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Fernandino L, Binder JR. How does the "default mode" network contribute to semantic cognition? BRAIN AND LANGUAGE 2024; 252:105405. [PMID: 38579461 PMCID: PMC11135161 DOI: 10.1016/j.bandl.2024.105405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 02/26/2024] [Accepted: 03/23/2024] [Indexed: 04/07/2024]
Abstract
This review examines whether and how the "default mode" network (DMN) contributes to semantic processing. We review evidence implicating the DMN in the processing of individual word meanings and in sentence- and discourse-level semantics. Next, we argue that the areas comprising the DMN contribute to semantic processing by coordinating and integrating the simultaneous activity of local neuronal ensembles across multiple unimodal and multimodal cortical regions, creating a transient, global neuronal ensemble. The resulting ensemble implements an integrated simulation of phenomenological experience - that is, an embodied situation model - constructed from various modalities of experiential memory traces. These situation models, we argue, are necessary not only for semantic processing but also for aspects of cognition that are not traditionally considered semantic. Although many aspects of this proposal remain provisional, we believe it provides new insights into the relationships between semantic and non-semantic cognition and into the functions of the DMN.
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Affiliation(s)
- Leonardo Fernandino
- Department of Neurology, Medical College of Wisconsin, USA; Department of Biomedical Engineering, Medical College of Wisconsin, USA.
| | - Jeffrey R Binder
- Department of Neurology, Medical College of Wisconsin, USA; Department of Biophysics, Medical College of Wisconsin, USA
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2
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Carlos AF, Weigand SD, Duffy JR, Clark HM, Utianski RL, Machulda MM, Botha H, Thu Pham NT, Lowe VJ, Schwarz CG, Whitwell JL, Josephs KA. Volumetric analysis of hippocampal subregions and subfields in left and right semantic dementia. Brain Commun 2024; 6:fcae097. [PMID: 38572268 PMCID: PMC10988847 DOI: 10.1093/braincomms/fcae097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/20/2023] [Accepted: 03/21/2024] [Indexed: 04/05/2024] Open
Abstract
Two variants of semantic dementia are recognized based on the laterality of temporal lobe involvement: a left-predominant variant associated with verbal knowledge impairment and a right-predominant variant associated with behavioural changes and non-verbal knowledge loss. This cross-sectional clinicoradiologic study aimed to assess whole hippocampal, subregion, and/or subfield volume loss in semantic dementia versus controls and across its variants. Thirty-five semantic dementia participants and 15 controls from the Neurodegenerative Research Group at Mayo Clinic who had completed 3.0-T volumetric magnetic resonance imaging and 18F-fluorodeoxyglucose-positron emission tomography were included. Classification as left-predominant (n = 25) or right-predominant (n = 10) variant was based on temporal lobe hypometabolism. Volumes of hippocampal subregions (head, body, and tail) and subfields (parasubiculum, presubiculum, subiculum, cornu ammonis 1, cornu ammonis 3, cornu ammonis 4, dentate gyrus, molecular layer, hippocampal-amygdaloid transition area, and fimbria) were obtained using FreeSurfer 7. Subfield volumes were measured separately from head and body subregions. We fit linear mixed-effects models using log-transformed whole hippocampal/subregion/subfield volumes as dependent variables; age, sex, total intracranial volume, hemisphere and a group-by-hemisphere interaction as fixed effects; and subregion/subfield nested within hemisphere as a random effect. Significant results (P < 0.05) are hereby reported. At the whole hippocampal level, the dominant (predominantly involved) hemisphere of both variants showed 23-27% smaller volumes than controls. The non-dominant (less involved) hemisphere of the right-predominant variant also showed volume loss versus controls and the left-predominant variant. At the subregional level, both variants showed 17-28% smaller dominant hemisphere head, body, and tail than controls, with the right-predominant variant also showing 8-12% smaller non-dominant hemisphere head than controls and left-predominant variant. At the subfield level, the left-predominant variant showed 12-36% smaller volumes across all dominant hemisphere subfields and 14-15% smaller non-dominant hemisphere parasubiculum, presubiculum (head and body), subiculum (head) and hippocampal-amygdaloid transition area than controls. The right-predominant variant showed 16-49% smaller volumes across all dominant hemisphere subfields and 14-22% smaller parasubiculum, presubiculum, subiculum, cornu ammonis 3, hippocampal-amygdaloid transition area (all from the head) and fimbria of non-dominant hemisphere versus controls. Comparison of dominant hemispheres showed 16-29% smaller volumes of the parasubiculum, presubiculum (head) and fimbria in the right-predominant than left-predominant variant; comparison of non-dominant hemispheres showed 12-15% smaller cornu ammonis 3, cornu ammonis 4, dentate gyrus, hippocampal-amygdaloid transition area (all from the head) and cornu ammonis 1, cornu ammonis 3 and cornu ammonis 4 (all from the body) in the right-predominant variant. All hippocampal subregion/subfield volumes are affected in semantic dementia, although some are more affected in both dominant and non-dominant hemispheres of the right-predominant than the left-predominant variant by the time of presentation. Involvement of hippocampal structures is apparently more subregion dependent than subfield dependent, indicating possible superiority of subregion volumes as disease biomarkers.
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Affiliation(s)
- Arenn F Carlos
- Department of Neurology, Mayo Clinic, Rochester, MN 55905 USA
| | - Stephen D Weigand
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55905 USA
| | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, MN 55905 USA
| | - Heather M Clark
- Department of Neurology, Mayo Clinic, Rochester, MN 55905 USA
| | - Rene L Utianski
- Department of Neurology, Mayo Clinic, Rochester, MN 55905 USA
| | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905 USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN 55905 USA
| | | | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN 55905 USA
| | | | | | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, MN 55905 USA
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Lan F, Roquet D, Dalton MA, El-Omar H, Ahmed RM, Piguet O, Irish M. Exploring graded profiles of hippocampal atrophy along the anterior-posterior axis in semantic dementia and Alzheimer's disease. Neurobiol Aging 2024; 135:70-78. [PMID: 38232501 DOI: 10.1016/j.neurobiolaging.2024.01.004] [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: 07/13/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 01/19/2024]
Abstract
Mounting evidence indicates marked hippocampal degeneration in semantic dementia (SD) however, the spatial distribution of hippocampal atrophy profiles in this syndrome remains unclear. Using a recently developed parcellation approach, we extracted hippocampal volumes from four distinct subregions running from anterior to posterior along the longitudinal axis (anterior, intermediate rostral, intermediate caudal, and posterior). Volumetric differences in hippocampal subregions were compared between 21 SD, 24 matched Alzheimer's disease (AD), and 27 healthy older Control participants. Despite comparable overall hippocampal volume loss, SD and AD groups diverged in terms of the magnitude of atrophy along the anterior-posterior axis of the hippocampus. Global hippocampal atrophy was observed in AD, with no discernible gradation or lateralisation. In contrast, SD patients displayed graded bilateral hippocampal atrophy, most pronounced on the left-hand side, and concentrated in anterior relative to posterior subregions. Finally, we found preliminary evidence that disease-specific vulnerability along the anterior-posterior axis of the hippocampus was associated with canonical clinical features of these syndromes.
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Affiliation(s)
- Fang Lan
- 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
| | - Daniel Roquet
- 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
| | - Marshall A Dalton
- 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
| | - 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
| | - 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
| | - 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.
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Lorca-Puls DL, Gajardo-Vidal A, Mandelli ML, Illán-Gala I, Ezzes Z, Wauters LD, Battistella G, Bogley R, Ratnasiri B, Licata AE, Battista P, García AM, Tee BL, Lukic S, Boxer AL, Rosen HJ, Seeley WW, Grinberg LT, Spina S, Miller BL, Miller ZA, Henry ML, Dronkers NF, Gorno-Tempini ML. Neural basis of speech and grammar symptoms in non-fluent variant primary progressive aphasia spectrum. Brain 2024; 147:607-626. [PMID: 37769652 PMCID: PMC10834255 DOI: 10.1093/brain/awad327] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 07/28/2023] [Accepted: 08/29/2023] [Indexed: 10/03/2023] Open
Abstract
The non-fluent/agrammatic variant of primary progressive aphasia (nfvPPA) is a neurodegenerative syndrome primarily defined by the presence of apraxia of speech (AoS) and/or expressive agrammatism. In addition, many patients exhibit dysarthria and/or receptive agrammatism. This leads to substantial phenotypic variation within the speech-language domain across individuals and time, in terms of both the specific combination of symptoms as well as their severity. How to resolve such phenotypic heterogeneity in nfvPPA is a matter of debate. 'Splitting' views propose separate clinical entities: 'primary progressive apraxia of speech' when AoS occurs in the absence of expressive agrammatism, 'progressive agrammatic aphasia' (PAA) in the opposite case, and 'AOS + PAA' when mixed motor speech and language symptoms are clearly present. While therapeutic interventions typically vary depending on the predominant symptom (e.g. AoS versus expressive agrammatism), the existence of behavioural, anatomical and pathological overlap across these phenotypes argues against drawing such clear-cut boundaries. In the current study, we contribute to this debate by mapping behaviour to brain in a large, prospective cohort of well characterized patients with nfvPPA (n = 104). We sought to advance scientific understanding of nfvPPA and the neural basis of speech-language by uncovering where in the brain the degree of MRI-based atrophy is associated with inter-patient variability in the presence and severity of AoS, dysarthria, expressive agrammatism or receptive agrammatism. Our cross-sectional examination of brain-behaviour relationships revealed three main observations. First, we found that the neural correlates of AoS and expressive agrammatism in nfvPPA lie side by side in the left posterior inferior frontal lobe, explaining their behavioural dissociation/association in previous reports. Second, we identified a 'left-right' and 'ventral-dorsal' neuroanatomical distinction between AoS versus dysarthria, highlighting (i) that dysarthria, but not AoS, is significantly influenced by tissue loss in right-hemisphere motor-speech regions; and (ii) that, within the left hemisphere, dysarthria and AoS map onto dorsally versus ventrally located motor-speech regions, respectively. Third, we confirmed that, within the large-scale grammar network, left frontal tissue loss is preferentially involved in expressive agrammatism and left temporal tissue loss in receptive agrammatism. Our findings thus contribute to define the function and location of the epicentres within the large-scale neural networks vulnerable to neurodegenerative changes in nfvPPA. We propose that nfvPPA be redefined as an umbrella term subsuming a spectrum of speech and/or language phenotypes that are closely linked by the underlying neuroanatomy and neuropathology.
