[Cognitive impairment in patients with Parkinson disease]

Parkinson disease is a progressive neurodegenerative disorder resulting in motor symptoms and cognitive deficits. Neuropsychological studies have suggested that patients with Parkinson disease exhibit a broad range of cognitive deficits even in the early stages of the disease. In this review, we discuss the neuropsychological evidence for cognitive impairment in patients with Parkinson disease, outlining the different domains of cognitive disturbance. First, we review previous findings on executive dysfunction, which is associated with a disruption in frontostriatal circuitry mainly driven by dopaminergic dysmodulation. Executive dysfunction is the core symptom in the cognitive deficits in Parkinson disease. Second, we focus on impairment in different domains of memory function, such as short-term and long-term memory. Third, we discuss the pattern of cognitive deficits in visuospatial ability, ranging from basic perceptual processes to rather complex motor skills. Next, we summarize the profile of cognitive deficits in language, although previous findings are mixed and hence this topic is relatively controversial. Finally, we introduce several recent findings on social cognitive deficits, which is a new area of research that has emerged in the past decade. We also discuss the possible neural mechanisms underlying each domain of cognitive deficits in patients with Parkinson disease.

[The language disorders in schizophrenia in neurolinguistic and psycholinguistic perspectives]

The descriptive psychopathology has classically equated the language with the formal aspects of thought. Recent developments in experimental and clinical research have emphasized the study of the language as a specific communicative ability. Within the framework of cognitive neuropsychology, the development of innovative research models, such as those based on the mentalizing ability, has allowed to formulate new hypotheses on the pathogenetic aspects of schizophrenia. Furthermore, mentalizing ability appears to be a basic skill for the pragmatic dimension of language. The author, after a brief description of the methods of investigation of neurolinguistics and psycholinguistics, presents a review of recent studies obtained by consulting the PubMed and PsycINFO databases. Finally, he focuses on the relationship between research findings and issues related to clinical practice.

[Postoperative cortical blindness after right upper lung lobectomy]

Changes in vision after non-ophthalmic surgery are a serious complication that can have devastating consequences due to its potential irreversibility. This not only leads to medical problems, but also legal ones. Many causes that affect sight during the peri-operative period have been identified, whether due to optic nerve damage or of extra-ocular origin (in the neuro-optic pathways and/or cerebral cortex). AU these may have a multifactorial origin, and there is still controversy as regards it pathogenesis and treatment. We present the case of a thoracic surgery patient who had a bilateral amaurosis in the post-operative period, which had a favourable outcome.

Memory processes in learning disability subtypes of children born preterm

The purpose of this study was to evaluate immediate auditory and visual memory processes in learning disability subtypes of 40 children born preterm. Three subgroups of children were examined: (a) primary language disability group (n = 13), (b) perceptual-motor disability group (n = 14), and (c) no learning disability diagnosis group without identified language or perceptual-motor learning disability (n = 13). Between-group comparisons indicate no significant differences in immediate auditory or visual memory performances between language and perceptual-motor learning disability groups. Within-group comparisons revealed that both learning disability groups performed significantly lower on a task of immediate memory when the mode of stimulus presentation and mode of response were visual.

A potential protective effect in multilingual patients with semantic dementia: two case reports of patients speaking Taiwanese and Japanese

PURPOSE

Several reports have suggested that multilingualism has a protective effect against semantic dementia. Here, we provide further evidence for this effect.

CASE REPORTS FIRST

The patient was a 75-year-old right-handed Taiwanese woman who had retired after working as a tailor. She was able to speak Taiwanese, Japanese and Mandarin Chinese fluently until 5 years ago. She gradually developed symptoms of profound anomia and difficulty with word-finding. Her mother tongue was Taiwanese and she had learned Japanese as her first symbolized language. She had used Mandarin Chinese for most of her life, but depended on Japanese to read and write (such as reading a newspaper and keeping accounts). However, she could now speak only very simple Taiwanese and Japanese, and could recognize only simple Japanese characters. SECOND: The patient was a 62-year-old right-handed man who had worked as an ironworker. He could speak Taiwanese and Mandarin Chinese fluently until 5 years ago. His mother tongue was Taiwanese. After 5 years of language deterioration, he was unable to communicate with his family members or recognize any characters, including numbers. SPECT RESULTS: Brain perfusion ECD SPECT (Tc-99m-ethyl cysteinate dimer single-photon emission computed tomography) showed less perfusion in the multilingual patient (Case #1) than in the bilingual patient (Case #2). Neuropsychological tests also demonstrated a slower rate of degeneration in the multilingual patient.

CONCLUSION

We speculate that reading and writing in Japanese had a greater impact on the semantic system in Case #1. Thus, this patient showed relatively less degeneration or functional inactivity, as shown by perfusion in the frontal lobe, and this might be due to the persistent activation involved in multilingualism.

[Brain plasticity for language in children and adolescents]

INTRODUCTION

Plasticity makes possible adaptative modelling of the nervous system to experiences i.e. learning and development.

AIM

To review current literature on clinical long term evolution and functional magnetic resonance imaging (fMRI) features of brain remodelling after focal stroke in left perisylvian regions involved in basic language processing during infancy and childhood.

DEVELOPMENT

Each of the main neurocognitive subsystems develops with different timing, so altered plasticity and vulnerability are diverse, according with age at insult and its topography. Genetic programming makes human brain capable for installing basic formal linguistic abilities on an associative perisylvian subsystem, highly specialised. A focal lesion of this region leads to remodelling phenomena by disinhibition of contralateral frontal and perisylvian structures and by a more or less efficacious activation of neighboring homolateral cortex, as it has been shown by fMRI studies and DTI tractography. As a result, very early local stroke to language areas is generally well compensated in terms of linguistic behaviour. Meanwhile acquired aphasias into middle and late childhood, even if they have a better prognosis than in adults, they fail to resume without lexical access defaults and/or difficulties in written language.

CONCLUSION

Brain plasticity can promote restoration and further development of language following a stroke in left peri-sylvian areas, specially when lesion occurs at perinatal to middle childhood.

[Differential diagnosis between the autistic spectrum and the schizophrenic spectrum]

INTRODUCTION

The nosological distinction between the autistic spectrum and the schizophrenic spectrum is clearly defined today, despite scientific evidence of the genetic relationship between the two conditions. The overlap between the negative symptoms of schizophrenia and certain autistic manifestations, and the fact that professionals who are not familiar with autistic spectrum disorders have misguidedly attributed positive symptoms of schizophrenia in autism together highlight the importance of deciphering the keys that make it possible to reach a differential diagnosis or to evaluate the comorbidity and co-occurrence of both spectra when this is the case.

DEVELOPMENT

The article analyses and unravels the manifestations of autism that could be mistaken for the psychotic dimension and the disorganisation dimension corresponding to the positive symptoms of the schizophrenic spectrum. It also seeks to clarify the psychological explanations justifying the manifestation of certain negative symptoms frequently associated with autism.

CONCLUSIONS

The keys to determining whether the clinical manifestations belong to the autistic spectrum, the schizophrenic spectrum or result from comorbidity lie in the evaluation of the developmental history of the person, the prodrome and onset of the condition, its course and the presence or absence of positive symptoms of schizophrenia. Determining them will play a crucial role in helping the professional to make decisions concerning both the diagnosis and treatment.

