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Premi E, Cotelli M, Gobbi E, Pagnoni I, Binetti G, Gadola Y, Libri I, Mattioli I, Pengo M, Iraji A, Calhoun VD, Alberici A, Borroni B, Manenti R. Neuroanatomical correlates of screening for aphasia in NeuroDegeneration (SAND) battery in non-fluent/agrammatic variant of primary progressive aphasia. Front Aging Neurosci 2022; 14:942095. [PMID: 36389058 PMCID: PMC9660243 DOI: 10.3389/fnagi.2022.942095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/11/2022] [Indexed: 06/04/2024] Open
Abstract
Background Non-fluent/agrammatic variant of Primary Progressive Aphasia (avPPA) is primarily characterized by language impairment due to atrophy of the inferior frontal gyrus and the insula cortex in the dominant hemisphere. The Screening for Aphasia in NeuroDegeneration (SAND) battery has been recently proposed as a screening tool for PPA, with several tasks designed to be specific for different language features. Applying multivariate approaches to neuroimaging data and verbal fluency tasks, Aachener Aphasie Test (AAT) naming subtest and SAND data may help in elucidating the neuroanatomical correlates of language deficits in avPPA. Objective To investigate the neuroanatomical correlates of language deficits in avPPA using verbal fluency tasks, AAT naming subtest and SAND scores as proxies of brain structural imaging abnormalities. Methods Thirty-one avPPA patients were consecutively enrolled and underwent extensive neuropsychological assessment and MRI scan. Raw scores of verbal fluency tasks, AAT naming subtest, and SAND subtests, namely living and non-living picture naming, auditory sentence comprehension, single-word comprehension, words and non-words repetition and sentence repetition, were used as proxies to explore structural (gray matter volume) neuroanatomical correlates. We assessed univariate (voxel-based morphometry, VBM) as well as multivariate (source-based morphometry, SBM) approaches. Age, gender, educational level, and disease severity were considered nuisance variables. Results SAND picture naming (total, living and non-living scores) and AAT naming scores showed a direct correlation with the left temporal network derived from SBM. At univariate analysis, the left middle temporal gyrus was directly correlated with SAND picture naming (total and non-living scores) and AAT naming score. When words and non-words repetition (total score) was considered, a direct correlation with the left temporal network (SBM) and with the left fusiform gyrus (VBM) was also evident. Conclusion Naming impairments that characterize avPPA are related to specific network-based involvement of the left temporal network, potentially expanding our knowledge on the neuroanatomical basis of this neurodegenerative condition.
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Affiliation(s)
- Enrico Premi
- Stroke Unit, Azienda Socio Sanitaria Territoriale Spedali Civili Brescia, Brescia, Italy
| | - Maria Cotelli
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Elena Gobbi
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Ilaria Pagnoni
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Giuliano Binetti
- MAC Memory Clinic and Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Yasmine Gadola
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Owensboro, Italy
| | - Ilenia Libri
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Owensboro, Italy
| | - Irene Mattioli
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Owensboro, Italy
| | - Marta Pengo
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Owensboro, Italy
| | - Armin Iraji
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia Institute of Technology, Georgia State University, Emory University, Atlanta, GA, United States
- Departments of Psychology and Computer Science, Georgia State University, Atlanta, GA, United States
| | - Vince D. Calhoun
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia Institute of Technology, Georgia State University, Emory University, Atlanta, GA, United States
- Departments of Psychology and Computer Science, Georgia State University, Atlanta, GA, United States
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Antonella Alberici
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Owensboro, Italy
| | - Barbara Borroni
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Owensboro, Italy
| | - Rosa Manenti
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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Kang SH, Park YH, Shin J, Kim HR, Yun J, Jang H, Kim HJ, Koh SB, Na DL, Suh MK, Seo SW. Cortical neuroanatomical changes related to specific language impairments in primary progressive aphasia. Front Aging Neurosci 2022; 14:878758. [PMID: 36092818 PMCID: PMC9452784 DOI: 10.3389/fnagi.2022.878758] [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: 02/18/2022] [Accepted: 08/01/2022] [Indexed: 11/24/2022] Open
Abstract
Objective Language function test-specific neural substrates in Korean patients with primary progressive aphasia (PPA) might differ from those in other causes of dementia and English-speaking PPA patients. We investigated the correlation between language performance tests and cortical thickness to determine neural substrates in Korean patients with PPA. Materials and methods Ninety-six patients with PPA were recruited from the memory clinic. To acquire neural substrates, we performed linear regression using the scores of each language test as a predictor, cortical thickness as an outcome and age, sex, years of education, and intracranial volume as confounders. Results Poor performance in each language function test was associated with lower cortical thickness in specific cortical regions: (1) object naming and the bilateral anterior to mid-portion of the lateral temporal and basal temporal regions; (2) semantic generative naming and the bilateral anterior to mid-portion of the lateral temporal and basal temporal regions; (3) phonemic generative naming and the left prefrontal and inferior parietal regions; and (4) comprehension and the left posterior portion of the superior and middle temporal regions. In particular, the neural substrates of the semantic generative naming test in PPA patients, left anterior to mid-portion of the lateral and basal temporal regions, quite differed from those in patients with other causes of dementia. Conclusion Our findings provide a better understanding of the different pathomechanisms for language impairments among PPA patients from those with other causes of dementia.
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Affiliation(s)
- Sung Hoon Kang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Yu Hyun Park
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea
| | - Jiho Shin
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hang-Rai Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Neurology, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, South Korea
| | - Jihwan Yun
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hyemin Jang
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hee Jin Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Seong-Beom Koh
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, South Korea
| | - Duk L. Na
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Mee Kyung Suh
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- *Correspondence: Mee Kyung Suh,
| | - Sang Won Seo
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, South Korea
- Department of Digital Health, SAIHST, Sungkyunkwan University, Seoul, South Korea
- Alzheimer’s Disease Convergence Research Center, Samsung Medical Center, Seoul, South Korea
- Sang Won Seo, ;
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Mesulam MM, Coventry CA, Bigio EH, Sridhar J, Gill N, Fought AJ, Zhang H, Thompson CK, Geula C, Gefen T, Flanagan M, Mao Q, Weintraub S, Rogalski EJ. Neuropathological fingerprints of survival, atrophy and language in primary progressive aphasia. Brain 2022; 145:2133-2148. [PMID: 35441216 PMCID: PMC9246707 DOI: 10.1093/brain/awab410] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/25/2021] [Accepted: 10/19/2021] [Indexed: 01/21/2023] Open
Abstract
Primary progressive aphasia is a neurodegenerative disease that selectively impairs language without equivalent impairment of speech, memory or comportment. In 118 consecutive autopsies on patients with primary progressive aphasia, primary diagnosis was Alzheimer's disease neuropathological changes (ADNC) in 42%, corticobasal degeneration or progressive supranuclear palsy neuropathology in 24%, Pick's disease neuropathology in 10%, transactive response DNA binding proteinopathy type A [TDP(A)] in 10%, TDP(C) in 11% and infrequent entities in 3%. Survival was longest in TDP(C) (13.2 ± 2.6 years) and shortest in TDP(A) (7.1 ± 2.4 years). A subset of 68 right-handed participants entered longitudinal investigations. They were classified as logopenic, agrammatic/non-fluent or semantic by quantitative algorithms. Each variant had a preferred but not invariant neuropathological correlate. Seventy-seven per cent of logopenics had ADNC, 56% of agrammatics had corticobasal degeneration/progressive supranuclear palsy or Pick's disease and 89% of semantics had TDP(C). Word comprehension impairments had strong predictive power for determining underlying neuropathology positively for TDP(C) and negatively for ADNC. Cortical atrophy was smallest in corticobasal degeneration/progressive supranuclear palsy and largest in TDP(A). Atrophy encompassed posterior frontal but not temporoparietal cortex in corticobasal degeneration/progressive supranuclear palsy, anterior temporal but not frontoparietal cortex in TDP(C), temporofrontal but not parietal cortex in Pick's disease and all three lobes with ADNC or TDP(A). There were individual deviations from these group patterns, accounting for less frequent clinicopathologic associations. The one common denominator was progressive asymmetric atrophy overwhelmingly favouring the left hemisphere language network. Comparisons of ADNC in typical amnestic versus atypical aphasic dementia and of TDP in type A versus type C revealed fundamental biological and clinical differences, suggesting that members of each pair may constitute distinct clinicopathologic entities despite identical downstream proteinopathies. Individual TDP(C) participants with unilateral left temporal atrophy displayed word comprehension impairments without additional object recognition deficits, helping to dissociate semantic primary progressive aphasia from semantic dementia. When common and uncommon associations were considered in the set of 68 participants, one neuropathology was found to cause multiple clinical subtypes, and one subtype of primary progressive aphasia to be caused by multiple neuropathologies, but with different probabilities. Occasionally, expected clinical manifestations of atrophy sites were absent, probably reflecting individual peculiarities of language organization. The hemispheric asymmetry of neurodegeneration and resultant language impairment in primary progressive aphasia reflect complex interactions among the cellular affinities of the degenerative disease, the constitutive biology of language cortex, familial or developmental vulnerabilities of this network and potential idiosyncrasies of functional anatomy in the affected individual.
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Affiliation(s)
- M Marsel Mesulam
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA
- Davee Department of Neurology, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Christina A Coventry
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Eileen H Bigio
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA
- Department of Pathology, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Jaiashre Sridhar
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Nathan Gill
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA
- Department of Preventive Medicine, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Angela J Fought
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Denver Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Hui Zhang
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA
- Department of Preventive Medicine, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Cynthia K Thompson
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA
- School of Communication, Northwestern University, Evanston, IL 60208, USA
| | - Changiz Geula
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Tamar Gefen
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Margaret Flanagan
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA
- Department of Pathology, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Qinwen Mao
- Department of Pathology, University of Utah, Salt Lake City, UT 84112, USA
| | - Sandra Weintraub
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Emily J Rogalski
- Mesulam Center for Cognitive Neurology and Alzheimer’s Disease, Feinberg School of Medicine, Chicago, IL 60611, USA
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Chicago, IL 60611, USA
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4
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The Impact of Primary Progressive Aphasia on Picture Naming and General Language Ability. Cogn Behav Neurol 2021; 34:188-199. [PMID: 34473670 DOI: 10.1097/wnn.0000000000000275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 12/23/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Primary progressive aphasia (PPA) is a clinical syndrome that is characterized by progressive deterioration of language while other cognitive domains remain relatively intact. The extent to which print exposure and cortical volume atrophy jointly influence picture naming and general language ability in individuals with PPA remains underexplored. OBJECTIVE To investigate the language performance of individuals with the nonfluent variant of primary progressive aphasia (nfvPPA) and to explore the impact of print exposure and cortical volume atrophy on their language ability. METHOD We compared 14 Greek individuals with nfvPPA and similar age, education, disease duration, and cognitive ability with age-, gender- and education-matched Greek controls on picture naming and on language tasks of the Boston Diagnostic Aphasia Examination-Short Form, including oral word reading, word and sentence repetition, complex ideational material, and reading comprehension. The effects of print exposure and left-hemisphere cortical volume on the individuals' language performance were estimated through stepwise regression models. RESULTS The language performance of the individuals with nfvPPA was affected by print exposure and cortical volume atrophy. Picture naming and word reading were affected by print exposure. The highest contributions of cortical volume atrophy were found for the repetition, complex ideational material, and reading comprehension tasks. CONCLUSION Print exposure and cortical volume atrophy may help explain variability in the language performance of nfvPPA individuals with similar age, education, disease duration, and cognitive ability.
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Clinical Characterization of Atypical Primary Progressive Aphasia in a 3-Year Longitudinal Study: A Case Report. Cogn Behav Neurol 2021; 34:233-244. [PMID: 34473676 DOI: 10.1097/wnn.0000000000000273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 01/04/2021] [Indexed: 11/26/2022]
Abstract
The logopenic variant of primary progressive aphasia (lvPPA) is the most recent variant of primary progressive aphasia (PPA) to be identified; thus far, it has been poorly investigated. Despite being typically associated with Alzheimer disease (AD), lvPPA has recently been linked to frontotemporal lobe degeneration (FTLD), with distinctive cognitive and neural features that are worthy of further investigation. Here, we describe the neuropsychological and linguistic profile, as well as cerebral abnormalities, of an individual exhibiting PPA and carrying a pathogenetic variant in the GRN gene, from a 3-year longitudinal perspective. The individual's initial profile resembled lvPPA because it was characterized by word-finding difficulties and phonological errors in spontaneous speech in addition to sentence repetition and phonological short-term memory impairments. The individual's structural and metabolic imaging data demonstrated left temporal and bilateral frontal atrophy and hypometabolism, respectively. On follow-up, as the pathology progressed, dysprosody, stereotypical speech patterns, agrammatism, and orofacial apraxia appeared, suggesting an overlap with the nonfluent variant of PPA (nfvPPA). Severe sentence comprehension impairment also became evident. Our longitudinal and multidisciplinary diagnostic approach allowed us to better characterize the progression of a GRN-positive lvPPA profile, providing neuropsychological and imaging indicators that might be helpful to improve classification between different PPA variants and to address a nosological issue. Finally, we discuss the importance of early diagnosis of PPA given the possible overlap between different PPA variants during the progression of the pathology.
