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Baqué L, Machuca MJ. Dysfluency in primary progressive aphasia: Temporal speech parameters. CLINICAL LINGUISTICS & PHONETICS 2024:1-34. [PMID: 39104133 DOI: 10.1080/02699206.2024.2378345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 06/28/2024] [Accepted: 07/05/2024] [Indexed: 08/07/2024]
Abstract
Analysing spontaneous speech in individuals experiencing fluency difficulties holds potential for diagnosing speech and language disorders, including Primary Progressive Aphasia (PPA). Dysfluency in the spontaneous speech of patients with PPA has mostly been described in terms of abnormal pausing behaviour, but the temporal features related to speech have drawn little attention. This study compares speech-related fluency parameters in the three main variants of PPA and in typical speech. Forty-three adults participated in this research, thirteen with the logopenic variant of PPA (lvPPA), ten with the non-fluent variant (nfvPPA), nine with the semantic variant (svPPA), and eleven who were healthy age-matched adults. Participants' fluency was assessed through a picture description task from which 42 parameters were computed including syllable duration, speaking pace, the duration of speech chunks (i.e. interpausal units, IPU), and the number of linguistic units per IPU and per second. The results showed that each PPA variant exhibited abnormal speech characteristics reflecting various underlying factors, from motor speech deficits to higher-level issues. Out of the 42 parameters considered, 37 proved useful for characterising dysfluency in the three main PPA variants and 35 in distinguishing among them. Therefore, taking into account not only pausing behaviour but also temporal speech parameters can provide a fuller understanding of dysfluency in PPA. However, no single parameter by itself sufficed to distinguish one PPA group from the other two, further evidence that dysfluency is not dichotomous but rather multidimensional, and that complementary multiparametric analyses are needed.
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Affiliation(s)
- Lorraine Baqué
- Departament de Filologia Francesa i Romànica, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - María-Jesús Machuca
- Departament de Filologia Espanyola, Universitat Autònoma de Barcelona, Bellaterra, Spain
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Ding J, Yang Q, Drossinos N, Guo Q. Advances in semantic dementia: Neuropsychology, pathology & neuroimaging. Ageing Res Rev 2024; 99:102375. [PMID: 38866186 DOI: 10.1016/j.arr.2024.102375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 06/14/2024]
Abstract
Semantic dementia is a kind of neurodegenerative disorder, characterized by prominent semantic impairments and anterior temporal lobe atrophy. Since 2010, more studies have devoted to this rare disorder, revealing that it is more complex than we think. Clinical advances include more specific findings of semantic impairments and other higher order cognitive deficits. Neuroimaging techniques can help revealing the different brain networks affected (both structurally and functionally) in this condition. Pathological and genetic studies have also found more complex situations of semantic dementia, which might explain the huge variance existing in semantic dementia. Moreover, the current diagnosis criteria mainly focus on semantic dementia's classical prototype. We further delineated the features of three subtypes of semantic dementia based on atrophy lateralization with three severity stages. In a broader background, as a part of the continuum of neurodegenerative disorders, semantic dementia is commonly compared with other resembling conditions. Therefore, we summarized the differential diagnosis between semantic dementia and them. Finally, we introduced the challenges and achievements of its diagnosis, treatment, care and cross cultural comparison. By providing a comprehensive picture of semantic dementia on different aspects of advances, we hope to deepen the understanding of semantic dementia and promote more inspirations on both clinical and theoretical studies about it.
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Affiliation(s)
- Junhua Ding
- Department of Gerontology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Psychology, University of Edinburgh, Edinburgh, UK
| | - Qing Yang
- Department of Rehabilitation, Hushan Hospital, Fudan University, Shanghai, China
| | - Niki Drossinos
- Division of Psychology, Communication and Human Neuroscience, University of Manchester, Manchester, UK
| | - Qihao Guo
- Department of Gerontology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Shebani Z, Patterson K. (What) can patients with semantic dementia learn? Neuropsychologia 2024; 197:108844. [PMID: 38428519 DOI: 10.1016/j.neuropsychologia.2024.108844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/17/2024] [Accepted: 02/27/2024] [Indexed: 03/03/2024]
Abstract
Semantic Dementia (SD) is a neurodegenerative disease characterised by progressive deterioration of semantic knowledge, resulting in diminished understanding of concepts, whether encountered in verbal or non-verbal form. Over the past three decades, a number of studies employing a range of treatment techniques and learning methods have examined whether patients with SD can relearn previously known concepts or learn and retain new information. In this article, we review this research, addressing two main questions: a) Can aspects of semantic knowledge that are 'lost' due to degeneration be re-acquired? b) How much do other memory systems (working and episodic memory) interact with and depend on semantic memory? Several studies demonstrate successful relearning of previously known words and concepts in SD, particularly after regular, prolonged practice; but this success tends to diminish once practice ceases, and furthermore often fails to generalise to other instances of the same object/concept. This pattern suggests that, with impaired semantic knowledge, learning relies to an abnormal extent on perceptual factors, making it difficult to abstract away from the specific visual or other perceptual format in which a given concept has been trained. Furthermore, the impact of semantic 'status' of a word or object on both working and episodic memory indicates pervasive interaction of these other memory systems with conceptual knowledge.
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Affiliation(s)
- Zubaida Shebani
- Department of Psychology, Sultan Qaboos University, Muscat, Oman.
| | - Karalyn Patterson
- Medical Research Council, Cognition and Brain Sciences Unit, University of Cambridge, UK
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Joubert S, Maquestiaux F, Enriquez-Rosas A, Villalpando JM, Brodeur C, Bier N. Smartphone use as an efficient tool to improve anomia in primary progressive aphasia. Neuropsychol Rehabil 2024; 34:362-387. [PMID: 36871267 DOI: 10.1080/09602011.2023.2181824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023]
Abstract
Cognitive interventions are helpful in the non-pharmacological management of Primary progressive aphasia (PPA) and other neurodegenerative disorders of cognition, by helping patients to compensate for their cognitive deficits and improve their functional independence. In this study, we examined the effectiveness of cognitive rehabilitation based on the use of mobile device technology in PPA. The aim of this research study was to determine if BL, a patient with semantic variant PPA (svPPA) and severe anomia, was able to learn using specific smartphone functions and an application to reduce her word finding difficulties. She was trained during the intervention sessions on a list of target pictures to measure changes in picture naming performance. Errorless learning was applied during learning. BL quickly learned to use smartphone functions and the application over the course of the intervention. She significantly improved her anomia for trained pictures, and to a lesser extent for untrained semantically related pictures. Picture naming performance was maintained six months after the intervention, and she continued to use her smartphone regularly to communicate with family members and friends. This study confirms that smartphone use can be learned in PPA, which can help reduce the symptoms of anomia and improve communication skills.
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Affiliation(s)
- Sven Joubert
- CIUSSS-CSMTL - Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Canada
- Département de psychologie, Université de Montréal, Montreal, Canada
| | - François Maquestiaux
- Centre de recherches sur les fonctionnements et dysfonctionnements psychologiques (CRFDP, EA 7475), université de Rouen Normandie, Rouen, France
- Laboratoire de recherches intégratives en neurosciences et psychologie cognitive (LINC, UR 481), université de Franche-Comté, Besançon, France
- Maison des sciences de l'homme et de l'environnement (MSHE) Ledoux, UFC, Besançon, France
| | | | - Juan Manuel Villalpando
- CIUSSS-CSMTL - Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Canada
- CIUSSS-CSMTL - Institut universitaire de gériatrie de Montréal (IUGM), Montreal, Canada
- Faculté de médecine, Université de Montréal, Montreal, Canada
| | - Catherine Brodeur
- CIUSSS-CSMTL - Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Canada
- CIUSSS-CSMTL - Institut universitaire de gériatrie de Montréal (IUGM), Montreal, Canada
- Faculté de médecine, Université de Montréal, Montreal, Canada
| | - Nathalie Bier
- CIUSSS-CSMTL - Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Canada
- Faculté de médecine, Université de Montréal, Montreal, Canada
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Robinaugh G, Henry ML, Cavanaugh R, Grasso SM. Computer-Based Naming Treatment for Semantic Variant Primary Progressive Aphasia With History of Traumatic Brain Injury: A Single-Case Experimental Design. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:524-544. [PMID: 38319636 PMCID: PMC11000793 DOI: 10.1044/2023_jslhr-23-00289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/28/2023] [Accepted: 10/27/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE The purpose of this study was to investigate the effectiveness of a self-administered naming treatment for one individual, B.N., presenting with semantic variant primary progressive aphasia (svPPA) and a history of traumatic brain injury (TBI). METHOD Naming treatment included components of Lexical Retrieval Cascade Treatment and was self-administered using an adaptive spaced retrieval software, Anki. Using a multiple-baseline, single-case experimental design, naming accuracy probes were taken during pretreatment, treatment, posttreatment, and follow-up (through 12 months) for 60 trained words and 10 untrained words. Item-level Bayesian generalized mixed-effects models were used to estimate (a) the treatment effect for trained words, (b) change in untrained words, and (c) maintenance of treatment effects from posttreatment to each subsequent follow-up. RESULTS Statistical analyses revealed that a gain of 35 out of 60 trained words (35.3; 90% CI [30.6, 39.5]) was directly attributable to treatment. Following treatment, evidence of generalization to untrained words was not observed. During the follow-up period, there was gradual decline in naming accuracy of trained items. CONCLUSIONS The positive treatment results reported here support the use of self-administered naming treatments for those with svPPA and a history of TBI. Although the utility of this treatment approach is constrained by patient factors including motivation, self-administered naming treatments represent a unique opportunity to expand access to speech-language intervention for people with svPPA, including those with concomitant diagnoses. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25119080.
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Affiliation(s)
- Gary Robinaugh
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
| | - Maya L. Henry
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
- Department of Neurology, Dell Medical School, The University of Texas at Austin
| | | | - Stephanie M. Grasso
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
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Strunk K, Weiss S, Müller HM. High-Frequency Language Therapy with Semantic Feature Analysis (SFA) and Transcranial Direct Current Stimulation (tDCS): A Longitudinal Single-Case Report of Semantic Variant of Primary Progressive Aphasia (svPPA). Brain Sci 2024; 14:133. [PMID: 38391708 PMCID: PMC10886986 DOI: 10.3390/brainsci14020133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The goal of this study was to investigate whether the combination of semantic feature analysis (SFA) and transcranial direct current stimulation (tDCS) is effective in treating word retrieval in the semantic variant of primary progressive aphasia (svPPA) and how long the potential effects last. METHODS A 56-year-old woman diagnosed with frontotemporal dementia (FTD) and svPPA participated in this longitudinal single-subject design. A total of four 2-week stimulation phases were conducted over a 14-month period, each of which was started depending on the participant's language performance. Follow-up testing was conducted shortly after the stimulation period, approximately 2 weeks, and approximately 4 weeks thereafter. RESULTS Significant improvement in word retrieval occurred after SFA and tDCS therapy. Two weeks after the end of each stimulation phase, approx. 80% of the trained words could be named correctly. For the untrained words, also significantly more words were correctly named at follow-ups compared to the baseline. Furthermore, the Boston Naming Test (BNT) demonstrated a significant increase in naming performance and showed that phonological cues facilitated word retrieval compared to semantic cues. CONCLUSION The combination of SFA and tDCS was able to counteract the expected language deterioration of a participant with svPPA. This effect increased until approximately 2 weeks after each intervention. In addition, a generalization of the effect to untrained words was shown.