[Syntactic and textual complexity in children with attention deficit hyperactivity disorder]

INTRODUCTION AND AIMS

. In this work we analyse the syntax used by children diagnosed with attention deficit hyperactivity disorder (ADHD) when writing texts with a narrative and argumentative superstructure. The basic data analysed are the ratio of syntactic complexity and the relative distribution of verb tenses, assuming that in fusional languages like Spanish the TAM system (tense, aspect, mode) is the direct linguistic correlate of the executive functions related with the management of temporality.

SUBJECTS AND METHODS

Children between 8 and 13 years of age were asked to write narrative and argumentative texts; data were obtained in clinical contexts. The use of complex syntactic structures and verb conjugation were analysed both quantitatively and qualitatively.

RESULTS AND CONCLUSIONS

The children with ADHD displayed lower values in terms of levels of syntactic complexity and used fewer subordinate clauses than the children in the control group in both types of texts. As far as verb tenses are concerned, they used a higher proportion of prototypical tenses, that is to say, the present simple in argumentation and the imperfect indicative in narrative texts.

The organization and anatomy of narrative comprehension and expression in Lewy body spectrum disorders

OBJECTIVE

Patients with Lewy body spectrum disorders (LBSD) such as Parkinson's disease, Parkinson's disease with dementia, and dementia with Lewy bodies exhibit deficits in both narrative comprehension and narrative expression. The present research examines the hypothesis that these impairments are due to a material-neutral deficit in organizational executive resources rather than to impairments of language per se. We predicted that comprehension and expression of narrative would be similarly affected and that deficits in both expression and comprehension of narrative would be related to the same anatomic distribution of prefrontal disease.

METHOD

We examined 29 LBSD patients and 26 healthy seniors on their comprehension and expression of narrative discourse. For comprehension, we measured accuracy and latency in judging events with high and low associativity from familiar scripts such as "going fishing." The expression task involved maintaining the connectedness of events while narrating a story from a wordless picture book.

RESULTS

LBSD patients were impaired on measures of narrative organization during both comprehension and expression relative to healthy seniors. Measures of organization during narrative expression and comprehension were significantly correlated with each other. These measures both correlated with executive measures but not with neuropsychological measures of lexical semantics or grammar. Voxel-based morphometry revealed overlapping regressions relating frontal atrophy to narrative comprehension, narrative expression, and measures of executive control.

CONCLUSIONS

Difficulty with narrative discourse in LBSD stems in part from a deficit of organization common to comprehension and expression. This deficit is related to prefrontal cortical atrophy in LBSD.

Testing the language of German cerebral palsy patients with right hemispheric language organization after early left hemispheric damage

Language functions are generally represented in the left cerebral hemisphere. After early (prenatally acquired or perinatally acquired) left hemispheric brain damage language functions may be salvaged by reorganization into the right hemisphere. This is different from brain lesions acquired in adulthood which normally lead to aphasia. Right hemispheric reorganized language (RL) is not associated with obvious language deficits. In this pilot study we compared a group of German-speaking patients with left hemispheric brain damage and RL with a group of matched healthy controls. The novel combination of reliable language lateralization as assessed by neuroimaging (functional magnetic resonance imaging) and specific linguistic tasks revealed significant differences between patients with RL and healthy controls in both language comprehension and production. Our results provide evidence for the hypothesis that RL is significantly different from normal left hemispheric language. This knowledge can be used to improve counselling of parents and to develop specific therapeutic approaches.

Language impairment in children perinatally infected with HIV compared to children who were HIV-exposed and uninfected

OBJECTIVE

To investigate the risk for language impairment (LI) in children perinatally infected or exposed to HIV.

METHODS

We evaluated the prevalence of LI in 7- to 16-year-old children with perinatal HIV infection (HIV+) compared with HIV-exposed and uninfected children, using a comprehensive standardized language test (Clinical Evaluation of Language Functioning-Fourth Edition [CELF-4]). LI was classified as primary LI (Pri-LI) (monolingual English exposure and no cognitive or hearing impairment), concurrent LI (Con-LI) (cognitive or hearing impairment), or no LI. Associations of demographic, caregiver, HIV disease, and antiretroviral treatment factors with LI category were evaluated using univariate and multivariable logistic regression models.

RESULTS

Of the 468 children with language assessments, 184 (39%) had LI. No difference was observed by HIV infection status for overall LI or for Pri-LI or Con-LI; mean (SD) CELF-4 scores were 88.5 (18.4) for HIV+ versus 87.5 (17.9) for HIV-exposed and uninfected children. After adjustment, black children had higher odds of Pri-LI versus no LI (adjusted odds ratio [aOR] = 2.43, p = .03). Children who were black, Hispanic, had a caregiver with low education or low intelligence quotient, or a nonbiological parent as caregiver had higher odds of Con-LI versus no LI. Among HIV+ children, viral load >400 copies/mL (aOR = 3.04, p < .001), Centers for Disease Control and Prevention Class C (aOR = 2.19, p = .02), and antiretroviral treatment initiation <6 months of age (aOR = 2.12, p = .02) were associated with higher odds of Con-LI versus no LI.

CONCLUSIONS

Children perinatally exposed to HIV are at high risk for LI, but such risk was not increased for youth with HIV. Risk factors differed for Pri-LI and Con-LI.

A computational approach to quantifiers as an explanation for some language impairments in schizophrenia

We compared the processing of natural language quantifiers in a group of patients with schizophrenia and a healthy control group. In both groups, the difficulty of the quantifiers was consistent with computational predictions, and patients with schizophrenia took more time to solve the problems. However, they were significantly less accurate only with proportional quantifiers, like more than half. This can be explained by noting that, according to the complexity perspective, only proportional quantifiers require working memory engagement.

LEARNING OUTCOMES

(1) Working memory deficits can be a source of language disorders in schizophrenia. (2) Processing of proportional quantifiers, like more than half or less than half involves working memory. (3) Patients with schizophrenia are less accurate only with proportional quantifiers, like more than half. (4) This result support the computational model of quantifiers processing.

A case study on the communication of older adolescents

This study compared the communication of two older male adolescents (aged 17 and 19 years) with each other (peer interaction) and with a teacher (non-peer interaction) in three different types of activity (casual conversation, providing/listening to a recount and collaborative problem-solving). Conversation analysis, selected analyses from the perspective of systemic functional linguistics and social psychology (communication accommodation theory) were applied in data analysis. Peer interaction showed fewer questions, fewer challenging moves and the absence of divergent accommodation strategies. In the non-peer interaction, the teacher's higher number of turns, questions and interruptions appeared to influence the opportunity for adolescent contribution to the interactions. Some aspects of language use by each adolescent - mean turn length, use of one-word utterances and sarcasm - were consistent across communication partner and activity. The methodology is suggested to provide a suitable procedure for use in similar research with older adolescents who have traumatic brain injury.

[Language impairment and semantic memory loss of semantic dementia]

Semantic dementia (SD) is a neurodegenerative disease characterized by atrophy of the anterior temporal regions and progressive loss of semantic memory. SD has recently been reported to be associated with a pathologic diagnosis of frontotemporal lobar degeneration (FTLD) with T^ar DNA-binding protein of 43 kDa (TDP-43) immunoreactive inclusions (FTLD-TDP) type 2 by Mackenzie. In the first several years of the disease, SD patients, especially those with left hemisphere-dominant temporal atrophy, present with primary progressive aphasia, in which language deterioration is obvious; however, they do not have other cognitive and behavioral impairments. The language impairment in SD is termed as word meaning aphasia, in which patients experience both word finding difficulties and word recognizing difficulties (two-way anomia). Phonemic cues are not effective in improving anomia. In addition, SD patients do not experience a sense of familiarity with words that they cannot find or recognize. While reading and writing Japanese words, SD patients, except those who also have motor neuron disease, exhibit well-preserved kana (phonogram) processing. However, in the case of kanji, they often exhibit surface dyslexia while reading and also exhibit phonetic miswriting. In the aphasic stage, SD patients can explain what the objects are and can use them appropriately; however, they cannot find or recognize the names of the objects. On progressing to the semantic memory impairment stage, the patients do not exhibit any familiarity with the objects whose names they cannot find or recognize and are unable to appropriately use these objects. Semantic memory impairment in SD is attributed to damage of gray matter and of superior and inferior white matter connections in the anterior temporal lobe.

