Aprosodia and prosoplegia with right frontal neurodegeneration

Case Series of Right-Hemisphere Nonfluent Variant of Primary Progressive Aphasia

BACKGROUND AND PURPOSE

Nonfluent variant primary progressive aphasia (nfvPPA) is a neurodegenerative disorder characterized by the progressive deterioration of language functions that typically appears with atrophy predominating in the left peri-insular region (left-nfvPPA) on imaging. While both left-dominant and right-dominant presentations have been reported in semantic variant primary progressive aphasia, the other language presentation of frontotemporal dementia, no case series of nfvPPA with predominantly right-sided atrophy of the peri-insular region (right-nfvPPA) have been reported previously. This study explored whether such entities exist and what their clinical features might be.

METHODS

A retrospective review of brain imaging data obtained from an established cohort of patients diagnosed with nfvPPA was performed to identify right-nfvPPA cases, followed by detailed analyses of their clinical profiles and imaging results compared to matched typical left-nfvPPA cases and healthy control group.

RESULTS

Four of 55 individuals meeting the consensus diagnostic criteria for nfvPPA demonstrated right-nfvPPA. No significant differences were noted in their clinical and neuropsychological profiles. Detailed imaging analyses demonstrated that the individuals with right-nfvPPA did not demonstrate atrophy of the anterior cingulate gyrus, unlike those in the left-nfvPPA group.

CONCLUSIONS

This study has revealed several intriguing differences between right-nfvPPA and left-nfvPPA, particularly in the prevalence of impairments in motor speech and naming as well as imaging differences. These findings warrant further exploration in a larger cohort to improve our understanding of neural network organization and its dysfunction in neurodegenerative disorders.

Affective prosody disorders in adults with neurological conditions: A scoping review

BACKGROUND

Individuals with affective-prosodic deficits have difficulty understanding or expressing emotions and attitudes through prosody. Affective prosody disorders can occur in multiple neurological conditions, but the limited knowledge about the clinical groups prone to deficits complicates their identification in clinical settings. Additionally, the nature of the disturbance underlying affective prosody disorder observed in different neurological conditions remains poorly understood.

AIMS

To bridge these knowledge gaps and provide relevant information to speech-language pathologists for the management of affective prosody disorders, this study provides an overview of research findings on affective-prosodic deficits in adults with neurological conditions by answering two questions: (1) Which clinical groups present with acquired affective prosodic impairments following brain damage? (2) Which aspects of affective prosody comprehension and production are negatively affected in these neurological conditions?

METHODS & PROCEDURES

We conducted a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. A literature search was undertaken in five electronic databases (MEDLINE, PsycINFO, EMBASE, CINAHL and Linguistics, and Language Behavior Abstracts) to identify primary studies reporting affective prosody disorders in adults with neurological impairments. We extracted data on clinical groups and characterised their deficits based on the assessment task used.

OUTCOMES & RESULTS

The review of 98 studies identified affective-prosodic deficits in 17 neurological conditions. The task paradigms typically used in affective prosody research (discrimination, recognition, cross-modal integration, production on request, imitation and spontaneous production) do not target the processes underlying affective prosody comprehension and production. Therefore, based on the current state of knowledge, it is not possible to establish the level of processing at which impairment occurs in clinical groups. Nevertheless, deficits in the comprehension of affective prosody are observed in 14 clinical groups (mainly recognition deficits) and deficits in the production of affective prosody (either on request or spontaneously) in 10 clinical groups. Neurological conditions and types of deficits that have not been investigated in many studies are highlighted.

CONCLUSIONS & IMPLICATIONS

The aim of this scoping review was to provide an overview on acquired affective prosody disorders and to identify gaps in knowledge that warrant further investigation. Deficits in the comprehension or production of affective prosody are common to numerous clinical groups with various neurological conditions. However, the underlying cause of affective prosody disorders across them is still unknown. Future studies should implement standardised assessment methods with specific tasks based on a cognitive model to identify the underlying deficits of affective prosody disorders.

WHAT THIS PAPER ADDS

What is already known on the subject What is already known on the subjectAffective prosody is used to share emotions and attitudes through speech and plays a fundamental role in communication and social interactions. Affective prosody disorders can occur in various neurological conditions, but the limited knowledge about the clinical groups prone to affective-prosodic deficits and about the characteristics of different phenotypes of affective prosody disorders complicates their identification in clinical settings. Distinct abilities underlying the comprehension and production of affective prosody can be selectively impaired by brain damage, but the nature of the disturbance underlying affective prosody disorders in different neurological conditions remains unclear. What this study adds Affective-prosodic deficits are reported in 17 neurological conditions, despite being recognised as a core feature of the clinical profile in only a few of them. The assessment tasks typically used in affective prosody research do not provide accurate information about the specific neurocognitive processes impaired in the comprehension or production of affective prosody. Future studies should implement assessment methods based on a cognitive approach to identify underlying deficits. The assessment of cognitive/executive dysfunctions, motor speech impairment and aphasia might be important for distinguishing primary affective prosodic dysfunctions from those secondarily impacting affective prosody. What are the potential clinical implications of this study? Raising awareness about the possible presence of affective-prosodic disorders in numerous clinical groups will facilitate their recognition by speech-language pathologists and, consequently, their management in clinical settings. A comprehensive assessment covering multiple affective-prosodic skills could highlight specific aspects of affective prosody that warrant clinical intervention.

Incongruences Between Facial Expression and Self-Reported Emotional Reactivity in Frontotemporal Dementia and Related Disorders

OBJECTIVE

Emotional reactivity normally involves a synchronized coordination of subjective experience and facial expression. These aspects of emotional reactivity can be uncoupled by neurological illness and produce adverse consequences for patient and caregiver quality of life because of misunderstandings regarding the patient's presumed internal state. Frontotemporal dementia (FTD) is often associated with altered social and emotional functioning. FTD is a heterogeneous disease, and socioemotional changes in patients could result from altered internal experience, altered facial expressive ability, altered language skills, or other factors. The authors investigated how individuals with FTD subtypes differ from a healthy control group regarding the extent to which their facial expressivity aligns with their self-reported emotional experience.

METHODS

Using a compound measure of emotional reactivity to assess reactions to three emotionally provocative videos, the authors explored potential explanations for differences in alignment of facial expressivity with emotional experience, including parkinsonism, physiological reactivity, and nontarget verbal responses.

RESULTS

Participants with the three main subtypes of FTD all tended to express less emotion on their faces than they did through self-report.

CONCLUSIONS

Exploratory analyses suggest that reasons for this incongruence likely differ not only between but also within diagnostic subgroups.