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Affiliation(s)
- Diego L Lorca-Puls
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
- Sección de Neurología, Departamento de Especialidades, Facultad de Medicina, Universidad de Concepción, Concepción, 4070105, Chile
| | - Andrea Gajardo-Vidal
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
- Centro de Investigación en Complejidad Social (CICS), Facultad de Gobierno, Universidad del Desarrollo, Santiago, 7590943, Chile
- Dirección de Investigación y Doctorados, Vicerrectoría de Investigación y Doctorados, Universidad del Desarrollo, Concepción, 4070001, Chile
| | - Maria Luisa Mandelli
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
| | - Ignacio Illán-Gala
- Sant Pau Memory Unit, Department of Neurology, Biomedical Research Institute Sant Pau, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, 08025, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Madrid, 28029, Spain
- Global Brain Health Institute, University of California, San Francisco, CA 94143, USA
| | - Zoe Ezzes
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
| | - Lisa D Wauters
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
- Department of Speech, Language and Hearing Sciences, University of Texas, Austin, TX 78712-0114, USA
| | - Giovanni Battistella
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
- Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA 02114, USA
| | - Rian Bogley
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
| | - Buddhika Ratnasiri
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
| | - Abigail E Licata
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
| | - Petronilla Battista
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
- Global Brain Health Institute, University of California, San Francisco, CA 94143, USA
- Laboratory of Neuropsychology, Istituti Clinici Scientifici Maugeri IRCCS, Bari, 70124, Italy
| | - Adolfo M García
- Global Brain Health Institute, University of California, San Francisco, CA 94143, USA
- Centro de Neurociencias Cognitivas, Universidad de San Andrés, Buenos Aires, B1644BID, Argentina
- Departamento de Lingüística y Literatura, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, 9160000, Chile
| | - Boon Lead Tee
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
- Global Brain Health Institute, University of California, San Francisco, CA 94143, USA
| | - Sladjana Lukic
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
- Department of Communication Sciences and Disorders, Ruth S. Ammon College of Education and Health Sciences, Adelphi University, Garden City, NY 11530-0701, USA
| | - Adam L Boxer
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
| | - Howard J Rosen
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
| | - William W Seeley
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
- Department of Pathology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Lea T Grinberg
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
- Global Brain Health Institute, University of California, San Francisco, CA 94143, USA
- Department of Pathology, University of California San Francisco, San Francisco, CA 94143, USA
| | - Salvatore Spina
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
- Global Brain Health Institute, University of California, San Francisco, CA 94143, USA
| | - Zachary A Miller
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
| | - Maya L Henry
- Department of Speech, Language and Hearing Sciences, University of Texas, Austin, TX 78712-0114, USA
- Department of Neurology, Dell Medical School, University of Texas, Austin, TX 78712, USA
| | - Nina F Dronkers
- Department of Psychology, University of California, Berkeley, CA 94720, USA
- Department of Neurology, University of California, Davis, CA 95817, USA
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California, SanFrancisco, CA 94158, USA
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Che XQ, Lin GZ, Liu XH, Wang G, Zhao QH, Ren RJ. Genetic and Neuroimaging Analysis of SIGMAR1 for Frontotemporal Dementia. J Alzheimers Dis 2023; 95:469-475. [PMID: 37545231 DOI: 10.3233/jad-221195] [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] [Indexed: 08/08/2023]
Abstract
BACKGROUND Recently, Sigma nonopioid intracellular receptor 1 (SIGMAR1) variants have been shown harboring C9orf72 pathogenic repeat expansions in some frontotemporal dementia (FTD) cases. However, no SIGMAR1 genotype analysis has been reported in a cohort absent of C9orf72 pathogenic repeat expansions to date. OBJECTIVE The present study investigated the contribution of SIGMAR1 independent of C9orf72 gene status to FTD spectrum syndromes. METHODS We directly sequencing the entire coding region and a minimum of 50 bp from each of the flanking introns of SIGMAR1 gene in 82 sporadic FTD patients (female: male = 42 : 40) and 417 controls. For the patient carrying SIGMAR1 variant, a follow-up 3T MR imaging was performed in the study. RESULTS Gene sequencing of SIGMAR1 revealed a rare 3'UTR nucleotide variation rs192856872 in a male patient with semantic dementia independent of C9orf72 gene status. The MR imaging showed asymmetrical atrophy in the anterior temporal lobes and the degeneration extends caudally into the posterior temporal lobes as the disease progresses. ESEFinder analysis showed new SRSF1 and SRSF1-IgM-BRCA1 binding sites with significant scores, which is predicted to affect normal splicing. CONCLUSION We found a novel SIGMAR1 variant independent of C9orf72 gene status associated with semantic dementia phenotype.
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Affiliation(s)
- Xiang-Qian Che
- Department of Neurology & Neuroscience Institute, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guo-Zhen Lin
- Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Hong Liu
- Department of Neurology, Shanghai Putuo District People's Hospital, Shanghai, China
| | - Gang Wang
- Department of Neurology & Neuroscience Institute, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian-Hua Zhao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
- MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Ru-Jing Ren
- Department of Neurology & Neuroscience Institute, Ruijin Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Hodgson VJ, Lambon Ralph MA, Jackson RL. The cross-domain functional organization of posterior lateral temporal cortex: insights from ALE meta-analyses of 7 cognitive domains spanning 12,000 participants. Cereb Cortex 2022; 33:4990-5006. [PMID: 36269034 PMCID: PMC10110446 DOI: 10.1093/cercor/bhac394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 11/12/2022] Open
Abstract
The posterior lateral temporal cortex is implicated in many verbal, nonverbal, and social cognitive domains and processes. Yet without directly comparing these disparate domains, the region's organization remains unclear; do distinct processes engage discrete subregions, or could different domains engage shared neural correlates and processes? Here, using activation likelihood estimation meta-analyses, the bilateral posterior lateral temporal cortex subregions engaged in 7 domains were directly compared. These domains comprised semantics, semantic control, phonology, biological motion, face processing, theory of mind, and representation of tools. Although phonology and biological motion were predominantly associated with distinct regions, other domains implicated overlapping areas, perhaps due to shared underlying processes. Theory of mind recruited regions implicated in semantic representation, tools engaged semantic control areas, and faces engaged subregions for biological motion and theory of mind. This cross-domain approach provides insight into how posterior lateral temporal cortex is organized and why.
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Affiliation(s)
- Victoria J Hodgson
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, United Kingdom
| | - Matthew A Lambon Ralph
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, United Kingdom
| | - Rebecca L Jackson
- MRC Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, United Kingdom.,Department of Psychology & York Biomedical Research Institute, University of York, Heslington, York, YO10 5DD, United Kingdom
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Carthery-Goulart MT, de Oliveira R, de Almeida IJ, Campanha A, da Silva Souza D, Zana Y, Caramelli P, Machado TH. Sentence Comprehension in Primary Progressive Aphasia: A Study of the Application of the Brazilian Version of the Test for the Reception of Grammar (TROG2-Br). Front Neurol 2022; 13:815227. [PMID: 35651345 PMCID: PMC9149594 DOI: 10.3389/fneur.2022.815227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Sentence-comprehension deficits have been described in patients with primary progressive aphasia (PPA). However, most instruments to address this domain in more detail and in a clinical context have not been adapted and translated into several languages, posing limitations to clinical practice and cross-language research. Objectives The study aimed to (1) test the applicability of the Brazilian version of the Test for Reception of Grammar (TROG2-Br) to detect morphosyntactic deficits in patients with PPA; (2) investigate the association between performance in the test and sociodemographic and clinical variables (age, years of formal education, and disease duration); (3) characterize the performance of individuals presenting with the three more common variants of PPA (non-fluent, semantic, and logopenic) and mixed PPA (PPA-Mx) and analyze whether TROG-2 may assist in the distinction of these clinical profiles. Methods A total of 74 cognitively healthy participants and 34 individuals diagnosed with PPA were assessed with TROG2-Br. Overall scores (correct items, passed blocks), types, and categories of errors were analyzed. Results In controls, block scores were significantly correlated with years of formal education (Spearman's r = 0.33, p = 004) but not with age. In PPA, age, education, and disease duration were not significantly associated with performance in the test. Controls presented a significantly higher performance on TROG2-Br compared to PPA individuals and their errors pattern pointed to mild general cognitive processing difficulties (attention, working memory). PPA error types pointed to processing and morphosyntactic deficits in nonfluent or agrammatic PPA, (PPA-NF/A), logopenic PPA (PPA-L), and PPA-Mx. The semantic PPA (PPA-S) subgroup was qualitatively more similar to controls (processing difficulties and lower percentage of morphosyntactic errors). TROG2-Br presented good internal consistency and concurrent validity. Discussion Our results corroborate findings with TROG-2 in other populations. The performance of typical older adults with heterogeneous levels of education is discussed along with recommendations for clinical use of the test and future directions of research.
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Affiliation(s)
- Maria Teresa Carthery-Goulart
- Federal University of ABC (UFABC), Mathematics, Computing and Cognition Center (CMCC), São Bernardo do Campo, Brazil.,INCT-ECCE (Instituto Nacional de Ciência e Tecnologia sobre Comportamento, Cognição e Ensino), São Carlos, Brazil.,Cognitive and Behavioral Neurology Research Group of the Department of Neurology of the University of São Paulo (USP), School of Medicine, São Paulo, Brazil
| | - Rosimeire de Oliveira
- Federal University of ABC (UFABC), Mathematics, Computing and Cognition Center (CMCC), São Bernardo do Campo, Brazil
| | - Isabel Junqueira de Almeida
- Cognitive and Behavioral Neurology Research Group of the Department of Neurology of the University of São Paulo (USP), School of Medicine, São Paulo, Brazil
| | - Aline Campanha
- Cognitive and Behavioral Neurology Research Group, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Dayse da Silva Souza
- Federal University of ABC (UFABC), Mathematics, Computing and Cognition Center (CMCC), São Bernardo do Campo, Brazil
| | - Yossi Zana
- Federal University of ABC (UFABC), Mathematics, Computing and Cognition Center (CMCC), São Bernardo do Campo, Brazil
| | - Paulo Caramelli
- Cognitive and Behavioral Neurology Research Group, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Thais Helena Machado
- Cognitive and Behavioral Neurology Research Group, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
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8
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Riello M, Frangakis CE, Ficek B, Webster KT, Desmond JE, Faria AV, Hillis AE, Tsapkini K. Neural Correlates of Letter and Semantic Fluency in Primary Progressive Aphasia. Brain Sci 2021; 12:1. [PMID: 35053745 PMCID: PMC8773895 DOI: 10.3390/brainsci12010001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/21/2022] Open
Abstract
Verbal fluency (VF) is an informative cognitive task. Lesion and functional imaging studies implicate distinct cerebral areas that support letter versus semantic fluency and the understanding of neural and cognitive mechanisms underlying task performance. Most lesion studies include chronic stroke patients. People with primary progressive aphasia (PPA) provide complementary evidence for lesion-deficit associations, as different brain areas are affected in stroke versus PPA. In the present study we sought to determine imaging, clinical and demographic correlates of VF in PPA. Thirty-five patients with PPA underwent an assessment with letter and category VF tasks, evaluation of clinical features and an MRI scan for volumetric analysis. We used stepwise regression models to determine which brain areas are associated with VF performance while acknowledging the independent contribution of clinical and demographic factors. Letter fluency was predominantly associated with language severity (R2 = 38%), and correlated with the volume of the left superior temporal regions (R2 = 12%) and the right dorsolateral prefrontal area (R2 = 5%). Semantic fluency was predominantly associated with dementia severity (R2 = 47%) and correlated with the volume of the left inferior temporal gyrus (R2 = 7%). No other variables were significantly associated with performance in the two VF tasks. We concluded that, independently of disease severity, letter fluency is significantly associated with the volume of frontal and temporal areas whereas semantic fluency is associated mainly with the volume of temporal areas. Furthermore, our findings indicated that clinical severity plays a critical role in explaining VF performance in PPA, compared to the other clinical and demographic factors.
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Affiliation(s)
- Marianna Riello
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (M.R.); (B.F.); (K.T.W.); (J.E.D.); (A.E.H.)
| | - Constantine E. Frangakis
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD 21227, USA;
- Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD 21227, USA;
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21227, USA
| | - Bronte Ficek
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (M.R.); (B.F.); (K.T.W.); (J.E.D.); (A.E.H.)
| | - Kimberly T. Webster
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (M.R.); (B.F.); (K.T.W.); (J.E.D.); (A.E.H.)
- Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21227, USA
| | - John E. Desmond
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (M.R.); (B.F.); (K.T.W.); (J.E.D.); (A.E.H.)
| | - Andreia V. Faria
- Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD 21227, USA;
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (M.R.); (B.F.); (K.T.W.); (J.E.D.); (A.E.H.)
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (M.R.); (B.F.); (K.T.W.); (J.E.D.); (A.E.H.)
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD 21218, USA
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9
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Patel N, Peterson KA, Ingram RU, Storey I, Cappa SF, Catricala E, Halai A, Patterson KE, Lambon Ralph MA, Rowe JB, Garrard P. A 'Mini Linguistic State Examination' to classify primary progressive aphasia. Brain Commun 2021; 4:fcab299. [PMID: 35282164 PMCID: PMC8914496 DOI: 10.1093/braincomms/fcab299] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 09/27/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022] Open
Abstract
There are few available methods for qualitatively evaluating patients with primary progressive aphasia. Commonly adopted approaches are time-consuming, of limited accuracy or designed to assess different patient populations. This paper introduces a new clinical test-the Mini Linguistic State Examination-which was designed uniquely to enable a clinician to assess and subclassify both classical and mixed presentations of primary progressive aphasia. The adoption of a novel assessment method (error classification) greatly amplifies the clinical information that can be derived from a set of standard linguistic tasks and allows a five-dimensional profile to be defined. Fifty-four patients and 30 matched controls were recruited. Five domains of language competence (motor speech, phonology, semantics, syntax and working memory) were assessed using a sequence of 11 distinct linguistic assays. A random forest classification was used to assess the diagnostic accuracy for predicting primary progressive aphasia subtypes and create a decision tree as a guide to clinical classification. The random forest prediction model was 96% accurate overall (92% for the logopenic variant, 93% for the semantic variant and 98% for the non-fluent variant). The derived decision tree produced a correct classification of 91% of participants whose data were not included in the training set. The Mini Linguistic State Examination is a new cognitive test incorporating a novel and powerful, yet straightforward, approach to scoring. Rigorous assessment of its diagnostic accuracy confirmed excellent matching of primary progressive aphasia syndromes to clinical gold standard diagnoses. Adoption of the Mini Linguistic State Examination by clinicians will have a decisive impact on the consistency and uniformity with which patients can be described clinically. It will also facilitate screening for cohort-based research, including future therapeutic trials, and is suitable for describing, quantifying and monitoring language deficits in other brain disorders.
