Speech Metrics and Samples That Differentiate Between Nonfluent/Agrammatic and Logopenic Variants of Primary Progressive Aphasia

Language assessment in primary progressive aphasia: Which components should be tested?

INTRODUCTION

Primary progressive aphasia (PPA) is a dementia syndrome whose onset and course manifests with language deficits. There is a lack of instruments for clinical assessment of language in dementia and further research in the area is needed. Therefore, the objective of the present study was to identify language tasks that can aid the process of clinically diagnosing PPA and to determine those tasks most impaired in this population.

METHOD

A sample of 87 individuals comprising 2 groups was assessed: a PPA group (PPAG) of 29 PPA patients; and a control group (CG) of 58 healthy subjects matched for age and education. All participants underwent a brief cognitive battery followed by a comprehensive language assessment using the MTL-BR Battery.

RESULTS

A statistically significant performance difference was found between the PPAG and CG on the following tasks: structured interview, oral comprehension of phrases, oral narrative discourse, written comprehension of phrases, written dictation, sentence repetition, semantic verbal fluency, oral naming of nouns and verbs, object manipulation, phonological verbal fluency, body part recognition and left-right orientation, written naming of nouns, oral text comprehension, number dictation, written narrative discourse, written text comprehension and numerical calculations (mental and written).

CONCLUSION

The results revealed that performance of PPA patients was poorer compared to healthy subjects on various language tasks. The most useful subtests from the MTL-BR battery for aiding clinical diagnosis of PPA were identified, tasks which should be prioritized when assessing this patient group.

Investigating changes in connected speech in nonfluent/agrammatic primary progressive aphasia following script training

Script training is a speech-language intervention designed to promote fluent connected speech via repeated rehearsal of functional content. This type of treatment has proven beneficial for individuals with aphasia and apraxia of speech caused by stroke and, more recently, for individuals with primary progressive aphasia (PPA). In the largest study to-date evaluating the efficacy of script training in individuals with nonfluent/agrammatic primary progressive aphasia (nfvPPA; Henry et al., 2018), robust treatment effects were observed, with maintenance of gains up to one year post-treatment. However, outcomes were constrained to measures of script accuracy, intelligibility, and grammaticality, providing a limited view of potential treatment benefit to connected speech. The current study evaluated the utility of a broader set of connected speech measures for characterizing script training outcomes in 20 individuals with nfvPPA who were administered Video-Implemented Script Training for Aphasia (VISTA). Probes of trained and untrained script topics from pre- and post-treatment were transcribed, coded, and analyzed using Computerized Language ANalysis (CLAN, MacWhinney, 2000) to extract measures of fluency, grammar, and informativeness. Speech timing measures (e.g., articulation rate, mean pause duration) were derived from audio files. Participants demonstrated significant changes for trained topics from pre-to post-treatment in words per minute, fluency disruptions per hundred words, mean length of utterance in morphemes, grammatical complexity, and proportion of open to closed class words. Reductions were observed in mean and variability of syllable duration and mean pause duration, and speech to pause ratio increased. These findings lend additional support for script training as a means to promote fluency of connected speech in individuals with nfvPPA and illustrate the utility of automated and semi-automated measures for characterizing treatment effects following intervention.

Lexical markers of disordered speech in primary progressive aphasia and 'Parkinson-plus' disorders