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6
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Paek EJ, Murray LL, Newman SD. Effects of concurrent action and object naming treatment on naming skills and functional brain activation patterns in primary progressive aphasia: An fMRI study with a case-series design. BRAIN AND LANGUAGE 2021; 218:104950. [PMID: 33836414 DOI: 10.1016/j.bandl.2021.104950] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 11/18/2020] [Accepted: 03/28/2021] [Indexed: 06/12/2023]
Abstract
Individuals with primary progressive aphasia (PPA) exhibit differential impairment patterns in noun and verb naming, but it remains unclear whether anomia treatment results in similar improvements in noun and verb naming. Therefore, we examined the immediate and long-term (3-months post-treatment) behavioral and neural effects of an anomia treatment on object and action naming skills in PPA. A case-series design was utilized involving two individuals with PPA. Object and action words were trained concurrently and probed regularly using word lists matched on a number of lexical characteristics. One participant showed improvements in all word categories with different effect sizes whereas the other participant demonstrated improved naming only on trained object words. Treatment-induced fMRI changes were found in both hemispheres, with distinct patterns observed across participants. Further research is needed to better understand the effects of residual language and cognitive skills on behavioral and neurophysiological outcomes following anomia treatment for PPA.
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Affiliation(s)
- Eun Jin Paek
- Department of Audiology and Speech Pathology, College of Health Professions, The University of Tennessee Health Science Center, Knoxville, TN 37996, United States.
| | - Laura L Murray
- School of Communication Sciences and Disorders, Western University, London, Ontario N6G 1H1, Canada.
| | - Sharlene D Newman
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN 47401, United States; Department of Psychology, University of Alabama, Tuscaloosa, AL 35487, United States.
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Cho S, Nevler N, Ash S, Shellikeri S, Irwin DJ, Massimo L, Rascovsky K, Olm C, Grossman M, Liberman M. Automated analysis of lexical features in frontotemporal degeneration. Cortex 2021; 137:215-231. [PMID: 33640853 PMCID: PMC8044033 DOI: 10.1016/j.cortex.2021.01.012] [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: 02/26/2020] [Revised: 07/26/2020] [Accepted: 01/22/2021] [Indexed: 12/14/2022]
Abstract
We implemented an automated analysis of lexical aspects of semi-structured speech produced by healthy elderly controls (n = 37) and three patient groups with frontotemporal degeneration (FTD): behavioral variant FTD (n = 74), semantic variant primary progressive aphasia (svPPA, n = 42), and nonfluent/agrammatic PPA (naPPA, n = 22). Based on previous findings, we hypothesized that the three patient groups and controls would differ in the counts of part-of-speech (POS) categories and several lexical measures. With a natural language processing program, we automatically tagged POS categories of all words produced during a picture description task. We further counted the number of wh-words, and we rated nouns for abstractness, ambiguity, frequency, familiarity, and age of acquisition. We also computed the cross-entropy estimation, where low cross-entropy indicates high predictability, and lexical diversity for each description. We validated a subset of the POS data that were automatically tagged with the Google Universal POS scheme using gold-standard POS data tagged by a linguist, and we found that the POS categories from our automated methods were more than 90% accurate. For svPPA patients, we found fewer unique nouns than in naPPA and more pronouns and wh-words than in the other groups. We also found high abstractness, ambiguity, frequency, and familiarity for nouns and the lowest cross-entropy estimation among all groups. These measures were associated with cortical thinning in the left temporal lobe. In naPPA patients, we found increased speech errors and partial words compared to controls, and these impairments were associated with cortical thinning in the left middle frontal gyrus. bvFTD patients' adjective production was decreased compared to controls and was correlated with their apathy scores. Their adjective production was associated with cortical thinning in the dorsolateral frontal and orbitofrontal gyri. Our results demonstrate distinct language profiles in subgroups of FTD patients and validate our automated method of analyzing FTD patients' speech.
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Affiliation(s)
- Sunghye Cho
- Linguistic Data Consortium, University of Pennsylvania, Philadelphia, PA, USA.
| | - Naomi Nevler
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Sharon Ash
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Sanjana Shellikeri
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | - David J Irwin
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren Massimo
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Katya Rascovsky
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Christopher Olm
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA; Department of Radiology and Penn Image Computing and Science Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Murray Grossman
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark Liberman
- Linguistic Data Consortium, University of Pennsylvania, Philadelphia, PA, USA
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Miller HE, Cordella C, Collins JA, Ezzo R, Quimby M, Hochberg D, Tourville JA, Dickerson BC, Guenther FH. Neural substrates of verbal repetition deficits in primary progressive aphasia. Brain Commun 2021; 3:fcab015. [PMID: 33748756 PMCID: PMC7955979 DOI: 10.1093/braincomms/fcab015] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 12/22/2020] [Accepted: 12/28/2020] [Indexed: 11/18/2022] Open
Abstract
In this cross-sectional study, we examined the relationship between cortical thickness and performance on several verbal repetition tasks in a cohort of patients with primary progressive aphasia in order to test predictions generated by theoretical accounts of phonological working memory that predict phonological content buffers in left posterior inferior frontal sulcus and supramarginal gyrus. Cortical surfaces were reconstructed from magnetic resonance imaging scans from 42 participants diagnosed with primary progressive aphasia. Cortical thickness was measured in a set of anatomical regions spanning the entire cerebral cortex. Correlation analyses were performed between cortical thickness and average score across three phonological working memory-related tasks: the Repetition sub-test from the Western Aphasia Battery, a forward digit span task, and a backward digit span task. Significant correlations were found between average working memory score across tasks and cortical thickness in left supramarginal gyrus and left posterior inferior frontal sulcus, in support of prior theoretical accounts of phonological working memory. Exploratory whole-brain correlation analyses performed for each of the three behavioural tasks individually revealed a distinct set of positively correlated regions for each task. Comparison of cortical thickness measures from different primary progressive aphasia sub-types to cortical thickness in age-matched controls further revealed unique patterns of atrophy in the different subtypes.
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Affiliation(s)
- Hilary E Miller
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA 02215, USA
| | - Claire Cordella
- Department of Neurology, Frontotemporal Disorders Unit, Massachusetts General Hospital & Harvard Medical School, Charlestown, MA 02129, USA
| | - Jessica A Collins
- Department of Neurology, Frontotemporal Disorders Unit, Massachusetts General Hospital & Harvard Medical School, Charlestown, MA 02129, USA
| | - Rania Ezzo
- Department of Neurology, Frontotemporal Disorders Unit, Massachusetts General Hospital & Harvard Medical School, Charlestown, MA 02129, USA
| | - Megan Quimby
- Department of Neurology, Frontotemporal Disorders Unit, Massachusetts General Hospital & Harvard Medical School, Charlestown, MA 02129, USA
| | - Daisy Hochberg
- Department of Neurology, Frontotemporal Disorders Unit, Massachusetts General Hospital & Harvard Medical School, Charlestown, MA 02129, USA
| | - Jason A Tourville
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA 02215, USA
| | - Bradford C Dickerson
- Department of Neurology, Frontotemporal Disorders Unit, Massachusetts General Hospital & Harvard Medical School, Charlestown, MA 02129, USA
- Department of Radiology, Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA 02129, USA
| | - Frank H Guenther
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA 02215, USA
- Department of Biomedical Engineering, Boston University, Boston, MA 02215, USA
- The Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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Fan JM, Gorno-Tempini ML, Dronkers NF, Miller BL, Berger MS, Chang EF. Data-Driven, Visual Framework for the Characterization of Aphasias Across Stroke, Post-resective, and Neurodegenerative Disorders Over Time. Front Neurol 2020; 11:616764. [PMID: 33447252 PMCID: PMC7801263 DOI: 10.3389/fneur.2020.616764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/03/2020] [Indexed: 12/04/2022] Open
Abstract
Aphasia classifications and specialized language batteries differ across the fields of neurodegenerative disorders and lesional brain injuries, resulting in difficult comparisons of language deficits across etiologies. In this study, we present a simplified framework, in which a widely-used aphasia battery captures clinical clusters across disease etiologies and provides a quantitative and visual method to characterize and track patients over time. The framework is used to evaluate populations representing three disease etiologies: stroke, primary progressive aphasia (PPA), and post-operative aphasia. A total of 330 patients across three populations with cerebral injury leading to aphasia were investigated, including 76 patients with stroke, 107 patients meeting criteria for PPA, and 147 patients following left hemispheric resective surgery. Western Aphasia Battery (WAB) measures (Information Content, Fluency, answering Yes/No questions, Auditory Word Recognition, Sequential Commands, and Repetition) were collected across the three populations and analyzed to develop a multi-dimensional aphasia model using dimensionality reduction techniques. Two orthogonal dimensions were found to explain 87% of the variance across aphasia phenotypes and three disease etiologies. The first dimension reflects shared weighting across aphasia subscores and correlated with aphasia severity. The second dimension incorporates fluency and comprehension, thereby separating Wernicke's from Broca's aphasia, and the non-fluent/agrammatic from semantic PPA variants. Clusters representing clinical classifications, including late PPA presentations, were preserved within the two-dimensional space. Early PPA presentations were not classifiable, as specialized batteries are needed for phenotyping. Longitudinal data was further used to visualize the trajectory of aphasias during recovery or disease progression, including the rapid recovery of post-operative aphasic patients. This method has implications for the conceptualization of aphasia as a spectrum disorder across different disease etiology and may serve as a framework to track the trajectories of aphasia progression and recovery.
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Affiliation(s)
- Joline M Fan
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | | | - Nina F Dronkers
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States.,Department of Neurology, University of California, Davis, Davis, CA, United States
| | - Bruce L Miller
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Mitchel S Berger
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Edward F Chang
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
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10
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Cho S, Nevler N, Ash S, Shellikeri S, Irwin DJ, Massimo L, Rascovsky K, Olm C, Grossman M, Liberman M. Automated analysis of lexical features in Frontotemporal Degeneration. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2020:2020.09.10.20192054. [PMID: 33173922 PMCID: PMC7654918 DOI: 10.1101/2020.09.10.20192054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We implemented an automated analysis of lexical aspects of semi-structured speech produced by healthy elderly controls (n=37) and three patient groups with frontotemporal degeneration (FTD): behavioral variant FTD (n=74), semantic variant primary progressive aphasia (svPPA, n=42), and nonfluent/agrammatic PPA (naPPA, n=22). Based on previous findings, we hypothesized that the three patient groups and controls would differ in the counts of part-of-speech (POS) categories and several lexical measures. With a natural language processing program, we automatically tagged POS categories of all words produced during a picture description task. We further counted the number of wh -words, and we rated nouns for abstractness, ambiguity, frequency, familiarity, and age of acquisition. We also computed the cross-entropy estimation, which is a measure of word predictability, and lexical diversity for each description. We validated a subset of the POS data that were automatically tagged with the Google Universal POS scheme using gold-standard POS data tagged by a linguist, and we found that the POS categories from our automated methods were more than 90% accurate. For svPPA patients, we found fewer unique nouns than in naPPA and more pronouns and wh -words than in the other groups. We also found high abstractness, ambiguity, frequency, and familiarity for nouns and the lowest cross-entropy estimation among all groups. These measures were associated with cortical thinning in the left temporal lobe. In naPPA patients, we found increased speech errors and partial words compared to controls, and these impairments were associated with cortical thinning in the left middle frontal gyrus. bvFTD patients' adjective production was decreased compared to controls and was correlated with their apathy scores. Their adjective production was associated with cortical thinning in the dorsolateral frontal and orbitofrontal gyri. Our results demonstrate distinct language profiles in subgroups of FTD patients and validate our automated method of analyzing FTD patients' speech.
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Affiliation(s)
- Sunghye Cho
- Linguistic Data Consortium, University of Pennsylvania, Philadelphia, PA, USA
| | - Naomi Nevler
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Sharon Ash
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Sanjana Shellikeri
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | - David J. Irwin
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren Massimo
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Katya Rascovsky
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Christopher Olm
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
- Department of Radiology and Penn Image Computing and Science Laboratory, University of Pennsylvania, Philadelphia, PA, USA
| | - Murray Grossman
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Mark Liberman
- Linguistic Data Consortium, University of Pennsylvania, Philadelphia, PA, USA
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11
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Duffy JR, Utianski RL, Josephs KA. Primary Progressive Apraxia of Speech: From Recognition to Diagnosis and Care. APHASIOLOGY 2020; 35:560-591. [PMID: 34219857 PMCID: PMC8247786 DOI: 10.1080/02687038.2020.1787732] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 06/16/2020] [Indexed: 05/12/2023]
Abstract
BACKGROUND Apraxia of speech (AOS) can be caused by neurodegenerative disease and sometimes is its presenting sign (i.e., primary progressive apraxia of speech, PPAOS). During the last several decades our understanding of PPAOS has evolved from clinical recognition to a fuller understanding of its core and associated clinical features, its distinction from but relationship with primary progressive aphasia, its temporal course and eventual progression to include other neurological deficits, and its neuroimaging correlates and underlying pathology. AIMS This paper provides a comprehensive summary of the literature that has built the current knowledge base about PPAOS and progressive AOS as it co-occurs with progressive aphasia. It reviews the history of its emergence as a recognized syndrome; its relationship with the agrammatic/nonfluent variant of primary progressive aphasia; its salient perceptual features and subtypes; the acoustic and structural/physiological imaging measures that index its presence, severity, and distinction from aphasia; and principles and available data regarding its management and care. MAIN CONTRIBUTION A broad summary of what is known about AOS as a manifestation of neurodegenerative disease. CONCLUSIONS Primary progressive apraxia of speech is a recognizable syndrome that can be distinguished from other neurodegenerative conditions that affect speech and language.
