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Roheger M, Riemann S, Brauer A, McGowan E, Grittner U, Flöel A, Meinzer M. Non-pharmacological interventions for improving language and communication in people with primary progressive aphasia. Cochrane Database Syst Rev 2024; 5:CD015067. [PMID: 38808659 PMCID: PMC11134511 DOI: 10.1002/14651858.cd015067.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
BACKGROUND Primary progressive aphasia (PPA) accounts for approximately 43% of frontotemporal dementias and is mainly characterised by a progressive impairment of speech and communication abilities. Three clinical variants have been identified: (a) non-fluent/agrammatic, (b) semantic, and (c) logopenic/phonological PPA variants. There is currently no curative treatment for PPA, and the disease progresses inexorably over time, with devastating effects on speech and communication ability, functional status, and quality of life. Several non-pharmacological interventions that may improve symptoms (e.g. different forms of language training and non-invasive brain stimulation) have been investigated in people with PPA. OBJECTIVES To assess the effects of non-pharmacological interventions for people with PPA on word retrieval (our primary outcome), global language functions, cognition, quality of life, and adverse events. SEARCH METHODS We searched the Cochrane Dementia and Cognitive Improvement Group's trial register, MEDLINE (Ovid SP), Embase (Ovid SP), four other databases and two other trial registers. The latest searches were run on 26 January 2024. SELECTION CRITERIA We included randomised controlled trials (RCTs) evaluating the effects of non-pharmacological interventions in people with PPA. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS There were insufficient data available to conduct the network meta-analyses that we had originally planned (due to trial data being insufficiently reported or not reported at all, as well as the heterogeneous content of the included interventions). Therefore, we provide a descriptive summary of the included studies and results. We included 10 studies, with a total of 132 participants, evaluating non-pharmacological interventions. These were: transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS) as stand-alone treatments (used by two and one studies, respectively); tDCS combined with semantic and phonological word-retrieval training (five studies); tDCS combined with semantic word-retrieval training (one study); and tDCS combined with phonological word-retrieval training (one study). Results for our primary outcome of word retrieval were mixed. For the two studies that investigated the effects of tDCS as stand-alone treatment compared to placebo ("sham") tDCS, we rated the results as having very low-certainty evidence. One study found a significant beneficial effect on word retrieval after active tDCS; one study did not report any significant effects in favour of the active tDCS group. Five studies investigated tDCS administered to the dorsolateral prefrontal cortex, inferior frontal cortex, left frontotemporal region, or the temporoparietal cortex, combined with semantic and phonological word-retrieval training. The most consistent finding was enhancement of word-retrieval ability for trained items immediately after the intervention, when behavioural training was combined with active tDCS compared to behavioural training plus sham tDCS. We found mixed effects for untrained items and maintenance of treatment effects during follow-up assessments. We rated the certainty of the evidence as very low in all studies. One study investigated tDCS combined with semantic word-retrieval training. Training was provided across 15 sessions with a frequency of three to five sessions per week, depending on the personal preferences of the participants. tDCS targeted the left frontotemporal region. The study included three participants: two received 1 mA stimulation and one received 2 mA stimulation. The study showed mixed results. We rated it as very low-certainty evidence. One study investigated tDCS combined with phonological word-retrieval training. Training was again provided across 15 sessions over a period of three weeks. tDCS targeted the left inferior frontal gyrus. This study showed a significantly more pronounced improvement for trained and untrained words in favour of the group that had received active tDCS, but we rated the certainty of the evidence as very low. One study compared active rTMS applied to an individually determined target site to active rTMS applied to a control site (vertex) for effects on participants' word retrieval. This study demonstrated better word retrieval for active rTMS administered to individually determined target brain regions than in the control intervention, but we rated the results as having a very low certainty of evidence. Four studies assessed overall language ability, three studies assessed cognition, five studies assessed potential adverse effects of brain stimulation, and one study investigated quality of life. AUTHORS' CONCLUSIONS There is currently no high-certainty evidence to inform clinical decision-making regarding non-pharmacological treatment selection for people with PPA. Preliminary evidence suggests that the combination of active tDCS with specific language therapy may improve impaired word retrieval for specifically trained items beyond the effects of behavioural treatment alone. However, more research is needed, including high-quality RCTs with detailed descriptions of participants and methods, and consideration of outcomes such as quality of life, depressive symptoms, and overall cognitive functioning. Moreover, studies assessing optimal treatments (i.e. behavioural interventions, brain stimulation interventions, and their combinations) for individual patients and PPA subtypes are needed. We were not able to conduct the planned (network) meta-analyses due to missing data that could not be obtained from most of the authors, a general lack of RCTs in the field, and heterogeneous interventions in eligible trials. Journals should implement a mandatory data-sharing requirement to assure transparency and accessibility of data from clinical trials.
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Affiliation(s)
- Mandy Roheger
- Department of Psychology, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Steffen Riemann
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Andreas Brauer
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Ellen McGowan
- Speech and Language Therapy, Older People's Mental Health, Stockport, Pennine Care NHS Foundation Trust, Pennine Care NHS Foundation Trust, Stockport, UK
| | - Ulrike Grittner
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Agnes Flöel
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Marcus Meinzer
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
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Sanati M, Bayat S, Panahi MM, Khodadadi A, Rezaee S, Ghasimi M, Besharat S, Fooladi ZM, Dooghaee MA, Taheri MS, Dickerson BC, Goldberg A, Rezaii N. Impaired language in Alzheimer's disease: A comparison between English and Persian implicates content-word frequency rather than the noun-verb distinction. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.09.24305534. [PMID: 38645255 PMCID: PMC11030473 DOI: 10.1101/2024.04.09.24305534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
This study challenges the conventional psycholinguistic view that the distinction between nouns and verbs is pivotal in understanding language impairments in neurological disorders. Traditional views link frontal brain region damage with verb processing deficits and posterior temporoparietal damage with noun difficulties. However, this perspective is contested by findings from patients with Alzheimer's disease (pwAD), who show impairments in both word classes despite their typical temporoparietal atrophy. Notably, pwAD tend to use semantically lighter verbs in their speech than healthy individuals. By examining English-speaking pwAD and comparing them with Persian-speaking pwAD, this research aims to demonstrate that language impairments in Alzheimer's disease (AD) stem from the distributional properties of words within a language rather than distinct neural processing networks for nouns and verbs. We propose that the primary deficit in AD language production is an overreliance on high-frequency words. English has a set of particularly high-frequency verbs that surpass most nouns in usage frequency. Since pwAD tend to use high-frequency words, the byproduct of this word distribution in the English language would be an over-usage of high-frequency verbs. In contrast, Persian features complex verbs with an overall distribution lacking extremely high-frequency verbs like those found in English. As a result, we hypothesize that Persian-speaking pwAD would not have a bias toward the overuse of high-frequency verbs. We analyzed language samples from 95 English-speaking pwAD and 91 healthy controls, along with 27 Persian-speaking pwAD and 27 healthy controls. Employing uniform automated natural language processing methods, we measured the usage rates of nouns, verbs, and word frequencies across both cohorts. Our findings showed that English-speaking pwAD use higher-frequency verbs than healthy individuals, a pattern not mirrored by Persian-speaking pwAD. Crucially, we found a significant interaction between the frequencies of verbs used by English and Persian speakers with and without AD. Moreover, regression models that treated noun and verb frequencies as separate predictors did not outperform models that considered overall word frequency alone in classifying AD. In conclusion, this study suggests that language abnormalities among English-speaking pwAD reflect the unique distributional properties of words in English rather than a universal noun-verb class distinction. Beyond offering a new understanding of language abnormalities in AD, the study highlights the critical need for further investigation across diverse languages to deepen our insight into the mechanisms of language impairments in neurological disorders.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Mostafa Almasi Dooghaee
