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LoBue C, McClintock SM, Chiang HS, Helphrey J, Thakkar VJ, Hart J. A Critical Review of Noninvasive Brain Stimulation Technologies in Alzheimer's Dementia and Primary Progressive Aphasia. J Alzheimers Dis 2024:JAD240230. [PMID: 38905047 DOI: 10.3233/jad-240230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2024]
Abstract
Multiple pharmacologic agents now have been approved in the United States and other countries as treatment to slow disease and clinical progression for Alzheimer's disease. Given these treatments have not been proven to lessen the cognitive deficits already manifested in the Alzheimer's Clinical Syndrome (ACS), and none are aimed for another debilitating dementia syndrome identified as primary progressive aphasia (PPA), there is an urgent need for new, safe, tolerable, and efficacious treatments to mitigate the cognitive deficits experienced in ACS and PPA. Noninvasive brain stimulation has shown promise for enhancing cognitive functioning, and there has been interest in its potential therapeutic value in ACS and PPA. This review critically examines the evidence of five technologies in ACS and PPA: transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), transcranial random noise stimulation (tRNS), repetitive transcranial magnetic stimulation (rTMS), and noninvasive vagus nerve stimulation (nVNS). Many randomized controlled trials of tDCS and rTMS report positive treatment effects on cognition in ACS and PPA that persist out to at least 8 weeks, whereas there are few trials for tACS and none for tRNS and nVNS. However, most positive trials did not identify clinically meaningful changes, underscoring that clinical efficacy has yet to be established in ACS and PPA. Much is still to be learned about noninvasive brain stimulation in ACS and PPA, and shifting the focus to prioritize clinical significance in addition to statistical significance in trials could yield greater success in understanding its potential cognitive effects and optimal parameters.
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Affiliation(s)
- Christian LoBue
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Shawn M McClintock
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Hsueh-Sheng Chiang
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA
| | - Jessica Helphrey
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vishal J Thakkar
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John Hart
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, TX, USA
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Landin-Romero R, Kumfor F, Ys Lee A, Leyton C, Piguet O. Clinical and cortical trajectories in non-fluent primary progressive aphasia and Alzheimer's disease: A role for emotion processing. Brain Res 2024; 1829:148777. [PMID: 38286395 DOI: 10.1016/j.brainres.2024.148777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 01/31/2024]
Abstract
OBJECTIVES To examine the clinical trajectories and neural correlates of cognitive and emotion processing changes in the non-fluent/agrammatic (nfvPPA) and the logopenic (lvPPA) variants of primary progressive aphasia (PPA). DESIGN Observational case-control longitudinal cohort study. SETTING Research clinic of frontotemporal dementia. PARTICIPANTS This study recruited 29 non-semantic PPA patients (15 nfvPPA and 14 lvPPA) and compared them with 15 Alzheimer's disease (AD) patients and 14 healthy controls. MEASUREMENTS Participants completed an annual assessment (median = 2 years; range = 1-5 years) of general cognition, emotion processing and structural MRI. Linear mixed effects models investigated clinical and imaging trajectories between groups. RESULTS Over time, lvPPA showed the greatest cognitive deterioration. In contrast, nfvPPA showed significant decline in emotion recognition, whereas AD showed preserved emotion recognition, even with disease progression. Importantly, lvPPA also developed emotion processing impairments, with disease progression. Both nfvPPA and lvPPA showed continuing cortical atrophy in hallmark language-processing regions associated with these syndromes, together with progressive involvement of the right hemisphere regions, mirroring left hemisphere atrophy patterns at presentation. Decline in emotion processing was associated with bilateral frontal atrophy in nfvPPA and right temporal atrophy in lvPPA. CONCLUSIONS Our results show divergent clinical courses in nfvPPA and lvPPA, with rapid cognitive and neural deterioration in lvPPA and emotion processing decline in both groups and support the concurrent assessment of cognition and emotion processing in the clinic to inform diagnosis and monitoring in the non-semantic variants of PPA.
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Affiliation(s)
- Ramon Landin-Romero
- Sydney School of Health Sciences & Brain and Mind Centre, The University of Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders, Australia.
| | - Fiona Kumfor
- School of Psychology & Brain and Mind Centre, The University of Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders, Australia
| | - Austin Ys Lee
- ARC Centre of Excellence in Cognition and its Disorders, Australia
| | - Cristian Leyton
- School of Psychology & Brain and Mind Centre, The University of Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders, Australia
| | - Olivier Piguet
- School of Psychology & Brain and Mind Centre, The University of Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders, Australia
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Santi GC, Conca F, Esposito V, Polito C, Caminiti SP, Boccalini C, Morinelli C, Berti V, Mazzeo S, Bessi V, Marcone A, Iannaccone S, Kim SK, Sorbi S, Perani D, Cappa SF, Catricalà E. Heterogeneity and overlap in the continuum of linguistic profile of logopenic and semantic variants of primary progressive aphasia: a Profile Analysis based on Multidimensional Scaling study. Alzheimers Res Ther 2024; 16:49. [PMID: 38448894 PMCID: PMC10918940 DOI: 10.1186/s13195-024-01403-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/29/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Primary progressive aphasia (PPA) diagnostic criteria underestimate the complex presentation of semantic (sv) and logopenic (lv) variants, in which symptoms partially overlap, and mixed clinical presentation (mixed-PPA) and heterogenous profile (lvPPA +) are frequent. Conceptualization of similarities and differences of these clinical conditions is still scarce. METHODS Lexical, semantic, phonological, and working memory errors from nine language tasks of sixty-seven PPA were analyzed using Profile Analysis based on Multidimensional Scaling, which allowed us to create a distributed representation of patients' linguistic performance in a shared space. Patients had been studied with [18F] FDG-PET. Correlations were performed between metabolic and behavioral data. RESULTS Patients' profiles were distributed across a continuum. All PPA, but two, presented a lexical retrieval impairment, in terms of reduced production of verbs and nouns. svPPA patients occupied a fairly clumped space along the continuum, showing a preponderant semantic deficit, which correlated to fusiform gyrus hypometabolism, while only few presented working memory deficits. Adjacently, lvPPA + presented a semantic impairment combined with phonological deficits, which correlated with metabolism in the anterior fusiform gyrus and posterior middle temporal gyrus. Starting from the shared phonological deficit side, a large portion of the space was occupied by all lvPPA, showing a combination of phonological, lexical, and working memory deficits, with the latter correlating with posterior temporo-parietal hypometabolism. Mixed PPA did not show unique profile, distributing across the space. DISCUSSION Different clinical PPA entities exist but overlaps are frequent. Identifying shared and unique clinical markers is critical for research and clinical practice. Further research is needed to identify the role of genetic and pathological factors in such distribution, including also higher sample size of less represented groups.
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Affiliation(s)
- Gaia Chiara Santi
- IUSS Cognitive Neuroscience (ICoN) Center, Scuola Universitaria Superiore IUSS, Pavia, Italy
| | | | | | | | | | | | - Carmen Morinelli
- Research and Innovation Centre for Dementia-CRIDEM, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Valentina Berti
- Department of Biomedical Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | - Salvatore Mazzeo
- Research and Innovation Centre for Dementia-CRIDEM, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Valentina Bessi
- Research and Innovation Centre for Dementia-CRIDEM, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Alessandra Marcone
- Department of Rehabilitation and Functional Recovery, San Raffaele Hospital, Milan, Italy
| | - Sandro Iannaccone
- Department of Rehabilitation and Functional Recovery, San Raffaele Hospital, Milan, Italy
| | - Se-Kang Kim
- Department of Paediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Sandro Sorbi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
- Research and Innovation Centre for Dementia-CRIDEM, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Daniela Perani
- Vita-Salute San Raffaele University, Milan, Italy
- Nuclear Medicine Unit, San Raffaele Hospital, Milan, Italy
| | - Stefano F Cappa
- IUSS Cognitive Neuroscience (ICoN) Center, Scuola Universitaria Superiore IUSS, Pavia, Italy.
- IRCCS Mondino Foundation, Pavia, Italy, Pavia, Italy.
| | - Eleonora Catricalà
- IUSS Cognitive Neuroscience (ICoN) Center, Scuola Universitaria Superiore IUSS, Pavia, Italy
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Gajardo-Vidal A, Montembeault M, Lorca-Puls DL, Licata AE, Bogley R, Erlhoff S, Ratnasiri B, Ezzes Z, Battistella G, Tsoy E, Pereira CW, DeLeon J, Tee BL, Henry ML, Miller ZA, Rankin KP, Mandelli ML, Possin KL, Gorno-Tempini ML. Assessing processing speed and its neural correlates in the three variants of primary progressive aphasia with a non-verbal tablet-based task. Cortex 2024; 171:165-177. [PMID: 38000139 PMCID: PMC10922977 DOI: 10.1016/j.cortex.2023.10.011] [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: 05/26/2023] [Revised: 09/29/2023] [Accepted: 10/18/2023] [Indexed: 11/26/2023]
Abstract
Prior research has revealed distinctive patterns of impaired language abilities across the three variants of Primary Progressive Aphasia (PPA): nonfluent/agrammatic (nfvPPA), logopenic (lvPPA) and semantic (svPPA). However, little is known about whether, and to what extent, non-verbal cognitive abilities, such as processing speed, are impacted in PPA patients. This is because neuropsychological tests typically contain linguistic stimuli and require spoken output, being therefore sensitive to verbal deficits in aphasic patients. The aim of this study is to investigate potential differences in processing speed between PPA patients and healthy controls, and among the three PPA variants, using a brief non-verbal tablet-based task (Match) modeled after the WAIS-III digit symbol coding test, and to determine its neural correlates. Here, we compared performance on the Match task between PPA patients (n = 61) and healthy controls (n = 59) and across the three PPA variants. We correlated performance on Match with voxelwise gray and white matter volumes. We found that lvPPA and nfvPPA patients performed significantly worse on Match than healthy controls and svPPA patients. Worse performance on Match across PPA patients was associated with reduced gray matter volume in specific parts of the left middle frontal gyrus, superior parietal lobule, and precuneus, and reduced white matter volume in the left parietal lobe. To conclude, our behavioral findings reveal that processing speed is differentially impacted across the three PPA variants and provide support for the potential clinical utility of a tabled-based task (Match) to assess non-verbal cognition. In addition, our neuroimaging findings confirm the importance of a set of fronto-parietal regions that previous research has associated with processing speed and executive control. Finally, our behavioral and neuroimaging findings combined indicate that differences in processing speed are largely explained by the unequal distribution of atrophy in these fronto-parietal regions across the three PPA variants.
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Affiliation(s)
- Andrea Gajardo-Vidal
- Centro de Investigación en Complejidad Social (CICS), Facultad de Gobierno, Universidad del Desarrollo, Santiago, Chile.
| | - Maxime Montembeault
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA; Douglas Mental Health University Institute, Montréal, QC H4H 1R3, Canada; Department of Psychiatry, McGill University, Montréal, QC H3A 1A1, Canada
| | - Diego L Lorca-Puls
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA; Sección de Neurología, Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Concepción, Chile
| | - Abigail E Licata
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Rian Bogley
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Sabrina Erlhoff
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Buddhika Ratnasiri
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Zoe Ezzes
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Giovanni Battistella
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Elena Tsoy
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Christa Watson Pereira
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Jessica DeLeon
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Boon Lead Tee
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Maya L Henry
- Department of Speech, Language, and Hearing Sciences, University of Texas, Austin, TX, USA
| | - Zachary A Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Katherine P Rankin
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Maria Luisa Mandelli
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Katherine L Possin
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
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He R, Yuan X, Hinzen W. Episodic Thinking in Alzheimer's Disease Through the Lens of Language: Linguistic Analysis and Transformer-Based Classification. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:87-95. [PMID: 37870893 DOI: 10.1044/2023_ajslp-23-00066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
PURPOSE Episodic memory decline is a hallmark of Alzheimer's disease (AD) and linked to deficits in episodic thinking directed to the future. We addressed the question whether a deficit in episodic thinking can be picked up directly from connected speech and its detection can be automatized. METHOD We linguistically classified 2,809 utterances (including embedded clauses in the utterances) from picture descriptions from 70 healthy older controls, 82 people with mild probable AD (pAD), and 46 people with moderate pAD for whether they were episodic, nonepisodic, or "other" (e.g., off-task). Generalized linear regression models were used to investigate how ratios of these categories change in AD, controlling for age, gender, and education. Finally, we applied deep learning technique to explore the feasibility of automating the episodicity analysis. RESULTS Decline in episodicity significantly distinguished controls from both mild pAD and moderate pAD. Correlation analysis suggested this decline not to be an effect of age, gender, and education but of cognitive ability. The decline was not compensated by an increase of nonepisodic utterances but mainly of off-task expressions. A transformer-based classifier to explore the possibility of automatizing the classification of episodicity achieved a macro F1 score of 0.913 in the ternary classification. CONCLUSION These results show that a loss of episodicity is an early effect in AD that is manifested in spontaneous speech and can be reliably measured by both humans and machines.