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Affiliation(s)
- Nikil Patel
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, London SW17 0RE, UK
| | - Katie A. Peterson
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge CB2 0SP, UK
| | - Ruth U. Ingram
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester M13 9PL, UK
| | - Ian Storey
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, London SW17 0RE, UK
| | - Stefano F. Cappa
- University Institute for Advanced Studies IUSS, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | | | - Ajay Halai
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge CB2 0SP, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
| | - Karalyn E. Patterson
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge CB2 0SP, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
| | | | - James B. Rowe
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge CB2 0SP, UK
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
| | - Peter Garrard
- Molecular and Clinical Sciences Research Institute, St George’s, University of London, London SW17 0RE, UK
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10
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Lukic S, Borghesani V, Weis E, Welch A, Bogley R, Neuhaus J, Deleon J, Miller ZA, Kramer JH, Miller BL, Dronkers NF, Gorno-Tempini ML. Dissociating nouns and verbs in temporal and perisylvian networks: Evidence from neurodegenerative diseases. Cortex 2021; 142:47-61. [PMID: 34182153 PMCID: PMC8556704 DOI: 10.1016/j.cortex.2021.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 02/27/2021] [Accepted: 05/08/2021] [Indexed: 12/11/2022]
Abstract
Naming of nouns and verbs can be selectively impaired in neurological disorders, but the specificity of the neural and cognitive correlates of such dissociation remains unclear. Functional imaging and stroke research sought to identify cortical regions selectively recruited for nouns versus verbs, yet findings are inconsistent. The present study investigated this issue in neurodegenerative diseases known to selectively affect different brain networks, thus providing new critical evidence of network specificity. We examined naming performances on nouns and verbs in 146 patients with different neurodegenerative syndromes (Primary Progressive Aphasia - PPA, Alzheimer's disease - AD, and behavioral variant Frontotemporal Dementia - FTD) and 30 healthy adults. We then correlated naming scores with MRI-derived cortical thickness values as well as with performances in semantic and syntactic tasks, across all subjects. Results indicated that patients with the semantic variant PPA named significantly fewer nouns than verbs. Instead, nonfluent/agrammatic PPA patients named fewer verbs than nouns. Across all subjects, performance on nouns (adjusted for verbs) specifically correlated with cortical atrophy in left anterior temporal regions, and performance on verbs (adjusted for nouns) with atrophy in left inferior and middle frontal, inferior parietal and posterior temporal regions. Furthermore, lower lexical-semantic abilities correlated with deficits in naming both nouns and verbs, while lower syntactic abilities only correlated with naming verbs. Our results show that different neural and cognitive mechanisms underlie naming of specific grammatical categories in neurodegenerative diseases. Importantly, our findings showed that verb processing depends on a widespread perisylvian networks, suggesting that some regions might be involved in processing different types of action knowledge. These findings have important implications for early differential diagnosis of neurodegenerative disorders.
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Affiliation(s)
- Sladjana Lukic
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA.
| | - Valentina Borghesani
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Elizabeth Weis
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Ariane Welch
- 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
| | - John Neuhaus
- 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
| | - Zachary A Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Joel H Kramer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
| | - Nina F Dronkers
- University of California, Berkeley, CA, USA; University of California, Davis, CA, USA
| | - Maria L Gorno-Tempini
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA
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11
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Lakretz Y, Hupkes D, Vergallito A, Marelli M, Baroni M, Dehaene S. Mechanisms for handling nested dependencies in neural-network language models and humans. Cognition 2021; 213:104699. [PMID: 33941375 DOI: 10.1016/j.cognition.2021.104699] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 03/17/2021] [Accepted: 03/22/2021] [Indexed: 11/25/2022]
Abstract
Recursive processing in sentence comprehension is considered a hallmark of human linguistic abilities. However, its underlying neural mechanisms remain largely unknown. We studied whether a modern artificial neural network trained with "deep learning" methods mimics a central aspect of human sentence processing, namely the storing of grammatical number and gender information in working memory and its use in long-distance agreement (e.g., capturing the correct number agreement between subject and verb when they are separated by other phrases). Although the network, a recurrent architecture with Long Short-Term Memory units, was solely trained to predict the next word in a large corpus, analysis showed the emergence of a very sparse set of specialized units that successfully handled local and long-distance syntactic agreement for grammatical number. However, the simulations also showed that this mechanism does not support full recursion and fails with some long-range embedded dependencies. We tested the model's predictions in a behavioral experiment where humans detected violations in number agreement in sentences with systematic variations in the singular/plural status of multiple nouns, with or without embedding. Human and model error patterns were remarkably similar, showing that the model echoes various effects observed in human data. However, a key difference was that, with embedded long-range dependencies, humans remained above chance level, while the model's systematic errors brought it below chance. Overall, our study shows that exploring the ways in which modern artificial neural networks process sentences leads to precise and testable hypotheses about human linguistic performance.
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Affiliation(s)
- Yair Lakretz
- Cognitive Neuroimaging Unit, CEA, INSERM, Université Paris-Saclay, NeuroSpin center, 91191 Gif/Yvette, France.
| | | | | | - Marco Marelli
- Department of Psychology and NeuroMi, University of Milano Bicocca, Milano, Italy
| | - Marco Baroni
- Facebook AI Research, Paris, France; Catalan Institute for Research and Advanced Studies, Barcelona 08010, Spain
| | - Stanislas Dehaene
- Cognitive Neuroimaging Unit, CEA, INSERM, Université Paris-Saclay, NeuroSpin center, 91191 Gif/Yvette, France; Collège de France, Université Paris-Sciences-Lettres (PSL), 11 Place Marcelin Berthelot, 75005 Paris, France
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12
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Lasaponara S, Marson F, Doricchi F, Cavallo M. A Scoping Review of Cognitive Training in Neurodegenerative Diseases via Computerized and Virtual Reality Tools: What We Know So Far. Brain Sci 2021; 11:528. [PMID: 33919244 PMCID: PMC8143131 DOI: 10.3390/brainsci11050528] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 11/17/2022] Open
Abstract
Most prevalent neurodegenerative diseases such as Alzheimer's disease, frontotemporal dementia, Parkinson's disease and multiple sclerosis are heterogeneous in their clinical profiles and underlying pathophysiology, although they typically share the presence of cognitive impairment that worsens significantly during the course of the disease. Viable pharmacological options for cognitive symptoms in these clinical conditions are currently lacking. In recent years, several studies have started to apply Computerized Cognitive Training (CCT) and Virtual Reality (VR) tools to try and contrast patients' cognitive decay over time. However, no in-depth literature review of the contribution of these promising therapeutic options across main neurodegenerative diseases has been conducted yet. The present paper reports the state-of-the-art of CCT and VR studies targeting cognitive impairment in most common neurodegenerative conditions. Our twofold aim is to point out the scientific evidence available so far and to support health professionals to consider these promising therapeutic tools when planning rehabilitative interventions, especially when the access to regular and frequent hospital consultations is not easy to be provided.
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Affiliation(s)
- Stefano Lasaponara
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy; (S.L.); (F.D.)
- Department of Human Sciences, LUMSA University, 00193 Rome, Italy
| | - Fabio Marson
- Research Institute for Neuroscience, Education and Didactics, Fondazione Patrizio Paoletti, 06081 Assisi, Italy;
- Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy
| | - Fabrizio Doricchi
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy; (S.L.); (F.D.)
- Department of Neuropsychology, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
| | - Marco Cavallo
- Faculty of Psychology, eCampus University, 22060 Novedrate, Italy
- Clinical Psychology Service, Saint George Foundation, 12030 Cavallermaggiore, Italy
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13
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Marson F, Lasaponara S, Cavallo M. A Scoping Review of Neuromodulation Techniques in Neurodegenerative Diseases: A Useful Tool for Clinical Practice? ACTA ACUST UNITED AC 2021; 57:medicina57030215. [PMID: 33673455 PMCID: PMC7997187 DOI: 10.3390/medicina57030215] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/14/2021] [Accepted: 02/23/2021] [Indexed: 12/16/2022]
Abstract
Background and Objectives: Neurodegenerative diseases that typically affect the elderly such as Alzheimer’s disease, Parkinson’s disease and frontotemporal dementia are typically characterised by significant cognitive impairment that worsens significantly over time. To date, viable pharmacological options for the cognitive symptoms in these clinical conditions are lacking. In recent years, various studies have employed neuromodulation techniques to try and contrast patients’ decay. Materials and Methods: We conducted an in-depth literature review of the state-of-the-art of the contribution of these techniques across these neurodegenerative diseases. Results: The present review reports that neuromodulation techniques targeting cognitive impairment do not allow to draw yet any definitive conclusion about their clinical efficacy although preliminary evidence is very encouraging. Conclusions: Further and more robust studies should evaluate the potentialities and limitations of the application of these promising therapeutic tools to neurodegenerative diseases.
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Affiliation(s)
- Fabio Marson
- Research Institute for Neuroscience, Education and Didactics, Fondazione Patrizio Paoletti, 06081 Assisi, Italy;
- Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy
| | - Stefano Lasaponara
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy;
- Department of Human Sciences, LUMSA University, 00193 Rome, Italy
| | - Marco Cavallo
- Faculty of Psychology, eCampus University, 22060 Novedrate, Italy
- Clinical Psychology Service, Saint George Foundation, 12030 Cavallermaggiore, Italy
- Correspondence: ; Tel.: +39-3478306430
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14
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Arshad F, Paplikar A, Mekala S, Varghese F, Purushothaman VV, Kumar DJ, Shingavi L, Vengalil S, Ramakrishnan S, Yadav R, Pal PK, Nalini A, Alladi S. Social Cognition Deficits Are Pervasive across Both Classical and Overlap Frontotemporal Dementia Syndromes. Dement Geriatr Cogn Dis Extra 2020; 10:115-126. [PMID: 33442389 PMCID: PMC7772884 DOI: 10.1159/000511329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 12/12/2022] Open
Abstract
Objectives Frontotemporal dementia (FTD) syndromes are a complex group of disorders characterised by profound changes in behaviour and cognition. Many of the observed behavioural abnormalities are now recognised to be due to impaired social cognition. While deficits in emotion recognition and empathy are well-recognised in behavioural-variant (Bv)FTD, limited information exists about the nature of social cognitive impairment in the language variant primary progressive aphasia (PPA) that includes progressive non-fluent aphasia (PNFA) and semantic dementia (SD), and in the motor variants FTD amyotrophic lateral sclerosis (FTD-ALS) and FTD progressive supranuclear palsy (FTD-PSP). This prospective study sought to explore the nature and profile of social cognition deficits across the spectrum of FTD. Methods Sixty patients on the FTD spectrum, i.e., classical (16 with BvFTD and 20 with PPA) and overlap FTD syndromes (13 with FTD-ALS and 11 with FTD-PSP) were evaluated by means of the social cognition tasks, the Interpersonal Reactivity Index (IRI) for empathy, and pictures of facial affect (POFA) for emotion recognition. General cognition and behaviour were also assessed. Results A significant impairment in emotion recognition and empathy was detected in both the classical and overlap FTD syndromes. The recognition of positive emotions was relatively preserved compared to that of negative emotions. Among the FTD subtypes, maximal impairment of empathy was demonstrated in FTD-PSP. Conclusion Social cognition impairment is pervasive across the spectrum of FTD disorders, and tests of emotion recognition and empathy are clinically useful to identify the nature of behavioural problems in both classical and overlap FTD. Our findings also have implications for understanding the neural basis of social cognition in FTD.
