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Chatterjee M, Özdemir S, Fritz C, Möbius W, Kleineidam L, Mandelkow E, Biernat J, Doğdu C, Peters O, Cosma NC, Wang X, Schneider LS, Priller J, Spruth E, Kühn AA, Krause P, Klockgether T, Vogt IR, Kimmich O, Spottke A, Hoffmann DC, Fliessbach K, Miklitz C, McCormick C, Weydt P, Falkenburger B, Brandt M, Guenther R, Dinter E, Wiltfang J, Hansen N, Bähr M, Zerr I, Flöel A, Nestor PJ, Düzel E, Glanz W, Incesoy E, Bürger K, Janowitz D, Perneczky R, Rauchmann BS, Hopfner F, Wagemann O, Levin J, Teipel S, Kilimann I, Goerss D, Prudlo J, Gasser T, Brockmann K, Mengel D, Zimmermann M, Synofzik M, Wilke C, Selma-González J, Turon-Sans J, Santos-Santos MA, Alcolea D, Rubio-Guerra S, Fortea J, Carbayo Á, Lleó A, Rojas-García R, Illán-Gala I, Wagner M, Frommann I, Roeske S, Bertram L, Heneka MT, Brosseron F, Ramirez A, Schmid M, Beschorner R, Halle A, Herms J, Neumann M, Barthélemy NR, Bateman RJ, Rizzu P, Heutink P, Dols-Icardo O, Höglinger G, Hermann A, Schneider A. Plasma extracellular vesicle tau and TDP-43 as diagnostic biomarkers in FTD and ALS. Nat Med 2024; 30:1771-1783. [PMID: 38890531 PMCID: PMC11186765 DOI: 10.1038/s41591-024-02937-4] [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: 07/10/2023] [Accepted: 03/21/2024] [Indexed: 06/20/2024]
Abstract
Minimally invasive biomarkers are urgently needed to detect molecular pathology in frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS). Here, we show that plasma extracellular vesicles (EVs) contain quantifiable amounts of TDP-43 and full-length tau, which allow the quantification of 3-repeat (3R) and 4-repeat (4R) tau isoforms. Plasma EV TDP-43 levels and EV 3R/4R tau ratios were determined in a cohort of 704 patients, including 37 genetically and 31 neuropathologically proven cases. Diagnostic groups comprised patients with TDP-43 proteinopathy ALS, 4R tauopathy progressive supranuclear palsy, behavior variant FTD (bvFTD) as a group with either tau or TDP-43 pathology, and healthy controls. EV tau ratios were low in progressive supranuclear palsy and high in bvFTD with tau pathology. EV TDP-43 levels were high in ALS and in bvFTD with TDP-43 pathology. Both markers discriminated between the diagnostic groups with area under the curve values >0.9, and between TDP-43 and tau pathology in bvFTD. Both markers strongly correlated with neurodegeneration, and clinical and neuropsychological markers of disease severity. Findings were replicated in an independent validation cohort of 292 patients including 34 genetically confirmed cases. Taken together, the combination of EV TDP-43 levels and EV 3R/4R tau ratios may aid the molecular diagnosis of FTD, FTD spectrum disorders and ALS, providing a potential biomarker to monitor disease progression and target engagement in clinical trials.
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Grants
- R01 AG080470 NIA NIH HHS
- This study was funded by a grant from the German Federal Ministry of Education and Research, BMBF, grant identifier 01KX2230 to AS. AS received funding from the Federal Ministry of Education and Research, BMBF (DESCARTES consortium, grant identifier 01EK2102A, and PREPARE, grant identifier 01GP2213A), Verum Foundation and BMBF/NUM (UTN consortium). A.S. received funding from Cure Alzheimer’s Fund and from Netzwerke NRW iBehave consortium. A.S. is member of the DFG-funded Cluster of Excellence ImmunoSensation2 - EXC2151 – 390873048. A.S. and A.R. were supported by La Fundación Reina Sofía, proyecto “MANOLO BARRÓS”. A.S. received funding by the Target ALS Foundation (TALS).
- MC received funding from Deutsche Demenzhilfe DZNE Innovative Minds Program and the Manfred-Strohscheer-Foundation.
- L.K. received funding from the Hertie Foundation, Hertie Network of Excellence in Clinical Neurosciences and from the JPND grant 01ED2007B (PreAdapt).
- Cure Alzheimer Foundation, Katharina Hard Foundation
- NRW Netzwerke iBehave
- DFG, Neuro-AcSis
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Affiliation(s)
| | - Selcuk Özdemir
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Genetics, Atatürk University, Erzurum, Turkey
| | - Christian Fritz
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Wiebke Möbius
- Department of Neurogenetics, Max Planck Institute for Multidisciplinary Sciences, Göttingen, Germany
- Cluster of Excellence 'Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells' (MBExC), University of Göttingen, Göttingen, Germany
| | - Luca Kleineidam
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Old Age Psychiatry and Cognitive Disorders, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Eckhard Mandelkow
- Department of Old Age Psychiatry and Cognitive Disorders, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Jacek Biernat
- Department of Old Age Psychiatry and Cognitive Disorders, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Cem Doğdu
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Oliver Peters
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Psychiatry and Psychotherapy, Berlin, Germany
| | | | - Xiao Wang
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
| | | | - Josef Priller
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Technical University of Munich School of Medicine, Munich, Germany
- University of Edinburgh and UK DRI, Edinburgh, UK
| | - Eike Spruth
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea A Kühn
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Patricia Krause
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Klockgether
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neurology, University of Bonn, Bonn, Germany
| | - Ina R Vogt
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Okka Kimmich
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Annika Spottke
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neurology, University of Bonn, Bonn, Germany
| | | | - Klaus Fliessbach
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Old Age Psychiatry and Cognitive Disorders, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Carolin Miklitz
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Old Age Psychiatry and Cognitive Disorders, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Cornelia McCormick
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Old Age Psychiatry and Cognitive Disorders, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Patrick Weydt
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Björn Falkenburger
- German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Moritz Brandt
- German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - René Guenther
- German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Elisabeth Dinter
- German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany
- Department of Neurology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Jens Wiltfang
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
- Neurosciences and Signaling Group, Institute of Biomedicine (iBiMED), Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Niels Hansen
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
| | - Mathias Bähr
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
- Department of Neurology, University Medical Center, Georg August University, Göttingen, Germany
- Cluster of Excellence Nanoscale Microscopy and Molecular Physiology of the Brain (CNMPB), University Medical Center Göttingen, Göttingen, Germany
| | - Inga Zerr
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
- Department of Neurology, University Medical Center, Georg August University, Göttingen, Germany
| | - Agnes Flöel
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
| | - Peter J Nestor
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Queensland Brain Institute, University of Queensland and Mater Public Hospital, Brisbane, Queensland, Australia
| | - Emrah Düzel
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University, Magdeburg, Germany
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Wenzel Glanz
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University, Magdeburg, Germany
- Clinic for Neurology, University Hospital Magdeburg, Magdeburg, Germany
| | - Enise Incesoy
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
- Institute of Cognitive Neurology and Dementia Research, Otto-von-Guericke University, Magdeburg, Germany
- Department of Psychiatry and Psychotherapy, University Hospital Magdeburg, Magdeburg, Germany
| | - Katharina Bürger
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Daniel Janowitz
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Robert Perneczky
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy) Munich, Munich, Germany
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK
| | - Boris S Rauchmann
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
- Department of Neuroradiology, University Hospital LMU, Munich, Germany
- Sheffield Institute for Translational Neuroscience (SITraN), University of Sheffield, Sheffield, UK
| | - Franziska Hopfner
- Department of Neurology, University Hospital of Munich, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Olivia Wagemann
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Department of Neurology, University Hospital of Munich, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Johannes Levin
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy) Munich, Munich, Germany
- Department of Neurology, University Hospital of Munich, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Stefan Teipel
- German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
- Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Ingo Kilimann
- German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
- Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Doreen Goerss
- German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
| | - Johannes Prudlo
- German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
- Department of Neurology, Rostock University Medical Centre, Rostock, Germany
| | - Thomas Gasser
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Kathrin Brockmann
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - David Mengel
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Milan Zimmermann
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Matthis Synofzik
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Carlo Wilke
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Hertie Institute for Clinical Brain Research, Department of Neurodegenerative Diseases, University of Tübingen, Tübingen, Germany
| | - Judit Selma-González
- Sant Pau Memory Unit, Department of Neurology, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Motor Neuron Disease Clinic, Neuromuscular Diseases Unit, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Janina Turon-Sans
- Motor Neuron Disease Clinic, Neuromuscular Diseases Unit, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Miguel Angel Santos-Santos
- Sant Pau Memory Unit, Department of Neurology, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Daniel Alcolea
- Sant Pau Memory Unit, Department of Neurology, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Sara Rubio-Guerra
- Sant Pau Memory Unit, Department of Neurology, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Juan Fortea
- Sant Pau Memory Unit, Department of Neurology, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Álvaro Carbayo
- Motor Neuron Disease Clinic, Neuromuscular Diseases Unit, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Alberto Lleó
- Sant Pau Memory Unit, Department of Neurology, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Ricardo Rojas-García
- Motor Neuron Disease Clinic, Neuromuscular Diseases Unit, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Ignacio Illán-Gala
- Sant Pau Memory Unit, Department of Neurology, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Michael Wagner
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Old Age Psychiatry and Cognitive Disorders, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Ingo Frommann
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Old Age Psychiatry and Cognitive Disorders, University Hospital Bonn, University of Bonn, Bonn, Germany
| | - Sandra Roeske
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Lucas Bertram
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - Michael T Heneka
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Belvaux, Luxembourg
- Department of Infectious Diseases and Immunology, University of Massachussetss Medical School, North Worcester, MA, USA
| | | | - Alfredo Ramirez
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Old Age Psychiatry and Cognitive Disorders, University Hospital Bonn, University of Bonn, Bonn, Germany
- Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- Division of Neurogenetics and Molecular Psychiatry, Department of Psychiatry, University of Cologne, Cologne, Germany
- Department of Psychiatry, Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, UT Health San Antonio, San Antonio, TX, USA
| | - Matthias Schmid
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Rudi Beschorner
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Department of Neuropathology, University of Tübingen, Tübingen, Germany
| | - Annett Halle
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neuropathology, University Hospital Bonn, Bonn, Germany
| | - Jochen Herms
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy) Munich, Munich, Germany
- Center for Neuropathology and Prion Research, LMU Munich, Munich, Germany
| | - Manuela Neumann
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
- Department of Neuropathology, University of Tübingen, Tübingen, Germany
| | - Nicolas R Barthélemy
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Tracy Family SILQ Center for Neurodegenerative Biology, St. Louis, MO, USA
| | - Randall J Bateman
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Tracy Family SILQ Center for Neurodegenerative Biology, St. Louis, MO, USA
| | - Patrizia Rizzu
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Peter Heutink
- German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Oriol Dols-Icardo
- Sant Pau Memory Unit, Department of Neurology, Institut de Recerca Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Günter Höglinger
- German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy) Munich, Munich, Germany
- Department of Neurology, University Hospital of Munich, Ludwig-Maximilians-Universität (LMU) Munich, Munich, Germany
| | - Andreas Hermann
- German Centre for Neurodegenerative Diseases (DZNE), Rostock/Greifswald, Germany
- Translational Neurodegeneration Section 'Albrecht Kossel' and Center for Transdisciplinary Neurosciences, University Medical Center Rostock, Rostock, Germany
| | - Anja Schneider
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany.
