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Peterson KA, Patterson K, Rowe JB. Language impairment in progressive supranuclear palsy and corticobasal syndrome. J Neurol 2021; 268:796-809. [PMID: 31321513 PMCID: PMC7914167 DOI: 10.1007/s00415-019-09463-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/06/2019] [Accepted: 07/09/2019] [Indexed: 12/11/2022]
Abstract
Although commonly known as movement disorders, progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS) may present with changes in speech and language alongside or even before motor symptoms. The differential diagnosis of these two disorders can be challenging, especially in the early stages. Here we review their impact on speech and language. We discuss the neurobiological and clinical-phenomenological overlap of PSP and CBS with each other, and with other disorders including non-fluent agrammatic primary progressive aphasia and primary progressive apraxia of speech. Because language impairment is often an early and persistent problem in CBS and PSP, there is a need for improved methods for language screening in primary and secondary care, and more detailed language assessments in tertiary healthcare settings. Improved language assessment may aid differential diagnosis as well as inform clinical management decisions.
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Affiliation(s)
- Katie A Peterson
- Department of Clinical Neurosciences and MRC Cognition and Brain Sciences Unit, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, UK.
| | - Karalyn Patterson
- Department of Clinical Neurosciences and MRC Cognition and Brain Sciences Unit, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, UK
| | - James B Rowe
- Department of Clinical Neurosciences and MRC Cognition and Brain Sciences Unit, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, UK
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Kübel S, Stegmayer K, Vanbellingen T, Walther S, Bohlhalter S. Deficient supplementary motor area at rest: Neural basis of limb kinetic deficits in Parkinson's disease. Hum Brain Mapp 2018; 39:3691-3700. [PMID: 29722099 DOI: 10.1002/hbm.24204] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 04/16/2018] [Accepted: 04/23/2018] [Indexed: 12/14/2022] Open
Abstract
Parkinson's disease (PD) patients frequently suffer from limb kinetic apraxia (LKA) affecting quality of life. LKA denotes an impairment of precise and independent finger movements beyond bradykinesia, which is reliably assessed by coin rotation (CR) task. BOLD fMRI detected activation of a left inferior parietal-premotor praxis network in PD during CR. Here, we explored which network site is most critical for LKA using arterial spin labeling (ASL). Based on a hierarchical model, we hypothesized that LKA would predominantly affect the functional integrity of premotor areas including supplementary motor areas (SMA). Furthermore, we suspected that for praxis function with higher demand on temporal-spatial processing such as gesturing, inferior parietal lobule (IPL) upstream to premotor areas would be essential. A total of 21 PD patients and 20 healthy controls underwent ASL acquisition during rest. Behavioral assessment outside the scanner involved the CR, finger tapping task, and the test of upper limb apraxia (TULIA). Whole-brain analysis of activity at rest showed a significant reduction of CR-related perfusion in the left SMA of PD. Furthermore, the positive correlation between SMA perfusion and CR, seen in controls, was lost in patients. By contrast, TULIA was significantly associated with the perfusion of left IPL in both patients and controls. In conclusion, the findings suggest that LKA in PD are linked to an intrinsic disruption of the left SMA function, which may only be overcome by compensatory network activation. In addition, gestural performance relies on IPL which remains available for functional recruitment in early PD.