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Affiliation(s)
- Joseph R Duffy
- Departments of Neurology, Mayo Clinic, Rochester, MN, USA
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12
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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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13
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Abstract
Frontal lobe-executive functions are heavily dependent on distal white matter connectivity. Even with healthy aging there is an increase in leukoaraiosis that might interrupt this connectivity. The goal of this study is to learn 1) the location, depth, and percentage of leukoaraiosis in white matter among a sample of non-demented older adults and 2) associations between these leukoarioasis metrics and composites of cognitive efficiency (processing speed, working memory, and inhibitory function), and episodic memory. Participants were 154 non-demented older adults (age range 60-85) who completed a brain MRI and neuropsychological testing on the same day. Brain MRIs were segmented via Freesurfer and white matter leukoaraiosis depth segmentations was based on published criteria. On average, leukoaraiosis occupied 1 % of total white matter. There was no difference in LA distribution in the frontal (1.12%), parietal (1.10%), and occipital (0.95%) lobes; there was less LA load within the temporal lobe (0.23%). For cortical depth, leukoaraiosis was predominantly in the periventricular region (3.39%; deep 1.46%, infracortical 0.15%). Only increasing frontal lobe and periventricular leukoaraiosis were associated with a reduction in processing speed, working memory, and inhibitory function. Despite the general presence of LA throughout the brain, only frontal and periventricular LA contributed to the speeded and mental manipulation of executive functioning. This study provides a normative description of LA for non-demented adults to use as a comparison to more disease samples.
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14
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Faulkner JW, Wilshire CE. Mapping eloquent cortex: A voxel-based lesion-symptom mapping study of core speech production capacities in brain tumour patients. BRAIN AND LANGUAGE 2020; 200:104710. [PMID: 31739187 DOI: 10.1016/j.bandl.2019.104710] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/21/2019] [Accepted: 10/09/2019] [Indexed: 06/10/2023]
Abstract
This study used voxel-based lesion-symptom mapping to examine the cortical and white matter regions associated with language production impairments in a sample of 63 preoperative tumour patients. We identified four cognitive functions considered crucial for spoken language production: semantic-to-lexical mapping (selecting the appropriate lexical label for the intended concept); phonological encoding (retrieving the word's phonological form); articulatory-motor planning (programming the articulatory motor movements); and goal-driven language selection (exerting top-down control over the words selected for production). Each participant received a score estimating their competence on each function. We then mapped the region(s) where pathology was significantly associated with low scores. For semantic-to-lexical mapping, the critical map encompassed portions of the left posterior middle and inferior temporal gyri, extending into posterior fusiform gyrus, overlapping substantially with the territory of the inferior longitudinal fasciculus. For phonological encoding, the map encompassed the left inferior parietal lobe and posterior middle temporal gyrus, overlapping with the territory of the inferior longitudinal and posterior arcuate fasciculi. For articulatory-motor planning, the map encompassed parts of the left frontal pole, frontal operculum, and inferior frontal gyrus, and overlapped with the territory of the frontal aslant tract. Finally, the map for goal-driven language selection encompassed the left frontal pole and the anterior cingulate cortex. We compare our findings with those from other neuropsychological samples, and conclude that the study of tumour patients offers evidence that complements that available from other populations.
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Affiliation(s)
- Josh W Faulkner
- School of Psychology, Victoria University of Wellington, New Zealand
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15
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Bruffaerts R, Schaeverbeke J, De Weer AS, Nelissen N, Dries E, Van Bouwel K, Sieben A, Bergmans B, Swinnen C, Pijnenburg Y, Sunaert S, Vandenbulcke M, Vandenberghe R. Multivariate analysis reveals anatomical correlates of naming errors in primary progressive aphasia. Neurobiol Aging 2019; 88:71-82. [PMID: 31955981 DOI: 10.1016/j.neurobiolaging.2019.12.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/10/2019] [Accepted: 12/15/2019] [Indexed: 12/30/2022]
Abstract
Primary progressive aphasia (PPA) is an overarching term for a heterogeneous group of neurodegenerative diseases which affect language processing. Impaired picture naming has been linked to atrophy of the anterior temporal lobe in the semantic variant of PPA. Although atrophy of the anterior temporal lobe proposedly impairs picture naming by undermining access to semantic knowledge, picture naming also entails object recognition and lexical retrieval. Using multivariate analysis, we investigated whether cortical atrophy relates to different types of naming errors generated during picture naming in 43 PPA patients (13 semantic, 9 logopenic, 11 nonfluent, and 10 mixed variant). Omissions were associated with atrophy of the anterior temporal lobes. Semantic errors, for example, mistaking a rhinoceros for a hippopotamus, were associated with atrophy of the left mid and posterior fusiform cortex and the posterior middle and inferior temporal gyrus. Semantic errors and atrophy in these regions occurred in each PPA subtype, without major between-subtype differences. We propose that pathological changes to neural mechanisms associated with semantic errors occur across the PPA spectrum.
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Affiliation(s)
- Rose Bruffaerts
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium; Neurology Department, University Hospitals Leuven, Leuven, Belgium.
| | - Jolien Schaeverbeke
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - An-Sofie De Weer
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Natalie Nelissen
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Eva Dries
- Neurology Department, University Hospitals Leuven, Leuven, Belgium
| | - Karen Van Bouwel
- Neurology Department, University Hospitals Leuven, Leuven, Belgium
| | - Anne Sieben
- Neurology Department, University Hospital Ghent, Ghent, Belgium
| | - Bruno Bergmans
- Neurology Department, University Hospital Ghent, Ghent, Belgium; Neurology Department, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | | | - Yolande Pijnenburg
- Neurology Department, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Stefan Sunaert
- Radiology Department, University Hospitals Leuven, Leuven, Belgium
| | | | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Leuven, Belgium; Neurology Department, University Hospitals Leuven, Leuven, Belgium
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16
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Owens TE, Machulda MM, Duffy JR, Strand EA, Clark HM, Boland S, Martin PR, Lowe VJ, Jack CR, Whitwell JL, Josephs KA. Patterns of Neuropsychological Dysfunction and Cortical Volume Changes in Logopenic Aphasia. J Alzheimers Dis 2019; 66:1015-1025. [PMID: 30372673 DOI: 10.3233/jad-171175] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Neuropsychological assessment can add essential information to the characterization of individuals presenting with the logopenic variant of primary progressive aphasia (lvPPA). OBJECTIVE This study examined the neuropsychological characteristics of lvPPA patients. We also examined differences in regional and whole brain atrophy based on neuropsychological profiles. METHODS We conducted a hierarchical cluster analysis on memory, executive functioning, and visuospatial neuropsychological test data for 56 individuals with lvPPA. We then compared resultant clusters to left middle temporal, inferior parietal, and superior parietal regions-of-interest using multivariate analysis of covariance. We also performed voxel-level analyses. RESULTS We identified three clusters characterized as lvPPA with no neurocognitive impairment (n = 5), lvPPA with mild neurocognitive deficits (n = 23), and lvPPA with marked cognitive deficits (n = 28). WAB-AQ was associated with left middle temporal volume. Superior parietal volumes were smaller for the lvPPA group with marked cognitive symptoms compared to the less severe groups. Voxel-level analyses showed greater atrophy in temporal, parietal, lateral occipital, and frontal regions, left worse than right. Age, disease duration, gender, WAB-AQ, and PiB-PET did not account for differences between groups. CONCLUSIONS LvPPA patients without cognitive deficits in other domains were relatively uncommon while 50% of our sample exhibited pronounced neurocognitive deficits outside the language domain. Pronounced cognitive deficits in lvPPA are associated with widespread atrophy, left worse than right. Our study underscores the importance of examining neuropsychological function in addition to language in patients with lvPPA.
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17
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Slegers A, Filiou RP, Montembeault M, Brambati SM. Connected Speech Features from Picture Description in Alzheimer's Disease: A Systematic Review. J Alzheimers Dis 2019; 65:519-542. [PMID: 30103314 DOI: 10.3233/jad-170881] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The language changes that occur over the course of Alzheimer's disease (AD) can impact communication abilities and have profound functional consequences. Picture description tasks can be used to approximate everyday communication abilities of AD patients. As various methods and variables have been studied over the years, current knowledge about the most affected features of AD discourse in the context of picture descriptions is difficult to summarize. This systematic review aims to provide researchers with an overview of the most common areas of impairment in AD discourse as they appear in picture description tasks. Based on the 44 articles fulfilling inclusion criteria, our findings reflect a multidimensional pattern of changes in the production (speech rate), syntactic (length of utterance), lexical (word-frequency and use of pronouns), fluency (repetitions and word-finding difficulties), semantic (information units), and discourse (efficiency) domains. We discuss our findings in the light of current research and point to potential scientific and clinical uses of picture description tasks in the context of AD.
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Affiliation(s)
- Antoine Slegers
- Département de Psychologie, Université de Montréal, Montréal, QC, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
| | - Renée-Pier Filiou
- Département de Psychologie, Université de Montréal, Montréal, QC, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
| | - Maxime Montembeault
- Département de Psychologie, Université de Montréal, Montréal, QC, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
| | - Simona Maria Brambati
- Département de Psychologie, Université de Montréal, Montréal, QC, Canada.,Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal (CRIUGM), CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, Canada
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18
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Utianski RL, Duffy JR, Clark HM, Machulda MM, Dickson DW, Whitwell JL, Josephs KA. Prominent auditory deficits in primary progressive aphasia: A case study. Cortex 2019; 117:396-406. [PMID: 30878181 DOI: 10.1016/j.cortex.2019.01.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/24/2018] [Accepted: 01/27/2019] [Indexed: 12/14/2022]
Abstract
Aphasia typically is associated with comparable difficulties in written and spoken modalities of language expression and comprehension. In contrast, auditory verbal agnosia is the disproportionate difficulty comprehending spoken compared to written language, also typically greater than difficulties with spoken and written language expression, in the absence of a primary sensory deficit. The terms pure word deafness and auditory verbal agnosia are often used synonymously. However, the broader term of auditory agnosia more accurately reflects difficulty processing both speech and non-speech sounds whereas individuals with auditory verbal agnosia (pure word deafness) have preserved processing of environmental sounds. Auditory agnosia is reported in the stroke literature, but rarely reported in progressive neurologic disorders. Here, we report a case of a woman who presented with what is best described as a prominent auditory deficit in the context of an initially unclassifiable, or mixed, primary progressive aphasia (PPA) with accompanying apraxia of speech. Her clinical presentation shared features with auditory agnosia, although sensory functioning was not formally assessed. We report clinical and neuroimaging data spanning 6 years and subsequent autopsy results. She presented at 65 years of age, 5 years post onset of symptoms that included insidious and progressive difficulties thinking of words, constructing sentences, pronouncing words, and understanding instructions. She had disproportionate difficulty with comprehension of spoken compared to written language. She eventually developed features of the nonfluent/agrammatic variant of PPA, as well as an apraxia of speech. Imaging with [18F]-fluorodeoxyglucose (FDG)-PET revealed progression of bilateral (left greater than right) hypometabolism involving the frontal, temporal (predominantly the lateral superior gyrus), and parietal lobes, that eventually included the supplementary motor area, anterior cingulate, and caudate. Autopsy revealed pathological lesions consistent with corticobasal degeneration.
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Affiliation(s)
| | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.
| | | | - Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
| | - Dennis W Dickson
- Department of Pathology and Neurology, Mayo Clinic, Jacksonville, FL, USA.
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19
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Schaeverbeke J, Gabel S, Meersmans K, Bruffaerts R, Liuzzi AG, Evenepoel C, Dries E, Van Bouwel K, Sieben A, Pijnenburg Y, Peeters R, Bormans G, Van Laere K, Koole M, Dupont P, Vandenberghe R. Single-word comprehension deficits in the nonfluent variant of primary progressive aphasia. Alzheimers Res Ther 2018; 10:68. [PMID: 30021613 PMCID: PMC6052568 DOI: 10.1186/s13195-018-0393-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 05/30/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND A subset of patients with the nonfluent variant of primary progressive aphasia (PPA) exhibit concomitant single-word comprehension problems, constituting a 'mixed variant' phenotype. This phenotype is rare and currently not fully characterized. The aim of this study was twofold: to assess the prevalence and nature of single-word comprehension problems in the nonfluent variant and to study multimodal imaging characteristics of atrophy, tau, and amyloid burden associated with this mixed phenotype. METHODS A consecutive memory-clinic recruited series of 20 PPA patients (12 nonfluent, five semantic, and three logopenic variants) were studied on neurolinguistic and neuropsychological domains relative to 64 cognitively intact healthy older control subjects. The neuroimaging battery included high-resolution volumetric magnetic resonance imaging processed with voxel-based morphometry, and positron emission tomography with the tau-tracer [18F]-THK5351 and amyloid-tracer [11C]-Pittsburgh Compound B. RESULTS Seven out of 12 subjects who had been classified a priori with nonfluent variant PPA showed deficits on conventional single-word comprehension tasks along with speech apraxia and agrammatism, corresponding to a mixed variant phenotype. These mixed variant cases included three females and four males, with a mean age at onset of 65 years (range 44-77 years). Object knowledge and object recognition were additionally affected, although less severely compared with the semantic variant. The mixed variant was characterized by a distributed atrophy pattern in frontal and temporoparietal regions. A more focal pattern of elevated [18F]-THK5351 binding was present in the supplementary motor area, the left premotor cortex, midbrain, and basal ganglia. This pattern was closely similar to that seen in pure nonfluent variant PPA. At the individual patient level, elevated [18F]-THK5351 binding in the supplementary motor area and premotor cortex was present in six out of seven mixed variant cases and in five and four of these cases, respectively, in the thalamus and midbrain. Amyloid biomarker positivity was present in two out of seven mixed variant cases, compared with none of the five pure nonfluent cases. CONCLUSIONS A substantial proportion of PPA patients with speech apraxia and agrammatism also have single-word comprehension deficits. At the neurobiological level, the mixed variant shows a high degree of similarity with the pure nonfluent variant of PPA. TRIAL REGISTRATION EudraCT, 2014-002976-10 . Registered on 13-01-2015.