- Abrar Institute of Higher Education
- Azad University Science and Research Branch
- Institute for Cognitive Science Studies
- Mashhad University of Medical Science
- Shahid Beheshti University of Medical Sciences
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School
- Princeton University
| | | | - Bradford C Dickerson
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School
| | | | - Neguine Rezaii
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School
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Walenski M, Sostarics T, Mesulam MM, Thompson CK. The production of adjectives in narratives by individuals with primary progressive aphasia. JOURNAL OF NEUROLINGUISTICS 2024; 69:101179. [PMID: 37994312 PMCID: PMC10662918 DOI: 10.1016/j.jneuroling.2023.101179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Adjectives (e.g., hungry) are an important part of language, but have been little studied in individuals with impaired language. Adjectives are used in two different ways in English: attributively, to modify a noun (the hungry dog); or predicatively, after a verb (the dog is hungry). Attributive adjectives have a more complex grammatical structure than predicative adjectives, and may therefore be particularly prone to disruption in individuals with grammatical impairments. We investigated adjective production in three subtypes of primary progressive aphasia (PPA: agrammatic, semantic, logopenic), as well as in agrammatic stroke aphasia and a group of healthy control participants. Participants produced narratives based on picture books, and we coded every adjective they produced for its syntactic structure. Compared to healthy controls, the two agrammatic groups, but not the other two patient groups, produced significantly fewer attributive adjectives per sentence. All four patient groups were similar to controls for their rate of predicative adjective production. In addition, we found a significant correlation in the agrammatic PPA participants between their rate of producing attributive adjective and impaired production of sentences with complex syntactic structure (subject cleft sentences like It was the boy that chased the girl); no such correlation was found for predicative adjectives. Irrespective of structure, we examined the lexical characteristics of the adjectives that were produced, including length, frequency, semantic diversity and neighborhood density. Overall, the lexical characteristics of the produced adjectives were largely consistent with the language profile of each group. In sum, the results suggest that attributive adjectives present a particular challenge for individuals with agrammatic language production, and add a new dimension to the description of agrammatism. Our results further suggest that attributive adjectives may be a fruitful target for improved treatment and recovery of agrammatic language.
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Affiliation(s)
- Matthew Walenski
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
| | - Thomas Sostarics
- Department of Linguistics, Northwestern University, Evanston, IL, USA
| | - M. Marsel Mesulam
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University, Chicago, IL, USA
| | - Cynthia K. Thompson
- Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL, USA
- Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Stockbridge MD, Venezia JH, Vitti E, Tippett DC, Hillis AE. Verb Frequency and Density Drive Naming Performance in Primary Progressive Aphasia. APHASIOLOGY 2022; 37:1964-1980. [PMID: 38155815 PMCID: PMC10752624 DOI: 10.1080/02687038.2022.2142036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
Background Recent work has highlighted the utility of the Boston Naming Test and Hopkins Action Naming Assessment (HANA) for distinguishing between semantic (svPPA), logopenic (lvPPA) and non-fluent agrammatic (nfavPPA) variants of primary progressive aphasia (PPA). Aims To determine whether item level differences between variants on when naming verbs on the HANA were able to be accounted for using common variables of lexical interest: word frequency, semantic density, concreteness, or valency. We also examined three specific hypotheses: (1) svPPA and lvPPA may result in increased difficulty with decreased semantic density compared to nfavPPA; (2) svPPA may result in increased difficulty with decreased concreteness; and (3) nfavPPA may result in increased difficulty with high syntactic valency. Methods & Procedures 268 patients with PPA were evaluated using the HANA. A hierarchical Bayesian regression approach was adopted to account for effects of repeated measurement within participants and items. Outcomes & Results The main effects of variant and verb trait were significant in all models, as was the interaction for frequency, semantic density, and valency. Increasing frequency, semantic density, and concreteness led to better performance, while increasing valency led to poorer performance. Low semantic density contributed to greater difficulty in svPPA and lvPPA, but low concreteness did not uniquely impact verb naming in svPPA. Those with nfavPPA had no particular difficulty as a result of valency. Conclusions Prior studies have identified the independent effects of frequency and semantic density on verb naming in PPA, which were confirmed by our analyses, and the best predictions of the data were achieved by combining these dimensions. This investigation complements our previous work highlighting the value of the HANA for efficiently demonstrating verb performance in PPA.
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Affiliation(s)
- Melissa D. Stockbridge
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287
| | - Jonathan H. Venezia
- VA Loma Linda Healthcare System, Loma Linda, CA 92357
- Department of Otolaryngology & Head and Neck Surgery, Loma Linda University School of Medicine, Loma Linda, CA 92350
| | - Emilia Vitti
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287
| | - Donna C. Tippett
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287
- Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD 21287
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD 21287
- Department of Cognitive Science, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD 21218
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Kintz S, Wright HH. Light verb production in healthy ageing and dementia. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:796-807. [PMID: 35393738 DOI: 10.1111/1460-6984.12721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Light verbs are highly frequent and semantically impoverished words. It is currently not known whether light verb production in discourse tasks differs by age or for people with dementia of the Alzheimer's type (DAT). AIMS The purpose of the current study was two-fold: (1) to determine whether there is a relationship between age and the proportion of light verbs produce during a narrative discourse task; and (2) to determine whether people with DAT produce a different proportion of light verbs compared with neurotypical adults. METHODS & PROCEDURES A total of 469 neurotypical adults and 12 participants with DAT produced narratives from a wordless picture book. OUTCOME & RESULTS The results indicated that light verb production increases as a function of age, even when controlling for education, and people with DAT produced a higher light verb-word ratio compared with neurotypical adults when matched for age and education. CONCLUSION & IMPLICATION Light verb use may increase as a function of age due to declines in retrieval ability. These declines are not only more pronounced in people with DAT, but also semantic knowledge deficits may contribute to a reliance on light verbs. WHAT THIS PAPER ADDS Light verbs are typically some of the first verbs learned due to their simple semantic construction and high frequency. However, two things are unknown: (1) how light verbs changed across the adult lifespan; and (2) whether cognitive impairment changes light verb production. The study found that light verb production increases as a function of age, and that people with DAT used a higher ratio of light verbs to words in a narrative task compared with neurotypical adults. However, despite the findings, more research is needed to determine their clinical utility. Future research may wish to investigate whether light verbs (1) facilitate comprehension in older adults or (2) may be used in cognitive-linguistic assessments for cognitive impairments.