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Affiliation(s)
- Faheem Arshad
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Avanthi Paplikar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Shailaja Mekala
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Feba Varghese
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Darshini Jeevandra Kumar
- Department of Speech Pathology and Audiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Leena Shingavi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Subasree Ramakrishnan
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Atchayaram Nalini
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
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15
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Häkkinen S, Chu SA, Lee SE. Neuroimaging in genetic frontotemporal dementia and amyotrophic lateral sclerosis. Neurobiol Dis 2020; 145:105063. [PMID: 32890771 DOI: 10.1016/j.nbd.2020.105063] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/30/2020] [Accepted: 08/26/2020] [Indexed: 02/06/2023] Open
Abstract
Frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS) have a strong clinical, genetic and pathological overlap. This review focuses on the current understanding of structural, functional and molecular neuroimaging signatures of genetic FTD and ALS. We overview quantitative neuroimaging studies on the most common genes associated with FTD (MAPT, GRN), ALS (SOD1), and both (C9orf72), and summarize visual observations of images reported in the rarer genes (CHMP2B, TARDBP, FUS, OPTN, VCP, UBQLN2, SQSTM1, TREM2, CHCHD10, TBK1).
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Affiliation(s)
- Suvi Häkkinen
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Stephanie A Chu
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Suzee E Lee
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
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16
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Luzzatti C, Mauri I, Castiglioni S, Zuffi M, Spartà C, Somalvico F, Franceschi M. Evaluating Semantic Knowledge Through a Semantic Association Task in Individuals With Dementia. Am J Alzheimers Dis Other Demen 2020; 35:1533317520917294. [PMID: 32308008 PMCID: PMC10623912 DOI: 10.1177/1533317520917294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2024]
Abstract
Conceptual knowledge is supported by multiple semantic systems that are specialized for the analysis of different properties associated with object concepts. Various types of semantic association between concrete concepts-categorical (CA), encyclopedic (EA), functional (FA), and visual-encyclopedic (VEA) associations-were tested through a new picture-to-picture matching task (semantic association task, SAT). Forty individuals with Alzheimer's disease (AD), 13 with behavioral variant of frontotemporal dementia (bv-FTD), 6 with primary progressive aphasia (PPA), and 37 healthy participants were tested with the SAT. Within-group comparisons highlighted a global impairment of all types of semantic association in bv-FTD individuals but a disproportionate impairment of EA and FA, with relative sparing of CA and VEA, in AD individuals. Single-case analyses detected dissociations in all dementia groups. Conceptual knowledge can be selectively impaired in various types of neurodegenerative disease on the basis of the specific cognitive process that is disrupted.
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Affiliation(s)
- Claudio Luzzatti
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
| | - Ilaria Mauri
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
| | | | - Marta Zuffi
- Department of Neurology, MultiMedica Hospital, Castellanza, Italy
| | - Chiara Spartà
- Department of Psychology, University of Milan-Bicocca, Milan, Italy
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17
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Prabhakar AT, Mathew V, Sivadasan A, Aaron S, George A, Alexander M. Clinical profile of primary progressive aphasias in a tertiary care centre from India. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2019; 21:547-552. [PMID: 30642192 DOI: 10.1080/17549507.2018.1545870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 10/25/2018] [Accepted: 10/31/2018] [Indexed: 06/09/2023]
Abstract
Purpose: Progressive language dysfunction due to a selective neurodegeneration of the language networks is called primary progressive aphasia (PPA). However, demographic data on PPA is limited. In this study from India, we determined the prevalence and clinical profile of patients presenting with PPA and its subtypes.Method: Patients who were admitted to the neurosciences department during the period between January 2012 and December 2016 were screened, and patients who presented with slowly progressive aphasia for at least 2 years without other significant cognitive or behavioural symptoms and preservation of daily living activities were included. Patients had to fulfil the international consensus group criteria for PPA. All patients were evaluated with the mini-mental status examination (MMSE) and Strub and Black battery for neuropsychological testing. The language was tested using the progressive aphasia language scale (PALS).Result: During the study period from January 2012 to December 2016, 23 patients fulfilled the international consensus criteria for PPA. Of these, 16 (69.6%) patients were diagnosed with PPA-G, 6 (26%) patients had PPA-S and 1 (4.4%) patient had PPA-L.Conclusion: PPA is not an uncommon entity in India and the most common subtype in this study was PPA-G.
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Affiliation(s)
| | - Vivek Mathew
- Department of neurological sciences, Christian medical college, Vellore, India
| | - Ajith Sivadasan
- Department of neurological sciences, Christian medical college, Vellore, India
| | - Sanjith Aaron
- Department of neurological sciences, Christian medical college, Vellore, India
| | - Anirudh George
- Department of neurological sciences, Christian medical college, Vellore, India
| | - Mathew Alexander
- Department of neurological sciences, Christian medical college, Vellore, India
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18
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Lukic S, Mandelli ML, Welch A, Jordan K, Shwe W, Neuhaus J, Miller Z, Hubbard HI, Henry M, Miller BL, Dronkers NF, Gorno-Tempini ML. Neurocognitive basis of repetition deficits in primary progressive aphasia. BRAIN AND LANGUAGE 2019; 194:35-45. [PMID: 31055171 PMCID: PMC6669076 DOI: 10.1016/j.bandl.2019.04.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 04/10/2019] [Accepted: 04/13/2019] [Indexed: 05/15/2023]
Abstract
Previous studies indicate that repetition is affected in primary progressive aphasia (PPA), particularly in the logopenic variant, due to limited auditory-verbal short-term memory (avSTM). We tested repetition of phrases varied by length (short, long) and meaning (meaningful, non-meaningful) in 58 participants (22 logopenic, 19 nonfluent, and 17 semantic variants) and 21 healthy controls using a modified Bayles repetition test. We evaluated the relation between cortical thickness and repetition performance and whether sub-scores could discriminate PPA variants. Logopenic participants showed impaired repetition across all phrases, specifically in repeating long phrases and any phrases that were non-meaningful. Nonfluent, semantic, and healthy control participants only had difficulty repeating long, non-meaningful phrases. Poor repetition of long phrases was associated with cortical thinning in left temporo-parietal areas across all variants, highlighting the importance of these areas in avSTM. Finally, Bayles repetition phrases can assist classification in PPA, discriminating logopenic from nonfluent/semantic participants with 89% accuracy.
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Affiliation(s)
- Sladjana Lukic
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA 94158, USA.
| | - Maria Luisa Mandelli
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA 94158, USA
| | - Ariane Welch
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA 94158, USA
| | - Kesshi Jordan
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA 94158, USA
| | - Wendy Shwe
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA 94158, USA
| | - John Neuhaus
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA 94158, USA
| | - Zachary Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA 94158, USA
| | | | - Maya Henry
- University of Texas, Austin, TX 78705, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA 94158, USA
| | - Nina F Dronkers
- University of California, Berkeley, CA 94720, USA; University of California, Davis, CA 95616, USA
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA 94158, USA
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19
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Ash S, Nevler N, Phillips J, Irwin DJ, McMillan CT, Rascovsky K, Grossman M. A longitudinal study of speech production in primary progressive aphasia and behavioral variant frontotemporal dementia. BRAIN AND LANGUAGE 2019; 194:46-57. [PMID: 31075725 PMCID: PMC6656376 DOI: 10.1016/j.bandl.2019.04.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 02/10/2019] [Accepted: 04/22/2019] [Indexed: 05/03/2023]
Abstract
We examined longitudinal change in language expression during a semi-structured speech sample in 48 patients with primary progressive aphasia (PPA) or behavioral variant frontotemporal dementia (bvFTD) and related this to longitudinal neuroimaging of cortical thickness available in 25 of these patients. All patient groups declined significantly on measures of both speech fluency and grammar, although patients with nonfluent/agrammatic PPA (naPPA) declined to a greater extent than patients with the semantic variant, the logopenic variant, and bvFTD. These patient groups also declined on several neuropsychological measures, but there was no correlation between decline in speech expression and decline in neuropsychological performance. Longitudinal decline in grammaticality, assessed by the number of well-formed sentences produced, was associated with longitudinal progression of gray matter atrophy in left frontal operculum/insula and bilateral temporal cortex.
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Affiliation(s)
- Sharon Ash
- Penn Frontotemporal Degeneration Center and Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, United States.
| | - Naomi Nevler
- Penn Frontotemporal Degeneration Center and Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, United States
| | - Jeffrey Phillips
- Penn Frontotemporal Degeneration Center and Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, United States
| | - David J Irwin
- Penn Frontotemporal Degeneration Center and Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, United States
| | - Corey T McMillan
- Penn Frontotemporal Degeneration Center and Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, United States
| | - Katya Rascovsky
- Penn Frontotemporal Degeneration Center and Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, United States
| | - Murray Grossman
- Penn Frontotemporal Degeneration Center and Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, United States
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Chen Y, Chen K, Ding J, Zhang Y, Yang Q, Lv Y, Guo Q, Han Z. Neural substrates of amodal and modality-specific semantic processing within the temporal lobe: A lesion-behavior mapping study of semantic dementia. Cortex 2019; 120:78-91. [PMID: 31280071 DOI: 10.1016/j.cortex.2019.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 03/27/2019] [Accepted: 05/29/2019] [Indexed: 11/29/2022]
Abstract
Although the human temporal lobe has been documented to participate in semantic processing of both verbal and nonverbal stimuli, the exact neural basis underlying the common and unique processing of the two modalities is unclear. Semantic dementia (SD), a disease with a semantic-selective deficit due to predominant temporal lobe atrophy is an ideal lesion model to address this issue. However, many previous studies of SD used an impure patient sample or did not appropriately control for common components between tasks. To overcome these limitations, the present study aims to identify amodal semantic hubs and modality-specific regions in the temporal lobe by investigating behavioral performance on a verbal modality task (word associative matching) and a nonverbal modality task (picture associative matching) and neuroimaging data in 33 SD patients. We found that the left anterior fusiform gyrus was an amodal semantic hub whose gray matter volume correlated significantly with both modalities. We also observed two verbal modality-specific regions (the left posterior inferior temporal gyrus and the left middle superior temporal gyrus) and a nonverbal modality-specific region (the right lateral anterior middle temporal gyrus) whose gray matter volume correlated significantly with one modality when performance on the other modality was partialled out. The results remained significant when we excluded a wide range of potential confounding variables. Furthermore, to confirm the observed effects, we compared the performance of left- and right-hemispheric-predominant atrophic patients on the verbal and nonverbal tasks. The left-predominant patients showed more severe deficits in performance of the verbal task than the right-predominant patients, whereas the two groups of patients presented comparable deficits in the performance of the nonverbal task. These findings refined the structure of semantic network in the temporal lobe, deepening our understanding of the critical role of the temporal lobe in semantic processing.
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Affiliation(s)
- Yan Chen
- State Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal University, 100875, China; College of Biomedical Engineering and Instrument Sciences, Zhejiang University, 310027, China
| | - Keliang Chen
- Department of Neurology, Huashan Hospital, Fudan University, 200040, China
| | - Junhua Ding
- State Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal University, 100875, China
| | - Yumei Zhang
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, 100050, China
| | - Qing Yang
- Department of Neurology, Huashan Hospital, Fudan University, 200040, China
| | - Yingru Lv
- Department of Radiology, Huashan Hospital, Fudan University, 200040, China
| | - Qihao Guo
- Department of Gerontology, Shanghai Jiaotong University Affiliated Sixth People's Hospital, 200233, China
| | - Zaizhu Han
- State Key Laboratory of Cognitive Neuroscience and Learning, IDG/McGovern Institute for Brain Research, Beijing Normal University, 100875, China.