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Affiliation(s)
- Katharina Strunk
- Experimental Neurolinguistics Group, Bielefeld University, Universitätsstrasse 25, 33615 Bielefeld, Germany
| | - Sabine Weiss
- Experimental Neurolinguistics Group, Bielefeld University, Universitätsstrasse 25, 33615 Bielefeld, Germany
- Center for Cognitive Interaction Technology (CITEC), Bielefeld University, Inspiration 1, 33619 Bielefeld, Germany
- Clinical Linguistics, Bielefeld University, Universitätsstrasse 25, 33615 Bielefeld, Germany
| | - Horst M Müller
- Experimental Neurolinguistics Group, Bielefeld University, Universitätsstrasse 25, 33615 Bielefeld, Germany
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Cotelli M, Baglio F, Manenti R, Blasi V, Galimberti D, Gobbi E, Pagnoni I, Rossetto F, Rotondo E, Esposito V, De Icco R, Giudice C, Tassorelli C, Catricalà E, Perini G, Alaimo C, Campana E, Benussi L, Ghidoni R, Binetti G, Carandini T, Cappa SF. A Multimodal Approach for Clinical Diagnosis and Treatment of Primary Progressive Aphasia (MAINSTREAM): A Study Protocol. Brain Sci 2023; 13:1060. [PMID: 37508992 PMCID: PMC10377301 DOI: 10.3390/brainsci13071060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/27/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Primary Progressive Aphasia (PPA) is a syndrome due to different neurodegenerative disorders selectively disrupting language functions. PPA specialist care is underdeveloped. There are very few specialists (neurologists, psychiatrists, neuropsychologists, and speech therapists) and few hospital- or community-based services dedicated to the diagnosis and continuing care of people with PPA. Currently, healthcare systems struggle to provide adequate coverage of care that is too often fragmented, uncoordinated, and unresponsive to the needs of people with PPA and their families. Recently, attention has been gained by non-invasive brain stimulation techniques that allow a personalized treatment approach, such as transcranial Direct Current Stimulation (tDCS). The MAINSTREAM trial looks forward to introducing and evaluating therapeutic innovations such as tDCS coupled with language therapy in rehabilitation settings. A Multimodal Approach for Clinical Diagnosis and Treatment of Primary Progressive Aphasia, MAINSTREAM (ID: 3430931) was registered in the clinicaltrials.gov database (identifier: NCT05730023) on 15 February 2023.
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Affiliation(s)
- Maria Cotelli
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy
| | | | - Rosa Manenti
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy
| | - Valeria Blasi
- IRCCS Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
| | - Daniela Galimberti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Deparment of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
| | - Elena Gobbi
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy
| | - Ilaria Pagnoni
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy
| | | | - Emanuela Rotondo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | | | - Roberto De Icco
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Movement Analysis Research Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Carla Giudice
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Movement Analysis Research Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Cristina Tassorelli
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
- Movement Analysis Research Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Eleonora Catricalà
- ICoN Cognitive Neuroscience Center, Institute for Advanced Studies, IUSS, 27100 Pavia, Italy
| | - Giulia Perini
- Dementia Research Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Cristina Alaimo
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy
| | - Elena Campana
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy
| | - Luisa Benussi
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy
| | - Roberta Ghidoni
- Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy
| | - Giuliano Binetti
- MAC-Memory Clinic and Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, 25125 Brescia, Italy
| | - Tiziana Carandini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Stefano Francesco Cappa
- Dementia Research Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
- ICoN Cognitive Neuroscience Center, Institute for Advanced Studies, IUSS, 27100 Pavia, Italy
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Nickels K, Beeson PM, Rising K, Jebahi F, Kielar A. Positive changes to written language following phonological treatment in logopenic variant primary progressive aphasia: Case report. Front Hum Neurosci 2023; 16:1006350. [PMID: 36760227 PMCID: PMC9905434 DOI: 10.3389/fnhum.2022.1006350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 12/31/2022] [Indexed: 01/26/2023] Open
Abstract
Phonological impairment contributes to deficits in repetition and spoken naming in logopenic variant Primary Progressive Aphasia (lvPPA), but weakened phonology can also affect written language skills. In this experimental case report, we demonstrate phonological text agraphia in a 71-year-old woman in the early stages of lvPPA that undermined her ability to write meaningful, grammatical sentences. We investigated the therapeutic value of a rigorous treatment protocol to strengthen phonological manipulation skills coupled with transcranial direct current stimulation (tDCS). Intervention took place 5 days a week for 2 weeks with active tDCS, followed by a 2-month rest period, and then a second period of phonological treatment with sham tDCS. Over the course of treatment, our participant demonstrated improved phonological transcoding and manipulation skills as well as marked improvement in the proportion of grammatically well-formed, meaningful written narratives. Improvements in spelling and letter selection were also observed. Treatment gains were documented during phonological intervention in both active tDCS and sham treatment phases and were maintained 2 months after the conclusion of intervention. Importantly, improvements were observed in the context of a progressive disorder. These data present compelling evidence regarding the impairment-based approach that targets compromised phonological skills, presenting opportunity for improving functional written communication skills relevant to the everyday lives of individuals with lvPPA.
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Affiliation(s)
- Katlyn Nickels
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, AZ, United States,*Correspondence: Katlyn Nickels,
| | - Pélagie M. Beeson
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, AZ, United States,Department of Neurology, The University of Arizona, Tucson, AZ, United States
| | - Kindle Rising
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, AZ, United States
| | - Fatima Jebahi
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, AZ, United States
| | - Aneta Kielar
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, AZ, United States
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Dial HR, Europa E, Grasso SM, Mandelli ML, Schaffer KM, Hubbard HI, Wauters LD, Wineholt L, Wilson SM, Gorno-Tempini ML, Henry ML. Baseline structural imaging correlates of treatment outcomes in semantic variant primary progressive aphasia. Cortex 2023; 158:158-175. [PMID: 36577212 PMCID: PMC9904210 DOI: 10.1016/j.cortex.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 02/25/2022] [Accepted: 10/12/2022] [Indexed: 12/03/2022]
Abstract
Semantic variant primary progressive aphasia (svPPA) is a neurodegenerative disorder characterized by a loss of semantic knowledge in the context of anterior temporal lobe atrophy (left > right). Core features of svPPA include anomia and single-word comprehension impairment. Despite growing evidence supporting treatment for anomia in svPPA, there is a paucity of research investigating neural mechanisms supporting treatment-induced gains and generalization to untrained items. In the current study, we examined the relation between the structural integrity of brain parenchyma (tissue inclusive of gray and white matter) at pre-treatment and treatment outcomes for trained and untrained items in a group of 19 individuals with svPPA who completed lexical retrieval treatment. Two structural neuroimaging approaches were used: an exploratory, whole-brain, voxel-wise approach and an a priori region of interest (ROI) approach. Based on previous research, bilateral temporal (inferior, middle, and superior temporal gyri), parietal (supramarginal and angular gyri), frontal (inferior and middle frontal gyri) and medial temporal (hippocampus and parahippocampal gyri) ROIs were selected from the Automated Anatomical Labeling (AAL) atlas. Analyses revealed improved naming of trained items and generalization to untrained items following treatment, providing converging evidence that individuals with svPPA can benefit from treatment for anomia. Better post-treatment naming accuracy was associated with the structural integrity of inferior parietal cortex and the hippocampus. Specifically, improved naming of trained items was related to the left supramarginal (phonological processing) and angular gyri (phonological and semantic processing), and improved naming of trained and untrained items was related to the left hippocampus (episodic, context-based memory). Future research should examine treatment outcomes in relation to pre-treatment functional and structural connectivity as well as changes in network dynamics following speech-language intervention to further elucidate the neural mechanisms underlying treatment response in svPPA and related disorders.
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Affiliation(s)
- Heather R Dial
- Department of Communication Sciences and Disorders, University of Houston, 3871 Holman St, Houston, TX, USA; Department of Speech, Language and Hearing Sciences, University of Texas at Austin, 2504A Whitis Avenue (A1100), Austin, TX USA.
| | - Eduardo Europa
- Connie L. Lurie College of Education, San Jose State University, One Washington Square, San Jose, CA, USA
| | - Stephanie M Grasso
- Department of Speech, Language and Hearing Sciences, University of Texas at Austin, 2504A Whitis Avenue (A1100), Austin, TX USA
| | - Maria Luisa Mandelli
- Memory and Aging Center, University of California, San Francisco. 675 Nelson Rising Lane (Suite 190), San Francisco, CA USA
| | - Kristin M Schaffer
- Department of Speech, Language and Hearing Sciences, University of Texas at Austin, 2504A Whitis Avenue (A1100), Austin, TX USA
| | - H Isabel Hubbard
- College of Health Sciences, University of Kentucky, 900 S. Limestone, Lexington, KY, USA
| | - Lisa D Wauters
- Department of Speech, Language and Hearing Sciences, University of Texas at Austin, 2504A Whitis Avenue (A1100), Austin, TX USA
| | - Lindsey Wineholt
- Department of Speech, Language and Hearing Sciences, University of Texas at Austin, 2504A Whitis Avenue (A1100), Austin, TX USA
| | - Stephen M Wilson
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Ave S, Nashville, TN, USA
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, University of California, San Francisco. 675 Nelson Rising Lane (Suite 190), San Francisco, CA USA
| | - Maya L Henry
- Department of Speech, Language and Hearing Sciences, University of Texas at Austin, 2504A Whitis Avenue (A1100), Austin, TX USA; Department of Neurology, Dell Medical School, University of Texas at Austin, 1601 Trinity St., Bldg. B, Stop Z0700, Austin, TX USA
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10
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Sheppard SM. Noninvasive brain stimulation to augment language therapy for primary progressive aphasia. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:251-260. [PMID: 35078603 DOI: 10.1016/b978-0-12-823384-9.00018-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Primary progressive aphasia (PPA) is a debilitating disorder characterized by the gradual loss of language functioning resulting from neurodegenerative diseases including frontotemporal lobar degeneration or Alzheimer's disease pathology. There is a dearth of research investigating language therapy in PPA. Unlike individuals with poststroke aphasia, language skills are expected to decline over time, so the goal of treatment is often to preserve existing language functioning. There has been an increasing interest in using non-invasive brain stimulation including transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) to augment traditional behavioral therapy in PPA. Research is promising and suggests neuromodulation can lead to generalization and maintenance of treatment effects for a longer period compared to behavioral therapy alone. Emerging research is also beginning to identify predictors of treatment response. Yet there is still much to learn regarding how neuromodulation factors (e.g., type of stimulation, stimulation intensity), participant factors (e.g., demographics, extent and location of atrophy), and treatment factors (e.g., type of language therapy, and dosage) will interact to predict treatment response. We are moving toward a promising future where individuals with PPA will benefit from individualized therapy protocols pairing traditional language therapy with neuromodulation.
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Affiliation(s)
- Shannon M Sheppard
- Department of Communication Sciences & Disorders, Chapman University, Irvine, CA, United States.
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11
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Basilakos A, Fridriksson J. Types of motor speech impairments associated with neurologic diseases. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:71-79. [PMID: 35078611 DOI: 10.1016/b978-0-12-823384-9.00004-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Speech disturbances are common consequences of acquired brain injury or neurodegenerative impairment. Although sudden difficulties with speech may signal acute pathologic conditions such as cerebrovascular accidents, determining the etiology of insidious disruptions in communication can be less straightforward. The identification of motor speech impairment, independent of difficulties with language, can be useful for diagnosis since there are subtle, albeit distinct, patterns of speech production impairments associated with different neurologic conditions. Furthermore, the identification of impairments specific to speech production can help elucidate the suspected pathologic mechanisms or even the neuroanatomic structures compromised. During a routine clinical evaluation, early warning signs of motor speech impairment may go undetected if a clinician is unaccustomed to examining motor speech or is unaware of its manifestations. Accordingly, this chapter provides clinicians with a concise yet thorough guide for the practical assessment and differential diagnosis of motor speech disorders (MSDs)-apraxia of speech and dysarthrias. This chapter is divided into neurologic conditions associated with disorders of speech planning/programming, execution, and articulatory control. The underlying mechanisms associated with these impairments are presented both from a clinical perspective as well as through a scientific discussion of recent research in the field on MSDs.
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Affiliation(s)
- Alexandra Basilakos
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, United States
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, United States.
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12
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Robinaugh G, Henry ML. Behavioral interventions for primary progressive aphasia. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:221-240. [PMID: 35078600 DOI: 10.1016/b978-0-12-823384-9.00011-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Primary progressive aphasia (PPA) is a neurodegenerative syndrome characterized by a gradual loss of communication ability. Due to the centrality of communication deficits, speech-language pathologists play a prominent role in the provision of care for individuals with PPA. In this chapter, we outline a person-centered approach to the management of PPA that aims to preserve independence for as long as possible while anticipating future decline in communication and other domains. A growing evidence base supports the utility of speech-language treatment approaches in PPA, including restitutive, compensatory, and communication partner-focused techniques. Restitutive interventions aim to rebuild lost communication skills, such as naming or fluent speech production. Compensatory approaches include training with high- and low-tech augmentative and alternative communication systems that provide complementary means of communication beyond speech. Communication partner interventions focus on education and strategy training in order to equip conversation partners as skilled communication facilitators. Throughout intervention, clinicians should aim to provide treatment that impacts functional communication and promotes social engagement. Given the documented benefits of speech-language intervention in PPA, we are optimistic that such treatment will become the standard of care and that additional research will continue to improve the quality and accessibility of behavioral interventions.
