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Kaltsa M, Tsolaki A, Lazarou I, Mittas I, Papageorgiou M, Papadopoulou D, Tsimpli IM, Tsolaki M. Assessing the Linguistic Capacity Across Alzheimer's Disease and Its Preclinical Stages: Evidence from Narrative Macrostructure in Elderly Speakers of Greek. J Alzheimers Dis 2024:JAD240496. [PMID: 39121121 DOI: 10.3233/jad-240496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2024]
Abstract
Background The assessment of language deficits can be valuable in the early clinical diagnosis of neurodegenerative disorders, including Alzheimer's disease (AD). Objective The present study aims to explore whether language markers at the macrostructural level could assist with the placement of an individual across the dementia continuum employing production data from structured narratives. Methods We administered a Picture Sequence Narrative Discourse Task to 170 speakers of Greek: young healthy controls (yHC), cognitively intact healthy elders (eHC), elder participants with subjective cognitive impairment (SCI), with mild cognitive impairment (MCI), and with AD dementia at the mild/moderate stages. Structural MRIs, medical history, neurological examination, and neuropsychological/cognitive screening determined the status of each speaker to appropriately groupthem. Results The data analysis revealed that the Macrostructure Index, Irrelevant Info, and Narration Density markers can track cognitive decline and AD (p < 0.001; Macrostructural Index: eHC versus AD Sensitivity 93.8%, Specificity 74.4%, MCI versus AD Sensitivity 93.8%, Specificity 66.7%; Narration Density: eHC versus AD Sensitivity 90.6%, Specificity 71.8%, MCI versus AD Sensitivity 93.8%, Specificity 66.7%). Moreover, Narrative Complexity was significantly affected for subjects with AD, Irrelevant Info increased in the narrations of speakers with MCI and AD, while Narration Length did not appear to indubitably differentiate between the cognitively intact groups and the clinical ones. Conclusions Narrative Macrostructure Indices provide valuable information on the language profile of speakers with(out) intact cognition revealing subtle early signs of cognitive decline and AD suggesting that the inclusion of language-based assessment tools would facilitate the clinical process.
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Affiliation(s)
- Maria Kaltsa
- Department of Theoretical & Applied Linguistics, School of English, Faculty of Philosophy, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anthoula Tsolaki
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Greek Alzheimer's Association and Related Disorders (GAARD), Greece
| | - Ioulietta Lazarou
- Greek Alzheimer's Association and Related Disorders (GAARD), Greece
- Centre for Research and Technology-Hellas, Thessaloniki, Greece
| | - Ilias Mittas
- Department of Linguistics, School of Philology, Faculty of Philosophy, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mairi Papageorgiou
- Department of Linguistics, School of Philology, Faculty of Philosophy, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Despina Papadopoulou
- Department of Linguistics, School of Philology, Faculty of Philosophy, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ianthi Maria Tsimpli
- Faculty of Modern and Medieval Languages and Linguistics, University of Cambridge, Cambridge, UK
| | - Magda Tsolaki
- Greek Alzheimer's Association and Related Disorders (GAARD), Greece
- 1st Department of Neurology, AHEPA University Hospital, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Laboratory of Neurodegenerative Diseases, Center for Interdisciplinary Research and Innovation (CIRI - AUTh), Balkan Center, Aristotle University of Thessaloniki, Hellas, Greece
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Kaltsa M, Tsolaki A, Lazarou I, Mittas I, Papageorgiou M, Papadopoulou D, Tsimpli IM, Tsolaki M. Language Markers of Dementia and Their Role in Early Diagnosis of Alzheimer's Disease: Exploring Grammatical and Syntactic Competence via Sentence Repetition. J Alzheimers Dis Rep 2024; 8:1115-1132. [PMID: 39114543 PMCID: PMC11305841 DOI: 10.3233/adr-230204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 06/21/2024] [Indexed: 08/10/2024] Open
Abstract
Background Earlier research focuses primarily on the cognitive changes due to Alzheimer's disease (AD); however, little is known with regard to changes in language competence across the lifespan. Objective The present study aims to investigate the decline of language skills at the grammatical and syntactic levels due to changes in cognitive function. Methods We administered the Litmus Sentence Repetition Task (SRT) to 150 native speakers of Greek who fall into five groups: 1) young healthy speakers, 2) cognitively intact elder healthy speakers, 3) speakers with subjective cognitive impairment (SCI), 4) speakers with mild cognitive impairment (MCI); and 5) speakers with AD dementia at the mild/moderate stages. All participants underwent a physical and neurological examination and cognitive screening with a standardized neuropsychological battery to assess cognitive status comprehensively and evaluate aspects like working memory, executive function, attention and memory to appropriately classify them. Results The data analysis revealed that the SRT had high discriminatory value in the development of AD; specifically, both accuracy and grammaticality indices were related to cognitive decline. Additionally, syntax significantly affected the performance of speakers with structures such as clitics being particularly challenging and in most structures the performance of speakers with MCI drops significantly compared to speakers with SCI. Conclusions Linguistic indices revealed subtle early signs of cognitive decline that can be helpful in the early detection of AD, thus facilitating the clinical process offering support to language-based assessment tools such as sentence repetition, a non-invasive type of assessment to evaluate symptoms of AD.