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Convery R, Mead S, Rohrer JD. Review: Clinical, genetic and neuroimaging features of frontotemporal dementia. Neuropathol Appl Neurobiol 2019; 45:6-18. [DOI: 10.1111/nan.12535] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 12/10/2018] [Indexed: 12/12/2022]
Affiliation(s)
- R. Convery
- Dementia Research Centre; Department of Neurodegenerative Disease; UCL Queen Square Institute of Neurology; London UK
| | - S. Mead
- UCL Institute of Prion Diseases; MRC Prion Unit at UCL; London UK
| | - J. D. Rohrer
- Dementia Research Centre; Department of Neurodegenerative Disease; UCL Queen Square Institute of Neurology; London UK
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Nevler N, Ash S, Irwin DJ, Liberman M, Grossman M. Validated automatic speech biomarkers in primary progressive aphasia. Ann Clin Transl Neurol 2018; 6:4-14. [PMID: 30656179 PMCID: PMC6331511 DOI: 10.1002/acn3.653] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 12/13/2022] Open
Abstract
Objective To automatically extract and quantify specific disease biomarkers of prosody from the acoustic properties of speech in patients with primary progressive aphasia. Methods We analyzed speech samples from 59 progressive aphasic patients (non‐fluent/agrammatic = 15, semantic = 21, logopenic = 23; ages 50–85 years) and 31 matched healthy controls (ages 54–89 years). Using a novel, automated speech analysis protocol, we extracted acoustic measurements of prosody, including fundamental frequency and speech and silent pause durations, and compared these between groups. We then examined their relationships with clinical tests, gray matter atrophy, and cerebrospinal fluid analytes. Results We found a narrowed range of fundamental frequency in patients with non‐fluent/agrammatic variant aphasia (mean 3.86 ± 1.15 semitones) compared with healthy controls (6.06 ± 1.95 semitones; P < 0.001) and patients with semantic variant aphasia (6.12 ± 1.77 semitones; P = 0.001). Mean pause rate was significantly increased in the non‐fluent/agrammatic group (mean 61.4 ± 20.8 pauses per minute) and the logopenic group (58.7 ± 16.4 pauses per minute) compared to controls. In an exploratory analysis, narrowed fundamental frequency range was associated with atrophy in the left inferior frontal cortex. Cerebrospinal level of phosphorylated tau was associated with an acoustic classifier combining fundamental frequency range and pause rate (r = 0.58, P = 0.007). Receiver operating characteristic analysis with this combined classifier distinguished non‐fluent/agrammatic speakers from healthy controls (AUC = 0.94) and from semantic variant patients (AUC = 0.86). Interpretation Restricted fundamental frequency range and increased pause rate are characteristic markers of speech in non‐fluent/agrammatic primary progressive aphasia. These can be extracted with automated speech analysis and are associated with left inferior frontal atrophy and cerebrospinal phosphorylated tau level.
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Affiliation(s)
- Naomi Nevler
- Penn Frontotemporal Degeneration Center Department of Neurology University of Pennsylvania Philadelphia Pennsylvania
| | - Sharon Ash
- Penn Frontotemporal Degeneration Center Department of Neurology University of Pennsylvania Philadelphia Pennsylvania
| | - David J Irwin
- Penn Frontotemporal Degeneration Center Department of Neurology University of Pennsylvania Philadelphia Pennsylvania
| | - Mark Liberman
- Linguistic Data Consortium Department of Linguistics University of Pennsylvania Philadelphia Pennsylvania
| | - Murray Grossman
- Penn Frontotemporal Degeneration Center Department of Neurology University of Pennsylvania Philadelphia Pennsylvania
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Abstract
PURPOSE Primary progressive aphasia (PPA) is a neurological syndrome in which language functions become progressively impaired with relative sparing of memory and other instrumental functions. The pathologic causes of PPA are heterogeneous, but studies suggest that logopenic PPA (LPA) is underpinned by Alzheimer disease (AD) pathology in a high proportion of cases. The purposes of this descriptive and retrospective study were to characterize F-florbetapir PET imaging in a group of patients with a clinical syndrome of PPA, to determine the value of clinical characterization based on language phenotype in predicting the underlying pathology of PPA with F-florbetapir, and to quantify amyloid load in PPA subjects classified as "positive" F-florbetapir scans. Then, we compare the quantification and distribution of F-florbetapir uptake with those of typical, predominantly amnestic AD patients. METHODS We conducted a PET study with F-florbetapir in a cohort of 12 right-handed patients diagnosed with PPA: 3 patients with semantic-variant PPA, 5 with nonfluent PPA, 1 with LPA, and 3 unclassifiable patients. We evaluated amyloid deposition between APP groups and 11 patients with typical amnestic AD. RESULTS Among the 12 patients with PPA syndrome, 8 (66.7%) were considered as amyloid positive. One of the 3 patients with semantic-variant PPA was F-florbetapir positive. In contrast, 4 of the 5 nonfluent-variant PPA, 2 of the 3 unclassifiable cases and the single patient with LPA were F-florbetapir positive. A significantly higher F-florbetapir uptake was observed in PPA F-florbetapir-positive patients compared with typical AD patients. This difference was observed in all regions of interest, except in posterior cingulate and temporal cortex. CONCLUSIONS These results suggest that F-florbetapir PET may be useful in a routine clinical procedure to improve the reliability of identifying AD pathology in patients with PPA syndrome, with different clinical subtypes of the PPA syndrome.
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Dalton SGH, Shultz C, Henry ML, Hillis AE, Richardson JD. Describing Phonological Paraphasias in Three Variants of Primary Progressive Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:336-349. [PMID: 29497748 PMCID: PMC6111492 DOI: 10.1044/2017_ajslp-16-0210] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 06/19/2017] [Indexed: 05/15/2023]
Abstract
PURPOSE The purpose of this study was to describe the linguistic environment of phonological paraphasias in 3 variants of primary progressive aphasia (semantic, logopenic, and nonfluent) and to describe the profiles of paraphasia production for each of these variants. METHOD Discourse samples of 26 individuals diagnosed with primary progressive aphasia were investigated for phonological paraphasias using the criteria established for the Philadelphia Naming Test (Moss Rehabilitation Research Institute, 2013). Phonological paraphasias were coded for paraphasia type, part of speech of the target word, target word frequency, type of segment in error, word position of consonant errors, type of error, and degree of change in consonant errors. RESULTS Eighteen individuals across the 3 variants produced phonological paraphasias. Most paraphasias were nonword, followed by formal, and then mixed, with errors primarily occurring on nouns and verbs, with relatively few on function words. Most errors were substitutions, followed by addition and deletion errors, and few sequencing errors. Errors were evenly distributed across vowels, consonant singletons, and clusters, with more errors occurring in initial and medial positions of words than in the final position of words. Most consonant errors consisted of only a single-feature change, with few 2- or 3-feature changes. Importantly, paraphasia productions by variant differed from these aggregate results, with unique production patterns for each variant. CONCLUSIONS These results suggest that a system where paraphasias are coded as present versus absent may be insufficient to adequately distinguish between the 3 subtypes of PPA. The 3 variants demonstrate patterns that may be used to improve phenotyping and diagnostic sensitivity. These results should be integrated with recent findings on phonological processing and speech rate. Future research should attempt to replicate these results in a larger sample of participants with longer speech samples and varied elicitation tasks. SUPPLEMENTAL MATERIALS https://doi.org/10.23641/asha.5558107.
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Macoir J, Lavoie M, Laforce R, Brambati SM, Wilson MA. Dysexecutive Symptoms in Primary Progressive Aphasia: Beyond Diagnostic Criteria. J Geriatr Psychiatry Neurol 2017; 30:151-161. [PMID: 28355946 DOI: 10.1177/0891988717700507] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Primary progressive aphasia (PPA) is a heterogeneous neurodegenerative condition in which the most prominent clinical feature is language difficulties. Other cognitive domains have been described to remain unaffected at the early stages of the disease and, therefore, excluded from diagnostic criteria. However, we show in this article that executive function (EF) disorders may be present in the 3 variants (nonfluent/agrammatic, logopenic, and semantic) of PPA. We also illustrate changes in language and EF by means of a 3-year behavioral and neuroimaging longitudinal study of a patient suffering from the semantic variant of PPA. This review provides an update on current knowledge of PPA, suggesting that dysexecutive symptoms may be encountered in the 3 PPA variants, in their early phases and/or in more advanced stages, when atrophy extends to adjacent brain areas.
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Affiliation(s)
- Joël Macoir
- 1 Département de réadaptation, Faculté de médecine, Université Laval, Québec, Canada.,2 Centre de recherche de l'Institut universitaire en santé mentale de Québec, Québec, Canada
| | - Monica Lavoie
- 1 Département de réadaptation, Faculté de médecine, Université Laval, Québec, Canada.,2 Centre de recherche de l'Institut universitaire en santé mentale de Québec, Québec, Canada
| | - Robert Laforce
- 3 Clinique interdisciplinaire de mémoire, CHU de Québec-Hôpital de l'Enfant-Jésus, Québec, Canada.,4 Département de médecine, Faculté de médecine, Université Laval, Québec, Canada
| | - Simona M Brambati
- 5 Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
| | - Maximiliano A Wilson
- 1 Département de réadaptation, Faculté de médecine, Université Laval, Québec, Canada.,2 Centre de recherche de l'Institut universitaire en santé mentale de Québec, Québec, Canada
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Sajjadi SA, Sheikh-Bahaei N, Cross J, Gillard JH, Scoffings D, Nestor PJ. Can MRI Visual Assessment Differentiate the Variants of Primary-Progressive Aphasia? AJNR Am J Neuroradiol 2017; 38:954-960. [PMID: 28341715 DOI: 10.3174/ajnr.a5126] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 01/02/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Primary-progressive aphasia is a clinically and pathologically heterogeneous condition. Nonfluent, semantic, and logopenic are the currently recognized clinical variants. The recommendations for the classification of primary-progressive aphasia have advocated variant-specific patterns of atrophy. The aims of the present study were to evaluate the sensitivity and specificity of the proposed imaging criteria and to assess the intra- and interrater reporting agreements. MATERIALS AND METHODS The cohort comprised 51 patients with a root diagnosis of primary-progressive aphasia, 25 patients with typical Alzheimer disease, and 26 matched control participants. Group-level analysis (voxel-based morphometry) confirmed the proposed atrophy patterns for the 3 syndromes. The individual T1-weighted anatomic images were reported by 3 senior neuroradiologists. RESULTS We observed a dichotomized pattern of high sensitivity (92%) and specificity (93%) for the proposed atrophy pattern of semantic-variant primary-progressive aphasia and low sensitivity (21% for nonfluent-variant primary-progressive aphasia and 43% for logopenic-variant primary-progressive aphasia) but high specificity (91% for nonfluent-variant primary-progressive aphasia and 95% for logopenic-variant primary-progressive aphasia) in other primary-progressive aphasia variants and Alzheimer disease (sensitivity 43%, specificity 92%). MR imaging was least sensitive for the diagnosis of nonfluent-variant primary-progressive aphasia. Intrarater agreement analysis showed mean κ values above the widely accepted threshold of 0.6 (mean, 0.63 ± 0.16). Pair-wise interobserver agreement outcomes, however, were well below this threshold in 5 of the 6 possible interrater contrasts (mean, 0.41 ± 0.09). CONCLUSIONS While the group-level results were in precise agreement with the recommendations, semantic-variant primary-progressive aphasia was the only subtype for which the proposed recommendations were both sensitive and specific at an individual level.