[The logopenic variant of primary progressive aphasia]

The logopenic variant of primary progressive aphasia [also referred to as logopenic progressive aphasia (LPA)] is the most recently identified variant of primary progressive aphasia (PPA). This disorder, characterized by a unique speech and language profile, occurs due to damage to specific anatomical areas. An international panel of experts has established a set of diagnostic criteria for PPA and its clinical variants. The clinical diagnostic criteria for the logopenic variant include core features such as impaired single-word retrieval in spontaneous speech and impaired repetition of sentences and phrases. Additional features, of which at least 3 are essential for diagnosing the logopenic variant, include phonological errors in speech, spared single-word comprehension and object knowledge, spared motor speech, and lack of frank agrammatism. For a next imaging-supported diagnosis, the aforementioned clinical features must be accompanied by imaging findings revealing atrophy, hypoperfusion, or hypometabolism in the left temporo-parietal junction area. Finally, a pathology-confirmed case of the logopenic variant requires a clinical diagnosis of the syndrome accompanied by histopathological data or the presence of a known pathogenic mutation. Studies have clarified the clinical phenotype of this disorder, suggesting a prominent impairment of the phonological working memory. Several studies have provided evidences of a possible link between the logopenic phenotype and the specific pathological and genetic correlates. The diagnostic guidelines will enable a more accurate identification of the individuals with the logopenic variant, thus facilitating the documentation of the course of illness and, ultimately, the underlying pathological substrate in this patient group via the pathology-confirmed series.

Fold-A-Board communication device

Aphasia is an impairment of language resulting from stroke that can affect a person's ability to use and comprehend words. People who have aphasia often keep a writing device handy to write down information that they have trouble communicating verbally. Device options include expensive keyboard devices or more commonly small inexpensive notebooks. Neither of these options fits the needs of someone with communication problems and the use of only one hand. Our goal was to design a device that would allow persons with aphasia and use of one hand to be able to communicate more easily with others on a daily basis. The information gathered from the interviews and observations gave us direction in our design process. We determined that the device should be accessible with one hand, be small in size, have an erasable surface, and have a professional appearance. Our final design is the Fold-A-Board communication device. The Fold-A-Board communication device meets all the requirements for an easy-to-use writing device.

Cerebral language reorganization in the chronic stage of recovery: a longitudinal fMRI study

The goal of the present study was to investigate whether spontaneous functional recovery following insult to the language-dominant hemisphere continues in the so-called "chronic stage," and if so, to examine its neuro-functional correlates. We used a longitudinal functional magnetic resonance imaging (fMRI) block design, where each young patient served as his/her own control. Specifically, we examined whether language functions differed significantly in two monitoring sessions conducted years apart, both in the chronic stage, where almost no functional changes are expected. We focused on a unique cohort of young brain damaged patients with aphasiogenic lesions occurring after normal language acquisition, in order to maximize the potential of plasticity for language reorganization following brain damage. The most striking finding was that the linguistic recovery of our patients was significant not just relative to their linguistic scores on initial testing (T1), but also in absolute terms, relative to the respective age-matched normal population. Such improvement, therefore, cannot be simply attributed to the natural process of development. Overall, we found that right hemisphere (RH) activation was associated with better recovery in the chronic stage. Our longitudinal findings may challenge the view of recovery as ending within the first year following onset, suggesting that the RH may provide the substrate for ongoing plasticity in the damaged brain.

Language organization and reorganization in epilepsy

The vast majority of healthy individuals are left hemisphere dominant for language; however, individuals with left hemisphere epilepsy have a higher likelihood of atypical language organization. The cerebral organization of language in epilepsy has been studied with invasive procedures such as Wada testing and electrical cortical stimulation mapping (ESM), and more recently, with noninvasive neuroimaging techniques such as functional magnetic resonance imaging (fMRI). Investigators have used these techniques to explore the influence of unique clinical features inherent in epilepsy that might contribute to the reorganization of language, such as location of seizure onset, age of seizure onset, and extent of interictal epileptiform activity. In this paper, we review the contribution of these and other clinical variables to the lateralization and localization of language in epilepsy, and how these patient-related variables affect the results from these three different, yet complementary methodologies. Unlike the abrupt language changes that occur following acute brain injury with disruption of established language circuits, converging evidence suggests that the chronic nature of epileptic activity can result in a developmental shift of language from the left to the right hemisphere or re-routing of language pathways from traditional to non-traditional areas within the dominant left hemisphere. Clinical variables have been shown to contribute to cerebral language reorganization in the setting of chronic seizure disorders, yet such factors have not been reliable predictors of altered language networks in individual patients, underscoring the need for language lateralization and localization procedures when definitive identification of language cortex is necessary for clinical care.

Semantic fluency and executive functions as candidate endophenotypes for the early diagnosis of schizophrenia in Han Chinese

Neurocognitive deficits are recognized as core features of schizophrenia. The aim of this study was to compare the cognitive performance of antipsychotic, drug-naive patients with first-episode schizophrenia (FES patients) to their healthy siblings and to healthy controls from the Han Chinese population for exploring potential endophenotypes for the early detection of schizophrenia. A battery of cognitive assessment tools was used to measure seven cognitive domains in matched groups consisting of 56 subjects each. Cognitive tests included the grooved pegboard test (GPT), the category fluency test (CFT), the trail making test A (TMT-A), the Wechsler memory scale-III spatial span test (WMS-III SST), the Hopkins verbal learning test-revised (HVLT-R), the brief visuospatial memory test-revised (BVMT-R), the paced auditory serial addition test (PASAT), and the Wisconsin card sorting test-64 cards version (WCST-64). The performances of FEP patients were inferior to normal controls on all neuropsychological tests, while siblings were lower than healthy controls in many of the same tasks. Patients' performances were lower than siblings' on all tests except for the CFT, the WMS-III SST backward test, and four subtests of the WCST-64. Our data suggest that FEP patients exhibited pronounced impairment of fine motor skills, speed of processing, attention, verbal memory, visual memory, and executive function, while siblings exhibited deficits intermediate between those of schizophrenic patients and the control group. Semantic fluency function and executive function may be potential endophenotypes for the early diagnosis of schizophrenia.

What can iconic gestures tell us about the language system? A case of conduction aphasia

BACKGROUND

Speech and language therapists rarely analyse iconic gesture when assessing a client with aphasia, despite a growing body of research suggesting that language and gesture are part of either the same system or two highly integrated systems. This may be because there has been limited research that has systematically analysed iconic gesture production by people with aphasia.

AIMS

The aim was to determine whether the gesture production of a participant with conduction aphasia was able to provide information about her language system.

