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Baqué L, Machuca MJ. Dysfluency in primary progressive aphasia: Temporal speech parameters. CLINICAL LINGUISTICS & PHONETICS 2024:1-34. [PMID: 39104133 DOI: 10.1080/02699206.2024.2378345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 06/28/2024] [Accepted: 07/05/2024] [Indexed: 08/07/2024]
Abstract
Analysing spontaneous speech in individuals experiencing fluency difficulties holds potential for diagnosing speech and language disorders, including Primary Progressive Aphasia (PPA). Dysfluency in the spontaneous speech of patients with PPA has mostly been described in terms of abnormal pausing behaviour, but the temporal features related to speech have drawn little attention. This study compares speech-related fluency parameters in the three main variants of PPA and in typical speech. Forty-three adults participated in this research, thirteen with the logopenic variant of PPA (lvPPA), ten with the non-fluent variant (nfvPPA), nine with the semantic variant (svPPA), and eleven who were healthy age-matched adults. Participants' fluency was assessed through a picture description task from which 42 parameters were computed including syllable duration, speaking pace, the duration of speech chunks (i.e. interpausal units, IPU), and the number of linguistic units per IPU and per second. The results showed that each PPA variant exhibited abnormal speech characteristics reflecting various underlying factors, from motor speech deficits to higher-level issues. Out of the 42 parameters considered, 37 proved useful for characterising dysfluency in the three main PPA variants and 35 in distinguishing among them. Therefore, taking into account not only pausing behaviour but also temporal speech parameters can provide a fuller understanding of dysfluency in PPA. However, no single parameter by itself sufficed to distinguish one PPA group from the other two, further evidence that dysfluency is not dichotomous but rather multidimensional, and that complementary multiparametric analyses are needed.
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Affiliation(s)
- Lorraine Baqué
- Departament de Filologia Francesa i Romànica, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - María-Jesús Machuca
- Departament de Filologia Espanyola, Universitat Autònoma de Barcelona, Bellaterra, Spain
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Landin-Romero R, Kumfor F, Ys Lee A, Leyton C, Piguet O. Clinical and cortical trajectories in non-fluent primary progressive aphasia and Alzheimer's disease: A role for emotion processing. Brain Res 2024; 1829:148777. [PMID: 38286395 DOI: 10.1016/j.brainres.2024.148777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 01/31/2024]
Abstract
OBJECTIVES To examine the clinical trajectories and neural correlates of cognitive and emotion processing changes in the non-fluent/agrammatic (nfvPPA) and the logopenic (lvPPA) variants of primary progressive aphasia (PPA). DESIGN Observational case-control longitudinal cohort study. SETTING Research clinic of frontotemporal dementia. PARTICIPANTS This study recruited 29 non-semantic PPA patients (15 nfvPPA and 14 lvPPA) and compared them with 15 Alzheimer's disease (AD) patients and 14 healthy controls. MEASUREMENTS Participants completed an annual assessment (median = 2 years; range = 1-5 years) of general cognition, emotion processing and structural MRI. Linear mixed effects models investigated clinical and imaging trajectories between groups. RESULTS Over time, lvPPA showed the greatest cognitive deterioration. In contrast, nfvPPA showed significant decline in emotion recognition, whereas AD showed preserved emotion recognition, even with disease progression. Importantly, lvPPA also developed emotion processing impairments, with disease progression. Both nfvPPA and lvPPA showed continuing cortical atrophy in hallmark language-processing regions associated with these syndromes, together with progressive involvement of the right hemisphere regions, mirroring left hemisphere atrophy patterns at presentation. Decline in emotion processing was associated with bilateral frontal atrophy in nfvPPA and right temporal atrophy in lvPPA. CONCLUSIONS Our results show divergent clinical courses in nfvPPA and lvPPA, with rapid cognitive and neural deterioration in lvPPA and emotion processing decline in both groups and support the concurrent assessment of cognition and emotion processing in the clinic to inform diagnosis and monitoring in the non-semantic variants of PPA.
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Affiliation(s)
- Ramon Landin-Romero
- Sydney School of Health Sciences & Brain and Mind Centre, The University of Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders, Australia.
| | - Fiona Kumfor
- School of Psychology & Brain and Mind Centre, The University of Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders, Australia
| | - Austin Ys Lee
- ARC Centre of Excellence in Cognition and its Disorders, Australia
| | - Cristian Leyton
- School of Psychology & Brain and Mind Centre, The University of Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders, Australia
| | - Olivier Piguet
- School of Psychology & Brain and Mind Centre, The University of Sydney, Australia; ARC Centre of Excellence in Cognition and its Disorders, Australia
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Ramanan S, Halai AD, Garcia-Penton L, Perry AG, Patel N, Peterson KA, Ingram RU, Storey I, Cappa SF, Catricala E, Patterson K, Rowe JB, Garrard P, Ralph MAL. The neural substrates of transdiagnostic cognitive-linguistic heterogeneity in primary progressive aphasia. Alzheimers Res Ther 2023; 15:219. [PMID: 38102724 PMCID: PMC10724982 DOI: 10.1186/s13195-023-01350-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/08/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Clinical variants of primary progressive aphasia (PPA) are diagnosed based on characteristic patterns of language deficits, supported by corresponding neural changes on brain imaging. However, there is (i) considerable phenotypic variability within and between each diagnostic category with partially overlapping profiles of language performance between variants and (ii) accompanying non-linguistic cognitive impairments that may be independent of aphasia magnitude and disease severity. The neurobiological basis of this cognitive-linguistic heterogeneity remains unclear. Understanding the relationship between these variables would improve PPA clinical/research characterisation and strengthen clinical trial and symptomatic treatment design. We address these knowledge gaps using a data-driven transdiagnostic approach to chart cognitive-linguistic differences and their associations with grey/white matter degeneration across multiple PPA variants. METHODS Forty-seven patients (13 semantic, 15 non-fluent, and 19 logopenic variant PPA) underwent assessment of general cognition, errors on language performance, and structural and diffusion magnetic resonance imaging to index whole-brain grey and white matter changes. Behavioural data were entered into varimax-rotated principal component analyses to derive orthogonal dimensions explaining the majority of cognitive variance. To uncover neural correlates of cognitive heterogeneity, derived components were used as covariates in neuroimaging analyses of grey matter (voxel-based morphometry) and white matter (network-based statistics of structural connectomes). RESULTS Four behavioural components emerged: general cognition, semantic memory, working memory, and motor speech/phonology. Performance patterns on the latter three principal components were in keeping with each variant's characteristic profile, but with a spectrum rather than categorical distribution across the cohort. General cognitive changes were most marked in logopenic variant PPA. Regardless of clinical diagnosis, general cognitive impairment was associated with inferior/posterior parietal grey/white matter involvement, semantic memory deficits with bilateral anterior temporal grey/white matter changes, working memory impairment with temporoparietal and frontostriatal grey/white matter involvement, and motor speech/phonology deficits with inferior/middle frontal grey matter alterations. CONCLUSIONS Cognitive-linguistic heterogeneity in PPA closely relates to individual-level variations on multiple behavioural dimensions and grey/white matter degeneration of regions within and beyond the language network. We further show that employment of transdiagnostic approaches may help to understand clinical symptom boundaries and reveal clinical and neural profiles that are shared across categorically defined variants of PPA.
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Affiliation(s)
- Siddharth Ramanan
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, UK.
| | - Ajay D Halai
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, UK
| | - Lorna Garcia-Penton
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, UK
| | - Alistair G Perry
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | - Nikil Patel
- Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, UK
| | - Katie A Peterson
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | - Ruth U Ingram
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Ian Storey
- Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, UK
| | - Stefano F Cappa
- IUSS Cognitive Neuroscience Center (ICoN), University Institute of Advanced Studies IUSS, Pavia, Italy
- Dementia Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Eleonora Catricala
- IUSS Cognitive Neuroscience Center (ICoN), University Institute of Advanced Studies IUSS, Pavia, Italy
- Dementia Research Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Karalyn Patterson
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, UK
| | - James B Rowe
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, UK
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | - Peter Garrard
- Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, UK
| | - Matthew A Lambon Ralph
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, 15 Chaucer Road, Cambridge, CB2 7EF, UK
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Antonioni A, Raho EM, Lopriore P, Pace AP, Latino RR, Assogna M, Mancuso M, Gragnaniello D, Granieri E, Pugliatti M, Di Lorenzo F, Koch G. Frontotemporal Dementia, Where Do We Stand? A Narrative Review. Int J Mol Sci 2023; 24:11732. [PMID: 37511491 PMCID: PMC10380352 DOI: 10.3390/ijms241411732] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 07/30/2023] Open
Abstract
Frontotemporal dementia (FTD) is a neurodegenerative disease of growing interest, since it accounts for up to 10% of middle-age-onset dementias and entails a social, economic, and emotional burden for the patients and caregivers. It is characterised by a (at least initially) selective degeneration of the frontal and/or temporal lobe, generally leading to behavioural alterations, speech disorders, and psychiatric symptoms. Despite the recent advances, given its extreme heterogeneity, an overview that can bring together all the data currently available is still lacking. Here, we aim to provide a state of the art on the pathogenesis of this disease, starting with established findings and integrating them with more recent ones. In particular, advances in the genetics field will be examined, assessing them in relation to both the clinical manifestations and histopathological findings, as well as considering the link with other diseases, such as amyotrophic lateral sclerosis (ALS). Furthermore, the current diagnostic criteria will be explored, including neuroimaging methods, nuclear medicine investigations, and biomarkers on biological fluids. Of note, the promising information provided by neurophysiological investigations, i.e., electroencephalography and non-invasive brain stimulation techniques, concerning the alterations in brain networks and neurotransmitter systems will be reviewed. Finally, current and experimental therapies will be considered.
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Affiliation(s)
- Annibale Antonioni
- Unit of Clinical Neurology, Neurosciences and Rehabilitation Department, University of Ferrara, 44121 Ferrara, Italy
- Doctoral Program in Translational Neurosciences and Neurotechnologies, University of Ferrara, 44121 Ferrara, Italy
| | - Emanuela Maria Raho
- Unit of Clinical Neurology, Neurosciences and Rehabilitation Department, University of Ferrara, 44121 Ferrara, Italy
| | - Piervito Lopriore
- Neurological Institute, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Antonia Pia Pace
- Institute of Radiology, Department of Medicine, University of Udine, University Hospital S. Maria della Misericordia, Azienda Sanitaria-Universitaria Friuli Centrale, 33100 Udine, Italy
| | - Raffaela Rita Latino
- Complex Structure of Neurology, Emergency Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy
| | - Martina Assogna
- Centro Demenze, Policlinico Tor Vergata, University of Rome 'Tor Vergata', 00133 Rome, Italy
- Non Invasive Brain Stimulation Unit, Istituto di Ricovero e Cura a Carattere Scientifico Santa Lucia, 00179 Rome, Italy
| | - Michelangelo Mancuso
- Neurological Institute, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Daniela Gragnaniello
- Nuerology Unit, Neurosciences and Rehabilitation Department, Ferrara University Hospital, 44124 Ferrara, Italy
| | - Enrico Granieri
- Unit of Clinical Neurology, Neurosciences and Rehabilitation Department, University of Ferrara, 44121 Ferrara, Italy
| | - Maura Pugliatti
- Unit of Clinical Neurology, Neurosciences and Rehabilitation Department, University of Ferrara, 44121 Ferrara, Italy
| | - Francesco Di Lorenzo
- Non Invasive Brain Stimulation Unit, Istituto di Ricovero e Cura a Carattere Scientifico Santa Lucia, 00179 Rome, Italy
| | - Giacomo Koch
- Non Invasive Brain Stimulation Unit, Istituto di Ricovero e Cura a Carattere Scientifico Santa Lucia, 00179 Rome, Italy
- Iit@Unife Center for Translational Neurophysiology, Istituto Italiano di Tecnologia, 44121 Ferrara, Italy
- Section of Human Physiology, Neurosciences and Rehabilitation Department, University of Ferrara, 44121 Ferrara, Italy
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Ash S, Nevler N, Irwin DJ, Shellikeri S, Rascovsky K, Shaw L, Lee EB, Trojanowski JQ, Grossman M. Apraxia of Speech in the Spontaneous Speech of Nonfluent/Agrammatic Primary Progressive Aphasia. J Alzheimers Dis Rep 2023; 7:589-604. [PMID: 37313492 PMCID: PMC10259074 DOI: 10.3233/adr-220089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/13/2023] [Indexed: 06/15/2023] Open
Abstract
Background Apraxia of speech (AOS) is a core feature of nonfluent/agrammatic primary progressive aphasia (naPPA), but its precise characteristics and the prevalence of AOS features in spontaneous speech are debated. Objective To assess the frequency of features of AOS in the spontaneous, connected speech of individuals with naPPA and to evaluate whether these features are associated with an underlying motor disorder such as corticobasal syndrome or progressive supranuclear palsy. Methods We examined features of AOS in 30 patients with naPPA using a picture description task. We compared these patients to 22 individuals with behavioral variant frontotemporal dementia and 30 healthy controls. Each speech sample was evaluated perceptually for lengthened speech segments and quantitatively for speech sound distortions, pauses between and within words, and articulatory groping. We compared subgroups of naPPA with and without at least two features of AOS to assess the possible contribution of a motor impairment to speech production deficits. Results naPPA patients produced both speech sound distortions and other speech sound errors. Speech segmentation was found in 27/30 (90%) of individuals. Distortions were identified in 8/30 (27%) of individuals, and other speech sound errors occurred in 18/30 (60%) of individuals. Frequent articulatory groping was observed in 6/30 (20%) of individuals. Lengthened segments were observed rarely. There were no differences in the frequencies of AOS features among naPPA subgroups as a function of extrapyramidal disease. Conclusion Features of AOS occur with varying frequency in the spontaneous speech of individuals with naPPA, independently of an underlying motor disorder.