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Affiliation(s)
- Jolien Schaeverbeke
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Alzheimer Research Centre KU Leuven, Leuven Research Institute for Neuroscience & Disease, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Silvy Gabel
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Alzheimer Research Centre KU Leuven, Leuven Research Institute for Neuroscience & Disease, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Karen Meersmans
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Rose Bruffaerts
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Alzheimer Research Centre KU Leuven, Leuven Research Institute for Neuroscience & Disease, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Neurology Department, University Hospitals Leuven, Herestraat 49 - box 7003, 3000 Leuven, Belgium
| | - Antonietta Gabriella Liuzzi
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Charlotte Evenepoel
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Alzheimer Research Centre KU Leuven, Leuven Research Institute for Neuroscience & Disease, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Eva Dries
- Neurology Department, University Hospitals Leuven, Herestraat 49 - box 7003, 3000 Leuven, Belgium
| | - Karen Van Bouwel
- Neurology Department, University Hospitals Leuven, Herestraat 49 - box 7003, 3000 Leuven, Belgium
| | - Anne Sieben
- Neurodegenerative Brain Diseases Group, Center for Molecular Neurology, VIB, Universiteitsplein 1, 2610 Antwerp, Belgium
- Institute Born-Bunge, Neuropathology and Laboratory of Neurochemistry and Behavior, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium
- Neurology Department, University Hospitals Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Yolande Pijnenburg
- Old Age Psychiatry Department, GGZinGeest, Van Hilligaertstraat 21, 1072 JX Amsterdam, The Netherlands
- Alzheimer Center & Department of Neurology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Ronald Peeters
- Radiology Department, University Hospitals Leuven, Herestraat 49, Leuven, 30000 Belgium
| | - Guy Bormans
- Laboratory of Radiopharmaceutical Research, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Koen Van Laere
- Alzheimer Research Centre KU Leuven, Leuven Research Institute for Neuroscience & Disease, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Michel Koole
- Nuclear Medicine and Molecular Imaging, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Patrick Dupont
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Alzheimer Research Centre KU Leuven, Leuven Research Institute for Neuroscience & Disease, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Rik Vandenberghe
- Laboratory for Cognitive Neurology, Department of Neurosciences, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Alzheimer Research Centre KU Leuven, Leuven Research Institute for Neuroscience & Disease, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
- Neurology Department, University Hospitals Leuven, Herestraat 49 - box 7003, 3000 Leuven, Belgium
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20
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Whitwell JL, Weigand SD, Duffy JR, Clark HM, Strand EA, Machulda MM, Spychalla AJ, Senjem ML, Jack CR, Josephs KA. Predicting clinical decline in progressive agrammatic aphasia and apraxia of speech. Neurology 2017; 89:2271-2279. [PMID: 29093069 DOI: 10.1212/wnl.0000000000004685] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 09/08/2017] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To determine whether baseline clinical and MRI features predict rate of clinical decline in patients with progressive apraxia of speech (AOS). METHODS Thirty-four patients with progressive AOS, with AOS either in isolation or in the presence of agrammatic aphasia, were followed up longitudinally for up to 4 visits, with clinical testing and MRI at each visit. Linear mixed-effects regression models including all visits (n = 94) were used to assess baseline clinical and MRI variables that predict rate of worsening of aphasia, motor speech, parkinsonism, and behavior. Clinical predictors included baseline severity and AOS type. MRI predictors included baseline frontal, premotor, motor, and striatal gray matter volumes. RESULTS More severe parkinsonism at baseline was associated with faster rate of decline in parkinsonism. Patients with predominant sound distortions (AOS type 1) showed faster rates of decline in aphasia and motor speech, while patients with segmented speech (AOS type 2) showed faster rates of decline in parkinsonism. On MRI, we observed trends for fastest rates of decline in aphasia in patients with relatively small left, but preserved right, Broca area and precentral cortex. Bilateral reductions in lateral premotor cortex were associated with faster rates of decline of behavior. No associations were observed between volumes and decline in motor speech or parkinsonism. CONCLUSIONS Rate of decline of each of the 4 clinical features assessed was associated with different baseline clinical and regional MRI predictors. Our findings could help improve prognostic estimates for these patients.
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Affiliation(s)
- Jennifer L Whitwell
- From the Department of Radiology (J.L.W., A.J.S., M.L.S., C.R.J.), Department of Health Sciences Research (Biostatistics) (S.D.W.), Department of Neurology (Speech Pathology) (J.R.D., H.M.C., E.A.S.), Department of Psychiatry & Psychology (Neuropsychology) (M.M.M.), Department of Information Technology (M.L.S.), and Department of Neurology (Behavioral Neurology and Movement Disorders) (K.A.J.), Mayo Clinic, Rochester, MN.
| | - Stephen D Weigand
- From the Department of Radiology (J.L.W., A.J.S., M.L.S., C.R.J.), Department of Health Sciences Research (Biostatistics) (S.D.W.), Department of Neurology (Speech Pathology) (J.R.D., H.M.C., E.A.S.), Department of Psychiatry & Psychology (Neuropsychology) (M.M.M.), Department of Information Technology (M.L.S.), and Department of Neurology (Behavioral Neurology and Movement Disorders) (K.A.J.), Mayo Clinic, Rochester, MN
| | - Joseph R Duffy
- From the Department of Radiology (J.L.W., A.J.S., M.L.S., C.R.J.), Department of Health Sciences Research (Biostatistics) (S.D.W.), Department of Neurology (Speech Pathology) (J.R.D., H.M.C., E.A.S.), Department of Psychiatry & Psychology (Neuropsychology) (M.M.M.), Department of Information Technology (M.L.S.), and Department of Neurology (Behavioral Neurology and Movement Disorders) (K.A.J.), Mayo Clinic, Rochester, MN
| | - Heather M Clark
- From the Department of Radiology (J.L.W., A.J.S., M.L.S., C.R.J.), Department of Health Sciences Research (Biostatistics) (S.D.W.), Department of Neurology (Speech Pathology) (J.R.D., H.M.C., E.A.S.), Department of Psychiatry & Psychology (Neuropsychology) (M.M.M.), Department of Information Technology (M.L.S.), and Department of Neurology (Behavioral Neurology and Movement Disorders) (K.A.J.), Mayo Clinic, Rochester, MN
| | - Edythe A Strand
- From the Department of Radiology (J.L.W., A.J.S., M.L.S., C.R.J.), Department of Health Sciences Research (Biostatistics) (S.D.W.), Department of Neurology (Speech Pathology) (J.R.D., H.M.C., E.A.S.), Department of Psychiatry & Psychology (Neuropsychology) (M.M.M.), Department of Information Technology (M.L.S.), and Department of Neurology (Behavioral Neurology and Movement Disorders) (K.A.J.), Mayo Clinic, Rochester, MN
| | - Mary M Machulda
- From the Department of Radiology (J.L.W., A.J.S., M.L.S., C.R.J.), Department of Health Sciences Research (Biostatistics) (S.D.W.), Department of Neurology (Speech Pathology) (J.R.D., H.M.C., E.A.S.), Department of Psychiatry & Psychology (Neuropsychology) (M.M.M.), Department of Information Technology (M.L.S.), and Department of Neurology (Behavioral Neurology and Movement Disorders) (K.A.J.), Mayo Clinic, Rochester, MN
| | - Anthony J Spychalla
- From the Department of Radiology (J.L.W., A.J.S., M.L.S., C.R.J.), Department of Health Sciences Research (Biostatistics) (S.D.W.), Department of Neurology (Speech Pathology) (J.R.D., H.M.C., E.A.S.), Department of Psychiatry & Psychology (Neuropsychology) (M.M.M.), Department of Information Technology (M.L.S.), and Department of Neurology (Behavioral Neurology and Movement Disorders) (K.A.J.), Mayo Clinic, Rochester, MN
| | - Matthew L Senjem
- From the Department of Radiology (J.L.W., A.J.S., M.L.S., C.R.J.), Department of Health Sciences Research (Biostatistics) (S.D.W.), Department of Neurology (Speech Pathology) (J.R.D., H.M.C., E.A.S.), Department of Psychiatry & Psychology (Neuropsychology) (M.M.M.), Department of Information Technology (M.L.S.), and Department of Neurology (Behavioral Neurology and Movement Disorders) (K.A.J.), Mayo Clinic, Rochester, MN
| | - Clifford R Jack
- From the Department of Radiology (J.L.W., A.J.S., M.L.S., C.R.J.), Department of Health Sciences Research (Biostatistics) (S.D.W.), Department of Neurology (Speech Pathology) (J.R.D., H.M.C., E.A.S.), Department of Psychiatry & Psychology (Neuropsychology) (M.M.M.), Department of Information Technology (M.L.S.), and Department of Neurology (Behavioral Neurology and Movement Disorders) (K.A.J.), Mayo Clinic, Rochester, MN
| | - Keith A Josephs
- From the Department of Radiology (J.L.W., A.J.S., M.L.S., C.R.J.), Department of Health Sciences Research (Biostatistics) (S.D.W.), Department of Neurology (Speech Pathology) (J.R.D., H.M.C., E.A.S.), Department of Psychiatry & Psychology (Neuropsychology) (M.M.M.), Department of Information Technology (M.L.S.), and Department of Neurology (Behavioral Neurology and Movement Disorders) (K.A.J.), Mayo Clinic, Rochester, MN
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Domain-General Brain Regions Do Not Track Linguistic Input as Closely as Language-Selective Regions. J Neurosci 2017; 37:9999-10011. [PMID: 28871034 DOI: 10.1523/jneurosci.3642-16.2017] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 08/16/2017] [Accepted: 08/18/2017] [Indexed: 01/05/2023] Open
Abstract
Language comprehension engages a cortical network of left frontal and temporal regions. Activity in this network is language-selective, showing virtually no modulation by nonlinguistic tasks. In addition, language comprehension engages a second network consisting of bilateral frontal, parietal, cingulate, and insular regions. Activity in this "multiple demand" (MD) network scales with comprehension difficulty, but also with cognitive effort across a wide range of nonlinguistic tasks in a domain-general fashion. Given the functional dissociation between the language and MD networks, their respective contributions to comprehension are likely distinct, yet such differences remain elusive. Prior neuroimaging studies have suggested that activity in each network covaries with some linguistic features that, behaviorally, influence on-line processing and comprehension. This sensitivity of the language and MD networks to local input characteristics has often been interpreted, implicitly or explicitly, as evidence that both networks track linguistic input closely, and in a manner consistent across individuals. Here, we used fMRI to directly test this assumption by comparing the BOLD signal time courses in each network across different people (n = 45, men and women) listening to the same story. Language network activity showed fewer individual differences, indicative of closer input tracking, whereas MD network activity was more idiosyncratic and, moreover, showed lower reliability within an individual across repetitions of a story. These findings constrain cognitive models of language comprehension by suggesting a novel distinction between the processes implemented in the language and MD networks.SIGNIFICANCE STATEMENT Language comprehension recruits both language-specific mechanisms and domain-general mechanisms that are engaged in many cognitive processes. In the human cortex, language-selective mechanisms are implemented in the left-lateralized "core language network", whereas domain-general mechanisms are implemented in the bilateral "multiple demand" (MD) network. Here, we report the first direct comparison of the respective contributions of these networks to naturalistic story comprehension. Using a novel combination of neuroimaging approaches we find that MD regions track stories less closely than language regions. This finding constrains the possible contributions of the MD network to comprehension, contrasts with accounts positing that this network has continuous access to linguistic input, and suggests a new typology of comprehension processes based on their extent of input tracking.
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22
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Meyer AM, Faria AV, Tippett DC, Hillis AE, Friedman RB. The Relationship Between Baseline Volume in Temporal Areas and Post-Treatment Naming Accuracy in Primary Progressive Aphasia. APHASIOLOGY 2017; 31:1059-1077. [PMID: 29628604 PMCID: PMC5889050 DOI: 10.1080/02687038.2017.1296557] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Structural imaging has not been used previously to predict the effect of treatment in primary progressive aphasia (PPA). AIMS This study examined relationships between baseline brain volume and the effects of phonological and orthographic treatments for anomia in PPA. It was predicted that lower baseline volume would be associated with lower post-treatment naming accuracy for treated items and smaller generalization effects. METHODS & PROCEDURES Twenty-one individuals with PPA participated. The treatment stimuli consisted of nouns that were consistently named correctly at baseline (Prophylaxis items) and/or nouns that were consistently named incorrectly at baseline (Remediation items). All 21 participants had Prophylaxis items, while 10 participants had Remediation items. Naming accuracy for untrained and trained items (Exemplar set 1) was measured. In addition, stimulus generalization was examined by having participants name an alternative exemplar of each untrained and trained item (Exemplar set 2). Correlational analyses focused on the relationships between naming accuracy and volume of regions previously identified as having a role in naming and semantic processing. OUTCOMES & RESULTS Unexpectedly, there were no significant correlations between baseline volume and post-treatment accuracy for treated items. However, baseline volume within the left temporal pole was positively correlated with post-treatment accuracy for Untrained Exemplar set 2 Prophylaxis items, while baseline volume in the left inferior temporal gyrus was positively correlated with post-treatment accuracy for Untrained Exemplar set 1 Remediation items. CONCLUSIONS These findings suggest that lower volume in the left temporal pole is associated with decline for Untrained items, while lower volume in the left inferior temporal gyrus is associated with a lack of improvement for Untrained items. Possible explanations for the different patterns observed across Exemplar sets are discussed.