METHODS & PROCEDURES

The iconic gestures produced by a participant with conduction aphasia (LT) and five control participants produced during the retelling of a cartoon were analysed. In particular, the iconic gestures produced during lexical retrieval difficulties (co-tip-of-the-tongue (co-TOT) gestures) were compared with the iconic gestures produced during fluent speech (co-speech gestures).

OUTCOMES & RESULTS

It was found that LT produced 57 co-speech gestures that were similar in form to the co-speech gestures produced by the control participants (mean = 34.2, standard deviation (SD) = 22.2). LT also produced an additional eleven co-TOT gestures that were unlike her co-speech gestures and unlike the co-speech gestures produced by the control participants. While the co-speech gestures depicted events, the co-TOT gestures depicted 'things' (for example, objects and animals). Furthermore, all but one of the co-TOT gestures produced by LT was classified as a shape-outline gesture, whereas co-speech gestures were rarely classified as shape-outline gestures. LT also produced a new type of gesture that has not previously been described in the literature: a homophone gesture. This co-TOT homophone gesture depicted the homophone of the target word. The iconic gestures produced by LT suggest that she had an intact semantic system but had difficulties with phonological encoding, consistent with a diagnosis of conduction aphasia. This raises the possibility that iconic gesture production can provide evidence about the level of breakdown in the language system.

CONCLUSIONS & IMPLICATIONS

A larger study exploring the gestures produced by participants with aphasia is required. The research also highlights the importance of including gesture assessments in SLT's work with adults with acquired language disorder.

Long-term neurodevelopmental outcomes of congenital diaphragmatic hernia survivors not treated with extracorporeal membrane oxygenation

BACKGROUND/PURPOSE

Although there has been a marked improvement in the survival of children with congenital diaphragmatic hernia (CDH) in the past 2 decades, there are few reports of long-term neurodevelopmental outcome in this population. The present study examined neurodevelopmental outcomes in 10- to 16-year-old CDH survivors not treated with extracorporeal membrane oxygenation (ECMO).

METHODS

Parents of 27 CDH survivors completed questionnaires assessing medical problems, daily living skills, educational outcomes, behavioral problems, and executive functioning. Fifteen CDH survivors and matched full-term controls completed standardized intelligence, academic achievement, phonological processing, and working memory tests.

RESULTS

Non-ECMO-treated CDH survivors demonstrated high rates of clinically significant difficulties on standardized academic achievement measures, and 14 of the 27 survivors had a formal diagnosis of specific learning disability, attention deficit hyperactivity disorder, or developmental disability. Specific problems with executive function, cognitive and attentional weaknesses, and social difficulties were more common in CDH patients than controls. Perioperative hypocapnia was linked to executive dysfunction, behavioral problems, lowered intelligence, and poor achievement in mathematics.

CONCLUSIONS

Non-ECMO-treated CDH survivors are at substantial risk for neurodevelopmental problems in late childhood and adolescence.

Cognitive and linguistic abnormalities in benign childhood epilepsy with centrotemporal spikes

AIM

To assess the cognitive function and language ability in children with benign partial epilepsy with centrotemporal spikes.

METHODS

Twenty-five patients with benign partial epilepsy with centrotemporal spikes were included. They were divided into two subgroups. Group I: 10 patients with rolandic focus who were not treated. Group II: 15 patients with rolandic focus receiving treatment. A third Group of 12 healthy subjects have been studied. All children underwent standardized neuropsychological testing: electroencephalogram recording, Wechsler Intelligence Scale for Children-revised, Peabody Picture Vocabulary Test-III (PPVT-III) and Boston Naming Test (BNT), both during active disease (T1) and 2 years after recovery from epilepsy (T2).

RESULTS

At T1 evaluation, no significant differences in group I and II patients about general intelligence, when compared with controls, were found. Group I and II patients were impaired with respect to controls in the receptive and expressive vocabulary evaluated with PCVT-III and BNT, respectively. At T2 evaluation, group I and II patients showed a normalization of the language abnormalities.

CONCLUSION

Deficits of speech-related abilities can be detected in children with this type of epilepsy: these dysfunctions seem to be independent of the effects of antiepileptic treatment and are reversible after remission of epilepsy.

Action (verb) fluency in schizophrenia: getting a grip on odd speech

BACKGROUND

Formal thought disorder (TD) is a key symptom of schizophrenia with a significant impact on interpersonal relationships. Current cognitive models emphasize disordered language functioning and abnormalities accessing semantic representations. The cortical mechanisms for language and motor function are closely linked, hence action-related language may be impaired in TD, yet existing studies have focussed exclusively on object (noun) rather than action (verb) semantics.

METHOD

In order to examine this issue both action (verb) and traditional semantic (tools, fruits, musical instruments) and phonological (FAS) fluency tasks were completed by individuals with schizophrenia (N=53) and healthy controls (N=69). Fluency performance was measured as the total number of correct words generated in 60s. The Schizotypal Personality Questionnaire (SPQ) was used to index odd and disorganized speech, as well as positive and negative symptoms.

RESULTS

Fluency on all tasks was impaired in schizophrenia, compared to controls, with a similar effect size. Within the schizophrenia group Odd Speech was correlated with poor fluency for actions, tools and musical instruments but not fruit or phonological fluency. These action-related fluency deficits were also correlated with Constricted Affect and Social Anxiety but not with Unusual Perceptions/Odd Beliefs.

CONCLUSION

These results point to a unique connection and possible common aetiology between action fluency and odd speech in schizophrenia rather than a general impairment in language/executive functions common to fluency tasks. The findings provide the first evidence of a specific role of action-based language production deficits in TD together with a joint effect on social interaction skills.

Survey of speech and language therapy provision for people with Parkinson's disease in the United Kingdom: patients' and carers' perspectives

BACKGROUND

Communication and swallowing changes are prominent in Parkinson's disease, but there remains a lack of information regarding the experiences and expectations of people with Parkinson's disease in respect of speech-language therapy (SLT) services.

AIMS

To conduct a survey of people with Parkinson's disease and their carers in the United Kingdom to elicit their views concerning communication and swallowing changes in Parkinson's disease and the support they envisage in helping with these changes.

METHODS & PROCEDURES

A national survey utilizing a questionnaire developed for the project, accessible by people with Parkinson's disease in web-based, e-mail or paper forms.

OUTCOMES & RESULTS

A total of 168 people with Parkinson's disease (median = 7 years since diagnosis, range = 0.5-30) and 47 carers who provided their impression of the experience of the PwPD responded. Of these 215, 92 (43%) had no contact with SLT services. In general those who had seen an SLT found it a positive experience. Pointers for improvement centred around timing, intensity, duration and access to SLT as well as issues around transfer and maintenance of gains outside of clinic and (lack of) attention to psychosocial dimensions. Availability of ongoing support as the situation evolved and access to SLT when it was needed were two prominent features desired of a responsive service.

CONCLUSIONS & IMPLICATIONS

Responses suggest that when SLT is available it offers positive support, but respondents felt (re)access when and where SLT is needed could improve, as well as what aspects of swallowing and communication were addressed in assessment and therapy. We reflect on possible recommendations to address the challenges for SLT services in considering organization and content of provision.

National survey of speech and language therapy provision for people with Parkinson's disease in the United Kingdom: therapists' practices

BACKGROUND

Communication and swallowing changes feature prominently in Parkinson's disease. People with Parkinson's disease appear under-represented in speech-language therapy clinics in the United Kingdom. The nature of the speech-language therapy services in the UK to people with Parkinson's disease has not been examined.