Connected speech samples elicited by a picture description task are widely used in the assessment of aphasias, but it is not clear what their interpretation should focus on. Although such samples are easy to collect, analyses of them tend to be time-consuming, inconsistently conducted and impractical for non-specialist settings. Here, we analysed connected speech samples from patients with the three variants of primary progressive aphasia (semantic, svPPA N = 9; logopenic, lvPPA N = 9; and non-fluent, nfvPPA N = 9), progressive supranuclear palsy (PSP Richardson's syndrome N = 10), corticobasal syndrome (CBS N = 13) and age-matched healthy controls (N = 24). There were three principal aims: (i) to determine the differences in quantitative language output and psycholinguistic properties of words produced by patients and controls, (ii) to identify the neural correlates of connected speech measures and (iii) to develop a simple clinical measurement tool. Using data-driven methods, we optimized a 15-word checklist for use with the Boston Diagnostic Aphasia Examination 'cookie theft' and Mini Linguistic State Examination 'beach scene' pictures and tested the predictive validity of outputs from least absolute shrinkage and selection operator (LASSO) models using an independent clinical sample from a second site. The total language output was significantly reduced in patients with nfvPPA, PSP and CBS relative to those with svPPA and controls. The speech of patients with lvPPA and svPPA contained a disproportionately greater number of words of both high frequency and high semantic diversity. Results from our exploratory voxel-based morphometry analyses across the whole group revealed correlations between grey matter volume in (i) bilateral frontal lobes with overall language output, (ii) the left frontal and superior temporal regions with speech complexity, (iii) bilateral frontotemporal regions with phonology and (iv) bilateral cingulate and subcortical regions with age of acquisition. With the 15-word checklists, the LASSO models showed excellent accuracy for within-sample k-fold classification (over 93%) and out-of-sample validation (over 90%) between patients and controls. Between the motor disorders (nfvPPA, PSP and CBS) and lexico-semantic groups (svPPA and lvPPA), the LASSO models showed excellent accuracy for within-sample k-fold classification (88-92%) and moderately good (59-74%) differentiation for out-of-sample validation. In conclusion, we propose that a simple 15-word checklist provides a suitable screening test to identify people with progressive aphasia, while further specialist assessment is needed to differentiate accurately some groups (e.g. svPPA versus lvPPA and PSP versus nfvPPA).

Stability Over Time of Word Syllable Duration for Speakers With Acquired Apraxia of Speech

PURPOSE

Neurogenic speech and language disorders-such as acquired apraxia of speech (AOS) and aphasia with phonemic paraphasia (APP)-are often misdiagnosed due to similarities in clinical presentation. Word syllable duration (WSD)-a measure of average syllable length in multisyllabic words-serves as a proxy for speech rate, which is an important and arguably more objective clinical characteristic of AOS and APP. This study reports stability of WSD over time for speakers with AOS (and aphasia).

METHOD

Twenty-nine participants with AOS and aphasia (11 women and 18 men, Mage = 53.5 years, SD = 13.3) repeated 30 multisyllabic words (of three-, four-, and five-syllable lengths) on three occasions across 4 weeks. WSDs were calculated for each word and then averaged across each list (i.e., word length), as well as across combined lists (i.e., all 30 words) to yield four WSDs for each participant at each time point. Stability over time was calculated using Friedman's test for the group and using Spearman's rho for the individual level. Effects of time and word length were examined using robust mixed-effects linear regression.

RESULTS

Friedman's tests and correlations indicated no significant difference in WSDs across sampling occasions for each word length separately or combined. WSD correlated positively with AOS severity and negatively with intelligibility but was not correlated with aphasia severity. Regression analyses confirmed WSD to be stable over time, while WSD calculated from only five tokens (i.e., WSD-5) was less stable over time.

CONCLUSIONS

Results indicate that WSD can be a stable measure over time, at the individual and group level, providing support for its use in diagnosis and/or as an outcome measure, both clinically and for research. In general, WSD outperformed WSD-5, suggesting that it may be better to calculate WSD from more than five tokens. Stability of WSD in other populations and suitability for differential diagnosis need to be determined. Currently, differentiating disorders by speaking rate, alone, is not recommended.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25438735.