- Department of Old Age Psychiatry and Cognitive Disorders, University Hospital Bonn, University of Bonn, Bonn, Germany.
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Shtyrov Y, Efremov A, Kuptsova A, Wennekers T, Gutkin B, Garagnani M. Breakdown of category-specific word representations in a brain-constrained neurocomputational model of semantic dementia. Sci Rep 2023; 13:19572. [PMID: 37949997 PMCID: PMC10638411 DOI: 10.1038/s41598-023-41922-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 09/04/2023] [Indexed: 11/12/2023] Open
Abstract
The neurobiological nature of semantic knowledge, i.e., the encoding and storage of conceptual information in the human brain, remains a poorly understood and hotly debated subject. Clinical data on semantic deficits and neuroimaging evidence from healthy individuals have suggested multiple cortical regions to be involved in the processing of meaning. These include semantic hubs (most notably, anterior temporal lobe, ATL) that take part in semantic processing in general as well as sensorimotor areas that process specific aspects/categories according to their modality. Biologically inspired neurocomputational models can help elucidate the exact roles of these regions in the functioning of the semantic system and, importantly, in its breakdown in neurological deficits. We used a neuroanatomically constrained computational model of frontotemporal cortices implicated in word acquisition and processing, and adapted it to simulate and explain the effects of semantic dementia (SD) on word processing abilities. SD is a devastating, yet insufficiently understood progressive neurodegenerative disease, characterised by semantic knowledge deterioration that is hypothesised to be specifically related to neural damage in the ATL. The behaviour of our brain-based model is in full accordance with clinical data-namely, word comprehension performance decreases as SD lesions in ATL progress, whereas word repetition abilities remain less affected. Furthermore, our model makes predictions about lesion- and category-specific effects of SD: our simulation results indicate that word processing should be more impaired for object- than for action-related words, and that degradation of white matter should produce more severe consequences than the same proportion of grey matter decay. In sum, the present results provide a neuromechanistic explanatory account of cortical-level language impairments observed during the onset and progress of semantic dementia.
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Affiliation(s)
- Yury Shtyrov
- Center of Functionally Integrative Neuroscience (CFIN), Institute for Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Aleksei Efremov
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, HSE University, Moscow, Russia
- Montreal Neurological Institute-Hospital, McGill University, Montreal, Quebec, Canada
| | - Anastasia Kuptsova
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, HSE University, Moscow, Russia
| | - Thomas Wennekers
- School of Engineering, Computing and Mathematics, University of Plymouth, Plymouth, UK
| | - Boris Gutkin
- Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, HSE University, Moscow, Russia
- Département d'Etudes Cognitives, École Normale Supérieure, Paris, France
| | - Max Garagnani
- Department of Computing, Goldsmiths - University of London, London, UK.
- Brain Language Laboratory, Department of Philosophy and Humanities, Freie Universität Berlin, Berlin, Germany.
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Henríquez F, Cabello V, Baez S, de Souza LC, Lillo P, Martínez-Pernía D, Olavarría L, Torralva T, Slachevsky A. Multidimensional Clinical Assessment in Frontotemporal Dementia and Its Spectrum in Latin America and the Caribbean: A Narrative Review and a Glance at Future Challenges. Front Neurol 2022; 12:768591. [PMID: 35250791 PMCID: PMC8890568 DOI: 10.3389/fneur.2021.768591] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/13/2021] [Indexed: 12/14/2022] Open
Abstract
Frontotemporal dementia (FTD) is the third most common form of dementia across all age groups and is a leading cause of early-onset dementia. The Frontotemporal dementia (FTD) includes a spectrum of diseases that are classified according to their clinical presentation and patterns of neurodegeneration. There are two main types of FTD: behavioral FTD variant (bvFTD), characterized by a deterioration in social function, behavior, and personality; and primary progressive aphasias (PPA), characterized by a deficit in language skills. There are other types of FTD-related disorders that present motor impairment and/or parkinsonism, including FTD with motor neuron disease (FTD-MND), progressive supranuclear palsy (PSP), and corticobasal syndrome (CBS). The FTD and its associated disorders present great clinical heterogeneity. The diagnosis of FTD is based on the identification through clinical assessments of a specific clinical phenotype of impairments in different domains, complemented by an evaluation through instruments, i.e., tests and questionnaires, validated for the population under study, thus, achieving timely detection and treatment. While the prevalence of dementia in Latin America and the Caribbean (LAC) is increasing rapidly, there is still a lack of standardized instruments and consensus for FTD diagnosis. In this context, it is important to review the published tests and questionnaires adapted and/or validated in LAC for the assessment of cognition, behavior, functionality, and gait in FTD and its spectrum. Therefore, our paper has three main goals. First, to present a narrative review of the main tests and questionnaires published in LAC for the assessment of FTD and its spectrum in six dimensions: (i) Cognitive screening; (ii) Neuropsychological assessment divided by cognitive domain; (iii) Gait assessment; (iv) Behavioral and neuropsychiatric symptoms; (v) Functional assessment; and (vi) Global Rating Scale. Second, to propose a multidimensional clinical assessment of FTD in LAC identifying the main gaps. Lastly, it is proposed to create a LAC consortium that will discuss strategies to address the current challenges in the field.
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Affiliation(s)
- Fernando Henríquez
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department – Institute of Biomedical Sciences (ICBM), Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
- Laboratory for Cognitive and Evolutionary Neuroscience (LaNCE), Department of Psychiatry, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Victoria Cabello
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department – Institute of Biomedical Sciences (ICBM), Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Sandra Baez
- Universidad de los Andes, Departamento de Psicología, Bogotá, Colombia
| | - Leonardo Cruz de Souza
- Programa de Pós-Graduação em Neurociências da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Patricia Lillo
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Departamento de Neurología Sur, Facultad de Medicina, Universidad de Chile, Santiago, Chile
- Unidad de Neurología, Hospital San José, Santiago, Chile
| | - David Martínez-Pernía
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Center for Social and Cognitive Neuroscience (CSCN), School of Psychology, Universidad Adolfo Ibáñez, Santiago, Chile
| | - Loreto Olavarría
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department – Institute of Biomedical Sciences (ICBM), Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Teresa Torralva
- Institute of Cognitive and Translational Neuroscience (INCYT), Instituto de Neurología Cognitiva Foundation, Favaloro University, Buenos Aires, Argentina
| | - Andrea Slachevsky
- Geroscience Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago, Chile
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department – Institute of Biomedical Sciences (ICBM), Neuroscience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago, Chile
- Department of Neurology and Psychiatry, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
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4
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Seckin M, Ricard I, Raiser T, Heitkamp N, Ebert A, Prix C, Levin J, Diehl-Schmid J, Riedl L, Roßmeier C, Hoen N, Schroeter ML, Marschhauser A, Obrig H, Benke T, Kornhuber J, Fliessbach K, Schneider A, Wiltfang J, Jahn H, Fassbender K, Prudlo J, Lauer M, Duning T, Wilke C, Synofzik M, Anderl-Straub S, Semler E, Lombardi J, Landwehrmeyer B, Ludolph A, Otto M, Danek A. Utility of the Repeat and Point Test for Subtyping Patients With Primary Progressive Aphasia. Alzheimer Dis Assoc Disord 2022; 36:44-51. [PMID: 35001030 DOI: 10.1097/wad.0000000000000482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 11/07/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Primary progressive aphasia (PPA) may present with three distinct clinical sybtypes: semantic variant PPA (svPPA), nonfluent/agrammatic variant PPA (nfvPPA), and logopenic variant PPA (lvPPA). OBJECTIVE The aim was to examine the utility of the German version of the Repeat and Point (R&P) Test for subtyping patients with PPA. METHOD During the R&P Test, the examiner reads out aloud a noun and the participants are asked to repeat the word and subsequently point to the corresponding picture. Data from 204 patients (68 svPPA, 85 nfvPPA, and 51 lvPPA) and 33 healthy controls were analyzed. RESULTS Controls completed both tasks with >90% accuracy. Patients with svPPA had high scores in repetition (mean=9.2±1.32) but low scores in pointing (mean=6±2.52). In contrast, patients with nfvPPA and lvPPA performed comparably in both tasks with lower scores in repetition (mean=7.4±2.7 for nfvPPA and 8.2±2.34 for lvPPA) but higher scores in pointing (mean=8.9±1.41 for nfvPPA and 8.6±1.62 for lvPPA). The R&P Test had high accuracy discriminating svPPA from nfvPPA (83% accuracy) and lvPPA (79% accuracy). However, there was low accuracy discriminating nfvPPA from lvPPA (<60%). CONCLUSION The R&P Test helps to differentiate svPPA from 2 nonsemantic variants (nfvPPA and lvPPA). However, additional tests are required for the differentiation of nfvPPA and lvPPA.