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Affiliation(s)
- Rui He
- Department of Translation and Language Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Xiaofeng Yuan
- Department of Translation and Language Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Wolfram Hinzen
- Department of Translation and Language Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Intitut Català de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
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Ramanan S, Halai AD, Garcia-Penton L, Perry AG, Patel N, Peterson KA, Ingram RU, Storey I, Cappa SF, Catricala E, Patterson K, Rowe JB, Garrard P, Ralph MAL. The neural substrates of transdiagnostic cognitive-linguistic heterogeneity in primary progressive aphasia. Alzheimers Res Ther 2023; 15:219. [PMID: 38102724 PMCID: PMC10724982 DOI: 10.1186/s13195-023-01350-2] [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: 07/18/2023] [Accepted: 11/08/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Clinical variants of primary progressive aphasia (PPA) are diagnosed based on characteristic patterns of language deficits, supported by corresponding neural changes on brain imaging. However, there is (i) considerable phenotypic variability within and between each diagnostic category with partially overlapping profiles of language performance between variants and (ii) accompanying non-linguistic cognitive impairments that may be independent of aphasia magnitude and disease severity. The neurobiological basis of this cognitive-linguistic heterogeneity remains unclear. Understanding the relationship between these variables would improve PPA clinical/research characterisation and strengthen clinical trial and symptomatic treatment design. We address these knowledge gaps using a data-driven transdiagnostic approach to chart cognitive-linguistic differences and their associations with grey/white matter degeneration across multiple PPA variants. METHODS Forty-seven patients (13 semantic, 15 non-fluent, and 19 logopenic variant PPA) underwent assessment of general cognition, errors on language performance, and structural and diffusion magnetic resonance imaging to index whole-brain grey and white matter changes. Behavioural data were entered into varimax-rotated principal component analyses to derive orthogonal dimensions explaining the majority of cognitive variance. To uncover neural correlates of cognitive heterogeneity, derived components were used as covariates in neuroimaging analyses of grey matter (voxel-based morphometry) and white matter (network-based statistics of structural connectomes). RESULTS Four behavioural components emerged: general cognition, semantic memory, working memory, and motor speech/phonology. Performance patterns on the latter three principal components were in keeping with each variant's characteristic profile, but with a spectrum rather than categorical distribution across the cohort. General cognitive changes were most marked in logopenic variant PPA. Regardless of clinical diagnosis, general cognitive impairment was associated with inferior/posterior parietal grey/white matter involvement, semantic memory deficits with bilateral anterior temporal grey/white matter changes, working memory impairment with temporoparietal and frontostriatal grey/white matter involvement, and motor speech/phonology deficits with inferior/middle frontal grey matter alterations. CONCLUSIONS Cognitive-linguistic heterogeneity in PPA closely relates to individual-level variations on multiple behavioural dimensions and grey/white matter degeneration of regions within and beyond the language network. We further show that employment of transdiagnostic approaches may help to understand clinical symptom boundaries and reveal clinical and neural profiles that are shared across categorically defined variants of PPA.
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Affiliation(s)
- Siddharth Ramanan
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, UK.
| | - Ajay D Halai
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, UK
| | - Lorna Garcia-Penton
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, UK
| | - Alistair G Perry
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | - Nikil Patel
- Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, UK
| | - Katie A Peterson
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | - Ruth U Ingram
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Ian Storey
- Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, UK
| | - Stefano F Cappa
- IUSS Cognitive Neuroscience Center (ICoN), University Institute of Advanced Studies IUSS, Pavia, Italy
- Dementia Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Eleonora Catricala
- IUSS Cognitive Neuroscience Center (ICoN), University Institute of Advanced Studies IUSS, Pavia, Italy
- Dementia Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Karalyn Patterson
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, UK
| | - James B Rowe
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, UK
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | - Peter Garrard
- Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, UK
| | - Matthew A Lambon Ralph
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, UK
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Wauters LD, Croot K, Dial HR, Duffy JR, Grasso SM, Kim E, Schaffer Mendez K, Ballard KJ, Clark HM, Kohley L, Murray LL, Rogalski EJ, Figeys M, Milman L, Henry ML. Behavioral Treatment for Speech and Language in Primary Progressive Aphasia and Primary Progressive Apraxia of Speech: A Systematic Review. Neuropsychol Rev 2023:10.1007/s11065-023-09607-1. [PMID: 37792075 DOI: 10.1007/s11065-023-09607-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 06/13/2023] [Indexed: 10/05/2023]
Abstract
Primary progressive aphasia (PPA) and primary progressive apraxia of speech (PPAOS) are neurodegenerative syndromes characterized by progressive decline in language or speech. There is a growing number of studies investigating speech-language interventions for PPA/PPAOS. An updated systematic evaluation of the treatment evidence is warranted to inform best clinical practice and guide future treatment research. We systematically reviewed the evidence for behavioral treatment for speech and language in this population. Reviewed articles were published in peer-reviewed journals through 31 May 2021. We evaluated level of evidence, reporting quality, and risk of bias using a modified version of the American Speech-Language Hearing Association (ASHA) Levels of Evidence, an appraisal point system, additional reporting quality and internal/external validity items, and, as appropriate, the Single Case Experimental Design Scale or the Physiotherapy Evidence Database - PsycBITE Rating Scale for Randomized and Non-Randomized Controlled Trials. Results were synthesized using quantitative summaries and narrative review. A total of 103 studies reported treatment outcomes for 626 individuals with PPA; no studies used the diagnostic label PPAOS. Most studies evaluated interventions for word retrieval. The highest-quality evidence was provided by 45 experimental and quasi-experimental studies (16 controlled group studies, 29 single-subject designs). All (k = 45/45) reported improvement on a primary outcome measure; most reported generalization (k = 34/43), maintenance (k = 34/39), or social validity (k = 17/19) of treatment for at least one participant. The available evidence supports speech-language intervention for persons with PPA; however, treatment for PPAOS awaits systematic investigation. Implications and limitations of the evidence and the review are discussed.
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Affiliation(s)
- Lisa D Wauters
- Department of Speech, Language, and Hearing Sciences, University of Texas at Austin, 2504A Whitis Ave. (A1100), 78712, Austin, TX, USA
| | - Karen Croot
- School of Psychology, University of Sydney, 2006, Sydney, NSW, Australia
| | - Heather R Dial
- Department of Communication Sciences and Disorders, University of Houston, Houston, TX, 77204, USA
| | - Joseph R Duffy
- Department of Neurology, Division of Speech Pathology, Mayo Clinic, Rochester, MN, 55902, USA
| | - Stephanie M Grasso
- Department of Speech, Language, and Hearing Sciences, University of Texas at Austin, 2504A Whitis Ave. (A1100), 78712, Austin, TX, USA
| | - Esther Kim
- US Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine, University of Alberta, T6G 2R3, Edmonton, AB, Canada
| | | | - Kirrie J Ballard
- Faculty of Medicine & Health and Brain & Mind Centre, University of Sydney, Sydney, NSW, 2006, Australia
| | - Heather M Clark
- Department of Neurology, Division of Speech Pathology, Mayo Clinic, Rochester, MN, 55902, USA
| | - Leeah Kohley
- Department of Speech, Language, and Hearing Sciences, University of Texas at Austin, 2504A Whitis Ave. (A1100), 78712, Austin, TX, USA
| | - Laura L Murray
- School of Communication Sciences and Disorders, Western University, London, ON, N6A 3K7, Canada
| | - Emily J Rogalski
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, 60611, Chicago, IL, USA
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University, Feinberg School of Medicine, 60611, Chicago, IL, USA
| | - Mathieu Figeys
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - Lisa Milman
- Department of Communicative Disorders and Deaf Education, Utah State University, Logan, UT, 84322, USA
| | - Maya L Henry
- Department of Speech, Language, and Hearing Sciences, University of Texas at Austin, 2504A Whitis Ave. (A1100), 78712, Austin, TX, USA.
- Department of Neurology, Dell Medical School, University of Texas at Austin, 78712, Austin, TX, USA.
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8
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Hinkley LBN, Thompson M, Miller ZA, Borghesani V, Mizuiri D, Shwe W, Licata A, Ninomiya S, Lauricella M, Mandelli ML, Miller BL, Houde J, Gorno‐Tempini ML, Nagarajan SS. Distinct neurophysiology during nonword repetition in logopenic and non-fluent variants of primary progressive aphasia. Hum Brain Mapp 2023; 44:4833-4847. [PMID: 37516916 PMCID: PMC10472914 DOI: 10.1002/hbm.26408] [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: 12/20/2022] [Revised: 04/25/2023] [Accepted: 06/11/2023] [Indexed: 07/31/2023] Open
Abstract
Overlapping clinical presentations in primary progressive aphasia (PPA) variants present challenges for diagnosis and understanding pathophysiology, particularly in the early stages of the disease when behavioral (speech) symptoms are not clearly evident. Divergent atrophy patterns (temporoparietal degeneration in logopenic variant lvPPA, frontal degeneration in nonfluent variant nfvPPA) can partially account for differential speech production errors in the two groups in the later stages of the disease. While the existing dogma states that neurodegeneration is the root cause of compromised behavior and cortical activity in PPA, the extent to which neurophysiological signatures of speech dysfunction manifest independent of their divergent atrophy patterns remain unknown. We test the hypothesis that nonword deficits in lvPPA and nfvPPA arise from distinct patterns of neural oscillations that are unrelated to atrophy. We use a novel structure-function imaging approach integrating magnetoencephalographic imaging of neural oscillations during a non-word repetition task with voxel-based morphometry-derived measures of gray matter volume to isolate neural oscillation abnormalities independent of atrophy. We find reduced beta band neural activity in left temporal regions associated with the late stages of auditory encoding unique to patients with lvPPA and reduced high-gamma neural activity over left frontal regions associated with the early stages of motor preparation in patients with nfvPPA. Neither of these patterns of reduced cortical oscillations was explained by cortical atrophy in our statistical model. These findings highlight the importance of structure-function imaging in revealing neurophysiological sequelae in early stages of dementia when neither structural atrophy nor behavioral deficits are clinically distinct.
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Affiliation(s)
- Leighton B. N. Hinkley
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Megan Thompson
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Zachary A. Miller
- Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | | - Danielle Mizuiri
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Wendy Shwe
- Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Abigail Licata
- Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Seigo Ninomiya
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Michael Lauricella
- Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | | - Bruce L. Miller
- Department of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - John Houde
- Department of Otolaryngology – Head and Neck SurgeryUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | | | - Srikantan S. Nagarajan
- Department of Radiology and Biomedical ImagingUniversity of CaliforniaSan FranciscoCaliforniaUSA
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9
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Calandri IL, Crivelli L, Morello Garcia F, Allegri RF. Utility of a Spanish version of Three Words-Three Shapes Test to detect memory impairment in primary progressive aphasia. APPLIED NEUROPSYCHOLOGY. ADULT 2023; 30:20-26. [PMID: 33836135 DOI: 10.1080/23279095.2021.1907391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Three Words-Three Shapes (3W3S) is a bedside test that assesses verbal and non-verbal memory and has proven useful in staging memory decline in amnestic disorders and primary progressive aphasia. Given its simple structure, the 3W3S can be easily adapted to other languages maintaining the original shapes and only modifying the words. We aim to validate a Spanish version of the 3W3S test and establish whether memory loss patterns present in amnesic disorders associated with Alzheimer's etiology and PPA were correctly characterized. METHOD The translation and adaptation of the 3W3S were performed according to standardized guidelines and applied to a cohort of patients with Dementia of Alzheimer's type (DAT = 20), mild cognitive impairment (aMCI= 20), primary progressive aphasia (PPA = 20), and healthy controls (HC = 20). RESULTS In verbal memory performance, PPA patients' score was lower than that of MCI and HC and similar to DAT's in the effortless encoding (p < 0.001), delayed recall (p < 0.001), and recognition (p < 0.012). For non-verbal performance, PPA patients performed better than DAT and similar to HC and MCI subjects (p < 0.001). CONCLUSIONS Results show good applicability of 3W3S to determine memory function in PPA patients, independently from language ability. Visual and verbal components of memory are dissociated in PPA.
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Affiliation(s)
| | - Lucia Crivelli
- Ageing and Memory Clinic, FLENI, Buenos Aires, Argentina
| | - Florentina Morello Garcia
- Instituto de Investigaciones en Psicología, Universidad de Buenos Aires, Buenos Aires, Argentina.,Consejo Nacional de investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
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10
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Liu J, Ota S, Kawakami N, Kanno S, Suzuki K. Dyslexia and dysgraphia of primary progressive aphasia in Chinese: A systematic review. Front Neurol 2022; 13:1025660. [PMID: 36561305 PMCID: PMC9764844 DOI: 10.3389/fneur.2022.1025660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Currently, little is known about Chinese-speaking primary progressive aphasia (PPA) patients compared to patients who speak Indo-European languages. We examined the demographics and clinical manifestations, particularly reading and writing characteristics, of Chinese patients with PPA over the last two decades to establish a comprehensive profile and improve diagnosis and care. Methods We reviewed the demographic features, clinical manifestations, and radiological features of Chinese-speaking PPA patients from 56 articles published since 1994. We then summarized the specific reading and writing errors of Chinese-speaking patients. Results The average age of onset for Chinese-speaking patients was in their early 60's, and there were slightly more male patients than female patients. The core symptoms and images of Chinese-speaking patients were similar to those of patients who speak Indo-European languages. Reading and writing error patterns differed due to Chinese's distinct tone and orthography. The types of reading errors reported in Chinese-speaking patients with PPA included tonal errors, regularization errors, visually related errors, semantic errors, phonological errors, unrelated errors, and non-response. Among these errors, regularization errors were the most common in semantic variant PPA, and tonal errors were specific to Chinese. Writing errors mainly consisted of non-character errors (stroke, radical/component, visual, pictograph, dyskinetic errors, and spatial errors), phonologically plausible errors, orthographically similar errors, semantic errors, compound word errors, sequence errors, unrelated errors, and non-response. Conclusion This paper provides the latest comprehensive demographic information and unique presentations on the reading and writing of Chinese-speaking patients with PPA. More detailed studies are needed to address the frequency of errors in reading and writing and their anatomical substrates.