AIMS

To ascertain the number of speech-language therapists in the UK who work with people with Parkinson's disease; to establish the nature of contacts in terms of caseloads, referral stages and routes, management practices, assessments and treatments employed; and to reflect on service provision in relation to published guidelines.

METHODS & PROCEDURES

A questionnaire survey of speech-language therapists.

OUTCOMES & RESULTS

A total of 185 speech-language therapists responded. They were treating a median of three (inter-quartile range (IQR) = 1-6) people with Parkinson's disease with a further median of five (IQR = 1-10) on review. The majority of contacts were for assessment and advice given, especially in later and earlier stages of Parkinson's disease. Typically, respondents offered a median of six sessions (IQR = 6-8) of treatment, each session lasting a median of 45 min (IQR = 45-60), delivered over a median period of 42 days (IQR = 28-56). Speech-language therapists worked in a variety of settings, predominantly hospital. They received referrals principally from medical specialities, from whom the majority had support. Referrals were perceived in general to be later in Parkinson's disease progression than desired. Assessment focused primarily on impairment measures, in contrast to a belief that therapy focus on activity and participation issues. Speech-language therapists were relatively confident in treating people with Parkinson's disease, but 75% wanted more training.

CONCLUSIONS & IMPLICATIONS

Speech-language therapist services for people with Parkinson's disease in the UK are restricted on most dimensions. Management practices often do not match guideline suggestions. Consideration needs to be given to the training for, content of and delivery of speech-language therapy services for people with Parkinson's disease.

Agnosic or semantic impairment in very mild Alzheimer's disease?

The present study investigated object recognition impairment and the existence of category effects in patients with mild Alzheimer's disease. A battery of tests was designed to assess the deterioration of semantic memory and/or the existence of agnosia by evaluating visual and auditory naming, knowledge of structural descriptions (pre-semantic representation of an object within each perceptual system) and conceptual knowledge. The group of Alzheimer's patients were impaired in all experimental tests as compared to healthy participants. This result suggests an impairment of multiple levels of object integration processing even at an early stage of the disease. The patients also demonstrated a category effect with massive difficulties in recognizing human actions and musical instruments as compared to the other categories. This study provides an innovative clinical tool for exploring the recognition of visual and auditory objects at different levels of representation, allowing for the description of early signs of Alzheimer disease.

Effect of Parkinson's disease on the production of structured and unstructured speaking tasks: respiratory physiologic and linguistic considerations

PURPOSE

To examine the effects of cognitive-linguistic deficits and respiratory physiologic changes on respiratory support for speech in individuals with Parkinson's disease (PD) using two speech tasks: reading and extemporaneous speech.

METHOD

Five women with PD, 9 men with PD, and 14 age- and sex-matched control participants read a passage and spoke extemporaneously on a topic of their choice at comfortable loudness. Sound pressure level, syllables per breath group, speech rate, and lung volume parameters were measured. Number of formulation errors, disfluencies, and filled pauses were counted.

RESULTS

Individuals with PD produced shorter utterances compared with control participants. The relationships between utterance length and lung volume initiation and inspiratory duration were weaker for individuals with PD than for control participants, particularly for the extemporaneous speech task. These results suggest less consistent planning for utterance length by individuals with PD in extemporaneous speech. Individuals with PD produced more formulation errors in both tasks and significantly fewer filled pauses in extemporaneous speech.

CONCLUSION

Both respiratory physiologic and cognitive-linguistic issues affected speech production by individuals with PD. Overall, individuals with PD had difficulty planning or coordinating language formulation and respiratory support, particularly during extemporaneous speech.

[Imaging of language and communication in dementia]

BACKGROUND

Social interaction in patients with dementia is compromised by language problems and impairment of other cognitive domains involved in communication.

AIM

To describe language and communication problems in patients with dementia and to provide insight into the neurological basis of these problems.

METHOD

Our study is based on some of our own research findings and on relevant literature concerning the imaging of language and communication in patients with Alzheimer's disease and frontotemporal degeneration.

RESULTS

Imaging revealed that the clinical expression of communicative disorders in patients with cortical neurodegeneration depends on regional brain atrophy and a possible functional reorganisation triggered by neuropathological changes.

CONCLUSION

Brain imaging increases our knowledge about the pathogenesis of communicative disorders in dementia.

Safety and efficacy of rivastigmine in adolescents with Down syndrome: long-term follow-up

Following the completion of a 20-week, open-label study of the safety and efficacy of liquid rivastigmine for adolescents with Down syndrome, 5 of the 10 adolescents in the clinical trial continued long-term rivastigmine therapy and 5 did not. After an average period of 38 months, all 10 subjects returned for a follow-up assessment to determine the safety and efficacy of long-term rivastigmine use. Rivastigmine was well tolerated and overall health appeared to be unaffected by long-term rivastigmine use. Performance change on cognitive and language measures administered at the termination of the open-label clinical trial was compared between the two groups. No between-group difference in median performance change across the long-term period was found, suggesting that the long-term use of rivastigmine does not improve cognitive and language performance. However, two subjects demonstrated remarkable improvement in adaptive function over the long-term period. Both subjects had received long-term rivastigmine therapy. The discussion addresses the challenge of assessing cognitive change in clinical trials using adolescents with Down syndrome as subjects and the use of group versus individual data to evaluate the relevance of medication effects.

[Language disorders in ALS/FTLD]

In the 1990s, the concept of frontotemporal lobar degeneration (FTLD) was proposed as a clinicopathological entity preferentially involving the frontotemporal lobes, and recent pathological findings have suggested a linkage of FTLD with ALS. FTLD includes frontotemporal dementia (FTD), reflecting behavioral changes, and progressive non-fluent aphasia (PNFA) and semantic dementia (SD) as language disorders. Although language problems appear to have become of interest relatively recently, an historical Japanese account (1893) written by Watanabe described aphasia in bulbar-onset ALS. This report is entitled "A patient who manifested cortical motor aphasia concurrently with bulbar palsy and progressive muscular atrophy", and is the first case report of aphasia published in Japan. Thus, language problems in ALS may have been overlooked for many years. We have reported that ALS patients frequently show omission and paragraphia of kana letters, and syntactic errors in writing, and that these observations differ across patients. We also showed double dissociation between errors in kana and kanji characters in some patients, with preferential involvement of the frontotemporal lobes and frontal- and temporal-lobe predominance for kana and kanji, respectively. We also showed that the writing errors can appear as agraphia without aphasia.

Language, motor and speed of processing deficits in adolescents with subclinical psychotic symptoms

OBJECTIVES

Neuropsychological impairment is a core feature of schizophrenia. Adolescents reporting subclinical psychotic symptoms are considered to be at greater risk of developing a psychotic illness later in life than adolescents who do not report such symptoms and, thus, may represent an at-risk group for further study. We wished to investigate neuropsychological functioning in early adolescence in relation to reports of psychotic symptoms.

METHODS

Participants were recruited from local primary schools after a two-stage screening and parental consent process. In brief, 277 adolescents were screened and 37 attended for testing. Seventeen adolescents who were deemed to report 'definite' psychotic symptoms after clinical interview and 20 control adolescents underwent a clinical interview and a one-hour neuropsychological battery.

RESULTS

Adolescents who report psychotic symptoms exhibited significant impairments in receptive language (as measured by the British Picture Vocabulary Scale), motor function (as measured by the Pegboard test) and executive function/speed of processing (as measured by the Trail-Making test). There were no significant differences between the groups on measures of attention, memory or expressive language, abstract reasoning or overall scholastic ability.