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Affiliation(s)
- Gary Robinaugh
- Department of Speech, Language, and Hearing Sciences, University of Texas, Austin, TX, United States
| | - Maya L Henry
- Department of Speech, Language, and Hearing Sciences, University of Texas, Austin, TX, United States.
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13
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Semantic Variant Primary Progressive Aphasia: Practical Recommendations for Treatment from 20 Years of Behavioural Research. Brain Sci 2021; 11:brainsci11121552. [PMID: 34942854 PMCID: PMC8699306 DOI: 10.3390/brainsci11121552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 12/01/2022] Open
Abstract
People with semantic variant primary progressive aphasia (svPPA) present with a characteristic progressive breakdown of semantic knowledge. There are currently no pharmacological interventions to cure or slow svPPA, but promising behavioural approaches are increasingly reported. This article offers an overview of the last two decades of research into interventions to support language in people with svPPA including recommendations for clinical practice and future research based on the best available evidence. We offer a lay summary in English, Spanish and French for education and dissemination purposes. This paper discusses the implications of right- versus left-predominant atrophy in svPPA, which naming therapies offer the best outcomes and how to capitalise on preserved long-term memory systems. Current knowledge regarding the maintenance and generalisation of language therapy gains is described in detail along with the development of compensatory approaches and educational and support group programmes. It is concluded that there is evidence to support an integrative framework of treatment and care as best practice for svPPA. Such an approach should combine rehabilitation interventions addressing the language impairment, compensatory approaches to support activities of daily living and provision of education and support within the context of dementia.
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14
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Coemans S, Struys E, Vandenborre D, Wilssens I, Engelborghs S, Paquier P, Tsapkini K, Keulen S. A Systematic Review of Transcranial Direct Current Stimulation in Primary Progressive Aphasia: Methodological Considerations. Front Aging Neurosci 2021; 13:710818. [PMID: 34690737 PMCID: PMC8530184 DOI: 10.3389/fnagi.2021.710818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022] Open
Abstract
A variety of tDCS approaches has been used to investigate the potential of tDCS to improve language outcomes, or slow down the decay of language competences caused by Primary Progressive Aphasia (PPA). The employed stimulation protocols and study designs in PPA are generally speaking similar to those deployed in post-stroke aphasic populations. These two etiologies of aphasia however differ substantially in their pathophysiology, and for both conditions the optimal stimulation paradigm still needs to be established. A systematic review was done and after applying inclusion and exclusion criteria, 15 articles were analyzed focusing on differences and similarities across studies especially focusing on PPA patient characteristics (age, PPA variant, language background), tDCS stimulation protocols (intensity, frequency, combined therapy, electrode configuration) and study design as recent reviews and group outcomes for individual studies suggest tDCS is an effective tool to improve language outcomes, while methodological approach and patient characteristics are mentioned as moderators that may influence treatment effects. We found that studies of tDCS in PPA have clinical and methodological and heterogeneity regarding patient populations, stimulation protocols and study design. While positive group results are usually found irrespective of these differences, the magnitude, duration and generalization of these outcomes differ when comparing stimulation locations, and when results are stratified according to the clinical variant of PPA. We interpret the results of included studies in light of patient characteristics and methodological decisions. Further, we highlight the role neuroimaging can play in study protocols and interpreting results and make recommendations for future work.
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Affiliation(s)
- Silke Coemans
- Clinical and Experimental Neurolinguistics, CLIEN, Vrije Universiteit Brussel, Brussels, Belgium
| | - Esli Struys
- Clinical and Experimental Neurolinguistics, CLIEN, Vrije Universiteit Brussel, Brussels, Belgium.,Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
| | - Dorien Vandenborre
- Department of Speech and Language Pathology, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Ineke Wilssens
- Department of Speech and Language Pathology, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Sebastiaan Engelborghs
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium.,Department of Neurology, Universitair Ziekenhuis Brussel, Brussels, Belgium.,Reference Center for Biological Markers of Dementia, BIODEM, Institute Born-Bunge, Universiteit Antwerpen, Antwerp, Belgium
| | - Philippe Paquier
- Clinical and Experimental Neurolinguistics, CLIEN, Vrije Universiteit Brussel, Brussels, Belgium.,Center for Research in Cognition and Neurosciences (CRCN), Université Libre de Bruxelles, Antwerp, Belgium.,Department of Translational Neurosciences (TNW), Universiteit Antwerpen, Antwerp, Belgium
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States.,Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
| | - Stefanie Keulen
- Clinical and Experimental Neurolinguistics, CLIEN, Vrije Universiteit Brussel, Brussels, Belgium
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15
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Grasso SM, Peña ED, Kazemi N, Mirzapour H, Neupane R, Bonakdarpour B, Gorno-Tempini ML, Henry ML. Treatment for Anomia in Bilingual Speakers with Progressive Aphasia. Brain Sci 2021; 11:1371. [PMID: 34827370 PMCID: PMC8615710 DOI: 10.3390/brainsci11111371] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/09/2021] [Accepted: 10/09/2021] [Indexed: 11/17/2022] Open
Abstract
Anomia is an early and prominent feature of primary progressive aphasia (PPA) and other neurodegenerative disorders. Research investigating treatment for lexical retrieval impairment in individuals with progressive anomia has focused primarily on monolingual speakers, and treatment in bilingual speakers is relatively unexplored. In this series of single-case experiments, 10 bilingual speakers with progressive anomia received lexical retrieval treatment designed to engage relatively spared cognitive-linguistic abilities and promote word retrieval. Treatment was administered in two phases, with one language targeted per phase. Cross-linguistic cognates (e.g., rose and rosa) were included as treatment targets to investigate their potential to facilitate cross-linguistic transfer. Performance on trained and untrained stimuli was evaluated before, during, and after each phase of treatment, and at 3, 6, and 12 months post-treatment. Participants demonstrated a significant treatment effect in each of their treated languages, with maintenance up to one year post-treatment for the majority of participants. Most participants showed a significant cross-linguistic transfer effect for trained cognates in both the dominant and nondominant language, with fewer than half of participants showing a significant translation effect for noncognates. A gradual diminution of translation and generalization effects was observed during the follow-up period. Findings support the implementation of dual-language intervention approaches for bilingual speakers with progressive anomia, irrespective of language dominance.
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Affiliation(s)
- Stephanie M. Grasso
- Department of Speech, Language and Hearing Sciences, University of Texas, Austin, TX 78705, USA; (N.K.); (H.M.); (R.N.); (M.L.H.)
| | - Elizabeth D. Peña
- School of Education, University of California, Irvine, CA 92697, USA;
| | - Nina Kazemi
- Department of Speech, Language and Hearing Sciences, University of Texas, Austin, TX 78705, USA; (N.K.); (H.M.); (R.N.); (M.L.H.)
| | - Haideh Mirzapour
- Department of Speech, Language and Hearing Sciences, University of Texas, Austin, TX 78705, USA; (N.K.); (H.M.); (R.N.); (M.L.H.)
| | - Rozen Neupane
- Department of Speech, Language and Hearing Sciences, University of Texas, Austin, TX 78705, USA; (N.K.); (H.M.); (R.N.); (M.L.H.)
| | - Borna Bonakdarpour
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA;
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA 94143, USA;
| | - Maya L. Henry
- Department of Speech, Language and Hearing Sciences, University of Texas, Austin, TX 78705, USA; (N.K.); (H.M.); (R.N.); (M.L.H.)
- Department of Neurology, Dell Medical School, University of Texas, Austin, TX 78705, USA
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16
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Schaffer KM, Henry ML. Counseling and Care Partner Training in Primary Progressive Aphasia. PERSPECTIVES OF THE ASHA SPECIAL INTEREST GROUPS 2021; 6:1015-1025. [PMID: 35935167 PMCID: PMC9351599 DOI: 10.1044/2021_persp-20-00296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Individuals with primary progressive aphasia (PPA) experience loss of communication abilities in the context of neurodegenerative disease. Consequently, many individuals with PPA endorse negative psychosocial effects, including social isolation, reduced communication confidence, and depression. Incorporating communication-centered counseling early and often within the speech-language pathology treatment framework is a vital component in holistically addressing the multifaceted ramifications of living with this devastating disorder. Additionally, care partners are key stakeholders in the treatment dynamic. Involving these individuals in the treatment paradigm through care partner training is crucial for facilitating optimal communication in daily life. The purpose of this narrative literature review is to discuss existing research regarding counseling and care partner training in PPA and to outline additional treatment considerations and future research needs in this understudied area. CONCLUSIONS Relative to studies that delineate restitutive speech-language interventions for PPA, the literature pertaining to counseling and care partner training is limited. Available evidence supports the utility of these approaches, which serve as complementary components to restitutive and compensatory speech-language intervention. Additional research is warranted to support generalizability and long-term benefit of these interventions, and to address facets of counseling and care partner training that have not been explored in PPA (e.g., counseling interventions drawing from specific psychotherapeutic traditions; multicultural counseling) or have only been explored to a limited degree (e.g., interventions that jointly provide counseling and partner training).
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Affiliation(s)
- Kristin M. Schaffer
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
| | - Maya L. Henry
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
- Dell Medical School, The University of Texas at Austin
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17
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Machado TH, Carthery-Goulart MT, Campanha AC, Caramelli P. Cognitive Intervention Strategies Directed to Speech and Language Deficits in Primary Progressive Aphasia: Practice-Based Evidence from 18 Cases. Brain Sci 2021; 11:brainsci11101268. [PMID: 34679333 PMCID: PMC8533834 DOI: 10.3390/brainsci11101268] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/16/2021] [Accepted: 09/18/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Practice-based evidence can inform and support clinical decision making. Case-report series about the implementation of programs in real-world clinical settings may contribute to verifying the effectiveness of interventions for treating PPA in specific contexts, as well as illustrating challenges that need to be overcome. OBJECTIVE To describe and provide practice-based evidence on the effectiveness of four cognitive rehabilitation programs designed for individuals with PPA and directed to speech and language impairments, which were implemented in a specialized outpatient clinic. METHODS Multiple single-case study. Eighteen individuals with different subtypes of PPA were each assigned to one out of four training programs based on comprehensive speech and language assessments. The treatments targeted naming deficits, sentence production, speech apraxia, and phonological deficits. Pre- and post-treatment assessments were undertaken to compare trained and untrained items. Gains were generalized to a different task in the first two types of intervention (naming and sentence production). A follow-up assessment was conducted 1-8 months after treatment among 7 participants. RESULTS All individuals presented better performance in the trained items at the post-test for each rehabilitation program accomplished, demonstrating that learning of the trained strategies was achieved during the active phase of treatment. For 13 individuals, statistical significance was reached; while for five, the results were maintained. Results about untrained items, generalization to other tasks, and follow-up assessments are presented. CONCLUSIONS The positive results found in our sample bring some practice-based evidence for the benefits of speech and language treatment strategies for clinical management of individuals with PPA.