Dysfluency in primary progressive aphasia: Temporal speech parameters

Analysing spontaneous speech in individuals experiencing fluency difficulties holds potential for diagnosing speech and language disorders, including Primary Progressive Aphasia (PPA). Dysfluency in the spontaneous speech of patients with PPA has mostly been described in terms of abnormal pausing behaviour, but the temporal features related to speech have drawn little attention. This study compares speech-related fluency parameters in the three main variants of PPA and in typical speech. Forty-three adults participated in this research, thirteen with the logopenic variant of PPA (lvPPA), ten with the non-fluent variant (nfvPPA), nine with the semantic variant (svPPA), and eleven who were healthy age-matched adults. Participants' fluency was assessed through a picture description task from which 42 parameters were computed including syllable duration, speaking pace, the duration of speech chunks (i.e. interpausal units, IPU), and the number of linguistic units per IPU and per second. The results showed that each PPA variant exhibited abnormal speech characteristics reflecting various underlying factors, from motor speech deficits to higher-level issues. Out of the 42 parameters considered, 37 proved useful for characterising dysfluency in the three main PPA variants and 35 in distinguishing among them. Therefore, taking into account not only pausing behaviour but also temporal speech parameters can provide a fuller understanding of dysfluency in PPA. However, no single parameter by itself sufficed to distinguish one PPA group from the other two, further evidence that dysfluency is not dichotomous but rather multidimensional, and that complementary multiparametric analyses are needed.

Connected Speech Fluency in Poststroke and Progressive Aphasia: A Scoping Review of Quantitative Approaches and Features

PURPOSE

Speech fluency has important diagnostic implications for individuals with poststroke aphasia (PSA) as well as primary progressive aphasia (PPA), and quantitative assessment of connected speech has emerged as a widely used approach across both etiologies. The purpose of this review was to provide a clearer picture on the range, nature, and utility of individual quantitative speech/language measures and methods used to assess connected speech fluency in PSA and PPA, and to compare approaches across etiologies.

METHOD

We conducted a scoping review of literature published between 2012 and 2022 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Forty-five studies were included in the review. Literature was charted and summarized by etiology and characteristics of included patient populations and method(s) used for derivation and analysis of speech/language features. For a subset of included articles, we also charted the individual quantitative speech/language features reported and the level of significance of reported results.

RESULTS

Results showed that similar methodological approaches have been used to quantify connected speech fluency in both PSA and PPA. Two hundred nine individual speech-language features were analyzed in total, with low levels of convergence across etiology on specific features but greater agreement on the most salient features. The most useful features for differentiating fluent from nonfluent aphasia in both PSA and PPA were features related to overall speech quantity, speech rate, or grammatical competence.

CONCLUSIONS

Data from this review demonstrate the feasibility and utility of quantitative approaches to index connected speech fluency in PSA and PPA. We identified emergent trends toward automated analysis methods and data-driven approaches, which offer promising avenues for clinical translation of quantitative approaches. There is a further need for improved consensus on which subset of individual features might be most clinically useful for assessment and monitoring of fluency.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.25537237.

Normative Values for Word Syllable Duration With Interpretation in a Large Sample of Stroke Survivors With Aphasia

PURPOSE

Slow speech rate and abnormal temporal prosody are primary diagnostic criteria for differentiating between people with aphasia who do and do not have apraxia of speech. We sought to identify appropriate cutoff values for abnormal word syllable duration (WSD) in a word repetition task, interpret them relative to a data set of people with chronic aphasia, and evaluate the extent to which manually derived measures could be approximated through an automated process that relied on commercial speech recognition technology.

METHOD

Fifty neurotypical participants produced 49 multisyllabic words during a repetition task. Audio recordings were submitted to an automated speech recognition (ASR) service (IBM Watson) to measure word duration and generate an orthographic transcription. The transcribed words were compared to a lexical database, and the number of syllables was identified. Automatic and manual measures were compared for 50% of the sample. Results were interpreted relative to WSD scores from an existing data set of 195 people with mostly chronic aphasia.