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Affiliation(s)
- Sharon Ash
- Penn Frontotemporal Degeneration Center and Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Naomi Nevler
- Penn Frontotemporal Degeneration Center and Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - David J. Irwin
- Penn Frontotemporal Degeneration Center and Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Sanjana Shellikeri
- Penn Frontotemporal Degeneration Center and Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Katya Rascovsky
- Penn Frontotemporal Degeneration Center and Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Leslie Shaw
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
| | - Edward B. Lee
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, USA
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Montembeault M, Miller ZA, Geraudie A, Pressman P, Slegers A, Millanski C, Licata A, Ratnasiri B, Mandelli ML, Henry M, Cobigo Y, Rosen HJ, Miller BL, Brambati SM, Gorno-Tempini ML, Battistella G. Spared speech fluency is associated with increased functional connectivity in the speech production network in semantic variant primary progressive aphasia. Brain Commun 2023; 5:fcad077. [PMID: 37038501 PMCID: PMC10082556 DOI: 10.1093/braincomms/fcad077] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 01/10/2023] [Accepted: 03/15/2023] [Indexed: 03/18/2023] Open
Abstract
Semantic variant primary progressive aphasia is a clinical syndrome characterized by marked semantic deficits, anterior temporal lobe atrophy and reduced connectivity within a distributed set of regions belonging to the functional network associated with semantic processing. However, to fully depict the clinical signature of semantic variant primary progressive aphasia, it is necessary to also characterize preserved neural networks and linguistic abilities, such as those subserving speech production. In this case-control observational study, we employed whole-brain seed-based connectivity on task-free MRI data of 32 semantic variant primary progressive aphasia patients and 46 healthy controls to investigate the functional connectivity of the speech production network and its relationship with the underlying grey matter. We investigated brain-behaviour correlations with speech fluency measures collected through clinical tests (verbal agility) and connected speech (speech rate and articulation rate). As a control network, we also investigated functional connectivity within the affected semantic network. Patients presented with increased connectivity in the speech production network between left inferior frontal and supramarginal regions, independent of underlying grey matter volume. In semantic variant primary progressive aphasia patients, preserved (verbal agility) and increased (articulation rate) speech fluency measures correlated with increased connectivity between inferior frontal and supramarginal regions. As expected, patients demonstrated decreased functional connectivity in the semantic network (dependent on the underlying grey matter atrophy) associated with average nouns' age of acquisition during connected speech. Collectively, these results provide a compelling model for studying compensation mechanisms in response to disease that might inform the design of future rehabilitation strategies in semantic variant primary progressive aphasia.
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Affiliation(s)
- Maxime Montembeault
- Memory and Aging Center, Department of Neurology, University of California in San Francisco, San Francisco, CA 94158, USA
- Douglas Mental Health University Institute, Montréal, QC H4H 1R3, Canada
- Department of Psychiatry, McGill University, Montréal, QC H3A 1A1, Canada
| | - Zachary A Miller
- Memory and Aging Center, Department of Neurology, University of California in San Francisco, San Francisco, CA 94158, USA
| | - Amandine Geraudie
- Memory and Aging Center, Department of Neurology, University of California in San Francisco, San Francisco, CA 94158, USA
- Department of Neurology, Toulouse University Hospital, Toulouse 31400, France
| | - Peter Pressman
- Department of Neurology, Behavioral Neurology Section, University of Colorado Anschutz Medical Campus, Aurora, CO 80238, USA
| | - Antoine Slegers
- Département de Psychologie, Université de Montréal, Montréal, QC H3C 3J7, Canada
- Centre de recherche de l’Institut Universitaire de Gériatrie de Montréal, Montréal, QC H3W 1W5, Canada
| | - Carly Millanski
- Memory and Aging Center, Department of Neurology, University of California in San Francisco, San Francisco, CA 94158, USA
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin, Austin, TX 78712-0114, USA
| | - Abigail Licata
- Memory and Aging Center, Department of Neurology, University of California in San Francisco, San Francisco, CA 94158, USA
| | - Buddhika Ratnasiri
- Memory and Aging Center, Department of Neurology, University of California in San Francisco, San Francisco, CA 94158, USA
| | - Maria Luisa Mandelli
- Memory and Aging Center, Department of Neurology, University of California in San Francisco, San Francisco, CA 94158, USA
| | - Maya Henry
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin, Austin, TX 78712-0114, USA
| | - Yann Cobigo
- Memory and Aging Center, Department of Neurology, University of California in San Francisco, San Francisco, CA 94158, USA
| | - Howard J Rosen
- Memory and Aging Center, Department of Neurology, University of California in San Francisco, San Francisco, CA 94158, USA
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California in San Francisco, San Francisco, CA 94158, USA
| | - Simona M Brambati
- Département de Psychologie, Université de Montréal, Montréal, QC H3C 3J7, Canada
- Centre de recherche de l’Institut Universitaire de Gériatrie de Montréal, Montréal, QC H3W 1W5, Canada
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, Department of Neurology, University of California in San Francisco, San Francisco, CA 94158, USA
| | - Giovanni Battistella
- Memory and Aging Center, Department of Neurology, University of California in San Francisco, San Francisco, CA 94158, USA
- Department of Otolaryngology—Head and Neck Surgery, Massachusetts Eye and Ear and Harvard Medical School, Boston, MA 02114, USA
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Petti U, Baker S, Korhonen A, Robin J. How Much Speech Data Is Needed for Tracking Language Change in Alzheimer's Disease? A Comparison of Random Length, 5-Min, and 1-Min Spontaneous Speech Samples. Digit Biomark 2023; 7:157-166. [PMID: 38029002 PMCID: PMC10673351 DOI: 10.1159/000533423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 07/28/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Changes in speech can act as biomarkers of cognitive decline in Alzheimer's disease (AD). While shorter speech samples would promote data collection and analysis, the minimum length of informative speech samples remains debated. This study aims to provide insight into the effect of sample length in analyzing longitudinal recordings of spontaneous speech in AD by comparing the original random length, 5- and 1-minute-long samples. We hope to understand whether capping the audio improves the accuracy of the analysis, and whether an extra 4 min conveys necessary information. Methods 110 spontaneous speech samples were collected from decades of Youtube videos of 17 public figures, 9 of whom eventually developed AD. 456 language features were extracted and their text-length-sensitivity, comparability, and ability to capture change over time were analyzed across three different sample lengths. Results Capped audio files had advantages over the random length ones. While most extracted features were statistically comparable or highly correlated across the datasets, potential effects of sample length should be acknowledged for some features. The 5-min dataset presented the highest reliability in tracking the evolution of the disease, suggesting that the 4 extra minutes do convey informative data. Conclusion Sample length seems to play an important role in extracting the language feature values from speech and tracking disease progress over time. We highlight the importance of further research into optimal sample length and standardization of methods when studying speech in AD.
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Affiliation(s)
- Ulla Petti
- Language Technology Lab, University of Cambridge, Cambridge, UK
| | - Simon Baker
- Language Technology Lab, University of Cambridge, Cambridge, UK
| | - Anna Korhonen
- Language Technology Lab, University of Cambridge, Cambridge, UK
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Coemans S, Keulen S, Savieri P, Tsapkini K, Engelborghs S, Chrispeels N, Vandenborre D, Paquier P, Wilssens I, Declerck M, Struys E. Executive functions in primary progressive aphasia: A meta-analysis. Cortex 2022; 157:304-322. [PMID: 36395634 PMCID: PMC11161026 DOI: 10.1016/j.cortex.2022.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/06/2022] [Accepted: 10/04/2022] [Indexed: 12/15/2022]
Abstract
Executive functions (EFs) refer to a set of cognitive processes, specifically shifting, inhibition, updating of working memory, and are involved in the cognitive control of behavior. Conflicting results have been reported regarding impairments of EFs in Primary Progressive Aphasia (PPA). We performed a multi-level meta-analysis to confirm whether deficits of EFs exist in this population, focusing on a common EFs composite, and the components shifting, inhibition and updating separately. We included 141 studies that report on 294 EFs tasks. The overall mean weighted effect size was large (d = -1,28), indicating poorer EFs in PPA as compared to age-matched cognitively healthy controls. Differences between effect sizes of the EFs components were not significant, indicating all components are affected similarly. Overall, moderator analysis revealed that PPA variant and disease duration were significant moderators of performance, while task modality and years of education were not. The non-fluent/agrammatic PPA and the logopenic PPA variants were similarly affected, but the semantic variant was affected to a lesser extent. We discuss implications for clinical and research settings, and future research.
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Affiliation(s)
- Silke Coemans
- Brussels Centre for Language Studies (BCLS), Vrije Universiteit Brussel (VUB), Brussels, Belgium.
| | - Stefanie Keulen
- Brussels Centre for Language Studies (BCLS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Perseverence Savieri
- Interfaculty Center for Data Processing and Statistics (ICDS), Vrije Universiteit Brussel (VUB), Brussels, Belgium; Biostatistics and Medical Informatics (BISI) Research Group, Department of Public Health, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
| | - Sebastiaan Engelborghs
- Neuroprotection & Neuromodulation, Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium; Department of Neurology, Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium; Department of Biomedical Sciences, Universiteit Antwerpen (UA), Antwerp, Belgium
| | - Nini Chrispeels
- Brussels Centre for Language Studies (BCLS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Dorien Vandenborre
- Department of Speech and Language Pathology, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Philippe Paquier
- Brussels Centre for Language Studies (BCLS), Vrije Universiteit Brussel (VUB), Brussels, Belgium; Center for Research in Cognition and Neurosciences (CRCN), Université Libre de Bruxelles (ULB), Brussels, Belgium; Department of Translational Neurosciences (TNW), Universiteit Antwerpen (UA), Antwerp, Belgium
| | - Ineke Wilssens
- Department of Speech and Language Pathology, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Mathieu Declerck
- Brussels Centre for Language Studies (BCLS), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Esli Struys
- Brussels Centre for Language Studies (BCLS), Vrije Universiteit Brussel (VUB), Brussels, Belgium; Center for Neurosciences (C4N), Vrije Universiteit Brussel (VUB), Brussels, Belgium
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9
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Hecker P, Steckhan N, Eyben F, Schuller BW, Arnrich B. Voice Analysis for Neurological Disorder Recognition–A Systematic Review and Perspective on Emerging Trends. Front Digit Health 2022; 4:842301. [PMID: 35899034 PMCID: PMC9309252 DOI: 10.3389/fdgth.2022.842301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 05/25/2022] [Indexed: 11/25/2022] Open
Abstract
Quantifying neurological disorders from voice is a rapidly growing field of research and holds promise for unobtrusive and large-scale disorder monitoring. The data recording setup and data analysis pipelines are both crucial aspects to effectively obtain relevant information from participants. Therefore, we performed a systematic review to provide a high-level overview of practices across various neurological disorders and highlight emerging trends. PRISMA-based literature searches were conducted through PubMed, Web of Science, and IEEE Xplore to identify publications in which original (i.e., newly recorded) datasets were collected. Disorders of interest were psychiatric as well as neurodegenerative disorders, such as bipolar disorder, depression, and stress, as well as amyotrophic lateral sclerosis amyotrophic lateral sclerosis, Alzheimer's, and Parkinson's disease, and speech impairments (aphasia, dysarthria, and dysphonia). Of the 43 retrieved studies, Parkinson's disease is represented most prominently with 19 discovered datasets. Free speech and read speech tasks are most commonly used across disorders. Besides popular feature extraction toolkits, many studies utilise custom-built feature sets. Correlations of acoustic features with psychiatric and neurodegenerative disorders are presented. In terms of analysis, statistical analysis for significance of individual features is commonly used, as well as predictive modeling approaches, especially with support vector machines and a small number of artificial neural networks. An emerging trend and recommendation for future studies is to collect data in everyday life to facilitate longitudinal data collection and to capture the behavior of participants more naturally. Another emerging trend is to record additional modalities to voice, which can potentially increase analytical performance.
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Affiliation(s)
- Pascal Hecker
- Digital Health – Connected Healthcare, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
- audEERING GmbH, Gilching, Germany
- *Correspondence: Pascal Hecker ; orcid.org/0000-0001-6604-1671
| | - Nico Steckhan
- Digital Health – Connected Healthcare, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
| | | | - Björn W. Schuller
- audEERING GmbH, Gilching, Germany
- EIHW – Chair of Embedded Intelligence for Health Care and Wellbeing, University of Augsburg, Augsburg, Germany
- GLAM – Group on Language, Audio, & Music, Imperial College London, London, United Kingdom
| | - Bert Arnrich
- Digital Health – Connected Healthcare, Hasso Plattner Institute, University of Potsdam, Potsdam, Germany
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10
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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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11
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Carthery-Goulart MT, de Oliveira R, de Almeida IJ, Campanha A, da Silva Souza D, Zana Y, Caramelli P, Machado TH. Sentence Comprehension in Primary Progressive Aphasia: A Study of the Application of the Brazilian Version of the Test for the Reception of Grammar (TROG2-Br). Front Neurol 2022; 13:815227. [PMID: 35651345 PMCID: PMC9149594 DOI: 10.3389/fneur.2022.815227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/22/2022] [Indexed: 11/13/2022] Open
Abstract
Sentence-comprehension deficits have been described in patients with primary progressive aphasia (PPA). However, most instruments to address this domain in more detail and in a clinical context have not been adapted and translated into several languages, posing limitations to clinical practice and cross-language research. Objectives The study aimed to (1) test the applicability of the Brazilian version of the Test for Reception of Grammar (TROG2-Br) to detect morphosyntactic deficits in patients with PPA; (2) investigate the association between performance in the test and sociodemographic and clinical variables (age, years of formal education, and disease duration); (3) characterize the performance of individuals presenting with the three more common variants of PPA (non-fluent, semantic, and logopenic) and mixed PPA (PPA-Mx) and analyze whether TROG-2 may assist in the distinction of these clinical profiles. Methods A total of 74 cognitively healthy participants and 34 individuals diagnosed with PPA were assessed with TROG2-Br. Overall scores (correct items, passed blocks), types, and categories of errors were analyzed. Results In controls, block scores were significantly correlated with years of formal education (Spearman's r = 0.33, p = 004) but not with age. In PPA, age, education, and disease duration were not significantly associated with performance in the test. Controls presented a significantly higher performance on TROG2-Br compared to PPA individuals and their errors pattern pointed to mild general cognitive processing difficulties (attention, working memory). PPA error types pointed to processing and morphosyntactic deficits in nonfluent or agrammatic PPA, (PPA-NF/A), logopenic PPA (PPA-L), and PPA-Mx. The semantic PPA (PPA-S) subgroup was qualitatively more similar to controls (processing difficulties and lower percentage of morphosyntactic errors). TROG2-Br presented good internal consistency and concurrent validity. Discussion Our results corroborate findings with TROG-2 in other populations. The performance of typical older adults with heterogeneous levels of education is discussed along with recommendations for clinical use of the test and future directions of research.