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Affiliation(s)
- Mustafa Seckin
- Neurologische Klinik und Poliklinik
- Acibadem Mehmet Ali Aydinlar University School of Medicine, Department of Neurology, İstanbul, Turkey
| | - Ingrid Ricard
- Institut für Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Ludwig-Maximilians-Unversität München
| | | | | | - Anne Ebert
- Neurologische Klinik, Universitätsmedizin Mannheim, Mannheim
| | | | - Johannes Levin
- Neurologische Klinik und Poliklinik
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE)
- Munich Cluster for Systems Neurology (SyNergy)
| | - Janine Diehl-Schmid
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich
| | - Lina Riedl
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich
| | - Carola Roßmeier
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich
| | - Nora Hoen
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich
| | - Matthias L Schroeter
- Max Planck Institute for Human Cognitive and Brain Sciences, Neurology, and Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig
| | - Anke Marschhauser
- Max Planck Institute for Human Cognitive and Brain Sciences, Neurology, and Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig
| | - Hellmuth Obrig
- Max Planck Institute for Human Cognitive and Brain Sciences, Neurology, and Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig
| | - Thomas Benke
- Universitätsklinik für Neurologie, Kognitive Neurologie und Neuropsychologie, Innsbruck, Austria
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg (FAU), Erlangen
| | - Klaus Fliessbach
- Klinik für Neurodegenerative Erkrankungen und Gerontopsychiatrie, Universitätsklinikum Bonn & Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Bonn
| | - Anja Schneider
- Klinik für Neurodegenerative Erkrankungen und Gerontopsychiatrie, Universitätsklinikum Bonn & Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Bonn
| | - Jens Wiltfang
- Klinik für Psychiatrie und Psychotherapie, Universitätsmedizin Göttingen, Göttingen
| | - Holger Jahn
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Klaus Fassbender
- Neurologische Klinik und Poliklinik, Universität des Saarlandes, KirrbergerStraße, Homburg
| | - Johannes Prudlo
- Klinik für Neurologie und Poliklinik, Universitätsklinikum Rostock, Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Rostock
| | - Martin Lauer
- Klinik und Poliklinik für Psychiatrie, Psychosomatik und Psychotherapie, Universität Würzburg, Würzburg
| | - Thomas Duning
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Westfälische-Wilhelms-Universität, Münster
| | - Carlo Wilke
- Department of Neurodegenerative Diseases, Centre for Neurology and Hertie-Institute for Clinical Brain Research, University Hospital
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Tübingen
| | - Matthis Synofzik
- Department of Neurodegenerative Diseases, Centre for Neurology and Hertie-Institute for Clinical Brain Research, University Hospital
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Tübingen
| | | | - Elisa Semler
- Neurologische Klinik und Poliklinik, Universität Ulm
| | | | | | - Albert Ludolph
- Neurologische Klinik und Poliklinik, Universität Ulm
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Ulm
| | - Markus Otto
- Neurologische Klinik und Poliklinik, Universität Ulm
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5
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Motor speech disorders in the nonfluent, semantic and logopenic variants of primary progressive aphasia. Cortex 2021; 140:66-79. [PMID: 33933931 DOI: 10.1016/j.cortex.2021.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/12/2021] [Accepted: 03/22/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Motor speech disorders (MSDs) are characteristic for nonfluent primary progressive aphasia (nfvPPA). In primary progressive aphasia (PPA) of the semantic (svPPA) and of the logopenic type (lvPPA), speech motor function is considered typically intact. However, knowledge on the prevalence of MSDs in svPPA and lvPPA is mainly based on studies with a priori knowledge of PPA syndrome diagnosis. This fully blinded retrospective study aims to provide data on the prevalence of all types of MSDs in a large sample of German-speaking patients with different subtypes of PPA. METHOD Two raters, blinded for PPA subtype, independently evaluated connected speech samples for MSD syndrome and severity from 161 patients diagnosed with nfvPPA, svPPA or lvPPA in the database of the German Consortium of Frontotemporal Lobar Degeneration (FTLDc). In case of disagreement, a third experienced rater re-evaluated the speech samples, followed by a consensus procedure. Consensus was reached for 160 patients (74 nfvPPA, 49 svPPA, 37 lvPPA). MAIN RESULTS Across all PPA syndromes, 43.8% of the patients showed MSDs. Patients with nfvPPA demonstrated the highest proportion of MSDs (62.2%), but MSDs were also identified in svPPA (26.5%) and lvPPA (29.7%), respectively. Overall, dysarthria was the most common class of MSDs, followed by apraxia of speech. In addition, we identified speech abnormalities presenting as "syllabic speech", "dysfluent speech", and "adynamic speech". DISCUSSION Our study confirmed MSDs as frequently occurring in PPA. The study also confirmed MSDs to be most common in patients with nfvPPA. However, MSDs were also found in substantial proportions of patients with svPPA and lvPPA. Furthermore, our study identified speech motor deficits that have not received attention in previous studies on PPA. The results are discussed against the background of the existing literature on MSDs in PPA, including theoretical considerations of the neuroanatomical conditions described for each of the different subtypes of PPA.
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The atrophy pattern in Alzheimer-related PPA is more widespread than that of the frontotemporal lobar degeneration associated variants. NEUROIMAGE-CLINICAL 2019; 24:101994. [PMID: 31505368 PMCID: PMC6734177 DOI: 10.1016/j.nicl.2019.101994] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 08/16/2019] [Accepted: 08/24/2019] [Indexed: 11/30/2022]
Abstract
Objective The three recognized variants of primary progressive aphasia (PPA) are associated with different loci of degeneration—left posterior perisylvian in logopenic variant (lvPPA), left frontal operculum in non-fluent variant (nfvPPA), and left rostroventral-temporal in semantic variant (svPPA). Meanwhile, it has become apparent that patients with lvPPA, in which Alzheimer pathology is the norm, frequently have more extensive language deficits—namely semantic and grammatical problems—than is captured in the strict diagnostic recommendations for this variant. We hypothesized that this may be because the degeneration in AD-related PPA typically extends beyond the left posterior perisylvian region. Methods Magnetic resonance images from 25 PPA patients (9AD-related PPA, 10 svPPA, 6 nfvPPA) and a healthy control cohort were used to calculate cortical thickness in three regions of interest (ROIs). The three ROIs being the left-hemispheric loci of maximal reported degeneration for each of the three variants of PPA. Results Consistent with past studies, the most severe cortical thinning was in the posterior perisylvian ROI in AD-related PPA; the ventral temporal ROI in svPPA; and the frontal opercular ROI in nfvPPA. Significant cortical thinning in AD-related PPA, however, was evident in all three ROIs. In contrast, thinning in svPPA and nfvPPA was largely restricted to their known peak loci of degeneration. Conclusions Although cortical degeneration in AD-related PPA is maximal in the left posterior perisylvian region, it extends more diffusely throughout the left hemisphere language network offering a plausible explanation for why the linguistic profile of lvPPA so often includes additional semantic and grammatic deficits. lvPPA is associated with AD pathology. AD-PPA present with more extensive deficits than lvPPA. Atrophy in AD-PPA encompasses the peak atrophy sites of the other PPA subtypes. The extended atrophy in AD-PPA explains the heterogeneity of linguistic deficits.
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7
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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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8
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Krein L, Jeon YH, Amberber AM, Fethney J. The Assessment of Language and Communication in Dementia: A Synthesis of Evidence. Am J Geriatr Psychiatry 2019; 27:363-377. [PMID: 30581140 DOI: 10.1016/j.jagp.2018.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Without the current option of a dementia cure, there is an existing need to focus on rehabilitation intervention. This includes interventions that address language and communication impairment (LCI), found to be present early in most types of dementia. Assessment of LCI can occur in many contexts (e.g., speech pathology, neuropsychology, occupational therapy) and is a vital initial step in providing adequate support to people living with dementia and their families. However, no previous research has compared the psychometric properties and utility of currently available and suitable tools for this purpose. METHODS Eighteen tools with the potential to assess language and communication in dementia were identified through a two-stage process, and a synthesis of evidence is provided. RESULTS Three tools satisfied all selection criteria: the Arizona Battery for Communication Disorders of Dementia, the Sydney Language Battery, and the Addenbrooke's Cognitive Examination III. Main limitations of the 18 tools reviewed concern a lack of standardization, normative data, and criterion validity, as well as poor evidence of reliability of tools originally developed for non-neurodegenerative LCI (e.g., aphasia in the context of cerebrovascular accidents). Furthermore, no tool considers the perspectives of people with dementia regarding the impact of LCI on their daily lives. CONCLUSION Further research is needed to improve reliability and validity of currently available tools for the linguistic assessment of people living with dementia. Importantly, a tool to assess early identification of language and communication difficulties and associated needs among people with dementia is warranted to facilitate timely management and support.