CONCLUSIONS

Taken together with the results from birth cohort, genetic high risk and prodromal studies, these findings are consistent with a neural inefficiency/disconnectivity hypothesis in those at risk for psychosis. These results highlight the need to investigate developmental brain circuits subserving language and motor function and processing speed and how these change over time in at-risk adolescents.

Decreased semantic competitive inhibition in Parkinson's disease: Evidence from an investigation of word search performance

Aberrant semantic competitive inhibition has been reported in Parkinson's disease (PD). Whether PD-related alterations cause an increase or a decrease in lateral inhibition, however, remains unclear. Accordingly, the present study aimed to examine semantic inhibition during lexical-semantic processing in non-demented people with PD. Twenty-two people with PD and 18 matched controls completed a computerized word search task in which both the relationship between the background items and the target (related or unrelated) and the search type (open e.g., any dog or closed e.g., collie) were manipulated. It was hypothesized that decreased semantic inhibition would be evidenced by abnormally short response times for open searches among words related to the target, while increased inhibition would lead to abnormally long response times. Analysis of the results revealed that control participants performed open searches faster for unrelated vs related word lists. In contrast, the PD group recorded similar response times regardless of background items. Hence, the present findings are consistent with the notion of decreased semantic competitive inhibition in PD and suggest that an impaired ability to inhibit unwanted information during lexical retrieval may underlie observed deficits on semantic tasks such as verbal fluency.

Cognition, language, and clinical pathological features of non-Alzheimer's dementias: an overview

There are many distinct forms of dementia whose pharmacological and behavioral management differ. Differential diagnosis among the dementia variants currently relies upon a weighted combination of genetic and protein biomarkers, neuroanatomical integrity, and behavior. Diagnostic specificity is complicated by a high degree of overlap in the initial presenting symptoms across dementia subtypes. For this reason, reliable markers are of considerable diagnostic value. Communication disorders have proven to be among the strongest predictors for discriminating among dementia subtypes. As such, speech-language pathologists may be poised to make an increasingly visible contribution to dementia diagnosis and its ongoing management. The value and durability of this potential contribution, however, demands an improved discipline-wide knowledge base about the unique features associated with different dementia variants. To this end we provide an overview of cognition, language, and clinical pathological features of four of the most common non-Alzheimer's dementias: frontotemporal dementia, vascular dementia, Lewy body disease dementia, and Parkinson's disease dementia.

LEARNING OUTCOMES

Readers will learn characteristics and distinguishing features of several non-Alzheimer's dementias, including Parkinson's disease dementia, frontotemporal dementia, vascular dementia, and Lewy body dementia. Readers will also learn to distinguish between several variants of frontotemporal dementia. Finally, readers will gain knowledge of the term primary progressive aphasia as it relates to the aforementioned dementia etiologies.

The nature of naming errors in primary progressive aphasia versus acute post-stroke aphasia

OBJECTIVE

To compare the distribution of error types across subgroups of primary progressive aphasia and poststroke aphasia in different vascular locations.

METHOD

We analyzed naming errors in 49 individuals with acute left hemisphere ischemic stroke and 55 individuals with three variants of primary progressive aphasia. Location of atrophy or ischemic stroke was characterized using MRI.

RESULTS

We found that distribution of error types was very similar across all subgroups, irrespective of the site or etiology of the lesion. The only significant difference across groups was the percentage of circumlocutions (F(7, 96) = 3.02, p = .005). Circumlocution errors were highest among logopenic variant PPA (24%) and semantic variant PPA (24%). Semantic coordinate errors were common in all groups, probably because they can arise from disruption of different cognitive processes underlying naming and, therefore, from different locations of brain damage.

CONCLUSIONS

Semantic errors are common among all types of primary progressive aphasia and poststroke aphasia, and the type of error depends in part on the location of damage.

Digit Span in Dyslexia: Variations According to Language Comprehension and Mathematics Skills

The aim of this study was to investigate digit span performance in dyslexia. It was hypothesised that differences would be found in accordance with subgrouping by language comprehension and mathematic skills, and by analyses of how the digit span scores were attained. Two digit span tasks were given to a group of dyslexic children and controls (n = 57), mean age 12.62 (SD = 1.43). The tasks were "Digit Span" of the WISC-R, and "Digit Span 2," where the use of back-up strategies like finger counting and lip reading were restricted. As expected, the digit span scores were significantly lower in the dyslexia group than in the control group. Restrictions of back-up strategies did not alter the scores in the control group, while the scores were lowered in the dyslexia group. Further analyses of longest digit span, serial recall, and serial position indicated different retrieval patterns in the subgroups. The subgroup with good language comprehension and mathematic skills (n = 12), showed impaired serial recall especially in backward recall. The subgroup with good language comprehension skills, but with mathematics impairment (n = 9), showed impaired serial recall in both forward and backward recall. The subgroup with language impairments (n = 16), recalled fewer digits than the two other subgroups. The findings were discussed in relation to the "Phonological loop" of the Multi Component Model of Working Memory, and implications for intervention were discussed.

The language phenotype of children and adolescents with Noonan syndrome

PURPOSE

This study presents an analysis of language skills in individuals with Noonan syndrome (NS), an autosomal dominant genetic disorder. We investigated whether the language impairments affecting some individuals arise from deficits specifically within the linguistic system or whether they are associated with cognitive, perceptual, and motor factors. Comparisons of language abilities among the different NS genotypes were also conducted.

METHOD

Sixty-six children and adolescents with NS were evaluated using standardized speech, language, and literacy assessments. Additional cognitive, perceptual, and motor tasks were administered to examine the relation of these factors to language development. Genotype was noted for those who underwent genetic testing.

RESULTS

Language impairments were more frequent in NS than in the general population and were associated with higher risk for reading and spelling difficulties. Language was significantly correlated with nonverbal cognition, hearing ability, articulation, motor dexterity, and phonological memory. Genotype analyses suggest that the higher performance of SOS1-positive than PTPN11-positive individuals on language tasks was largely mediated by differences in cognitive ability.

CONCLUSIONS

Our results indicate that variation in language skill in NS is closely related to cognitive, perceptual, and motor factors. It does not appear that specific aspects of language are selectively affected in this syndrome.

Overlaps between autism and language impairment: phenomimicry or shared etiology?

Traditionally, autistic spectrum disorder (ASD) and specific language impairment (SLI) are regarded as distinct conditions with separate etiologies. Yet these disorders co-occur at above chance levels, suggesting shared etiology. Simulations, however, show that additive pleiotropic genes cannot account for observed rates of language impairment in relatives, which are higher for probands with SLI than for those with ASD + language impairment. An alternative account is in terms of ‘phenomimicry’, i.e., language impairment in comorbid cases may be a consequence of ASD risk factors, and different from that seen in SLI. However, this cannot explain why molecular genetic studies have found a common risk genotype for ASD and SLI. This paper explores whether nonadditive genetic influences could account for both family and molecular findings. A modified simulation involving G × G interactions obtained levels of comorbidity and rates of impairment in relatives more consistent with observed values. The simulations further suggest that the shape of distributions of phenotypic trait scores for different genotypes may provide evidence of whether a gene is involved in epistasis.