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Affiliation(s)
- S A Sajjadi
- From the Department of Neurology (S.A.S.), University of California, Irvine, Irvine, California
| | - N Sheikh-Bahaei
- Department of Radiology (N.S.-B., J.H.G.), University of Cambridge, Cambridge, UK
- Department of Radiology (N.S.-.B., J.C., J.H.G., D.S.), Cambridge University Hospitals, Cambridge, UK
| | - J Cross
- Department of Radiology (N.S.-.B., J.C., J.H.G., D.S.), Cambridge University Hospitals, Cambridge, UK
| | - J H Gillard
- Department of Radiology (N.S.-B., J.H.G.), University of Cambridge, Cambridge, UK
- Department of Radiology (N.S.-.B., J.C., J.H.G., D.S.), Cambridge University Hospitals, Cambridge, UK
| | - D Scoffings
- Department of Radiology (N.S.-.B., J.C., J.H.G., D.S.), Cambridge University Hospitals, Cambridge, UK
| | - P J Nestor
- German Center for Neurodegenerative Diseases (P.J.N.), Magdeburg, Germany
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Wilson SM, DeMarco AT, Henry ML, Gesierich B, Babiak M, Miller BL, Gorno-Tempini ML. Variable disruption of a syntactic processing network in primary progressive aphasia. Brain 2016; 139:2994-3006. [PMID: 27554388 PMCID: PMC5091045 DOI: 10.1093/brain/aww218] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 06/23/2016] [Accepted: 07/12/2016] [Indexed: 11/13/2022] Open
Abstract
Syntactic processing deficits are highly variable in individuals with primary progressive aphasia. Damage to left inferior frontal cortex has been associated with syntactic deficits in primary progressive aphasia in a number of structural and functional neuroimaging studies. However, a contrasting picture of a broader syntactic network has emerged from neuropsychological studies in other aphasic cohorts, and functional imaging studies in healthy controls. To reconcile these findings, we used functional magnetic resonance imaging to investigate the functional neuroanatomy of syntactic comprehension in 51 individuals with primary progressive aphasia, composed of all clinical variants and a range of degrees of syntactic processing impairment. We used trial-by-trial reaction time as a proxy for syntactic processing load, to determine which regions were modulated by syntactic processing in each patient, and how the set of regions recruited was related to whether syntactic processing was ultimately successful or unsuccessful. Relationships between functional abnormalities and patterns of cortical atrophy were also investigated. We found that the individual degree of syntactic comprehension impairment was predicted by left frontal atrophy, but also by functional disruption of a broader syntactic processing network, comprising left posterior frontal cortex, left posterior temporal cortex, and the left intraparietal sulcus and adjacent regions. These regions were modulated by syntactic processing in healthy controls and in patients with primary progressive aphasia with relatively spared syntax, but they were modulated to a lesser extent or not at all in primary progressive aphasia patients whose syntax was relatively impaired. Our findings suggest that syntactic comprehension deficits in primary progressive aphasia reflect not only structural and functional changes in left frontal cortex, but also disruption of a wider syntactic processing network.
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Affiliation(s)
- Stephen M. Wilson
- 1 Department of Speech, Language, and Hearing Sciences, University of Arizona, Tucson, AZ, USA
- 2 Department of Neurology, University of Arizona, Tucson, AZ, USA
- *Present address: Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew T. DeMarco
- 1 Department of Speech, Language, and Hearing Sciences, University of Arizona, Tucson, AZ, USA
| | - Maya L. Henry
- 3 Department of Neurology, University of California, San Francisco, CA, USA
- 4 Department of Communication Sciences and Disorders, University of Texas, Austin, TX, USA
| | - Benno Gesierich
- 3 Department of Neurology, University of California, San Francisco, CA, USA
| | - Miranda Babiak
- 3 Department of Neurology, University of California, San Francisco, CA, USA
| | - Bruce L. Miller
- 3 Department of Neurology, University of California, San Francisco, CA, USA
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Graham NL, Leonard C, Tang-Wai DF, Black S, Chow TW, Scott CJM, McNeely AA, Masellis M, Rochon E. Lack of Frank Agrammatism in the Nonfluent Agrammatic Variant of Primary Progressive Aphasia. Dement Geriatr Cogn Dis Extra 2016; 6:407-423. [PMID: 27790240 PMCID: PMC5075721 DOI: 10.1159/000448944] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background/Aims Frank agrammatism, defined as the omission and/or substitution of grammatical morphemes with associated grammatical errors, is variably reported in patients with nonfluent variant primary progressive aphasia (nfPPA). This study addressed whether frank agrammatism is typical in agrammatic nfPPA patients when this feature is not required for diagnosis. Method We assessed grammatical production in 9 patients who satisfied current diagnostic criteria. Although the focus was agrammatism, motor speech skills were also evaluated to determine whether dysfluency arose primarily from apraxia of speech (AOS), instead of, or in addition to, agrammatism. Volumetric MRI analyses provided impartial imaging-supported diagnosis. Results The majority of cases exhibited neither frank agrammatism nor AOS. Conclusion There are nfPPA patients with imaging-supported diagnosis and preserved motor speech skills who do not exhibit frank agrammatism, and this may persist beyond the earliest stages of the illness. Because absence of frank agrammatism is a subsidiary diagnostic feature in the logopenic variant of PPA, this result has implications for differentiation of the nonfluent and logopenic variants, and indicates that PPA patients with nonfluent speech in the absence of frank agrammatism or AOS do not necessarily have the logopenic variant.
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Affiliation(s)
- Naida L Graham
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Ont., Canada; Toronto Rehabilitation Institute, Toronto, Ont, Canada
| | - Carol Leonard
- Department of Audiology and Speech-Language Pathology, University of Ottawa, Ottawa, Ont, Canada
| | - David F Tang-Wai
- University Health Network Memory Clinic, Toronto Western Hospital, Ont., Canada; Department of Medicine (Neurology), University of Toronto, Ont., Canada
| | - Sandra Black
- Department of Medicine (Neurology), University of Toronto, Ont., Canada; L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Ont., Canada; Rotman Research Institute, University of Toronto, Toronto, Ont., Canada
| | - Tiffany W Chow
- Department of Medicine (Neurology), University of Toronto, Ont., Canada; Rotman Research Institute, University of Toronto, Toronto, Ont., Canada; Department of Psychiatry (Geriatric Psychiatry), University of Toronto, Toronto, Ont., Canada
| | - Chris J M Scott
- L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Ont., Canada
| | - Alicia A McNeely
- L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Ont., Canada
| | - Mario Masellis
- L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Ont., Canada
| | - Elizabeth Rochon
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Ont., Canada; Toronto Rehabilitation Institute, Toronto, Ont, Canada
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Progressive supranuclear palsy and corticobasal degeneration: Diagnostic challenges and clinicopathological considerations. Rev Neurol (Paris) 2016; 172:488-502. [DOI: 10.1016/j.neurol.2016.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/04/2016] [Accepted: 07/12/2016] [Indexed: 11/22/2022]
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Bautista A, Wilson SM. Neural responses to grammatically and lexically degraded speech. LANGUAGE, COGNITION AND NEUROSCIENCE 2016; 31:567-574. [PMID: 27525290 PMCID: PMC4981484 DOI: 10.1080/23273798.2015.1123281] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Linguistic stimuli that are degraded in various ways have been used in neuroimaging studies to uncover distinct roles for different brain regions involved in processing language. In order to identify brain regions differentially involved in grammatical and lexical processing, we spectrally rotated specific morphemes and manipulated morpheme order to create speech stimuli that were degraded either grammatically or lexically, yet were matched in intelligibility. Twelve healthy participants were scanned with functional MRI as they listened to the grammatically and lexically degraded stimuli, interspersed with clear stimuli in the context of a familiar narrative. Contrary to our expectations, we did not find any brain regions that were selectively sensitive to grammatical or lexical degradation. However, compared to previous studies, there was less signal reduction than anticipated in response to degradation of either type. These findings may reflect increased attention to the degraded stimuli due to the familiar narrative context, since attention to degraded speech has been shown to attenuate the signal decreases typically associated with reduced intelligibility.
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Affiliation(s)
- Alexa Bautista
- Department of Speech, Language, and Hearing Sciences, University of Arizona, Tucson, AZ 85721, USA
| | - Stephen M Wilson
- Department of Speech, Language, and Hearing Sciences, University of Arizona, Tucson, AZ 85721, USA
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Blanchard C, Raoux N, Matharan F, Amieva H. Are conceptual abilities impaired in schizophrenia? Psychiatry Res 2015; 228:399-403. [PMID: 26160201 DOI: 10.1016/j.psychres.2015.05.076] [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] [Received: 10/17/2014] [Revised: 03/24/2015] [Accepted: 05/25/2015] [Indexed: 11/29/2022]
Abstract
Whereas semantic processing deficits are well-documented in schizophrenia, conceptual abilities have been poorly explored. This study aims at specifically exploring conceptualization abilities in 34 adults fulfilling schizophrenia according to DSM-IV and 34 healthy controls with similar socio-demographic characteristics. The 2 groups were assessed on the WAIS-R similarities test and the concept generation test (Raoux et al., 2014) consisting of free-sorting 6 cards of pictures of animals and geometric shapes to be separated in two groups or categories based on common attributes. After each sorting, the participant is asked to explain his/her sorting. Whereas the schizophrenic patients performed significantly poorer than the control participants in the semantic knowledge and lexico-semantic tests, there was no difference neither in the WAIS-R similarities test nor in the concept generation test, which supports the hypothesis of preserved high level conceptualization abilities in schizophrenia. However, qualitative differences in performing the concept generation test were evidenced. The patients used more often mixed criteria leading them to compare two different hierarchical levels (e.g., low-level physical attributes vs. high-level semantic criteria). Furthermore, the qualitative analysis based on the explanations provided by the participants shows that the categorizations achieved by schizophrenic patients are more often based on unexpected criteria.
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Affiliation(s)
- Cécile Blanchard
- Centre Hospitalier Cadillac, 89 rue Cazeaux Cazalet, 33410 Cadillac, France
| | - Nadine Raoux
- U897 Inserm, ISPED Université de Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux Cedex, France.
| | - Fanny Matharan
- U897 Inserm, ISPED Université de Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux Cedex, France
| | - Hélène Amieva
- U897 Inserm, ISPED Université de Bordeaux, 146 rue Léo Saignat, 33076 Bordeaux Cedex, France
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Balconi M, Cotelli M, Brambilla M, Manenti R, Cosseddu M, Premi E, Gasparotti R, Zanetti O, Padovani A, Borroni B. Understanding Emotions in Frontotemporal Dementia: The Explicit and Implicit Emotional Cue Mismatch. J Alzheimers Dis 2015; 46:211-25. [DOI: 10.3233/jad-142826] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Michela Balconi
- Research Unit in Affective and Social Neuroscience, Department of Psychology, Catholic University, Milan, Italy
| | - Maria Cotelli
- Neuropsychology Unit, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Michela Brambilla
- Neuropsychology Unit, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Rosa Manenti
- Neuropsychology Unit, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Maura Cosseddu
- Centre for Aging Brain and Neurodegenerative Disorders, Neurology unit, University of Brescia, Brescia, Italy
| | - Enrico Premi
- Centre for Aging Brain and Neurodegenerative Disorders, Neurology unit, University of Brescia, Brescia, Italy
| | | | - Orazio Zanetti
- Alzheimer Unit, IRCCS Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Alessandro Padovani
- Centre for Aging Brain and Neurodegenerative Disorders, Neurology unit, University of Brescia, Brescia, Italy
| | - Barbara Borroni
- Centre for Aging Brain and Neurodegenerative Disorders, Neurology unit, University of Brescia, Brescia, Italy
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Maruta C, Pereira T, Madeira SC, De Mendonça A, Guerreiro M. Classification of primary progressive aphasia: Do unsupervised data mining methods support a logopenic variant? Amyotroph Lateral Scler Frontotemporal Degener 2015; 16:147-59. [PMID: 25871701 DOI: 10.3109/21678421.2015.1026266] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Our objective was to test whether data mining techniques, through an unsupervised learning approach, support the three-group diagnostic model of primary progressive aphasia (PPA) versus the existence of two main/classic groups. A series of 155 PPA patients observed in a clinical setting and subjected to at least one neuropsychological/language assessment was studied. Several demographic, clinical and neuropsychological attributes, grouped in distinct sets, were introduced in unsupervised learning methods (Expectation Maximization, K-Means, X-Means, Hierarchical Clustering and Consensus Clustering). Results demonstrated that unsupervised learning methods revealed two main groups consistently obtained throughout all the analyses (with different algorithms and different set of attributes). One group included most of the agrammatic/non-fluent and some logopenic cases while the other was mainly composed of semantic and logopenic cases. Clustering the patients in a larger number of groups (k > 2) revealed some clusters composed mostly of non-fluent or of semantic cases. However, we could not evidence any group chiefly composed of logopenic cases. In conclusion, unsupervised data mining approaches do not support a clear distinction of logopenic PPA as a separate variant.