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Affiliation(s)
- Luisa Krein
- Susan Wakil School of Nursing and Midwifery (LK, YJ, JF), University of Sydney, Sydney, Australia.
| | - Yun-Hee Jeon
- Susan Wakil School of Nursing and Midwifery (LK, YJ, JF), University of Sydney, Sydney, Australia
| | | | - Judith Fethney
- Susan Wakil School of Nursing and Midwifery (LK, YJ, JF), University of Sydney, Sydney, Australia
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9
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Henry ML, Grasso SM. Assessment of Individuals with Primary Progressive Aphasia. Semin Speech Lang 2018; 39:231-241. [PMID: 29933490 DOI: 10.1055/s-0038-1660782] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Speech-language pathologists play a crucial role in the assessment and treatment of individuals with primary progressive aphasia (PPA). The speech-language evaluation is a critical aspect of the diagnostic and rehabilitative process, informing differential diagnosis as well as intervention planning and monitoring of cognitive-linguistic status over time. The evaluation should include a thorough case history and interview and a detailed assessment of speech-language and cognitive functions, with tasks designed to detect core and associated deficits outlined in current diagnostic criteria. In this paper, we review assessments that can be utilized to examine communication and cognition in PPA, including general aphasia batteries designed for stroke and/or progressive aphasia as well as tests of specific cognitive-linguistic functions, including naming, object/person knowledge, single-word and sentence comprehension, repetition, spontaneous speech/language production, motor speech, written language, and nonlinguistic cognitive domains. The comprehensive evaluation can inform diagnostic decision making and facilitate planning of interventions that are tailored to the patient's current status and likely progression of deficits. As such, the speech-language evaluation allows the medical team to provide individuals with PPA and their families with appropriate recommendations for the present and the future.
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Affiliation(s)
- Maya L Henry
- Department of Communication Sciences and Disorders, University of Texas, Austin, Texas
| | - Stephanie M Grasso
- Department of Communication Sciences and Disorders, University of Texas, Austin, Texas
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10
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Semler E, Anderl-Straub S, Uttner I, Diehl-Schmid J, Danek A, Einsiedler B, Fassbender K, Fliessbach K, Huppertz HJ, Jahn H, Kornhuber J, Landwehrmeyer B, Lauer M, Muche R, Prudlo J, Schneider A, Schroeter ML, Ludolph AC, Otto M. A language-based sum score for the course and therapeutic intervention in primary progressive aphasia. ALZHEIMERS RESEARCH & THERAPY 2018; 10:41. [PMID: 29695300 PMCID: PMC5922300 DOI: 10.1186/s13195-018-0345-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 01/22/2018] [Indexed: 12/14/2022]
Abstract
Background With upcoming therapeutic interventions for patients with primary progressive aphasia (PPA), instruments for the follow-up of patients are needed to describe disease progression and to evaluate potential therapeutic effects. So far, volumetric brain changes have been proposed as clinical endpoints in the literature, but cognitive scores are still lacking. This study followed disease progression predominantly in language-based performance within 1 year and defined a PPA sum score which can be used in therapeutic interventions. Methods We assessed 28 patients with nonfluent variant PPA, 17 with semantic variant PPA, 13 with logopenic variant PPA, and 28 healthy controls in detail for 1 year. The most informative neuropsychological assessments were combined to a sum score, and associations between brain atrophy were investigated followed by a sample size calculation for clinical trials. Results Significant absolute changes up to 20% in cognitive tests were found after 1 year. Semantic and phonemic word fluency, Boston Naming Test, Digit Span, Token Test, AAT Written language, and Cookie Test were identified as the best markers for disease progression. These tasks provide the basis of a new PPA sum score. Assuming a therapeutic effect of 50% reduction in cognitive decline for sample size calculations, a number of 56 cases is needed to find a significant treatment effect. Correlations between cognitive decline and atrophy showed a correlation up to r = 0.7 between the sum score and frontal structures, namely the superior and inferior frontal gyrus, as well as with left-sided subcortical structures. Conclusion Our findings support the high performance of the proposed sum score in the follow-up of PPA and recommend it as an outcome measure in intervention studies. Electronic supplementary material The online version of this article (10.1186/s13195-018-0345-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elisa Semler
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Sarah Anderl-Straub
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Ingo Uttner
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Janine Diehl-Schmid
- Department of Psychiatry and Psychotherapy, Technische Universität (TU) München, München, Germany
| | - Adrian Danek
- Department of Neurology, Ludwig-Maximilians-Universität (LMU) München, München, Germany
| | - Beate Einsiedler
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | | | - Klaus Fliessbach
- Department of Psychiatry and Psychotherapy, University of Bonn and DZNE Bonn, Bonn, Germany
| | | | - Holger Jahn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-University Erlangen, Erlangen, Germany
| | | | - Martin Lauer
- Department of Psychiatry and Psychotherapy, University of Würzburg, Würzburg, Germany
| | - Rainer Muche
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Johannes Prudlo
- Department of Neurology, Rostock University Medical Center and German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Anja Schneider
- Department of Psychiatry and Psychotherapy, University of Göttingen, Göttingen, Germany
| | - Matthias L Schroeter
- Max Planck Institute for Human Cognitive and Brain Sciences & Clinic for Cognitive Neurology, University Hospital Leipzig, Leipzig, Germany
| | - Albert C Ludolph
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany
| | - Markus Otto
- Department of Neurology, University of Ulm, Oberer Eselsberg 45, 89081, Ulm, Germany.
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11
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Catricalà E, Gobbi E, Battista P, Miozzo A, Polito C, Boschi V, Esposito V, Cuoco S, Barone P, Sorbi S, Cappa SF, Garrard P. SAND: a Screening for Aphasia in NeuroDegeneration. Development and normative data. Neurol Sci 2017; 38:1469-1483. [PMID: 28578483 DOI: 10.1007/s10072-017-3001-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/17/2017] [Indexed: 12/12/2022]
Abstract
Language assessment has a critical role in the clinical diagnosis of neurodegenerative diseases, in particular, in the case of Primary Progressive Aphasia (PPA). The current diagnostic criteria (Gorno-Tempini et al., 2011) identify three main variants on the basis of clinical features and patterns of brain atrophy. Widely accepted tools to diagnose, clinically classify, and follow up the heterogeneous language profiles of PPA are still lacking. In this study, we develop a screening battery, composed of nine tests (picture naming, word and sentence comprehension, word and sentence repetition, reading, semantic association, writing and picture description), following the recommendations of current diagnostic guidelines and taking into account recent research on the topic. All tasks were developed with consideration of the psycholinguistic factors that can affect performance, with the aim of achieving sensitivity to the language deficit to which each task was relevant, and to allow identification of the selective characteristic impairments of each PPA variant. Normative data on 134 Italian subjects pooled across homogeneous subgroups for age, sex, and education are reported. Although further work is still needed, this battery represents a first step towards a concise multilingual standard language examination, a fast and simple tool to help clinicians and researchers in the diagnosis of PPA.
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Affiliation(s)
| | - Elena Gobbi
- Università Vita-Salute San Raffaele, Milano, Italia
| | - Petronilla Battista
- NEtS, Scuola Universitaria Superiore IUSS-Pavia, Pavia, Italia.,Unità di Malattie Neurodegenerative, Dipartimento di medicina di base, neuroscienze e organi del senso, Università di Bari Aldo Moro, Bari, Italia.,NEUROFARBA- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Firenze, Italia
| | - Antonio Miozzo
- Unità di Neurologia, Dipartimento di scienze cliniche e sperimentali, Università di Brescia, Brescia, Italia
| | - Cristina Polito
- SBSC - Dipartimento di Scienze Biomediche Sperimentali e Cliniche, Università di Firenze, Firenze, Italia
| | - Veronica Boschi
- NEtS, Scuola Universitaria Superiore IUSS-Pavia, Pavia, Italia
| | | | - Sofia Cuoco
- Facoltà di Medicina e Chirurgia, Università degli Studi di Salerno, Fisciano, Italia
| | - Paolo Barone
- Facoltà di Medicina e Chirurgia, Università degli Studi di Salerno, Fisciano, Italia
| | - Sandro Sorbi
- NEUROFARBA- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Firenze, Italia
| | - Stefano F Cappa
- NEtS, Scuola Universitaria Superiore IUSS-Pavia, Pavia, Italia.,IRCCS S. Giovanni di Dio Fatebenefratelli, Brescia, Italia
| | - Peter Garrard
- Neuroscience Research Centre, St George's-University of London, London, UK
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12
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Pilkington E, Keidel J, Kendrick LT, Saddy JD, Sage K, Robson H. Sources of Phoneme Errors in Repetition: Perseverative, Neologistic, and Lesion Patterns in Jargon Aphasia. Front Hum Neurosci 2017; 11:225. [PMID: 28522967 PMCID: PMC5415595 DOI: 10.3389/fnhum.2017.00225] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 04/18/2017] [Indexed: 11/13/2022] Open
Abstract
This study examined patterns of neologistic and perseverative errors during word repetition in fluent Jargon aphasia. The principal hypotheses accounting for Jargon production indicate that poor activation of a target stimulus leads to weakly activated target phoneme segments, which are outcompeted at the phonological encoding level. Voxel-lesion symptom mapping studies of word repetition errors suggest a breakdown in the translation from auditory-phonological analysis to motor activation. Behavioral analyses of repetition data were used to analyse the target relatedness (Phonological Overlap Index: POI) of neologistic errors and patterns of perseveration in 25 individuals with Jargon aphasia. Lesion-symptom analyses explored the relationship between neurological damage and jargon repetition in a group of 38 aphasia participants. Behavioral results showed that neologisms produced by 23 jargon individuals contained greater degrees of target lexico-phonological information than predicted by chance and that neologistic and perseverative production were closely associated. A significant relationship between jargon production and lesions to temporoparietal regions was identified. Region of interest regression analyses suggested that damage to the posterior superior temporal gyrus and superior temporal sulcus in combination was best predictive of a Jargon aphasia profile. Taken together, these results suggest that poor phonological encoding, secondary to impairment in sensory-motor integration, alongside impairments in self-monitoring result in jargon repetition. Insights for clinical management and future directions are discussed.