HIV-associated deficits in action (verb) generation may reflect astrocytosis

Commensurate with the hypothesized neural dissociation between verb and noun generation, research in HIV infection shows that, relative to noun fluency, action (verb) fluency is disproportionately impaired, more strongly related to executive dysfunction, and more sensitive to declines in everyday functioning. However, whether the neurobiological correlates of HIV-associated deficits in verb and noun generation are separable have not heretofore been investigated. The present study examined the biomarker correlates of action and noun fluency in 74 participants with HIV infection. Biomarkers of viral burden, neuroaxonal damage, macrophage activation, neuroprotection, inflammation, and astrocytosis were measured in plasma and cerebrospinal fluid (CSF). Deficits in action, but not noun generation, were significantly associated with higher CSF levels of S100beta, a marker of astrocyte activation, even after controlling for antiretroviral therapy, current immune compromise, and general cognitive impairment. Concurrent validity for the frontal systems hypothesis of verb generation was provided by post hoc analyses demonstrating that S100beta was also associated with measures of executive functions, but not semantic memory or psychomotor speed. Overall, these findings suggest that HIV-associated impairment in action fluency, and executive dysfunction more generally, may reflect astrocytosis (i.e., elevated S100beta). Complementing the literature in HIV and other clinical populations with frontal systems involvement, these data also support the possible neurobiological dissociation of noun and verb generation.

Hippocampal removal affects visual but not auditory naming

OBJECTIVE

Dominant, left anteromedial temporal lobe resection (AMTLR) for seizure control carries risks to verbal episodic memory and visual object naming. Consistent with traditional thinking, verbal memory decline is considered a consequence of hippocampal removal and naming decline has been attributed to lateral temporal resection. Interestingly, recent findings suggest a potential relation between visual naming and hippocampal integrity, which is consistent with studies that link the hippocampus with higher level visual processing. Historically, naming has been evaluated using visual object naming tasks; however, naming can also be assessed using auditory verbal descriptions. Recent cortical stimulation studies have shown a neuroanatomic distinction between visual naming and auditory description naming. We speculated that unlike visual naming, the hippocampus is not involved in auditory naming, and hypothesized that left AMTLR would not result in auditory naming decline, despite visual naming and verbal memory decline.

METHODS

In this cohort study, we tested auditory naming, visual naming, and verbal memory in 25 left medial temporal lobe epilepsy (MTLE) and 20 right MTLE patients pre-AMTLR and 1 year post-AMTLR.

RESULTS

Left AMTLR patients declined in visual naming and verbal memory, with no decline in auditory naming. Right AMTLR patients exhibited no decline.

CONCLUSIONS

Results suggest that left anteromedial temporal lobe resection presents a greater risk to visual naming than auditory naming in patients with left medial temporal lobe epilepsy.

Effects of online augmented kinematic and perceptual feedback on treatment of speech movements in apraxia of speech

Apraxia of speech (AOS) is a motor speech disorder characterized by disturbed spatial and temporal parameters of movement. Research on motor learning suggests that augmented feedback may provide a beneficial effect for training movement. This study examined the effects of the presence and frequency of online augmented visual kinematic feedback (AVKF) and clinician-provided perceptual feedback on speech accuracy in 2 adults with acquired AOS. Within a single-subject multiple-baseline design, AVKF was provided using electromagnetic midsagittal articulography (EMA) in 2 feedback conditions (50 or 100%). Articulator placement was specified for speech motor targets (SMTs). Treated and baselined SMTs were in the initial or final position of single-syllable words, in varying consonant-vowel or vowel-consonant contexts. SMTs were selected based on each participant's pre-assessed erred productions. Productions were digitally recorded and online perceptual judgments of accuracy (including segment and intersegment distortions) were made. Inter- and intra-judge reliability for perceptual accuracy was high. Results measured by visual inspection and effect size revealed positive acquisition and generalization effects for both participants. Generalization occurred across vowel contexts and to untreated probes. Results of the frequency manipulation were confounded by presentation order. Maintenance of learned and generalized effects were demonstrated for 1 participant. These data provide support for the role of augmented feedback in treating speech movements that result in perceptually accurate speech production. Future investigations will explore the independent contributions of each feedback type (i.e. kinematic and perceptual) in producing efficient and effective training of SMTs in persons with AOS.

[Language impairment in amyotrophic lateral sclerosis]

For a long time, amyotrophic lateral sclerosis (ALS) was thought to be a neuro-degenerative disease with selective involvement of the motor neuron system. However, it has recently been established that ALS is a multisystem disorder that not only involve the motor system but also affects cognition. A typical cognitive impairment in ALS is frontotemporal dementia: a clinical subtype of frontotemporal lobar degeneration (FTLD). Furthermore, language impairment, including progressive non-fluent aphasia (PA) and semantic dementia (SD), which are also FTLD subtypes, have been linked to bulbar-onset ALS. Beside recent studies a Japanese paper published in 1893 gives an account of aphasia in bulbar-onset ALS. Interestingly, this was the first account of aphasia in Japan. Thus, language-related problems in ALS may have been overlooked, because evaluation of aphasic problems in ALS patients is difficult, mainly because of progressive bulbar or pseudo-bulbar palsy that results in and dysarthria. From a clinical point of view, progressing bulbar symptoms and medical interventions, such artificial ventilation make it difficult to evaluate language functions in ALS. However, we do observe frequent omission and paragraphia of kana letters, and syntactic errors in writing. Interestingly, some patients make exhibit errors exclusively in the case of kanji characters. Thus, evaluation of writing samples is important if order to identify language problems in ALS patients. The findings may also provide additional information such as dissociation between errors made in kana and kanji characters. The characteristic features of writing errors are thought to reflect the nature of aphasia including PA and SD, that are easily masked by dysarthria. In addition, writing errors can appear as "isolated agraphia" without aphasia and dementia. Pathologically, writing errors should indicate the brain regions involved by ALS, e.g., hemispheric dominance and frontal or temporal lobe involvement. In addition, selective involvement of Exner's writing center in the frontal lobe may be responsible for "isolated agraphia". Hence, further studies are required to determine the clinical significance of writing errors in ALS patients and their pathological correlation.

Cerebellar mutism in pediatric acute disseminated encephalomyelitis

Acute disseminated encephalomyelitis is a demyelinating process affecting multiple areas of the central nervous system, frequently including the cerebellum. Cerebellar insult may lead to absence of speech or cerebellar mutism. Cerebellar mutism often occurs in young children after posterior fossa tumor resection, and generally appears as part of a larger subset of neurobehavioral signs and personality changes known as posterior fossa syndrome. Information on the impact of widespread cerebellar involvement on speech production, behavior, and long-term outcomes in acute disseminated encephalomyelitis is limited. We describe cases of acute disseminated encephalomyelitis with predominantly cerebellar involvement, with specific attention to cerebellar mutism. We conducted a retrospective chart review of children diagnosed with acute disseminated encephalomyelitis between 2005-2009 at a pediatric multiple sclerosis and demyelinating disorders clinic. Of 19 patients diagnosed with acute disseminated encephalomyelitis, six (32%) manifested primary cerebellar involvement. Of these six, four (67%) exhibited acute language disturbance, with three (50%) exhibiting mutism. The three patients with cerebellar mutism experienced protracted speech and language deficits after follow-ups from 6 months to 4 years. Widespread cerebellar involvement in acute disseminated encephalomyelitis may result in cerebellar mutism, in addition to persistent neurocognitive and behavioral problems.

Relation of executive functioning to pragmatic outcome following severe traumatic brain injury

PURPOSE

This study was designed to explore the behavioral nature of pragmatic impairment following severe traumatic brain injury (TBI) and to evaluate the contribution of executive skills to the experience of pragmatic difficulties after TBI.