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Affiliation(s)
- Thais Helena Machado
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil;
- Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil;
- Av Prudente de Morais, 290-Sala 1106, Belo Horizonte 30380-002, MG, Brazil
- Correspondence:
| | - Maria Teresa Carthery-Goulart
- Grupo de Estudos em Neurociência da Linguagem e Cognição, Núcleo Interdisciplinar de Neurociência Aplicada, Centro de Matemática, Computação e Cognição da Universidade Federal do ABC, São Bernardo do Campo 09210-580, SP, Brazil;
- Grupo de Neurologia Cognitiva e do Comportamento, Divisão de Clínica Neurológica, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, SP, Brazil
- INCT-ECCE (Instituto Nacional de Ciência e Tecnologia sobre Comportamento, Cognição e Ensino), Rodovia Washington Luís, Km 235, São Carlos 13565-905, SP, Brazil
| | - Aline Carvalho Campanha
- Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil;
| | - Paulo Caramelli
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil;
- Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil;
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18
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Pagnoni I, Gobbi E, Premi E, Borroni B, Binetti G, Cotelli M, Manenti R. Language training for oral and written naming impairment in primary progressive aphasia: a review. Transl Neurodegener 2021; 10:24. [PMID: 34266501 PMCID: PMC8282407 DOI: 10.1186/s40035-021-00248-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary progressive aphasia (PPA) is a neurodegenerative disorder characterized by a gradual, insidious and progressive loss of language abilities, with naming difficulties being an early and persistent impairment common to all three variants. In the absence of effective pharmacological treatments and given the progressive nature of the disorder, in the past few decades, many studies have investigated the effectiveness of language training to minimize the functional impact of word-finding difficulties in daily life. MAIN BODY We review language treatments most commonly used in clinical practice among patients with different variants of PPA, with a focus on the enhancement of spoken and written naming abilities. Generalization of gains to the ability to name untrained stimuli or to other language abilities and the maintenance of these results over time are also discussed. Forty-eight studies were included in this literature review, identifying four main types of language treatment: a) lexical retrieval treatment, b) phonological and/or orthographic treatment, c) semantic treatment, and d) a multimodality approach treatment. Overall, language training is able to induce immediate improvements of naming abilities in all variants of PPA. Moreover, despite the large variability among results, generalization and long-term effects can be recorded after the training. The reviewed studies also suggest that one factor that determines the choice of a particular approach is the compromised components of the lexical/semantic processing system. CONCLUSION The majority of studies have demonstrated improvements of naming abilities following language treatments. Given the progressive nature of PPA, it is essential to apply language treatment in the early stages of the disease.
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Affiliation(s)
- Ilaria Pagnoni
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Elena Gobbi
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Enrico Premi
- Vascular Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, Brescia, Italy
| | - Barbara Borroni
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giuliano Binetti
- MAC Memory Clinic and Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Maria Cotelli
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
| | - Rosa Manenti
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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19
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Paek EJ, Murray LL, Newman SD. Effects of concurrent action and object naming treatment on naming skills and functional brain activation patterns in primary progressive aphasia: An fMRI study with a case-series design. BRAIN AND LANGUAGE 2021; 218:104950. [PMID: 33836414 DOI: 10.1016/j.bandl.2021.104950] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 11/18/2020] [Accepted: 03/28/2021] [Indexed: 06/12/2023]
Abstract
Individuals with primary progressive aphasia (PPA) exhibit differential impairment patterns in noun and verb naming, but it remains unclear whether anomia treatment results in similar improvements in noun and verb naming. Therefore, we examined the immediate and long-term (3-months post-treatment) behavioral and neural effects of an anomia treatment on object and action naming skills in PPA. A case-series design was utilized involving two individuals with PPA. Object and action words were trained concurrently and probed regularly using word lists matched on a number of lexical characteristics. One participant showed improvements in all word categories with different effect sizes whereas the other participant demonstrated improved naming only on trained object words. Treatment-induced fMRI changes were found in both hemispheres, with distinct patterns observed across participants. Further research is needed to better understand the effects of residual language and cognitive skills on behavioral and neurophysiological outcomes following anomia treatment for PPA.
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Affiliation(s)
- Eun Jin Paek
- Department of Audiology and Speech Pathology, College of Health Professions, The University of Tennessee Health Science Center, Knoxville, TN 37996, United States.
| | - Laura L Murray
- School of Communication Sciences and Disorders, Western University, London, Ontario N6G 1H1, Canada.
| | - Sharlene D Newman
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN 47401, United States; Department of Psychology, University of Alabama, Tuscaloosa, AL 35487, United States.
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20
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Nealon KC, Edmonds LA. Effects of Verb Network Strengthening Treatment on Sound-Level and Speech Production Errors in Individuals With Aphasia and Acquired Apraxia of Speech. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1446-1458. [PMID: 34010033 DOI: 10.1044/2021_ajslp-20-00141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose This retrospective pilot study investigated whether sound-level and speech production errors decreased in confrontation naming following Verb Network Strengthening Treatment (VNeST) for four participants with acquired apraxia of speech (A-AOS) and aphasia for whom lexical retrieval was previously reported. Specifically, we investigated a potential increase in correct number of syllables per word and posttreatment changes across three domains of speech: segmental production, fluency, and prosody. It was hypothesized that treatment shown to increase lexical retrieval in persons with aphasia and A-AOS could potentially facilitate a reduction in sound-level and speech production errors consistent with dual diagnoses of A-AOS and aphasia. Method Naming responses from four participants with aphasia and A-AOS who previously participated in VNeST studies were investigated for correct number of syllables per word and measures of segmental speech, fluency, and prosody. Results Significant gains in at least one measure of speech production were reported for three of the participants. One participant demonstrated decreased segmental speech errors, two showed significant reduction on syllable segmentation, and two demonstrated a significant reduction on false starts and pauses. Significant gains in production of correct number of syllables were limited to one participant, and one participant did not demonstrate increased accuracy on any measure of speech production. Conclusions While speech production errors consistent with motor speech impairment cannot always be definitively distinguished from the confound of aphasia, two participants produced significantly decreased segmentation of syllables, a characteristic unique to A-AOS. The sound-level and speech production changes recorded may be attributed to a combination of interacting motor and language processes and resource allocation. In addition, specific components of VNeST may have contributed to speech production changes. Future work will focus on a prospective study of effects of language therapy (e.g., VNeST) on measures of speech production with investigation beyond the single-word level.
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Affiliation(s)
- Kate C Nealon
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
| | - Lisa A Edmonds
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY
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21
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Petroi D, Walker GM, Duffy JR, Hickok GS, Josephs KA. A Cognitive Psychometric Investigation of Word Production and Phonological Error Rates in Logopenic Progressive Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1194-1202. [PMID: 33872514 PMCID: PMC8702835 DOI: 10.1044/2021_ajslp-20-00221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 01/10/2021] [Accepted: 01/19/2021] [Indexed: 06/12/2023]
Abstract
Purpose This study investigated the relationship between word production rates (WPRs) and phonological error rates (PERs) in generative and responsive tasks in logopenic progressive aphasia (lvPPA). We examined whether a portion of the reduced WPR during generative tasks related directly to phonological impairments affecting PER on all tasks, irrespective of other task differences that contributed to WPR. Method Two cognitive psychometric models were hypothesized and fit to the total number of words produced and the number of phonological errors produced by 22 participants on 10 tasks. Bayesian inference was used to construct posterior distributions of participant ability and task difficulty parameters. Model fit statistics were compared. Association strengths for average generative WPR and average responsive PER were also evaluated with linear least-squares regression. Results Average generative WPR and average responsive PER were significantly associated (r = -.77, p = .00002). A cognitive psychometric model that assumed reduced WPR on generative tasks reflects a portion of general phonological impairment yielded better fit than a model that ignored performance differences between generative and responsive tasks. Generative fluency tasks that elicited few phonological errors still reflected phonological impairment, via suppression. Individual participants were estimated to suppress between 62% and 93% of phonological errors on generative tasks that would have emerged on responsive tasks. Conclusions Suppression of phonological errors may present as decreased WPR on generative tasks in lvPPA. Failure to account for this suppression tendency may lead to overestimation of phonological ability. The findings indicate the need to account for task demands in assessing lvPPA.
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Affiliation(s)
- Diana Petroi
- Department of Neurology, Mayo Clinic, Rochester, MN
- Department of Communication Sciences and Disorders, Biola University, CA
| | - Grant M. Walker
- Department of Cognitive Sciences, University of California, Irvine, CA
| | | | - Gregory S. Hickok
- Department of Cognitive Sciences, University of California, Irvine, CA
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22
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Taylor-Rubin C, Croot K, Nickels L. Speech and language therapy in primary progressive aphasia: a critical review of current practice. Expert Rev Neurother 2021; 21:419-430. [PMID: 33641570 DOI: 10.1080/14737175.2021.1897253] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Primary progressive aphasia (PPA) is a complex language-led dementia syndrome whereby disproportionate deterioration of speech and language occurs subsequent to neurodegenerative disease in the early to mid-stages of the condition. As no effective pharmacotherapies are currently available, speech and language therapies are the optimum treatment to maximize communication for as long as possible. AREAS COVERED The authors present an overview of current speech-language therapy practices in PPA, highlighting recent research on effective treatments. EXPERT OPINION The challenges in this complex field of practice are described. We highlight the challenge of improving access to speech-language therapy by advocating for increased referral rates. The authors also suggest effective incorporation of innovative technologies in treatment and an enhanced evidence base for the utility of lexical retrieval treatment in improving everyday communication as challenges for the future. Finally, increased provision of PPA-specific education and support for individuals and their families is required.
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Affiliation(s)
- Cathleen Taylor-Rubin
- Department of Cognitive Science, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 3, Australian Hearing Hub, 16 University Road, Macquarie University, Sydney, NSW, Australia.,Department of Speech Pathology, Uniting War Memorial Hospital, South Eastern Sydney Local Health District War Memorial Hospital, Waverley, NSW, Australia
| | - Karen Croot
- Department of Cognitive Science, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 3, Australian Hearing Hub, 16 University Road, Macquarie University, Sydney, NSW, Australia.,Faculty of Science, School of Psychology, Brennan MacCallum Building, Camperdown, NSW, Australia
| | - Lyndsey Nickels
- Department of Cognitive Science, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 3, Australian Hearing Hub, 16 University Road, Macquarie University, Sydney, NSW, Australia
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23
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Beales A, Whitworth A, Cartwright J, Panegyres PK, Kane RT. Making the Right Connections: Maximizing Lexical Generalization in Lexical Impairments in Primary Progressive Aphasia and Alzheimer's Disease. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:697-712. [PMID: 33751904 DOI: 10.1044/2020_ajslp-20-00019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose Positive intervention effects following lexical retrieval interventions are increasingly reported with people with progressive language impairments; however, generalization of therapy gains are less frequently evident and less well understood. This study sought to explore the impact of specific therapy ingredients on generalization outcomes. Method Twelve participants with progressive lexical retrieval deficits (four each with semantic variant primary progressive aphasia, logopenic variant primary progressive aphasia, and Alzheimer's disease, amnestic presentation) and their family members participated in a 6-week intervention that aimed to increase access to different word classes (nouns, verbs, and adjectives) through a strategic self-cueing approach. Generalization was actively facilitated through strategy practice in connected speech. Repeated baselines of picture naming and connected speech were conducted prior to intervention and repeated immediately post and at 6 weeks following intervention. Results All three diagnostic groups showed significant improvements in naming performance post-intervention for all word classes and for both treated and untreated items, demonstrating consistent treatment effectiveness and generalization at the word level. No changes in the informativeness or efficiency of connected speech were found. Conclusions Despite heterogeneity across participants, widespread evidence of both treatment effects and generalization to untreated items was found for all diagnostic groups and word classes. The consistent within-level generalization across all groups is explored here in relation to optimization of strategy use through incorporation of cognitive scaffolds, strategic practice at the connected speech level, and the inclusion of family members. The absence of across-level generalization to connected speech is also explored. Supplemental Material https://doi.org/10.23641/asha.14219771.
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Affiliation(s)
- Ashleigh Beales
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Anne Whitworth
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Jade Cartwright
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - Peter K Panegyres
- Neurodegenerative Disorders Research, West Perth, Western Australia, Australia
| | - Robert T Kane
- School of Psychology, Curtin University, Perth, Western Australia, Australia
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Is word learning enough? Improved verb phrase production following cueing of verbs and nouns in primary progressive aphasia. Cortex 2021; 139:178-197. [PMID: 33873038 DOI: 10.1016/j.cortex.2021.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 01/25/2021] [Accepted: 02/18/2021] [Indexed: 11/23/2022]
Abstract
There is little evidence that, for people with aphasia, successful outcomes following lexical retrieval treatment generalise beyond single word retrieval to sentence production or daily communication. This study aimed to develop greater understanding of the mechanisms of generalisation. We employed a cueing task to simulate the effects of lexical retrieval treatment. A single noun or verb was provided and the effect on production of a corresponding verb phrase examined. Sixteen individuals with primary progressive aphasia (PPA) were asked to produce verb phrases to describe action pictures accompanied by i) a verb cue where a spoken and written verb was also presented with the picture; ii) a noun cue where a spoken and written noun was presented with the picture; iii) a no cue condition where only the picture was presented. Across the case series, both verb and noun cueing improved verb phrase production relative to no cue, with verb cueing being most effective. At the level of the single case, thirteen individuals showed significantly increased production of verb phrases with verb cueing, and seven individuals with noun cueing. In addition, seven individuals showed significantly greater benefit from verb cueing compared to noun cueing, and none showed the reverse. This suggests that improvements in verb phrase production may also be achievable following treatment-induced improvements in lexical retrieval. Greater benefit from verb cues than noun cues raises important theoretical issues regarding sentence construction and clinical issues around the most effective treatment techniques for people with aphasia.