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Affiliation(s)
- Aaron M. Meyer
- Center for Aphasia Research and Rehabilitation, Georgetown University Medical Center, Washington, DC
| | - Andreia V. Faria
- Department of Neurology, Johns Hopkins University, Baltimore, MD
| | - Donna C. Tippett
- Department of Neurology, Johns Hopkins University, Baltimore, MD
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins University, Baltimore, MD
| | - Rhonda B. Friedman
- Center for Aphasia Research and Rehabilitation, Georgetown University Medical Center, Washington, DC
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23
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Cousins KAQ, Ash S, Irwin DJ, Grossman M. Dissociable substrates underlie the production of abstract and concrete nouns. BRAIN AND LANGUAGE 2017; 165:45-54. [PMID: 27912073 PMCID: PMC5237409 DOI: 10.1016/j.bandl.2016.11.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/14/2016] [Accepted: 11/14/2016] [Indexed: 05/20/2023]
Affiliation(s)
- Katheryn A Q Cousins
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, United States.
| | - Sharon Ash
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, United States
| | - David J Irwin
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, United States
| | - Murray Grossman
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, United States.
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24
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Whitwell JL, Duffy JR, Machulda MM, Clark HM, Strand EA, Senjem ML, Gunter JL, Spychalla AJ, Petersen RC, Jack CR, Josephs KA. Tracking the development of agrammatic aphasia: A tensor-based morphometry study. Cortex 2016; 90:138-148. [PMID: 27771043 DOI: 10.1016/j.cortex.2016.09.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 07/06/2016] [Accepted: 09/18/2016] [Indexed: 12/12/2022]
Abstract
Agrammatic aphasia can be observed in neurodegenerative disorders and has been traditionally linked with damage to Broca's area, although there have been disagreements concerning whether damage to Broca's area is necessary or sufficient for the development of agrammatism. We aimed to investigate the neuroanatomical correlates of the emergence of agrammatic aphasia utilizing a unique cohort of patients with primary progressive apraxia of speech (PPAOS) that did not have agrammatism at baseline but developed agrammatic aphasia over time. Twenty PPAOS patients were recruited and underwent detailed speech/language assessments and 3T MRI at two visits, approximately two years apart. None of the patients showed evidence of agrammatism in writing or speech at baseline. Eight patients developed aphasia at follow-up (progressors) and 12 did not (non-progressors). Tensor-based morphometry utilizing symmetric normalization (SyN) was used to assess patterns of grey matter atrophy and voxel-based morphometry was used to assess patterns of grey matter loss at baseline. The progressors were younger at onset and more likely to show distorted sound substitutions or additions compared to non-progressors. Both groups showed change over time in premotor and motor cortices, posterior frontal lobe, basal ganglia, thalamus and midbrain, but the progressors showed greater rates of atrophy in left pars triangularis, thalamus and putamen compared to non-progressors. The progressors also showed greater grey matter loss in pars triangularis and putamen at baseline. This cohort provided a unique opportunity to assess the anatomical changes that accompany the development of agrammatic aphasia. The results suggest that damage to a network of regions including Broca's area, thalamus and basal ganglia are responsible for the development of agrammatic aphasia in PPAOS. Clinical and neuroimaging abnormalities were also present before the onset of agrammatism that could help improve prognosis in these subjects.
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Affiliation(s)
| | - Joseph R Duffy
- Department of Neurology (Speech Pathology), Mayo Clinic, Rochester, MN, USA
| | - Mary M Machulda
- Department of Psychiatry & Psychology (Neuropsychology), Mayo Clinic, Rochester, MN, USA
| | - Heather M Clark
- Department of Neurology (Speech Pathology), Mayo Clinic, Rochester, MN, USA
| | - Edythe A Strand
- Department of Neurology (Speech Pathology), Mayo Clinic, Rochester, MN, USA
| | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Jeffrey L Gunter
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | | | - Ronald C Petersen
- Department of Neurology (Behavioral Neurology), Mayo Clinic, Rochester, MN, USA
| | | | - Keith A Josephs
- Department of Neurology (Behavioral Neurology), Mayo Clinic, Rochester, MN, USA; Department of Neurology (Movement Disorders), Mayo Clinic, Rochester, MN, USA
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25
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Ash S, Ternes K, Bisbing T, Min NE, Moran E, York C, McMillan CT, Irwin DJ, Grossman M. Dissociation of quantifiers and object nouns in speech in focal neurodegenerative disease. Neuropsychologia 2016; 89:141-152. [PMID: 27301638 DOI: 10.1016/j.neuropsychologia.2016.06.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 06/10/2016] [Accepted: 06/10/2016] [Indexed: 10/21/2022]
Abstract
Quantifiers such as many and some are thought to depend in part on the conceptual representation of number knowledge, while object nouns such as cookie and boy appear to depend in part on visual feature knowledge associated with object concepts. Further, number knowledge is associated with a frontal-parietal network while object knowledge is related in part to anterior and ventral portions of the temporal lobe. We examined the cognitive and anatomic basis for the spontaneous speech production of quantifiers and object nouns in non-aphasic patients with focal neurodegenerative disease associated with corticobasal syndrome (CBS, n=33), behavioral variant frontotemporal degeneration (bvFTD, n=54), and semantic variant primary progressive aphasia (svPPA, n=19). We recorded a semi-structured speech sample elicited from patients and healthy seniors (n=27) during description of the Cookie Theft scene. We observed a dissociation: CBS and bvFTD were significantly impaired in the production of quantifiers but not object nouns, while svPPA were significantly impaired in the production of object nouns but not quantifiers. MRI analysis revealed that quantifier production deficits in CBS and bvFTD were associated with disease in a frontal-parietal network important for number knowledge, while impaired production of object nouns in all patient groups was related to disease in inferior temporal regions important for representations of visual feature knowledge of objects. These findings imply that partially dissociable representations in semantic memory may underlie different segments of the lexicon.
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Affiliation(s)
- Sharon Ash
- Department of Neurology and the Penn Frontotemporal Degeneration Center, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States.
| | - Kylie Ternes
- Department of Neurology and the Penn Frontotemporal Degeneration Center, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States.
| | - Teagan Bisbing
- Department of Neurology and the Penn Frontotemporal Degeneration Center, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States.
| | - Nam Eun Min
- Department of Neurology and the Penn Frontotemporal Degeneration Center, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States.
| | - Eileen Moran
- Department of Neurology and the Penn Frontotemporal Degeneration Center, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States.
| | - Collin York
- Department of Neurology and the Penn Frontotemporal Degeneration Center, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States.
| | - Corey T McMillan
- Department of Neurology and the Penn Frontotemporal Degeneration Center, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States.
| | - David J Irwin
- Department of Neurology and the Penn Frontotemporal Degeneration Center, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States; Center for Neurodegenerative Disease Research, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States.
| | - Murray Grossman
- Department of Neurology and the Penn Frontotemporal Degeneration Center, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, United States.
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Cousins KAQ, York C, Bauer L, Grossman M. Cognitive and anatomic double dissociation in the representation of concrete and abstract words in semantic variant and behavioral variant frontotemporal degeneration. Neuropsychologia 2016; 84:244-51. [PMID: 26944874 DOI: 10.1016/j.neuropsychologia.2016.02.025] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 02/26/2016] [Accepted: 02/28/2016] [Indexed: 10/22/2022]
Abstract
We examine the anatomic basis for abstract and concrete lexical representations in semantic memory by assessing patients with focal neurodegenerative disease. Prior evidence from healthy adult studies suggests that there may be an anatomical dissociation between abstract and concrete representations: abstract words more strongly activate the left inferior frontal gyrus relative to concrete words, while concrete words more strongly activate left anterior-inferior temporal regions. However, this double dissociation has not been directly examined. We test this dissociation in two patient groups with focal cortical atrophy in each of these regions, the behavioral variant of Frontotemporal Degeneration (bvFTD) and the semantic variant of Primary Progressive Aphasia (svPPA). We administered an associativity judgment task for abstract and concrete words, where subjects select which of two words is best associated with a given target word. Both bvFTD and svPPA patients were significantly impaired in their overall performance compared to controls. While controls treated concrete and abstract words equally, we found a category-specific double dissociation in patients' judgments: bvFTD patients showed a concreteness effect (CE), with significantly worse performance for abstract compared to concrete words, while svPPA patients showed reversal of the CE, with significantly worse performance for concrete over abstract words. Regression analyses also revealed an anatomic double dissociation: The CE is associated with inferior frontal atrophy in bvFTD, while reversal of the CE is associated with left anterior-inferior temporal atrophy in svPPA. These results support a cognitive and anatomic model of semantic memory organization where abstract and concrete representations are supported by dissociable neuroanatomic substrates.
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Affiliation(s)
- Katheryn A Q Cousins
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, United States.
| | - Collin York
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, United States
| | - Laura Bauer
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, United States
| | - Murray Grossman
- Department of Neurology and Penn Frontotemporal Degeneration Center, University of Pennsylvania, United States.
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27
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Migliaccio R, Boutet C, Valabregue R, Ferrieux S, Nogues M, Lehéricy S, Dormont D, Levy R, Dubois B, Teichmann M. The Brain Network of Naming: A Lesson from Primary Progressive Aphasia. PLoS One 2016; 11:e0148707. [PMID: 26901052 PMCID: PMC4764674 DOI: 10.1371/journal.pone.0148707] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/20/2016] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Word finding depends on the processing of semantic and lexical information, and it involves an intermediate level for mapping semantic-to-lexical information which also subserves lexical-to-semantic mapping during word comprehension. However, the brain regions implementing these components are still controversial and have not been clarified via a comprehensive lesion model encompassing the whole range of language-related cortices. Primary progressive aphasia (PPA), for which anomia is thought to be the most common sign, provides such a model, but the exploration of cortical areas impacting naming in its three main variants and the underlying processing mechanisms is still lacking. METHODS We addressed this double issue, related to language structure and PPA, with thirty patients (11 semantic, 12 logopenic, 7 agrammatic variant) using a picture-naming task and voxel-based morphometry for anatomo-functional correlation. First, we analyzed correlations for each of the three variants to identify the regions impacting naming in PPA and to disentangle the core regions of word finding. We then combined the three variants and correlation analyses for naming (semantic-to-lexical mapping) and single-word comprehension (lexical-to-semantic mapping), predicting an overlap zone corresponding to a bidirectional lexical-semantic hub. RESULTS AND CONCLUSIONS Our results showed that superior portions of the left temporal pole and left posterior temporal cortices impact semantic and lexical naming mechanisms in semantic and logopenic PPA, respectively. In agrammatic PPA naming deficits were rare, and did not correlate with any cortical region. Combined analyses revealed a cortical overlap zone in superior/middle mid-temporal cortices, distinct from the two former regions, impacting bidirectional binding of lexical and semantic information. Altogether, our findings indicate that lexical/semantic word processing depends on an anterior-posterior axis within lateral-temporal cortices, including an anatomically intermediate hub dedicated to lexical-semantic integration. Within this axis our data reveal the underpinnings of anomia in the PPA variants, which is of relevance for both diagnosis and future therapy strategies.