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Affiliation(s)
- Maria Kaltsa
- Department of Theoretical & Applied Linguistics, School of English, Faculty of Philosophy, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anthoula Tsolaki
- School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Greek Alzheimer’s Association and Related Disorders (GAARD), Thessaloniki, Greece
| | - Ioulietta Lazarou
- Greek Alzheimer’s Association and Related Disorders (GAARD), Thessaloniki, Greece
- Centre for Research and Technology-Hellas, Thessaloniki, Greece
| | - Ilias Mittas
- Department of Linguistics, School of Philology, Faculty of Philosophy, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mairi Papageorgiou
- Department of Linguistics, School of Philology, Faculty of Philosophy, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Despina Papadopoulou
- Department of Linguistics, School of Philology, Faculty of Philosophy, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ianthi Maria Tsimpli
- Faculty of Modern and Medieval Languages and Linguistics, University of Cambridge, Cambridge, UK
| | - Magda Tsolaki
- Greek Alzheimer’s Association and Related Disorders (GAARD), Thessaloniki, Greece
- First Department of Neurology, AHEPA University Hospital, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Laboratory of Neurodegenerative Diseases, Center for Interdisciplinary Research and Innovation (CIRI – AUTh), Balkan Center, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Sanati M, Bayat S, Panahi MM, Khodadadi A, Rezaee S, Ghasimi M, Besharat S, Fooladi ZM, Dooghaee MA, Taheri MS, Dickerson BC, Goldberg A, Rezaii N. Impaired language in Alzheimer's disease: A comparison between English and Persian implicates content-word frequency rather than the noun-verb distinction. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.09.24305534. [PMID: 38645255 PMCID: PMC11030473 DOI: 10.1101/2024.04.09.24305534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
This study challenges the conventional psycholinguistic view that the distinction between nouns and verbs is pivotal in understanding language impairments in neurological disorders. Traditional views link frontal brain region damage with verb processing deficits and posterior temporoparietal damage with noun difficulties. However, this perspective is contested by findings from patients with Alzheimer's disease (pwAD), who show impairments in both word classes despite their typical temporoparietal atrophy. Notably, pwAD tend to use semantically lighter verbs in their speech than healthy individuals. By examining English-speaking pwAD and comparing them with Persian-speaking pwAD, this research aims to demonstrate that language impairments in Alzheimer's disease (AD) stem from the distributional properties of words within a language rather than distinct neural processing networks for nouns and verbs. We propose that the primary deficit in AD language production is an overreliance on high-frequency words. English has a set of particularly high-frequency verbs that surpass most nouns in usage frequency. Since pwAD tend to use high-frequency words, the byproduct of this word distribution in the English language would be an over-usage of high-frequency verbs. In contrast, Persian features complex verbs with an overall distribution lacking extremely high-frequency verbs like those found in English. As a result, we hypothesize that Persian-speaking pwAD would not have a bias toward the overuse of high-frequency verbs. We analyzed language samples from 95 English-speaking pwAD and 91 healthy controls, along with 27 Persian-speaking pwAD and 27 healthy controls. Employing uniform automated natural language processing methods, we measured the usage rates of nouns, verbs, and word frequencies across both cohorts. Our findings showed that English-speaking pwAD use higher-frequency verbs than healthy individuals, a pattern not mirrored by Persian-speaking pwAD. Crucially, we found a significant interaction between the frequencies of verbs used by English and Persian speakers with and without AD. Moreover, regression models that treated noun and verb frequencies as separate predictors did not outperform models that considered overall word frequency alone in classifying AD. In conclusion, this study suggests that language abnormalities among English-speaking pwAD reflect the unique distributional properties of words in English rather than a universal noun-verb class distinction. Beyond offering a new understanding of language abnormalities in AD, the study highlights the critical need for further investigation across diverse languages to deepen our insight into the mechanisms of language impairments in neurological disorders.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Mostafa Almasi Dooghaee
- Abrar Institute of Higher Education
- Azad University Science and Research Branch
- Institute for Cognitive Science Studies
- Mashhad University of Medical Science
- Shahid Beheshti University of Medical Sciences
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School
- Princeton University
| | | | - Bradford C Dickerson
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School
| | | | - Neguine Rezaii
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School