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Coemans S, Keulen S, Savieri P, Tsapkini K, Engelborghs S, Chrispeels N, Vandenborre D, Paquier P, Wilssens I, Declerck M, Struys E. Executive functions in primary progressive aphasia: A meta-analysis. Cortex 2022; 157:304-322. [PMID: 36395634 PMCID: PMC11161026 DOI: 10.1016/j.cortex.2022.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/06/2022] [Accepted: 10/04/2022] [Indexed: 12/15/2022]
Abstract
Executive functions (EFs) refer to a set of cognitive processes, specifically shifting, inhibition, updating of working memory, and are involved in the cognitive control of behavior. Conflicting results have been reported regarding impairments of EFs in Primary Progressive Aphasia (PPA). We performed a multi-level meta-analysis to confirm whether deficits of EFs exist in this population, focusing on a common EFs composite, and the components shifting, inhibition and updating separately. We included 141 studies that report on 294 EFs tasks. The overall mean weighted effect size was large (d = -1,28), indicating poorer EFs in PPA as compared to age-matched cognitively healthy controls. Differences between effect sizes of the EFs components were not significant, indicating all components are affected similarly. Overall, moderator analysis revealed that PPA variant and disease duration were significant moderators of performance, while task modality and years of education were not. The non-fluent/agrammatic PPA and the logopenic PPA variants were similarly affected, but the semantic variant was affected to a lesser extent. We discuss implications for clinical and research settings, and future research.
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Affiliation(s)
- Silke Coemans
- Brussels Centre for Language Studies (BCLS), Vrije Universiteit Brussel (VUB), Brussels, Belgium.
| | - Stefanie Keulen
- Brussels Centre for Language Studies (BCLS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Perseverence Savieri
- Interfaculty Center for Data Processing and Statistics (ICDS), Vrije Universiteit Brussel (VUB), Brussels, Belgium; Biostatistics and Medical Informatics (BISI) Research Group, Department of Public Health, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
| | - Sebastiaan Engelborghs
- Neuroprotection & Neuromodulation, Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium; Department of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium; Department of Biomedical Sciences, Universiteit Antwerpen (UA), Antwerp, Belgium
| | - Nini Chrispeels
- Brussels Centre for Language Studies (BCLS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Dorien Vandenborre
- Department of Speech and Language Pathology, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Philippe Paquier
- Brussels Centre for Language Studies (BCLS), Vrije Universiteit Brussel (VUB), Brussels, Belgium; Center for Research in Cognition and Neurosciences (CRCN), Université Libre de Bruxelles (ULB), Brussels, Belgium; Department of Translational Neurosciences (TNW), Universiteit Antwerpen (UA), Antwerp, Belgium
| | - Ineke Wilssens
- Department of Speech and Language Pathology, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Mathieu Declerck
- Brussels Centre for Language Studies (BCLS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Esli Struys
- Brussels Centre for Language Studies (BCLS), Vrije Universiteit Brussel (VUB), Brussels, Belgium; Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium
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12
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Characterization of the logopenic variant of Primary Progressive Aphasia: A systematic review and meta-analysis. Ageing Res Rev 2022; 82:101760. [PMID: 36244629 DOI: 10.1016/j.arr.2022.101760] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 10/11/2022] [Indexed: 01/31/2023]
Abstract
The linguistic and anatomical variability of the logopenic variant of Primary Progressive Aphasia (lv-PPA) as defined by current diagnostic criteria has been the topic of an intense debate. The present review and meta-analysis aims at characterizing the profile of lv-PPA, by a comprehensive analysis of the available literature on the neuropsychological, neuroimaging, electrophysiological, pathological, and genetic features of lv-PPA. We conducted a systematic bibliographic search, leading to the inclusion of 207 papers. Of them, 12 were used for the Anatomical Likelihood Estimation meta-analysis on grey matter revealed by magnetic resonance imaging data. The results suggest that the current guidelines outline a relatively consistent syndrome, characterized by a core set of linguistic and, to a lesser extent, non-linguistic deficits, mirroring the involvement of left temporal and parietal regions typically affected by Alzheimer Disease pathology. Variations of the lv-PPA profile are discussed in terms of heterogeneity of the neuropsychological instruments and the diagnostic criteria adopted.
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13
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Comprehensive qualitative characterization of linguistic performance profiles in primary progressive aphasia: a multivariate study with FDG-PET. Neurobiol Aging 2022; 120:137-148. [DOI: 10.1016/j.neurobiolaging.2022.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 08/17/2022] [Accepted: 09/02/2022] [Indexed: 12/22/2022]
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Irish M. Autobiographical memory in dementia syndromes—An integrative review. WIRES COGNITIVE SCIENCE 2022; 14:e1630. [DOI: 10.1002/wcs.1630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Muireann Irish
- School of Psychology and Brain & Mind Centre The University of Sydney Sydney Australia
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15
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Kaczmarek B, Ilkowska Z, Kropinska S, Tobis S, Krzyminska-Siemaszko R, Kaluzniak-Szymanowska A, Wieczorowska-Tobis K. Applying ACE-III, M-ACE and MMSE to Diagnostic Screening Assessment of Cognitive Functions within the Polish Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912257. [PMID: 36231581 PMCID: PMC9566735 DOI: 10.3390/ijerph191912257] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/09/2022] [Accepted: 09/17/2022] [Indexed: 05/04/2023]
Abstract
The research aims to compare the accuracy of the mini-mental state examination (MMSE), the Addenbrooke's cognitive examination III (ACE-III) and the mini-Addenbrooke's cognitive examination (M-ACE) within the Polish population. The model comprised several stages: the features of each test were compared; the shifts in result categorisations between the norm and below the norm were analysed; a third category-mild cognitive impairment (MCI)-was included. Additionally, particular ACE-III domains that scored below domain-specific norm thresholds were analysed to establish the potential early predictors of dementia. All tests correlated to a high and very high degree-cf. MMSE and ACE-III (r = 0.817; p < 0.001), MMSE and M-ACE (r = 0.753; p < 0.001), ACE-III and M-ACE (r = 0.942; p < 0.001). The area under the ROC curve for the ACE-III diagnostic variable had a high value (AUC = 0.920 ± 0.014). A cut-off point of 81 points was suggested for ACE-III; the M-ACE diagnostic variable had an equally high value (AUC = 0.891 ± 0.017). A cut-off point of 20 points was suggested. A significant decrease in the mean score values for people who scored norm or below the norm under ACE-III, as compared to the MMSE results for norm (p < 0.0001), occurred for speech fluency (which decreased by 26.4%). The tests in question are characterised by high sensitivity and specificity. Targeted ACE-III seems best recommended for use in specialised diagnostic centres, whereas M-ACE appears to be a better suited diagnostic alternative for primary health care centres in comparison to MMSE.
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Affiliation(s)
- Beata Kaczmarek
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245 Poznan, Poland
- Correspondence:
| | - Zofia Ilkowska
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245 Poznan, Poland
| | - Sylwia Kropinska
- Department of Palliative Medicine, Poznan University of Medical Sciences, 61-245 Poznan, Poland
| | - Sławomir Tobis
- Department of Occupational Therapy, Poznan University of Medical Sciences, 60-781 Poznan, Poland
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16
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Foxe D, Hu A, Cheung SC, Ahmed RM, Cordato NJ, Devenney E, Hwang YT, Halliday GM, Mueller N, Leyton CE, Hodges JR, Burrell JR, Irish M, Piguet O. Utility of the Addenbrooke’s Cognitive Examination III online calculator to differentiate the primary progressive aphasia variants. Brain Commun 2022; 4:fcac161. [PMID: 35912134 PMCID: PMC9336588 DOI: 10.1093/braincomms/fcac161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/11/2022] [Accepted: 06/16/2022] [Indexed: 12/22/2022] Open
Abstract
The Addenbrooke’s Cognitive Examination III is a brief cognitive screening tool that is widely used for the detection and monitoring of dementia. Recent findings suggest that the three variants of primary progressive aphasia can be distinguished based on their distinct profiles on the five subdomain scores of this test. Here, we investigated the utility of the Addenbrooke’s Cognitive Examination III to differentiate the primary progressive aphasia variants based on their item-by-item performance profiles on this test. From these results, we created an interactive primary progressive aphasia Addenbrooke’s Cognitive Examination III calculator which predicts the variant based on a patient’s unique item-by-item profile. Twenty-eight logopenic variant, 25 non-fluent variant and 37 semantic variant primary progressive aphasia patients and 104 healthy controls completed the Addenbrooke’s Cognitive Examination III at first clinical presentation. Multinomial regression analyses were conducted to establish performance profiles among groups, and R Shiny from RStudio was used to create the interactive Addenbrooke’s Cognitive Examination III diagnostic calculator. To verify its accuracy, probability values of the regression model were derived based on a 5-fold cross-validation of cases. The calculator’s accuracy was then verified in an independent sample of 17 logopenic, 19 non-fluent and 13 semantic variant primary progressive aphasia patients and 68 Alzheimer’s disease patients who had completed the Addenbrooke’s Cognitive Examination III (or an older version of this test: Revised) and had in vivo amyloid-PET imaging and/or brain autopsy pathological confirmation. Cross-validation of cases in the calculator model revealed different rates of sensitivity in classifying variants: semantic = 100%, non-fluent = 80.6% and logopenic = 79.9%; healthy controls were distinguished from primary progressive aphasia patients with 100% sensitivity. Verification of in vivo amyloid and/or autopsy-confirmed patients showed that the calculator correctly classified 10/13 (77%) semantic variant, 3/19 (16%) non-fluent variant and 4/17 (24%) logopenic variant patients. Importantly, for patients who were not classified, diagnostic probability values mostly pointed toward the correct clinical diagnosis. Furthermore, misclassified diagnoses of the primary progressive aphasia cohort were rare (1/49; 2%). Although 22 of the 68 Alzheimer’s disease patients (32%) were misclassified with primary progressive aphasia, 19/22 were misclassified with the logopenic variant (i.e. falling within the same neuropathological entity). The Addenbrooke’s Cognitive Examination III primary progressive aphasia diagnostic calculator demonstrates sound accuracy in differentiating the variants based on an item-by-item Addenbrooke’s Cognitive Examination III profile. This calculator represents a new frontier in using data-driven approaches to differentiate the primary progressive aphasia variants.
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Affiliation(s)
- D Foxe
- School of Psychology, The University of Sydney , 94 Mallett St, Sydney, NSW 2006 , Australia
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
| | - A Hu
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
- School of Mathematics and Statistics, The University of Sydney , Sydney, NSW 2006 , Australia
| | - S C Cheung
- School of Psychology, The University of Sydney , 94 Mallett St, Sydney, NSW 2006 , Australia
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
| | - R M Ahmed
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
- Central Clinical School, The University of Sydney , Sydney, NSW 2006 , Australia
| | - N J Cordato
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
- St George Clinical School, University of New South Wales , Sydney, NSW 2217 , Australia
- The Department of Aged Care, St George Hospital , Sydney, NSW 2217 , Australia
- Calvary Health Care Kogarah, Calvary Community Health , Sydney, NSW 2217 , Australia
| | - E Devenney
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
- Central Clinical School, The University of Sydney , Sydney, NSW 2006 , Australia
| | - Y T Hwang
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
- Central Clinical School, The University of Sydney , Sydney, NSW 2006 , Australia
| | - G M Halliday
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
- Central Clinical School, The University of Sydney , Sydney, NSW 2006 , Australia
| | - N Mueller
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
- Central Clinical School, The University of Sydney , Sydney, NSW 2006 , Australia
| | - C E Leyton
- School of Psychology, The University of Sydney , 94 Mallett St, Sydney, NSW 2006 , Australia
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
| | - J R Hodges
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
| | - J R Burrell
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
- Concord Clinical School, Sydney Medical School, The University of Sydney , Sydney, NSW 2139 , Australia
| | - M Irish
- School of Psychology, The University of Sydney , 94 Mallett St, Sydney, NSW 2006 , Australia
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
| | - O Piguet
- School of Psychology, The University of Sydney , 94 Mallett St, Sydney, NSW 2006 , Australia
- Brain and Mind Centre, The University of Sydney , Sydney, NSW 2050 , Australia
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17
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Kobayashi R, Hayashi H, Kawakatsu S, Shibuya Y, Morioka D, Ohba M, Yoshioka M, Sakamoto K, Kanoto M, Otani K. Comparing Medial Temporal Atrophy Between Early-Onset Semantic Dementia and Early-Onset Alzheimer's Disease Using Voxel-Based Morphometry: A Multicenter MRI Study. Curr Alzheimer Res 2022; 19:503-510. [PMID: 35996258 DOI: 10.2174/1567205019666220820145429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Early-onset Semantic dementia (EOSD) and early-onset Alzheimer's disease (EOAD) are often difficult to clinically differentiate in the early stages of the diseases because of the overlaps of clinical symptoms such as language symptoms. We compared the degree of atrophy in medial temporal structures between the two types of dementia using the voxel-based specific regional analysis system for Alzheimer's disease (VSRAD). METHODS The participants included 29 (age: 61.7±4.5 years) and 39 (age: 60.2±4.9 years) patients with EOSD and EOAD, respectively. The degree of atrophy in medial temporal structures was quantified using the VSRAD for magnetic resonance imaging data. Receiver operating characteristic (ROC) analysis was performed to distinguish patients with EOSD and EOAD using the mean Z score (Z-score) in bilateral medial temporal structures and the absolute value (laterality score) of the laterality of Z-score (| right-left |) for indicating the degree of asymmetrical atrophy in medial temporal structures. RESULTS The EOSD group had significantly higher Z and laterality scores than the EOAD group (Zscores: mean ± standard deviation: 3.74±1.05 vs. 1.56±0.81, respectively; P<0.001; laterality score: mean ± standard deviation: 2.35±1.23 vs. 0.68±0.51, respectively; P<0.001). In ROC analysis, the sensitivity and specificity to differentiate EOSD from EOAD by a Z-score of 2.29 were 97% and 85%, respectively and by the laterality score of 1.05 were 93% and 85%, respectively. CONCLUSION EOSD leads to more severe and asymmetrical atrophy in medial temporal structures than EOAD. The VSRAD may be useful to distinguish between these dementias that have several clinically similar symptoms.