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Affiliation(s)
- Raffaella Migliaccio
- Institut du Cerveau et de la Moelle Epinière, UMR INSERM-CNRS-UPMC 1127, Frontlab, Paris, France
- Department of Neurology, National Reference Center for « PPA and rare dementias », Pitié Salpêtrière Hospital, AP-HP, Paris, France
| | - Claire Boutet
- Institut du Cerveau et de la Moelle Epinière, UMR INSERM-CNRS-UPMC 1127, Frontlab, Paris, France
- Centre de Neuro-imagerie de Recherche (CENIR), Institut du Cerveau et de la Moëlle Epinière, Paris, France
| | - Romain Valabregue
- Institut du Cerveau et de la Moelle Epinière, UMR INSERM-CNRS-UPMC 1127, Frontlab, Paris, France
- Centre de Neuro-imagerie de Recherche (CENIR), Institut du Cerveau et de la Moëlle Epinière, Paris, France
| | - Sophie Ferrieux
- Department of Neurology, National Reference Center for « PPA and rare dementias », Pitié Salpêtrière Hospital, AP-HP, Paris, France
| | - Marie Nogues
- Department of Neurology, National Reference Center for « PPA and rare dementias », Pitié Salpêtrière Hospital, AP-HP, Paris, France
| | - Stéphane Lehéricy
- Institut du Cerveau et de la Moelle Epinière, UMR INSERM-CNRS-UPMC 1127, Frontlab, Paris, France
- Centre de Neuro-imagerie de Recherche (CENIR), Institut du Cerveau et de la Moëlle Epinière, Paris, France
| | - Didier Dormont
- Université Pierre et Marie Curie, INSERM, UMR-S 678, Paris, France
- Service de Neuroradiologie Diagnostique et Fonctionnelle, Hôpital de la Pitié-Salpêtrière, AP-HP, Paris, France
| | - Richard Levy
- Institut du Cerveau et de la Moelle Epinière, UMR INSERM-CNRS-UPMC 1127, Frontlab, Paris, France
- Department of Neurology, Hôpital Saint Antoine, AP-HP, Paris, France
| | - Bruno Dubois
- Institut du Cerveau et de la Moelle Epinière, UMR INSERM-CNRS-UPMC 1127, Frontlab, Paris, France
- Department of Neurology, National Reference Center for « PPA and rare dementias », Pitié Salpêtrière Hospital, AP-HP, Paris, France
| | - Marc Teichmann
- Institut du Cerveau et de la Moelle Epinière, UMR INSERM-CNRS-UPMC 1127, Frontlab, Paris, France
- Department of Neurology, National Reference Center for « PPA and rare dementias », Pitié Salpêtrière Hospital, AP-HP, Paris, France
- * E-mail:
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28
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Blank I, Balewski Z, Mahowald K, Fedorenko E. Syntactic processing is distributed across the language system. Neuroimage 2016; 127:307-323. [PMID: 26666896 PMCID: PMC4755877 DOI: 10.1016/j.neuroimage.2015.11.069] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 10/23/2015] [Accepted: 11/28/2015] [Indexed: 11/30/2022] Open
Abstract
Language comprehension recruits an extended set of regions in the human brain. Is syntactic processing localized to a particular region or regions within this system, or is it distributed across the entire ensemble of brain regions that support high-level linguistic processing? Evidence from aphasic patients is more consistent with the latter possibility: damage to many different language regions and to white-matter tracts connecting them has been shown to lead to similar syntactic comprehension deficits. However, brain imaging investigations of syntactic processing continue to focus on particular regions within the language system, often parts of Broca's area and regions in the posterior temporal cortex. We hypothesized that, whereas the entire language system is in fact sensitive to syntactic complexity, the effects in some regions may be difficult to detect because of the overall lower response to language stimuli. Using an individual-subjects approach to localizing the language system, shown in prior work to be more sensitive than traditional group analyses, we indeed find responses to syntactic complexity throughout this system, consistent with the findings from the neuropsychological patient literature. We speculate that such distributed nature of syntactic processing could perhaps imply that syntax is inseparable from other aspects of language comprehension (e.g., lexico-semantic processing), in line with current linguistic and psycholinguistic theories and evidence. Neuroimaging investigations of syntactic processing thus need to expand their scope to include the entire system of high-level language processing regions in order to fully understand how syntax is instantiated in the human brain.
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Affiliation(s)
- Idan Blank
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, 77 Massachusetts Ave., Cambridge, MA 02139, USA; McGovern Institute for Brain Research, Massachusetts Institute of Technology, 77 Massachusetts Ave., Cambridge, MA 02139, USA.
| | - Zuzanna Balewski
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, 77 Massachusetts Ave., Cambridge, MA 02139, USA
| | - Kyle Mahowald
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, 77 Massachusetts Ave., Cambridge, MA 02139, USA
| | - Evelina Fedorenko
- Department of Psychiatry, Massachusetts General Hospital, East 13th Street, Charlestown, MA 02129, USA.
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Yoo Y, Shin SA, Park S, Lee JH, Youn JH, Kim YK, Lee JY. The Korean Size/Weight Attribute Test: A Semantic Knowledge Test for Korean Older Adults and Brain-Imaging Evidence. J Alzheimers Dis 2015; 49:377-86. [DOI: 10.3233/jad-150492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Yongjoon Yoo
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seong A. Shin
- Department of Biomedical Sciences, Seoul National University, Seoul, Republic of Korea
| | - Soowon Park
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine and SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
- Department of Education, Seoul National University, Seoul, Republic of Korea
| | - Ji-Hye Lee
- Yongmoon Graduate School of Counseling Psychology, Seoul, Republic of Korea
| | - Jung-Hae Youn
- Yongmoon Graduate School of Counseling Psychology, Seoul, Republic of Korea
| | - Yu Kyeong Kim
- Department of Nuclear Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Jun-Young Lee
- Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine and SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
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Roehrich-Gascon D, Small SL, Tremblay P. Structural correlates of spoken language abilities: A surface-based region-of interest morphometry study. BRAIN AND LANGUAGE 2015; 149:46-54. [PMID: 26185048 PMCID: PMC4587378 DOI: 10.1016/j.bandl.2015.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 06/04/2015] [Accepted: 06/06/2015] [Indexed: 06/04/2023]
Abstract
Brain structure can predict many aspects of human behavior, though the extent of this relationship in healthy adults, particularly for language-related skills, remains largely unknown. The objective of the present study was to explore this relation using magnetic resonance imaging (MRI) on a group of 21 healthy young adults who completed two language tasks: (1) semantic fluency and (2) sentence generation. For each region of interest, cortical thickness, surface area, and volume were calculated. The results show that verbal fluency scores correlated mainly with measures of brain morphology in the left inferior frontal cortex and bilateral insula. Sentence generation scores correlated with structure of the left inferior parietal and right inferior frontal regions. These results reveal that the anatomy of several structures in frontal and parietal lobes is associated with spoken language performance. The presence of both negative and positive correlations highlights the complex relation between brain and language.
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Affiliation(s)
- Didier Roehrich-Gascon
- Centre de Recherche de l'Institut Universitaire en santé mentale de Québec (CRIUSMQ), Québec City, QC, Canada; Université Laval, Faculté de médecine, Québec City, QC, Canada
| | | | - Pascale Tremblay
- Centre de Recherche de l'Institut Universitaire en santé mentale de Québec (CRIUSMQ), Québec City, QC, Canada; Université Laval, Faculté de médecine, Québec City, QC, Canada.
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31
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Wilson SM, Lam D, Babiak MC, Perry DW, Shih T, Hess CP, Berger MS, Chang EF. Transient aphasias after left hemisphere resective surgery. J Neurosurg 2015; 123:581-93. [PMID: 26115463 DOI: 10.3171/2015.4.jns141962] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Transient aphasias are often observed in the first few days after a patient has undergone resection in the language-dominant hemisphere. The aims of this prospective study were to characterize the incidence and nature of these aphasias and to determine whether there are relationships between location of the surgical site and deficits in specific language domains. METHODS One hundred ten patients undergoing resection to the language-dominant hemisphere participated in the study. Language was evaluated prior to surgery and 2-3 days and 1 month postsurgery using the Western Aphasia Battery and the Boston Naming Test. Voxel-based lesion-symptom mapping was used to identify relationships between the surgical site location assessed on MRI and deficits in fluency, information content, comprehension, repetition, and naming. RESULTS Seventy-one percent of patients were classified as aphasic based on the Western Aphasia Battery 2-3 days postsurgery, with deficits observed in each of the language domains examined. Fluency deficits were associated with resection of the precentral gyrus and adjacent inferior frontal cortex. Reduced information content of spoken output was associated with resection of the ventral precentral gyrus and posterior inferior frontal gyrus (pars opercularis). Repetition deficits were associated with resection of the posterior superior temporal gyrus. Naming deficits were associated with resection of the ventral temporal cortex, with midtemporal and posterior temporal damage more predictive of naming deficits than anterior temporal damage. By 1 month postsurgery, nearly all language deficits were resolved, and no language measure except for naming differed significantly from its presurgical level. CONCLUSIONS These findings show that transient aphasias are very common after left hemisphere resective surgery and that the precise nature of the aphasia depends on the specific location of the surgical site. The patient cohort in this study provides a unique window into the neural basis of language because resections are discrete, their locations are not limited by vascular distribution or patterns of neurodegeneration, and language can be studied prior to substantial reorganization.
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Affiliation(s)
- Stephen M Wilson
- Departments of 1 Speech, Language, and Hearing Sciences and.,Neurology, University of Arizona, Tucson, Arizona; and
| | | | | | | | - Tina Shih
- Neurology, and.,UCSF Epilepsy Center, University of California, San Francisco, California
| | | | | | - Edward F Chang
- Departments of 3 Neurological Surgery.,UCSF Epilepsy Center, University of California, San Francisco, California
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Whitwell JL, Jones DT, Duffy JR, Strand EA, Machulda MM, Przybelski SA, Vemuri P, Gregg BE, Gunter JL, Senjem ML, Petersen RC, Jack CR, Josephs KA. Working memory and language network dysfunctions in logopenic aphasia: a task-free fMRI comparison with Alzheimer's dementia. Neurobiol Aging 2014; 36:1245-52. [PMID: 25592958 DOI: 10.1016/j.neurobiolaging.2014.12.013] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 11/19/2014] [Accepted: 12/10/2014] [Indexed: 12/14/2022]
Abstract
We aimed to determine whether network-level functional connectivity differs in 2 clinical variants of Alzheimer's disease: logopenic primary progressive aphasia (lvPPA) and dementia of the Alzheimer's type (DAT). Twenty-four lvPPA subjects with amyloid deposition on positron emission tomography and task-free functional magnetic resonance imaging were matched to 24 amyloid-positive DAT subjects and 24 amyloid-negative controls. Independent-component analysis and spatial-temporal dual regression were used to assess functional connectivity within the language network, left and right working memory networks, and ventral default mode network. lvPPA showed reduced connectivity in left temporal language network and inferior parietal and prefrontal regions of the left working memory network compared with controls and DAT. Both groups showed reduced connectivity in the parietal regions of the right working memory network compared with controls. Only DAT showed reduced ventral default mode network connectivity compared with controls. Aphasia severity correlated with connectivity in the left working memory network within lvPPA. Patterns of network dysfunction differ across these 2 clinical variants of Alzheimer's disease, with lvPPA particularly associated with disruptions in the language and left working memory networks.
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Affiliation(s)
| | - David T Jones
- Department of Neurology (Behavioral Neurology), Mayo Clinic, Rochester, MN, USA
| | - Joseph R Duffy
- Department of Neurology (Speech Pathology), Mayo Clinic, Rochester, MN, USA
| | - Edythe A Strand
- Department of Neurology (Speech Pathology), Mayo Clinic, Rochester, MN, USA
| | - Mary M Machulda
- Department of Psychiatry and Psychology (Neuropsychology), Mayo Clinic, Rochester, MN, USA
| | - Scott A Przybelski
- Department of Health Sciences Research (Biostatistics), Mayo Clinic, Rochester, MN, USA
| | | | - Brian E Gregg
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Jeffrey L Gunter
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | - Ronald C Petersen
- Department of Neurology (Behavioral Neurology), Mayo Clinic, Rochester, MN, USA
| | | | - Keith A Josephs
- Department of Neurology (Behavioral Neurology), Mayo Clinic, Rochester, MN, USA
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Duffy JR, Strand EA, Josephs KA. Motor Speech Disorders Associated with Primary Progressive Aphasia. APHASIOLOGY 2014; 28:1004-1017. [PMID: 25309017 PMCID: PMC4191906 DOI: 10.1080/02687038.2013.869307] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Primary progressive aphasia (PPA) and conditions that overlap with it can be accompanied by motor speech disorders. Recognition and understanding of motor speech disorders can contribute to a fuller clinical understanding of PPA and its management as well as its localization and underlying pathology. AIMS To review the types of motor speech disorders that may occur with PPA, its primary variants, and its overlap syndromes (progressive supranuclear palsy syndrome, corticobasal syndrome, motor neuron disease), as well as with primary progressive apraxia of speech. MAIN CONTRIBUTION The review should assist clinicians' and researchers' understanding of the relationship between motor speech disorders and PPA and its major variants. It also highlights the importance of recognizing neurodegenerative apraxia of speech as a condition that can occur with little or no evidence of aphasia. CONCLUSION Motor speech disorders can occur with PPA. Their recognition can contribute to clinical diagnosis and management of PPA and to understanding and predicting the localization and pathology associated with PPA variants and conditions that can overlap with them.
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Affiliation(s)
- Joseph R Duffy
- Dept. of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, U.S.A
| | - Edythe A Strand
- Dept. of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, U.S.A
| | - Keith A Josephs
- Dept. of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, U.S.A
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Abstract
Logopenic progressive aphasia is the most recently described clinical variant of primary progressive aphasia (PPA), defined by impairment of lexical retrieval and sentence repetition. Unlike other PPA variants, the logopenic variant of PPA (lv-PPA) is commonly associated with Alzheimer's disease (AD), a fact that is relevant to the selection of patients for clinical trials and disease-modifying therapies. Despite the straightforward definition and coherent pathological association, the existence of lv-PPA has been challenged, as its distinction from AD or other PPA variants can be difficult. Despite these issues, lv-PPA patients display characteristic linguistic deficits, a pattern of brain atrophy, and possibly genetic susceptibility, which warrant considering this variant as a discrete AD endophenotype. More specific clinical and anatomical markers can strengthen the consistency of this syndrome.