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Affiliation(s)
- Stephen Kintz
- Department of Speech Language Pathology, University of Arkansas at Little Rock, Little Rock, AR, USA
| | - Heather Harris Wright
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
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Lukic S, Licata AE, Weis E, Bogley R, Ratnasiri B, Welch AE, Hinkley LBN, Miller Z, Garcia AM, Houde JF, Nagarajan SS, Gorno-Tempini ML, Borghesani V. Auditory Verb Generation Performance Patterns Dissociate Variants of Primary Progressive Aphasia. Front Psychol 2022; 13:887591. [PMID: 35814055 PMCID: PMC9267767 DOI: 10.3389/fpsyg.2022.887591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Primary progressive aphasia (PPA) is a clinical syndrome in which patients progressively lose speech and language abilities. Three variants are recognized: logopenic (lvPPA), associated with phonology and/or short-term verbal memory deficits accompanied by left temporo-parietal atrophy; semantic (svPPA), associated with semantic deficits and anterior temporal lobe (ATL) atrophy; non-fluent (nfvPPA) associated with grammar and/or speech-motor deficits and inferior frontal gyrus (IFG) atrophy. Here, we set out to investigate whether the three variants of PPA can be dissociated based on error patterns in a single language task. We recruited 21 lvPPA, 28 svPPA, and 24 nfvPPA patients, together with 31 healthy controls, and analyzed their performance on an auditory noun-to-verb generation task, which requires auditory analysis of the input, access to and selection of relevant lexical and semantic knowledge, as well as preparation and execution of speech. Task accuracy differed across the three variants and controls, with lvPPA and nfvPPA having the lowest and highest accuracy, respectively. Critically, machine learning analysis of the different error types yielded above-chance classification of patients into their corresponding group. An analysis of the error types revealed clear variant-specific effects: lvPPA patients produced the highest percentage of "not-a-verb" responses and the highest number of semantically related nouns (production of baseball instead of throw to noun ball); in contrast, svPPA patients produced the highest percentage of "unrelated verb" responses and the highest number of light verbs (production of take instead of throw to noun ball). Taken together, our findings indicate that error patterns in an auditory verb generation task are associated with the breakdown of different neurocognitive mechanisms across PPA variants. Specifically, they corroborate the link between temporo-parietal regions with lexical processing, as well as ATL with semantic processes. These findings illustrate how the analysis of pattern of responses can help PPA phenotyping and heighten diagnostic sensitivity, while providing insights on the neural correlates of different components of language.
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Affiliation(s)
- Sladjana Lukic
- Department of Communication Sciences and Disorders, Ruth S. Ammon College of Education and Health Sciences, Adelphi University, Garden City, NY, United States
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Abigail E. Licata
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurology, Dyslexia Center, University of California, San Francisco, San Francisco, CA, United States
| | - Elizabeth Weis
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Rian Bogley
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurology, Dyslexia Center, University of California, San Francisco, San Francisco, CA, United States
| | - Buddhika Ratnasiri
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Ariane E. Welch
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Leighton B. N. Hinkley
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Z. Miller
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurology, Dyslexia Center, University of California, San Francisco, San Francisco, CA, United States
| | - Adolfo M. Garcia
- Cognitive Neuroscience Center, Universidad de San Andrés, Buenos Aires, Argentina
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
- National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
- Departamento de Lingüística y Literatura, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, Chile
| | - John F. Houde
- Department of Otolaryngology – Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Srikantan S. Nagarajan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Maria Luisa Gorno-Tempini
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurology, Dyslexia Center, University of California, San Francisco, San Francisco, CA, United States
| | - Valentina Borghesani
- Department of Psychology, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche de l’Institut Universitaire de Gériatrie de Montréal, Montréal, QC, Canada
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Tippett DC, Keser Z. Clinical and neuroimaging characteristics of primary progressive aphasia. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:81-97. [PMID: 35078612 PMCID: PMC9951770 DOI: 10.1016/b978-0-12-823384-9.00016-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The chapter covers the clinical syndrome of a primary progressive aphasia (PPA), the demographics of this rare neurodegenerative disease, defining clinical and neuroanatomic characteristics of each PPA variant, disease progression, and behavioral features. The chapter begins with a brief introduction that includes references to seminal papers that defined this clinical syndrome and its three variants. The classic PPA subtypes discussed in the chapter are semantic variant PPA (svPPA), nonfluent/agrammatic PPA (nfaPPA), and logopenic variant PPA (lvPPA). The key language and cognitive characteristics, and language tasks that can elicit these language impairments, are detailed. Overlap in the clinical profiles of the PPA variants, which make differential diagnosis challenging, are explained. Disease progression is described, revealing that the PPA variants become more similar over time. Although PPA is language-predominant dementia, there are behavioral manifestations, particularly in svPPA. Changes in behavior in this variant are addressed as well as behavioral changes in nfaPPA and lvPPA that are less well recognized. The patterns of atrophy in the left temporal, parietal, and/or frontal cortices unique to each PPA variant are described. The underlying neuropathologies of the PPA variants are discussed, specifically tauopathies and non-tauopathies associated with svPPA and nfaPPA and Alzheimer's disease pathology in lvPPA.
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Affiliation(s)
- Donna C. Tippett
- Departments of Neurology, Otolaryngology—Head and Neck Surgery, and Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Zafer Keser
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
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Stockbridge MD, Tippett DC, Breining BL, Vitti E, Hillis AE. Task performance to discriminate among variants of primary progressive aphasia. Cortex 2021; 145:201-211. [PMID: 34742101 PMCID: PMC8633174 DOI: 10.1016/j.cortex.2021.09.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/13/2021] [Accepted: 09/30/2021] [Indexed: 12/16/2022]
Abstract
Primary progressive aphasia can be distinguished into one of three variants: semantic, non-fluent/agrammatic, and logopenic. While a considerable body of work exists characterizing each variant, few prior studies have addressed the problem of optimizing behavioral assessment in a typical outpatient evaluation setting. Our aim is to examine the sensitivity and specificity of a battery of cognitive and linguistic assessments and determine optimal scores for distinguishing patients' subtype based on these instruments. This was a retrospective analysis of outpatient clinical testing of individuals with known or suspected primary progressive aphasia. Evaluations included the National Alzheimer's Coordinating Center frontotemporal lobar degeneration module and additional measures of naming, semantic association, word verification, and picture description. Receiver operating characteristic analysis was used to examine the utility of each task in distinguishing each variant from the others. Logistic regressions were used to examine the combined utility of tasks for distinguishing a given subtype. We examined 435 evaluations of 222 patients retrospectively. The battery was most consistent in distinguishing semantic variant by low scores and non-fluent/agrammatic variant by high scores on a similar subset of tasks. Tasks best distinguishing semantic variant produced a model that correctly classified 86% of cases. Tasks best distinguishing non-fluent/agrammatic variant correctly classified 77% of cases. The battery of tasks was weakest in identifying logopenic variant; only the ratio of sentence reading to sentence repetition performance was identified as a reasonable predictor, and it had predictive accuracy of 67%. Naming assessments were the strongest basis for distinguishing all variants, particularly semantic variant from non-fluent/agrammatic variant. These data illustrate that a number of commonly used assessments perform at chance in distinguishing variant and preliminarily support an abbreviated battery that marginally favors tools not currently included in the frontotemporal lobar degeneration module.