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Affiliation(s)
- Stefanie Kübel
- Neurocenter, Luzerner Kantonsspital, Spitalstrasse 31, Luzern 16, 6000, Switzerland
| | - Katharina Stegmayer
- University Hospital of Psychiatry, Bolligenstrasse 111, Bern 60, 3000, Switzerland
| | - Tim Vanbellingen
- Neurocenter, Luzerner Kantonsspital, Spitalstrasse 31, Luzern 16, 6000, Switzerland.,Gerontechnology and Rehabilitation Group, University of Bern, Murtenstrasse 50, Bern, 3008, Switzerland
| | - Sebastian Walther
- University Hospital of Psychiatry, Bolligenstrasse 111, Bern 60, 3000, Switzerland
| | - Stephan Bohlhalter
- Neurocenter, Luzerner Kantonsspital, Spitalstrasse 31, Luzern 16, 6000, Switzerland.,Department of Clinical Research, University of Bern, Bern, 3000, Switzerland
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Misch MR, Mitchell S, Francis PL, Sherborn K, Meradje K, McNeely AA, Honjo K, Zhao J, Scott CJ, Caldwell CB, Ehrlich L, Shammi P, MacIntosh BJ, Bilbao JM, Lang AE, Black SE, Masellis M. Differentiating between visual hallucination-free dementia with Lewy bodies and corticobasal syndrome on the basis of neuropsychology and perfusion single-photon emission computed tomography. ALZHEIMERS RESEARCH & THERAPY 2014; 6:71. [PMID: 25484929 PMCID: PMC4256921 DOI: 10.1186/s13195-014-0071-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 10/08/2014] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Dementia with Lewy bodies (DLB) and Corticobasal Syndrome (CBS) are atypical parkinsonian disorders with fronto-subcortical and posterior cognitive dysfunction as common features. While visual hallucinations are a good predictor of Lewy body pathology and are rare in CBS, they are not exhibited in all cases of DLB. Given the clinical overlap between these disorders, neuropsychological and imaging markers may aid in distinguishing these entities. METHODS Prospectively recruited case-control cohorts of CBS (n =31) and visual hallucination-free DLB (n =30), completed neuropsychological and neuropsychiatric measures as well as brain perfusion single-photon emission computed tomography and structural magnetic resonance imaging (MRI). Perfusion data were available for forty-two controls. Behavioural, perfusion, and cortical volume and thickness measures were compared between the groups to identify features that serve to differentiate them. RESULTS The Lewy body with no hallucinations group performed more poorly on measures of episodic memory compared to the corticobasal group, including the delayed and cued recall portions of the California Verbal Learning Test (F (1, 42) =23.1, P <0.001 and F (1, 42) =14.0, P =0.001 respectively) and the delayed visual reproduction of the Wechsler Memory Scale-Revised (F (1, 36) =9.7, P =0.004). The Lewy body group also demonstrated reduced perfusion in the left occipital pole compared to the corticobasal group (F (1,57) =7.4, P =0.009). At autopsy, the Lewy body cases all demonstrated mixed dementia with Lewy bodies, Alzheimer's disease and small vessel arteriosclerosis, while the corticobasal cases demonstrated classical corticobasal degeneration in five, dementia with agyrophilic grains + corticobasal degeneration + cerebral amyloid angiopathy in one, Progressive Supranuclear Palsy in two, and Frontotemporal Lobar Degeneration-Ubiquitin/TAR DNA-binding protein 43 proteinopathy in one. MRI measures were not significantly different between the patient groups. CONCLUSIONS Reduced perfusion in the left occipital region and worse episodic memory performance may help to distinguish between DLB cases who have never manifested with visual hallucinations and CBS at earlier stages of the disease. Development of reliable neuropsychological and imaging markers that improve diagnostic accuracy will become increasingly important as disease modifying therapies become available.