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Saunders S, Haider F, Ritchie CW, Muniz Terrera G, Luz S. Longitudinal observational cohort study: Speech for Intelligent cognition change tracking and DEtection of Alzheimer's Disease (SIDE-AD). BMJ Open 2024; 14:e082388. [PMID: 38548356 PMCID: PMC10982798 DOI: 10.1136/bmjopen-2023-082388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/19/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION There is emerging evidence that speech may be a potential indicator and manifestation of early Alzheimer's disease (AD) pathology. Therefore, the University of Edinburgh and Sony Research have partnered to create the Speech for Intelligent cognition change tracking and DEtection of Alzheimer's Disease (SIDE-AD) study, which aims to develop digital speech-based biomarkers for use in neurodegenerative disease. METHODS AND ANALYSIS SIDE-AD is an observational longitudinal study, collecting samples of spontaneous speech. Participants are recruited from existing cohort studies as well as from the National Health Service (NHS)memory clinics in Scotland. Using an online platform, participants record a voice sample talking about their brain health and rate their mood, anxiety and apathy. The speech biomarkers will be analysed longitudinally, and we will use machine learning and natural language processing technology to automate the assessment of the respondents' speech patterns. ETHICS AND DISSEMINATION The SIDE-AD study has been approved by the NHS Research Ethics Committee (REC reference: 23/WM/0153, protocol number AC23046, IRAS Project ID 323311) and received NHS management approvals from Lothian, Fife and Forth Valley NHS boards. Our main ethical considerations pertain to the remote administration of the study, such as taking remote consent. To address this, we implemented a consent process, whereby the first step of the consent is done entirely remotely but a member of the research team contacts the participant over the phone to consent participants to the optional, most sensitive, elements of the study. Results will be presented at conferences, published in peer-reviewed journals and communicated to study participants.
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Affiliation(s)
| | - Fasih Haider
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Craig W Ritchie
- Department of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
- Scottish Brain Sciences, Edinburgh, UK
| | - Graciela Muniz Terrera
- Centre for Dementia Prevention, University of Edinburgh, Edinburgh, UK
- Heritage College of Osteopathic Medicine, Ohio University, Athens, Ohio, USA
| | - Saturnino Luz
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh School of Molecular Genetic and Population Health Sciences, Edinburgh, UK
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Malcorra BLC, García AO, Marcotte K, de Paz H, Schilling LP, da Silva Filho IG, Soder R, da Rosa Franco A, Loureiro F, Hübner LC. Exploring Spoken Discourse and Its Neural Correlates in Women With Alzheimer's Disease With Low Levels of Education and Socioeconomic Status. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:893-911. [PMID: 38157526 DOI: 10.1044/2023_ajslp-23-00137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
PURPOSE Early impairments in spoken discourse abilities have been identified in Alzheimer's disease (AD). However, the impact of AD on spoken discourse and the associated neuroanatomical correlates have mainly been studied in populations with higher levels of education, although preliminary evidence seems to indicate that socioeconomic status (SES) and level of education have an impact on spoken discourse. The purpose of this study was to analyze microstructural variables in spoken discourse in people with AD with low-to-middle SES and low level of education and to study their association with gray matter (GM) density. METHOD Nine women with AD and 10 matched (age, SES, and education) women without brain injury (WWBI) underwent a neuropsychological assessment, which included two spoken discourse tasks, and structural magnetic resonance imaging. Microstructural variables were extracted from the discourse samples using NILC-Metrix software. Brain density, measured by voxel-based morphometry, was compared between groups and then correlated with the differentiating microstructural variables. RESULTS The AD group produced a lower diversity of verbal time moods and fewer words and sentences than WWBI but a greater diversity of pronouns, prepositions, and lexical richness. At the neural level, the AD group presented a lower GM density bilaterally in the hippocampus, the inferior temporal gyrus, and the anterior cingulate gyrus. Number of words and sentences produced were associated with GM density in the left parahippocampal gyrus, whereas the diversity of verbal moods was associated with the basal ganglia and the anterior cingulate gyrus bilaterally. CONCLUSIONS The present findings are mainly consistent with previous studies conducted in groups with higher levels of SES and education, but they suggest that atrophy in the left inferior temporal gyrus could be critical in AD in populations with lower levels of SES and education. This research provides evidence on the importance of pursuing further studies including people with various SES and education levels. WHAT IS ALREADY KNOWN ON THIS SUBJECT Spoken discourse has been shown to be affected in Alzheimer disease, but most studies have been conducted on individuals with middle-to-high SES and high educational levels. WHAT THIS STUDY ADDS The study reports on microstructural measures of spoken discourse in groups of women in the early stage of AD and healthy women, with low-to-middle SES and lower levels of education. CLINICAL IMPLICATIONS OF THIS STUDY This study highlights the importance of taking into consideration the SES and education level in spoken discourse analysis and in investigating the neural correlates of AD. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24905046.