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Affiliation(s)
- Emma Pilkington
- School of Psychology and Clinical Language Sciences, University of ReadingReading, UK
| | - James Keidel
- School of Psychology, University of SussexBrighton, UK
| | - Luke T Kendrick
- School of Psychology and Clinical Language Sciences, University of ReadingReading, UK
| | - James D Saddy
- School of Psychology and Clinical Language Sciences, University of ReadingReading, UK
| | - Karen Sage
- Department of Allied Health Professions, Sheffield Hallam UniversitySheffield, UK.,Centre for Health and Social Care, Sheffield Hallam UniversitySheffield, UK
| | - Holly Robson
- School of Psychology and Clinical Language Sciences, University of ReadingReading, UK
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13
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Boschi V, Catricalà E, Consonni M, Chesi C, Moro A, Cappa SF. Connected Speech in Neurodegenerative Language Disorders: A Review. Front Psychol 2017; 8:269. [PMID: 28321196 PMCID: PMC5337522 DOI: 10.3389/fpsyg.2017.00269] [Citation(s) in RCA: 148] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 02/10/2017] [Indexed: 12/12/2022] Open
Abstract
Language assessment has a crucial role in the clinical diagnosis of several neurodegenerative diseases. The analysis of extended speech production is a precious source of information encompassing the phonetic, phonological, lexico-semantic, morpho-syntactic, and pragmatic levels of language organization. The knowledge about the distinctive linguistic variables identifying language deficits associated to different neurodegenerative diseases has progressively improved in the last years. However, the heterogeneity of such variables and of the way they are measured and classified limits any generalization and makes the comparison among studies difficult. Here we present an exhaustive review of the studies focusing on the linguistic variables derived from the analysis of connected speech samples, with the aim of characterizing the language disorders of the most prevalent neurodegenerative diseases, including primary progressive aphasia, Alzheimer's disease, movement disorders, and amyotrophic lateral sclerosis. A total of 61 studies have been included, considering only those reporting group analysis and comparisons with a group of healthy persons. This review first analyzes the differences in the tasks used to elicit connected speech, namely picture description, story narration, and interview, considering the possible different contributions to the assessment of different linguistic domains. This is followed by an analysis of the terminologies and of the methods of measurements of the variables, indicating the need for harmonization and standardization. The final section reviews the linguistic domains affected by each different neurodegenerative disease, indicating the variables most consistently impaired at each level and suggesting the key variables helping in the differential diagnosis among diseases. While a large amount of valuable information is already available, the review highlights the need of further work, including the development of automated methods, to take advantage of the richness of connected speech analysis for both research and clinical purposes.
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Affiliation(s)
- Veronica Boschi
- NETS, Center for Neurocognition, Epistemology and Theoretical Syntax, Institute for Advanced Study-Pavia Pavia, Italy
| | - Eleonora Catricalà
- NETS, Center for Neurocognition, Epistemology and Theoretical Syntax, Institute for Advanced Study-Pavia Pavia, Italy
| | - Monica Consonni
- Third Neurology Unit and Motor Neuron Diseases Center, IRCCS Foundation "Carlo Besta" Neurological Institute Milan, Italy
| | - Cristiano Chesi
- NETS, Center for Neurocognition, Epistemology and Theoretical Syntax, Institute for Advanced Study-Pavia Pavia, Italy
| | - Andrea Moro
- NETS, Center for Neurocognition, Epistemology and Theoretical Syntax, Institute for Advanced Study-Pavia Pavia, Italy
| | - Stefano F Cappa
- NETS, Center for Neurocognition, Epistemology and Theoretical Syntax, Institute for Advanced Study-PaviaPavia, Italy; IRCCS S. Giovanni di Dio FatebenefratelliBrescia, Italy
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Bürger K, Arzberger T, Stephan J, Levin J, Edbauer D. [Pathomechanisms and clinical aspects of frontotemporal lobar degeneration]. DER NERVENARZT 2016; 88:163-172. [PMID: 27999880 DOI: 10.1007/s00115-016-0259-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Frontotemporal lobar degeneration (FTLD) includes a spectrum of heterogeneous clinical and neuropathological diseases. In a strict sense this includes the behavioral variant of frontotemporal dementia (bvFTD) and primary progressive aphasia (PPA) and both variants can be associated with amyotrophic lateral sclerosis (FTD-ALS). In a broader sense FTLD also includes progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS). In recent years the strong genetic component of FTLD has become increasingly clear. OBJECTIVE The association between clinical presentation, neuropathology, genetics and pathophysiological mechanisms of FTLD are presented. RESULTS The diagnostic criteria and tools for the clinical differential diagnosis of FTLD are presented. At autopsy patients show neuronal and glial inclusions of Tau, TDP-43 or FUS. While Tau pathology is often associated with extrapyramidal symptoms, patients with TDP-43 and FUS inclusions often also show signs of ALS. Pathogenic mutations directly increase the aggregation propensity of these proteins or impair protein degradation through autophagy or the proteasome. Pathogenic mutations in most FTLD genes trigger cytoplasmic missorting and aggregation of the RNA-binding protein TDP-43 and thus lead to a nuclear loss of TDP-43 function. Microgliosis and mutations in GRN and TREM2 suggest an important role of neuroinflammation in FTLD. CONCLUSION There is still no causal therapy for FTLD but preclinical studies focusing on pathogenic mutations in C9orf72, GRN and Tau may lead to clinical trials soon; therefore, establishing large well characterized patient cohorts is crucial for trial readiness.
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Affiliation(s)
- K Bürger
- Institut für Schlaganfall und Demenzforschung, Klinikum der Universität München, Ludwig-Maximilians-Universität München, München, Deutschland
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Feodor-Lynen-Str. 17, 81377, München, Deutschland
| | - T Arzberger
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Feodor-Lynen-Str. 17, 81377, München, Deutschland
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, Ludwig-Maximilians-Universität München, München, Deutschland
- Zentrum für Neuropathologie und Prionforschung, Ludwig-Maximilians-Universität München, München, Deutschland
| | - J Stephan
- Institut für Schlaganfall und Demenzforschung, Klinikum der Universität München, Ludwig-Maximilians-Universität München, München, Deutschland
- Klinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, Ludwig-Maximilians-Universität München, München, Deutschland
| | - J Levin
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Feodor-Lynen-Str. 17, 81377, München, Deutschland
- Neurologische Klinik und Poliklinik, Klinikum der Universität München, Ludwig-Maximilians-Universität München, München, Deutschland
| | - D Edbauer
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Feodor-Lynen-Str. 17, 81377, München, Deutschland.
- Munich Cluster of Systems Neurology (SyNergy), Ludwig-Maximilians-Universität München, München, Deutschland.
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Graham NL, Leonard C, Tang-Wai DF, Black S, Chow TW, Scott CJM, McNeely AA, Masellis M, Rochon E. Lack of Frank Agrammatism in the Nonfluent Agrammatic Variant of Primary Progressive Aphasia. Dement Geriatr Cogn Dis Extra 2016; 6:407-423. [PMID: 27790240 PMCID: PMC5075721 DOI: 10.1159/000448944] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background/Aims Frank agrammatism, defined as the omission and/or substitution of grammatical morphemes with associated grammatical errors, is variably reported in patients with nonfluent variant primary progressive aphasia (nfPPA). This study addressed whether frank agrammatism is typical in agrammatic nfPPA patients when this feature is not required for diagnosis. Method We assessed grammatical production in 9 patients who satisfied current diagnostic criteria. Although the focus was agrammatism, motor speech skills were also evaluated to determine whether dysfluency arose primarily from apraxia of speech (AOS), instead of, or in addition to, agrammatism. Volumetric MRI analyses provided impartial imaging-supported diagnosis. Results The majority of cases exhibited neither frank agrammatism nor AOS. Conclusion There are nfPPA patients with imaging-supported diagnosis and preserved motor speech skills who do not exhibit frank agrammatism, and this may persist beyond the earliest stages of the illness. Because absence of frank agrammatism is a subsidiary diagnostic feature in the logopenic variant of PPA, this result has implications for differentiation of the nonfluent and logopenic variants, and indicates that PPA patients with nonfluent speech in the absence of frank agrammatism or AOS do not necessarily have the logopenic variant.
