Losing control of your languages: A case study

Effects of Cerebellar Transcranial Direct Current Stimulation in Bilingual Logopenic Primary Progressive Aphasia

Background

Primary progressive aphasia (PPA) is a language-based dementia, causing progressive decline of language functions. Transcranial direct current stimulation (tDCS) can augment effects of speech-and language therapy (SLT). However, this has not been investigated in bilingual patients with PPA.

Objective

We evaluated the case of Mr. G., a French (native language, L1)/Dutch (second language, L2)-speaking 59-year-old male, with logopenic PPA, associated with Alzheimer's disease pathology. We aimed to characterize his patterns of language decline and evaluate the effects of tDCS applied to the right posterolateral cerebellum on his language abilities and executive control circuits.

Methods

In a within-subject controlled design, Mr. G received 9 sessions of sham and anodal tDCS combined with semantic and phonological SLT in L2. Changes were evaluated with an oral naming task in L2, the Boston Naming Task and subtests of the Bilingual Aphasia Test in in L2 and L1, the Stroop Test and Attention Network Test, before and after each phase of stimulation (sham/tDCS) and at 2-month follow-up.

Results

After anodal tDCS, but not after sham, results improved significantly on oral naming in L2, with generalization to untrained tasks and cross-language transfer (CLT) to L1: picture naming in both languages, syntactic comprehension and repetition in L2, and response times in the incongruent condition of the Attention Network Test, indicating increased inhibitory control.

Conclusions

Our preliminary results are the first to indicate that tDCS applied to the cerebellum may be a valuable tool to enhance the effects of SLT in bilingual patients with logopenic PPA.

Bilingual Primary Progressive Aphasia: A Scoping Review of Assessment and Treatment Practices

BACKGROUND

Primary progressive aphasia (PPA) is a neurodegenerative syndrome characterized by speech and/or language impairment with relatively spared cognition. Research investigating behavioral speech-language intervention and methods for cognitive-linguistic assessment in PPA has predominantly centered around monolingual speakers. This gap hinders the widespread adoption of evidence-based approaches and exacerbates the inequities faced by culturally and linguistically diverse populations living with PPA.

OBJECTIVE

This scoping review synthesizes the current evidence for assessment and treatment practices in bilingual PPA as well as the operationalization of bilingualism in PPA.

METHODS

Arksey & O'Malley's scoping review methodology was utilized. Information was extracted from each study and entered into a data-charting template designed to capture information regarding operationalization of bilingualism in PPA and assessment and treatment practices.

RESULTS

Of the 16 identified studies, 14 reported the results of assessments conducted in both languages. Three studies reported positive naming treatment outcomes. Thirteen studies included English-speaking participants, revealing linguistic bias. Most studies reported age of acquisition, proficiency, and patterns of language use rather than providing an operational definition for bilingualism.

CONCLUSIONS

Neither formal assessment measures nor clear guidelines for assessment of bilingual PPA currently exist; however, language-specific measures are emerging. Speech-language intervention in bilingual PPA has been relatively unexplored, representing a significant gap in the literature. In order to improve diagnostic and treatment options for bilingual PPA, targeted efforts to increase representation of bilinguals from various sociocultural contexts, as well as those who speak a variety of language pairs, is necessary.

A case-study of language-specific executive disorder

Executive control is recruited for language processing, particularly in complex linguistic tasks. Although the issue of the existence of an executive control specific to language is still an open issue, there is much evidence that executively-demanding language tasks rely on domain-general rather than language-specific executive resources. Here, we addressed this issue by assessing verbal and non-verbal executive capacities in LG, an aphasic patient after a stroke. First, we showed that LG's performance was spared in all non-verbal tasks regardless of the executive demands. Second, by contrasting conditions of high and low executive demand in verbal tasks, we showed that LG was only impaired in verbal task with high executive demand. The performance dissociation between low and high executive demand conditions in the verbal domain, not observed in the non-verbal domain, shows that verbal executive control partly dissociates from non-verbal executive control. This language-specific executive disorder suggests that some executive processes might be language-specific.

Voluntary Language Switching in the Context of Bilingual Aphasia

As studies of bilingual language control (BLC) seek to explore the underpinnings of bilinguals’ abilities to juggle two languages, different types of language switching tasks have been used to uncover switching and mixing effects and thereby reveal what proactive and reactive control mechanisms are involved in language switching. Voluntary language switching tasks, where a bilingual participant can switch freely between their languages while naming, are being utilized more often due to their greater ecological validity compared to cued switching paradigms. Because this type of task had not yet been applied to language switching in bilingual patients, our study sought to explore voluntary switching in bilinguals with aphasia (BWAs) as well as in healthy bilinguals. In Experiment 1, we replicated previously reported results of switch costs and mixing benefits within our own bilingual population of Catalan-Spanish bilinguals. With Experiment 2, we compared both the performances of BWAs as a group and as individuals against control group performance. Results illustrated a complex picture of language control abilities, indicating varying degrees of association and dissociation between factors of BLC. Given the diversity of impairments in BWAs’ language control mechanisms, we highlight the need to examine BLC at the individual level and through the lens of theoretical cognitive control frameworks in order to further parse out how bilinguals regulate their language switching.

SUBTLEX-CAT: Subtitle word frequencies and contextual diversity for Catalan

SUBTLEX-CAT is a word frequency and contextual diversity database for Catalan, obtained from a 278-million-word corpus based on subtitles supplied from broadcast Catalan television. Like all previous SUBTLEX corpora, it comprises subtitles from films and TV series. In addition, it includes a wider range of TV shows (e.g., news, documentaries, debates, and talk shows) than has been included in most previous databases. Frequency metrics were obtained for the whole corpus, on the one hand, and only for films and fiction TV series, on the other. Two lexical decision experiments revealed that the subtitle-based metrics outperformed the previously available frequency estimates, computed from either written texts or texts from the Internet. Furthermore, the metrics obtained from the whole corpus were better predictors than the ones obtained from films and fiction TV series alone. In both experiments, the best predictor of response times and accuracy was contextual diversity.