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Affiliation(s)
- Ryota Kobayashi
- Department of Psychiatry, Yamagata University School of Medicine, Iidanishi 2-2-2, Yamagata 990-9585, Japan
| | - Hiroshi Hayashi
- Department of Occupational Therapy, Fukushima Medical University School of Health Sciences, Sakaemachi 10-6, Fukushima 960-8516, Japan
| | - Shinobu Kawakatsu
- Department of Neuropsychiatry, Aizu Medical Center, Fukushima Medical University, Kawahigashi 21-2, Aizuwakamatsu 969-3492, Japan
| | - Yuzuru Shibuya
- Department of Psychiatry, Nihonkai General Hospital, Akihocho 30, Sakata 998-8501, Japan
| | - Daichi Morioka
- Department of Psychiatry, Yamagata University School of Medicine, Iidanishi 2-2-2, Yamagata 990-9585, Japan
| | - Makoto Ohba
- Department of Radiology, Yamagata University Hospital, Iidanishi 2-2-2, Yamagata 990- 9585, Japan
| | - Masanori Yoshioka
- Department of Radiology, Yamagata University Hospital, Iidanishi 2-2-2, Yamagata 990- 9585, Japan
| | - Kazutaka Sakamoto
- Department of Psychiatry, Yamagata University School of Medicine, Iidanishi 2-2-2, Yamagata 990-9585, Japan.,Department of Neuropsychiatry, Aizu Medical Center, Fukushima Medical University, Kawahigashi 21-2, Aizuwakamatsu 969-3492, Japan
| | - Masafumi Kanoto
- Department of Radiology, Division of Diagnostic Radiology, Yamagata University School of Medicine, Iidanishi 2-2-2, Yamagata 990-9585, Japan
| | - Koichi Otani
- Department of Psychiatry, Yamagata University School of Medicine, Iidanishi 2-2-2, Yamagata 990-9585, Japan
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Neuropsychological Profiles of Patients with Progressive Apraxia of Speech and Aphasia. J Int Neuropsychol Soc 2022; 28:441-451. [PMID: 34289926 PMCID: PMC8986341 DOI: 10.1017/s1355617721000692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To characterize and compare the neuropsychological profiles of patients with primary progressive apraxia of speech (PPAOS) and apraxia of speech with progressive agrammatic aphasia (AOS-PAA). METHOD Thirty-nine patients with PPAOS and 49 patients with AOS-PAA underwent formal neurological, speech, language, and neuropsychological evaluations. Cognitive domains assessed included immediate and delayed episodic memory (Wechsler Memory Scale-Third edition; Logical Memory; Visual Reproduction; Rey Auditory Verbal Learning Test), processing speed (Trail Making Test A), executive functioning (Trail Making Test B; Delis-Kaplan Executive Functioning Scale - Sorting), and visuospatial ability (Rey-Osterrieth Complex Figure copy). RESULTS The PPAOS patients were cognitively average or higher in the domains of immediate and delayed episodic memory, processing speed, executive functioning, and visuospatial ability. Patients with AOS-PAA performed more poorly on tests of immediate and delayed episodic memory and executive functioning compared to those with PPAOS. For every 1 unit increase in aphasia severity (e.g. mild to moderate), performance declined by 1/3 to 1/2 a standard deviation depending on cognitive domain. The degree of decline was stronger within the more verbally mediated domains, but was also notable in less verbally mediated domains. CONCLUSION The study provides neuropsychological evidence further supporting the distinction of PPAOS from primary progressive aphasia and should be used to inform future diagnostic criteria. More immediately, it informs prognostication and treatment planning.
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Tee BL, Watson Pereira C, Lukic S, Bajorek LP, Allen IE, Miller ZA, Casaletto KB, Miller BL, Gorno-Tempini ML. Neuroanatomical correlations of visuospatial processing in primary progressive aphasia. Brain Commun 2022; 4:fcac060. [PMID: 35386217 PMCID: PMC8977647 DOI: 10.1093/braincomms/fcac060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 12/10/2021] [Accepted: 03/10/2022] [Indexed: 11/14/2022] Open
Abstract
Clinical phenotyping of primary progressive aphasia has largely focused on speech and language presentations, leaving other cognitive domains under-examined. This study investigated the diagnostic utility of visuospatial profiles and examined their neural basis among the three main primary progressive aphasia variants. We studied the neuropsychological performances of 118 primary progressive aphasia participants and 30 cognitively normal controls, across 11 measures of visuospatial cognition, and investigated their neural correlates via voxel-based morphometry analysis using visuospatial composite scores derived from principal component analysis. The principal component analysis identified three main factors: visuospatial-executive, visuospatial-memory and visuomotor components. Logopenic variant primary progressive aphasia performed significantly worst across all components; nonfluent/agrammatic variant primary progressive aphasia showed deficits in the visuospatial-executive and visuomotor components compared with controls; and the semantic variant primary progressive aphasia scored significantly lower than nonfluent/agrammatic variant primary progressive aphasia and control in the visuospatial-memory component. Grey matter volumes over the right parieto-occipital cortices correlated with visuospatial-executive performance; volumetric changes in the right anterior parahippocampal gyrus and amygdala were associated with visuospatial-memory function, and visuomotor composite scores correlated significantly with the grey matter volume at the right precentral gyrus. Discriminant function analysis identified three visuospatial measures: Visual Object and Space Perception and Benson figure copy and recall test, which classified 79.7% (94/118) of primary progressive aphasia into their specific variant. This study shows that each primary progressive aphasia variant also carries a distinctive visuospatial cognitive profile that corresponds with grey matter volumetric changes and in turn can be largely represented by their performance on the visuomotor, visuospatial-memory and executive functions.
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Affiliation(s)
- Boon Lead Tee
- Memory and Aging Center, University of California at San Francisco, San Francisco, CA, USA
- Department of Neurology, Dyslexia Center, University of California, San Francisco, CA, USA
- Global Brain Health Institute, University of California, San Francisco, CA, USA
- Department of Neurology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
- Tzu Chi University, No. 701號, Section 3, Zhongyang Rd, Hualien City, Hualien County, Taiwan 970
| | - Christa Watson Pereira
- Memory and Aging Center, University of California at San Francisco, San Francisco, CA, USA
- Department of Neurology, Dyslexia Center, University of California, San Francisco, CA, USA
| | - Sladjana Lukic
- Memory and Aging Center, University of California at San Francisco, San Francisco, CA, USA
- Department of Neurology, Dyslexia Center, University of California, San Francisco, CA, USA
| | - Lynn P. Bajorek
- Memory and Aging Center, University of California at San Francisco, San Francisco, CA, USA
- Department of Neurology, Dyslexia Center, University of California, San Francisco, CA, USA
| | - Isabel Elaine Allen
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Zachary A. Miller
- Memory and Aging Center, University of California at San Francisco, San Francisco, CA, USA
- Department of Neurology, Dyslexia Center, University of California, San Francisco, CA, USA
| | - Kaitlin B. Casaletto
- Memory and Aging Center, University of California at San Francisco, San Francisco, CA, USA
| | - Bruce L. Miller
- Memory and Aging Center, University of California at San Francisco, San Francisco, CA, USA
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, University of California at San Francisco, San Francisco, CA, USA
- Department of Neurology, Dyslexia Center, University of California, San Francisco, CA, USA
- Global Brain Health Institute, University of California, San Francisco, CA, USA
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Verbal and Nonverbal Memory in Neurodegenerative and Stroke Aphasia: Evidence From the Turkish Version of the Three Words Three Shapes Test. Cogn Behav Neurol 2022; 35:49-65. [PMID: 35239599 DOI: 10.1097/wnn.0000000000000294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/05/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although language impairment is the most salient feature of cognitive impairment in both primary progressive aphasia (PPA) and stroke aphasia (SA), memory can also be impaired in both patient populations. OBJECTIVE To identify distinctive features of verbal and nonverbal memory processing in individuals with PPA and those with SA. METHOD We gave individuals with PPA (n = 14), those with SA (n = 8), and healthy controls (HC; n = 13) a comprehensive neuropsychological test battery and the Turkish version of the Three Words Three Shapes Test (3W3S-Turkish). The 3W3S-Turkish Test includes five subtests: Copy, Incidental Recall, Acquisition, Delayed Recall, and Recognition. High-resolution brain scans were performed in a subset of individuals with PPA and those with SA. Lesion distribution was limited to the dorsal language areas in the SA group, whereas peak atrophy areas in the PPA group extended beyond the language network, including the medial temporal lobe, precuneus, and posterior/medial portions of the cingulate cortex. RESULTS Both the PPA and SA groups showed impairment in incidental recall, and the PPA group showed additional impairment in delayed recall. Greater impairment for verbal stimuli suggestive of material-specific memory impairment was evident in the PPA group's scores on the Incidental Recall and Delayed Recall subtests. Both aphasia groups retained the acquired information regardless of material type. CONCLUSION Although both aphasia groups shared similarities in the involvement of the dorsal prefrontal working memory/attention network, the PPA group showed greater impairment in delayed recall compared with the SA group.
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Afthinos A, Themistocleous C, Herrmann O, Fan H, Lu H, Tsapkini K. The Contribution of Working Memory Areas to Verbal Learning and Recall in Primary Progressive Aphasia. Front Neurol 2022; 13:698200. [PMID: 35250797 PMCID: PMC8892377 DOI: 10.3389/fneur.2022.698200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 01/04/2022] [Indexed: 11/13/2022] Open
Abstract
Recent evidence of domain-specific working memory (WM) systems has identified the areas and networks which are involved in phonological, orthographic, and semantic WM, as well as in higher level domain-general WM functions. The contribution of these areas throughout the process of verbal learning and recall is still unclear. In the present study, we asked, what is the contribution of domain-specific specialized WM systems in the course of verbal learning and recall? To answer this question, we regressed the perfusion data from pseudo-continuous arterial spin labeling (pCASL) MRI with all the immediate, consecutive, and delayed recall stages of the Rey Auditory Verbal Learning Test (RAVLT) from a group of patients with Primary Progressive Aphasia (PPA), a neurodegenerative syndrome in which language is the primary deficit. We found that the early stages of verbal learning involve the areas with subserving phonological processing (left superior temporal gyrus), as well as semantic WM memory (left angular gyrus, AG_L). As learning unfolds, areas with subserving semantic WM (AG_L), as well as lexical/semantic (inferior temporal and fusiform gyri, temporal pole), and episodic memory (hippocampal complex) become more involved. Finally, a delayed recall depends entirely on semantic and episodic memory areas (hippocampal complex, temporal pole, and gyri). Our results suggest that AG_L subserving domain-specific (semantic) WM is involved only during verbal learning, but a delayed recall depends only on medial and cortical temporal areas.