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Interference Resolution in Nonfluent Variant Primary Progressive Aphasia: Evidence From a Picture-Word Interference Task. Cogn Behav Neurol 2021; 34:11-25. [PMID: 33652466 DOI: 10.1097/wnn.0000000000000255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 08/25/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Picture-word interference tasks have been used to investigate (a) the time course of lexical access in individuals with primary progressive aphasia (PPA) and (b) how these individuals resolve competition during lexical selection. OBJECTIVE To investigate the time course of Greek-speaking individuals with PPA to produce grammatical gender-marked determiner phrases by examining their picture-naming latencies in the context of distractor words. METHOD Eight individuals with nonfluent variant PPA (nfv-PPA; M age = 62.8 years) and eight cognitively intact controls (M age = 61.1 years) participated in our study. In a picture-word interference task, the study participants named depicted objects by producing determiner + noun sequences. Interference was generated by manipulating the grammatical gender of the depicted objects and distractor words. Two stimulus onset asynchronies were used: +200 ms and +400 ms. RESULTS The individuals with nfv-PPA exhibited longer picture-naming latencies than the controls (P = 0.003). The controls exhibited interference from incongruent distractors at both asynchronies (P < 0.001); the individuals with PPA exhibited interference from incongruent distractors only at the +400-ms interval (P = 0.002). The gender-congruency effect was stronger for the individuals with PPA than for the controls at the +400-ms interval (P = 0.05); the opposite pattern was observed at the +200-ms interval (P = 0.024). CONCLUSION Gender interference resolution was abnormal in the individuals with nfv-PPA. The results point to deficits in lexicosyntactic networks that compromised the time course of picture-naming production.
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de Aguiar V, Rofes A, Wendt H, Ficek BN, Webster K, Tsapkini K. Treating lexical retrieval using letter fluency and tDCS in primary progressive aphasia: a single-case study. APHASIOLOGY 2021; 36:353-379. [PMID: 38765920 PMCID: PMC11101187 DOI: 10.1080/02687038.2021.1881432] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 01/20/2021] [Indexed: 05/22/2024]
Abstract
Background In early stages, individuals with Primary Progressive Aphasia (PPA) report language symptoms while scoring within norm in formal language tests. Early intervention is important due to the progressive nature of the disease. Method We report a single case study of an individual with logopenic variant PPA (lvPPA). We tested whether letter fluency, used as a therapy task, can improve lexical retrieval when combined with tDCS to either the left inferior-frontal gyrus (IFG) or the left inferior parietal lobe (IPL), administered in two separate therapy phases separated by a wash-out period of three months. Outcomes and results We observed increases in number of words retrieved during a letter fluency task in trained and untrained letters, when letter fluency therapy (LeFT) was administered with anodal tDCS. When LeFT was combined with left IFG stimulation, words produced in a letter fluency task were lower frequency and higher age of acquisition after treatment, compared to before treatment and there was also an increase in accuracy and response times in an untrained picture-naming task. Conclusions The results indicate that letter fluency therapy combined anodal tDCS is effective in improving lexical retrieval, particularly when left IFG stimulation was used. Effects generalize beyond the trained task, albeit slowing down of responses in picture naming. This task may provide a useful clinical intervention strategy for patients with mild anomia, who are not challenged enough by traditional naming therapies.
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Affiliation(s)
- Vânia de Aguiar
- Department of Neurology, Johns Hopkins Medicine
- Center for Language and Cognition Groningen (CLCG), University of Groningen
| | - Adrià Rofes
- Center for Language and Cognition Groningen (CLCG), University of Groningen
- Department of Cognitive Science, Johns Hopkins University
| | - Haley Wendt
- Department of Neurology, Johns Hopkins Medicine
| | | | - Kimberly Webster
- Department of Neurology, Johns Hopkins Medicine
- Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins Medicine
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins Medicine
- Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins Medicine
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Taylor-Rubin C, Nickels L, Croot K. Exploring the effects of verb and noun treatment on verb phrase production in primary progressive aphasia: A series of single case experimental design studies. Neuropsychol Rehabil 2021; 32:1121-1163. [PMID: 33557713 DOI: 10.1080/09602011.2021.1879174] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Evidence of generalization to connected speech following lexical retrieval treatment in Primary Progressive Aphasia (PPA) is scarce. Consequently, this study systematically investigated changes in verb phrase production following lexical retrieval treatment in a series of single case experimental design studies. Four individuals with PPA (three semantic- and one logopenic variant PPA) who had previously demonstrated that they could integrate verbs and nouns into sentence structures in a cueing paradigm, undertook a sequence of verb and noun lexical retrieval treatments using Repetition and Reading in the Presence of a Picture. Production of treated nouns- and/or verbs-in-isolation significantly improved following treatment for three of the four participants. Verb phrase production did not improve for one of these participants (logopenic PPA), perhaps due to the relatively small treatment dose. Two participants (semantic variant PPA) did, however, demonstrate across-level generalization, with improvement in treated verbs and using those verbs in (untreated) verb phrases. Their verb phrase production improved most after lexical retrieval treatment for both nouns and verbs, suggesting this combined approach may benefit across-level generalization for some individuals in clinical practice.
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Affiliation(s)
- Cathleen Taylor-Rubin
- Department of Cognitive Science, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.,Department of Speech Pathology, South East Sydney Local Health District, Uniting War Memorial Hospital, Sydney, Australia
| | - Lyndsey Nickels
- Department of Cognitive Science, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia
| | - Karen Croot
- School of Psychology, University of Sydney, Sydney, Australia
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Thompson CK, Barbieri E, Mack JE, Wilkins A, Xie KY. Plasticity of sentence processing networks: evidence from a patient with agrammatic variant of primary progressive aphasia (PPA). Neurocase 2021; 27:39-56. [PMID: 33378229 PMCID: PMC8026534 DOI: 10.1080/13554794.2020.1862241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
This study reports the results of a longitudinal study examining the effects of treatment for sentence processing deficits for a 70-year-old gentleman (DK) with the agrammatic variant of Primary Progressive Aphasia (PPA). On entry into the study, he presented with a 2-year history of impaired verb and sentence processing and concomitant neural atrophy in primarily subcortical regions. Spanning an 18-month period, treatment focused on improving comprehension and production of syntactically complex, passive and object cleft, structures, consecutively. Results, derived from extensive behavioral and neurocognitive testing, showed not only improved ability to comprehend and produce both trained and untrained, less complex, linguistically related structures in offline tasks, but also improved online sentence processing strategies as revealed by partially normalized eye movements in online comprehension (i.e., emergence of thematic prediction and thematic integration) and production (i.e., use of incremental processing) tasks. Changes in neural activation from pre- to post-treatment of both structures also were found, with upregulation of tissue in both the left and right hemispheres, overlapping with regions recruited by neurotypical adults performing the same task. These findings indicate that Treatment of Underlying Forms (TUF) is effective for treatment of patients with the agrammatic variant of PPA (as it is for those with stroke-induced agrammatism), and show that unaffected neural tissue in patients with PPA is malleable and may be recruited to support language, providing evidence of experience-based plasticity in neurodegenerative disease.
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Affiliation(s)
- Cynthia K. Thompson
- Aphasia and Neurolinguistics Research Laboratory, Center for the Neurobiology of Language Recovery, Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
- Department of Neurology, Northwestern University, Chicago, IL, United States
- Cognitive Neurology and Alzheimer’s Disease Center, Northwestern University, Chicago, IL, United States
| | - Elena Barbieri
- Aphasia and Neurolinguistics Research Laboratory, Center for the Neurobiology of Language Recovery, Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
| | - Jennifer E. Mack
- Aphasia and Neurolinguistics Research Laboratory, Center for the Neurobiology of Language Recovery, Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
| | - Aaron Wilkins
- Center for Audiology, Speech, Language, and Learning, Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
| | - Kathy Y. Xie
- Aphasia and Neurolinguistics Research Laboratory, Center for the Neurobiology of Language Recovery, Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
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Europa E, Iaccarino L, Perry DC, Weis E, Welch AE, Rabinovici GD, Miller BL, Gorno-Tempini ML, Henry ML. Diagnostic Assessment in Primary Progressive Aphasia: An Illustrative Case Example. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1833-1849. [PMID: 32910678 PMCID: PMC8740567 DOI: 10.1044/2020_ajslp-20-00007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/15/2020] [Accepted: 05/27/2020] [Indexed: 06/11/2023]
Abstract
Purpose Diagnosis and classification of primary progressive aphasia (PPA) requires confirmation of specific speech and language symptoms, highlighting the important role of speech-language pathologists in the evaluation process. The purpose of this case report is to inform speech-language pathologists regarding current practices for diagnostic assessment in PPA, describing standard approaches as well as complementary, state-of-the-art procedures that may improve diagnostic precision. Method We describe the diagnostic evaluation of a 49-year-old woman with complaints of progressive word-finding difficulty. She completed standard neurological, neuropsychological, and speech-language evaluations, as well as magnetic resonance and positron emission tomography imaging of her brain. In addition, a history of developmental speech, language, and learning abilities was obtained, as well as genetic testing and assessment of cerebrospinal fluid biomarkers. We discuss the evaluation results in the context of the most current research related to PPA diagnosis. Conclusion Detailed behavioral assessment, thorough intake of symptom history and neurodevelopmental differences, multimodal neuroimaging, and comprehensive examination of genes and biomarkers are of paramount importance for detecting and characterizing PPA, with ramifications for early behavioral and/or pharmacological intervention. Supplemental Material https://doi.org/10.23641/asha.12771113.
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Affiliation(s)
- Eduardo Europa
- Memory and Aging Center, University of California, San Francisco
| | | | - David C. Perry
- Memory and Aging Center, University of California, San Francisco
| | - Elizabeth Weis
- Memory and Aging Center, University of California, San Francisco
| | - Ariane E. Welch
- Memory and Aging Center, University of California, San Francisco
| | | | - Bruce L. Miller
- Memory and Aging Center, University of California, San Francisco
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, University of California, San Francisco
- Dyslexia Center, University of California, San Francisco
| | - Maya L. Henry
- Department of Communication Sciences and Disorders, The University of Texas at Austin
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VandeVrede L, Ljubenkov PA, Rojas JC, Welch AE, Boxer AL. Four-Repeat Tauopathies: Current Management and Future Treatments. Neurotherapeutics 2020; 17:1563-1581. [PMID: 32676851 PMCID: PMC7851277 DOI: 10.1007/s13311-020-00888-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Four-repeat tauopathies are a neurodegenerative disease characterized by brain parenchymal accumulation of a specific isoform of the protein tau, which gives rise to a wide breadth of clinical syndromes encompassing diverse symptomatology, with the most common syndromes being progressive supranuclear palsy-Richardson's and corticobasal syndrome. Despite the lack of effective disease-modifying therapies, targeted treatment of symptoms can improve quality of life for patients with 4-repeat tauopathies. However, managing these symptoms can be a daunting task, even for those familiar with the diseases, as they span motor, sensory, cognitive, affective, autonomic, and behavioral domains. This review describes current approaches to symptomatic management of common clinical symptoms in 4-repeat tauopathies with a focus on practical patient management, including pharmacologic and nonpharmacologic strategies, and concludes with a discussion of the history and future of disease-modifying therapeutics and clinical trials in this population.