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Affiliation(s)
- Naida L Graham
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Ont., Canada; Toronto Rehabilitation Institute, Toronto, Ont, Canada
| | - Carol Leonard
- Department of Audiology and Speech-Language Pathology, University of Ottawa, Ottawa, Ont, Canada
| | - David F Tang-Wai
- University Health Network Memory Clinic, Toronto Western Hospital, Ont., Canada; Department of Medicine (Neurology), University of Toronto, Ont., Canada
| | - Sandra Black
- Department of Medicine (Neurology), University of Toronto, Ont., Canada; L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Ont., Canada; Rotman Research Institute, University of Toronto, Toronto, Ont., Canada
| | - Tiffany W Chow
- Department of Medicine (Neurology), University of Toronto, Ont., Canada; Rotman Research Institute, University of Toronto, Toronto, Ont., Canada; Department of Psychiatry (Geriatric Psychiatry), University of Toronto, Toronto, Ont., Canada
| | - Chris J M Scott
- L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Ont., Canada
| | - Alicia A McNeely
- L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Ont., Canada
| | - Mario Masellis
- L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Ont., Canada
| | - Elizabeth Rochon
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Ont., Canada; Toronto Rehabilitation Institute, Toronto, Ont, Canada
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Kielar A, Deschamps T, Jokel R, Meltzer JA. Functional reorganization of language networks for semantics and syntax in chronic stroke: Evidence from MEG. Hum Brain Mapp 2016; 37:2869-93. [PMID: 27091757 DOI: 10.1002/hbm.23212] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 03/29/2016] [Accepted: 04/04/2016] [Indexed: 11/09/2022] Open
Abstract
Using magnetoencephalography, we investigated the potential of perilesional and contralesional activity to support language recovery in patients with poststroke aphasia. In healthy young controls, left-lateralized ventral frontotemporal regions responded to semantic anomalies during sentence comprehension and bilateral dorsal frontoparietal regions responded to syntactic anomalies. Older adults showed more extensive bilateral responses to the syntactic anomalies and less lateralized responses to the semantic anomalies, with decreased activation in the left occipital and parietal regions for both semantic and syntactic anomalies. In aphasic participants, we observed compensatory recruitment in the right hemisphere (RH), which varied depending on the type of linguistic information that was processed. For semantic anomalies, aphasic patients activated some preserved left hemisphere regions adjacent to the lesion, as well as homologous parietal and temporal RH areas. Patients also recruited right inferior and dorsolateral frontal cortex that was not activated in the healthy participants. Responses for syntactic anomalies did not reach significance in patients. Correlation analyses indicated that recruitment of homologous temporoparietal RH areas is associated with better semantic performance, whereas higher accuracy on the syntactic task was related to bilateral superior temporoparietal and right frontal activity. The results suggest that better recovery of semantic processing is associated with a shift to ventral brain regions in the RH. In contrast, preservation of syntactic processing is mediated by dorsal areas, bilaterally, although recovery of syntactic processing tends to be poorer than semantic. Hum Brain Mapp 37:2869-2893, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Aneta Kielar
- Rotman Research Institute, Baycrest Health Sciences Toronto, Toronto, Ontario, Canada.,Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada
| | - Tiffany Deschamps
- Rotman Research Institute, Baycrest Health Sciences Toronto, Toronto, Ontario, Canada
| | - Regina Jokel
- Rotman Research Institute, Baycrest Health Sciences Toronto, Toronto, Ontario, Canada.,Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Jed A Meltzer
- Rotman Research Institute, Baycrest Health Sciences Toronto, Toronto, Ontario, Canada.,Department of Psychology, University of Toronto, Toronto, Ontario, Canada.,Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada.,Canadian Partnership for Stroke Recovery, Ottawa, Ontario, Canada
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Patterson K, Kopelman MD, Woollams AM, Brownsett SL, Geranmayeh F, Wise RJ. Semantic memory: Which side are you on? Neuropsychologia 2015; 76:182-91. [DOI: 10.1016/j.neuropsychologia.2014.11.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 11/10/2014] [Accepted: 11/20/2014] [Indexed: 01/08/2023]
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Marcotte K, Graham NL, Black SE, Tang-Wai D, Chow TW, Freedman M, Rochon E, Leonard C. Verb production in the nonfluent and semantic variants of primary progressive aphasia: The influence of lexical and semantic factors. Cogn Neuropsychol 2014; 31:565-83. [DOI: 10.1080/02643294.2014.970154] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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19
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Kertesz A, Harciarek M. Primary progressive aphasia. Scand J Psychol 2014; 55:191-201. [DOI: 10.1111/sjop.12105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 01/05/2014] [Indexed: 12/12/2022]
Affiliation(s)
- Andrew Kertesz
- Department of Clinical Neurological Sciences; Western University; London Ontario Canada
| | - Michał Harciarek
- Division of Clinical Psychology and Neuropsychology; Institute of Psychology; University of Gdańsk; Gdańsk Poland
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Bishop DVM, Nation K, Patterson K. When words fail us: insights into language processing from developmental and acquired disorders. Philos Trans R Soc Lond B Biol Sci 2013; 369:20120403. [PMID: 24324244 PMCID: PMC3866430 DOI: 10.1098/rstb.2012.0403] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Acquired disorders of language represent loss of previously acquired skills, usually with relatively specific impairments. In children with developmental disorders of language, we may also see selective impairment in some skills; but in this case, the acquisition of language or literacy is affected from the outset. Because systems for processing spoken and written language change as they develop, we should beware of drawing too close a parallel between developmental and acquired disorders. Nevertheless, comparisons between the two may yield new insights. A key feature of connectionist models simulating acquired disorders is the interaction of components of language processing with each other and with other cognitive domains. This kind of model might help make sense of patterns of comorbidity in developmental disorders. Meanwhile, the study of developmental disorders emphasizes learning and change in underlying representations, allowing us to study how heterogeneity in cognitive profile may relate not just to neurobiology but also to experience. Children with persistent language difficulties pose challenges both to our efforts at intervention and to theories of learning of written and spoken language. Future attention to learning in individuals with developmental and acquired disorders could be of both theoretical and applied value.
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Affiliation(s)
- Dorothy V. M. Bishop
- Department of Experimental Psychology, University of Oxford, 9 South Parks Road, Oxford OX1 3UD, UK
| | - Kate Nation
- Department of Experimental Psychology, University of Oxford, 9 South Parks Road, Oxford OX1 3UD, UK
| | - Karalyn Patterson
- Clinical Neurosciences, University of Cambridge, Herchel Smith Building, Forvie Site, Robinson Way, Cambridge CB2 2PY, UK
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21
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Savage S, Hsieh S, Leslie F, Foxe D, Piguet O, Hodges JR. Distinguishing subtypes in primary progressive aphasia: application of the Sydney language battery. Dement Geriatr Cogn Disord 2013; 35:208-18. [PMID: 23467307 DOI: 10.1159/000346389] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Primary progressive aphasia (PPA) comprises three main subtypes, varying in clinical features, patterns of brain atrophy, and underlying pathology. Differentiation of these variants is important for treatment and planning; however, simple, effective cognitive tests to aid diagnosis are lacking. This study introduces a new language battery - the SYDBAT (Sydney Language Battery) - to assist clinicians. METHODS Fifty-seven PPA patients and 54 age- and education-matched healthy controls were compared on naming, repetition, word comprehension, and semantic association subtests. RESULTS Significant group differences were found for all tasks, reflecting different language profiles for each group. Using discriminative function analysis, 80% of PPA cases were correctly classified from three SYDBAT scores, from which a simple diagnostic algorithm was defined. CONCLUSION The SYDBAT is a fast and simple tool which provides a valuable adjunct to clinicians diagnosing PPA.
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Affiliation(s)
- Sharon Savage
- Neuroscience Research Australia, University of New South Wales, Sydney, N.S.W., Australia
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22
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Episodic future thinking is impaired in the behavioural variant of frontotemporal dementia. Cortex 2013; 49:2377-88. [DOI: 10.1016/j.cortex.2013.03.002] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 03/08/2013] [Accepted: 03/08/2013] [Indexed: 11/22/2022]
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Harciarek M, Cosentino S. Language, executive function and social cognition in the diagnosis of frontotemporal dementia syndromes. Int Rev Psychiatry 2013; 25:178-96. [PMID: 23611348 PMCID: PMC4481322 DOI: 10.3109/09540261.2013.763340] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Frontotemporal dementia (FTD) represents a spectrum of non-Alzheimer's degenerative conditions associated with focal atrophy of the frontal and/or temporal lobes. Frontal and temporal regions of the brain have been shown to be strongly involved in executive function, social cognition and language processing and, thus, deficits in these domains are frequently seen in patients with FTD or may even be hallmarks of a specific FTD subtype (i.e. relatively selective and progressive language impairment in primary progressive aphasia). In this review we have attempted to delineate how language, executive function, and social cognition may contribute to the diagnosis of FTD syndromes, namely the behavioural variant FTD as well as the language variants of FTD including the three subtypes of primary progressive aphasia (PPA): non-fluent/agrammatic, semantic and logopenic. This review also addresses the extent to which deficits in these cognitive areas contribute to the differential diagnosis of FTD versus Alzheimer's disease (AD). Finally, early clinical determinants of pathology are briefly discussed and contemporary challenges to the diagnosis of FTD are presented.
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Affiliation(s)
- Michał Harciarek
- Division of Clinical Psychology and Neuropsychology, Institute of Psychology, University of Gdańsk, Poland.