RESULTS

ASR correctly identified 83% of target words and 98% of target syllable counts. Automated word duration calculations were longer than manual measures due to imprecise cursor placement. Upon applying regression coefficients to the automated measures and examining the frequency distributions for both manual and estimated measures, a WSD of 303-316 ms was found to indicate longer-than-normal performance (corresponding to the 95th percentile). With this cutoff, 40%-45% of participants with aphasia in our comparison sample had an abnormally long WSD.

CONCLUSIONS

We recommend using a rounded WSD cutoff score between 303 and 316 ms for manual measures. Future research will focus on customizing automated WSD methods to speech samples from people with aphasia, identifying target words that maximize production and measurement reliability, and developing WSD standard scores based on a large participant sample with and without aphasia.

Speech and phonological impairment across Alzheimer's disease severity

INTRODUCTION

Phonetic-phonological impairments have been described in dementia due to Alzheimer's disease (AD). However, whether the likely phonological-linguistic changes progress with the evolution of the disease or whether phonetic-motor manifestations occur in all three stages of AD (mild, moderate, and severe) has not yet been clarified. Thus, the aim of this study was to verify whether phonological-linguistic and phonetic-motor speech manifestations occur in the mild, moderate, and severe stages of AD.

METHODS

Thirty participants in each stage of probable AD (mild, moderate, and severe) and 30 healthy older adults underwent cognitive, instrumental activities of daily living and phonetic-phonological assessments. Phonetic-phonological manifestations were classified into three types: likely phonetic-motor, likely phonological-linguistic, and manifestations that may occur in disorders of both phonetic and phonological origin.

RESULTS

The manifestations analyzed in this study occurred rarely. The manifestations that may occur in disorders of both phonetic and phonological origin were the most common in all stages of the disease. The likely phonetic-motor manifestations emerged during the mild stage of the disease (distortions, prolonged intersegment duration, and vowel prolongations), while the likely phonological-linguistic manifestations were present mainly in the moderate (substitutions and attempts at the word level) and severe stages (substitutions, attempts at the word level, self-corrections, and anticipations). The occurrence of phonetic-phonological manifestations increased with disease progression.

CONCLUSIONS

The type of phonological and phonetic manifestations in the individuals with AD differed according to the dementia stage and were statistically more frequent as dementia worsened.

A Wearable System for Continuous Monitoring and Assessment of Speech, Gait, and Cognitive Decline for Early Diagnosis of ADRD

Early detection of cognitive decline is essential to study mild cognitive impairment and Alzheimer's Disease in order to develop targeted interventions and prevent or stop the progression of dementia. This requires continuous and longitudinal assessment and tracking of the related physiological and behavioral changes during daily life. In this paper, we present a low cost and low power wearable system custom designed to track the trends in speech, gait, and cognitive stress while also considering the important human factor needs such as privacy and compliance. In the form factors of a wristband and waist-patch, this multimodal, multi-sensor system measures inertial signals, sound, heart rate, electrodermal activity and pulse transit time. A total power consumption of 2.6 mW without any duty cycling allows for more than 3 weeks of run time between charges when 1500 mAh batteries are used.Clinical Relevance- Much earlier detection of Alzheimer's disease and related dementias may be possible by continuous monitoring of physiological and behavioral state using application specific wearable sensors during the activities of daily life.

Speech Motor Profiles in Primary Progressive Aphasia

PURPOSE

Previous research on motor speech disorders (MSDs) in primary progressive aphasia (PPA) has largely focused on patients with the nonfluent/agrammatic variant of PPA (nfvPPA), with few systematic descriptions of MSDs in variants other than nfvPPA. There has also been an emphasis on studying apraxia of speech, whereas less is known about dysarthria or other forms of MSDs. This study aimed to examine the qualitative and quantitative characteristics of MSDs in a prospective sample of individuals with PPA independent of subtype.

METHOD

We included 38 participants with a root diagnosis of PPA according to current consensus criteria, including one case with primary progressive apraxia of speech. Speech tasks comprised various speech modalities and levels of complexity. Expert raters used a novel protocol for auditory speech analyses covering all major dimensions of speech.