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Affiliation(s)
- Lawren VandeVrede
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA.
| | - Peter A Ljubenkov
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Julio C Rojas
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Ariane E Welch
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Adam L Boxer
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA
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Bilingualism in Primary Progressive Aphasia: A Retrospective Study on Clinical and Language Characteristics. Alzheimer Dis Assoc Disord 2020; 33:47-53. [PMID: 30640254 DOI: 10.1097/wad.0000000000000288] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Primary progressive aphasia (PPA) is a neurodegenerative disorder characterized by progressive deterioration of language. Being rare, reports of PPA in multilingual individuals are scarce, despite more than half of the world population being multilingual. METHODS We describe clinical characteristics of 33 bilingual patients with PPA, including symptom presentation and language deficits pattern in their first (L1) and second language (L2), through a systematic literature review and new cases retrospectively identified in 5 countries. RESULTS In total, 14 patients presented with nonfluent/agrammatic variant, 6 with semantic variant, and 13 with logopenic variant, with a median symptom onset of 2 years. Word-finding difficulties was the first symptom in 65% of all cases, initially noticed in L2, and not always the dominant language. Our group had 22 different languages as L1, and 9 as L2. At the whole-group level there was a tendency for parallel impairment in both languages, in line with the shared bilingual neural substrate hypothesis, but each PPA variant showed some heterogeneity. DISCUSSION Each PPA variant showed heterogeneity, showing the need for comprehensive language and cognitive assessment across languages, as well as further clarification on the role of language mediators.
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Cotelli M, Manenti R, Ferrari C, Gobbi E, Macis A, Cappa SF. Effectiveness of language training and non-invasive brain stimulation on oral and written naming performance in Primary Progressive Aphasia: A meta-analysis and systematic review. Neurosci Biobehav Rev 2020; 108:498-525. [DOI: 10.1016/j.neubiorev.2019.12.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 10/11/2019] [Accepted: 12/03/2019] [Indexed: 12/14/2022]
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de Aguiar V, Zhao Y, Faria A, Ficek B, Webster KT, Wendt H, Wang Z, Hillis AE, Onyike CU, Frangakis C, Caffo B, Tsapkini K. Brain volumes as predictors of tDCS effects in primary progressive aphasia. BRAIN AND LANGUAGE 2020; 200:104707. [PMID: 31704518 PMCID: PMC7709910 DOI: 10.1016/j.bandl.2019.104707] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 10/01/2019] [Accepted: 10/08/2019] [Indexed: 05/28/2023]
Abstract
The current study aims to determine the brain areas critical for response to anodal transcranial direct current stimulation (tDCS) in PPA. Anodal tDCS and sham were administered over the left inferior frontal gyrus (IFG), combined with written naming/spelling therapy. Thirty people with PPA were included in this study, and assessed immediately, 2 weeks, and 2 months post-therapy. We identified anatomical areas whose volumes significantly predicted the additional tDCS effects. For trained words, the volumes of the left Angular Gyrus and left Posterior Cingulate Cortex predicted the additional tDCS gain. For untrained words, the volumes of the left Middle Frontal Gyrus, left Supramarginal Gyrus, and right Posterior Cingulate Cortex predicted the additional tDCS gain. These findings show that areas involved in language, attention and working memory contribute to the maintenance and generalization of stimulation effects. The findings highlight that tDCS possibly affects areas anatomically or functionally connected to stimulation targets.
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Affiliation(s)
- Vânia de Aguiar
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States; Center for Language and Cognition Groningen (CLCG), University of Groningen, Netherlands.
| | - Yi Zhao
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | - Andreia Faria
- Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Bronte Ficek
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Kimberly T Webster
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Haley Wendt
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Zeyi Wang
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States; Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States; Department of Physical Medicine & Rehabilitation, Johns Hopkins University, Baltimore, MD, United States
| | - Chiadi U Onyike
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Constantine Frangakis
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, United States; Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD, United States; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Brian Caffo
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD, United States
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States; Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
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de Aguiar V, Zhao Y, Ficek BN, Webster K, Rofes A, Wendt H, Frangakis C, Caffo B, Hillis AE, Rapp B, Tsapkini K. Cognitive and language performance predicts effects of spelling intervention and tDCS in Primary Progressive Aphasia. Cortex 2019; 124:66-84. [PMID: 31838450 DOI: 10.1016/j.cortex.2019.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 03/16/2019] [Accepted: 11/04/2019] [Indexed: 11/25/2022]
Abstract
Predictors of treatment effects allow individual tailoring of treatment characteristics, thereby saving resources and optimizing outcomes. Electrical stimulation coupled with language intervention has shown promising results in improving language performance in individuals with Primary Progressive Aphasia (PPA). The current study aimed to identify language and cognitive variables associated with response to therapy consisting of language intervention combined with transcranial direct current stimulation (tDCS). Forty individuals with PPA received written naming/spelling intervention combined with anodal tDCS or Sham, using a between-subjects, randomized design, with intervention delivered over a period of 3 weeks. Participants were assessed using a battery of neuropsychological tests before and after each phase. We measured letter accuracy during spelling of trained and untrained words, before, immediately after, 2 weeks, and 2 months after therapy. We used step-wise regression methods to identify variables amongst the neuropsychological measures and experimental factors that were significantly associated with therapy outcomes at each time-point. For trained words, improvement was related to pre-therapy scores, in RAVLT (5 trials sum), pseudoword spelling, object naming, digit span backward, spatial span backward and years post symptom onset. Regarding generalization to untrained words, improvement in spelling was associated with pseudoword spelling, RAVLT proactive interference, RAVLT immediate recall. Generalization effects were larger under tDCS compared to Sham at the 2-month post training measurement. We conclude that, for trained words, patients who improve the most are those who retain for longer language skills such as sublexical spelling processes (phoneme-to-grapheme correspondences) and word retrieval, and other cognitive functions such as executive functions and working memory, and those who have a better learning capacity. Generalization to untrained words occurs through improvement in knowledge of phoneme-to-grapheme correspondences. Furthermore, tDCS enhances the generalizability and duration of therapy effects.
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Affiliation(s)
- Vânia de Aguiar
- Department of Neurology, Johns Hopkins Medicine; Centre for Language and Cognition Groningen (CLCG), University of Groningen.
| | - Yi Zhao
- Department of Biostatistics, Johns Hopkins School of Public Health
| | | | - Kimberly Webster
- Department of Neurology, Johns Hopkins Medicine; Department of Otolaryngology, Johns Hopkins Medicine
| | - Adrià Rofes
- Centre for Language and Cognition Groningen (CLCG), University of Groningen; Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland; Department of Cognitive Science, Johns Hopkins University
| | - Haley Wendt
- Department of Neurology, Johns Hopkins Medicine
| | | | - Brian Caffo
- Department of Biostatistics, Johns Hopkins School of Public Health
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins Medicine; Department of Cognitive Science, Johns Hopkins University; Department of Physical Medicine & Rehabilitation, Johns Hopkins University
| | - Brenda Rapp
- Department of Cognitive Science, Johns Hopkins University
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins Medicine; Department of Cognitive Science, Johns Hopkins University
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Beeson PM, Bayley C, Shultz C, Rising K. Maximising recovery from aphasia with central and peripheral agraphia: The benefit of sequential treatments. Neuropsychol Rehabil 2019; 29:1399-1425. [PMID: 29298550 DOI: 10.1080/09602011.2017.1417873] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Maximal recovery from acquired language impairment may require progression from one behavioural treatment protocol to the next in order to build upon residual and relearned cognitive-linguistic and sensory-motor processes. We present a five-stage treatment sequence that was initiated at one year post stroke in a woman with acquired impairments of spoken and written language. As is typical of individuals with left perisylvian damage, she demonstrated marked impairment of phonological retrieval and sublexical phonology, but she also faced additional challenges due to impaired letter shape knowledge and visual attention. The treatment sequence included (1) written spelling of targeted words, (2) retraining sublexical sound-to-letter correspondences and phonological manipulation skills, (3) training strategic approaches to maximise interactive use of lexical, phonological, and orthographic knowledge, (4) lexical retrieval of spoken words, and finally (5) sentence-level stimulation to improve grammatical form of written narratives. This Phase II clinical study documented positive direct treatment outcomes along with evidence of a significant reduction in the underlying deficits and generalisation to untrained items and language tasks. Improvements on a comprehensive assessment battery were realised as functional gains in everyday written and spoken communication, including improved lexical retrieval and grammatical complexity of written narratives. This case provides a valuable example of the cumulative therapeutic benefit of sequential application of theoretically motivated treatment protocols.
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Affiliation(s)
- Pélagie M Beeson
- Department of Speech, Language, and Hearing Sciences, The University of Arizona , Tucson , AZ , USA.,Department of Neurology, The University of Arizona , Tucson , AZ , USA
| | - Chelsea Bayley
- Department of Speech, Language, and Hearing Sciences, The University of Arizona , Tucson , AZ , USA
| | - Christine Shultz
- Department of Speech, Language, and Hearing Sciences, The University of Arizona , Tucson , AZ , USA
| | - Kindle Rising
- Department of Speech, Language, and Hearing Sciences, The University of Arizona , Tucson , AZ , USA
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Henry ML, Hubbard HI, Grasso SM, Dial HR, Beeson PM, Miller BL, Gorno-Tempini ML. Treatment for Word Retrieval in Semantic and Logopenic Variants of Primary Progressive Aphasia: Immediate and Long-Term Outcomes. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:2723-2749. [PMID: 31390290 PMCID: PMC6802912 DOI: 10.1044/2018_jslhr-l-18-0144] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 10/23/2018] [Accepted: 12/16/2018] [Indexed: 05/25/2023]
Abstract
Purpose Recent studies confirm the utility of speech-language intervention in primary progressive aphasia (PPA); however, long-term outcomes, ideal dosage parameters, and relative benefits of intervention across clinical variants warrant additional investigation. The purpose of this study was to determine whether naming treatment affords significant, lasting, and generalized improvement for individuals with semantic and logopenic PPA and whether dosage manipulations significantly affect treatment outcomes. Method Eighteen individuals with PPA (9 semantic and 9 logopenic variant) underwent lexical retrieval treatment designed to leverage spared cognitive-linguistic domains and develop self-cueing strategies to promote naming. One group (n = 10) underwent once-weekly treatment sessions, and the other group (n = 8) received the same treatment with 2 sessions per week and an additional "booster" treatment phase at 3 months post-treatment. Performance on trained and untrained targets/tasks was measured immediately after treatment and at 3, 6, and 12 months post-treatment. Results Outcomes from the full cohort of individuals with PPA showed significantly improved naming of trained items immediately post-treatment and at all follow-up assessments through 1 year. Generalized improvement on untrained items was significant up to 6 months post-treatment. The positive response to treatment was comparable regardless of session frequency or inclusion of a booster phase. Outcomes were comparable across PPA subtypes, as was maintenance of gains over the post-treatment period. Conclusion This study documents positive naming treatment outcomes for a group of individuals with PPA, demonstrating strong direct treatment effects, maintenance of gains up to 1 year post-treatment, and generalization to untrained items. Lexical retrieval treatment, in conjunction with daily home practice, had a strong positive effect that did not require more than 1 clinician-directed treatment session per week. Findings confirm that strategic training designed to capitalize on spared cognitive-linguistic abilities results in significant and lasting improvement, despite ongoing disease progression, in PPA.
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Affiliation(s)
- Maya L. Henry
- Department of Communication Sciences and Disorders, The University of Texas at Austin
| | - H. Isabel Hubbard
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
- Department of Communication Science and Disorders, University of Kentucky, Lexington
| | - Stephanie M. Grasso
- Department of Communication Sciences and Disorders, The University of Texas at Austin
| | - Heather R. Dial
- Department of Communication Sciences and Disorders, The University of Texas at Austin
| | - Pélagie M. Beeson
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson
| | - Bruce L. Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
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Grasso SM, Cruz DF, Benavidez R, Peña ED, Henry ML. Video-Implemented Script Training in a Bilingual Spanish-English Speaker With Aphasia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:2295-2316. [PMID: 31251684 PMCID: PMC6808363 DOI: 10.1044/2018_jslhr-l-18-0048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 06/17/2018] [Accepted: 11/21/2018] [Indexed: 06/09/2023]
Abstract
Purpose This study examines the utility of Video-Implemented Script Training for Aphasia (VISTA) for improving speech production and fluency in a Spanish-English bilingual speaker with aphasia. Method In this single-subject, multiple-baseline intervention study, VISTA was utilized to facilitate fluent and intelligible speech through training with an audiovisual speech model. Scripts were developed from personalized topics of interest, and training stimuli were tailored for speech rate and linguistic complexity. One trained script per language contained a high proportion of cognates in order to examine the potential for enhancing cross-linguistic transfer. Primary and secondary outcome measures for trained and untrained scripts were percent correct and intelligible scripted words, grammatical errors, speech rate, and total percent intelligibility. Results R. C. showed significant improvement in accuracy, intelligibility, and grammaticality of trained scripts. Results revealed cross-linguistic transfer for both languages of treatment. A significantly greater magnitude of cross-language transfer was observed for scripts that were not cognate dense. Conclusions VISTA is a viable treatment method for bilingual individuals with aphasia. Cross-linguistic transfer was diminished when incorporating scripts with a high proportion of cognates; however, this may not be true for all bilingual individuals with aphasia and should be explored with additional participants.