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Abstract
Logopenic progressive aphasia (LPA) is a form of primary progressive aphasia (PPA) characterized by hesitant speech with marked impairment in naming and repetition. LPA is associated with brain atrophy in the left temporal and inferior parietal cortices and is predominantly associated with Alzheimer’s disease (AD) pathology. In contrast to LPA, ‘‘typical’’ AD is commonly associated with episodic memory disturbance and bilateral medial temporal lobe atrophy. Recent evidence suggests verbal short-term memory is more impaired than visuospatial short-term memory in LPA. This study investigated verbal and visuospatial short-term memory in 12 LPA and 12 AD patients matched for disease severity, and in 12 age- and education-matched healthy controls. Overall, both patient groups showed significantly reduced verbal and visuospatial spans compared with controls. In addition, LPA patients performed significantly worse than AD patients on both forward and backward conditions of the Digit Span task. In contrast, no difference was present between patient groups on either version of the Spatial Span task. Importantly, LPA patients showed better visuospatial than verbal span whereas AD patients and controls did not differ across modality. This study demonstrates the specificity of the short-term memory disturbance in LPA, which arises from a breakdown of the phonological system.
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25
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Exploring the content and quality of episodic future simulations in semantic dementia. Neuropsychologia 2012; 50:3488-95. [DOI: 10.1016/j.neuropsychologia.2012.09.012] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 08/29/2012] [Accepted: 09/04/2012] [Indexed: 11/20/2022]
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26
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Woollams AM, Patterson K. The consequences of progressive phonological impairment for reading aloud. Neuropsychologia 2012; 50:3469-77. [PMID: 23000132 DOI: 10.1016/j.neuropsychologia.2012.09.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 09/09/2012] [Accepted: 09/12/2012] [Indexed: 10/27/2022]
Abstract
The 'primary systems' view of reading disorders proposes that there are no neural regions devoted exclusively to reading, and therefore that acquired dyslexias should reliably co-occur with deficits in more general underlying capacities. This perspective predicted that surface dyslexia, a selective deficit in reading aloud 'exception' words (those with atypical spelling-sound characteristics), should be a consistent feature of semantic dementia, a progressive disorder of conceptual knowledge, and just such a pattern has been observed in previous research. In a similar vein, one might expect the gradual deterioration of phonological processing seen in the nonfluent forms of progressive aphasia to be accompanied by phonological dyslexia, a selective deficit in reading of unfamiliar letter strings, i.e., nonwords. The present study, reporting a case-series consideration of reading-aloud data from 16 progressive nonfluent aphasic patients, revealed a pattern in which both low-frequency exception word and nonword reading were comparably compromised. The severity of the reading disorder was predicted by scores on the expressive language task of picture naming but not the receptive task of spoken word-to-picture matching. Our hypothesis that a phonological deficit underpins diminished performance for both naming and reading was supported by the finding that reading-aloud performance was predicted specifically by the rate of phonological errors in picture naming. Moreover, the strength of this relationship was similar for low-frequency exception words and nonwords, suggesting that reading deficits for these two types of items in this disorder shared a common cause: a progressive impairment of phonological processing.
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Affiliation(s)
- Anna M Woollams
- University of Manchester, UK & MRC Cognition and Brain Sciences Unit, Cambridge, UK.
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27
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Irish M, Addis DR, Hodges JR, Piguet O. Considering the role of semantic memory in episodic future thinking: evidence from semantic dementia. Brain 2012; 135:2178-91. [DOI: 10.1093/brain/aws119] [Citation(s) in RCA: 285] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Harciarek M, Kertesz A. Primary progressive aphasias and their contribution to the contemporary knowledge about the brain-language relationship. Neuropsychol Rev 2011; 21:271-87. [PMID: 21809067 PMCID: PMC3158975 DOI: 10.1007/s11065-011-9175-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 07/25/2011] [Indexed: 12/12/2022]
Abstract
Primary progressive aphasia (PPA), typically resulting from a neurodegenerative disease such as frontotemporal dementia/Pick Complex or Alzheimer's disease, is a heterogeneous clinical condition characterized by a progressive loss of specific language functions with initial sparing of other cognitive domains. Based on the constellation of symptoms, PPA has been classified into a nonfluent, semantic, or logopenic variant. This review of the literature aims to characterize the speech and language impairment, cognition, neuroimaging, pathology, genetics, and epidemiology associated with each of these variants. Some therapeutic recommendations, theoretical implications, and directions for future research have been also provided.
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Affiliation(s)
- Michał Harciarek
- Department of Social Sciences, Division of Clinical Psychology and Neuropsychology, Institute of Psychology, University of Gdańsk, Bażyńskiego 4, 80-952 Gdańsk, Poland.
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Leyton CE, Hodges JR. Frontotemporal dementias: Recent advances and current controversies. Ann Indian Acad Neurol 2011; 13:S74-80. [PMID: 21369422 PMCID: PMC3039165 DOI: 10.4103/0972-2327.74249] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2010] [Accepted: 07/25/2010] [Indexed: 12/12/2022] Open
Abstract
Frontotemporal dementia (FTD) syndromes comprise a heterogeneous group of neurodegenerative conditions characterized by atrophy in the frontal and temporal lobes. Three main clinical variants are recognized: Behavioral variant (bv-FTD), Semantic dementia (SD), and Progressive nonfluent aphasia (PNFA). However, logopenic/phonological (LPA) variant has been recently described, showing a distinctive pattern of brain atrophy and often associated to Alzheimer's disease pathology. The diagnosis of FTD is challenging, since there is clinical, pathological, and genetic overlap between the variants and other neurodegenerative diseases, such as motoneuron disease (MND) and corticobasal degeneration (CBD). In addition, patients with gene mutations (tau and progranulin) display an inconsistent clinical phenotype and the correspondence between the clinical variant and its pathology is unpredictable. New cognitive tests based on social cognition and emotional recognition together with advances in molecular pathology and genetics have contributed to an improved understanding. There is now a real possibility of accurate biomarkers for early diagnosis. The present review concentrates on new insights and debates in FTD.
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Affiliation(s)
- Cristian E Leyton
- Neuroscience Research Australia (NeuRA), The University of New South Wales, Sydney, Australia
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Acosta-Cabronero J, Patterson K, Fryer TD, Hodges JR, Pengas G, Williams GB, Nestor PJ. Atrophy, hypometabolism and white matter abnormalities in semantic dementia tell a coherent story. Brain 2011; 134:2025-35. [DOI: 10.1093/brain/awr119] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Santos MDD, Mac-Kay APMG. Resultados preliminares do estudo da compreensão em sujeitos disatricos. REVISTA CEFAC 2011. [DOI: 10.1590/s1516-18462011005000042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: apresentar estudo sobre a compreensão de linguagem em sujeitos disártricos. MÉTODO: estudo retrospectivo, descritivo, de caráter qualitativo e quantitativo com 60 sujeitos com idade entre 40 a 70 anos. Foi realizado o cruzamento das tarefas de compreensão do protocolo Montreal Toulouse (versão alfa): compreensão de palavras orais (CPO) e escritas (CPE); frases simples orais (CFSO) e escritas(CFSE); frases complexas orais (CFCO) e escritas (CFCE). RESULTADOS: com respeito à comparação entre a compreensão oral e a escrita, quanto maior a CPO maior a CPE; quanto maior a CFSO, maior CFSE e vice-versa; relativamente à compreensão oral e escrita, quanto maior a CP, maior CF; quanto maior a CFS, maior CFC e vice-versa; em relação à comparação de idade, gênero, e CFCO e CFCE, não se observa relações significativas. CONCLUSÃO: nos pacientes deste estudo, verificou-se que a compreensão das estruturas mais simples favorece a compreensão das mais complexas; a dificuldade de compreensão de estruturas simples apresenta relação direta com a dificuldade de compreensão de estruturas complexas.
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Profiles of recent autobiographical memory retrieval in semantic dementia, behavioural-variant frontotemporal dementia, and Alzheimer's disease. Neuropsychologia 2011; 49:2694-702. [PMID: 21658396 DOI: 10.1016/j.neuropsychologia.2011.05.017] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 05/18/2011] [Accepted: 05/23/2011] [Indexed: 11/23/2022]
Abstract
Episodic autobiographical memory (ABM) comprises recollection for events that are grounded within a specific spatiotemporal context, and usually accompanied by perceptual and emotional information. The neural substrates mediating ABM retrieval are those harbouring significant pathology in semantic dementia (SD) and behavioural-variant frontotemporal dementia (bvFTD), the most common subtypes of FTD. Relatively little is known, however, regarding the differential patterns of contextual details during episodic ABM retrieval across these dementia syndromes. This study investigated episodic ABM retrieval under free and probed recall conditions from 4 time periods with the aim to identify disease-specific profiles of episodic ABM contextual details. Episodic ABM was measured in 25 SD and 15 bvFTD patients and their performance contrasted to that of 17 Alzheimer's disease (AD) patients and 19 age-matched controls. Critically, SD patients showed relatively preserved recent ABM in comparison with remote epochs. In contrast, bvFTD and AD patients showed a reduced capacity to recall specific and contextually rich ABMs across all life epochs, in both free and probed recall conditions. Analyses of the recent period (last 12 months) provided evidence for different profiles of contextual episodic details recalled in dementia syndromes. Following probing, SD patients' recall deficits emanated exclusively from compromised Emotion/Thoughts and Spatiotemporal details. In contrast, bvFTD patients were significantly impaired across all categories of contextual details whereas AD patients showed deficits for Event and Emotion/Thoughts details only. As the largest study of ABM in FTD to date, these findings emphasise the differential impairment of recent ABM contextual details contingent on the underlying disease pathology. In addition, these results point towards the importance of investigating the constituent elements of emotion processing and strategic retrieval processes as potential variables mediating recent episodic ABM retrieval.