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Affiliation(s)
- Alexandros Afthinos
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | | | - Olivia Herrmann
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Hongli Fan
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, MD, United States
| | - Hanzhang Lu
- The Russell H. Morgan Department of Radiology & Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD, United States
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
- *Correspondence: Kyrana Tsapkini
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22
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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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23
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Janssen N, Roelofs A, van den Berg E, Eikelboom WS, Holleman MA, In de Braek DMJM, Piguet O, Piai V, Kessels RPC. The Diagnostic Value of Language Screening in Primary Progressive Aphasia: Validation and Application of the Sydney Language Battery. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:200-214. [PMID: 34875177 DOI: 10.1044/2021_jslhr-21-00024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE The three variants of primary progressive aphasia (PPA) differ in clinical presentation, underlying brain pathology, and clinical course, which stresses the need for early differentiation. However, brief cognitive tests that validly distinguish between all PPA variants are lacking. The Sydney Language Battery (SYDBAT) is a promising screening instrument that can be used as a first step in a comprehensive neuropsychological assessment to distinguish PPA subtypes, but evidence on its validity and reliability is to date limited. In the current study, the validation and diagnostic value of the SYDBAT are described for discriminating PPA subtypes as well as distinguishing PPA from mild cognitive impairment (MCI) or Alzheimer's dementia (AD). METHOD Forty-five patients with PPA (13 with semantic PPA, 20 with logopenic PPA, and 12 with nonfluent/agrammatic PPA), 25 MCI patients, 13 AD patients, and 50 cognitively unimpaired controls were included in this study. Both patients and controls completed the SYDBAT-NL (Dutch version). Performance on and predictive ability of the four subtests (i.e., Naming, Word Comprehension, Repetition, and Semantic Association) were assessed. In addition, construct validity and internal consistency were examined. RESULTS Different SYDBAT performance patterns were found across PPA and non-PPA patient groups. While a discriminant function analysis based on SYDBAT subtest scores could predict PPA subtype with 78% accuracy, it was more difficult to disentangle PPA from non-PPA patients based on SYDBAT scores alone. For assisting in clinical interpretation, simple rules were set up and translated into a diagnostic decision tree for subtyping PPA, which was capable of diagnosing a large proportion of the cases. Satisfying validity and reliability measures were found. CONCLUSIONS The SYDBAT is an easy-to-use and promising screen for assessing single-word language processes, which may contribute to the differential diagnostic process of PPA and the assessment of language impairment in MCI and AD. It can be easily implemented for initial screening of patients in a memory clinic.
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Affiliation(s)
- Nikki Janssen
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ardi Roelofs
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - Esther van den Berg
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Willem S Eikelboom
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Meike A Holleman
- Department of Medical Psychology, Jeroen Bosch Hospital, Den Bosch, the Netherlands
| | | | - Olivier Piguet
- School of Psychology, The University of Sydney, New South Wales, Australia
- Brain and Mind Centre, The University of Sydney, New South Wales, Australia
| | - Vitória Piai
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Roy P C Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
- Vincent van Gogh Institute for Psychiatry, Venray, the Netherlands
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Tippett DC, Keser Z. Clinical and neuroimaging characteristics of primary progressive aphasia. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:81-97. [PMID: 35078612 PMCID: PMC9951770 DOI: 10.1016/b978-0-12-823384-9.00016-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The chapter covers the clinical syndrome of a primary progressive aphasia (PPA), the demographics of this rare neurodegenerative disease, defining clinical and neuroanatomic characteristics of each PPA variant, disease progression, and behavioral features. The chapter begins with a brief introduction that includes references to seminal papers that defined this clinical syndrome and its three variants. The classic PPA subtypes discussed in the chapter are semantic variant PPA (svPPA), nonfluent/agrammatic PPA (nfaPPA), and logopenic variant PPA (lvPPA). The key language and cognitive characteristics, and language tasks that can elicit these language impairments, are detailed. Overlap in the clinical profiles of the PPA variants, which make differential diagnosis challenging, are explained. Disease progression is described, revealing that the PPA variants become more similar over time. Although PPA is language-predominant dementia, there are behavioral manifestations, particularly in svPPA. Changes in behavior in this variant are addressed as well as behavioral changes in nfaPPA and lvPPA that are less well recognized. The patterns of atrophy in the left temporal, parietal, and/or frontal cortices unique to each PPA variant are described. The underlying neuropathologies of the PPA variants are discussed, specifically tauopathies and non-tauopathies associated with svPPA and nfaPPA and Alzheimer's disease pathology in lvPPA.
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Affiliation(s)
- Donna C. Tippett
- Departments of Neurology, Otolaryngology—Head and Neck Surgery, and Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Zafer Keser
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
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25
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Geraudie A, Battista P, García AM, Allen IE, Miller ZA, Gorno-Tempini ML, Montembeault M. Speech and language impairments in behavioral variant frontotemporal dementia: A systematic review. Neurosci Biobehav Rev 2021; 131:1076-1095. [PMID: 34673112 DOI: 10.1016/j.neubiorev.2021.10.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 10/12/2021] [Accepted: 10/14/2021] [Indexed: 01/11/2023]
Abstract
Although behavioral variant frontotemporal dementia (bvFTD) is classically defined by behavioral and socio-emotional changes, impairments often extend to other cognitive functions. These include early speech and language deficits related to the disease's core neural disruptions. Yet, their scope and clinical relevance remains poorly understood. This systematic review characterizes such disturbances in bvFTD, considering clinically, neuroanatomically, genetically, and neuropathologically defined subgroups. We included 181 experimental studies, with at least 5 bvFTD patients diagnosed using accepted criteria, comparing speech and language outcomes between bvFTD patients and healthy controls or between bvFTD subgroups. Results reveal extensive and heterogeneous deficits across cohorts, with (a) consistent lexico-semantic, reading & writing, and prosodic impairments; (b) inconsistent deficits in motor speech and grammar; and (c) relative preservation of phonological skills. Also, preliminary findings suggest that the severity of speech and language deficits might be associated with global cognitive impairment, predominantly temporal or fronto-temporal atrophy and MAPT mutations (vs C9orf72). Although under-recognized, these impairments contribute to patient characterization and phenotyping, while potentially informing diagnosis and management.
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Affiliation(s)
- Amandine Geraudie
- Memory and Aging Center, Department of Neurology, University of California San Francisco, CA, USA; Neurology Department, Toulouse University Hospital, Toulouse, France
| | - Petronilla Battista
- Memory and Aging Center, Department of Neurology, University of California San Francisco, CA, USA; Global Brain Health Institute, University of California, San Francisco, USA; Istituti Clinici Scientifici Maugeri IRCCS, Institute of Bari, Via Generale Nicola Bellomo, Bari, Italy
| | - Adolfo M García
- Global Brain Health Institute, University of California, San Francisco, USA; Universidad De San Andrés, Buenos Aires, Argentina; National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, Chile
| | - Isabel E Allen
- Global Brain Health Institute, University of California, San Francisco, USA; Department of Epidemiology & Biostatistics, University of California San Francisco, CA, USA
| | - Zachary A Miller
- Memory and Aging Center, Department of Neurology, University of California San Francisco, CA, USA
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, Department of Neurology, University of California San Francisco, CA, USA; Global Brain Health Institute, University of California, San Francisco, USA
| | - Maxime Montembeault
- Memory and Aging Center, Department of Neurology, University of California San Francisco, CA, USA.
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26
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Ramanan S, Foxe D, El-Omar H, Ahmed RM, Hodges JR, Piguet O, Irish M. Evidence for a pervasive autobiographical memory impairment in Logopenic Progressive Aphasia. Neurobiol Aging 2021; 108:168-178. [PMID: 34653892 DOI: 10.1016/j.neurobiolaging.2021.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 11/17/2022]
Abstract
Although characterized primarily as a language disorder, mounting evidence indicates episodic amnesia in Logopenic Progressive Aphasia (LPA). Whether such memory disturbances extend to information encoded pre-disease onset remains unclear. To address this question, we examined autobiographical memory in 10 LPA patients, contrasted with 18 typical amnestic Alzheimer's disease and 16 healthy Control participants. A validated assessment, the Autobiographical Interview, was employed to explore autobiographical memory performance across the lifespan under free and probed recall conditions. Relative to Controls, LPA patients showed global impairments across all time periods for free recall, scoring at the same level as disease-matched cases of Alzheimer's disease. Importantly, these retrieval deficits persisted in LPA, even when structured probing was provided, and could not be explained by overall level of language disruption or amount of information generated during autobiographical narration. Autobiographical memory impairments in LPA related to gray matter intensity decrease in predominantly posterior parietal brain regions implicated in memory retrieval. Together, our results suggest that episodic memory disturbances may be an under-appreciated clinical feature of LPA.
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Affiliation(s)
- Siddharth Ramanan
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, School of Psychology, Sydney, New South Wales, Australia; ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia; Medical Research Council Cognition and Brain Sciences Unit at The University of Cambridge, Cambridge, UK.
| | - David Foxe
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, School of Psychology, Sydney, New South Wales, Australia; ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - Hashim El-Omar
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia
| | - Rebekah M Ahmed
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; Memory and Cognition Clinic, Department of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - John R Hodges
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia; The University of Sydney, School of Medical Sciences, Sydney, New South Wales, Australia
| | - Olivier Piguet
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, School of Psychology, Sydney, New South Wales, Australia; ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia
| | - Muireann Irish
- The University of Sydney, Brain and Mind Centre, Sydney, New South Wales, Australia; The University of Sydney, School of Psychology, Sydney, New South Wales, Australia; ARC Centre of Excellence in Cognition and its Disorders, Sydney, New South Wales, Australia.
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de la Sablonnière J, Tastevin M, Lavoie M, Laforce R. Longitudinal Changes in Cognition, Behaviours, and Functional Abilities in the Three Main Variants of Primary Progressive Aphasia: A Literature Review. Brain Sci 2021; 11:1209. [PMID: 34573229 PMCID: PMC8466869 DOI: 10.3390/brainsci11091209] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/04/2021] [Accepted: 09/09/2021] [Indexed: 11/22/2022] Open
Abstract
Primary progressive aphasias (PPAs) are a group of neurodegenerative diseases presenting with insidious and relentless language impairment. Three main PPA variants have been described: the non-fluent/agrammatic variant (nfvPPA), the semantic variant (svPPA), and the logopenic variant (lvPPA). At the time of diagnosis, patients and their families' main question pertains to prognosis and evolution, but very few data exist to support clinicians' claims. The objective of this study was to review the current literature on the longitudinal changes in cognition, behaviours, and functional abilities in the three main PPA variants. A comprehensive review was undertaken via a search on PUBMED and EMBASE. Two authors independently reviewed a total of 65 full-text records for eligibility. A total of 14 group studies and one meta-analysis were included. Among these, eight studies included all three PPA variants. Eight studies were prospective, and the follow-up duration was between one and five years. Overall, svPPA patients showed more behavioural disturbances both at baseline and over the course of the disease. Patients with lvPPA showed a worse cognitive decline, especially in episodic memory, and faster progression to dementia. Finally, patients with nfvPPA showed the most significant losses in language production and functional abilities. Data regarding the prodromal and last stages of PPA are still missing and studies with a longer follow-up observation period are needed.
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Affiliation(s)
| | | | | | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire, Département des Sciences Neurologiques du CHU de Québec, Faculté de Médecine, Université Laval, Quebec City, QC G1J 1Z4, Canada; (J.d.l.S.); (M.T.); (M.L.)
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28
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Verbal Short-Term Memory Disturbance in the Primary Progressive Aphasias: Challenges and Distinctions in a Clinical Setting. Brain Sci 2021; 11:brainsci11081060. [PMID: 34439679 PMCID: PMC8391512 DOI: 10.3390/brainsci11081060] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/05/2021] [Accepted: 08/09/2021] [Indexed: 01/22/2023] Open
Abstract
Impaired verbal ‘phonological’ short-term memory is considered a cardinal feature of the logopenic variant of primary progressive aphasia (lv-PPA) and is assumed to underpin most of the language deficits in this syndrome. Clinically, examination of verbal short-term memory in individuals presenting with PPA is common practice and serves two objectives: (i) to help understand the possible mechanisms underlying the patient’s language profile and (ii) to help differentiate lv-PPA from other PPA variants or from other dementia syndromes. Distinction between lv-PPA and the non-fluent variant of PPA (nfv-PPA), however, can be especially challenging due to overlapping language profiles and comparable psychometric performances on verbal short-term memory tests. Here, we present case vignettes of the three PPA variants (lv-PPA, nfv-PPA, and the semantic variant (sv-PPA)) and typical Alzheimer’s disease (AD). These vignettes provide a detailed description of the short-term and working memory profiles typically found in these patients and highlight how speech output and language comprehension deficits across the PPA variants differentially interfere with verbal memory performance. We demonstrate that a combination of verbal short-term and working memory measures provides crucial information regarding the cognitive mechanisms underlying language disturbances in PPA. In addition, we propose that analogous visuospatial span tasks are essential for the assessment of PPA as they measure memory capacity without language contamination.
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29
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Foxe D, Irish M, D'Mello M, Barhon L, Burrell JR, Kessels RPC, Piguet O. The Box Task: A novel tool to differentiate the primary progressive aphasias. Eur J Neurol 2021; 28:3945-3954. [PMID: 34310820 DOI: 10.1111/ene.15035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/20/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Differentiating the primary progressive aphasia (PPA) variants in clinical settings remains complex and challenging, especially for the logopenic (lv-PPA) and non-fluent variants (nfv-PPA). Recent studies suggest that visuospatial memory is more compromised in lv-PPA than in nfv-PPA and is relatively spared in the semantic variant (sv-PPA). Accordingly, assessment of visuospatial memory performance may assist in the differential diagnosis of PPA variants. Here, we investigated the utility of a novel computerised visuospatial working memory test-the Box Task-to differentiate the three PPA variants and typical Alzheimer's disease (AD). METHODS Eighteen lv-PPA, 14 nfv-PPA, 23 sv-PPA, 33 AD patients, and 32 healthy controls matched for age and education were recruited. All participants completed the computerised Box Task and WMS-III Spatial Span as measures of visuospatial working memory. RESULTS The lv-PPA group made significantly more Box Task between-search errors than nfv-PPA, sv-PPA and control groups. The AD group, however, displayed the greatest impairments on this measure relative to the PPA variants. Logistic regression analyses in lv-PPA and nfv-PPA demonstrated that the combination of Box Task between-search error variables (i.e., 4- and 6-box levels) could correctly classify 72% of lv-PPA patients and nearly 79% of nfv-PPA patients. Area under the receiver operator characteristics curve (AUC) analyses revealed the Box Task was more sensitive than Spatial Span at differentiating lv-PPA from nfv-PPA. CONCLUSIONS Our findings suggest that a simple, computerised measure of visuospatial working memory-the Box Task-shows potential diagnostic utility in differentiating lv-PPA from the other PPA variants.