RESULTS

Of the participants, 47.4% presented with some form of MSD. Individual speech motor profiles varied widely with respect to the different speech dimensions. Besides apraxia of speech, we observed different dysarthria syndromes, special forms of MSDs (e.g., neurogenic stuttering), and mixed forms. Degrees of severity ranged from mild to severe. We also observed MSDs in patients whose speech and language profiles were incompatible with nfvPPA.

CONCLUSIONS

The results confirm that MSDs are common in PPA and can manifest in different syndromes. The findings emphasize that future studies of MSDs in PPA should be extended to all clinical variants and should take into account the qualitative characteristics of motor speech dysfunction across speech dimensions.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.22555534.

The Apraxia of Speech Rating Scale: Reliability, Validity, and Utility

PURPOSE

The purpose of this study was to examine the interrater reliability and validity of the Apraxia of Speech Rating Scale (ASRS-3.5) as an index of the presence and severity of apraxia of speech (AOS) and the prominence of several of its important features.

METHOD

Interrater reliability was assessed for 27 participants. Validity was examined in a cohort of 308 participants (120 with and 188 without progressive AOS) through item analysis; item-Total score correlations; correlations among ASRS Total score and component subscores and independent clinical ratings of AOS, dysarthria and aphasia severity, intelligibility, and articulatory errors, as well as years postonset and age; and regression models assessing item and Total score prediction of AOS presence.

RESULTS

Interrater reliability was good or excellent for most items and excellent for the Total score. Item and Total score analyses revealed good separation of participants with versus without AOS. Inter-item and item-Total score correlations were generally moderately high as were correlations between the ASRS Total score and independent ratings of AOS severity, intelligibility, and articulatory errors. The Total score was not meaningfully correlated with ratings of aphasia and dysarthria severity, years postonset, or age. Total scores below 7 and above 10 revealed excellent diagnostic sensitivity and specificity for AOS. The presence of eight or more abnormal features was also highly predictive of AOS presence.

CONCLUSIONS

The ASRS-3.5 is a reliable and valid scale for identifying the presence and severity of AOS and its predominant features. It has excellent sensitivity to AOS presence and excellent specificity relative to aphasia and dysarthria in patients with neurodegenerative disease.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21817584.

Acoustic and Kinematic Assessment of Motor Speech Impairment in Patients With Suspected Four-Repeat Tauopathies

PURPOSE

The aim of this study was to use acoustic and kinematic speech measures to characterize type of motor speech impairment-apraxia of speech (AOS) versus dysarthria-in individuals with four-repeat tauopathy (4RT)-associated syndromes, including nonfluent variant primary progressive aphasia (nfvPPA), primary progressive AOS (PPAOS), corticobasal syndrome (CBS), and progressive supranuclear palsy syndrome (PSPs).

METHOD

Twenty patient participants were recruited and stratified into two groups: (a) a motor-speech-impaired group of individuals with nfvPPA, PPAOS, CBS, or PSPs and suspected 4RT pathology ("MSI+") and (b) a non-motor-speech-impaired group of individuals with logopenic variant primary progressive aphasia ("MSI-"). Ten healthy, age-matched controls also participated in the study. Participants completed a battery of speech tasks, and 15 acoustic and kinematic speech measures were derived. Quantitative speech measures were grouped into feature categories ("AOS features," "dysarthria features," "shared features"). In addition to quantitative speech measures, two certified speech-language pathologists made independent, blinded auditory-perceptual ratings of motor speech impairment. A principal component analysis (PCA) was conducted to investigate the relative contributions of quantitative features.

RESULTS

Quantitative speech measures were generally concordant with independent clinician ratings of motor speech impairment severity. Hypothesis-driven groupings of quantitative measures differentiated predominantly apraxic from predominantly dysarthric presentations within the MSI+ group. PCA results provided additional evidence for differential profiles of motor speech impairment in the MSI+ group; heterogeneity across individuals is explained in large part by varying levels of overall severity-captured by the shared feature variable group-and degree of apraxia severity, as measured by the AOS feature variable group.