METHOD

Participants were grouped into 43 TBI dyads (TBI adults and close relatives) and 43 control dyads. All TBI participants had sustained severe injury (mean posttraumatic amnesia duration = 45.19 days, SD = 39.15) due to a moving vehicle-related trauma. A minimum of 2 years had elapsed since injury (M = 5.36 years, SD = 3.61). The La Trobe Communication Questionnaire (LCQ; Douglas, O'Flaherty, & Snow, 2000) was administered to all participants. Measures of executive function included the following: the FAS verbal fluency task (Spreen & Benton, 1969), the Speed and Capacity of Language Processing test (Baddeley, Emslie, & Nimmo-Smith, 1992), and the Rey Auditory Verbal Learning Task (Rey, 1964).

RESULTS

Perceptions of TBI participants and their relatives were significantly correlated (r = .63, p < .001) and significantly different from those of controls, F(1, 84) = 37.2, p < .001. Pragmatic difficulties represented violations in 3 domains of Grice's (1975) Cooperative Principle (Quantity, Relation, and Manner), and executive function measures predicted 37% (32% adjusted) of the variability in LCQ scores.

CONCLUSIONS

The study demonstrates evidence of a significant association between executive impairment and the pragmatic communication difficulties experienced by individuals with TBI.

Pragmatic comprehension deficit in Parkinson's disease

Recognizing the specific speech act (Searle, 1969) that a speaker performs with an utterance is a fundamental feature of pragmatic competence. However, little is known about neurocognitive mediation of speech act comprehension. The present research examined the extent to which people with Parkinson's disease (PD) comprehend specific speech acts. In the first experiment, participants read conversational utterances and then performed a lexical decision task (decide whether a target string of letters was a word). Consistent with past research, nonimpaired participants performed this task more quickly when the target string was the speech act associated with the preceding utterance. In contrast, people with PD did not demonstrate this effect, suggesting that speech act activation is slowed or is not an automatic component of comprehension for people with PD. In a second study, participants were given unlimited time to indicate their recognition of the speech act performed with an utterance. PD participants were significantly poorer at this task than were control participants. We conclude that a previously undocumented language disorder exists in PD and that this disorder involves a selective deficit in speech act comprehension. Frontostriatal systems (the systems impaired in PD) likely contribute to normal speech act comprehension.

Preserving syntactic processing across the adult life span: the modulation of the frontotemporal language system in the context of age-related atrophy

Although widespread neural atrophy is an inevitable consequence of normal aging, not all cognitive abilities decline as we age. For example, spoken language comprehension tends to be preserved, despite atrophy in neural regions involved in language function. Here, we combined measures of behavior, functional activation, and gray matter (GM) change in a younger (19-34 years) and older group (49-86 years) of participants to identify the mechanisms leading to preserved language comprehension across the adult life span. We focussed primarily on syntactic functions because these are strongly left lateralized, providing the potential for contralateral recruitment. In an functional magnetic resonance imaging study, we used a word-monitoring task to minimize working memory demands, manipulating the availability of semantics and syntax to ask whether syntax is preserved in aging because of the functional recruitment of other brain regions, which successfully compensate for neural atrophy. Performance in the older group was preserved despite GM loss. This preservation was related to increased activity in right hemisphere frontotemporal regions, which was associated with age-related atrophy in the left hemisphere frontotemporal network activated in the young. We argue that preserved syntactic processing across the life span is due to the shift from a primarily left hemisphere frontotemporal system to a bilateral functional language network.

Diagnosis and management of Duchenne muscular dystrophy, part 2: implementation of multidisciplinary care

Optimum management of Duchenne muscular dystrophy (DMD) requires a multidisciplinary approach that focuses on anticipatory and preventive measures as well as active interventions to address the primary and secondary aspects of the disorder. Implementing comprehensive management strategies can favourably alter the natural history of the disease and improve function, quality of life, and longevity. Standardised care can also facilitate planning for multicentre trials and help with the identification of areas in which care can be improved. Here, we present a comprehensive set of DMD care recommendations for management of rehabilitation, orthopaedic, respiratory, cardiovascular, gastroenterology/nutrition, and pain issues, as well as general surgical and emergency-room precautions. Together with part 1 of this Review, which focuses on diagnosis, pharmacological treatment, and psychosocial care, these recommendations allow diagnosis and management to occur in a coordinated multidisciplinary fashion.

[Relearning vocabulary. A comparative analysis between a case of dementia and Alzheimer's disease with predominant compromise of language]

INTRODUCTION

Semantic dementia is characterised by a progressive loss of semantic content that initially affects the capacity to name things, and is associated with asymmetric atrophy of the anterior temporal lobes. In Alzheimer's disease (AD) with predominant compromise of language, anomia is also the main symptom. The study examined the capacity to relearn vocabulary of two patients, each exhibiting one of these two forms of degenerative anomia.

CASE REPORTS

The two cases presented similar ages, gender, levels of schooling and degree of compromise. Their capacity to name a list of 40 pictures was evaluated at baseline, following 20 sessions of relearning, at one month and at six months. The patient with semantic dementia named 25/40 objects at baseline, 40/40 after relearning, 35/40 at one month and 27/40 at six months. The patient with AD named 29/40 at baseline, 30/40 after relearning, 29/40 at one month and 32/40 at six months. No intrusions were observed following relearning.

CONCLUSIONS

The patient with semantic dementia was able to relearn all the vocabulary she was shown, even though she lost everything she had acquired after treatment was interrupted. The AD patient did not improve her naming capacity with therapy. These differences suggest that the learning and consolidation circuits are affected in different ways. Subjects with semantic dementia, but not those with AD, could benefit from word relearning strategies with this method.

Grammatical processing in schizophrenia: evidence from morphology

Patients with psychiatric disorders such as schizophrenia commonly present with impaired language. Here we investigate language in schizophrenia with a focus on inflectional morphology, using an intensively studied and relatively well-understood linguistic paradigm. Patients with schizophrenia (n=43) and age-matched healthy control subjects (n=42) were asked to produce past tenses of regular (slip), irregular (swim), and novel (plag) English verbs. Patients were impaired at regulars and novels (slipped, plagged), with relative sparing of irregulars (swam), controlling for numerous subject- and item-specific factors (e.g., IQ, phonological complexity). Additionally, patients' thought-disorder scores significantly predicted their performance at regular and novel (but not irregular) past-tense production. The results support grammatical deficits in schizophrenia, with a relative sparing of lexical memory, and suggest that thought disorder may be linked with grammatical impairments in the disorder.

[Summer school speech therapy for children with cleft palate and language disorder]

INTRODUCTION

Cleft palate patients with language impairment require specific therapy.

OBJECTIVE

Study two modalities of speech intervention in cleft palate children with associated linguistic impairment, a conventional approach providing speech therapy, twice a week, and a speech summer camp for a period of three weeks.

MATERIALS AND METHODS

Twenty-five cleft palate patients with language impairment were studied. A matched control group was gathered. Patients included in the first group attended a three week duration speech summer camp. Control patients included in the second group received speech therapy twice a week.

RESULTS

At the onset of either the summer camp or the speech intervention period, the severity of language impairment was evenly distributed with non-significant differences across groups (p > 0.05). After the summer camp or 9 months of speech therapy sessions, both groups showed a significant decrease in the severity of language impairment (p < 0.05). At the end of the summer camp, and the therapy period, non-significant differences, were found between groups (p > 0.05).

CONCLUSIONS

Speech summer camp is a reliable and efficient method to provide speech therapy for left palate patients with language impairment.