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Affiliation(s)
- Cristian E Leyton
- Neuroscience Research Australia, Barker Street, PO Box 1165, Randwick, NSW, 2031, Australia,
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35
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Frings L, Dressel K, Abel S, Mader I, Glauche V, Weiller C, Hüll M. Longitudinal cerebral diffusion changes reflect progressive decline of language and cognition. Psychiatry Res 2013; 214:395-401. [PMID: 24144508 DOI: 10.1016/j.pscychresns.2013.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 08/08/2013] [Accepted: 08/09/2013] [Indexed: 10/26/2022]
Abstract
Language deficits are regularly found in cortical neurodegenerative diseases. The progression of language deficits shows a considerable inter-individual variability even within one diagnostic group. We aimed at detecting patterns of altered diffusion as well as atrophy of cerebral gray and white matter which underlie ongoing language-related deterioration in patients with cortical neurodegenerative diseases. Diffusion tensor imaging and T1-weighted MRI data of 26 patients with clinically diagnosed neurodegenerative disorders were acquired at baseline and 14 months later in this prospective study. Language functions were assessed with a confrontation naming test and the Token Test. Diffusion and voxel-based morphometric measures were calculated and correlates of language performance were evaluated. Across all patients, the naming impairment was related to diffusion (false discovery rate-corrected P<0.05 at baseline) and atrophy abnormalities (family-wise error (FWE)-corrected P<0.05 at follow-up) primarily in the left temporal lobe. Deficits in the Token Test were correlated with predominantly left frontal MRI abnormalities (FWE-corrected P<0.05). The Token Test performance decline over 14 months was accompanied by further increasing abnormalities in the frontal cortex, left caudate, parietal cortex (all FWE-corrected P<0.05), and posterior callosal body (FWE-corrected P=0.055). Both diffusion and structural MRI were apt to elucidate the underpinnings of inter-individual differences in language-related deficits and to detect longitudinal changes that accompanied ongoing cognition and language decline, with mean diffusivity appearing most sensitive. This might indicate the usefulness of diffusion measures as markers for successful intervention in therapy studies.
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Affiliation(s)
- Lars Frings
- Center of Geriatrics and Gerontology Freiburg, University Medical Center, University of Freiburg, Germany; Section of Geriatric Psychiatry and Neuropsychology, University Medical Center, University of Freiburg, Germany; Department of Radiation Oncology, University Medical Center, University of Freiburg, Germany.
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36
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Agosta F, Galantucci S, Canu E, Cappa SF, Magnani G, Franceschi M, Falini A, Comi G, Filippi M. Disruption of structural connectivity along the dorsal and ventral language pathways in patients with nonfluent and semantic variant primary progressive aphasia: a DT MRI study and a literature review. BRAIN AND LANGUAGE 2013; 127:157-66. [PMID: 23890877 DOI: 10.1016/j.bandl.2013.06.003] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 05/10/2013] [Accepted: 06/24/2013] [Indexed: 05/16/2023]
Abstract
Nonfluent (NFV) and semantic (SV) variants of primary progressive aphasia (PPA) are associated with distinct patterns of focal cortical atrophy and underlying pathology. Previous diffusion tensor (DT) MRI studies showed a more ventral white matter (WM) involvement in SV patients and a more widespread frontal involvement in NFV. Aim of this manuscript is twofold. First, we wished to provide a brief state-of-the-art review on WM damage in PPA. Second, we used DT MRI to assess the topography of WM microstructural damage along dorsal and ventral language pathways and corpus callosum in patients with NFV and SV. Our findings show that the two PPA variants share an overlapping pattern of dorsal and ventral pathway abnormalities. In addition to these common abnormalities, variant-specific WM changes were also found, with NFV patients having a more severe damage to the dorsal (fronto-parietal) WM connections within the left superior longitudinal fasciculus/arcuate and SV patients showing a greater left ventral tract involvement (inferior longitudinal and uncinate fasciculi). These findings offer evidence that both dorsal and ventral language networks may contribute to the relatively selective deficits in NFV and SV patients.
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Affiliation(s)
- Federica Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Race DS, Tsapkini K, Crinion J, Newhart M, Davis C, Gomez Y, Hillis AE, Faria AV. An area essential for linking word meanings to word forms: evidence from primary progressive aphasia. BRAIN AND LANGUAGE 2013; 127:167-176. [PMID: 24183469 PMCID: PMC3906671 DOI: 10.1016/j.bandl.2013.09.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 07/18/2013] [Accepted: 09/06/2013] [Indexed: 06/02/2023]
Abstract
We investigated the relationship between deficits in naming and areas of focal atrophy in primary progressive aphasia (a neurodegenerative disease that specifically affects language processing). We tested patients, across multiple input modalities, on traditional naming tasks (picture naming) and more complex tasks (sentence completion with a name, naming in response to a question) and obtained high resolution MRI. Across most tasks, error rates were correlated with atrophy in the left middle and posterior inferior temporal gyrus. Overall, this result converges with prior literature suggesting that this region plays a major role in modality independent lexical processing.
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Affiliation(s)
- D S Race
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA
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38
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Machulda MM, Whitwell JL, Duffy JR, Strand EA, Dean PM, Senjem ML, Jack CR, Josephs KA. Identification of an atypical variant of logopenic progressive aphasia. BRAIN AND LANGUAGE 2013; 127:139-144. [PMID: 23566690 PMCID: PMC3725183 DOI: 10.1016/j.bandl.2013.02.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 01/15/2013] [Accepted: 02/03/2013] [Indexed: 05/29/2023]
Abstract
The purpose of this study was to examine the association between aphasia severity and neurocognitive function, disease duration and temporoparietal atrophy in 21 individuals with the logopenic variant of primary progressive aphasia (lvPPA). We found significant correlations between aphasia severity and degree of neurocognitive impairment as well as temporoparietal atrophy; but not disease duration. Cluster analysis identified three variants of lvPPA: (1) subjects with mild aphasia and short disease duration (mild typical lvPPA); (2) subjects with mild aphasia and long disease duration (mild atypical lvPPA); and, (3) subjects with severe aphasia and relatively long disease duration (severe typical lvPPA). All three variants showed temporoparietal atrophy, with the mild atypical group showing the least atrophy despite the longest disease duration. The mild atypical group also showed mild neuropsychological impairment. The subjects with mild aphasia and neuropsychological impairment despite long disease duration may represent a slowly progressive variant of lvPPA.
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Affiliation(s)
- Mary M Machulda
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States.
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39
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Qin YY, Hsu JT, Yoshida S, Faria AV, Oishi K, Unschuld PG, Redgrave GW, Ying SH, Ross CA, van Zijl PCM, Hillis AE, Albert MS, Lyketsos CG, Miller MI, Mori S, Oishi K. Gross feature recognition of Anatomical Images based on Atlas grid (GAIA): Incorporating the local discrepancy between an atlas and a target image to capture the features of anatomic brain MRI. NEUROIMAGE-CLINICAL 2013; 3:202-11. [PMID: 24179864 PMCID: PMC3791278 DOI: 10.1016/j.nicl.2013.08.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 07/20/2013] [Accepted: 08/07/2013] [Indexed: 11/30/2022]
Abstract
We aimed to develop a new method to convert T1-weighted brain MRIs to feature vectors, which could be used for content-based image retrieval (CBIR). To overcome the wide range of anatomical variability in clinical cases and the inconsistency of imaging protocols, we introduced the Gross feature recognition of Anatomical Images based on Atlas grid (GAIA), in which the local intensity alteration, caused by pathological (e.g., ischemia) or physiological (development and aging) intensity changes, as well as by atlas–image misregistration, is used to capture the anatomical features of target images. As a proof-of-concept, the GAIA was applied for pattern recognition of the neuroanatomical features of multiple stages of Alzheimer's disease, Huntington's disease, spinocerebellar ataxia type 6, and four subtypes of primary progressive aphasia. For each of these diseases, feature vectors based on a training dataset were applied to a test dataset to evaluate the accuracy of pattern recognition. The feature vectors extracted from the training dataset agreed well with the known pathological hallmarks of the selected neurodegenerative diseases. Overall, discriminant scores of the test images accurately categorized these test images to the correct disease categories. Images without typical disease-related anatomical features were misclassified. The proposed method is a promising method for image feature extraction based on disease-related anatomical features, which should enable users to submit a patient image and search past clinical cases with similar anatomical phenotypes. A novel method to convert anatomical brain MRIs to feature vectors is introduced. Degree of local atlas–image disagreement is used to capture the anatomical features. The method was applied for pattern recognition of various neurodegenerative diseases. The feature vectors agreed well with the known pathological hallmarks of diseases. The method accurately categorized test images to the correct disease categories.
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Affiliation(s)
- Yuan-Yuan Qin
- The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, USA ; Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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40
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Whitwell JL, Josephs KA. Recent advances in the imaging of frontotemporal dementia. Curr Neurol Neurosci Rep 2013; 12:715-23. [PMID: 23015371 DOI: 10.1007/s11910-012-0317-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Neuroimaging has played an important role in the characterization of the frontotemporal dementia (FTD) syndromes, demonstrating neurodegenerative signatures that can aid in the differentiation of FTD from other neurodegenerative disorders. Recent advances have been driven largely by the refinement of the clinical syndromes that underlie FTD, and by the discovery of new genetic and pathological features associated with FTD. Many new imaging techniques and modalities are also now available that allow the assessment of other aspects of brain structure and function, such as diffusion tensor imaging and resting-state functional MRI. Studies have used these recent techniques, as well as traditional volumetric MRI, to provide further insight into disease progression across the many clinical, genetic, and pathological variants of FTD. Importantly, neuroimaging signatures have been identified that will improve the clinician's ability to predict underlying genetic and pathological features, and hence ultimately improve patient diagnosis.
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Affiliation(s)
- Jennifer L Whitwell
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.
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41
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Nho K, Risacher SL, Crane PK, DeCarli C, Glymour MM, Habeck C, Kim S, Lee GJ, Mormino E, Mukherjee S, Shen L, West JD, Saykin AJ. Voxel and surface-based topography of memory and executive deficits in mild cognitive impairment and Alzheimer's disease. Brain Imaging Behav 2012; 6:551-67. [PMID: 23070747 PMCID: PMC3532574 DOI: 10.1007/s11682-012-9203-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Mild cognitive impairment (MCI) and Alzheimer's disease (AD) are associated with a progressive loss of cognitive abilities. In the present report, we assessed the relationship of memory and executive function with brain structure in a sample of 810 Alzheimer's Disease Neuroimaging Initiative (ADNI) participants, including 188 AD, 396 MCI, and 226 healthy older adults (HC). Composite scores of memory (ADNI-Mem) and executive function (ADNI-Exec) were generated by applying modern psychometric theory to item-level data from ADNI's neuropsychological battery. We performed voxel-based morphometry (VBM) and surface-based association (SurfStat) analyses to evaluate relationships of ADNI-Mem and ADNI-Exec with grey matter (GM) density and cortical thickness across the whole brain in the combined sample and within diagnostic groups. We observed strong associations between ADNI-Mem and medial and lateral temporal lobe atrophy. Lower ADNI-Exec scores were associated with advanced GM and cortical atrophy across broadly distributed regions, most impressively in the bilateral parietal and temporal lobes. We also evaluated ADNI-Exec adjusted for ADNI-Mem, and found associations with GM density and cortical thickness primarily in the bilateral parietal, temporal, and frontal lobes. Within-group analyses suggest these associations are strongest in patients with MCI and AD. The present study provides insight into the spatially unbiased associations between brain atrophy and memory and executive function, and underscores the importance of structural brain changes in early cognitive decline.
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Affiliation(s)
- Kwangsik Nho
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Shannon L. Risacher
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Paul K. Crane
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Charles DeCarli
- Department of Neurology and the Center for Neuroscience, School of Medicine, University of California Davis, Davis, CA, USA
| | - M. Maria Glymour
- Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA
| | - Christian Habeck
- Cognitive Neuroscience Division of Taub Institute for the Study of Alzheimer’s Disease and Aging Brain, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Sungeun Kim
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Grace J. Lee
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Elizabeth Mormino
- Helen Wills Neuroscience Institute, University of California Berkeley, Berkeley, CA, USA
| | | | - Li Shen
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John D. West
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Andrew J. Saykin
- Center for Neuroimaging, Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
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Shim H, Hurley RS, Rogalski E, Mesulam MM. Anatomic, clinical, and neuropsychological correlates of spelling errors in primary progressive aphasia. Neuropsychologia 2012; 50:1929-35. [PMID: 22579708 DOI: 10.1016/j.neuropsychologia.2012.04.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Revised: 04/17/2012] [Accepted: 04/19/2012] [Indexed: 11/15/2022]
Abstract
This study evaluates spelling errors in the three subtypes of primary progressive aphasia (PPA): agrammatic (PPA-G), logopenic (PPA-L), and semantic (PPA-S). Forty-one PPA patients and 36 age-matched healthy controls were administered a test of spelling. The total number of errors and types of errors in spelling to dictation of regular words, exception words and nonwords, were recorded. Error types were classified based on phonetic plausibility. In the first analysis, scores were evaluated by clinical diagnosis. Errors in spelling exception words and phonetically plausible errors were seen in PPA-S. Conversely, PPA-G was associated with errors in nonword spelling and phonetically implausible errors. In the next analysis, spelling scores were correlated to other neuropsychological language test scores. Significant correlations were found between exception word spelling and measures of naming and single word comprehension. Nonword spelling correlated with tests of grammar and repetition. Global language measures did not correlate significantly with spelling scores, however. Cortical thickness analysis based on MRI showed that atrophy in several language regions of interest were correlated with spelling errors. Atrophy in the left supramarginal gyrus and inferior frontal gyrus (IFG) pars orbitalis correlated with errors in nonword spelling, while thinning in the left temporal pole and fusiform gyrus correlated with errors in exception word spelling. Additionally, phonetically implausible errors in regular word spelling correlated with thinning in the left IFG pars triangularis and pars opercularis. Together, these findings suggest two independent systems for spelling to dictation, one phonetic (phoneme to grapheme conversion), and one lexical (whole word retrieval).