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Affiliation(s)
- Bárbara Luzia Covatti Malcorra
- Department of Linguistics, School of Humanities, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Alberto Osa García
- Centre de recherche du Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Québec, Canada
- École d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, Québec, Canada
| | - Karine Marcotte
- Centre de recherche du Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Québec, Canada
- École d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, Québec, Canada
| | - Hanna de Paz
- Centre de recherche du Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Québec, Canada
- École d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, Québec, Canada
| | - Lucas Porcello Schilling
- Graduate Course in Medicine and Healthy Sciences, School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
- Graduate Course in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
- Brain Institute of Rio Grande do Sul (InsCer)Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
- Institute of Geriatrics and Gerontology, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Irênio Gomes da Silva Filho
- Graduate Course in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Ricardo Soder
- Graduate Course in Medicine and Healthy Sciences, School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
- Brain Institute of Rio Grande do Sul (InsCer)Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Alexandre da Rosa Franco
- Center for Biomedical Imaging and Neuromodulation, The Nathan S. Kline for Psychiatric Research, Orangeburg, NY
- Center for the Developing Brain, Child Mind Institute, New York, NY
- Department of Psychiatry, NYU Grossman School of Medicine, New York
| | - Fernanda Loureiro
- Graduate Course in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Lilian Cristine Hübner
- Department of Linguistics, School of Humanities, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
- Institute of Geriatrics and Gerontology, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
- National Council for Scientific and Technological Development (CNPq), Brasília, DF, Brazil
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Nobukawa S, Ikeda T, Kikuchi M, Takahashi T. Atypical instantaneous spatio-temporal patterns of neural dynamics in Alzheimer's disease. Sci Rep 2024; 14:88. [PMID: 38167950 PMCID: PMC10761722 DOI: 10.1038/s41598-023-50265-3] [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: 06/16/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
Cognitive functions produced by large-scale neural integrations are the most representative 'emergence phenomena' in complex systems. A novel approach focusing on the instantaneous phase difference of brain oscillations across brain regions has succeeded in detecting moment-to-moment dynamic functional connectivity. However, it is restricted to pairwise observations of two brain regions, contrary to large-scale spatial neural integration in the whole-brain. In this study, we introduce a microstate analysis to capture whole-brain instantaneous phase distributions instead of pairwise differences. Upon applying this method to electroencephalography signals of Alzheimer's disease (AD), which is characterised by progressive cognitive decline, the AD-specific state transition among the four states defined as the leading phase location due to the loss of brain regional interactions could be promptly characterised. In conclusion, our synthetic analysis approach, focusing on the microstate and instantaneous phase, enables the capture of the instantaneous spatiotemporal neural dynamics of brain activity and characterises its pathological conditions.
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Affiliation(s)
- Sou Nobukawa
- Department of Computer Science, Chiba Institute of Technology, 2-17-1 Tsudanuma, Narashino, 275-0016, Chiba, Japan.
- Research Center for Mathematical Engineering, Chiba Institute of Technology, 2-17-1 Tsudanuma, Narashino, 275-0016, Chiba, Japan.
- Department of Preventive Intervention for Psychiatric Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, 187-8661, Tokyo, Japan.