CONCLUSIONS

Quantitative features reveal heterogeneity of MSI in the 4RT group in terms of both overall severity and subtype of MSI. Results suggest the potential for acoustic and kinematic speech assessment methods to inform characterization of motor speech impairment in 4RT-associated syndromes.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21401778.

Silent Pauses and Speech Indices as Biomarkers for Primary Progressive Aphasia

Background and Objectives: Recent studies highlight the importance of investigating biomarkers for diagnosing and classifying patients with primary progressive aphasia (PPA). Even though there is ongoing research on pathophysiological indices in this field, the use of behavioral variables, and especially speech-derived factors, has drawn little attention in the relevant literature. The present study aims to investigate the possible utility of speech-derived indices, particularly silent pauses, as biomarkers for primary progressive aphasia (PPA). Materials and Methods: We recruited 22 PPA patients and 17 healthy controls, from whom we obtained speech samples based on two elicitation tasks, i.e., cookie theft picture description (CTP) and the patients’ personal narration of the disease onset and course. Results: Four main indices were derived from these speech samples: speech rate, articulation rate, pause frequency, and pause duration. In order to investigate whether these indices could be used to discriminate between the four groups of participants (healthy individuals and the three patient subgroups corresponding to the three variants of PPA), we conducted three sets of analyses: a series of ANOVAs, two principal component analyses (PCAs), and two hierarchical cluster analyses (HCAs). The ANOVAs revealed significant differences between the four subgroups for all four variables, with the CTP results being more robust. The subsequent PCAs and HCAs were in accordance with the initial statistical comparisons, revealing that the speech-derived indices for CTP provided a clearer classification and were especially useful for distinguishing the non-fluent variant from healthy participants as well as from the two other PPA taxonomic categories. Conclusions: In sum, we argue that speech-derived indices, and especially silent pauses, could be used as complementary biomarkers to efficiently discriminate between PPA and healthy speakers, as well as between the three variants of the disease.

Automated Detection of Speech Timing Alterations in Autopsy-Confirmed Nonfluent/Agrammatic Variant Primary Progressive Aphasia

BACKGROUND AND OBJECTIVES

Motor speech function, including speech timing, is a key domain for diagnosing nonfluent/agrammatic variant primary progressive aphasia (nfvPPA). Yet, standard assessments use subjective, specialist-dependent evaluations, undermining reliability and scalability. Moreover, few studies have examined relevant anatomo-clinical alterations in patients with pathologically confirmed diagnoses. This study overcomes such caveats using automated speech timing analyses in a unique cohort of autopsy-proven cases.

METHODS

In a cross-sectional study, we administered an overt reading task and quantified articulation rate, mean syllable and pause duration, and syllable and pause duration variability. Neuroanatomical disruptions were assessed using cortical thickness and white matter (WM) atrophy analysis.

RESULTS

We evaluated 22 persons with nfvPPA (mean age: 67.3 years; 13 female patients) and confirmed underlying 4-repeat tauopathy, 15 persons with semantic variant primary progressive aphasia (svPPA; mean age: 66.5 years; 8 female patients), and 10 healthy controls (HCs; 70 years; 5 female patients). All 5 speech timing measures revealed alterations in persons with nfvPPA relative to both the HC and svPPA groups, controlling for dementia severity. The articulation rate robustly discriminated individuals with nfvPPA from HCs (area under the ROC curve [AUC] = 0.95), outperforming specialist-dependent perceptual measures of dysarthria and apraxia of speech severity. Patients with nfvPPA exhibited structural abnormalities in left precentral and middle frontal as well as bilateral superior frontal regions, including their underlying WM. The articulation rate correlated with atrophy of the left pars opercularis and supplementary/presupplementary motor areas. Secondary analyses showed that, controlling for dementia severity, all measures yielded greater deficits in patients with nfvPPA and corticobasal degeneration (nfvPPA-CBD, n = 12) than in those with progressive supranuclear palsy pathology (nfvPPA-PSP, n = 10). The articulation rate robustly discriminated between individuals in each subgroup (AUC = 0.82). More widespread cortical thinning was observed for the nfvPPA-CBD than the nfvPPA-PSP group across frontal regions.