Neural basis of bilingual language control

Acquiring and speaking a second language increases demand on the processes of language control for bilingual as compared to monolingual speakers. Language control for bilingual speakers involves the ability to keep the two languages separated to avoid interference and to select one language or the other in a given conversational context. This ability is what we refer with the term "bilingual language control" (BLC). It is now well established that the architecture of this complex system of language control encompasses brain networks involving cortical and subcortical structures, each responsible for different cognitive processes such as goal maintenance, conflict monitoring, interference suppression, and selective response inhibition. Furthermore, advances have been made in determining the overlap between the BLC and the nonlinguistic executive control networks, under the hypothesis that the BLC processes are just an instantiation of a more domain-general control system. Here, we review the current knowledge about the neural basis of these control systems. Results from brain imaging studies of healthy adults and on the performance of bilingual individuals with brain damage are discussed.

Semantic interference and its control: A functional neuroimaging and connectivity study

During picture naming, the ease with which humans generate words is dependent upon the context in which they are named. For instances, naming previously presented items results in facilitation. Instead, naming a picture semantically related to previous items displays persistent interference effects (i.e., cumulative semantic interference, CSI). The neural correlates of CSI are still unclear and it is a matter of debate whether semantic control, or cognitive control more in general, is necessary for the resolution of CSI. We carried out an event-related fMRI experiment to assess the neural underpinnings of the CSI effect and the involvement and nature of semantic control. Both left inferior frontal gyrus (LIFG) and the left caudate nucleus (LCN) showed a linear increase of BOLD response positively associated with the consecutive number of presentations of semantically related pictures independently of task-load. The generalized psychophysiological interaction analysis showed that LIFG demonstrated a quantitative neural connectivity difference with the left supramarginal and angular gyri for increases of task-load and with the fusiform gyri for linear CSI increases. Furthermore, seed-to-voxel functional connectivity showed that LIFG activity coupled with different regions involved in cognitive control and lexicosemantic processing when semantic interference was elicited to a minimum or maximum degree. Our results are consistent with the lexical-competitive nature of the CSI effect, and we provide novel evidence that semantic control lies upon a more general cognitive control network (i.e., LIFG and LCN) responsible for resolving interference between competing semantically related items through connectivity with different brain areas in order to guarantee the correct response. Hum Brain Mapp 37:4179-4196, 2016. © 2016 Wiley Periodicals, Inc.

Grammatical Class Effects Across Impaired Child and Adult Populations

The aims of this study are to compare quantitative and qualitative differences for noun/verb retrieval across language-impaired groups, examine naming errors with reference to psycholinguistic models of word processing, and shed light on the nature of the naming deficit as well as determine relevant group commonalities and differences. This includes an attempt to establish whether error types differentiate language-impaired children from adults, to determine effects of psycholinguistic variables on naming accuracies, and to link the results to genetic mechanisms and/or neural circuitry in the brain. A total of 89 (language-)impaired participants took part in this report: 24 adults with acquired aphasia, 20 adults with schizophrenia-spectrum disorder, 31 adults with relapsing-remitting multiple sclerosis, and 14 children with specific language impairment. The results of simultaneous multiple regression analyses for the errors in verb naming compared to the psycholinguistic variables for all language-impaired groups are reported and discussed in relation to models of lexical processing. This discussion will lead to considerations of genetic and/or neurobiological underpinnings: Presence of the noun-verb dissociation in focal and non-focal brain impairment make localization theories redundant, but support for wider neural network involvement.The patterns reported cannot be reduced to any one level of language processing, suggesting multiple interactions at different levels (e.g., receptive vs. expressive language abilities).Semantic-conceptual properties constrain syntactic properties with implications for phonological word form retrieval.Competition needs to be resolved at both conceptual and phonological levels of representation. Moreover, this study may provide a cross-pathological baseline that can be probed further with respect to recent suggestions concerning a reconsideration of open- vs. closed-class items, according to which verbs may actually fall into the latter rather than the standardly received former class.

The role of executive control in bilingual language production: A study with Parkinson's disease individuals

The basal ganglia are critically involved in language control (LC) processes, allowing a bilingual to utter correctly in one language without interference from the non-requested language. It has been hypothesized that the neural mechanism of LC closely resembles domain-general executive control (EC). The purpose of the present study is to investigate the integrity of bilingual LC and its overlap with domain-general EC in a clinical population such as individuals with Parkinson's disease (PD), notoriously associated with structural damage in the basal ganglia. We approach these issues in two ways. First, we employed a language switching task to investigate the integrity of LC in a group of Catalan-Spanish bilingual individuals with PD, as compared to a group of matched healthy controls. Second, to test the relationship between domain-general EC and LC we compared the performances of individuals with PD and healthy controls also in a non-linguistic switching task. We highlight that, compared to controls, individuals with PD report decreased processing speed, less accuracy and larger switching costs in terms of RT and errors in the language switching task, whereas in the non-linguistic switching task PD patients showed only increased switching cost in terms of errors. However, we report a positive correlation between the magnitudes of linguistic and non-linguistic mixing costs in individuals with PD. Taken together, these results support the notion of a critical role of the basal ganglia and connected structures in LC, and suggest a possible link between LC and domain-general EC.