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Affiliation(s)
- Maria Teresa Carthery-Goulart
- Federal University of ABC (UFABC), Mathematics, Computing and Cognition Center (CMCC), São Bernardo do Campo, Brazil.,INCT-ECCE (Instituto Nacional de Ciência e Tecnologia sobre Comportamento, Cognição e Ensino), São Carlos, Brazil.,Cognitive and Behavioral Neurology Research Group of the Department of Neurology of the University of São Paulo (USP), School of Medicine, São Paulo, Brazil
| | - Rosimeire de Oliveira
- Federal University of ABC (UFABC), Mathematics, Computing and Cognition Center (CMCC), São Bernardo do Campo, Brazil
| | - Isabel Junqueira de Almeida
- Cognitive and Behavioral Neurology Research Group of the Department of Neurology of the University of São Paulo (USP), School of Medicine, São Paulo, Brazil
| | - Aline Campanha
- Cognitive and Behavioral Neurology Research Group, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Dayse da Silva Souza
- Federal University of ABC (UFABC), Mathematics, Computing and Cognition Center (CMCC), São Bernardo do Campo, Brazil
| | - Yossi Zana
- Federal University of ABC (UFABC), Mathematics, Computing and Cognition Center (CMCC), São Bernardo do Campo, Brazil
| | - Paulo Caramelli
- Cognitive and Behavioral Neurology Research Group, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Thais Helena Machado
- Cognitive and Behavioral Neurology Research Group, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
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12
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Manouilidou C, Nerantzini M, Chiappetta BM, Mesulam MM, Thompson CK. What Language Disorders Reveal About the Mechanisms of Morphological Processing. Front Psychol 2021; 12:701802. [PMID: 34912261 PMCID: PMC8667867 DOI: 10.3389/fpsyg.2021.701802] [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: 04/28/2021] [Accepted: 10/27/2021] [Indexed: 11/19/2022] Open
Abstract
We addressed an understudied topic in the literature of language disorders, that is, processing of derivational morphology, a domain which requires integration of semantic and syntactic knowledge. Current psycholinguistic literature suggests that word processing involves morpheme recognition, which occurs immediately upon encountering a complex word. Subsequent processes take place in order to interpret the combination of stem and affix. We investigated the abilities of individuals with agrammatic (PPA-G) and logopenic (PPA-L) variants of primary progressive aphasia (PPA) and individuals with stroke-induced agrammatic aphasia (StrAg) to process pseudowords which violate either the syntactic (word class) rules (*reheavy) or the semantic compatibility (argument structure specifications of the base form) rules (*reswim). To this end, we quantified aspects of word knowledge and explored how the distinct deficits of the populations under investigation affect their performance. Thirty brain-damaged individuals and 10 healthy controls participated in a lexical decision task. We hypothesized that the two agrammatic groups (PPA-G and StrAg) would have difficulties detecting syntactic violations, while no difficulties were expected for PPA-L. Accuracy and Reaction Time (RT) patterns indicated: the PPA-L group made fewer errors but yielded slower RTs compared to the two agrammatic groups which did not differ from one another. Accuracy rates suggest that individuals with PPA-L distinguish *reheavy from *reswim, reflecting access to and differential processing of syntactic vs. semantic violations. In contrast, the two agrammatic groups do not distinguish between *reheavy and *reswim. The lack of difference stems from a particularly impaired performance in detecting syntactic violations, as they were equally unsuccessful at detecting *reheavy and *reswim. Reduced grammatical abilities assessed through language measures are a significant predictor for this performance, suggesting that the "hardware" to process syntactic information is impaired. Therefore, they can only judge violations semantically where both *reheavy and *reswim fail to pass as semantically ill-formed. This finding further suggests that impaired grammatical knowledge can affect word level processing as well. Results are in line with the psycholinguistic literature which postulates the existence of various stages in accessing complex pseudowords, highlighting the contribution of syntactic/grammatical knowledge. Further, it points to the worth of studying impaired language performance for informing normal language processes.
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Affiliation(s)
- Christina Manouilidou
- Department of Comparative and General Linguistics, University of Ljubljana, Ljubljana, Slovenia
| | | | - Brianne M. Chiappetta
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
| | - M. Marsel Mesulam
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University, Chicago, IL, United States
| | - Cynthia K. Thompson
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Northwestern University, Chicago, IL, United States
- Department of Neurology, Northwestern University, Chicago, IL, United States
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13
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Gleichgerrcht E, Roth R, Fridriksson J, den Ouden D, Delgaizo J, Stark B, Hickok G, Rorden C, Wilmskoetter J, Hillis A, Bonilha L. Neural bases of elements of syntax during speech production in patients with aphasia. BRAIN AND LANGUAGE 2021; 222:105025. [PMID: 34555689 PMCID: PMC8546356 DOI: 10.1016/j.bandl.2021.105025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/08/2021] [Accepted: 09/08/2021] [Indexed: 06/13/2023]
Abstract
The ability to string together words into a structured arrangement capable of conveying nuanced information is key to speech production. The assessment of the neural bases for structuring sentences has been challenged by the need of experts to delineate the aberrant morphosyntactic structures in aphasic speech. Most studies have relied on focused tasks with limited ecological validity. We characterized syntactic complexity during connected speech produced by patients with chronic post-stroke aphasia. We automated this process by employing Natural Language Processing (NLP). We conducted voxel-based and connectome-based lesion-symptom mapping to identify brain regions crucially associated with sentence production and syntactic complexity. Posterior-inferior aspects of left frontal and parietal lobes, as well as white matter tracts connecting these areas, were essential for syntactic complexity, particularly the posterior inferior frontal gyrus. These findings suggest that sentence structuring during word production depends on the integrity of Broca's area and the dorsal stream of language processing.
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Affiliation(s)
| | - Rebecca Roth
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Dirk den Ouden
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - John Delgaizo
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Brielle Stark
- Department of Speech and Hearing Sciences, Indiana University, Bloomington, IN, USA
| | - Gregory Hickok
- Department of Cognitive Sciences, University of California, Irvine, CA, USA
| | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Janina Wilmskoetter
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA
| | - Argye Hillis
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, Charleston, SC, USA.
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14
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Plonka A, Mouton A, Macoir J, Tran TM, Derremaux A, Robert P, Manera V, Gros A. Primary Progressive Aphasia: Use of Graphical Markers for an Early and Differential Diagnosis. Brain Sci 2021; 11:1198. [PMID: 34573219 PMCID: PMC8464890 DOI: 10.3390/brainsci11091198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 11/25/2022] Open
Abstract
Primary progressive aphasia (PPA) brings together neurodegenerative pathologies whose main characteristic is to start with a progressive language disorder. PPA diagnosis is often delayed in non-specialised clinical settings. With the technologies' development, new writing parameters can be extracted, such as the writing pressure on a touch pad. Despite some studies having highlighted differences between patients with typical Alzheimer's disease (AD) and healthy controls, writing parameters in PPAs are understudied. The objective was to verify if the writing pressure in different linguistic and non-linguistic tasks can differentiate patients with PPA from patients with AD and healthy subjects. Patients with PPA (n = 32), patients with AD (n = 22) and healthy controls (n = 26) were included in this study. They performed a set of handwriting tasks on an iPad® digital tablet, including linguistic, cognitive non-linguistic, and non-cognitive non-linguistic tasks. Average and maximum writing pressures were extracted for each task. We found significant differences in writing pressure, between healthy controls and patients with PPA, and between patients with PPA and AD. However, the classification of performances was dependent on the nature of the tasks. These results suggest that measuring writing pressure in graphical tasks may improve the early diagnosis of PPA, and the differential diagnosis between PPA and AD.
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Affiliation(s)
- Alexandra Plonka
- Département d’Orthophonie de Nice, Faculté de Médecine, Université Côte d’Azur, 06000 Nice, France; (A.M.); (P.R.); (A.G.)
- Laboratoire CoBTeK (Cognition Behaviour Technology), Université Côte d’Azur, 06000 Nice, France; (A.D.); (V.M.)
- Institut NeuroMod, Université Côte d’Azur, 06902 Sophia-Antipolis, France
| | - Aurélie Mouton
- Département d’Orthophonie de Nice, Faculté de Médecine, Université Côte d’Azur, 06000 Nice, France; (A.M.); (P.R.); (A.G.)
- Laboratoire CoBTeK (Cognition Behaviour Technology), Université Côte d’Azur, 06000 Nice, France; (A.D.); (V.M.)
- Service Clinique Gériatrique du Cerveau et du Mouvement, CMRR, Centre Hospitalier Universitaire, 06000 Nice, France
| | - Joël Macoir
- Département de Réadaptation, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada;
- Centre de Recherche CERVO (CERVO Brain Research Centre), Québec, QC G1J 2G3, Canada
| | - Thi-Mai Tran
- Laboratoire STL, UMR 8163, Département d‘Orthophonie, UFR3S, Université de Lille, 59000 Lille, France;
| | - Alexandre Derremaux
- Laboratoire CoBTeK (Cognition Behaviour Technology), Université Côte d’Azur, 06000 Nice, France; (A.D.); (V.M.)
| | - Philippe Robert
- Département d’Orthophonie de Nice, Faculté de Médecine, Université Côte d’Azur, 06000 Nice, France; (A.M.); (P.R.); (A.G.)
- Laboratoire CoBTeK (Cognition Behaviour Technology), Université Côte d’Azur, 06000 Nice, France; (A.D.); (V.M.)
- Service Clinique Gériatrique du Cerveau et du Mouvement, CMRR, Centre Hospitalier Universitaire, 06000 Nice, France
| | - Valeria Manera
- Laboratoire CoBTeK (Cognition Behaviour Technology), Université Côte d’Azur, 06000 Nice, France; (A.D.); (V.M.)
| | - Auriane Gros
- Département d’Orthophonie de Nice, Faculté de Médecine, Université Côte d’Azur, 06000 Nice, France; (A.M.); (P.R.); (A.G.)
- Laboratoire CoBTeK (Cognition Behaviour Technology), Université Côte d’Azur, 06000 Nice, France; (A.D.); (V.M.)
- Service Clinique Gériatrique du Cerveau et du Mouvement, CMRR, Centre Hospitalier Universitaire, 06000 Nice, France
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15
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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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16
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Kourtidou E, Kasselimis D, Angelopoulou G, Karavasilis E, Velonakis G, Kelekis N, Zalonis I, Evdokimidis I, Potagas C, Petrides M. The Role of the Right Hemisphere White Matter Tracts in Chronic Aphasic Patients After Damage of the Language Tracts in the Left Hemisphere. Front Hum Neurosci 2021; 15:635750. [PMID: 34239424 PMCID: PMC8258417 DOI: 10.3389/fnhum.2021.635750] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/12/2021] [Indexed: 11/13/2022] Open
Abstract
The involvement of the right hemisphere (RH) in language, and especially after aphasia resulting from left hemisphere (LH) lesions, has been recently highlighted. The present study investigates white matter structure in the right hemisphere of 25 chronic post-stroke aphasic patients after LH lesions in comparison with 24 healthy controls, focusing on the four cortico-cortical tracts that link posterior parietal and temporal language-related areas with Broca’s region in the inferior frontal gyrus of the LH: the Superior Longitudinal Fasciculi II and III (SLF II and SLF III), the Arcuate Fasciculus (AF), and the Temporo-Frontal extreme capsule Fasciculus (TFexcF). Additionally, the relationship of these RH white matter tracts to language performance was examined. The patients with post-stroke aphasia in the chronic phase and the healthy control participants underwent diffusion tensor imaging (DTI) examination. The aphasic patients were assessed with standard aphasia tests. The results demonstrated increased axial diffusivity in the RH tracts of the aphasic patients. Patients were then divided according to the extent of the left hemisphere white matter loss. Correlations of language performance with radial diffusivity (RD) in the right hemisphere homologs of the tracts examined were demonstrated for the TFexcF, SLF III, and AF in the subgroup with limited damage to the LH language networks and only with the TFexcF in the subgroup with extensive damage. The results argue in favor of compensatory roles of the right hemisphere tracts in language functions when the LH networks are disrupted.