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Affiliation(s)
- Stephanie M. Grasso
- Department of Communication Sciences & Disorders, The University of Texas at Austin
| | - Diana F. Cruz
- Department of Communication Sciences & Disorders, The University of Texas at Austin
| | - Rosa Benavidez
- Department of Communication Sciences & Disorders, The University of Texas at Austin
| | | | - Maya L. Henry
- Department of Communication Sciences & Disorders, The University of Texas at Austin
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Croot K, Raiser T, Taylor-Rubin C, Ruggero L, Ackl N, Wlasich E, Danek A, Scharfenberg A, Foxe D, Hodges JR, Piguet O, Kochan NA, Nickels L. Lexical retrieval treatment in primary progressive aphasia: An investigation of treatment duration in a heterogeneous case series. Cortex 2019; 115:133-158. [DOI: 10.1016/j.cortex.2019.01.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 09/21/2018] [Accepted: 01/09/2019] [Indexed: 10/27/2022]
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Paek EJ, Murray LL, Newman SD, Kim DJ. Test-retest reliability in an fMRI study of naming in dementia. BRAIN AND LANGUAGE 2019; 191:31-45. [PMID: 30807893 DOI: 10.1016/j.bandl.2019.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 12/18/2018] [Accepted: 02/12/2019] [Indexed: 06/09/2023]
Abstract
fMRI has been used as an outcome measure in dementia treatment studies, with many previous studies comparing only single pre- and post-treatment fMRI scans to determine treatment-induced neural changes, while utilizing single subject experimental designs. The purpose of the current study was to evaluate fMRI test-retest reliability in dementia patients and typical older adults using noun and verb confrontation naming to evaluate the validity of using a single pre/post-treatment scan comparison. Seven individuals with dementia and 9 control participants were tested three times over two months using the same fMRI procedures. Differences in individual and group level activation patterns were observed that varied across time. Additionally, the extent of variability fluctuated across individuals, groups, and the grammatical category of target words. Our findings suggested that one time fMRI scanning may inadequately represent an individual's typical brain activation pattern, particularly an individual with dementia. Thus, multiple imaging baselines are recommended.
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Affiliation(s)
- Eun Jin Paek
- Department of Audiology and Speech Pathology, University of Tennessee Health Science Center, Knoxville, TN 37996, United States.
| | - Laura L Murray
- School of Communication Sciences and Disorders, Western University, London, Ontario N6G 1H1, Canada.
| | - Sharlene D Newman
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN 47401, United States.
| | - Dae-Jin Kim
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN 47401, United States.
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40
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Ficek BN, Wang Z, Zhao Y, Webster KT, Desmond JE, Hillis AE, Frangakis C, Faria AV, Caffo B, Tsapkini K. "The effect of tDCS on functional connectivity in primary progressive aphasia" NeuroImage: Clinical, volume 19 (2018), pages 703-715. NEUROIMAGE-CLINICAL 2019; 22:101734. [PMID: 30878405 PMCID: PMC6543522 DOI: 10.1016/j.nicl.2019.101734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Transcranial direct current stimulation (tDCS) is an innovative technique recently shown to improve language outcomes even in neurodegenerative conditions such as primary progressive aphasia (PPA), but the underlying brain mechanisms are not known. The present study tested whether the additional language gains with repetitive tDCS (over sham) in PPA are caused by changes in functional connectivity between the stimulated area (the left inferior frontal gyrus (IFG)) and the rest of the language network. We scanned 24 PPA participants (11 female) before and after language intervention (written naming/spelling) with a resting-state fMRI sequence and compared changes before and after three weeks of tDCS or sham coupled with language therapy. We correlated changes in the language network as well as in the default mode network (DMN) with language therapy outcome measures (letter accuracy in written naming). Significant tDCS effects in functional connectivity were observed between the stimulated area and other language network areas and between the language network and the DMN. TDCS over the left IFG lowered the connectivity between the above pairs. Changes in functional connectivity correlated with improvement in language scores (letter accuracy as a proxy for written naming) evaluated before and after therapy. These results suggest that one mechanism for anodal tDCS over the left IFG in PPA is a decrease in functional connectivity (compared to sham) between the stimulated site and other posterior areas of the language network. These results are in line with similar decreases in connectivity observed after tDCS over the left IFG in aging and other neurodegenerative conditions.
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Affiliation(s)
- Bronte N Ficek
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Zeyi Wang
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD 21287, USA
| | - Yi Zhao
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD 21287, USA
| | - Kimberly T Webster
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - John E Desmond
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; Department of Cognitive Science, Johns Hopkins University, Baltimore, MD 21218, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Constantine Frangakis
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD 21287, USA; Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | | | - Brian Caffo
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD 21287, USA
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; Department of Cognitive Science, Johns Hopkins University, Baltimore, MD 21218, USA.
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Dial HR, Hinshelwood HA, Grasso SM, Hubbard HI, Gorno-Tempini ML, Henry ML. Investigating the utility of teletherapy in individuals with primary progressive aphasia. Clin Interv Aging 2019; 14:453-471. [PMID: 30880927 PMCID: PMC6394239 DOI: 10.2147/cia.s178878] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Primary progressive aphasia (PPA) is a neurodegenerative disorder characterized by progressive deterioration of speech and language. A growing body of research supports the utility of speech and language intervention in individuals with PPA, although access to these services remains limited. One potential means of increasing treatment accessibility is the delivery of treatment via telemedicine. Evidence supports the use of teletherapy in stroke-induced aphasia, but research examining the application of teletherapy in PPA is limited. In the current study, a non-randomized group comparison design was used to evaluate the feasibility and utility of treatment delivered via teletherapy relative to treatment administered in person for individuals with PPA. METHODS Two treatment protocols were administered as part of a larger study investigating treatment for speech and language deficits in PPA. Participants with semantic (n=10) and logopenic (n=11) PPA received lexical retrieval treatment and individuals with nonfluent/agrammatic PPA (n=10) received video-implemented script training for aphasia designed to promote speech production and fluency. Treatment was administered via teletherapy for approximately half of the participants receiving each intervention. Treatment outcomes and performance on standardized tests were assessed at pre-treatment and post-treatment, as well as 3, 6, and 12 months post-treatment. RESULTS Overall, both treatment approaches resulted in significant gains for primary outcome measures. Critically, comparison of in-person and teletherapy groups revealed comparable outcomes. Generalization to untrained targets and tasks and maintenance of treatment-induced gains were also comparable for traditional vs teletherapy participants. CONCLUSION Overall, treatment outcomes were largely equivalent for individuals receiving treatment via teletherapy vs traditional, in-person delivery. Results support the application of teletherapy for administering restitutive interventions to individuals with mild-to-moderate PPA. Potential implications for using teletherapy in the treatment of cognitive-linguistic and motoric impairments in other disorders and suggestions for administering treatment via telemedicine are discussed.
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Affiliation(s)
- Heather R Dial
- Communication Sciences and Disorders, University of Texas at Austin, Austin, TX, USA,
| | | | - Stephanie M Grasso
- Communication Sciences and Disorders, University of Texas at Austin, Austin, TX, USA,
| | - H Isabel Hubbard
- Communication Sciences and Disorders, University of Alberta, Edmonton, AB, Canada
| | | | - Maya L Henry
- Communication Sciences and Disorders, University of Texas at Austin, Austin, TX, USA,
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Lavoie M, Bier N, Laforce R, Macoir J. Improvement in functional vocabulary and generalization to conversation following a self-administered treatment using a smart tablet in primary progressive aphasia. Neuropsychol Rehabil 2019; 30:1224-1254. [PMID: 30714482 DOI: 10.1080/09602011.2019.1570943] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Currently, public services in speech-language pathology for primary progressive aphasia (PPA) are very limited, although several interventions have been shown to be effective. In this context, new technologies have the potential to enable people with PPA to improve their communication skills. The main aim of this study was to investigate the efficacy of a self-administered therapy using a smart tablet to improve naming of functional words and to assess generalization to an ecological conversation task. Five adults with PPA completed the protocol. Using an ABA design with multiple baselines, naming performance was compared across four equivalent lists: (1) trained with functional words; (2) trained with words from a picture database; (3) exposed but not trained; and (4) not exposed (control). Treatment was self-administered four times a week for a period of four consecutive weeks. A significant improvement for trained words was found in all five participants, and gains were maintained two months post-treatment in four of them. Moreover, in three participants, evidence of generalization was found in conversation. This study supports the efficacy of using a smart tablet to improve naming in PPA and suggests the possibility of generalization to an ecological context.
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Affiliation(s)
- Monica Lavoie
- Département de réadaptation, Université Laval, Québec, QC, Canada.,Centre de recherche CERVO - Brain Research Centre, Québec, QC, Canada
| | - Nathalie Bier
- École de réadaptation, Université de Montréal, Montréal, QC, Canada.,Centre de recherche, Institut universitaire de gériatrie de Montréal, Montréal, QC, Canada
| | - Robert Laforce
- Clinique interdisciplinaire de mémoire, CHU de Québec-Hôpital de l'Enfant-Jésus, Québec, QC, Canada.,Département de médecine, Université Laval, Québec, QC, Canada
| | - Joël Macoir
- Département de réadaptation, Université Laval, Québec, QC, Canada.,Centre de recherche CERVO - Brain Research Centre, Québec, QC, Canada
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43
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Krajenbrink T, Croot K, Taylor-Rubin C, Nickels L. Treatment for spoken and written word retrieval in the semantic variant of primary progressive aphasia. Neuropsychol Rehabil 2018; 30:915-947. [PMID: 30198389 DOI: 10.1080/09602011.2018.1518780] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study investigated whether a treatment programme for spoken word retrieval, supplemented with written naming, was beneficial for an individual with right-hemisphere dominant semantic variant of PPA (svPPA). Assessment and treatment were delivered remotely through Skype. Treatment consisted of two phases of lexical retrieval therapy (Repetition and Reading in the Presence of a Picture: RRIPP), with and without written responses (Phases 1 and 2 respectively), and a third treatment phase based on the procedures of Conceptual Enrichment (COEN) therapy. The first two phases of treatment resulted in short-lasting improvements in spoken and written word retrieval, with greater improvement in Phase 2 when written production was also required. Both treatment phases resulted in gains only for treated items, but generalised to different depictions to those treated. However, Phase 2 also resulted in significant improvement of treated items on a comprehension task. COEN treatment did not result in significant gains in word retrieval or comprehension. This study reinforces the value of a simple lexical retrieval treatment delivered remotely. It adds to the current evidence that anomia in svPPA can be responsive to treatment, but also shows that challenges remain regarding maintenance effects and the generalisation of treatment effects to connected speech.