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Affiliation(s)
- Melissa D Stockbridge
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Donna C Tippett
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bonnie L Breining
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emilia Vitti
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Cognitive Science, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, USA
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Coemans S, Struys E, Vandenborre D, Wilssens I, Engelborghs S, Paquier P, Tsapkini K, Keulen S. A Systematic Review of Transcranial Direct Current Stimulation in Primary Progressive Aphasia: Methodological Considerations. Front Aging Neurosci 2021; 13:710818. [PMID: 34690737 PMCID: PMC8530184 DOI: 10.3389/fnagi.2021.710818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022] Open
Abstract
A variety of tDCS approaches has been used to investigate the potential of tDCS to improve language outcomes, or slow down the decay of language competences caused by Primary Progressive Aphasia (PPA). The employed stimulation protocols and study designs in PPA are generally speaking similar to those deployed in post-stroke aphasic populations. These two etiologies of aphasia however differ substantially in their pathophysiology, and for both conditions the optimal stimulation paradigm still needs to be established. A systematic review was done and after applying inclusion and exclusion criteria, 15 articles were analyzed focusing on differences and similarities across studies especially focusing on PPA patient characteristics (age, PPA variant, language background), tDCS stimulation protocols (intensity, frequency, combined therapy, electrode configuration) and study design as recent reviews and group outcomes for individual studies suggest tDCS is an effective tool to improve language outcomes, while methodological approach and patient characteristics are mentioned as moderators that may influence treatment effects. We found that studies of tDCS in PPA have clinical and methodological and heterogeneity regarding patient populations, stimulation protocols and study design. While positive group results are usually found irrespective of these differences, the magnitude, duration and generalization of these outcomes differ when comparing stimulation locations, and when results are stratified according to the clinical variant of PPA. We interpret the results of included studies in light of patient characteristics and methodological decisions. Further, we highlight the role neuroimaging can play in study protocols and interpreting results and make recommendations for future work.
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Affiliation(s)
- Silke Coemans
- Clinical and Experimental Neurolinguistics, CLIEN, Vrije Universiteit Brussel, Brussels, Belgium
| | - Esli Struys
- Clinical and Experimental Neurolinguistics, CLIEN, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
| | - Dorien Vandenborre
- Department of Speech and Language Pathology, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Ineke Wilssens
- Department of Speech and Language Pathology, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Sebastiaan Engelborghs
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Neurology, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Reference Center for Biological Markers of Dementia, BIODEM, Institute Born-Bunge, Universiteit Antwerpen, Antwerp, Belgium
| | - Philippe Paquier
- Clinical and Experimental Neurolinguistics, CLIEN, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Research in Cognition and Neurosciences (CRCN), Université Libre de Bruxelles, Antwerp, Belgium
- Department of Translational Neurosciences (TNW), Universiteit Antwerpen, Antwerp, Belgium
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
| | - Stefanie Keulen
- Clinical and Experimental Neurolinguistics, CLIEN, Vrije Universiteit Brussel, Brussels, Belgium
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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: 15] [Impact Index Per Article: 5.0] [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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Lavoie M, Black SE, Tang-Wai DF, Graham NL, Stewart S, Leonard C, Rochon E. Description of connected speech across different elicitation tasks in the logopenic variant of primary progressive aphasia. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:1074-1085. [PMID: 34383346 DOI: 10.1111/1460-6984.12660] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 05/06/2021] [Accepted: 06/27/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Despite its importance, in-depth analysis of connected speech is often neglected in the diagnosis of primary progressive aphasia (PPA) - especially for the logopenic variant (lvPPA) for which unreliable differential diagnosis has been documented. Only a few studies have been conducted on this topic in lvPPA. AIMS The aim of this study was to describe and compare lexico-semantic and morphosyntactic features of connected speech in participants with lvPPA, in comparison with healthy controls, using three different elicitation tasks (i.e., picture description, story narration and semi-structured interviews). In addition to a number of discourse features, we were particularly interested in the presence or absence of syntactic deficits in this PPA variant in line with recent findings. METHODS & PROCEDURES A prospective group study was conducted to compare lvPPA participants (n = 13) to age- and education-matched healthy controls (n = 13). For each individual, connected speech was obtained using three tasks: (1) The Cookie Theft picture description; (2) Cinderella Story; (3) Topic-directed interview. Production on each task was recorded, transcribed and analysed according to the Quantitative Production Analysis (QPA) protocol, a tool developed by Berndt et al. (2000) for the analysis of sentence production in aphasia. Differences between lvPPA and healthy controls and among elicitation tasks were analysed using repeated measures multilevel mixed-effects regression, separately for each outcome. OUTCOMES & RESULTS Four measures were significantly different between lvPPA participants and healthy controls across all elicitation tasks. Specifically, lvPPA participants produced a reduced proportion of open-class words, a higher proportion of verbs, a higher proportion of pronouns and fewer well-formed sentences. For these measures, the difference between lvPPA and healthy controls was consistent among elicitation tasks, except for the proportion of well-formed sentences, where the difference between the two groups was significantly greater in the story narration task than in the other tasks. CONCLUSIONS & IMPLICATIONS Across elicitation tasks that used the same analysis protocol (i.e., QPA), a similar pattern of deficits in connected speech emerged in lvPPA patients. Importantly, the findings replicate previous studies, which used different elicitation tasks and analysis protocols. Especially in relation to the documented syntactic deficits, these findings provide implications for differential diagnosis in PPA. WHAT THIS PAPER ADDS What is already known on the subject Connected speech analysis can provide an important contribution to the language assessment for the logopenic variant of primary progressive aphasia (lvPPA). However, only a few studies have been conducted with this population. What this paper adds to existing knowledge This study highlights differences between patients with lvPPA and healthy controls regarding the proportion of open-class words, nouns, verbs and well-formed sentences. What are the potential or actual clinical implications of this work? Importantly, our results highlight syntactic deficits in the same group of individuals with lvPPA, using the same analysis protocol and across various elicitation tasks, which has implications for differential diagnosis.