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Affiliation(s)
- Evie Kourtidou
- Neuropsychology and Language Disorders Unit, Eginition Hospital, First Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Kasselimis
- Neuropsychology and Language Disorders Unit, Eginition Hospital, First Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Angelopoulou
- Neuropsychology and Language Disorders Unit, Eginition Hospital, First Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstratios Karavasilis
- Second Department of Radiology, National and Kapodistrian University of Athens, General University Hospital "Attikon", Haidari, Greece
| | - Georgios Velonakis
- Second Department of Radiology, National and Kapodistrian University of Athens, General University Hospital "Attikon", Haidari, Greece
| | - Nikolaos Kelekis
- Second Department of Radiology, National and Kapodistrian University of Athens, General University Hospital "Attikon", Haidari, Greece
| | - Ioannis Zalonis
- Eginition Hospital, Neuropsychological Laboratory, First Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Evdokimidis
- Neuropsychology and Language Disorders Unit, Eginition Hospital, First Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantin Potagas
- Neuropsychology and Language Disorders Unit, Eginition Hospital, First Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Petrides
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
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Taylor-Rubin C, Croot K, Nickels L. Speech and language therapy in primary progressive aphasia: a critical review of current practice. Expert Rev Neurother 2021; 21:419-430. [PMID: 33641570 DOI: 10.1080/14737175.2021.1897253] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Primary progressive aphasia (PPA) is a complex language-led dementia syndrome whereby disproportionate deterioration of speech and language occurs subsequent to neurodegenerative disease in the early to mid-stages of the condition. As no effective pharmacotherapies are currently available, speech and language therapies are the optimum treatment to maximize communication for as long as possible. AREAS COVERED The authors present an overview of current speech-language therapy practices in PPA, highlighting recent research on effective treatments. EXPERT OPINION The challenges in this complex field of practice are described. We highlight the challenge of improving access to speech-language therapy by advocating for increased referral rates. The authors also suggest effective incorporation of innovative technologies in treatment and an enhanced evidence base for the utility of lexical retrieval treatment in improving everyday communication as challenges for the future. Finally, increased provision of PPA-specific education and support for individuals and their families is required.
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Affiliation(s)
- Cathleen Taylor-Rubin
- Department of Cognitive Science, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 3, Australian Hearing Hub, 16 University Road, Macquarie University, Sydney, NSW, Australia.,Department of Speech Pathology, Uniting War Memorial Hospital, South Eastern Sydney Local Health District War Memorial Hospital, Waverley, NSW, Australia
| | - Karen Croot
- Department of Cognitive Science, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 3, Australian Hearing Hub, 16 University Road, Macquarie University, Sydney, NSW, Australia.,Faculty of Science, School of Psychology, Brennan MacCallum Building, Camperdown, NSW, Australia
| | - Lyndsey Nickels
- Department of Cognitive Science, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 3, Australian Hearing Hub, 16 University Road, Macquarie University, Sydney, NSW, Australia
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18
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Haley KL, Jacks A, Jarrett J, Ray T, Cunningham KT, Gorno-Tempini ML, Henry ML. Speech Metrics and Samples That Differentiate Between Nonfluent/Agrammatic and Logopenic Variants of Primary Progressive Aphasia. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:754-775. [PMID: 33630653 PMCID: PMC8608203 DOI: 10.1044/2020_jslhr-20-00445] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/19/2020] [Accepted: 11/29/2020] [Indexed: 05/12/2023]
Abstract
Purpose Of the three currently recognized variants of primary progressive aphasia, behavioral differentiation between the nonfluent/agrammatic (nfvPPA) and logopenic (lvPPA) variants is particularly difficult. The challenge includes uncertainty regarding diagnosis of apraxia of speech, which is subsumed within criteria for variant classification. The purpose of this study was to determine the extent to which a variety of speech articulation and prosody metrics for apraxia of speech differentiate between nfvPPA and lvPPA across diverse speech samples. Method The study involved 25 participants with progressive aphasia (10 with nfvPPA, 10 with lvPPA, and five with the semantic variant). Speech samples included a word repetition task, a picture description task, and a story narrative task. We completed acoustic analyses of temporal prosody and quantitative perceptual analyses based on narrow phonetic transcription and then evaluated the degree of differentiation between nfvPPA and lvPPA participants (with the semantic variant serving as a reference point for minimal speech production impairment). Results Most, but not all, articulatory and prosodic metrics differentiated statistically between the nfvPPA and lvPPA groups. Measures of distortion frequency, syllable duration, syllable scanning, and-to a limited extent-syllable stress and phonemic accuracy showed greater impairment in the nfvPPA group. Contrary to expectations, classification was most accurate in connected speech samples. A customized connected speech metric-the narrative syllable duration-yielded excellent to perfect classification accuracy. Discussion Measures of average syllable duration in multisyllabic utterances are useful diagnostic tools for differentiating between nfvPPA and lvPPA, particularly when based on connected speech samples. As such, they are suitable candidates for automatization, large-scale study, and application to clinical practice. The observation that both speech rate and distortion frequency differentiated more effectively in connected speech than on a motor speech examination suggests that it will be important to evaluate interactions between speech and discourse production in future research.
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Affiliation(s)
- Katarina L. Haley
- Division of Speech and Hearing Sciences, University of North Carolina at Chapel Hill
| | - Adam Jacks
- Division of Speech and Hearing Sciences, University of North Carolina at Chapel Hill
| | - Jordan Jarrett
- Division of Speech and Hearing Sciences, University of North Carolina at Chapel Hill
| | - Taylor Ray
- Division of Speech and Hearing Sciences, University of North Carolina at Chapel Hill
| | - Kevin T. Cunningham
- Division of Speech and Hearing Sciences, University of North Carolina at Chapel Hill
| | | | - Maya L. Henry
- Department of Speech, Language, and Hearing Sciences and Department of Neurology, Dell Medical School, The University of Texas at Austin
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19
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Is word learning enough? Improved verb phrase production following cueing of verbs and nouns in primary progressive aphasia. Cortex 2021; 139:178-197. [PMID: 33873038 DOI: 10.1016/j.cortex.2021.02.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 01/25/2021] [Accepted: 02/18/2021] [Indexed: 11/23/2022]
Abstract
There is little evidence that, for people with aphasia, successful outcomes following lexical retrieval treatment generalise beyond single word retrieval to sentence production or daily communication. This study aimed to develop greater understanding of the mechanisms of generalisation. We employed a cueing task to simulate the effects of lexical retrieval treatment. A single noun or verb was provided and the effect on production of a corresponding verb phrase examined. Sixteen individuals with primary progressive aphasia (PPA) were asked to produce verb phrases to describe action pictures accompanied by i) a verb cue where a spoken and written verb was also presented with the picture; ii) a noun cue where a spoken and written noun was presented with the picture; iii) a no cue condition where only the picture was presented. Across the case series, both verb and noun cueing improved verb phrase production relative to no cue, with verb cueing being most effective. At the level of the single case, thirteen individuals showed significantly increased production of verb phrases with verb cueing, and seven individuals with noun cueing. In addition, seven individuals showed significantly greater benefit from verb cueing compared to noun cueing, and none showed the reverse. This suggests that improvements in verb phrase production may also be achievable following treatment-induced improvements in lexical retrieval. Greater benefit from verb cues than noun cues raises important theoretical issues regarding sentence construction and clinical issues around the most effective treatment techniques for people with aphasia.
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20
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Utianski RL, Martin PR, Hanley H, Duffy JR, Botha H, Clark HM, Whitwell JL, Josephs KA. A Longitudinal Evaluation of Speech Rate in Primary Progressive Apraxia of Speech. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:392-404. [PMID: 33476188 PMCID: PMC8632475 DOI: 10.1044/2020_jslhr-20-00253] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/27/2020] [Accepted: 10/24/2020] [Indexed: 05/19/2023]
Abstract
Purpose Individuals with primary progressive apraxia of speech (PPAOS) have apraxia of speech (AOS) in which disruptions in articulation or prosody predominate the speech pattern, referred to, respectively, as phonetic or prosodic subtypes. Many develop aphasia and/or dysarthria. Past research has demonstrated that simple temporal acoustic measures are sensitive to the presence of AOS. The aim of this study was to describe the change in temporal acoustic measures over time and assess if specific patterns of AOS or co-occurring aphasia or dysarthria impact the rate of change over time. Method Durations for multiple productions of the words cat, catnip, catapult, and catastrophe, in an imitative speech task, were recorded for 73 patients, with two to six visits each. A linear mixed-effects model was used to assess the cross-sectional differences and longitudinal influence of AOS subtype and presence of aphasia/dysarthria on speech rate. Pearson correlations were calculated between rate measures and performance on other clinical measures. Results Cross-sectionally, patients with prosodic-predominant PPAOS produced words more slowly than those with phonetic-predominant PPAOS. Patients with either aphasia or dysarthria produced words more slowly than those without. Longitudinally, the speech rate of patients with phonetic-predominant PPAOS had a reduction of 0.5 syllables per second per year. Patients with prosodic-predominant AOS changed less quickly, as did those who developed aphasia. Dysarthria did not impact rate of change. There were strong associations between speech rate measures and other clinical indices of speech and language functioning. Conclusion Simple temporal acoustic measures may reflect the subtype of AOS (phonetic or prosodic predominant), serve as an index of progression of AOS, and inform prognostication relative to the presenting combination of speech and language features. Supplemental Material https://doi.org/10.23641/asha.13564724.
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Affiliation(s)
| | | | - Holly Hanley
- Department of Communication Sciences and Disorders, Appalachian State University, Boone, NC
| | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN
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21
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Ingram RU, Halai AD, Pobric G, Sajjadi S, Patterson K, Lambon Ralph MA. Graded, multidimensional intra- and intergroup variations in primary progressive aphasia and post-stroke aphasia. Brain 2021; 143:3121-3135. [PMID: 32940648 PMCID: PMC7586084 DOI: 10.1093/brain/awaa245] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/30/2020] [Accepted: 06/17/2020] [Indexed: 12/14/2022] Open
Abstract
Language impairments caused by stroke (post-stroke aphasia, PSA) and neurodegeneration (primary progressive aphasia, PPA) have overlapping symptomatology, nomenclature and are classically divided into categorical subtypes. Surprisingly, PPA and PSA have rarely been directly compared in detail. Rather, previous studies have compared certain subtypes (e.g. semantic variants) or have focused on a specific cognitive/linguistic task (e.g. reading). This study assessed a large range of linguistic and cognitive tasks across the full spectra of PSA and PPA. We applied varimax-rotated principal component analysis to explore the underlying structure of the variance in the assessment scores. Similar phonological, semantic and fluency-related components were found for PSA and PPA. A combined principal component analysis across the two aetiologies revealed graded intra- and intergroup variations on all four extracted components. Classification analysis was used to test, formally, whether there were any categorical boundaries for any subtypes of PPA or PSA. Semantic dementia formed a true diagnostic category (i.e. within group homogeneity and distinct between-group differences), whereas there was considerable overlap and graded variations within and between other subtypes of PPA and PSA. These results suggest that (i) a multidimensional rather than categorical classification system may be a better conceptualization of aphasia from both causes; and (ii) despite the very different types of pathology, these broad classes of aphasia have considerable features in common.
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Affiliation(s)
- Ruth U Ingram
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, UK
| | - Ajay D Halai
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Gorana Pobric
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, UK
| | - Seyed Sajjadi
- Department of Neurology, University of California, Irvine, Irvine, USA
| | - Karalyn Patterson
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK.,Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
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22
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Themistocleous C, Webster K, Afthinos A, Tsapkini K. Part of Speech Production in Patients With Primary Progressive Aphasia: An Analysis Based on Natural Language Processing. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:466-480. [PMID: 32697669 PMCID: PMC8702871 DOI: 10.1044/2020_ajslp-19-00114] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 02/14/2020] [Accepted: 05/13/2020] [Indexed: 06/11/2023]
Abstract
Background Primary progressive aphasia (PPA) is a neurodegenerative disorder characterized by a progressive decline of language functions. Its symptoms are grouped into three PPA variants: nonfluent PPA, logopenic PPA, and semantic PPA. Grammatical deficiencies differ depending on the PPA variant. Aims This study aims to determine the differences between PPA variants with respect to part of speech (POS) production and to identify morphological markers that classify PPA variants using machine learning. By fulfilling these aims, the overarching goal is to provide objective measures that can facilitate clinical diagnosis, evaluation, and prognosis. Method and Procedure Connected speech productions from PPA patients produced in a picture description task were transcribed, and the POS class of each word was estimated using natural language processing, namely, POS tagging. We then implemented a twofold analysis: (a) linear regression to determine how patients with nonfluent PPA, semantic PPA, and logopenic PPA variants differ in their POS productions and (b) a supervised classification analysis based on POS using machine learning models (i.e., random forests, decision trees, and support vector machines) to subtype PPA variants and generate feature importance (FI). Outcome and Results Using an automated analysis of a short picture description task, this study showed that content versus function words can distinguish patients with nonfluent PPA, semantic PPA, and logopenic PPA variants. Verbs were less important as distinguishing features of patients with different PPA variants than earlier thought. Finally, the study showed that among the most important distinguishing features of PPA variants were elaborative speech elements, such as adjectives and adverbs.
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Affiliation(s)
| | - Kimberly Webster
- Department of Otolaryngology, Johns Hopkins Medicine, Baltimore MD
| | | | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Cognitive Science, Johns Hopkins University, Baltimore MD
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23
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Taylor-Rubin C, Nickels L, Croot K. Exploring the effects of verb and noun treatment on verb phrase production in primary progressive aphasia: A series of single case experimental design studies. Neuropsychol Rehabil 2021; 32:1121-1163. [PMID: 33557713 DOI: 10.1080/09602011.2021.1879174] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Evidence of generalization to connected speech following lexical retrieval treatment in Primary Progressive Aphasia (PPA) is scarce. Consequently, this study systematically investigated changes in verb phrase production following lexical retrieval treatment in a series of single case experimental design studies. Four individuals with PPA (three semantic- and one logopenic variant PPA) who had previously demonstrated that they could integrate verbs and nouns into sentence structures in a cueing paradigm, undertook a sequence of verb and noun lexical retrieval treatments using Repetition and Reading in the Presence of a Picture. Production of treated nouns- and/or verbs-in-isolation significantly improved following treatment for three of the four participants. Verb phrase production did not improve for one of these participants (logopenic PPA), perhaps due to the relatively small treatment dose. Two participants (semantic variant PPA) did, however, demonstrate across-level generalization, with improvement in treated verbs and using those verbs in (untreated) verb phrases. Their verb phrase production improved most after lexical retrieval treatment for both nouns and verbs, suggesting this combined approach may benefit across-level generalization for some individuals in clinical practice.