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Affiliation(s)
- Trudy Krajenbrink
- ARC Centre of Excellence in Cognition and its Disorders, Department of Cognitive Science, Macquarie University, Sydney, Australia
| | - Karen Croot
- ARC Centre of Excellence in Cognition and its Disorders, Department of Cognitive Science, Macquarie University, Sydney, Australia.,The School of Psychology, University of Sydney, Sydney, Australia
| | - Cathleen Taylor-Rubin
- ARC Centre of Excellence in Cognition and its Disorders, Department of Cognitive Science, Macquarie University, Sydney, Australia.,Speech Pathology Department, War Memorial Hospital, Sydney, Australia
| | - Lyndsey Nickels
- ARC Centre of Excellence in Cognition and its Disorders, Department of Cognitive Science, Macquarie University, Sydney, Australia
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44
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The Effect of Word Retrieval Therapy in Primary Progressive Aphasia: A Single-Case Study. ARCHIVES OF NEUROSCIENCE 2018. [DOI: 10.5812/ans.67577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sebastian R, Thompson CB, Wang NY, Wright A, Meyer A, Friedman RB, Hillis AE, Tippett DC. Patterns of Decline in Naming and Semantic Knowledge in Primary Progressive Aphasia. APHASIOLOGY 2018; 32:1010-1030. [PMID: 30613121 PMCID: PMC6317736 DOI: 10.1080/02687038.2018.1490388] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Individuals with primary progressive aphasia (PPA) and their caregivers want to know what to expect so that they can plan support appropriately. The ability to predict decline in naming and semantic knowledge, and advise individuals with PPA and their caregivers regarding future planning, would be invaluable clinically. AIMS The aims of this study were to investigate patterns of decline in naming and semantic knowledge in each of the clinical variants of PPA (logopenic variant PPA, lvPPA; nonfluent agrammatic PPA, nfaPPA; and semantic variant PPA, svPPA) and to examine the effects of other variables on rate of decline. We hypothesized that speech-language rehabilitation, higher education, and higher baseline test scores would be associated with slower decline, and older age with faster decline. METHODS AND PROCEDURES A total of ninety-four participants with PPA underwent language testing, including thirty six participants with lvPPA, thirty-one participants with nfaPPA, and twenty-seven participants with svPPA. All participant groups were similar in age and education. We focused on decline on three tests: the short form of the Boston Naming Test (BNT), the Hopkins Assessment of Naming Actions (HANA), and the short form of the Pyramids and Palm Trees Test (PPTT). OUTCOME AND RESULTS Across language tests, the most precipitous rates of decline (loss of points per month) occurred in nfaPPA, followed by svPPA, then lvPPA. Female sex, longer symptom duration, higher baseline test score, and speech-language rehabilitation were associated with slower decline. CONCLUSIONS PPA variants were distinguishable by rapidity of decline, with nfaPPA having the most precipitous decline. As hypothesized, higher baseline test scores and speech-language rehabilitation were associated with slower decline. Surprisingly, age and education were not important prognostically for individuals in this study. Further study of prognostically-relevant variables in PPA is indicated in this population.
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Affiliation(s)
- Rajani Sebastian
- Department of Neurology, Johns Hopkins University School of Medicine, Phipps 446, 600 N. Wolfe Street, Baltimore, Maryland 21287 USA; Telephone (410) 614-2381; , , ,
| | - Carol B Thompson
- Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E-3142, Baltimore, Maryland 21205-2179 USA; Telephone (410) 502-9142;
| | - Nae-Yuh Wang
- Johns Hopkins Biostatistics Center, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E-3142, Baltimore, Maryland 21205-2179 USA; Telephone (410) 502-9142;
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA 21287
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205-2179 USA
- Welch Center for Prevention, Epidemiology & Clinical Research, Johns Hopkins Bloomberg School of Public Health, 2024 E. Monument Street, Suite 2-500, Baltimore, Maryland 21205-2179 USA; Telephone (410) 614-3994;
| | - Amy Wright
- Department of Neurology, Johns Hopkins University School of Medicine, Phipps 446, 600 N. Wolfe Street, Baltimore, Maryland 21287 USA; Telephone (410) 614-2381; , , ,
| | - Aaron Meyer
- Cognitive Neuropsychology Lab, Center for Aphasia Research and Rehabilitation, Georgetown University Medical Center, Building D, Suite 207, 4000 Reservoir Road, Washington, DC 20057 USA; Telephone (202) 687-4196; ,
| | - Rhonda B Friedman
- Cognitive Neuropsychology Lab, Center for Aphasia Research and Rehabilitation, Georgetown University Medical Center, Building D, Suite 207, 4000 Reservoir Road, Washington, DC 20057 USA; Telephone (202) 687-4196; ,
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Phipps 446, 600 N. Wolfe Street, Baltimore, Maryland 21287 USA; Telephone (410) 614-2381; , , ,
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Cognitive Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - Donna C Tippett
- Department of Neurology, Johns Hopkins University School of Medicine, Phipps 446, 600 N. Wolfe Street, Baltimore, Maryland 21287 USA; Telephone (410) 614-2381; , , ,
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Ficek BN, Wang Z, Zhao Y, Webster KT, Desmond JE, Hillis AE, Frangakis C, Vasconcellos Faria A, Caffo B, Tsapkini K. The effect of tDCS on functional connectivity in primary progressive aphasia. NEUROIMAGE-CLINICAL 2018; 19:703-715. [PMID: 30009127 PMCID: PMC6041563 DOI: 10.1016/j.nicl.2018.05.023] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/27/2018] [Accepted: 05/19/2018] [Indexed: 01/21/2023]
Abstract
Transcranial direct current stimulation (tDCS) is an innovative technique recently shown to improve language outcomes even in neurodegenerative conditions such as primary progressive aphasia (PPA), but the underlying brain mechanisms are not known. The present study tested whether the additional language gains with repetitive tDCS (over sham) in PPA are caused by changes in functional connectivity between the stimulated area (the left inferior frontal gyrus (IFG)) and the rest of the language network. We scanned 24 PPA participants (11 female) before and after language intervention (written naming/spelling) with a resting-state fMRI sequence and compared changes before and after three weeks of tDCS or sham coupled with language therapy. We correlated changes in the language network as well as in the default mode network (DMN) with language therapy outcome measures (letter accuracy in written naming). Significant tDCS effects in functional connectivity were observed between the stimulated area and other language network areas and between the language network and the DMN. TDCS over the left IFG lowered the connectivity between the above pairs. Changes in functional connectivity correlated with improvement in language scores (letter accuracy as a proxy for written naming) evaluated before and after therapy. These results suggest that one mechanism for anodal tDCS over the left IFG in PPA is a decrease in functional connectivity (compared to sham) between the stimulated site and other posterior areas of the language network. These results are in line with similar decreases in connectivity observed after tDCS over the left IFG in aging and other neurodegenerative conditions.
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Affiliation(s)
- Bronte N Ficek
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Zeyi Wang
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD 21287, USA
| | - Yi Zhao
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD 21287, USA
| | - Kimberly T Webster
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - John E Desmond
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; Department of Cognitive Science, Johns Hopkins University, Baltimore, MD 21218, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Constantine Frangakis
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD 21287, USA; Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | | | - Brian Caffo
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD 21287, USA
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; Department of Cognitive Science, Johns Hopkins University, Baltimore, MD 21218, USA.
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47
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Ficek BN, Wang Z, Zhao Y, Webster KT, Desmond JE, Hillis AE, Frangakis C, Vasconcellos Faria A, Caffo B, Tsapkini K. The effect of tDCS on functional connectivity in primary progressive aphasia. Neuroimage Clin 2018; 19:703-715. [PMID: 30009127 PMCID: PMC6041563 DOI: 10.1016/j.nicl.2018.05.023 10.1016/j.nicl.2019.101734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/27/2018] [Accepted: 05/19/2018] [Indexed: 10/05/2023]
Abstract
Transcranial direct current stimulation (tDCS) is an innovative technique recently shown to improve language outcomes even in neurodegenerative conditions such as primary progressive aphasia (PPA), but the underlying brain mechanisms are not known. The present study tested whether the additional language gains with repetitive tDCS (over sham) in PPA are caused by changes in functional connectivity between the stimulated area (the left inferior frontal gyrus (IFG)) and the rest of the language network. We scanned 24 PPA participants (11 female) before and after language intervention (written naming/spelling) with a resting-state fMRI sequence and compared changes before and after three weeks of tDCS or sham coupled with language therapy. We correlated changes in the language network as well as in the default mode network (DMN) with language therapy outcome measures (letter accuracy in written naming). Significant tDCS effects in functional connectivity were observed between the stimulated area and other language network areas and between the language network and the DMN. TDCS over the left IFG lowered the connectivity between the above pairs. Changes in functional connectivity correlated with improvement in language scores (letter accuracy as a proxy for written naming) evaluated before and after therapy. These results suggest that one mechanism for anodal tDCS over the left IFG in PPA is a decrease in functional connectivity (compared to sham) between the stimulated site and other posterior areas of the language network. These results are in line with similar decreases in connectivity observed after tDCS over the left IFG in aging and other neurodegenerative conditions.
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Affiliation(s)
- Bronte N Ficek
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Zeyi Wang
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD 21287, USA
| | - Yi Zhao
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD 21287, USA
| | - Kimberly T Webster
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - John E Desmond
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; Department of Cognitive Science, Johns Hopkins University, Baltimore, MD 21218, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Constantine Frangakis
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD 21287, USA; Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | | | - Brian Caffo
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD 21287, USA
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA; Department of Cognitive Science, Johns Hopkins University, Baltimore, MD 21218, USA.
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Meyer AM, Tippett DC, Turner RS, Friedman RB. Long-Term maintenance of anomia treatment effects in primary progressive aphasia. Neuropsychol Rehabil 2018; 29:1439-1463. [PMID: 29380657 DOI: 10.1080/09602011.2018.1425146] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study examined the maintenance of anomia treatment effects in primary progressive aphasia (PPA). Following baseline testing, a phonological treatment and an orthographic treatment were administered over the course of six months. The treatment stimuli consisted of nouns that were consistently named correctly at baseline (Prophylaxis items) and/or nouns that were consistently named incorrectly at baseline (Remediation items). Naming accuracy was measured at baseline, and it was measured at 1 month, 8 months, and 15 months post-treatment. The change in naming accuracy from baseline to each post-treatment evaluation was calculated within each treatment condition, and within a matched untrained condition. The change in naming accuracy was then compared between the three conditions. The results of these analyses indicate that phonological and orthographic treatments are both effective in the Prophylaxis and Remediation of anomia in all three variants of PPA. For Prophylaxis items, some of the effects of each treatment can persist for as long as 15 months post-treatment. These long-term treatment effects were more robust in the orthographic treatment condition and for participants with the semantic variant of PPA.
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Affiliation(s)
- Aaron M Meyer
- Center for Aphasia Research and Rehabilitation, Georgetown University Medical Center , Washington , DC , USA
| | - Donna C Tippett
- Department of Neurology, Johns Hopkins University , Baltimore , MD , USA
| | - R Scott Turner
- Department of Neurology, Georgetown University Medical Center , Washington , DC , USA
| | - Rhonda B Friedman
- Center for Aphasia Research and Rehabilitation, Georgetown University Medical Center , Washington , DC , USA
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49
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Kim M. Effect of Lexical Retrieval Cascade Treatment on Naming and Discourse of Individuals with Logopenic Variant of Primary Progressive Aphasia (lvPPA). ACTA ACUST UNITED AC 2017. [DOI: 10.21849/cacd.2017.00171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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50
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Cadório I, Lousada M, Martins P, Figueiredo D. Generalization and maintenance of treatment gains in primary progressive aphasia (PPA): a systematic review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2017; 52:543-560. [PMID: 28120406 DOI: 10.1111/1460-6984.12310] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 11/14/2016] [Accepted: 11/15/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Cognitive-linguistic treatments and interventions targeting communication have been developed within the context of primary progressive aphasia (PPA), however knowledge about the scope of generalization and maintenance of therapy gains considering PPA subtypes remains scarce and awaits systematic investigation. AIMS To analyse the effects of semantic therapy on generalization and maintenance of treatment outcomes in individuals with PPA, considering its different subtypes. METHODS & PROCEDURES Central, PubMed, Medline, Web of Knowledge and Scopus were used to retrieve articles of interest. A total of 25 non-randomized studies published between 2000 and 2016 met the eligibility criteria and therefore were included in this study. MAIN CONTRIBUTION This systematic review provides evidence-based information for clinical practice in PPA. Generalization and maintenance effects post-treatment for each PPA variant are analysed and discussed. Several factors are described as important to maximize the scope for generalization and maintenance of treatment gains. CONCLUSIONS & IMPLICATIONS Generalization is particularly hard to achieve in the semantic variant, as in the face of degraded semantic knowledge learning is rigid and context dependent. In contrast, non-fluent and logopenic variants offer better scope for generalization. Maintenance patterns do not seem to be influenced by PPA subtype, but rather by other factors such as continued practice, treatment length and frequency of sessions. In the future, clinicians should consider the PPA subtype when planning the treatment protocol.
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Affiliation(s)
- Inês Cadório
- Center for Health Technology and Services Research (CINTESIS.UA), Department of Education, University of Aveiro, Aveiro, Portugal
| | - Marisa Lousada
- Center for Health Technology and Services Research (CINTESIS.UA), School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal
| | - Paula Martins
- School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal
| | - Daniela Figueiredo
- Center for Health Technology and Services Research (CINTESIS.UA), School of Health Sciences (ESSUA), University of Aveiro, Aveiro, Portugal
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