| | - Takashi Ikeda
- Research Center for Child Mental Development, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8640, Ishikawa, Japan
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University, and University of Fukui, 2-2 Yamadaoka, Suita, 565-0871, Osaka, Japan
| | - Mitsuru Kikuchi
- Research Center for Child Mental Development, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8640, Ishikawa, Japan
- Department of Psychiatry and Behavioral Science, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8640, Ishikawa, Japan
| | - Tetsuya Takahashi
- Research Center for Child Mental Development, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8640, Ishikawa, Japan
- Department of Neuropsychiatry, University of Fukui, 23-3 Matsuoka, Yoshida, 910-1193, Fukui, Japan
- Uozu Shinkei Sanatorium, 1784-1 Eguchi, Uozu, 937-0017, Toyama, Japan
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Varlokosta S, Fragkopoulou K, Arfani D, Manouilidou C. Methodologies for assessing morphosyntactic ability in people with Alzheimer's disease. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:38-57. [PMID: 36840629 DOI: 10.1111/1460-6984.12862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 01/27/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND The detection and description of language impairments in neurodegenerative diseases like Alzheimer's Disease (AD) play an important role in research, clinical diagnosis and intervention. Various methodological protocols have been implemented for the assessment of morphosyntactic abilities in AD; narrative discourse elicitation tasks and structured experimental tasks for production, offline and online structured experimental tasks for comprehension. Very few studies implement and compare different methodological protocols; thus, little is known about the advantages and disadvantages of each methodology. AIMS To discuss and compare the main behavioral methodological approaches and tasks that have been used in psycholinguistic research to assess different aspects of morphosyntactic production and comprehension in individuals with AD at the word and sentence levels. METHODS A narrative review was conducted through searches in the scientific databases Google Scholar, Scopus, Science Direct, MITCogNet, PubMed. Only studies written in English, that reported quantitative data and were published in peer-reviewed journals were considered with respect to their methodological protocol. Moreover, we considered studies that reported research on all stages of the disease and we included only studies that also reported results of a healthy control group. Studies that implemented standardized assessment tools were not considered in this review. OUTCOMES & RESULTS The main narrative discourse elicitation tasks implemented for the assessment of morphosyntactic production include interviews, picture-description and story narration, whereas the main structured experimental tasks include sentence completion, constrained sentence production, sentence repetition and naming. Morphosyntactic comprehension in AD has been assessed with the use of structured experimental tasks, both offline (sentence-picture matching, grammaticality judgment) and online (cross-modal naming,speeded sentence acceptability judgment, auditory moving window, word detection, reading). For each task we considered studies that reported results from different morphosyntactic structures and phenomena in as many different languages as possible. CONCLUSIONS & IMPLICATIONS Our review revealed strengths and weaknesses of these methods but also directions for future research. Narrative discourse elicitation tasks as well as structured experimental tasks have been used in a variety of languages, and have uncovered preserved morphosyntactic production but also deficits in people with AD. A combination of narrative discourse elicitation and structured production tasks for the assessment of the same morphosyntactic structure has been rarely used. Regarding comprehension, offline tasks have been implemented in various languages, whereas online tasks have been mainly used in English. Offline and online experimental paradigms have often produced contradictory results even within the same study. The discrepancy between the two paradigms has been attributed to the different working memory demands they impose to the comprehender or to the different parsing processes they tap. Strengths and shortcomings of each methodology are summarized in the paper, and comparisons between different tasks are attempted when this is possible. Thus, the paper may serve as a methodological guide for the study of morphosyntax in AD and possibly in other neurodegenerative diseases. WHAT THIS PAPER ADDS What is already known on this subject For the assessment of morphosyntactic abilities in AD, various methodological paradigms have been implemented: narrative discourse elicitation tasks and structured experimental tasks for production, and offline and online structured experimental tasks for comprehension. Very few studies implement and compare different methodological protocols; thus, little is known about the advantages and disadvantages of each methodology. What this paper adds to existing knowledge The paper presents an overview of methodologies that have been used to assess morphosyntactic production and comprehension of people with AD at the word and sentence levels. The paper summarizes the strengths and shortcomings of each methodology, providing both the researcher and the clinician with some directions in their endeavour of investigating language in AD. Also, the paper highlights the need for further research that will implement carefully scrutinized tasks from various experimental paradigms and will explore distinct aspects of the AD patients' morphosyntactic abilities in typologically different languages. What are the potential or actual clinical implications of this work? The paper may serve as a reference point for (psycho-)linguists who wish to study morphosyntactic abilities in AD, and for speech and language therapists who might need to apply morphosyntactic protocols to their patients in order to assess them or design appropriate therapeutic interventions for production and comprehension deficits.
