status examination is essential for the evaluation of patients with cognitive symptoms. Selective use of laboratory testing and neuroimaging can aid in the diagnosis of dementia by excluding non-neurodegenerative etiologies. Neurodegenerative disease-specific tests are in development and will enhance diagnosis and efforts for disease-modifying therapy development.