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Affiliation(s)
- Cathleen Taylor-Rubin
- Department of Cognitive Science, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.,Department of Speech Pathology, South East Sydney Local Health District, Uniting War Memorial Hospital, Sydney, Australia
| | - Lyndsey Nickels
- Department of Cognitive Science, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia
| | - Karen Croot
- School of Psychology, University of Sydney, Sydney, Australia
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24
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Barbieri E, Litcofsky KA, Walenski M, Chiappetta B, Mesulam MM, Thompson CK. Online sentence processing impairments in agrammatic and logopenic primary progressive aphasia: Evidence from ERP. Neuropsychologia 2021; 151:107728. [PMID: 33326758 PMCID: PMC7875464 DOI: 10.1016/j.neuropsychologia.2020.107728] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
Evidence from psycholinguistic research indicates that sentence processing is impaired in Primary Progressive Aphasia (PPA), and more so in individuals with agrammatic (PPA-G) than logopenic (PPA-L) subtypes. Studies have mostly focused on offline sentence production ability, reporting impaired production of verb morphology (e.g., tense, agreement) and verb-argument structure (VAS) in PPA-G, and mixed findings in PPA-L. However, little is known about real-time sentence comprehension in PPA. The present study is the first to compare real-time semantic, morphosyntactic and VAS processing in individuals with PPA (10 with PPA-G and 9 with PPA-L), and in two groups of healthy (22 young and 19 older) individuals, using event-related potentials (ERP). Participants were instructed to listen to sentences that were either well-formed (n = 150) or contained a violation of semantics (e.g., *Owen was mentoring pumpkins at the party, n = 50), morphosyntax (e.g., *The actors was singing in the theatre, n = 50) or VAS (*Ryan was devouring on the couch, n = 50), and were required to perform a sentence acceptability judgment task while EEG was recorded. Results indicated that in the semantic task both healthy and PPA groups showed an N400 response to semantic violations, which was delayed in PPA and older (vs. younger) groups. Morphosyntactic violations elicited a P600 in both groups of healthy individuals and in PPA-L, but not in PPA-G. A similar P600 response was also found only in healthy individuals for VAS violations; whereas, abnormal ERP responses were observed in both PPA groups, with PPA-G showing no evidence of VAS violation detection and PPA-L showing a delayed and abnormally-distributed positive component that was negatively associated with offline sentence comprehension scores. These findings support characterizations of sentence processing impairments in PPA-G, by providing online evidence that VAS and morphosyntactic processing are impaired, in the face of substantially preserved semantic processing. In addition, the results indicate that on-line processing of VAS information may also be impaired in PPA-L, despite their near-normal accuracy on standardized language tests of argument structure production.
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Affiliation(s)
- Elena Barbieri
- Aphasia and Neurolinguistics Research Laboratory, Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States.
| | - Kaitlyn A Litcofsky
- Aphasia and Neurolinguistics Research Laboratory, Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
| | - Matthew Walenski
- Aphasia and Neurolinguistics Research Laboratory, Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
| | - Brianne Chiappetta
- Aphasia and Neurolinguistics Research Laboratory, Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
| | - Marek-Marsel Mesulam
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University, Chicago, IL, United States; Department of Neurology, Northwestern University, Chicago, IL, United States
| | - Cynthia K Thompson
- Aphasia and Neurolinguistics Research Laboratory, Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States; Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University, Chicago, IL, United States; Department of Neurology, Northwestern University, Chicago, IL, United States
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25
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Breakdowns in Informativeness of Naturalistic Speech Production in Primary Progressive Aphasia. Brain Sci 2021; 11:brainsci11020130. [PMID: 33498260 PMCID: PMC7909266 DOI: 10.3390/brainsci11020130] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/15/2021] [Accepted: 01/15/2021] [Indexed: 11/17/2022] Open
Abstract
“Functional communication” refers to an individual’s ability to communicate effectively in his or her everyday environment, and thus is a paramount skill to monitor and target therapeutically in people with aphasia. However, traditional controlled-paradigm assessments commonly used in both research and clinical settings often fail to adequately capture this ability. In the current study, facets of functional communication were measured from picture-elicited speech samples from 70 individuals with mild primary progressive aphasia (PPA), including the three variants, and 31 age-matched controls. Building upon methods recently used by Berube et al. (2019), we measured the informativeness of speech by quantifying the content of each patient’s description that was relevant to a picture relative to the total amount of speech they produced. Importantly, form-based errors, such as mispronunciations of words, unusual word choices, or grammatical mistakes are not penalized in this approach. We found that the relative informativeness, or efficiency, of speech was preserved in non-fluent variant PPA patients as compared with controls, whereas the logopenic and semantic variant PPA patients produced significantly less informative output. Furthermore, reduced informativeness in the semantic variant is attributable to a lower production of content units and a propensity for self-referential tangents, whereas for the logopenic variant, a lower production of content units and relatively ”empty” speech and false starts contribute to this reduction. These findings demonstrate that functional communication impairment does not uniformly affect all the PPA variants and highlight the utility of naturalistic speech analysis for measuring the breakdown of functional communication in PPA.
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26
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Mack JE, Barbieri E, Weintraub S, Mesulam MM, Thompson CK. Quantifying grammatical impairments in primary progressive aphasia: Structured language tests and narrative language production. Neuropsychologia 2020; 151:107713. [PMID: 33285187 DOI: 10.1016/j.neuropsychologia.2020.107713] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 11/06/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE This study examined grammatical production impairments in primary progressive aphasia (PPA), as measured by structured tests and narrative samples. We aimed to quantify the strength of the relationship between grammatical measures across tasks, and identify factors that condition it. Three grammatical domains were investigated: overall sentence production, verb morphology, and verb-argument structure. METHODS 77 participants with PPA (34 PPA-G, 16 PPA-L, 15 PPA-S and 12 other) completed a battery of grammatical tests and a narrative language sample was obtained. Accuracy scores were computed for the language tests and the narrative samples were analyzed for both accuracy of selected narrative variables as well as grammatical diversity across the three grammatical domains. Principal components analysis (PCA) and multiple regression were used to examine cross-task relationships for all measures. RESULTS As expected on the basis of classification criteria, accuracy scores were lower for the PPA-G group as compared to the PPA-L and PPA-S participants for overall sentence production and verb morphology, but not argument structure. Grammatical accuracy in narratives strongly predicted overall language test performance in PPA-G, whereas grammatical diversity in narratives did so in PPA-L, and no significant correspondence between narrative and language test performance was found for PPA-S. For individuals with severe grammatical impairments only, error distribution for both morphology and argument structure was strongly associated in structured tasks and narratives. CONCLUSIONS Grammatical production in narrative language predicts accuracy elicited with structured language tests in PPA. However, unique narrative production patterns distinguish PPA by subtype: accuracy for PPA-G, and grammatical diversity for PPA-L. The impairment in PPA-G is likely to reflect a core impairment in grammar whereas that of PPA-L may be closely tied to the word retrieval and verbal working memory deficits that characterize this variant. This underscores the theoretical distinction between PPA-L and PPA-G, as well as the importance of including grammatical diversity measures in analyses of language production, especially for patients who do not display frank agrammatism. Further, the results suggest that measures of domain-specific language deficits (i.e., verb morphology vs. argument structure) are robust across tasks only in individuals with severe grammatical impairments.
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Affiliation(s)
- Jennifer E Mack
- Roxelyn & Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, USA.
| | - Elena Barbieri
- Roxelyn & Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, USA
| | - Sandra Weintraub
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University, USA; Ken & Ruth Davee Department of Neurology, Northwestern University, USA; Department of Psychiatry and Behavioral Sciences, Northwestern University, USA
| | - M-Marsel Mesulam
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University, USA; Ken & Ruth Davee Department of Neurology, Northwestern University, USA
| | - Cynthia K Thompson
- Roxelyn & Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, USA; Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University, USA; Ken & Ruth Davee Department of Neurology, Northwestern University, USA
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27
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Faroqi-Shah Y, Treanor A, Ratner NB, Ficek B, Webster K, Tsapkini K. Using narratives in differential diagnosis of neurodegenerative syndromes. JOURNAL OF COMMUNICATION DISORDERS 2020; 85:105994. [PMID: 32388191 PMCID: PMC7304645 DOI: 10.1016/j.jcomdis.2020.105994] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/25/2020] [Accepted: 03/29/2020] [Indexed: 05/16/2023]
Abstract
PURPOSE Language decline has been associated with healthy aging and with various neurodegenerative conditions, making it challenging to differentiate among these conditions. This study examined the utility of linguistic measures derived from a short narrative language sample for 1) identifying language characteristics and cut-off scores to differentiate between healthy aging, Primary Progressive Aphasia (PPA), Mild Cognitive Impairment (MCI), and Alzheimer's dementia (AD); and 2) differentiating among PPA variants in which language is the primary impairment. METHOD Participants were 25 neurologically healthy English speakers, 20 individuals with MCI, 20 with AD, and 26 with PPA (non-fluent/agrammatic N = 10, logopenic N = 9, semantic N = 7). Narrative language samples of the Cookie Theft Picture of persons with healthy aging, MCI and AD were retrospectively obtained from the DementiaBank database (https://talkbank.org/DementiaBank/) and PPA samples were obtained from an ongoing research study. The language samples were analyzed for fluency, word retrieval success, grammatical accuracy, and errors using automated and manual analysis methods. The sensitivity and specificity of various language measures was computed. RESULTS Participants with PPA scored lower than neurologically healthy and MCI groups on fluency (words per minute and disfluencies), word retrieval (Correct Information Units and number of errors), and sentence grammaticality. PPA and AD groups did not differ on language measures. Agrammatic PPA participants scored lower than logopenic and semantic PPA groups on several measures, while logopenic and semantic PPA did not differ on any measures. CONCLUSION Measures derived from brief language samples and analyzed using mostly automated methods are clinically useful in differentiating PPA from healthy aging and MCI, and agrammatic PPA from other variants. The sensitivity and specificity of these measures is modest and can be improved when coupled with clinical presentation.
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Affiliation(s)
- Yasmeen Faroqi-Shah
- University of Maryland, Department of Hearing and Speech Sciences, United States.
| | - Ashlyn Treanor
- University of Maryland, Department of Hearing and Speech Sciences, United States
| | - Nan Bernstein Ratner
- University of Maryland, Department of Hearing and Speech Sciences, United States
| | - Bronte Ficek
- Johns Hopkins University, Department of Neurology, United States
| | - Kimberly Webster
- Johns Hopkins University, Department of Neurology, United States
| | - Kyrana Tsapkini
- Johns Hopkins University, Department of Neurology, United States
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28
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Abstract
Objectives: Recently, new criteria for sensitive and specific clinical diagnosis of progressive supranuclear palsy (PSP) have been addressed while distinct clinical phenotypes of the disorder have been increasingly described in the literature. This study aimed to describe past and present aspects of the disease as well as to highlight the cognitive and behavioral profile of PSP patients in relation to the underlying pathology, genetics and treatment procedures.Methods: A Medline and Scopus search was performed to identify articles published on this topic. Articles published solely in English were considered.Results: The most common clinical characteristics of PSP included early postural instability and falls, vertical supranuclear gaze palsy, parkinsonism with poor response to levodopa and pseudobulbar palsy. Frontal dysfunction and verbal fluency deficits were the most distinct cognitive impairments in PSP while memory, visuospatial and social cognition could also be affected. Apathy and impulsivity were also present in PSP patients and had significant impact on relatives and caregivers.Conclusions: PSP is a neurodegenerative disorder with prominent tau neuropathology. Movement, motivation and communication impairments in patients with PSP may limit participation in everyday living activities. Comprehensive neuropsychological assessments are of significant importance for PSP cognitive evaluation. Pharmacologic and non-pharmacologic approaches could be applied in order to relieve patients and improve quality of life.Clinical Implications: Executive dysfunction is the most notable cognitive impairment and dominates the neuropsychological profile of patients with PSP.
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Affiliation(s)
| | - Kleopatra H Schulpis
- Institute of Child Health, Research Center, "Aghia Sophia" Children's Hospital, Athens, Greece
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Duncan ES, Donovan NJ, Sajjadi SA. Clinical Assessment of Characteristics of Apraxia of Speech in Primary Progressive Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:485-497. [PMID: 31419154 DOI: 10.1044/2019_ajslp-cac48-18-0225] [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 We sought to examine interrater reliability in clinical assessment of apraxia of speech (AOS) in individuals with primary progressive aphasia and to identify speech characteristics predictive of AOS diagnosis. Method Fifty-two individuals with primary progressive aphasia were recorded performing a variety of speech tasks. These recordings were viewed by 2 experienced speech-language pathologists, who independently rated them on the presence and severity of AOS as well as 14 associated speech characteristics. We calculated interrater reliability (percent agreement and Cohen's kappa) for these ratings. For each rater, we used stepwise regression to identify speech characteristics significantly predictive of AOS diagnosis. We used the overlap between raters to create a more parsimonious model, which we evaluated with multiple linear regression. Results Results yielded high agreement on the presence (90%) and severity of AOS (weighted Cohen's κ = .834) but lower agreement for specific speech characteristics (weighted Cohen's κ ranging from .036 to .582). Stepwise regression identified 2 speech characteristics predictive of AOS diagnosis for both raters (articulatory groping and increased errors with increased length/complexity). These alone accounted for ≥ 50% of the variance of AOS severity in the constrained model. Conclusions Our study adds to a growing body of research that highlights the difficulty in objective clinical characterization of AOS and perceptual characterization of speech features. It further supports the need for consensus diagnostic criteria with standardized testing tools and for the identification and validation of objective markers of AOS. Additionally, these findings underscore the need for a training protocol if diagnostic tools are to be effective when shared beyond the research teams that develop and test them and disseminated to practicing speech-language pathologists, in order to ensure consistent application.