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Affiliation(s)
- Spyridoula Varlokosta
- Department of Linguistics, Faculty of Philology, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Fragkopoulou
- Department of Linguistics, Faculty of Philology, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitra Arfani
- Department of Linguistics, Faculty of Philology, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Manouilidou
- Department of Comparative and General Linguistics, Faculty of Arts, University of Ljubljana, Ljubljana, Slovenia
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Ivanova O, Martínez-Nicolás I, Meilán JJG. Speech changes in old age: Methodological considerations for speech-based discrimination of healthy ageing and Alzheimer's disease. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:13-37. [PMID: 37140204 DOI: 10.1111/1460-6984.12888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 04/03/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Recent evidence suggests that speech substantially changes in ageing. As a complex neurophysiological process, it can accurately reflect changes in the motor and cognitive systems underpinning human speech. Since healthy ageing is not always easily discriminable from early stages of dementia based on cognitive and behavioural hallmarks, speech is explored as a preclinical biomarker of pathological itineraries in old age. A greater and more specific impairment of neuromuscular activation, as well as a specific cognitive and linguistic impairment in dementia, unchain discriminating changes in speech. Yet, there is no consensus on such discriminatory speech parameters, neither on how they should be elicited and assessed. AIMS To provide a state-of-the-art on speech parameters that allow for early discrimination between healthy and pathological ageing; the aetiology of these parameters; the effect of the type of experimental stimuli on speech elicitation and the predictive power of different speech parameters; and the most promising methods for speech analysis and their clinical implications. METHODS & PROCEDURES A scoping review methodology is used in accordance with the PRISMA model. Following a systematic search of PubMed, PsycINFO and CINAHL, 24 studies are included and analysed in the review. MAIN CONTRIBUTION The results of this review yield three key questions for the clinical assessment of speech in ageing. First, acoustic and temporal parameters are more sensitive to changes in pathological ageing and, of these two, temporal variables are more affected by cognitive impairment. Second, different types of stimuli can trigger speech parameters with different degree of accuracy for the discrimination of clinical groups. Tasks with higher cognitive load are more precise in eliciting higher levels of accuracy. Finally, automatic speech analysis for the discrimination of healthy and pathological ageing should be improved for both research and clinical practice. CONCLUSIONS & IMPLICATIONS Speech analysis is a promising non-invasive tool for the preclinical screening of healthy and pathological ageing. The main current challenges of speech analysis in ageing are the automatization of its clinical assessment and the consideration of the speaker's cognitive background during evaluation. WHAT THIS PAPER ADDS What is already known on the subject Societal aging goes hand in hand with the rising incidence of ageing-related neurodegenerations, mainly Alzheimer's disease (AD). This is particularly noteworthy in countries with longer life expectancies. Healthy ageing and early stages of AD share a set of cognitive and behavioural characteristics. Since there is no cure for dementias, developing methods for accurate discrimination of healthy ageing and early AD is currently a priority. Speech has been described as one of the most significantly impaired features in AD. Neuropathological alterations in motor and cognitive systems would underlie specific speech impairment in dementia. Since speech can be evaluated quickly, non-invasively and inexpensively, its value for the clinical assessment of ageing itineraries may be particularly high. What this paper adds to existing knowledge Theoretical and experimental advances in the assessment of speech as a marker of AD have developed rapidly over the last decade. Yet, they are not always known to clinicians. Furthermore, there is a need to provide an updated state-of-the-art on which speech features are discriminatory to AD, how they can be assessed, what kind of results they can yield, and how such results should be interpreted. This article provides an updated overview of speech profiling, methods of speech measurement and analysis, and the clinical power of speech assessment for early discrimination of AD as the most common cause of dementia. What are the potential or actual clinical implications of this work? This article provides an overview of the predictive potential of different speech parameters in relation to AD cognitive impairment. In addition, it discusses the effect that the cognitive state, the type of elicitation task and the type of assessment method may have on the results of the speech-based analysis in ageing.
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Affiliation(s)
- Olga Ivanova
- Spanish Language Department, Faculty of Philology, University of Salamanca, Salamanca, Spain
- Institute of Neuroscience of Castilla y León, Salamanca, Spain
| | - Israel Martínez-Nicolás
- Department of Basic Psychology, Psychobiology and Behavioral Science Methodology, Faculty of Psychology, University of Salamanca, Salamanca, Spain
- Institute of Neuroscience of Castilla y León, Salamanca, Spain
| | - Juan José García Meilán
- Department of Basic Psychology, Psychobiology and Behavioral Science Methodology, Faculty of Psychology, University of Salamanca, Salamanca, Spain
- Institute of Neuroscience of Castilla y León, Salamanca, Spain
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García AM, de Leon J, Tee BL, Blasi DE, Gorno-Tempini ML. Speech and language markers of neurodegeneration: a call for global equity. Brain 2023; 146:4870-4879. [PMID: 37497623 PMCID: PMC10690018 DOI: 10.1093/brain/awad253] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/29/2023] [Accepted: 07/15/2023] [Indexed: 07/28/2023] Open
Abstract
In the field of neurodegeneration, speech and language assessments are useful for diagnosing aphasic syndromes and for characterizing other disorders. As a complement to classic tests, scalable and low-cost digital tools can capture relevant anomalies automatically, potentially supporting the quest for globally equitable markers of brain health. However, this promise remains unfulfilled due to limited linguistic diversity in scientific works and clinical instruments. Here we argue for cross-linguistic research as a core strategy to counter this problem. First, we survey the contributions of linguistic assessments in the study of primary progressive aphasia and the three most prevalent neurodegenerative disorders worldwide-Alzheimer's disease, Parkinson's disease, and behavioural variant frontotemporal dementia. Second, we address two forms of linguistic unfairness in the literature: the neglect of most of the world's 7000 languages and the preponderance of English-speaking cohorts. Third, we review studies showing that linguistic dysfunctions in a given disorder may vary depending on the patient's language and that English speakers offer a suboptimal benchmark for other language groups. Finally, we highlight different approaches, tools and initiatives for cross-linguistic research, identifying core challenges for their deployment. Overall, we seek to inspire timely actions to counter a looming source of inequity in behavioural neurology.