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Affiliation(s)
- David Foxe
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Muireann Irish
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Mirelle D'Mello
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Lucienne Barhon
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - James R Burrell
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,Concord Clinical School, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Roy P C Kessels
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands.,Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands.,Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Olivier Piguet
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia
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Ulugut H, Stek S, Wagemans LEE, Jutten RJ, Keulen MA, Bouwman FH, Prins ND, Lemstra AW, Krudop W, Teunissen CE, van Berckel BNM, Ossenkoppele R, Barkhof F, van der Flier WM, Scheltens P, Pijnenburg YAL. The natural history of primary progressive aphasia: beyond aphasia. J Neurol 2021; 269:1375-1385. [PMID: 34216263 PMCID: PMC8857134 DOI: 10.1007/s00415-021-10689-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/15/2021] [Accepted: 06/24/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Primary progressive aphasia (PPA) is divided into three prototypical subtypes that are all characterized by their single core symptom of aphasia. Although later in their course, other cognitive, behavioral, and motor domains may become involved, little is known about the progression profile of each subtype relative to the other subtypes. METHODS In this longitudinal retrospective cohort study, based on the recent biomarker-supported diagnostic criteria, 24 subjects diagnosed with semantic variant (svPPA), 22 with non-fluent variant (nfvPPA), and 18 with logopenic variant (lvPPA) were collected and followed up for 1-6 years. Symptom distribution, cognitive test and neuropsychiatric inventory scores, and progression into another syndrome were assessed. RESULTS Over time, lvPPA progressed with broader language problems (PPA-extended) and nfvPPA progressed to mutism, whereas semantic impairment remained the major problem in svPPA. Apart from linguistic problems, svPPA developed pronounced behavioral disturbances, whereas lvPPA exhibited a greater cognitive decline. By contrast, in nfvPPA motor deficits were more common. Furthermore, within 5 years (IQR = 2.5) after clinical onset, 65.6% of the patients additionally fulfilled the clinical criteria for another neurodegenerative syndrome (PPA-plus). Fourteen out of 24 (58%) svPPA patients additionally met the diagnostic criteria of behavioral variant frontotemporal dementia (5.1 years, IQR = 1.1), whereas the clinical features of 15/18 (83%) lvPPA patients were consistent with Alzheimer disease dementia (4.5 years IQR = 3.4). Furthermore, 12/22 (54%) of the subjects with the nfvPPA progressed to meet the diagnostic criteria of corticobasal syndrome, progressive supranuclear palsy, or motor neuron disease (5.1 years IQR = 3.4). DISCUSSION Despite aphasia being the initial and unique hallmark of the syndrome, our longitudinal results showed that PPA is not a language limited disorder and progression differs widely for each subtype, both with respect to the nature of symptoms and disease duration.
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Affiliation(s)
- Hulya Ulugut
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands.
| | - Simone Stek
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Lianne E E Wagemans
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Roos J Jutten
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Maria Antoinette Keulen
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Femke H Bouwman
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Niels D Prins
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Afina W Lemstra
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Welmoed Krudop
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Charlotte E Teunissen
- Neurological Laboratory Clinical Chemistry, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Bart N M van Berckel
- Department of Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Rik Ossenkoppele
- Department of Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- Clinical Memory Research Unit, Lund University, Lund, Sweden
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
- UCL Institutes of Neurology and Healthcare Engineering, University College London, London, UK
| | - Wiesje M van der Flier
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Philip Scheltens
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Yolande A L Pijnenburg
- Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
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Macoir J, Légaré A, Lavoie M. Contribution of the Cognitive Approach to Language Assessment to the Differential Diagnosis of Primary Progressive Aphasia. Brain Sci 2021; 11:brainsci11060815. [PMID: 34205444 PMCID: PMC8234372 DOI: 10.3390/brainsci11060815] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 11/17/2022] Open
Abstract
Diagnosis of primary progressive aphasia (PPA) is essentially based on the identification of progressive impairment of language abilities while other cognitive functions are preserved. The three variants of PPA are characterized by core and supportive clinical features related to the presence or absence of language impairment in different linguistic domains. In this article, we review the cognitive neuropsychological approach to the assessment of PPA and its contribution to the differential diagnosis of the three variants. The main advantage of this assessment approach is that it goes beyond the mere description and classification of clinical syndromes and identifies impaired and preserved cognitive and linguistic components and processes. The article is structured according to the main language domains: spoken production, language comprehension, and written language. Each section includes a brief description of the cognitive processes involved in the assessment tasks, followed by a discussion of typical characteristics for each PPA variant and common pitfalls in the interpretation of the results. In addition, the clinical benefit of the cognitive neuropsychological approach for the behavioral management of PPA is briefly sketched out in the conclusion.
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Affiliation(s)
- Joël Macoir
- Département de Réadaptation, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada;
- Centre de Recherche CERVO (CERVO Brain Research Centre), Québec, QC G1J 2G3, Canada
- Correspondence: ; Tel.: +1-418-656-2131 (ext. 412190)
| | - Annie Légaré
- Département de Réadaptation, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada;
| | - Monica Lavoie
- Chaire de Recherche sur les Aphasies Primaires Progressives—Fondation de la Famille Lemaire, Québec, QC G1J 1Z4, Canada;
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Montreuil S, Poulin E, Bergeron D, Sellami L, Verret L, Fortin MP, Poulin S, Macoir J, Hudon C, Bouchard RW, Lavoie M, Laforce R. Cognitive Profile of the Logopenic Variant of Primary Progressive Aphasia Using the Dépistage Cognitif de Québec. Dement Geriatr Cogn Disord 2021; 49:410-417. [PMID: 33113530 DOI: 10.1159/000510501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/24/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The logopenic variant of primary progressive aphasia (lvPPA) is characterized by impaired word-finding and sentence repetition with phonologic errors but spared motor speech and grammar and semantic knowledge. Although its language deficits have been well studied, the full spectrum of cognitive changes in the lvPPA remains to be defined. We aimed to explore the neurocognitive profile of the lvPPA using a newly developed cognitive screening tool for atypical dementias, the Dépistage Cognitif de Québec (DCQ). METHODS We compared 29 patients with lvPPA to 72 amnestic variant Alzheimer disease (aAD) to 438 healthy control (HC) participants. Performance on the 5 indexes of the DCQ (Memory, Visuospatial, Executive, Language and Behavioral) was compared between the 3 groups. RESULTS Results showed a significantly lower performance for lvPPA participants in all neurocognitive domains, when compared to HC. When compared to aAD, lvPPA participants had significantly lower scores for language, executive, and visuospatial abilities, but not for memory and behavior. CONCLUSION Altogether, these findings better define the neurocognitive changes of lvPPA.
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Affiliation(s)
- Sarah Montreuil
- Clinique Interdisciplinaire de Mémoire, CHU de Québec/Université Laval/Hôpital de l'Enfant-Jésus, Québec, Québec, Canada
| | - Elizabeth Poulin
- Clinique Interdisciplinaire de Mémoire, CHU de Québec/Université Laval/Hôpital de l'Enfant-Jésus, Québec, Québec, Canada
| | - David Bergeron
- Clinique Interdisciplinaire de Mémoire, CHU de Québec/Université Laval/Hôpital de l'Enfant-Jésus, Québec, Québec, Canada
| | - Leila Sellami
- Clinique Interdisciplinaire de Mémoire, CHU de Québec/Université Laval/Hôpital de l'Enfant-Jésus, Québec, Québec, Canada
| | - Louis Verret
- Clinique Interdisciplinaire de Mémoire, CHU de Québec/Université Laval/Hôpital de l'Enfant-Jésus, Québec, Québec, Canada
| | - Marie-Pierre Fortin
- Clinique Interdisciplinaire de Mémoire, CHU de Québec/Université Laval/Hôpital de l'Enfant-Jésus, Québec, Québec, Canada
| | - Stéphane Poulin
- Clinique Interdisciplinaire de Mémoire, CHU de Québec/Université Laval/Hôpital de l'Enfant-Jésus, Québec, Québec, Canada
| | - Joël Macoir
- Département de Réadaptation, Faculté de Médecine, Université Laval, Québec, Québec, Canada
| | - Carol Hudon
- École de Psychologie, Faculté des Sciences Sociales, Université Laval, Québec, Québec, Canada
| | - Rémi W Bouchard
- Clinique Interdisciplinaire de Mémoire, CHU de Québec/Université Laval/Hôpital de l'Enfant-Jésus, Québec, Québec, Canada
| | - Monica Lavoie
- Clinique Interdisciplinaire de Mémoire, CHU de Québec/Université Laval/Hôpital de l'Enfant-Jésus, Québec, Québec, Canada
| | - Robert Laforce
- Clinique Interdisciplinaire de Mémoire, CHU de Québec/Université Laval/Hôpital de l'Enfant-Jésus, Québec, Québec, Canada,
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Mesulam MM, Coventry C, Kuang A, Bigio EH, Mao Q, Flanagan ME, Gefen T, Sridhar J, Geula C, Zhang H, Weintraub S, Rogalski EJ. Memory Resilience in Alzheimer Disease With Primary Progressive Aphasia. Neurology 2021; 96:e916-e925. [PMID: 33441454 PMCID: PMC8105903 DOI: 10.1212/wnl.0000000000011397] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/25/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether memory is preserved longitudinally in primary progressive aphasia (PPA) associated with Alzheimer disease (AD) and to identify potential factors that maintain memory despite underlying neurofibrillary degeneration of mediotemporal memory areas. METHODS Longitudinal memory assessment was done in 17 patients with PPA with autopsy or biomarker evidence of AD (PPA-AD) and 14 patients with amnestic dementia of the Alzheimer type with AD at autopsy (DAT-AD). RESULTS In PPA-AD, episodic memory, tested with nonverbal items, was preserved at the initial testing and showed no decline at retesting 2.35 ± 0.78 years later, at which time symptoms had been present for 6.26 ± 2.21 years. In contrast, language functions declined significantly during the same period. In DAT-AD, both verbal memory and language declined with equal severity. Although imaging showed asymmetric left-sided mediotemporal atrophy in PPA-AD, autopsy revealed bilateral hippocampo-entorhinal neurofibrillary degeneration at Braak stages V and VI. Compared to DAT-AD, however, the PPA-AD group had lower incidence of APOE ε4 and of mediotemporal TAR DNA-binding protein 43 (TDP-43) pathology. CONCLUSIONS Memory preservation in PPA is not just an incidental finding at onset but a core feature that persists for years despite the hippocampo-entorhinal AD neuropathology that is as severe as that of DAT-AD. Asymmetry of mediotemporal atrophy and a lesser impact of APOE ε4 and of TDP-43 on the integrity of memory circuitry may constitute some of the factors underlying this resilience. Our results also suggest that current controversies on memory in PPA-AD reflect inconsistencies in the diagnosis of logopenic PPA, the clinical variant most frequently associated with AD. CLINICALTRIALSGOV IDENTIFIER NCT00537004 and NCT03371706.