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Affiliation(s)
- E Susan Duncan
- Department of Communication Sciences & Disorders, Louisiana State University, Baton Rouge
| | - Neila J Donovan
- Department of Communication Sciences & Disorders, Louisiana State University, Baton Rouge
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Dalton SGH, Hubbard HI, Richardson JD. Moving Toward Non-transcription based Discourse Analysis in Stable and Progressive Aphasia. Semin Speech Lang 2020; 41:32-44. [PMID: 31869847 PMCID: PMC11363584 DOI: 10.1055/s-0039-3400990] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Measurement of communication ability at the discourse level holds promise for predicting how well persons with stable (e.g., stroke-induced), or progressive aphasia navigate everyday communicative interactions. However, barriers to the clinical utilization of discourse measures have persisted. Recent advancements in the standardization of elicitation protocols and the existence of large databases for development of normative references have begun to address some of these barriers. Still, time remains a consistently reported barrier by clinicians. Non-transcription based discourse measurement would reduce the time required for discourse analysis, making clinical utilization a reality. The purpose of this article is to present evidence regarding discourse measures (main concept analysis, core lexicon, and derived efficiency scores) that are well suited to non-transcription based analysis. Combined with previous research, our results suggest that these measures are sensitive to changes following stroke or neurodegenerative disease. Given the evidence, further research specifically assessing the reliability of these measures in clinical implementation is warranted.
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Affiliation(s)
| | - H Isabel Hubbard
- Department of Communication Sciences and Disorders, University of Kentucky, Lexington, Kentucky
| | - Jessica D Richardson
- Department of Speech and Hearing Sciences, University of New Mexico, Albuquerque, New Mexico
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31
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Ash S, Nevler N, Phillips J, Irwin DJ, McMillan CT, Rascovsky K, Grossman M. A longitudinal study of speech production in primary progressive aphasia and behavioral variant frontotemporal dementia. BRAIN AND LANGUAGE 2019; 194:46-57. [PMID: 31075725 PMCID: PMC6656376 DOI: 10.1016/j.bandl.2019.04.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 02/10/2019] [Accepted: 04/22/2019] [Indexed: 05/03/2023]
Abstract
We examined longitudinal change in language expression during a semi-structured speech sample in 48 patients with primary progressive aphasia (PPA) or behavioral variant frontotemporal dementia (bvFTD) and related this to longitudinal neuroimaging of cortical thickness available in 25 of these patients. All patient groups declined significantly on measures of both speech fluency and grammar, although patients with nonfluent/agrammatic PPA (naPPA) declined to a greater extent than patients with the semantic variant, the logopenic variant, and bvFTD. These patient groups also declined on several neuropsychological measures, but there was no correlation between decline in speech expression and decline in neuropsychological performance. Longitudinal decline in grammaticality, assessed by the number of well-formed sentences produced, was associated with longitudinal progression of gray matter atrophy in left frontal operculum/insula and bilateral temporal cortex.
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Affiliation(s)
- Sharon Ash
- Penn Frontotemporal Degeneration Center and Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, United States.
| | - Naomi Nevler
- Penn Frontotemporal Degeneration Center and Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, United States
| | - Jeffrey Phillips
- Penn Frontotemporal Degeneration Center and Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, United States
| | - David J Irwin
- Penn Frontotemporal Degeneration Center and Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, United States
| | - Corey T McMillan
- Penn Frontotemporal Degeneration Center and Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, United States
| | - Katya Rascovsky
- Penn Frontotemporal Degeneration Center and Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, United States
| | - Murray Grossman
- Penn Frontotemporal Degeneration Center and Department of Neurology, Perelman School of Medicine of the University of Pennsylvania, United States
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32
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Hodges JR, Piguet O. Progress and Challenges in Frontotemporal Dementia Research: A 20-Year Review. J Alzheimers Dis 2019; 62:1467-1480. [PMID: 29504536 PMCID: PMC5870022 DOI: 10.3233/jad-171087] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The landscape of frontotemporal dementia (FTD) has evolved remarkably in recent years and is barely recognizable from two decades ago. Knowledge of the clinical phenomenology, cognition, neuroimaging, genetics, pathology of the different subtypes of FTD, and their relations to other neurodegenerative conditions, has increased rapidly, due in part, to the growing interests into these neurodegenerative brain conditions. This article reviews the major advances in the field of FTD over the past 20 years, focusing primarily on the work of Frontier, the frontotemporal dementia clinical research group, based in Sydney, Australia. Topics covered include clinical presentations (cognition, behavior, neuroimaging), pathology, genetics, and disease progression, as well as interventions and carer directed research. This review demonstrates the improvement in diagnostic accuracy and capacity to provide advice on genetic risks, prognosis, and outcome. The next major challenge will be to capitalize on these research findings to develop effective disease modifying drugs, which are currently lacking.
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Affiliation(s)
- John R Hodges
- The University of Sydney, Sydney Medical School and Brain and Mind Centre, Sydney, Australia.,ARC Centre of Excellence in Cognition and its Disorders, Sydney, Australia
| | - Olivier Piguet
- ARC Centre of Excellence in Cognition and its Disorders, Sydney, Australia.,The University of Sydney, School of Psychology, and Brain and Mind Centre, Sydney, Australia
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Utianski RL, Duffy JR, Clark HM, Strand EA, Boland SM, Machulda MM, Whitwell JL, Josephs KA. Clinical Progression in Four Cases of Primary Progressive Apraxia of Speech. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2018; 27:1303-1318. [PMID: 30458509 PMCID: PMC6436456 DOI: 10.1044/2018_ajslp-17-0227] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 05/14/2018] [Indexed: 05/12/2023]
Abstract
PURPOSE This case series details the clinical progression of patients with primary progressive apraxia of speech (PPAOS) to illustrate, using several methods and supplemental material examples, the changes that occur in speech and language functioning in this patient population. METHOD Four patients who presented with PPAOS were followed between 5 and 6 years. Two patients had predominant articulatory abnormalities (termed phonetic PPAOS), 1 had predominant prosodic abnormalities (prosodic PPAOS), and 1 had relatively equal articulatory and prosodic abnormalities (mixed PPAOS). Detailed speech (including acoustics), language, neurologic, and neuropsychological data were collected. RESULTS At initial exam, the patients ranged from 60 to 77 years old, with presenting disease duration of 1.5-10 years. Although all patients presented with an isolated apraxia of speech, all developed varying degrees of aphasia and dysarthria. Patients with phonetic PPAOS developed relatively more severe aphasia than the other 2 patients. All patients eventually had severe functional communication limitations and required alternative or augmentative means of communication, although at varying times postonset of their initial speech problem. Two patients developed dysphagia, 3 showed mild-moderate Parkinsonism, and 2 developed depression. For all patients, simple temporal acoustic measurements documented slowed speech rate over time. CONCLUSIONS This case series demonstrates that patients who initially present with PPAOS may develop aphasia and dysarthria, cognitive and behavioral changes, and other neurologic signs. Whether these changes can be predicted by the perceptual characteristics of the apraxia of speech is yet to be determined. The detailed longitudinal profiles provide valuable clinical insight into the progression of disease in people with PPAOS. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.7051616.
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Affiliation(s)
| | | | | | | | | | - Mary M. Machulda
- Department of Psychiatry & Psychology Services, Mayo Clinic, Rochester, MN
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Tetzloff KA, Utianski RL, Duffy JR, Clark HM, Strand EA, Josephs KA, Whitwell JL. Quantitative Analysis of Agrammatism in Agrammatic Primary Progressive Aphasia and Dominant Apraxia of Speech. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2018; 61:2337-2346. [PMID: 30098169 PMCID: PMC6195051 DOI: 10.1044/2018_jslhr-l-17-0474] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 04/18/2018] [Accepted: 05/08/2018] [Indexed: 05/26/2023]
Abstract
PURPOSE The aims of the study were to assess and compare grammatical deficits in written and spoken language production in subjects with agrammatic primary progressive aphasia (agPPA) and in subjects with agrammatism in the context of dominant apraxia of speech (DAOS) and to investigate neuroanatomical correlates. METHOD Eight agPPA and 21 DAOS subjects performed the picture description task of the Western Aphasia Battery (WAB) both in writing and orally. Responses were transcribed and coded for linguistic analysis. agPPA and DAOS were compared to 13 subjects with primary progressive apraxia of speech (PPAOS) who did not have agrammatism. Spearman correlations were performed between the written and spoken variables. Patterns of atrophy in each group were compared, and relationships between the different linguistic measures and integrity of Broca's area were assessed. RESULTS agPPA and DAOS both showed lower mean length of utterance, fewer grammatical utterances, more nonutterances, more syntactic and semantic errors, and fewer complex utterances than PPAOS in writing and speech, as well as fewer correct verbs and nouns in speech. Only verb ratio and proportion of grammatical utterances correlated between modalities. agPPA and DAOS both showed greater involvement of Broca's area than PPAOS, and atrophy of Broca's area correlated with proportion of grammatical and ungrammatical utterances and semantic errors in writing and speech. CONCLUSIONS agPPA and DAOS subjects showed similar patterns of agrammatism, although subjects performed differently when speaking versus writing. Integrity of Broca's area correlates with agrammatism.
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Affiliation(s)
| | - Rene L Utianski
- Department of Neurology, Division of Speech Pathology, Mayo Clinic, Rochester, MN
| | - Joseph R Duffy
- Department of Neurology, Division of Speech Pathology, Mayo Clinic, Rochester, MN
| | - Heather M Clark
- Department of Neurology, Division of Speech Pathology, Mayo Clinic, Rochester, MN
| | - Edythe A Strand
- Department of Neurology, Division of Speech Pathology, Mayo Clinic, Rochester, MN
| | - Keith A Josephs
- Department of Neurology, Division of Behavioral Neurology, Mayo Clinic, Rochester, MN
- Department of Neurology, Division of Movement Disorders, Mayo Clinic, Rochester, MN
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Gonçalves APB, Mello C, Pereira AH, Ferré P, Fonseca RP, Joanette Y. Executive functions assessment in patients with language impairment A systematic review. Dement Neuropsychol 2018; 12:272-283. [PMID: 30425791 PMCID: PMC6200159 DOI: 10.1590/1980-57642018dn12-030008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Acquired language impairments may accompany different conditions. Most recent studies have shown that there is an important relationship between language and cognitive functions, such as executive functions (EF). Therefore, we aimed to investigate which main EF components appear to have the greatest impact in the most prevalent acquired communication disorders in adults, and which neuropsychological tests are being used to evaluate them. In addition, we sought to characterize the relationship between the executive functions and language in these conditions. Working memory (WM) was the most frequently chosen cognitive measure, being evaluated by different span tasks. A relationship between WM and narrative and conversational discourse, writing abilities and grammatical comprehension was found. Other currently used cognitive tests included the Trail Making, Wisconsin, Stroop and Verbal Fluency tests. Language and EF have a complex relationship; hence, a complete assessment should reflect the dynamic processing of cognitive brain functions.
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Affiliation(s)
| | - Clarissa Mello
- Psychology Graduate Student, Pontifícia Universidade Católica do Rio Grande do Sul, RS, Brazil
| | | | - Perrine Ferré
- PhD, Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal
| | | | - Yves Joanette
- PhD, Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal
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36
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Abstract
Primary progressive aphasia (PPA) refers to a disorder of declining language associated with neurodegenerative diseases such as frontotemporal degeneration and Alzheimer disease. Variants of PPA are important to recognize from a medical perspective because these syndromes are clinical markers suggesting specific underlying pathology. In this review, I discuss linguistic aspects of PPA syndromes that may prove informative for parsing our language mechanism and identifying the neural representation of fundamental elements of language. I focus on the representation of word meaning in a discussion of semantic variant PPA, grammatical comprehension and expression in a discussion of nonfluent/agrammatic variant PPA, the supporting role of short-term memory in a discussion of logopenic variant PPA, and components of language associated with discourse in a discussion of behavioral variant frontotemporal dementia. PPA provides a novel perspective that uniquely addresses facets of language and its disorders while complementing traditional aphasia syndromes that follow stroke.
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Affiliation(s)
- Murray Grossman
- Penn Frontotemporal Degeneration Center and Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania 19104
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37
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Communication behaviors associated with successful conversation in semantic variant primary progressive aphasia. Int Psychogeriatr 2017; 29:1619-1632. [PMID: 28593829 DOI: 10.1017/s1041610217000813] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Primary progressive aphasia (PPA) affects a range of language and cognitive domains that impact on conversation. Little is known about conversation breakdown in the semantic variant of PPA (svPPA, also known as semantic dementia). This study investigates conversation of people with svPPA. METHODS Dyadic conversations about everyday activities between seven individuals with svPPA and their partners, and seven control pairs were video recorded and transcribed. Number of words, turns, and length of turns were measured. Trouble-indicating behaviors (TIBs) and repair behaviors were categorized and identified as successful or not for each participant in each dyad. RESULTS In general, individuals with svPPA were active participants in conversation, taking an equal proportion of turns, but indicating a great deal of more trouble in conversation, shown by the significantly higher number of TIBs than evidenced by partners or control participants. TIBs were interactive (asking for confirmation with a shorter repetition of the original utterance or a repetition which included a request for specific information) and non-interactive (such as failing to take up or continue the topic or a minimal response) and unlike those previously reported for people with other PPA variants and dementia of the Alzheimer type. Communication behaviors of the partner were critical to conversational success. CONCLUSIONS Examination of trouble and repair in 10-min conversations of individuals with svPPA and their important communication partners has potential to inform speech pathology interventions to enhance successful conversation, in svPPA and should be an integral part of the comprehensive care plan.