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Affiliation(s)
- Adolfo M García
- Global Brain Health Institute, University of California, San Francisco, CA 94143, USA
- Cognitive Neuroscience Center, Universidad de San Andrés, Buenos Aires B1644BID, Argentina
- Departamento de Lingüística y Literatura, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago 9160000, Chile
- Latin American Brain Health (BrainLat) Institute, Universidad Adolfo Ibáñez, Avenida Diagonal Las Torres 2640 (7941169), Santiago, Peñalolén, Región Metropolitana, Chile
| | - Jessica de Leon
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA 94143, USA
| | - Boon Lead Tee
- Global Brain Health Institute, University of California, San Francisco, CA 94143, USA
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA 94143, USA
| | - Damián E Blasi
- Data Science Initiative, Harvard University, Cambridge, MA 02138, USA
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA 02138, USA
- Department of Linguistic and Cultural Evolution, Max Planck Institute for the Science of Human History, Jena 07745, Germany
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA 94143, USA
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Gholami A. Alzheimer's disease: The role of proteins in formation, mechanisms, and new therapeutic approaches. Neurosci Lett 2023; 817:137532. [PMID: 37866702 DOI: 10.1016/j.neulet.2023.137532] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/03/2023] [Accepted: 10/18/2023] [Indexed: 10/24/2023]
Abstract
Alzheimer's disease (AD) is a progressive neurological disorder that affects the central nervous system (CNS), leading to memory and cognitive decline. In AD, the brain experiences three main structural changes: a significant decrease in the quantity of neurons, the development of neurofibrillary tangles (NFT) composed of hyperphosphorylated tau protein, and the formation of amyloid beta (Aβ) or senile plaques, which are protein deposits found outside cells and surrounded by dystrophic neurites. Genetic studies have identified four genes associated with autosomal dominant or familial early-onset AD (FAD): amyloid precursor protein (APP), presenilin 1 (PS1), presenilin 2 (PS2), and apolipoprotein E (ApoE). The formation of plaques primarily involves the accumulation of Aβ, which can be influenced by mutations in APP, PS1, PS2, or ApoE genes. Mutations in the APP and presenilin (PS) proteins can cause an increased amyloid β peptides production, especially the further form of amyloidogenic known as Aβ42. Apart from genetic factors, environmental factors such as cytokines and neurotoxins may also have a significant impact on the development and progression of AD by influencing the formation of amyloid plaques and intracellular tangles. Exploring the causes and implications of protein aggregation in the brain could lead to innovative therapeutic approaches. Some promising therapy strategies that have reached the clinical stage include using acetylcholinesterase inhibitors, estrogen, nonsteroidal anti-inflammatory drugs (NSAIDs), antioxidants, and antiapoptotic agents. The most hopeful therapeutic strategies involve inhibiting activity of secretase and preventing the β-amyloid oligomers and fibrils formation, which are associated with the β-amyloid fibrils accumulation in AD. Additionally, immunotherapy development holds promise as a progressive therapeutic approach for treatment of AD. Recently, the two primary categories of brain stimulation techniques that have been studied for the treatment of AD are invasive brain stimulation (IBS) and non-invasive brain stimulation (NIBS). In this article, the amyloid proteins that play a significant role in the AD formation, the mechanism of disease formation as well as new drugs utilized to treat of AD will be reviewed.
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Affiliation(s)
- Amirreza Gholami
- Department of Biology, Faculty of Natural Sciences, University of Tabriz, Tabriz, Iran.