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Affiliation(s)
- M-Marsel Mesulam
- From the Mesulam Center for Cognitive Neurology and Alzheimer's Disease (M.-M.M., C.C., E.H.B., Q.M., M.E.F., T.G., J.S., C.G., H.Z., S.W., E.J.R.), Department of Preventive Medicine (A.K., H.Z.), Department of Pathology (E.H.B., Q.M., M.E.F.), and Department of Psychiatry and Behavioral Sciences (T.G., S.W., E.J.R.), Northwestern University Feinberg School of Medicine, Chicago. IL.
| | - Christina Coventry
- From the Mesulam Center for Cognitive Neurology and Alzheimer's Disease (M.-M.M., C.C., E.H.B., Q.M., M.E.F., T.G., J.S., C.G., H.Z., S.W., E.J.R.), Department of Preventive Medicine (A.K., H.Z.), Department of Pathology (E.H.B., Q.M., M.E.F.), and Department of Psychiatry and Behavioral Sciences (T.G., S.W., E.J.R.), Northwestern University Feinberg School of Medicine, Chicago. IL
| | - Alan Kuang
- From the Mesulam Center for Cognitive Neurology and Alzheimer's Disease (M.-M.M., C.C., E.H.B., Q.M., M.E.F., T.G., J.S., C.G., H.Z., S.W., E.J.R.), Department of Preventive Medicine (A.K., H.Z.), Department of Pathology (E.H.B., Q.M., M.E.F.), and Department of Psychiatry and Behavioral Sciences (T.G., S.W., E.J.R.), Northwestern University Feinberg School of Medicine, Chicago. IL
| | - Eileen H Bigio
- From the Mesulam Center for Cognitive Neurology and Alzheimer's Disease (M.-M.M., C.C., E.H.B., Q.M., M.E.F., T.G., J.S., C.G., H.Z., S.W., E.J.R.), Department of Preventive Medicine (A.K., H.Z.), Department of Pathology (E.H.B., Q.M., M.E.F.), and Department of Psychiatry and Behavioral Sciences (T.G., S.W., E.J.R.), Northwestern University Feinberg School of Medicine, Chicago. IL
| | - Qinwen Mao
- From the Mesulam Center for Cognitive Neurology and Alzheimer's Disease (M.-M.M., C.C., E.H.B., Q.M., M.E.F., T.G., J.S., C.G., H.Z., S.W., E.J.R.), Department of Preventive Medicine (A.K., H.Z.), Department of Pathology (E.H.B., Q.M., M.E.F.), and Department of Psychiatry and Behavioral Sciences (T.G., S.W., E.J.R.), Northwestern University Feinberg School of Medicine, Chicago. IL
| | - Margaret E Flanagan
- From the Mesulam Center for Cognitive Neurology and Alzheimer's Disease (M.-M.M., C.C., E.H.B., Q.M., M.E.F., T.G., J.S., C.G., H.Z., S.W., E.J.R.), Department of Preventive Medicine (A.K., H.Z.), Department of Pathology (E.H.B., Q.M., M.E.F.), and Department of Psychiatry and Behavioral Sciences (T.G., S.W., E.J.R.), Northwestern University Feinberg School of Medicine, Chicago. IL
| | - Tamar Gefen
- From the Mesulam Center for Cognitive Neurology and Alzheimer's Disease (M.-M.M., C.C., E.H.B., Q.M., M.E.F., T.G., J.S., C.G., H.Z., S.W., E.J.R.), Department of Preventive Medicine (A.K., H.Z.), Department of Pathology (E.H.B., Q.M., M.E.F.), and Department of Psychiatry and Behavioral Sciences (T.G., S.W., E.J.R.), Northwestern University Feinberg School of Medicine, Chicago. IL
| | - Jaiashre Sridhar
- From the Mesulam Center for Cognitive Neurology and Alzheimer's Disease (M.-M.M., C.C., E.H.B., Q.M., M.E.F., T.G., J.S., C.G., H.Z., S.W., E.J.R.), Department of Preventive Medicine (A.K., H.Z.), Department of Pathology (E.H.B., Q.M., M.E.F.), and Department of Psychiatry and Behavioral Sciences (T.G., S.W., E.J.R.), Northwestern University Feinberg School of Medicine, Chicago. IL
| | - Changiz Geula
- From the Mesulam Center for Cognitive Neurology and Alzheimer's Disease (M.-M.M., C.C., E.H.B., Q.M., M.E.F., T.G., J.S., C.G., H.Z., S.W., E.J.R.), Department of Preventive Medicine (A.K., H.Z.), Department of Pathology (E.H.B., Q.M., M.E.F.), and Department of Psychiatry and Behavioral Sciences (T.G., S.W., E.J.R.), Northwestern University Feinberg School of Medicine, Chicago. IL
| | - Hui Zhang
- From the Mesulam Center for Cognitive Neurology and Alzheimer's Disease (M.-M.M., C.C., E.H.B., Q.M., M.E.F., T.G., J.S., C.G., H.Z., S.W., E.J.R.), Department of Preventive Medicine (A.K., H.Z.), Department of Pathology (E.H.B., Q.M., M.E.F.), and Department of Psychiatry and Behavioral Sciences (T.G., S.W., E.J.R.), Northwestern University Feinberg School of Medicine, Chicago. IL
| | - Sandra Weintraub
- From the Mesulam Center for Cognitive Neurology and Alzheimer's Disease (M.-M.M., C.C., E.H.B., Q.M., M.E.F., T.G., J.S., C.G., H.Z., S.W., E.J.R.), Department of Preventive Medicine (A.K., H.Z.), Department of Pathology (E.H.B., Q.M., M.E.F.), and Department of Psychiatry and Behavioral Sciences (T.G., S.W., E.J.R.), Northwestern University Feinberg School of Medicine, Chicago. IL
| | - Emily J Rogalski
- From the Mesulam Center for Cognitive Neurology and Alzheimer's Disease (M.-M.M., C.C., E.H.B., Q.M., M.E.F., T.G., J.S., C.G., H.Z., S.W., E.J.R.), Department of Preventive Medicine (A.K., H.Z.), Department of Pathology (E.H.B., Q.M., M.E.F.), and Department of Psychiatry and Behavioral Sciences (T.G., S.W., E.J.R.), Northwestern University Feinberg School of Medicine, Chicago. IL
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Abstract
PURPOSE OF REVIEW Frontotemporal dementia (FTD) is a rare dementia, that accounts for about 15% of all dementia cases. Despite consensus diagnostic criteria, FTD remains difficult to diagnose in life because of its complex and variable clinical phenomenology and heterogeneous disorders. This review provides an update on the current knowledge of the main FTD syndromes -- the behavioural variant, semantic variant, and nonfluent/agrammatic variant-- their brain abnormalities and genetic profiles. RECENT FINDINGS The complexity of the clinical features in FTD has become increasingly apparent, particularly in the domain of behaviour. Such behaviour changes are now also being recognized in the language variants of FTD. Initial interest on emotion processing and social cognition is now complemented by studies on other behavioural disturbance, that spans gambling, antisocial behaviours, repetitive behaviours, and apathy. At a biological level, novel pathological subcategories continue to be identified. From a genetic viewpoint, abnormalities in three genes explain nearly three quarters of familial cases of FTD. SUMMARY In the absence of effective drug treatments, novel approaches are needed to target some of the most disabling features of FTD, such as language loss or behaviour disturbance. Recent interventions appear promising but will require confirmation.
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Longitudinal cognitive and functional changes in primary progressive aphasia. J Neurol 2021; 268:1951-1961. [PMID: 33417000 DOI: 10.1007/s00415-020-10382-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/17/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The variants of primary progressive aphasia (PPA) are predominantly diagnosed on the basis of specific profiles of language impairments. Deficits in other cognitive domains and their evolution over time are less well documented. This study examined the cognitive profiles of the PPA variants over time and determined the contribution of cognition on functional capacity. METHODS Longitudinal performance on the Addenbrooke's Cognitive Examination-III (ACE-III) total and cognitive subdomains were investigated in 147 PPA individuals (41 logopenic [lv-PPA], 44 non-fluent [nfv-PPA], and 62 semantic variants [sv-PPA]). The relative contribution of ACE-III subdomain scores to overall functional capacity over time was identified using mixed and hierarchical regression modelling. RESULTS The annual rate of global ACE-III decline was twice that in lv-PPA than in nfv-PPA and sv-PPA, despite lv-PPA performing intermediate to the other variants at baseline assessment. Notably, attention and visuospatial subdomains declined faster in lv-PPA than in nfv-PPA and sv-PPA; and memory impairment was more severe in lv-PPA than in nfv-PPA at all time points. Functional decline was comparable across PPA variants; however, the contribution of cognition on functional capacity varied across variants and over time. CONCLUSION The cognitive profiles of the PPA variants are distinct at baseline and over time. Crucially, cognitive decline in lv-PPA was more widespread and pervasive than in nfv-PPA and sv-PPA. Our findings also demonstrate the complex interplay between cognition and functional capacity. This study underscores the importance of routinely assessing cognition and functional capacity in PPA to improve diagnostic accuracy and provide targeted support services.
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Rosell-Clari V, Hernández-Sacristán C, Cervera-Crespo T, Lorenzo-Cordero À. Assessing natural metalinguistic skills in people with Alzheimer's disease and frontotemporal dementia. JOURNAL OF COMMUNICATION DISORDERS 2021; 89:106058. [PMID: 33316623 DOI: 10.1016/j.jcomdis.2020.106058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 10/15/2020] [Accepted: 10/17/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The aim of this paper is to assess whether the use of natural metalinguistic skills can be used to differentiate linguistic-communicative profiles of people with dementia (Alzheimer's disease and frontotemporal dementia in the behavioural and primary progressive aphasia variants) in the earliest stages of the disease. METHOD A sample of 180 people was selected. Sixty had Alzheimer's disease, 20 had frontotemporal dementia of the behavioural variant, and 40 had frontotemporal dementia of the primary progressive aphasia variant (20 had non-fluent primary progressive aphasia and 20 had semantic dementia). The control group was composed of 60 healthy people with ages, gender, and professions as similar as possible to those of the people in the dementia groups. All the participants were administered the Spanish adaptation of the Mini-Mental State Examination (MMSE) and the Global Deterioration Scale (GDS) to assess dementia severity. To assess the use of natural metalinguistic skills, a 40-item test (MetAphAs), specifically designed for this aim, was administered. RESULTS The test showed high internal validity and high positive correlations with the MMSE. Statistically significant differences were observed in the total scores on this test and in the scores on each of its sections, when comparing the whole group and the subgroups of people with dementia with the control group. Additionally, the scores on most of the sections of the MetAphAs test presented statistically significant differences when the different subgroups of people with dementia were compared. CONCLUSIONS A test like the MetAphAs, specifically designed to assess natural metalinguistic abilities, may be useful for obtaining differential communicative-linguistic profiles according to the type of dementia in the early stages of the disease. However, additional research is needed to obtain more conclusive results.
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Affiliation(s)
- Vicent Rosell-Clari
- Department of Basic Psychology, University of Valencia, 21 Blasco Ibanez Avenue, 46010, Valencia, Spain.
| | - Carlos Hernández-Sacristán
- Department of Linguistics and Communication Sciences, University of Valencia, 32 Blasco Ibanez Avenue, 46010, Valencia, Spain.
| | - Teresa Cervera-Crespo
- Department of Basic Psychology, University of Valencia, 21 Blasco Ibanez Avenue, 46010, Valencia, Spain.
| | - Àgata Lorenzo-Cordero
- Department of Basic Psychology, University of Valencia, 21 Blasco Ibanez Avenue, 46010, Valencia, Spain.
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Bogolepova A, Vasenina E, Gomzyakova N, Gusev E, Dudchenko N, Emelin A, Zalutskaya N, Isaev R, Kotovskaya Y, Levin O, Litvinenko I, Lobzin V, Martynov M, Mkhitaryan E, Nikolay G, Palchikova E, Tkacheva O, Cherdak M, Chimagomedova A, Yakhno N. Clinical Guidelines for Cognitive Disorders in Elderly and Older Patients. Zh Nevrol Psikhiatr Im S S Korsakova 2021. [DOI: 10.17116/jnevro20211211036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Ramanan S, Roquet D, Goldberg ZL, Hodges JR, Piguet O, Irish M, Lambon Ralph MA. Establishing two principal dimensions of cognitive variation in logopenic progressive aphasia. Brain Commun 2020; 2:fcaa125. [PMID: 33376980 PMCID: PMC7750924 DOI: 10.1093/braincomms/fcaa125] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 06/25/2020] [Accepted: 07/13/2020] [Indexed: 12/28/2022] Open
Abstract
Logopenic progressive aphasia is a neurodegenerative syndrome characterized by sentence repetition and naming difficulties arising from left-lateralized temporoparietal atrophy. Clinical descriptions of logopenic progressive aphasia largely concentrate on profiling language deficits, however, accumulating evidence points to the presence of cognitive deficits even on tasks with minimal language demands. Although non-linguistic cognitive deficits in logopenic progressive aphasia are thought to scale with disease severity, patients at discrete stages of language dysfunction display overlapping cognitive profiles, suggesting individual-level variation in cognitive performance, independent of primary language dysfunction. To address this issue, we used principal component analysis to decompose the individual-level variation in cognitive performance in 43 well-characterized logopenic progressive aphasia patients who underwent multi-domain neuropsychological assessments and structural neuroimaging. The principal component analysis solution revealed the presence of two, statistically independent factors, providing stable and clinically intuitive explanations for the majority of variance in cognitive performance in the syndrome. Factor 1 reflected 'speech production and verbal memory' deficits which typify logopenic progressive aphasia. Systematic variations were also confirmed on a second, orthogonal factor mainly comprising visuospatial and executive processes. Adopting a case-comparison approach, we further demonstrate that pairs of patients with comparable Factor 1 scores, regardless of their severity, diverge considerably on visuo-executive test performance, underscoring the inter-individual variability in cognitive profiles in comparably 'logopenic' patients. Whole-brain voxel-based morphometry analyses revealed that speech production and verbal memory factor scores correlated with left middle frontal gyrus, while visuospatial and executive factor scores were associated with grey matter intensity of right-lateralized temporoparietal, middle frontal regions and their underlying white matter connectivity. Importantly, logopenic progressive aphasia patients with poorer visuospatial and executive factor scores demonstrated greater right-lateralized temporoparietal and frontal atrophy. Our findings demonstrate the inherent variation in cognitive performance at an individual- and group-level in logopenic progressive aphasia, suggesting the presence of a genuine co-occurring cognitive impairment that is statistically independent of language function and disease severity.