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38
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Crutch SJ, Schott JM, Rabinovici GD, Murray M, Snowden JS, van der Flier WM, Dickerson BC, Vandenberghe R, Ahmed S, Bak TH, Boeve BF, Butler C, Cappa SF, Ceccaldi M, de Souza LC, Dubois B, Felician O, Galasko D, Graff-Radford J, Graff-Radford NR, Hof PR, Krolak-Salmon P, Lehmann M, Magnin E, Mendez MF, Nestor PJ, Onyike CU, Pelak VS, Pijnenburg Y, Primativo S, Rossor MN, Ryan NS, Scheltens P, Shakespeare TJ, Suárez González A, Tang-Wai DF, Yong KXX, Carrillo M, Fox NC. Consensus classification of posterior cortical atrophy. Alzheimers Dement 2017; 13:870-884. [PMID: 28259709 PMCID: PMC5788455 DOI: 10.1016/j.jalz.2017.01.014] [Citation(s) in RCA: 377] [Impact Index Per Article: 53.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 01/06/2017] [Indexed: 11/23/2022]
Abstract
INTRODUCTION A classification framework for posterior cortical atrophy (PCA) is proposed to improve the uniformity of definition of the syndrome in a variety of research settings. METHODS Consensus statements about PCA were developed through a detailed literature review, the formation of an international multidisciplinary working party which convened on four occasions, and a Web-based quantitative survey regarding symptom frequency and the conceptualization of PCA. RESULTS A three-level classification framework for PCA is described comprising both syndrome- and disease-level descriptions. Classification level 1 (PCA) defines the core clinical, cognitive, and neuroimaging features and exclusion criteria of the clinico-radiological syndrome. Classification level 2 (PCA-pure, PCA-plus) establishes whether, in addition to the core PCA syndrome, the core features of any other neurodegenerative syndromes are present. Classification level 3 (PCA attributable to AD [PCA-AD], Lewy body disease [PCA-LBD], corticobasal degeneration [PCA-CBD], prion disease [PCA-prion]) provides a more formal determination of the underlying cause of the PCA syndrome, based on available pathophysiological biomarker evidence. The issue of additional syndrome-level descriptors is discussed in relation to the challenges of defining stages of syndrome severity and characterizing phenotypic heterogeneity within the PCA spectrum. DISCUSSION There was strong agreement regarding the definition of the core clinico-radiological syndrome, meaning that the current consensus statement should be regarded as a refinement, development, and extension of previous single-center PCA criteria rather than any wholesale alteration or redescription of the syndrome. The framework and terminology may facilitate the interpretation of research data across studies, be applicable across a broad range of research scenarios (e.g., behavioral interventions, pharmacological trials), and provide a foundation for future collaborative work.
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Affiliation(s)
| | | | - Gil D Rabinovici
- Department of Neurology, Memory & Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Melissa Murray
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, USA
| | - Julie S Snowden
- Cerebral Function Unit, Greater Manchester Neuroscience Centre, Salford Royal NHS Foundation Trust, Salford, UK; Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Wiesje M van der Flier
- Department of Neurology, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands; Alzheimer Center, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Bradford C Dickerson
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Samrah Ahmed
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Thomas H Bak
- Human Cognitive Neuroscience, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Christopher Butler
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Stefano F Cappa
- Center for Cognitive Neuroscience, Vita-Salute San Raffaele University, Milan, Italy
| | - Mathieu Ceccaldi
- INSERM U 1106, Institut des Neurosciences des Systèmes, Aix Marseille Université, Marseilles, France
| | - Leonardo Cruz de Souza
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Bruno Dubois
- Institute for Memory and Alzheimer's Disease, UMR-S975, Salpêtrière Hospital, Pierre & Marie Curie University, Paris, France
| | - Olivier Felician
- Aix-Marseille Université, INSERM, Institut de Neurosciences des Systèmes, Marseille, France; AP-HM Hôpitaux de la Timone, Service de Neurologie et Neuropsychologie, Marseille, France
| | - Douglas Galasko
- Department of Neurosciences, University of California, San Diego, San Diego, USA
| | | | | | - Patrick R Hof
- Fishberg Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, USA; Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Pierre Krolak-Salmon
- Clinical and Research Memory Center of Lyon, Hospices Civils de Lyon, INSERM U1028, CNRS UMR5292, University of Lyon, Lyon, France
| | - Manja Lehmann
- Dementia Research Centre, UCL Institute of Neurology, London, UK; Department of Neurology, Memory & Aging Center, University of California, San Francisco, San Francisco, CA, USA
| | - Eloi Magnin
- Department of Neurology, Regional Memory Centre (CMRR), CHU Besançon, Besançon, France
| | - Mario F Mendez
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Peter J Nestor
- Cognitive Neurology and Neurodegeneration Group, German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - Chiadi U Onyike
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Victoria S Pelak
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Yolande Pijnenburg
- Department of Neurology, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands; Alzheimer Center, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Silvia Primativo
- Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Martin N Rossor
- Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Natalie S Ryan
- Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Philip Scheltens
- Department of Neurology, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands; Alzheimer Center, VU University Medical Centre, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | | | - Aida Suárez González
- Dementia Research Centre, UCL Institute of Neurology, London, UK; Memory Disorders Unit, Neurology Department, University Hospital Virgen del Rocio, Seville, Spain
| | - David F Tang-Wai
- Division of Neurology, University Health Network Memory Clinic, University of Toronto, Toronto, Ontario, Canada
| | - Keir X X Yong
- Dementia Research Centre, UCL Institute of Neurology, London, UK
| | - Maria Carrillo
- Medical and Scientific Relations, Alzheimer's Association, Chicago, IL, USA
| | - Nick C Fox
- Dementia Research Centre, UCL Institute of Neurology, London, UK
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Catricalà E, Gobbi E, Battista P, Miozzo A, Polito C, Boschi V, Esposito V, Cuoco S, Barone P, Sorbi S, Cappa SF, Garrard P. SAND: a Screening for Aphasia in NeuroDegeneration. Development and normative data. Neurol Sci 2017; 38:1469-1483. [PMID: 28578483 DOI: 10.1007/s10072-017-3001-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/17/2017] [Indexed: 12/12/2022]
Abstract
Language assessment has a critical role in the clinical diagnosis of neurodegenerative diseases, in particular, in the case of Primary Progressive Aphasia (PPA). The current diagnostic criteria (Gorno-Tempini et al., 2011) identify three main variants on the basis of clinical features and patterns of brain atrophy. Widely accepted tools to diagnose, clinically classify, and follow up the heterogeneous language profiles of PPA are still lacking. In this study, we develop a screening battery, composed of nine tests (picture naming, word and sentence comprehension, word and sentence repetition, reading, semantic association, writing and picture description), following the recommendations of current diagnostic guidelines and taking into account recent research on the topic. All tasks were developed with consideration of the psycholinguistic factors that can affect performance, with the aim of achieving sensitivity to the language deficit to which each task was relevant, and to allow identification of the selective characteristic impairments of each PPA variant. Normative data on 134 Italian subjects pooled across homogeneous subgroups for age, sex, and education are reported. Although further work is still needed, this battery represents a first step towards a concise multilingual standard language examination, a fast and simple tool to help clinicians and researchers in the diagnosis of PPA.
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Affiliation(s)
| | - Elena Gobbi
- Università Vita-Salute San Raffaele, Milano, Italia
| | - Petronilla Battista
- NEtS, Scuola Universitaria Superiore IUSS-Pavia, Pavia, Italia.,Unità di Malattie Neurodegenerative, Dipartimento di medicina di base, neuroscienze e organi del senso, Università di Bari Aldo Moro, Bari, Italia.,NEUROFARBA- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Firenze, Italia
| | - Antonio Miozzo
- Unità di Neurologia, Dipartimento di scienze cliniche e sperimentali, Università di Brescia, Brescia, Italia
| | - Cristina Polito
- SBSC - Dipartimento di Scienze Biomediche Sperimentali e Cliniche, Università di Firenze, Firenze, Italia
| | - Veronica Boschi
- NEtS, Scuola Universitaria Superiore IUSS-Pavia, Pavia, Italia
| | | | - Sofia Cuoco
- Facoltà di Medicina e Chirurgia, Università degli Studi di Salerno, Fisciano, Italia
| | - Paolo Barone
- Facoltà di Medicina e Chirurgia, Università degli Studi di Salerno, Fisciano, Italia
| | - Sandro Sorbi
- NEUROFARBA- Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Firenze, Italia
| | - Stefano F Cappa
- NEtS, Scuola Universitaria Superiore IUSS-Pavia, Pavia, Italia.,IRCCS S. Giovanni di Dio Fatebenefratelli, Brescia, Italia
| | - Peter Garrard
- Neuroscience Research Centre, St George's-University of London, London, UK
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40
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Duffy JR, Hanley H, Utianski R, Clark H, Strand E, Josephs KA, Whitwell JL. Temporal acoustic measures distinguish primary progressive apraxia of speech from primary progressive aphasia. BRAIN AND LANGUAGE 2017; 168:84-94. [PMID: 28187331 PMCID: PMC5366265 DOI: 10.1016/j.bandl.2017.01.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 12/19/2016] [Accepted: 01/23/2017] [Indexed: 05/08/2023]
Abstract
The purpose of this study was to determine if acoustic measures of duration and syllable rate during word and sentence repetition, and a measure of within-word lexical stress, distinguish speakers with primary progressive apraxia of speech (PPAOS) from nonapraxic speakers with the agrammatic or logopenic variants of primary progressive aphasia (PPA), and control speakers. Results revealed that the PPAOS group had longer durations and reduced rate of syllable production for most words and sentences, and the measure of lexical stress. Sensitivity and specificity indices for the PPAOS versus the other groups were highest for longer multisyllabic words and sentences. For the PPAOS group, correlations between acoustic measures and perceptual ratings of AOS were moderately high to high. Several temporal measures used in this study may aid differential diagnosis and help quantify features of PPAOS that are distinct from those associated with PPA in which AOS is not present.
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Affiliation(s)
- Joseph R Duffy
- Department of Neurology (Speech Pathology), Mayo Clinic, Rochester, MN, USA.
| | - Holly Hanley
- Department of Communication Sciences and Disorders, University of North Carolina, Greensboro, NC, USA
| | - Rene Utianski
- Department of Neurology (Speech Pathology), Mayo Clinic, Rochester, MN, USA
| | - Heather Clark
- Department of Neurology (Speech Pathology), Mayo Clinic, Rochester, MN, USA
| | - Edythe Strand
- Department of Neurology (Speech Pathology), Mayo Clinic, Rochester, MN, USA
| | - Keith A Josephs
- Department of Neurology (Behavioral Neurology and Movement Disorders), Mayo Clinic, Rochester, MN, USA
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Macoir J, Lavoie M, Laforce R, Brambati SM, Wilson MA. Dysexecutive Symptoms in Primary Progressive Aphasia: Beyond Diagnostic Criteria. J Geriatr Psychiatry Neurol 2017; 30:151-161. [PMID: 28355946 DOI: 10.1177/0891988717700507] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Primary progressive aphasia (PPA) is a heterogeneous neurodegenerative condition in which the most prominent clinical feature is language difficulties. Other cognitive domains have been described to remain unaffected at the early stages of the disease and, therefore, excluded from diagnostic criteria. However, we show in this article that executive function (EF) disorders may be present in the 3 variants (nonfluent/agrammatic, logopenic, and semantic) of PPA. We also illustrate changes in language and EF by means of a 3-year behavioral and neuroimaging longitudinal study of a patient suffering from the semantic variant of PPA. This review provides an update on current knowledge of PPA, suggesting that dysexecutive symptoms may be encountered in the 3 PPA variants, in their early phases and/or in more advanced stages, when atrophy extends to adjacent brain areas.
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Affiliation(s)
- Joël Macoir
- 1 Département de réadaptation, Faculté de médecine, Université Laval, Québec, Canada.,2 Centre de recherche de l'Institut universitaire en santé mentale de Québec, Québec, Canada
| | - Monica Lavoie
- 1 Département de réadaptation, Faculté de médecine, Université Laval, Québec, Canada.,2 Centre de recherche de l'Institut universitaire en santé mentale de Québec, Québec, Canada
| | - Robert Laforce
- 3 Clinique interdisciplinaire de mémoire, CHU de Québec-Hôpital de l'Enfant-Jésus, Québec, Canada.,4 Département de médecine, Faculté de médecine, Université Laval, Québec, Canada
| | - Simona M Brambati
- 5 Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada
| | - Maximiliano A Wilson
- 1 Département de réadaptation, Faculté de médecine, Université Laval, Québec, Canada.,2 Centre de recherche de l'Institut universitaire en santé mentale de Québec, Québec, Canada
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Poole ML, Brodtmann A, Darby D, Vogel AP. Motor Speech Phenotypes of Frontotemporal Dementia, Primary Progressive Aphasia, and Progressive Apraxia of Speech. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2017; 60:897-911. [PMID: 28289749 DOI: 10.1044/2016_jslhr-s-16-0140] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 09/11/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE Our purpose was to create a comprehensive review of speech impairment in frontotemporal dementia (FTD), primary progressive aphasia (PPA), and progressive apraxia of speech in order to identify the most effective measures for diagnosis and monitoring, and to elucidate associations between speech and neuroimaging. METHOD Speech and neuroimaging data described in studies of FTD and PPA were systematically reviewed. A meta-analysis was conducted for speech measures that were used consistently in multiple studies. RESULTS The methods and nomenclature used to describe speech in these disorders varied between studies. Our meta-analysis identified 3 speech measures which differentiate variants or healthy control-group participants (e.g., nonfluent and logopenic variants of PPA from all other groups, behavioral-variant FTD from a control group). Deficits within the frontal-lobe speech networks are linked to motor speech profiles of the nonfluent variant of PPA and progressive apraxia of speech. Motor speech impairment is rarely reported in semantic and logopenic variants of PPA. Limited data are available on motor speech impairment in the behavioral variant of FTD. CONCLUSIONS Our review identified several measures of speech which may assist with diagnosis and classification, and consolidated the brain-behavior associations relating to speech in FTD, PPA, and progressive apraxia of speech.