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Affiliation(s)
- Carolina Maruta
- Laboratory of Language Research, Institute of Molecular Medicine, Faculty of Medicine, University of Lisbon , Portugal
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Manenti R, Bianchi M, Cosseddu M, Brambilla M, Rizzetti C, Padovani A, Borroni B, Cotelli M. Anodal transcranial direct current stimulation of parietal cortex enhances action naming in Corticobasal Syndrome. Front Aging Neurosci 2015; 7:49. [PMID: 25926792 PMCID: PMC4396503 DOI: 10.3389/fnagi.2015.00049] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 03/25/2015] [Indexed: 11/24/2022] Open
Abstract
Background: Corticobasal Syndrome (CBS) is a neurodegenerative disorder that overlaps both clinically and neuropathologically with Frontotemporal dementia (FTD) and is characterized by apraxia, alien limb phenomena, cortical sensory loss, cognitive impairment, behavioral changes and aphasia. It has been recently demonstrated that transcranial direct current stimulation (tDCS) improves naming in healthy subjects and in subjects with language deficits. Objective: The aim of the present study was to explore the extent to which anodal tDCS over the parietal cortex (PARC) could facilitate naming performance in CBS subjects. Methods: Anodal tDCS was applied to the left and right PARC during object and action naming in seventeen patients with a diagnosis of possible CBS. Participants underwent two sessions of anodal tDCS (left and right) and one session of placebo tDCS. Vocal responses were recorded and analyzed for accuracy and vocal Reaction Times (vRTs). Results: A shortening of naming latency for actions was observed only after active anodal stimulation over the left PARC, as compared to placebo and right stimulations. No effects have been reported for accuracy. Conclusions: Our preliminary finding demonstrated that tDCS decreased vocal reaction time during action naming in a sample of patients with CBS. A possible explanation of our results is that anodal tDCS over the left PARC effects the brain network implicated in action observation and representation. Further studies, based on larger patient samples, should be conducted to investigate the usefulness of tDCS as an additional treatment of linguistic deficits in CBS patients.
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Affiliation(s)
- Rosa Manenti
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli Brescia, Italy
| | - Marta Bianchi
- Centre for Aging Brain and Neurodegenerative Disorders, Neurology unit, University of Brescia Brescia, Italy
| | - Maura Cosseddu
- Centre for Aging Brain and Neurodegenerative Disorders, Neurology unit, University of Brescia Brescia, Italy
| | - Michela Brambilla
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli Brescia, Italy
| | | | - Alessandro Padovani
- Centre for Aging Brain and Neurodegenerative Disorders, Neurology unit, University of Brescia Brescia, Italy
| | - Barbara Borroni
- Centre for Aging Brain and Neurodegenerative Disorders, Neurology unit, University of Brescia Brescia, Italy
| | - Maria Cotelli
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli Brescia, Italy
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Abstract
'Primary progressive aphasia' (PPA) refers to core linguistic disorders caused by neurodegenerative disease. Three main PPA variants are recognized: nonfluent/agrammatic, semantic and logopenic. Correctly classifying patients during life according to the underlying histopathology will become increasingly important as cause-specific treatments become available. This article reviews clinical and histopathological studies of PPA, with particular reference to updated PPA classifications. Currently, one-to-one relationships do not exist within PPA subtypes. The semantic variant has the best correspondence between the clinical syndrome and the underlying pathological cause and the logopenic variant the worst correspondence. The use of future biomarkers should facilitate accurate clinicopathological correlation of patients during life.
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Affiliation(s)
- Jennifer M Harris
- Manchester Academic Health Sciences Centre, Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Salford, UK
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Milano NJ, Williamson JB, Heilman KM. Improved verbal learning in the semantic variant of primary progressive aphasia when using semantic cues. Neurocase 2015; 21:345-50. [PMID: 24611440 DOI: 10.1080/13554794.2014.894081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The semantic variant of primary progressive aphasia (PPA-S) is characterized by impairments in confrontation naming and single word comprehension. Although episodic memory may be relatively spared, there can be impairment in verbal learning tasks. We report a patient with PPA-S and impaired verbal learning who was tested to learn if when provided with semantic categories, her learning would improve. A 70-year-old right-handed woman with a 2-year history of progressive difficulties with word finding, naming, and memory was tested for language and memory deficits using the Hopkins Verbal Learning Test-Revised (HVLT-R). She was then retested with the HVLT-R after being provided with the three semantic categories to which these words belonged. Confrontation naming was impaired on the Boston Naming Test. Sentence repetition was normal. Comprehension testing with word picture matching and sentence comprehension was normal. On a test of semantic associations, Pyramids and Palm Trees, she was impaired. She was also impaired on tests of verbal learning (HVLT-R) (total: 13) but not recall. When a different version of the HVLT-R was given with the semantic categories of the words given beforehand, her scores improved (total: 26). This patient with PPA-S had an impairment of verbal learning, but not delayed recall. When given a semantic category cue beforehand, her verbal learning performance improved. This observation suggests that this patient did not spontaneously use semantic encoding. Using a semantic cueing strategy may help other patients with PPA-S improve their capacity for verbal learning.
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Affiliation(s)
- Nicholas J Milano
- a Department of Neurology , University of Florida College of Medicine , Gainesville , FL , USA
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Marcotte K, Graham NL, Black SE, Tang-Wai D, Chow TW, Freedman M, Rochon E, Leonard C. Verb production in the nonfluent and semantic variants of primary progressive aphasia: The influence of lexical and semantic factors. Cogn Neuropsychol 2014; 31:565-83. [DOI: 10.1080/02643294.2014.970154] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
BACKGROUND Grammatical impairments are commonly observed in the agrammatic subtype of primary progressive aphasia (PPA-G), whereas grammatical processing is relatively preserved in logopenic (PPA-L) and semantic (PPA-S) subtypes. AIMS We review research on grammatical deficits in PPA and associated neural mechanisms, with discussion focused on production and comprehension of four aspects of morphosyntactic structure: grammatical morphology, functional categories, verbs and verb argument structure, and complex syntactic structures. We also address assessment of grammatical deficits in PPA, with emphasis on behavioral tests of grammatical processing. Finally, we address research examining the effects of treatment for progressive grammatical impairments. MAIN CONTRIBUTION PPA-G is associated with grammatical deficits that are evident across linguistic domains in both production and comprehension. PPA-G is associated with damage to regions including the left inferior frontal gyrus (IFG) and dorsal white matter tracts, which have been linked to impaired comprehension and production of complex sentences. Detailing grammatical deficits in PPA is important for estimating the trajectory of language decline and associated neuropathology. We, therefore, highlight several new assessment tools for examining different aspects of morphosyntactic processing in PPA. CONCLUSIONS Individuals with PPA-G present with agrammatic deficit patterns distinct from those associated with PPA-L and PPA-S, but similar to those seen in agrammatism resulting from stroke, and patterns of cortical atrophy and white matter changes associated with PPA-G have been identified. Methods for clinical evaluation of agrammatism, focusing on comprehension and production of grammatical morphology, functional categories, verbs and verb argument structure, and complex syntactic structures are recommended and tools for this are emerging in the literature. Further research is needed to investigate the real-time processes underlying grammatical impairments in PPA, as well as the structural and functional neural correlates of grammatical impairments across linguistic domains. Few studies have examined the effects of treatment for grammatical impairments in PPA; research in this area is needed to better understand how (or if) grammatical processing ability can be improved, the potential for spared neural tissue to be recruited to support this, and whether the neural connections within areas of dysfunctional tissue required for grammatical processing can be enhanced using cortical stimulation.
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Affiliation(s)
- Cynthia K. Thompson
- Department of Communication Sciences and Disorders, Northwestern University Francis Searle Building, 2240 Campus Drive, Evanston, IL 60208
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, 320 E. Superior, Searle 11-453, Chicago, IL 60611
- Department of Neurology, Northwestern University Feinberg School of Medicine, Abbott Hall, 11 Floor, 710 North Lake Shore Drive, Chicago, IL 60611
| | - Jennifer E. Mack
- Department of Communication Sciences and Disorders, Northwestern University Francis Searle Building, 2240 Campus Drive, Evanston, IL 60208
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Wilson SM, Brandt TH, Henry ML, Babiak M, Ogar JM, Salli C, Wilson L, Peralta K, Miller BL, Gorno-Tempini ML. Inflectional morphology in primary progressive aphasia: an elicited production study. BRAIN AND LANGUAGE 2014; 136:58-68. [PMID: 25129631 PMCID: PMC4159758 DOI: 10.1016/j.bandl.2014.07.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 07/03/2014] [Accepted: 07/14/2014] [Indexed: 06/03/2023]
Abstract
Inflectional morphology lies at the intersection of phonology, syntax and the lexicon, three language domains that are differentially impacted in the three main variants of primary progressive aphasia (PPA). To characterize spared and impaired aspects of inflectional morphology in PPA, we elicited inflectional morphemes in 48 individuals with PPA and 13 healthy age-matched controls. We varied the factors of regularity, frequency, word class, and lexicality, and used voxel-based morphometry to identify brain regions where atrophy was predictive of deficits on particular conditions. All three PPA variants showed deficits in inflectional morphology, with the specific nature of the deficits dependent on the anatomical and linguistic features of each variant. Deficits in inflecting low-frequency irregular words were associated with semantic PPA, with lexical/semantic deficits, and with left temporal atrophy. Deficits in inflecting pseudowords were associated with non-fluent/agrammatic and logopenic variants, with phonological deficits, and with left frontal and parietal atrophy.
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Affiliation(s)
- Stephen M Wilson
- Department of Speech, Language, and Hearing Sciences, University of Arizona, USA; Department of Neurology, University of Arizona, USA; Department of Neurology, University of California, San Francisco, USA.
| | - Temre H Brandt
- Department of Speech, Language, and Hearing Sciences, University of Arizona, USA
| | - Maya L Henry
- Department of Neurology, University of California, San Francisco, USA; Department of Communication Sciences and Disorders, University of Texas, Austin, USA
| | - Miranda Babiak
- Department of Neurology, University of California, San Francisco, USA
| | - Jennifer M Ogar
- Department of Neurology, University of California, San Francisco, USA
| | - Chelsey Salli
- Department of Speech, Language, and Hearing Sciences, University of Arizona, USA
| | - Lisa Wilson
- Department of Speech, Language, and Hearing Sciences, University of Arizona, USA
| | - Karen Peralta
- Department of Speech, Language, and Hearing Sciences, University of Arizona, USA
| | - Bruce L Miller
- Department of Neurology, University of California, San Francisco, USA
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Faria AV, Sebastian R, Newhart M, Mori S, Hillis AE. Longitudinal Imaging and Deterioration in Word Comprehension in Primary Progressive Aphasia: Potential Clinical Significance. APHASIOLOGY 2014; 28:948-963. [PMID: 25435643 PMCID: PMC4243664 DOI: 10.1080/02687038.2014.911241] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
BACKGROUND Three variants of primary progressive aphasia (PPA), distinguished by language performance and supportive patterns of atrophy on imaging, have different clinical courses and the prognoses for specific functions. For example, semantic variant PPA alone is distinguished by impaired word comprehension. However, sometimes individuals with high education show normal performance on word comprehension tests early on, making classification difficult. Furthermore, as the condition progresses, individuals with other variants develop word comprehension deficits and other behavioral symptoms, making distinctions between variants less clear. Longitudinal brain imaging allows identification of specific areas of atrophy in individual patients, which identifies the location of disease in each patient. AIMS We hypothesized that the areas of atrophy in individual PPA participants would be closely correlated with decline in word comprehension over time. We propose that areas where tissue volume is correlated with word comprehension are areas that: (1) are essential for word comprehension, (2) compensate for word comprehension in some individuals with semantic variant PPA early in the course; and (3) show atrophy in individuals with logopenic and nonfluent variant PPA only late in the course. METHODS AND PROCEDURES Fifteen participants with PPA (5 logopenic variant PPA; 8 semantic variant PPA; 2 nonfluent/agrammatic variant PPA; mean age 67.8), underwent high resolution MRI and cognitive tests at least 9 months apart. The correlations between change in regional volumes and change in auditory word comprehension scores were investigated using Spearman test. OUTCOMES & RESULTS While scores on auditory word comprehension at Time 1 were correlated with volume loss in right and left temporal pole and left inferior temporal cortex (areas of atrophy associated with semantic variant PPA), deterioration in auditory word comprehension from Time 1 to Time 2 was associated with individual atrophy in left middle temporal cortex, left angular gyrus, and right inferior and middle temporal cortex. CONCLUSIONS Progressive atrophy in focal areas surrounding left temporal pole and left inferior temporal cortex, and right homologous area is closely related to progressive decline in auditory word comprehension. These correlations likely reflect areas that help support auditory word comprehension, effectively compensating for subtle deficits in some individuals early in the course of semantic variant PPA, as well as areas that are critical for auditory word comprehension that eventually atrophy in individuals with other variants of PPA. Individual patterns of atrophy also help us understand and predict the clinical course of individuals, such as associated behavioral or motor deficits.