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Affiliation(s)
- Monica Lavoie
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehab, University Health Network, Toronto, ON, Canada
| | - Sandra E Black
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada
- Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Toronto, ON, Canada
| | - David F Tang-Wai
- Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada
- University Health Network Memory Clinic, Toronto Western Hospital, Toronto, ON, Canada
| | - Naida L Graham
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehab, University Health Network, Toronto, ON, Canada
| | - Steven Stewart
- KITE, Toronto Rehab, University Health Network, Toronto, ON, Canada
| | - Carol Leonard
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Audiology and Speech-Language Pathology Program, University of Ottawa, Ottawa, ON, Canada
| | - Elizabeth Rochon
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- KITE, Toronto Rehab, University Health Network, Toronto, ON, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
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12
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Breining BL, Faria AV, Caffo B, Meier EL, Sheppard SM, Sebastian R, Tippett DC, Hillis AE. Neural regions underlying object and action naming: Complementary evidence from acute stroke and primary progressive aphasia. APHASIOLOGY 2021; 36:732-760. [PMID: 35832655 PMCID: PMC9272983 DOI: 10.1080/02687038.2021.1907291] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/11/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Naming impairment is commonly noted in individuals with aphasia. However, object naming receives more attention than action naming. Furthermore, most studies include participants with aphasia due to only one aetiology, commonly stroke. We developed a new assessment, the Hopkins Action Naming Assessment (HANA), to evaluate action naming impairments. AIMS Our aims were to show that the HANA is a useful tool that can (1) identify action naming impairments and (2) be used to investigate the neural substrates underlying naming. We paired the HANA with the Boston Naming Test (BNT) to compare action and object naming. We considered participants with aphasia due to primary progressive aphasia (PPA) or acute left hemisphere stroke to provide a more comprehensive picture of brain-behaviour relationships critical for naming. Behaviourally, we hypothesised that there would be a double dissociation between object and action naming performance. Neuroanatomically, we hypothesised that different neural substrates would be implicated in object vs. action naming and that different lesion-deficit associations would be identified in participants with PPA vs. acute stroke. METHODS & PROCEDURES Participants (N=138 with PPA, N=37 with acute stroke) completed the BNT and HANA. Behavioural performance was compared. A subset of participants (N=31 with PPA, N=37 with acute stroke) provided neuroimaging data. The whole brain was automatically segmented into regions of interest (ROIs). For participants with PPA, the image variables were the ROI volumes, normalised by the brain volume. For participants with acute stroke, the image variables were the percentage of each ROI affected by the lesion. The relationship between ROIs likely to be involved in naming performance was modelled with LASSO regression. OUTCOMES & RESULTS Behavioural results showed a double dissociation in performance: in each group, some participants displayed intact performance relative to healthy controls on actions but not objects and/or significantly better performance on actions than objects, while others showed the opposite pattern. These results support the need to assess both objects and actions when evaluating naming deficits. Neuroimaging results identified different regions associated with object vs. action naming, implicating overlapping but distinct networks of regions. Furthermore, results differed for participants with PPA vs. acute stroke, indicating that critical information may be missed when only one aetiology is considered. CONCLUSIONS Overall, the study provides a more comprehensive picture of the neural bases of naming, underscoring the importance of assessing both objects and actions and considering different aetiologies of damage. It demonstrates the utility of the HANA.
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Affiliation(s)
- Bonnie L. Breining
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Andreia V. Faria
- Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Brian Caffo
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD 21287, USA
| | - Erin L. Meier
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Shannon M. Sheppard
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
- Department of Communication Sciences & Disorders, Chapman University, Irvine, CA 92618, USA
| | - Rajani Sebastian
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Donna C. Tippett
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
- Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD 21218, USA
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13
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Papagno C, Casarotti A, Zarino B, Crepaldi D. A new test of action verb naming: normative data from 290 Italian adults. Neurol Sci 2020; 41:2811-2817. [PMID: 32281040 DOI: 10.1007/s10072-020-04353-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/16/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Verbs and nouns can be selectively impaired, suggesting that they are processed, at least in part, by distinct neural structures. While several tests of object naming are available, tasks involving action verb naming with normative data are lacking. We report the construction and standardization of a new test for the assessment of picture naming of actions. MATERIAL AND METHODS The test includes 50 stimuli, strictly controlled for several confounding variables. Normative data on 290 Italian subjects pooled across homogenous subgroups for age, sex, and education are reported. RESULTS Multiple regression analyses revealed that age and education significantly correlated with the subject's score. In particular, increasing age negatively affected performance, while the performance increased with a higher education. CONCLUSIONS In the clinical practice, the availability of equivalent scores will help the comparison with performance in the picture naming of objects. This test allows investigating action naming deficits in aphasic patients, in Parkinson's disease patients and in further neurodegenerative disorders, in which a specific impairment of action verbs is expected, filling a gap in the clinical neuropsychological assessment.
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Affiliation(s)
- Costanza Papagno
- CeRiN, CIMeC, University of Trento, Rovereto, Italy.
- Department of Psychology, University of Milano-Bicocca, Milan, Italy.
| | - Alessandra Casarotti
- Unit of Oncological Neurosurgery, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Barbara Zarino
- Neurosurgery Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Davide Crepaldi
- International School for Advanced Studies (SISSA), Trieste, Italy
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14
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Meyer AM, Snider SF, McGowan SA, Tippett DC, Hillis AE, Friedman RB. Grammatical Ability Predicts Relative Action Naming Impairment in Primary Progressive Aphasia. APHASIOLOGY 2020; 34:664-674. [PMID: 33716376 PMCID: PMC7954137 DOI: 10.1080/02687038.2020.1734527] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 02/20/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Findings from several studies have indicated that participants with nfvPPA and participants with svPPA exhibit different patterns on action and object naming tasks, while other recent studies have found that neither participants with nfvPPA nor participants with svPPA show a significant difference in accuracy between object naming and action naming. AIMS The goal of this study was to test the hypothesis that relative action naming impairment is associated with grammatical ability in PPA, rather than a specific subtype of PPA. METHODS & PROCEDURES Thirty-four participants with PPA completed the Boston Naming Test, the Action Naming subtest of the Boston Diagnostic Aphasia Examination, and the Northwestern Anagram Test, which was used to measure grammatical ability. Z-scores for the two naming tasks were calculated based on normative data from unimpaired controls. For each participant with PPA, the relative action naming impairment was calculated by subtracting the object naming z-score from the action naming z-score. Linear regression analysis was then used to evaluate the role of grammatical ability as a predictor of relative action naming impairment, while controlling for age, education, cognitive ability (as measured by the Montreal Cognitive Assessment), and semantic ability (as measured by the Pyramids and Palm Trees test). The interaction between grammatical ability and each control variable was also examined. OUTCOMES & RESULTS The main effect of grammatical ability was a significant predictor of relative action naming impairment, while none of the control variables was a significant predictor. However, the interaction between grammatical ability and semantic ability was also significant. CONCLUSIONS Individuals who have both grammatical impairment and semantic impairment have the largest relative action naming impairment. These individuals may benefit from a treatment that focuses on the retrieval of verbs and their arguments.