DISCUSSION

Automated speech timing analyses can capture specific markers of nfvPPA while potentially discriminating between patients with different tauopathies. Thanks to its objectivity and scalability; this approach could support standard speech assessments.

CLASSIFICATION OF EVIDENCE

This study provides Class III evidence that automated speech analysis can accurately differentiate patients with nonfluent PPA from normal controls and patients with semantic variant PPA.

Logogenic Primary Progressive Aphasia or Alzheimer Disease: Contribution of Acoustic Markers in Early Differential Diagnosis

The logopenic variant of Primary Progressive Aphasia (lvPPA), a syndromic disorder centered on language impairment, often presents variable underlying neurodegenerative pathologies such as Alzheimer Disease (AD). Actual language assessment tests and lumbar puncture, focused on AD diagnosis, cannot precisely distinguish the symptoms, or predict their progression at onset time. We analyzed acoustic markers, aiming to discriminate lvPPA and AD as well as the influence of AD biomarkers on acoustic profiles at the beginning of the disease. We recruited people with AD (n = 8) and with lvPPA (n = 8), with cerebrospinal fluid biomarker profiles determined by lumbar puncture. The participants performed a sentence repetition task that allows assessing potential lvPPA phonological loop deficits. We found that temporal and prosodic markers significantly differentiate the lvPPA and AD group at an early stage of the disease. Biomarker and acoustic profile comparisons discriminated the two lvPPA subgroups according to their biomarkers. For lvPPA with AD biomarkers, acoustic profile equivalent to an atypical AD form with a specific alteration of the phonological loop is shown. However, lvPPA without AD biomarkers has an acoustic profile approximating the one for DLFT. Therefore, these results allow us to classify lvPPA differentially from AD based on acoustic markers from a sentence repetition task. Furthermore, our results suggest that acoustic analysis would constitute a clinically efficient alternative to refused lumbar punctures. It offers the possibility to facilitate early, specific, and accessible neurodegenerative diagnosis and may ease early care with speech therapy, preventing the progression of symptoms.

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)

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.

[Preliminary study of the temporal variables of continuous speech in patients with neurodegenerative syndromes of the frontotemporal lobar degeneration spectrum]

INTRODUCTION

Neurodegenerative diseases, especially frontotemporal lobar degeneration and Alzheimer's disease, often lead to impaired language functions, and so speech analysis can provide objective measures with which to classify the different syndromes.

AIM

To study the nature, cognitive correlates and clinical utility of 21 variables related to speech and silence times.

SUBJECTS AND METHODS

Derivation of acoustic variables with Praat in three spontaneous speech tasks conducted in 22 subjects, distributed in six diagnostic groups (five with neurodegenerative diseases + control). A descriptive analysis is performed, with ROC and principal component curves, to study how acoustic variables are related to the different neurodegenerative syndromes and what information they can provide.

RESULTS

Three groups of variables are identified related, respectively, to: a) total number of silent pauses and total duration of the task; b) variability of the phonic groups; and c) variability of the periods of silence. These components correlate differentially with the different syndromes studied.

CONCLUSIONS

Detailed analysis of speech and silence times can provide relevant information for the diagnosis of different neurodegenerative syndromes that are not reflected in traditional neuropsychological assessments. Thus, the total number of silent pauses may be a valuable aid in discriminating patients with lexical access deficits, phonic group parameters seem to reflect motor speech problems, and pause variability is associated with dysexecutive and global impairment.