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Méligne D, Fossard M, Belliard S, Moreaud O, Duvignau K, Démonet JF. Verb production during action naming in semantic dementia. JOURNAL OF COMMUNICATION DISORDERS 2011; 44:379-391. [PMID: 21237467 DOI: 10.1016/j.jcomdis.2010.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Revised: 07/19/2010] [Accepted: 12/07/2010] [Indexed: 05/30/2023]
Abstract
UNLABELLED In contrast with widely documented deficits of semantic knowledge relating to object concepts and the corresponding nouns in semantic dementia (SD), little is known about action semantics and verb production in SD. The degradation of action semantic knowledge was studied in 5 patients with SD compared with 17 matched control participants in an action naming task based on video clips. The pattern of errors, involving a huge proportion of generic verbs (e.g. "to remove" versus "to peel") relative to responses in control subjects, suggested a hierarchical, bottom-up deficit of action knowledge in SD patients. In addition, abnormal responses in patients consisted of verbs that were semantically related to the expected verbs produced by control subjects (e.g. "to undress" versus "to peel" for the action [To peel_orange]). This study suggests that, in SD, non-canonical responses to action naming reflect lack of both specificity and semantic relatedness relative to the expected responses. LEARNING OUTCOMES As a result of this activity, readers will recognize that semantic word knowledge disappears in semantic dementia using video clips of object-related actions. As a result of this activity, readers will discover that this semantic impairment followed a hierarchical pattern with the more specific verbs vanishing first.
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Affiliation(s)
- D Méligne
- Inserm, Imagerie cérébrale et handicaps neurologiques UMR 825, F-31059 Toulouse, France.
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Interhemispheric differences in knowledge of animals among patients with semantic dementia. Cogn Behav Neurol 2011; 23:240-6. [PMID: 21042206 DOI: 10.1097/wnn.0b013e3181f22448] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate interhemispheric differences on naming and fluency tasks for living versus nonliving things among patients with semantic dementia (SD). BACKGROUND In SD, left-temporal involvement impairs language and word comprehension, and right-temporal involvement impairs facial recognition. There may be other interhemispheric differences, particularly in the animate-inanimate dichotomy. METHOD On the basis of magnetic resonance imaging (MRI) ratings of anterior temporal atrophy, 36 patients who met criteria for SD were divided into 21 with left-predominant and 11 with right-predominant involvement (4 others were too symmetric for analysis). The left and right-predominant groups were compared on naming, fluency, and facial recognition tests. RESULTS Consistent with greater language impairment, the left-predominant patients had worse naming, especially inanimate and letter fluency, than the right-predominant patients. In contrast, difference in scores suggested selective impairment of animal naming, animal name fluency, and semantic knowledge for animate items among the right-predominant patients. Proportionally more right than left-predominant patients misnamed animal items and faces. CONCLUSIONS These findings support interhemispheric differences in animal knowledge. Whereas left-predominant SD equally affects animate and inanimate words from language involvement, right-predominant SD, with greater sparing of language, continues to impair other semantic aspects of animals. The right anterior temporal region seems to make a unique contribution to knowledge of living things.
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Ratnavalli E. Progress in the last decade in our understanding of primary progressive aphasia. Ann Indian Acad Neurol 2011; 13:S109-15. [PMID: 21369415 PMCID: PMC3039160 DOI: 10.4103/0972-2327.74255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 07/27/2010] [Indexed: 12/05/2022] Open
Abstract
Primary progressive aphasia (PPA) is a focal neurodegeneration of the brain affecting the language network. Patients can have isolated language impairment for years without impairment in other areas. PPA is classified as primary progressive nonfluent aphasia (PNFA), semantic dementia (SD), and logopenic aphasia, which have distinct patterns of atrophy on neuroimaging. PNFA and SD are included under frontotemporal lobar degenerations. PNFA patients have effortful speech with agrammatism, which is frequently associated with apraxia of speech and demonstrate atrophy in the left Broca’s area and surrounding region on neuroimaging. Patients with SD have dysnomia with loss of word and object (or face) meaning with asymmetric anterior temporal lobe atrophy. Logopenic aphasics have word finding difficulties with frequent pauses in conversation, intact grammar, and word comprehension but impaired repetition for sentences. The atrophy is predominantly in the left posterior temporal and inferior parietal regions. Recent studies have described several progranulin mutations on chromosome 17 in PNFA. The three clinical syndromes have a less robust relationship to the underlying pathology, which is heterogeneous and includes tauopathy, ubiquitinopathy, Pick’s disease, corticobasal degeneration, progressive supranuclear palsy, and Alzheimer’s disease. Recent studies, however, seem to indicate that a better characterization of the clinical phenotype (apraxic, agrammatic, semantic, logopenic, jargon) increases the predictive value of the underlying pathology. Substantial advances have been made in our understanding of PPAs but developing new biomarkers is essential in making accurate causative diagnoses in individual patients. This is critically important in the development and evaluation of disease-modifying drugs.
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Atrofie focali. Neurologia 2011. [DOI: 10.1016/s1634-7072(11)70571-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Abstract
BACKGROUND Frontotemporal dementia has recently been recognized as a common cause of young-onset dementia. OBJECTIVE To review the current approach to the clinical evaluation, understanding of pathophysiology, and management of frontotemporal dementia. RESULTS Two main clinical presentations are: (1) behavioral, with impulsive behaviors and disinhibition, change in personality such as apathy and indifference, and poor judgment, and (2) language, with a nonfluent aphasia with anomia (primary progressive aphasia), or a fluent aphasia with early loss of word meaning (semantic dementia). The differential diagnosis includes other neurodegenerative dementias, vascular and other conditions affecting the brain, and psychiatric diseases. Investigations, including neuropsychological testing, and structural and functional brain imaging, may help support the diagnosis. Recent advances in understanding the pathophysiology have suggested that most cases have underlying ubiquitin-positive inclusions, whereas some have tau-positive inclusions. Genetic mutations, particularly on chromosome 17 in the tau or progranulin genes, have been identified. Management includes a trial of symptomatic medications and a multifaceted approach, including environmental modification and long-term care planning. CONCLUSION Medical researchers studying frontotemporal dementia aim to identify disease-modifying drugs and, ultimately, a cure for this devastating disease.
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Foley JA, Della Sala S. Geographical distribution of Cortex publications. Cortex 2010; 46:410-9. [DOI: 10.1016/j.cortex.2009.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2009] [Accepted: 11/23/2009] [Indexed: 01/05/2023]
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Chow TW, Varpetian A, Moss T, Vinters HV, Marquez S, Miller C. Alzheimer's disease neuropathologic changes in semantic dementia. Neurocase 2010; 16:15-22. [PMID: 19866390 PMCID: PMC3049725 DOI: 10.1080/13554790903193174] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
UNLABELLED Neuropathologic change underlying primary progressive aphasia (PPA) most commonly includes one of the frontotemporal lobar degenerations, such as FTLD-tau or FTLD-ubiquitin. The next most frequent etiology of PPA is Alzheimer's disease (AD). We describe 5 subjects with clinical diagnoses of semantic dementia, who underwent longitudinal clinical evaluation and postmortem neuropathology examination of the central nervous system. This case series examines retrospectively which clinical parameters might have pointed to the neuropathological diagnosis of AD. CONCLUSION family history of late onset dementia, APOEepsilon4 status, combined features of semantic dementia and progressive non-fluent aphasia present early in illness, or generalized seizures, may indicate AD as the underlying pathology of semantic dementia.
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Affiliation(s)
- Tiffany W Chow
- Rotman Research Institute and Division of Neurology, Baycrest, Toronto, ON, Canada.
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Re-addressing gender bias in Cortex publications. Cortex 2009; 45:1126-37. [DOI: 10.1016/j.cortex.2009.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Revised: 04/13/2009] [Accepted: 04/13/2009] [Indexed: 11/22/2022]
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Wilson SM, Ogar JM, Laluz V, Growdon M, Jang J, Glenn S, Miller BL, Weiner MW, Gorno-Tempini ML. Automated MRI-based classification of primary progressive aphasia variants. Neuroimage 2009; 47:1558-67. [PMID: 19501654 DOI: 10.1016/j.neuroimage.2009.05.085] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Revised: 05/08/2009] [Accepted: 05/26/2009] [Indexed: 12/12/2022] Open
Abstract
Degeneration of language regions in the dominant hemisphere can result in primary progressive aphasia (PPA), a clinical syndrome characterized by progressive deficits in speech and/or language function. Recent studies have identified three variants of PPA: progressive non-fluent aphasia (PNFA), semantic dementia (SD) and logopenic progressive aphasia (LPA). Each variant is associated with characteristic linguistic features, distinct patterns of brain atrophy, and different likelihoods of particular underlying pathogenic processes, which makes correct differential diagnosis highly clinically relevant. Evaluation of linguistic behavior can be challenging for non-specialists, and neuroimaging findings in single subjects are often difficult to evaluate by eye. We investigated the utility of automated structural MR image analysis to discriminate PPA variants (N=86) from each other and from normal controls (N=115). T1 images were preprocessed to obtain modulated grey matter (GM) images. Feature selection was performed with principal components analysis (PCA) on GM images as well as images of lateralized atrophy. PC coefficients were classified with linear support vector machines, and a cross-validation scheme was used to obtain accuracy rates for generalization to novel cases. The overall mean accuracy in discriminating between pairs of groups was 92.2%. For one pair of groups, PNFA and SD, we also investigated the utility of including several linguistic variables as features. Models with both imaging and linguistic features performed better than models with only imaging or only linguistic features. These results suggest that automated methods could assist in the differential diagnosis of PPA variants, enabling therapies to be targeted to likely underlying etiologies.
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Affiliation(s)
- Stephen M Wilson
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA.
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