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Affiliation(s)
- Aaron M. Meyer
- Center for Aphasia Research and Rehabilitation, Georgetown University Medical Center
| | - Sarah F. Snider
- Center for Aphasia Research and Rehabilitation, Georgetown University Medical Center
| | - Shelby A. McGowan
- Center for Aphasia Research and Rehabilitation, Georgetown University Medical Center
| | | | | | - Rhonda B. Friedman
- Center for Aphasia Research and Rehabilitation, Georgetown University Medical Center
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15
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Auclair-Ouellet N, Fossard M, Macoir J, Laforce R. The Nonverbal Processing of Actions Is an Area of Relative Strength in the Semantic Variant of Primary Progressive Aphasia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:569-584. [PMID: 32013713 DOI: 10.1044/2019_jslhr-19-00271] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Better performance for actions compared to objects has been reported in the semantic variant of primary progressive aphasia (svPPA). This study investigated the influence of the assessment task (naming, semantic picture matching) over the dissociation between objects and actions. Method Ten individuals with svPPA and 17 matched controls completed object and action naming tests, and object and action semantic picture matching tests. Performance was compared between the svPPA and control groups, within the svPPA group, and for each participant with svPPA versus the control group individually. Results Compared to controls, participants with svPPA were impaired on object and action naming, and object and action semantic picture matching. As a group, participants with svPPA had an advantage for actions over objects and for semantic picture matching tests over naming tests. Eight participants had a better performance for actions compared to objects in naming, with three showing a significant difference. Nine participants had a better performance for actions compared to objects in semantic picture matching, with six showing a significant difference. For objects, semantic picture matching was better than naming in nine participants, with five showing a significant difference. For actions, semantic picture matching was better than naming in all 10 participants, with nine showing a significant difference. Conclusion The nonverbal processing of actions, as assessed with a semantic picture matching test, is an area of relative strength in svPPA. Clinical implications for assessment planning and interpretation and theoretical implications for current models of semantic cognition are discussed.
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Affiliation(s)
- Noémie Auclair-Ouellet
- Faculty of Medicine, School of Communication Sciences and Disorders, McGill University, Montréal, Québec, Canada
- Centre for Research on Brain, Language and Music, Montréal, Québec, Canada
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Québec, Canada
| | - Marion Fossard
- Faculté des lettres et sciences humaines, Institut des sciences logopédiques, Université de Neuchâtel, Neuchâtel, Switzerland
| | - Joël Macoir
- Faculté de Médecine, Département de Réadaptation, Université Laval, Quebec City, Québec, Canada
- Centre de Recherche CERVO, Québec City, Québec, Canada
| | - Robert Laforce
- Faculté de Médecine, Département de Médecine, Université Laval, Quebec City, Québec, Canada
- Clinique Interdisciplinaire de Mémoire, Centre Hospitalier Universitaire de Québec, Quebec City, Québec, Canada
- Chaire de recherche sur les aphasies primaires progressives-Fondation de la famille Lemaire, Quebec City, Québec, Canada
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16
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Semantic and lexical features of words dissimilarly affected by non-fluent, logopenic, and semantic primary progressive aphasia. J Int Neuropsychol Soc 2019; 25:1011-1022. [PMID: 31511121 PMCID: PMC6879829 DOI: 10.1017/s1355617719000948] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine the effect of three psycholinguistic variables-lexical frequency, age of acquisition (AoA), and neighborhood density (ND)-on lexical-semantic processing in individuals with non-fluent (nfvPPA), logopenic (lvPPA), and semantic primary progressive aphasia (svPPA). Identifying the scope and independence of these features can provide valuable information about the organization of words in our mind and brain. METHOD We administered a lexical decision task-with words carefully selected to permit distinguishing lexical frequency, AoA, and orthographic ND effects-to 41 individuals with PPA (13 nfvPPA, 14 lvPPA, 14 svPPA) and 25 controls. RESULTS Of the psycholinguistic variables studied, lexical frequency had the largest influence on lexical-semantic processing, but AoA and ND also played an independent role. The results reflect a brain-language relationship with different proportional effects of frequency, AoA, and ND in the PPA variants, in a pattern that is consistent with the organization of the mental lexicon. Individuals with nfvPPA and lvPPA experienced an ND effect consistent with the role of inferior frontal and temporoparietal regions in lexical analysis and word form processing. By contrast, individuals with svPPA experienced an AoA effect consistent with the role of the anterior temporal lobe in semantic processing. CONCLUSIONS The findings are in line with a hierarchical mental lexicon structure with a conceptual (semantic) and a lexeme (word-form) level, such that a selective deficit at one of these levels of the mental lexicon manifests differently in lexical-semantic processing performance, consistent with the affected language-specific brain region in each PPA variant.
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17
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Mack JE, Mesulam MM, Rogalski EJ, Thompson CK. Verb-argument integration in primary progressive aphasia: Real-time argument access and selection. Neuropsychologia 2019; 134:107192. [PMID: 31521633 DOI: 10.1016/j.neuropsychologia.2019.107192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 07/30/2019] [Accepted: 09/09/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Impaired sentence comprehension is observed in the three major subtypes of PPA, with distinct performance patterns relating to impairments in comprehending complex sentences in the agrammatic (PPA-G) and logopenic (PPA-L) variants and word comprehension in the semantic subtype (PPA-S). However, little is known about basic combinatory processes during sentence comprehension in PPA, such the integration of verbs with their subject and object(s) (verb-argument integration). METHODS The present study used visual-world eye-tracking to examine real-time verb-argument integration in individuals with PPA (12 with PPA-G, 10 with PPA-L, and 6 with PPA-S) and neurotypical older adults (15). Two baseline experiments probed eye movement control, using a non-linguistic task, and noun comprehension, respectively. Two verb-argument integration experiments examined the effects of verb meaning on (a) lexical access of the verb's direct object (argument access) and (b) selection of a semantically-appropriate direct object (argument selection), respectively. Eye movement analyses were conducted only for trials with correct behavioral responses, allowing us to distinguish accuracy and online processing. RESULTS The eye movement control experiment revealed no significant impairments in PPA, whereas the noun comprehension experiment revealed reduced accuracy and eye-movement latencies in PPA-S, and to a lesser extent PPA-G. In the argument access experiment, verb meaning facilitated argument access normally in PPA-G and PPA-L; in PPA-S, verb-meaning effects emerged on an atypical time course. In the argument selection experiment, significant impairments in accuracy were observed only in PPA-G, accompanied by markedly atypical eye movement patterns. CONCLUSION This study revealed two distinct patterns of impaired verb-argument integration in PPA. In PPA-S, impaired verb-argument integration was observed in the argument access experiment, indicating impairments in basic semantic combinatory processes which likely relate to damage in ventral language pathways. In contrast, listeners with PPA-G showed marked impairments of argument selection, likely relating to damage to left inferior frontal regions.