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Affiliation(s)
- Michael R Misch
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Sara Mitchell
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Philip L Francis
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Kayla Sherborn
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Katayoun Meradje
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Alicia A McNeely
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Kie Honjo
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Jiali Zhao
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Christopher Jm Scott
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Curtis B Caldwell
- Department of Medical Biophysics, Sunnybrook Health Sciences Centre, University of Toronto, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Lisa Ehrlich
- Department of Nuclear Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Prathiba Shammi
- Neuropsychology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Bradley J MacIntosh
- Department of Medical Biophysics, Sunnybrook Health Sciences Centre, University of Toronto, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Juan M Bilbao
- Department of Pathology, Sunnybrook Health Sciences Centre, University of Toronto, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Anthony E Lang
- Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Sandra E Black
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada ; Department of Medicine (Neurology), Brain Sciences Research Program, Sunnybrook Health Sciences, Centre University of Toronto, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
| | - Mario Masellis
- L.C. Campbell Cognitive Neurology Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada ; Department of Medicine (Neurology), Brain Sciences Research Program, Sunnybrook Health Sciences, Centre University of Toronto, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada ; Cognition & Movement Disorders Clinic, Sunnybrook Health Sciences Centre, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada ; Neurogenetics Section, Centre for Addiction and Mental Health, University of Toronto, Room A4 42, 2075 Bayview Avenue, Toronto, ON M4N 3M5 Canada
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Abstract
The definition of apraxia specifies that the disturbance of performed skilled movements cannot be explained by the more elemental motor disorders typical of patients with movement disorders. Generally this does not present a significant diagnostic problem when dealing with 'higher-level' praxic disturbances (e.g. ideational apraxia), but it can be a major confound in establishing the presence of limb-kinetic apraxia. Most motor disturbances characteristic of extrapyramidal disorders, particularly bradykinesia and dystonia, will compromise the ability to establish the presence of loss of dexterity and deftness that constitutes this subtype. The term 'apraxia' has also been applied to other motor disturbances, such as 'gait apraxia' and 'apraxia of eyelid opening', that perhaps are misnomers, demonstrating the lack of a coherent nomenclature in this field. Apraxia is a hallmark of corticobasal degeneration (CBD) and historically this has received the most attention among the movement disorders. Corticobasal degeneration is characterized by various forms of apraxia affecting limb function, particularly ideomotor apraxia and limb-kinetic apraxia, although buccofacial and oculomotor apraxia can be present as well. The syndrome of parkinsonism and prominent apraxia, designated the 'corticobasal syndrome' (CBS), may be caused by a variety of other central nervous system pathologies including progressive supranuclear palsy (PSP), Alzheimer's disease, dementia with Lewy bodies and frontotemporal dementias. Distinct from the CBS, PSP and Parkinson's disease can demonstrate varying degrees of apraxia on selected tests, especially in those patients with more severe cognitive dysfunction. Diseases that cause the combination of apraxia and a primary movement disorder most often involve a variety of cerebral cortical sites as well as basal ganglia structures. Clinical-pathological correlates and functional imaging studies are compromised by both this diffuse involvement and the confusion experienced in the clinical evaluation of apraxia in the face of the additional elemental movement disorders. Finally, although apraxia results in clear disability in patients with the CBS, it is not clear how milder ideomotor apraxia found on specific testing contributes to patients' overall day-to-day motor disability.
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Affiliation(s)
- Cindy Zadikoff
- Morton and Gloria Shulman Movement Disorders Center, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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Abstract
The presence of cognitive impairment in corticobasal degeneration (CBD) is now widely recognised. Our review of the literature reveals that, although the pattern and severity of neuropsychological impairments can be highly variable across patients, several general trends can be identified. The most characteristic impairments are limb apraxia (usually ideomotor), constructional and visuospatial difficulties, acalculia, frontal dysfunction, and nonfluent aphasia. The limb apraxia is associated with deficits in drawing, copying, and handwriting, but there is emerging evidence that the problems with handwriting are not due exclusively to the apraxia. The findings with respect to episodic memory are more variable, but when there is impairment in this area, it tends to be milder than that seen in Alzheimer's disease. Semantic memory functioning appears relatively preserved but has been poorly studied. Problems with speech are common, and may be due to dysarthria or buccofacial apraxia. Aphasia, although initially considered rare, is in fact a common accompaniment of CBD, may be the presenting feature, and is typically nonfluent in type. More systematic investigation of the clinical and neuropathological overlap between progressive nonfluent aphasia (generally considered to be a form of frontotemporal dementia) and CBD is needed.
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Affiliation(s)
- Naida L Graham
- University Neurology Unit, University of Cambridge, Cambridge, United Kingdom
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