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Affiliation(s)
- Andreia V. Faria
- Department of Radiology, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Rajani Sebastian
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore MD 21287, USA
| | - Melissa Newhart
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore MD 21287, USA
| | - Susumu Mori
- Department of Radiology, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore MD 21287, USA
- Department of Physical Medicine & Rehabilitation Medicine, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore MD 21287, USA
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD 21218, USA
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Tree J, Kay J. Longitudinal assessment of short-term memory deterioration in a logopenic variant primary progressive aphasia with post-mortem confirmed Alzheimer's Disease pathology. J Neuropsychol 2014; 9:184-202. [PMID: 24751373 DOI: 10.1111/jnp.12045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 03/08/2014] [Indexed: 11/30/2022]
Abstract
In the field of dementia research, there are reports of neurodegenerative cases with a focal loss of language, termed primary progressive aphasia (PPA). Currently, this condition has been further sub-classified, with the most recent sub-type dubbed logopenic variant (PPA-LV). As yet, there remains somewhat limited evaluation of the characteristics of this condition, with no studies providing longitudinal assessment accompanied by post-mortem examination. Moreover, a key characteristic of the PPA-LV case is a deterioration of phonological short-term memory, but again little work has scrutinized the nature of this impairment over time. The current study seeks to redress these oversights and presents detailed longitudinal examination of language and memory function in a case of PPA-LV, with special focus on tests linked to components of phonological short-term memory function. Our findings are then considered with reference to a contemporary model of the neuropsychology of phonological short-term memory. Additionally, post-mortem examinations indicated Alzheimer's disease type pathology, providing further evidence that the PPA-LV presentation may reflect an atypical presentation of this condition.
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Affiliation(s)
- Jeremy Tree
- Department of Psychology, Swansea University, Swansea, UK
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42
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Kertesz A, Harciarek M. Primary progressive aphasia. Scand J Psychol 2014; 55:191-201. [DOI: 10.1111/sjop.12105] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 01/05/2014] [Indexed: 12/12/2022]
Affiliation(s)
- Andrew Kertesz
- Department of Clinical Neurological Sciences; Western University; London Ontario Canada
| | - Michał Harciarek
- Division of Clinical Psychology and Neuropsychology; Institute of Psychology; University of Gdańsk; Gdańsk Poland
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Charles D, Olm C, Powers J, Ash S, Irwin DJ, McMillan CT, Rascovsky K, Grossman M. Grammatical comprehension deficits in non-fluent/agrammatic primary progressive aphasia. J Neurol Neurosurg Psychiatry 2014; 85:249-56. [PMID: 24039027 PMCID: PMC3925677 DOI: 10.1136/jnnp-2013-305749] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
IMPORTANCE Grammatical comprehension difficulty is an essential supporting feature of the non-fluent/agrammatic variant of primary progressive aphasia (naPPA), but well-controlled clinical measures of grammatical comprehension are unavailable. OBJECTIVE To develop a measure of grammatical comprehension and examine this comparatively in PPA variants and behavioural-variant frontotemporal degeneration (bvFTD) and to assess the neuroanatomic basis for these deficits with volumetric grey matter atrophy and whole-brain fractional anisotropy (FA) in white matter tracts. DESIGN Case-control study. SETTING Academic medical centre. PARTICIPANTS 39 patients with variants of PPA (naPPA=12, lvPPA=15 and svPPA=12), 27 bvFTD patients without aphasia and 12 healthy controls. MAIN OUTCOME MEASURE Grammatical comprehension accuracy. RESULTS Patients with naPPA had selective difficulty understanding cleft sentence structures, while all PPA variants and patients with bvFTD were impaired with sentences containing a centre-embedded subordinate clause. Patients with bvFTD were also impaired understanding sentences involving short-term memory. Linear regressions related grammatical comprehension difficulty in naPPA to left anterior-superior temporal atrophy and reduced FA in corpus callosum and inferior frontal-occipital fasciculus. Difficulty with centre-embedded sentences in other PPA variants was related to other brain regions. CONCLUSIONS AND RELEVANCE These findings emphasise a distinct grammatical comprehension deficit in naPPA and associate this with interruption of a frontal-temporal neural network.
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Affiliation(s)
- Dorothy Charles
- Department of Neurology and Penn FTD Center, University of Pennsylvania, , Philadelphia, Pennsylvania, USA
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Druks J, Weekes BS. Parallel deterioration to language processing in a bilingual speaker. Cogn Neuropsychol 2014; 30:578-96. [PMID: 24527801 DOI: 10.1080/02643294.2014.882814] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The convergence hypothesis [Green, D. W. (2003). The neural basis of the lexicon and the grammar in L2 acquisition: The convergence hypothesis. In R. van Hout, A. Hulk, F. Kuiken, & R. Towell (Eds.), The interface between syntax and the lexicon in second language acquisition (pp. 197-218). Amsterdam: John Benjamins] assumes that the neural substrates of language representations are shared between the languages of a bilingual speaker. One prediction of this hypothesis is that neurodegenerative disease should produce parallel deterioration to lexical and grammatical processing in bilingual aphasia. We tested this prediction with a late bilingual Hungarian (first language, L1)-English (second language, L2) speaker J.B. who had nonfluent progressive aphasia (NFPA). J.B. had acquired L2 in adolescence but was premorbidly proficient and used English as his dominant language throughout adult life. Our investigations showed comparable deterioration to lexical and grammatical knowledge in both languages during a one-year period. Parallel deterioration to language processing in a bilingual speaker with NFPA challenges the assumption that L1 and L2 rely on different brain mechanisms as assumed in some theories of bilingual language processing [Ullman, M. T. (2001). The neural basis of lexicon and grammar in first and second language: The declarative/procedural model. Bilingualism: Language and Cognition, 4(1), 105-122].
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Affiliation(s)
- Judit Druks
- a Division of Psychology and Language Sciences , University College London , UK
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45
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Abstract
Failure of inhibitory control is an early and consistent feature in patients suffering from frontotemporal dementia (FTD). This appears because of their pervasive ventromedial prefrontal atrophy-particularly in the orbitofrontal cortex-which has been linked to inhibitory dysfunction in studies on human and monkey lesions. However, the range of measures currently available to assess inhibitory processes in FTD is limited, and, as such, inhibitory dysfunction in FTD remains relatively underexplored. Subjective caregiver questionnaires are useful for defining disinhibition as it manifests behaviorally; however, endorsement of symptoms can vary largely across patients as it is contingent on the perceptiveness of the caregiver. The few objective neuropsychological tasks that tap directly into inhibitory functioning have potential, although they mostly rely on intact language and semantics, which can confound performance in FTD patients. An emergent possibility is to explore inhibitory functioning in FTD through nonverbal experimental tasks. Adaptation of such experimental tasks into clinical tools is a promising avenue for exploring one of the earliest behavioral features in FTD patients and concomitantly tap into their prevalent orbitofrontal cortex dysfunction. We suggest that improved characterization of early inhibitory dysfunction may facilitate more accurate diagnosis of FTD.
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Savage S, Hsieh S, Leslie F, Foxe D, Piguet O, Hodges JR. Distinguishing subtypes in primary progressive aphasia: application of the Sydney language battery. Dement Geriatr Cogn Disord 2013; 35:208-18. [PMID: 23467307 DOI: 10.1159/000346389] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Primary progressive aphasia (PPA) comprises three main subtypes, varying in clinical features, patterns of brain atrophy, and underlying pathology. Differentiation of these variants is important for treatment and planning; however, simple, effective cognitive tests to aid diagnosis are lacking. This study introduces a new language battery - the SYDBAT (Sydney Language Battery) - to assist clinicians. METHODS Fifty-seven PPA patients and 54 age- and education-matched healthy controls were compared on naming, repetition, word comprehension, and semantic association subtests. RESULTS Significant group differences were found for all tasks, reflecting different language profiles for each group. Using discriminative function analysis, 80% of PPA cases were correctly classified from three SYDBAT scores, from which a simple diagnostic algorithm was defined. CONCLUSION The SYDBAT is a fast and simple tool which provides a valuable adjunct to clinicians diagnosing PPA.
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Affiliation(s)
- Sharon Savage
- Neuroscience Research Australia, University of New South Wales, Sydney, N.S.W., Australia
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Wang J, Wu D, Chen Y, Yuan Y, Zhang M. Effects of transcranial direct current stimulation on language improvement and cortical activation in nonfluent variant primary progressive aphasia. Neurosci Lett 2013; 549:29-33. [PMID: 23800543 DOI: 10.1016/j.neulet.2013.06.019] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 06/11/2013] [Accepted: 06/13/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Jie Wang
- Department of Rehabilitation, Xuanwu Hospital of Capital Medical University, No. 45, Changchun St, Xicheng District, PO Box 100053, Beijing, China
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Harciarek M, Cosentino S. Language, executive function and social cognition in the diagnosis of frontotemporal dementia syndromes. Int Rev Psychiatry 2013; 25:178-96. [PMID: 23611348 PMCID: PMC4481322 DOI: 10.3109/09540261.2013.763340] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Frontotemporal dementia (FTD) represents a spectrum of non-Alzheimer's degenerative conditions associated with focal atrophy of the frontal and/or temporal lobes. Frontal and temporal regions of the brain have been shown to be strongly involved in executive function, social cognition and language processing and, thus, deficits in these domains are frequently seen in patients with FTD or may even be hallmarks of a specific FTD subtype (i.e. relatively selective and progressive language impairment in primary progressive aphasia). In this review we have attempted to delineate how language, executive function, and social cognition may contribute to the diagnosis of FTD syndromes, namely the behavioural variant FTD as well as the language variants of FTD including the three subtypes of primary progressive aphasia (PPA): non-fluent/agrammatic, semantic and logopenic. This review also addresses the extent to which deficits in these cognitive areas contribute to the differential diagnosis of FTD versus Alzheimer's disease (AD). Finally, early clinical determinants of pathology are briefly discussed and contemporary challenges to the diagnosis of FTD are presented.
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Affiliation(s)
- Michał Harciarek
- Division of Clinical Psychology and Neuropsychology, Institute of Psychology, University of Gdańsk, Poland.
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Memory for action sequences in semantic dementia. Neuropsychologia 2013; 51:1481-7. [PMID: 23499723 DOI: 10.1016/j.neuropsychologia.2013.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 02/26/2013] [Accepted: 02/27/2013] [Indexed: 11/22/2022]
Abstract
Semantic dementia (SD) is associated with a progressive, relatively selective, degeneration of semantic memory (both verbal and nonverbal facts and knowledge). Episodic memory, however, is thought to be relatively preserved. This study aimed to further assess the nonverbal, incidental, episodic memory profile associated with SD using deferred imitation, which measures recall by the nonverbal imitation of novel action sequences after a 24-h delay. The performance of six individuals with SD was compared to that of 10 healthy age- and education-matched controls. After a baseline phase, where sets of objects were presented for manipulation to measure the spontaneous production of relevant action sequences, participants were shown eight novel three-step action sequences with the sets of objects. The component actions of the sequences were causally related in four of the eight series and arbitrarily related in the remaining four, to investigate the influence of sequence structure on memory performance. All participants produced more target actions and pairs in the arbitrary sequences 24-h after demonstration compared to baseline, indicating memory for the sequences, but only the control group showed significant memory for the order of the causal sequences (pairs). Furthermore, and perhaps more strikingly, only the control participants showed a recall advantage for the causal relative to the arbitrary sequences, indicating that they, but not the patients, could take advantage of the semantic nature of these sequences. Together these findings suggest that individuals with SD show some nonverbal episodic memory, even after a 24-h delay, and that new anterograde memory can to some extent be established without significant support from semantic memory.
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Kavé G, Heinik J, Biran I. Preserved morphological processing in semantic dementia. Cogn Neuropsychol 2012; 29:550-68. [DOI: 10.1080/02643294.2012.759097] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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