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Affiliation(s)
- Siddharth Ramanan
- The University of Sydney, Brain and Mind Centre, Sydney, NSW, Australia
- The University of Sydney, School of Psychology, Sydney, NSW, Australia
- ARC Centre of Excellence in Cognition and its Disorders, Sydney, NSW, Australia
| | - Daniel Roquet
- The University of Sydney, Brain and Mind Centre, Sydney, NSW, Australia
- The University of Sydney, School of Psychology, Sydney, NSW, Australia
- ARC Centre of Excellence in Cognition and its Disorders, Sydney, NSW, Australia
| | - Zoë-Lee Goldberg
- The University of Sydney, Brain and Mind Centre, Sydney, NSW, Australia
| | - John R Hodges
- The University of Sydney, Brain and Mind Centre, Sydney, NSW, Australia
- ARC Centre of Excellence in Cognition and its Disorders, Sydney, NSW, Australia
- The University of Sydney, School of Medical Sciences, Sydney, NSW, Australia
| | - Olivier Piguet
- The University of Sydney, Brain and Mind Centre, Sydney, NSW, Australia
- The University of Sydney, School of Psychology, Sydney, NSW, Australia
- ARC Centre of Excellence in Cognition and its Disorders, Sydney, NSW, Australia
| | - Muireann Irish
- The University of Sydney, Brain and Mind Centre, Sydney, NSW, Australia
- The University of Sydney, School of Psychology, Sydney, NSW, Australia
- ARC Centre of Excellence in Cognition and its Disorders, Sydney, NSW, Australia
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Visuospatial short-term and working memory disturbance in the primary progressive aphasias: Neuroanatomical and clinical implications. Cortex 2020; 132:223-237. [PMID: 32998062 DOI: 10.1016/j.cortex.2020.08.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/28/2020] [Accepted: 08/26/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Primary progressive aphasia (PPA) comprises three main variants: logopenic (lv-PPA), non-fluent (nfv-PPA) and semantic variant (sv-PPA). Differentiating the language profiles of the PPA variants remains challenging, especially for lv-PPA and nfv-PPA. As such, diagnostic tools that do not rely on speech and language may offer some utility. Here, we investigated the short-term and working memory profiles of the PPA variants and typical Alzheimer's disease (AD), with a particular interest in the visuospatial system. We hypothesised visuospatial short-term and working memory would be more compromised in lv-PPA and AD than in the other PPA variants, and that this would relate to degeneration of posterior temporoparietal brain regions. METHOD Thirty-three lv-PPA, 26 nfv-PPA, 31 sv-PPA and 58 AD patients, and 45 matched healthy controls were recruited. All participants completed the WMS-III Spatial and Digit Span tasks and underwent a structural brain MRI for voxel-based morphometry analyses. RESULTS Relative to Controls, Spatial Span Forward (SSF) performance was impaired in lv-PPA and AD but not in nfv-PPA or sv-PPA. In contrast, Digit Span Forward (DSF) performance was impaired in lv-PPA and nfv-PPA (to a similar level), and AD, but was relatively intact in sv-PPA. As expected, most backward span scores across both modalities were lower than forward span scores. Neuroimaging analyses revealed that SSF and SSB performance in all patients combined correlated with grey matter intensity decrease in several clusters located in temporo-parieto-occipital brain regions. Post-hoc group comparisons of these regions showed that grey matter loss was more extensive in the lv-PPA and AD groups than in the nfv-PPA and sv-PPA groups. CONCLUSIONS The findings suggest that the visuospatial short-term and working memory profiles of the PPA variants are separable and likely reflect their distinct patterns of temporo-parieto-occipital brain atrophy.
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Mendez MF, Monserratt LH, Liang LJ, Chavez D, Jimenez EE, Maurer JJ, Laffey M. Neuropsychological Similarities and Differences Between Amnestic Alzheimer's Disease and its Non-Amnestic Variants. J Alzheimers Dis 2020; 69:849-855. [PMID: 31156165 DOI: 10.3233/jad-190124] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The neuropsychological recognition of early-onset Alzheimer's disease (AD) can be difficult because of non-amnestic variants such as logopenic variant primary progressive aphasia (lvPPA) and posterior cortical atrophy (PCA). OBJECTIVE This study evaluated the similarities and differences between typical amnestic AD (tAD) and lvPPA and PCA on a screening neuropsychological battery. METHODS We enrolled 51 patients meeting NIA-AA criteria for biomarker-supported AD (amnestic or non-amnestic) and having an age of onset of <65 years of age. Based on additional recommended clinical criteria for lvPPA and PCA, the early-onset AD patients were divided into three groups (28 tAD, 9 lvPPA, 14 PCA) of comparable age and dementia severity. We then analyzed their profiles on a focused, screening neuropsychological battery for early-onset AD. RESULTS In addition to greater variance on the Mini-Mental State Examination, the lvPPA and PCA variants had episodic memory impairment that did not significantly differ from the memory impairment in the tAD patients. Despite differences on language and visuospatial tasks, they did not significantly distinguish the lvPPA and PCA from tAD. The lvPPA group, however, was distinguishable by worse performance on measures reflecting working memory (digit span forward, memory registration). CONCLUSIONS On neuropsychological screening, all clinical early-onset AD subtypes may have memory impairments. Screening batteries for early-onset AD should also include measures of working memory, which is disproportionately decreased in lvPPA.
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Affiliation(s)
- Mario F Mendez
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.,Department Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.,Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Lorena H Monserratt
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Li-Jung Liang
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Diana Chavez
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.,Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Elvira E Jimenez
- Department of Neurology, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.,Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Joseph J Maurer
- Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Megan Laffey
- Neurobehavior Unit, V.A. Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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Ramanan S, Marstaller L, Hodges JR, Piguet O, Irish M. Understanding the neural basis of episodic amnesia in logopenic progressive aphasia: A multimodal neuroimaging study. Cortex 2020; 125:272-287. [DOI: 10.1016/j.cortex.2019.12.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 07/19/2019] [Accepted: 12/21/2019] [Indexed: 12/13/2022]
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Consistently inconsistent: Multimodal episodic deficits in semantic aphasia. Neuropsychologia 2020; 140:107392. [PMID: 32061831 DOI: 10.1016/j.neuropsychologia.2020.107392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/03/2020] [Accepted: 02/10/2020] [Indexed: 11/22/2022]
Abstract
Semantic Aphasia (SA) patients have difficulty accessing semantic knowledge in both verbal and non-verbal tasks appropriately for the current context. Automatically activated semantic knowledge overwhelms the system, because it is no longer able to inhibit interference from dominant meanings in order to select weaker alternatives. Episodic memory, like semantic memory, requires control to select relevant memories amongst competing episodes. For example, our memory for what we ate for breakfast last Saturday is affected by competition from numerous other breakfast meals eaten on other days. Where one is unable to guide retrieval, we may rely on automatically activated knowledge about "breakfast foods", and therefore experience false memories. Brain systems that support semantic control are also implicated in episodic control, and therefore deficits in semantic control are likely to cause more widespread problems. Despite this, nearly all research to date focuses on semantic performance alone. This study explored the impact of this semantic impairment on episodic recall. We used a verbal and non-verbal episodic memory task: participants remembered nursery rhymes in the verbal condition and logos and their associated products in the visual condition (e.g. bowl of cereal and coco-pops). For both tasks, we manipulated a) congruency with pre-existing knowledge (e.g. expectancy of trials: baa baa blackbuild - instead of sheep) and b) whether these trial types were blocked by congruency or mixed, as well as (c) distractor strength. If SA patients experience overwhelming automatic activation, they should find incongruent items more difficult to suppress, particularly when presented in an unpredictable task format. A total of 13 SA patients were compared to 33 controls across three experiments. In line with our predictions, SA patients found it more difficult to retrieve episodic memories which were in conflict with pre-existing semantic knowledge. This was true across modalities. Moreover, these deficits were accentuated when the congruency was presented in a mixed fashion, and so unpredictable across trials. Evidence of these episodic control impairments in SA cases supports the idea of a shared mechanism for semantic and episodic memory control.
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A Meta-Analysis of Neuropsychological Functioning in the Logopenic Variant of Primary Progressive Aphasia: Comparison with the Semantic and Non-Fluent Variants. J Int Neuropsychol Soc 2020; 26:322-330. [PMID: 31658919 DOI: 10.1017/s1355617719001115] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The logopenic variant of primary progressive aphasia (lvPPA) has disparate pathological and anatomical features when compared to the semantic (svPPA) and non-fluent (nfvPPA) variants of PPA. As such, there is increasing need for measures that improve diagnostic accuracy particularly when etiology-specific treatments become available. In the current study, we used meta-analytic methods to establish the neuropsychological profile of lvPPA and compare it to recent findings in svPPA and nfvPPA. METHODS We extracted neuropsychological data from 51 publications representing 663 lvPPA patients and 1379 controls. We calculated Hedges' g effect sizes for nine domains of neuropsychological functioning in lvPPA and assessed the influence of demographic, disease, and task characteristics on effect size magnitude. Results obtained in lvPPA were compared to findings in svPPA and nfvPPA. RESULTS In lvPPA, the magnitude of deficits in attention, math, visuospatial memory, and executive functioning were as prominent as language deficits. Within the language domain, lvPPA patients demonstrated greater naming than repetition deficits. Compared to svPPA and nfvPPA, lvPPA patients demonstrated greater neuropsychological deficits overall and greater impairment on attention, math, and visual set-shifting tests. CONCLUSIONS Tests of attention, delayed visuospatial memory, visual set-shifting, and math distinguish lvPPA from svPPA and nfvPPA likely reflecting the posterior temporoparietal atrophy observed early in the course of lvPPA. These findings support the inclusion of these measures in the clinical neuropsychological assessment of lvPPA and underscore the need for additional clinicopathological and longitudinal studies of arithmetic and visuospatial memory across the PPA variants.
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Henry ML, Hubbard HI, Grasso SM, Dial HR, Beeson PM, Miller BL, Gorno-Tempini ML. Treatment for Word Retrieval in Semantic and Logopenic Variants of Primary Progressive Aphasia: Immediate and Long-Term Outcomes. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:2723-2749. [PMID: 31390290 PMCID: PMC6802912 DOI: 10.1044/2018_jslhr-l-18-0144] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 10/23/2018] [Accepted: 12/16/2018] [Indexed: 05/25/2023]
Abstract
Purpose Recent studies confirm the utility of speech-language intervention in primary progressive aphasia (PPA); however, long-term outcomes, ideal dosage parameters, and relative benefits of intervention across clinical variants warrant additional investigation. The purpose of this study was to determine whether naming treatment affords significant, lasting, and generalized improvement for individuals with semantic and logopenic PPA and whether dosage manipulations significantly affect treatment outcomes. Method Eighteen individuals with PPA (9 semantic and 9 logopenic variant) underwent lexical retrieval treatment designed to leverage spared cognitive-linguistic domains and develop self-cueing strategies to promote naming. One group (n = 10) underwent once-weekly treatment sessions, and the other group (n = 8) received the same treatment with 2 sessions per week and an additional "booster" treatment phase at 3 months post-treatment. Performance on trained and untrained targets/tasks was measured immediately after treatment and at 3, 6, and 12 months post-treatment. Results Outcomes from the full cohort of individuals with PPA showed significantly improved naming of trained items immediately post-treatment and at all follow-up assessments through 1 year. Generalized improvement on untrained items was significant up to 6 months post-treatment. The positive response to treatment was comparable regardless of session frequency or inclusion of a booster phase. Outcomes were comparable across PPA subtypes, as was maintenance of gains over the post-treatment period. Conclusion This study documents positive naming treatment outcomes for a group of individuals with PPA, demonstrating strong direct treatment effects, maintenance of gains up to 1 year post-treatment, and generalization to untrained items. Lexical retrieval treatment, in conjunction with daily home practice, had a strong positive effect that did not require more than 1 clinician-directed treatment session per week. Findings confirm that strategic training designed to capitalize on spared cognitive-linguistic abilities results in significant and lasting improvement, despite ongoing disease progression, in PPA.
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Affiliation(s)
- Maya L. Henry
- Department of Communication Sciences and Disorders, The University of Texas at Austin
| | - H. Isabel Hubbard
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
- Department of Communication Science and Disorders, University of Kentucky, Lexington
| | - Stephanie M. Grasso
- Department of Communication Sciences and Disorders, The University of Texas at Austin
| | - Heather R. Dial
- Department of Communication Sciences and Disorders, The University of Texas at Austin
| | - Pélagie M. Beeson
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson
| | - Bruce L. Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
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More than words: Social cognition across variants of primary progressive aphasia. Neurosci Biobehav Rev 2019; 100:263-284. [PMID: 30876954 DOI: 10.1016/j.neubiorev.2019.02.020] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 12/06/2018] [Accepted: 02/27/2019] [Indexed: 12/14/2022]
Abstract
Although primary progressive aphasia (PPA) is clinically typified by linguistic impairments, emerging evidence highlights the presence of early deficits in social cognition. This review systematically describes the latter patterns, specifying their relation to the characteristic linguistic dysfunctions and atrophy patterns of non-fluent, semantic, and logopenic variants of the disease (nfvPPA, svPPA, and lvPPA, respectively), relative to closely related dementia types. Whereas the evidence on lvPPA proves scant, studies on nfvPPA and svPPA patients show consistent deficits in emotion recognition, theory of mind, and empathy. Notably, these seem to be intertwined with language impairments in nfvPPA, but they prove primary and independent of language disturbances in svPPA. Also, only the profile of svPPA resembles that of behavioral variant frontotemporal dementia, probably reflecting the overlap of fronto-temporal disruptions in both conditions. In short, the neurocognitive relationship between linguistic and socio-cognitive deficits cannot be precisely predicated for PPA as a whole; instead, specific links must be acknowledged in each variant. These emergent patterns pave the way for fruitful dimensional research in the field.
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