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Fisher MN, Casenhiser DM, Paek EJ. Objective and Subjective Clustering Methods for Verb Fluency Responses From Individuals With Alzheimer's Dementia and Cognitively Healthy Older Adults. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:2589-2601. [PMID: 37722380 PMCID: PMC10721246 DOI: 10.1044/2023_ajslp-22-00290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 03/13/2023] [Accepted: 06/27/2023] [Indexed: 09/20/2023]
Abstract
PURPOSE The verb fluency task has been researched using a variety of analysis methods and shown its sensitivity to declines in executive functioning and lexical retrieval abilities in various neurogenic populations. Few studies to date, however, have analyzed clusters and switches in the task, and there is a lack of robust analysis methods that preclude subjectivity and potential rater bias. The purpose of this study was to investigate the reliability when using subjective clustering methods and to determine the feasibility of using an objective clustering method to determine verb fluency performance in individuals with Alzheimer's dementia (IwDs) and cognitively healthy older adults (CHOAs). METHOD Responses from a verb fluency task were obtained from IwDs and CHOAs. Group differences were examined using an objective clustering method for multiple variables regarding clustering and switching. We also calculated the intrarater, interrater, and intermethod reliability using intraclass coefficients. RESULTS Significant group differences were found when utilizing the objective clustering method in all variables except the average cluster size, with IwDs performing poorer than CHOAs. Intrarater reliability was excellent. Interrater reliability between two authors and intermethod reliability between the objective and subjective methods were variable ranging from moderate to good. CONCLUSIONS The results from using the objective clustering method in this study are consistent with the previous literature, making it a viable option for clustering analyses on the verb fluency task, which naturally minimizes subjectivity and rater bias. Alternatively, employing a thoroughly validated and reliable subjective approach can also mitigate potential rater bias and improve replicability across studies. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24061017.
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Affiliation(s)
- Madison N. Fisher
- Department of Audiology and Speech Pathology, College of Health Professions, The University of Tennessee Health Science Center, Knoxville
| | - Devin M. Casenhiser
- Department of Audiology and Speech Pathology, College of Health Professions, The University of Tennessee Health Science Center, Knoxville
| | - Eun Jin Paek
- Department of Audiology and Speech Pathology, College of Health Professions, The University of Tennessee Health Science Center, Knoxville
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Beber BC, Liedtke FV, Oliveira FSD, Müller-Silveira L, Alves EV, Chaves MLF, Salles JFD. Clustering and switching analysis of verb fluency in individuals with Alzheimer's disease. Codas 2023; 35:e20210179. [PMID: 37075412 PMCID: PMC10145992 DOI: 10.1590/2317-1782/20232021179pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 03/18/2022] [Indexed: 04/21/2023] Open
Abstract
PURPOSE To investigate verb fluency performance in individuals with Alzheimer's disease compared with healthy older adults by analyzing total correct responses, number of clusters, average cluster size, and number of switches. METHODS This is a case-control study of 39 healthy older adults and 29 older adults with a diagnosis of Alzheimer's disease. Verb fluency performance was analyzed in terms of total number of correct verbs retrieved, number of clusters, average cluster size, and number of switches. To obtain the study outcomes, we previously conducted a procedure for categorization of the verbs that would compose the clusters. The classification of verbs was adapted for this study, including assessment by raters and analysis of inter-rater reliability. RESULTS Individuals with Alzheimer's disease showed significantly poorer performance than healthy controls in the number of switches and total number of correct verbs retrieved. The two groups did not differ significantly in the other measures. CONCLUSION In this study, individuals with Alzheimer's disease showed impaired verb fluency, characterized by a reduced number of verbs retrieved and fewer transitions between verb categories. The findings suggest that, in Alzheimer's disease, verb fluency is more sensitive to cognitive deficits resulting from executive dysfunction than from semantic disruption.
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Affiliation(s)
- Bárbara Costa Beber
- Departamento de Fonoaudiologia, Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA - Porto Alegre (RS), Brasil
- Programa de Pós-graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA - Porto Alegre (RS), Brasil
| | - Franceia Veiga Liedtke
- Programa de Pós-graduação em Psicologia, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS), Brasil
| | - Felipe Schroeder de Oliveira
- Programa de Pós-graduação em Psicologia, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS), Brasil
- Curso de Psicologia, Universidade Franciscana - UFN - Santa Maria (RS), Brasil
| | - Lucas Müller-Silveira
- Programa de Pós-graduação em Psicologia, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS), Brasil
| | - Emily Viega Alves
- Curso de Fonoaudiologia, Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA - Porto Alegre (RS), Brasil
| | - Márcia Lorena Fagundes Chaves
- Departamento de Medicina Interna, Programa de Pós-graduação em Medicina - Ciências Médicas, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS), Brasil
| | - Jerusa Fumagalli de Salles
- Programa de Pós-graduação em Psicologia, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS), Brasil
- Departamento de Psicologia do Desenvolvimento e da Personalidade, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS), Brasil
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