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Affiliation(s)
- Matthew L Poole
- Centre for Neuroscience of Speech, The University of Melbourne, Victoria, AustraliaEastern Cognitive Disorders Clinic, Monash University, Melbourne, Victoria, Australia
| | - Amy Brodtmann
- Eastern Cognitive Disorders Clinic, Monash University, Melbourne, Victoria, AustraliaFlorey Institute for Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - David Darby
- Eastern Cognitive Disorders Clinic, Monash University, Melbourne, Victoria, AustraliaFlorey Institute for Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Adam P Vogel
- Centre for Neuroscience of Speech, The University of Melbourne, Victoria, AustraliaEastern Cognitive Disorders Clinic, Monash University, Melbourne, Victoria, AustraliaDepartment of Neurodegeneration, Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
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Boschi V, Catricalà E, Consonni M, Chesi C, Moro A, Cappa SF. Connected Speech in Neurodegenerative Language Disorders: A Review. Front Psychol 2017; 8:269. [PMID: 28321196 PMCID: PMC5337522 DOI: 10.3389/fpsyg.2017.00269] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 02/10/2017] [Indexed: 12/12/2022] Open
Abstract
Language assessment has a crucial role in the clinical diagnosis of several neurodegenerative diseases. The analysis of extended speech production is a precious source of information encompassing the phonetic, phonological, lexico-semantic, morpho-syntactic, and pragmatic levels of language organization. The knowledge about the distinctive linguistic variables identifying language deficits associated to different neurodegenerative diseases has progressively improved in the last years. However, the heterogeneity of such variables and of the way they are measured and classified limits any generalization and makes the comparison among studies difficult. Here we present an exhaustive review of the studies focusing on the linguistic variables derived from the analysis of connected speech samples, with the aim of characterizing the language disorders of the most prevalent neurodegenerative diseases, including primary progressive aphasia, Alzheimer's disease, movement disorders, and amyotrophic lateral sclerosis. A total of 61 studies have been included, considering only those reporting group analysis and comparisons with a group of healthy persons. This review first analyzes the differences in the tasks used to elicit connected speech, namely picture description, story narration, and interview, considering the possible different contributions to the assessment of different linguistic domains. This is followed by an analysis of the terminologies and of the methods of measurements of the variables, indicating the need for harmonization and standardization. The final section reviews the linguistic domains affected by each different neurodegenerative disease, indicating the variables most consistently impaired at each level and suggesting the key variables helping in the differential diagnosis among diseases. While a large amount of valuable information is already available, the review highlights the need of further work, including the development of automated methods, to take advantage of the richness of connected speech analysis for both research and clinical purposes.
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Affiliation(s)
- Veronica Boschi
- NETS, Center for Neurocognition, Epistemology and Theoretical Syntax, Institute for Advanced Study-Pavia Pavia, Italy
| | - Eleonora Catricalà
- NETS, Center for Neurocognition, Epistemology and Theoretical Syntax, Institute for Advanced Study-Pavia Pavia, Italy
| | - Monica Consonni
- Third Neurology Unit and Motor Neuron Diseases Center, IRCCS Foundation "Carlo Besta" Neurological Institute Milan, Italy
| | - Cristiano Chesi
- NETS, Center for Neurocognition, Epistemology and Theoretical Syntax, Institute for Advanced Study-Pavia Pavia, Italy
| | - Andrea Moro
- NETS, Center for Neurocognition, Epistemology and Theoretical Syntax, Institute for Advanced Study-Pavia Pavia, Italy
| | - Stefano F Cappa
- NETS, Center for Neurocognition, Epistemology and Theoretical Syntax, Institute for Advanced Study-PaviaPavia, Italy; IRCCS S. Giovanni di Dio FatebenefratelliBrescia, Italy
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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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Roberts A, Savundranayagam M, Orange JB. Non-Alzheimer Dementias. PERSPECTIVES IN PRAGMATICS, PHILOSOPHY & PSYCHOLOGY 2017. [DOI: 10.1007/978-3-319-47489-2_14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Lopez G, Bayulkem K, Hallett M. Progressive supranuclear palsy (PSP): Richardson syndrome and other PSP variants. Acta Neurol Scand 2016; 134:242-9. [PMID: 27070344 DOI: 10.1111/ane.12546] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2015] [Indexed: 01/05/2023]
Abstract
Phenotypic heterogeneity of progressive supranuclear palsy (PSP) has been increasingly reported in the literature and can be the source of incorrect clinical diagnosis particularly in the early stages of the disease when the classically associated symptoms of early falls and supranuclear gaze palsy may not be apparent. In addition to Richardson syndrome (RS), several atypical clinical phenotypes have been described. Advances in genetic, neuroimaging, and biochemical/molecular technologies contribute to the identification of these clinical subtypes in the context of typical PSP pathological findings. Our goal is to review the phenomenology reported in the literature that is associated with confirmed histopathological changes consistent with a PSP diagnosis and to highlight the clinical spectrum of PSP. A systematic review of the literature in PubMed through July 2015 using MeSH terms and key words related to PSP was conducted. Articles describing PSP classifications, diagnostic criteria, and case reports were reviewed and summarized. Additional PSP phenotypes not seen in recent clinicopathological studies are included. These include primary lateral sclerosis, pallido-nigro-luysian degeneration, axonal dystrophy, and multiple system atrophy in the spectrum of atypical PSP variants beyond the traditionally classified PSP subtypes. This review is intended to help with the diagnostic challenges of atypical PSP variants. We believe that large multicenter clinicopathological studies will help expand our understanding of etiology and specific mechanisms of neurodegeneration and will aid in the appropriate interpretation of outcomes when conducting clinical and basic science research.
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Affiliation(s)
- G. Lopez
- Section on Molecular Neurogenetics; Medical Genetics Branch; NHGRI Intramural Research Program; National Institutes of Health; Bethesda MD USA
| | - K. Bayulkem
- Human Motor Control Section; National Institute of Neurological Disorders and Stroke; National Institutes of Health; Bethesda MD USA
| | - M. Hallett
- Human Motor Control Section; National Institute of Neurological Disorders and Stroke; National Institutes of Health; Bethesda MD USA
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Graham NL, Leonard C, Tang-Wai DF, Black S, Chow TW, Scott CJM, McNeely AA, Masellis M, Rochon E. Lack of Frank Agrammatism in the Nonfluent Agrammatic Variant of Primary Progressive Aphasia. Dement Geriatr Cogn Dis Extra 2016; 6:407-423. [PMID: 27790240 PMCID: PMC5075721 DOI: 10.1159/000448944] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background/Aims Frank agrammatism, defined as the omission and/or substitution of grammatical morphemes with associated grammatical errors, is variably reported in patients with nonfluent variant primary progressive aphasia (nfPPA). This study addressed whether frank agrammatism is typical in agrammatic nfPPA patients when this feature is not required for diagnosis. Method We assessed grammatical production in 9 patients who satisfied current diagnostic criteria. Although the focus was agrammatism, motor speech skills were also evaluated to determine whether dysfluency arose primarily from apraxia of speech (AOS), instead of, or in addition to, agrammatism. Volumetric MRI analyses provided impartial imaging-supported diagnosis. Results The majority of cases exhibited neither frank agrammatism nor AOS. Conclusion There are nfPPA patients with imaging-supported diagnosis and preserved motor speech skills who do not exhibit frank agrammatism, and this may persist beyond the earliest stages of the illness. Because absence of frank agrammatism is a subsidiary diagnostic feature in the logopenic variant of PPA, this result has implications for differentiation of the nonfluent and logopenic variants, and indicates that PPA patients with nonfluent speech in the absence of frank agrammatism or AOS do not necessarily have the logopenic variant.
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Affiliation(s)
- Naida L Graham
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Ont., Canada; Toronto Rehabilitation Institute, Toronto, Ont, Canada
| | - Carol Leonard
- Department of Audiology and Speech-Language Pathology, University of Ottawa, Ottawa, Ont, Canada
| | - David F Tang-Wai
- University Health Network Memory Clinic, Toronto Western Hospital, Ont., Canada; Department of Medicine (Neurology), University of Toronto, Ont., Canada
| | - Sandra Black
- Department of Medicine (Neurology), University of Toronto, Ont., Canada; L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Ont., Canada; Rotman Research Institute, University of Toronto, Toronto, Ont., Canada
| | - Tiffany W Chow
- Department of Medicine (Neurology), University of Toronto, Ont., Canada; Rotman Research Institute, University of Toronto, Toronto, Ont., Canada; Department of Psychiatry (Geriatric Psychiatry), University of Toronto, Toronto, Ont., Canada
| | - Chris J M Scott
- L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Ont., Canada
| | - Alicia A McNeely
- L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Ont., Canada
| | - Mario Masellis
- L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Ont., Canada
| | - Elizabeth Rochon
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Ont., Canada; Toronto Rehabilitation Institute, Toronto, Ont, Canada
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Yunusova Y, Graham NL, Shellikeri S, Phuong K, Kulkarni M, Rochon E, Tang-Wai DF, Chow TW, Black SE, Zinman LH, Green JR. Profiling Speech and Pausing in Amyotrophic Lateral Sclerosis (ALS) and Frontotemporal Dementia (FTD). PLoS One 2016; 11:e0147573. [PMID: 26789001 PMCID: PMC4720472 DOI: 10.1371/journal.pone.0147573] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 01/05/2016] [Indexed: 11/18/2022] Open
Abstract
Objective This study examines reading aloud in patients with amyotrophic lateral sclerosis (ALS) and those with frontotemporal dementia (FTD) in order to determine whether differences in patterns of speaking and pausing exist between patients with primary motor vs. primary cognitive-linguistic deficits, and in contrast to healthy controls. Design 136 participants were included in the study: 33 controls, 85 patients with ALS, and 18 patients with either the behavioural variant of FTD (FTD-BV) or progressive nonfluent aphasia (FTD-PNFA). Participants with ALS were further divided into 4 non-overlapping subgroups—mild, respiratory, bulbar (with oral-motor deficit) and bulbar-respiratory—based on the presence and severity of motor bulbar or respiratory signs. All participants read a passage aloud. Custom-made software was used to perform speech and pause analyses, and this provided measures of speaking and articulatory rates, duration of speech, and number and duration of pauses. These measures were statistically compared in different subgroups of patients. Results The results revealed clear differences between patient groups and healthy controls on the passage reading task. A speech-based motor function measure (i.e., articulatory rate) was able to distinguish patients with bulbar ALS or FTD-PNFA from those with respiratory ALS or FTD-BV. Distinguishing the disordered groups proved challenging based on the pausing measures. Conclusions and Relevance This study demonstrated the use of speech measures in the identification of those with an oral-motor deficit, and showed the usefulness of performing a relatively simple reading test to assess speech versus pause behaviors across the ALS—FTD disease continuum. The findings also suggest that motor speech assessment should be performed as part of the diagnostic workup for patients with FTD.
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Affiliation(s)
- Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- University Health Network—Toronto Rehabilitation Institute, Toronto, Ontario, Canada
- * E-mail:
| | - Naida L. Graham
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
- University Health Network—Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Sanjana Shellikeri
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Kent Phuong
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
| | | | - Elizabeth Rochon
- Department of Speech-Language Pathology, University of Toronto, Toronto, Ontario, Canada
- University Health Network—Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - David F. Tang-Wai
- Department of Medicine (Neurology), University of Toronto, Toronto, Ontario, Canada
- Division of Neurology, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Tiffany W. Chow
- Department of Medicine (Neurology), University of Toronto, Toronto, Ontario, Canada
- Rotman Research Institute, Toronto, Ontario, Canada
| | - Sandra E. Black
- Department of Medicine (Neurology), University of Toronto, Toronto, Ontario, Canada
- L.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Lorne H. Zinman
- Department of Medicine (Neurology), University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jordan R. Green
- MGH Institute of Health Professions, Boston, Massachusetts, United States of America
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Spalloni A, Longone P. Cognitive impairment in amyotrophic lateral sclerosis, clues from the SOD1 mouse. Neurosci Biobehav Rev 2016; 60:12-25. [DOI: 10.1016/j.neubiorev.2015.11.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 11/09/2015] [Accepted: 11/16/2015] [Indexed: 12/11/2022]
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Abstract
Frontotemporal dementia (FTD) was one of the lesser known dementias until the recent advancements revealing its genetic and pathological foundation. This common neurodegenerative disorder has three clinical subtypes- behavioral, semantic and progressive non fluent aphasia. The behavioral variant mostly exhibits personality changes, while the other two encompass various language deficits. This review discusses the basic pathology, genetics, clinical and histological presentation and the diagnosis of the 3 subtypes. It also deliberates the different therapeutic modalities currently available for frontotemporal dementia and the challenges faced by the caregivers. Lastly it explores the scope of further research into the diagnosis and management of FTD.
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Affiliation(s)
- Sayantani Ghosh
- Department of Neurology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Carol F Lippa
- Department of Neurology, Drexel University College of Medicine, Philadelphia, PA, USA
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