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Affiliation(s)
- Jennifer E Mack
- Roxelyn & Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, USA.
| | - M-Marsel Mesulam
- Mesulam Cognitive Neurology and Alzheimer's Disease Center, Northwestern University, USA; Ken & Ruth Davee Department of Neurology, Northwestern University, USA
| | - Emily J Rogalski
- Mesulam Cognitive Neurology and Alzheimer's Disease Center, Northwestern University, USA; Department of Psychiatry and Behavioral Sciences, Northwestern University, USA
| | - Cynthia K Thompson
- Roxelyn & Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, USA; Mesulam Cognitive Neurology and Alzheimer's Disease Center, Northwestern University, USA; Ken & Ruth Davee Department of Neurology, Northwestern University, USA
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18
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Steeb B, García-Cordero I, Huizing MC, Collazo L, Borovinsky G, Ferrari J, Cuitiño MM, Ibáñez A, Sedeño L, García AM. Progressive Compromise of Nouns and Action Verbs in Posterior Cortical Atrophy. Front Psychol 2018; 9:1345. [PMID: 30123155 PMCID: PMC6085559 DOI: 10.3389/fpsyg.2018.01345] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 07/13/2018] [Indexed: 12/18/2022] Open
Abstract
Processing of nouns and action verbs can be differentially compromised following lesions to posterior and anterior/motor brain regions, respectively. However, little is known about how these deficits progress in the course of neurodegeneration. To address this issue, we assessed productive lexical skills in a patient with posterior cortical atrophy (PCA) at two different stages of his pathology. On both occasions, he underwent a structural brain imaging protocol and completed semantic fluency tasks requiring retrieval of animals (nouns) and actions (verbs). Imaging results were compared with those of controls via voxel-based morphometry (VBM), whereas fluency performance was compared to age-matched norms through Crawford's t-tests. In the first assessment, the patient exhibited atrophy of more posterior regions supporting multimodal semantics (medial temporal and lingual gyri), together with a selective deficit in noun fluency. Then, by the second assessment, the patient's atrophy had progressed mainly toward fronto-motor regions (rolandic operculum, inferior and superior frontal gyri) and subcortical motor hubs (cerebellum, thalamus), and his fluency impairments had extended to action verbs. These results offer unprecedented evidence of the specificity of the pathways related to noun and action-verb impairments in the course of neurodegeneration, highlighting the latter's critical dependence on damage to regions supporting motor functions, as opposed to multimodal semantic processes.
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Affiliation(s)
- Brenda Steeb
- Laboratory of Language Research (LILEN), Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Indira García-Cordero
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Marjolein C Huizing
- Laboratory of Language Research (LILEN), Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Lucas Collazo
- Laboratory of Language Research (LILEN), Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Geraldine Borovinsky
- Laboratory of Language Research (LILEN), Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Jesica Ferrari
- Department of Language Speech, Institute of Cognitive Neurology, Buenos Aires, Argentina
| | - Macarena M Cuitiño
- Laboratory of Language Research (LILEN), Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.,Faculty of Psychology, Favaloro University, Buenos Aires, Argentina.,Faculty of Psychology, University of Buenos Aires, Buenos Aires, Argentina
| | - Agustín Ibáñez
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.,Universidad Autónoma del Caribe, Barranquilla, Colombia.,Center for Social and Cognitive Neuroscience, School of Psychology, Universidad Adolfo Ibáñez, Santiago de Chile, Chile.,Centre of Excellence in Cognition and its Disorders, Australian Research Council, Sydney, NSW, Australia
| | - Lucas Sedeño
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina
| | - Adolfo M García
- Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Buenos Aires, Argentina.,Faculty of Education, National University of Cuyo, Mendoza, Argentina
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19
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Koukoulioti V, Stavrakaki S, Konstantinopoulou E, Ioannidis P. Lexical and Grammatical Factors in Sentence Production in Semantic Dementia: Insights From Greek. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2018; 61:870-886. [PMID: 29635463 DOI: 10.1044/2017_jslhr-l-17-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 12/05/2017] [Indexed: 06/08/2023]
Abstract
PURPOSE Language production in semantic dementia (SD) is characterized by a lexical-semantic deficit and largely preserved argument structure and inflection production. This study investigates (a) the effect of argument structure on verb retrieval and (b) the interrelation between inflection marking and verb retrieval in SD. METHOD Seven individuals with SD and 7 healthy controls performed 2 sentence elicitation tasks. In Experiment 1, participants described the action taking place in a video. In Experiment 2, they watched the same videos preceded by a phrase prompting the production of past tense. Three verb classes were tested: (a) unergative (e.g., to walk), (b) unaccusative (e.g., to fall), and (c) transitive with 1 object (e.g., to read a book). RESULTS There was not any quantitative difference among the verb classes in Experiment 1, but error analysis hinted at difficulties related with argument structure complexity. The findings of Experiment 2 suggest no general effect of inflection on verb retrieval; nevertheless, inflection marking impeded the retrieval of verbs with complex argument structure. Large individual variation was established. CONCLUSIONS Argument structure complexity may challenge speakers with SD. Verb retrieval and inflection marking seem to interrelate at the expense of the former. Inflection production may be affected at severe stages of the disease. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.6030779.
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Affiliation(s)
- Vasiliki Koukoulioti
- Department of Linguistics, School of Philology, Aristotle University of Thessaloniki, Greece
- Institut für Linguistik, Goethe-Universität, Frankfurt am Main, Germany
| | - Stavroula Stavrakaki
- Department of Italian Language and Linguistics, Aristotle University of Thessaloniki, Greece
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20
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Morean DF. Effects of semantic weight on verb retrieval in individuals with aphasia: A different perspective. JOURNAL OF COMMUNICATION DISORDERS 2017; 69:119-129. [PMID: 28898710 DOI: 10.1016/j.jcomdis.2017.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 07/19/2017] [Accepted: 07/24/2017] [Indexed: 06/07/2023]
Abstract
The majority of people with aphasia have word retrieval difficulty and effective treatment remains elusive. There have been a few studies that have explored the effects of semantic complexity on verb retrieval in individuals with aphasia; each used a variation of Breedin et al.'s (1998) delayed repetition/story completion task. Although each subsequent investigator worked to address potential confounds in order to achieve more valid results that would give rise to a clearer understanding of these deficits, findings and their interpretations have varied. In our replication, groups of individuals with aphasia (9 agrammatic and 9 anomic) plus 12 age-matched controls participated in a story completion task that included novel distracter stories to prevent rehearsal. Additionally, stimuli were developed in strict adherence to novel semantic and syntactic templates to control for relevant factors, and stimuli were prerecorded to ensure uniform delivery. We calculated the number of target verbs produced and overall production of light and heavy verbs, and error analysis was performed with special attention to semantically appropriate substitutions. In contrast to previous studies, we found no significant performance differences on these measures within or between groups. Exploratory analyses were performed. Results are discussed in terms of relevant factors of verb retrieval and implications for future experimental design. Application to much-needed verb retrieval treatment is also considered.
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Affiliation(s)
- Diane F Morean
- Shirley Ryan Ability Lab (formerly, Rehabilitation Institute of Chicago), 355 East Erie Street, 25th Floor, Chicago, IL 60611, USA.
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21
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Marcotte K, Graham NL, Fraser KC, Meltzer JA, Tang-Wai DF, Chow TW, Freedman M, Leonard C, Black SE, Rochon E. White Matter Disruption and Connected Speech in Non-Fluent and Semantic Variants of Primary Progressive Aphasia. Dement Geriatr Cogn Dis Extra 2017; 7:52-73. [PMID: 28611820 PMCID: PMC5465709 DOI: 10.1159/000456710] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 01/06/2017] [Indexed: 02/04/2023] Open
Abstract
Differential patterns of white matter disruption have recently been reported in the non-fluent (nfvPPA) and semantic (svPPA) variants of primary progressive aphasia (PPA). No single measure is sufficient to distinguish between the PPA variants, but connected speech allows for the quantification of multiple measures. The aim of the present study was to further investigate the white matter correlates associated with connected speech features in PPA. We examined the relationship between white matter metrics and connected speech deficits using an automated analysis of transcriptions of connected speech and diffusion tensor imaging in language-related tracts. Syntactic, lexical, and semantic features were automatically extracted from transcriptions of topic-directed interviews conducted with groups of individuals with nfvPPA or svPPA as well as with a group of healthy controls. A principal component analysis was performed in order to reduce the number of language measures and yielded a five-factor solution. The results indicated that nfvPPA patients differed from healthy controls on a syntactic factor, and svPPA patients differed from controls on two semantic factors. However, the patient groups did not differ on any factor. Moreover, a correlational analysis revealed that the lexical richness factor was significantly correlated with radial diffusivity in the left inferior longitudinal fasciculus, which suggests that semantic deficits in connected speech reflect a disruption of this ventral pathway, and which is largely consistent with the results of previous studies. Using an automated approach for the analysis of connected speech combined with probabilistic tractography, the present findings demonstrate that nfvPPA patients are impaired relative to healthy controls on syntactic measures and have increased radial diffusivity in the left superior longitudinal fasciculus, whereas the svPPA group was impaired on lexico-semantic measures relative to controls and showed increased radial diffusivity in the uncinate and inferior longitudinal fasciculus bilaterally.
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Affiliation(s)
- Karine Marcotte
- aToronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada.,bÉcole d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada.,cCentre de recherche de l'Hôpital du Sacré-Cœur de Montréal, Montreal, Québec, Canada
| | - Naida L Graham
- aToronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada.,dDepartment of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kathleen C Fraser
- eDepartment of Computer Science, University of Toronto, Toronto, Ontario, Canada
| | - Jed A Meltzer
- dDepartment of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,fRotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada.,gDepartment of Psychology, University of Toronto, Toronto, Ontario, Canada.,hHeart and Stroke Foundation, Center for Stroke Recovery, Ottawa, Ontario, Canada
| | - David F Tang-Wai
- iDepartment of Medicine (Neurology), University of Toronto, Toronto, Ontario, Canada.,jUniversity Health Network Memory Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Tiffany W Chow
- fRotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada.,iDepartment of Medicine (Neurology), University of Toronto, Toronto, Ontario, Canada.,kDepartment of Clinical Neurology, University of Southern California, Los Angeles, California, USA
| | - Morris Freedman
- fRotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada.,lDepartment of Medicine, Division of Neurology, Baycrest Health Sciences, University of Toronto, and Mt. Sinai Hospital, Toronto, Ontario, Canada.,mSam and Ida Ross Memory Clinic, Baycrest Health Sciences, Toronto, Ontario, Canada
| | - Carol Leonard
- dDepartment of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,hHeart and Stroke Foundation, Center for Stroke Recovery, Ottawa, Ontario, Canada.,nSchool of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Sandra E Black
- aToronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada.,fRotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada.,hHeart and Stroke Foundation, Center for Stroke Recovery, Ottawa, Ontario, Canada.,iDepartment of Medicine (Neurology), University of Toronto, Toronto, Ontario, Canada.,oInstitute of Medical Science, University of Toronto, Toronto, Ontario, Canada.,pL.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,qBrain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Elizabeth Rochon
- aToronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada.,dDepartment of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,hHeart and Stroke Foundation, Center for Stroke Recovery, Ottawa, Ontario, Canada.,rRehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
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22
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Cupit J, Graham NL, Leonard C, Tang-Wai D, Black SE, Rochon E. Wh- questions and passive sentences in non-fluent variant PPA and semantic variant PPA: Longitudinal findings of an anagram production task. Cogn Neuropsychol 2016; 33:329-42. [PMID: 27341394 DOI: 10.1080/02643294.2016.1179179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Using an anagram task, we investigated longitudinal syntactic production by individuals with semantic variant primary progressive aphasia (svPPA) and non-fluent variant PPA (nfvPPA), compared to controls. The accuracy of the production of active and passive, and reversible and non-reversible sentences, as well as of wh- questions was compared across the three groups. Results showed a different pattern of syntactic impairment across the two patient groups. The nfvPPA group showed difficulty with wh- questions at Time 1 and impairment with the passive structure approximately one year later, at Time 2. Surprisingly, the svPPA group also showed difficulty with wh- questions from Time 1, but still no difficulty on passive sentences, two years later, at Time 3. Neither group had difficulty with reversibility. The results of the nfvPPA patients were as expected, and the results of the svPPA patients suggest that this group may exhibit a greater syntactic impairment than is typically recognized.
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Affiliation(s)
- Jennifer Cupit
- a Department of Speech-Language Pathology , Faculty of Medicine, University of Toronto , Toronto , ON , Canada.,b Toronto Rehabilitation Institute-University Health Network (TRI-UHN) , Toronto , ON , Canada
| | - Naida L Graham
- a Department of Speech-Language Pathology , Faculty of Medicine, University of Toronto , Toronto , ON , Canada.,b Toronto Rehabilitation Institute-University Health Network (TRI-UHN) , Toronto , ON , Canada
| | - Carol Leonard
- a Department of Speech-Language Pathology , Faculty of Medicine, University of Toronto , Toronto , ON , Canada.,c Audiology and Speech-Language Pathology Program , University of Ottawa , Ottawa , Canada
| | - David Tang-Wai
- d Toronto Western Hospital-University Health Network (TWH-UHN) , Toronto , ON , Canada.,j Department of Medicine (Neurology) , University of Toronto , Toronto , Canada
| | - Sandra E Black
- e Sunnybrook Health Sciences Centre , Toronto , ON , Canada.,f Institute of Medical Science, University of Toronto , Toronto , ON , Canada.,g L.C. Campbell Cognitive Neurology Research Unit , Sunnybrook Health Sciences Centre , Toronto , ON , Canada.,h Brain Sciences Research Program , Sunnybrook Research Institute , Toronto , ON , Canada.,i Rotman Research Institute-Baycrest Centre , Toronto , ON , Canada.,j Department of Medicine (Neurology) , University of Toronto , Toronto , Canada.,k Heart and Stroke Foundation , Partnership for Stroke Recovery , Ontario , ON , Canada
| | - Elizabeth Rochon
- a Department of Speech-Language Pathology , Faculty of Medicine, University of Toronto , Toronto , ON , Canada.,b Toronto Rehabilitation Institute-University Health Network (TRI-UHN) , Toronto , ON , Canada
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