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Affiliation(s)
- Hyungsub Shim
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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Mesulam MM, Wieneke C, Thompson C, Rogalski E, Weintraub S. Quantitative classification of primary progressive aphasia at early and mild impairment stages. Brain 2012; 135:1537-53. [PMID: 22525158 DOI: 10.1093/brain/aws080] [Citation(s) in RCA: 204] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The characteristics of early and mild disease in primary progressive aphasia are poorly understood. This report is based on 25 patients with aphasia quotients >85%, 13 of whom were within 2 years of symptom onset. Word-finding and spelling deficits were the most frequent initial signs. Diagnostic imaging was frequently negative and initial consultations seldom reached a correct diagnosis. Functionality was preserved, so that the patients fit current criteria for single-domain mild cognitive impairment. One goal was to determine whether recently published classification guidelines could be implemented at these early and mild disease stages. The quantitative testing of the recommended core and ancillary criteria led to the classification of ∼80% of the sample into agrammatic, logopenic and semantic variants. Biological validity of the resultant classification at these mild impairment stages was demonstrated by clinically concordant cortical atrophy patterns. A two-dimensional template based on orthogonal mapping of word comprehension and grammaticality provided comparable accuracy and led to a flexible road map that can guide the classification process quantitatively or qualitatively. Longitudinal evaluations of initially unclassifiable patients showed that the semantic variant can be preceded by a prodromal stage of focal left anterior temporal atrophy during which prominent anomia exists without word comprehension or object recognition impairments. Patterns of quantitative tests justified the distinction of grammar from speech abnormalities and the desirability of using the 'agrammatic' designation exclusively for loss of grammaticality, regardless of fluency or speech status. Two patients with simultaneous impairments of grammatical sentence production and word comprehension displayed focal atrophy of the inferior frontal gyrus and the anterior temporal lobe. These patients represent a fourth variant of 'mixed' primary progressive aphasia. Quantitative criteria were least effective in the distinction of the agrammatic from the logopenic variant and left considerable latitude to clinical judgement. The widely followed recommendation to wait for 2 years of relatively isolated and progressive language impairment before making a definitive diagnosis of primary progressive aphasia has promoted diagnostic specificity, but has also diverted attention away from early and mild disease. This study shows that this recommendation is unnecessarily restrictive and that quantitative guidelines can be implemented for the valid root diagnosis and subtyping of mildly impaired patients within 2 years of symptom onset. An emphasis on early diagnosis will promote a better characterization of the disease stages where therapeutic interventions are the most likely to succeed.
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Affiliation(s)
- M-Marsel Mesulam
- Cognitive Neurology and Alzheimer's Disease Centre, Northwestern University, Feinberg School of Medicine, 320 East Superior Street, Chicago, IL 60611, USA.
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Chen Y, Wolk DA, Reddin JS, Korczykowski M, Martinez PM, Musiek ES, Newberg AB, Julin P, Arnold SE, Greenberg JH, Detre JA. Voxel-level comparison of arterial spin-labeled perfusion MRI and FDG-PET in Alzheimer disease. Neurology 2011; 77:1977-85. [PMID: 22094481 DOI: 10.1212/wnl.0b013e31823a0ef7] [Citation(s) in RCA: 189] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We compared the ability of arterial spin labeling (ASL), an MRI method that measures cerebral blood flow (CBF), to that of FDG-PET in distinguishing patients with Alzheimer disease (AD) from healthy, age-matched controls. METHODS Fifteen patients with AD (mean age 72 ± 6 years, Mini-Mental State Examination score [MMSE] 20 ± 6) and 19 age-matched controls (mean age 68 ± 6 years, MMSE 29 ± 1) underwent structural MRI. Participants were injected with 5 mCi of FDG during pseudocontinuous ASL scan, which was followed by PET scanning. Statistical parametric mapping and regions of interest (ROI) analysis were used to compare the ability of the 2 modalities in distinguishing patients from controls. Similarity between the 2 modalities was further assessed with linear correlation maps of CBF and metabolism to neuropsychological test scores. RESULTS Good agreement between hypoperfusion and hypometabolism patterns was observed, with overlap primarily in bilateral angular gyri and posterior cingulate. ROI results showed similar scales of functional deficit between patients and controls in both modalities. Both ASL and FDG-PET were able to distinguish neural networks associated with different neuropsychological tests with good overlap between modalities. CONCLUSIONS Our voxel-wise results indicated that ASL-MRI provides largely overlapping information with FDG-PET. ROI analysis demonstrated that both modalities detected similar degrees of functional deficits in affected areas. Given its ease of acquisition and noninvasiveness, ASL-MRI may be an appealing alternative for AD studies.
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Affiliation(s)
- Y Chen
- Department of Neurology, University of Pennsylvania, 3W Gates Pavilion, 3400 Spruce St., Philadelphia, PA 19104, USA
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Abstract
Primary progressive aphasia (PPA) is a clinical dementia syndrome characterized by progressive decline in language function but relative sparing of other cognitive domains. There are three recognized PPA variants: agrammatic, semantic, and logopenic. Although each PPA subtype is characterized by the nature of the principal deficit, individual patients frequently display subtle impairments in additional language domains. The present study investigated the distribution of atrophy related to performance in specific language domains (i.e., grammatical processing, semantic processing, fluency, and sentence repetition) across PPA variants to better understand the anatomical substrates of language. Results showed regionally specific relationships, primarily in the left hemisphere, between atrophy and impairments in language performance. Most notable was the neuroanatomical distinction between fluency and grammatical processing. Poor fluency was associated with regions dorsal to the traditional boundaries of Broca's area in the inferior frontal sulcus and the posterior middle frontal gyrus, whereas grammatical processing was associated with more widespread atrophy, including the inferior frontal gyrus and supramarginal gyrus. Repetition performance was correlated with atrophy in the posterior superior temporal gyrus. The correlation of atrophy with semantic processing impairment was localized to the anterior temporal poles. Atrophy patterns were more closely correlated with domain-specific performance than with subtype. These results show that PPA reflects a selective disruption of the language network as a whole, with no rigid boundaries between subtypes. Further, these atrophy patterns reveal anatomical correlates of language that could not have been surmised in patients with aphasia resulting from cerebrovascular lesions.
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Agosta F, Canu E, Sarro L, Comi G, Filippi M. Neuroimaging findings in frontotemporal lobar degeneration spectrum of disorders. Cortex 2011; 48:389-413. [PMID: 21632046 DOI: 10.1016/j.cortex.2011.04.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2011] [Revised: 03/07/2011] [Accepted: 04/19/2011] [Indexed: 01/18/2023]
Abstract
Frontotemporal lobar degeneration (FTLD) is a clinically and pathologically heterogeneous spectrum of disorders. In the last few years, neuroimaging has contributed to the phenotypic characterisation of these patients. Complementary to the clinical and neuropsychological evaluations, structural magnetic resonance imaging (MRI) and functional techniques provide important pieces of information for the diagnosis of FTLD. They also appear to be useful in distinguishing FTLD from patients with Alzheimer's disease (AD). Preliminary studies in pathologically proven cases suggested that distinct patterns of tissue loss could assist in predicting in vivo the pathological subtype. Recent years have also witnessed impressive advances in the development of novel imaging approaches. Diffusion tensor MRI and functional MRI have improved our understanding of the pathophysiology of the disease, and this should lead to the identification of additional useful markers of disease progression. This reviews discusses comprehensively the state-of-the-art of neuroimaging in the study of FTLD spectrum of disorders, and attempts to envisage which will be new neuroimaging biomarkers that could serve as surrogate measures of the underlying pathology. This will be central in the design of treatment trials of experimental drugs, which are likely to emerge in the near future, to target the pathological processes associated with this condition.
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Affiliation(s)
- Federica Agosta
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, Scientific Institute and University Vita-Salute San Raffaele, Milan, Italy
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Gunawardena D, Ash S, McMillan C, Avants B, Gee J, Grossman M. Why are patients with progressive nonfluent aphasia nonfluent? Neurology 2010; 75:588-94. [PMID: 20713947 DOI: 10.1212/wnl.0b013e3181ed9c7d] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the cognitive and neural basis for nonfluent speech in progressive nonfluent aphasia (PNFA). BACKGROUND Nonfluent speech is the hallmark feature of PNFA, and this has been attributed to impairments in syntactic processing, motor-speech planning, and executive functioning that also occur in these patients. Patients with PNFA have left inferior frontal atrophy. METHODS A large semi-structured speech sample and neuropsychological measures of language and executive functioning were examined in 16 patients with PNFA, 12 patients with behavioral-variant frontotemporal dementia (bvFTD), and 13 age-matched controls. Speech fluency was quantified as words per minute (WPM) in the semi-structured speech sample. Stepwise linear regression analyses were used to relate WPM to grammatic, motor-speech planning, and executive aspects of patient functioning. These measures were then related to cortical thickness in 8 patients with PNFA and 7 patients with bvFTD using structural MRI. RESULTS WPM was significantly reduced in patients with PNFA relative to controls and patients with bvFTD. Regression analyses revealed that only grammatic measures predicted WPM in PNFA, whereas executive measures were the only significant predictor of WPM in bvFTD. Cortical thinning was significant in PNFA relative to controls in left inferior frontal and anterior-superior temporal regions, and a regression analysis related this area to reduced WPM in PNFA. Significant cortical thinning associated with limited grammatic processing also was seen in the left inferior frontal-superior temporal region in PNFA, and this overlapped with the area of frontal-temporal thinning related to reduced WPM. CONCLUSION Nonfluent speech in PNFA may be due in part to difficulty with grammatic processing associated with left inferior frontal and anterior-superior temporal disease.
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Affiliation(s)
- D Gunawardena
- Department of Neurology, 3 Gates, Hospital of the University of Pennsylvania, 3400 Spruce St., Philadelphia, PA 19104-4283, USA
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Sapolsky D, Bakkour A, Negreira A, Nalipinski P, Weintraub S, Mesulam MM, Caplan D, Dickerson BC. Cortical neuroanatomic correlates of symptom severity in primary progressive aphasia. Neurology 2010; 75:358-66. [PMID: 20660866 DOI: 10.1212/wnl.0b013e3181ea15e8] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To test the validity and reliability of a new measure of clinical impairment in primary progressive aphasia (PPA), the Progressive Aphasia Severity Scale (PASS), and to investigate relationships with MRI-based cortical thickness biomarkers for localizing and quantifying the severity of anatomic abnormalities. METHODS Patients with PPA were rated using the PASS and underwent performance-based language testing and MRI scans that were processed for cortical thickness measures. RESULTS The level of impairment in PASS fluency, syntax/grammar, and word comprehension showed strong specific correlations with performance-based measures of these domains of language, and demonstrated high interrater reliability. Left inferior frontal thinning correlated with impairment in fluency and grammar/syntax, while left temporopolar thinning correlated with impairment in word comprehension. Discriminant function analysis demonstrated that a combination of left inferior frontal, left temporopolar, and left superior temporal sulcal thickness separated the 3 PPA subtypes from each other with 100% accuracy (87% accuracy in a leave-one-out analysis). CONCLUSIONS The PASS, a novel measure of the severity of clinical impairment within domains of language typically affected in PPA, demonstrates reliable and valid clinical-behavioral properties. Furthermore, the presence of impairment in individual PASS domains demonstrates specific relationships with focal abnormalities in particular brain regions and the severity of impairment is strongly related to the severity of anatomic abnormality within the relevant brain region. These anatomic imaging biomarkers perform well in classifying PPA subtypes. These data provide robust support for the value of this novel clinical measure and the new imaging measure as markers for potential use in clinical research and trials in PPA.
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Affiliation(s)
- D Sapolsky
- MGH Frontotemporal Dementia Unit, Massachusetts General Hospital and Harvard Medical School, 149 13th Street, Charlestown, MA 02129, USA
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Wilson SM, Henry ML, Besbris M, Ogar JM, Dronkers NF, Jarrold W, Miller BL, Gorno-Tempini ML. Connected speech production in three variants of primary progressive aphasia. Brain 2010; 133:2069-88. [PMID: 20542982 PMCID: PMC2892940 DOI: 10.1093/brain/awq129] [Citation(s) in RCA: 312] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Revised: 04/21/2010] [Accepted: 04/25/2010] [Indexed: 11/13/2022] Open
Abstract
Primary progressive aphasia is a clinical syndrome defined by progressive deficits isolated to speech and/or language, and can be classified into non-fluent, semantic and logopenic variants based on motor speech, linguistic and cognitive features. The connected speech of patients with primary progressive aphasia has often been dichotomized simply as 'fluent' or 'non-fluent', however fluency is a multidimensional construct that encompasses features such as speech rate, phrase length, articulatory agility and syntactic structure, which are not always impacted in parallel. In this study, our first objective was to improve the characterization of connected speech production in each variant of primary progressive aphasia, by quantifying speech output along a number of motor speech and linguistic dimensions simultaneously. Secondly, we aimed to determine the neuroanatomical correlates of changes along these different dimensions. We recorded, transcribed and analysed speech samples for 50 patients with primary progressive aphasia, along with neurodegenerative and normal control groups. Patients were scanned with magnetic resonance imaging, and voxel-based morphometry was used to identify regions where atrophy correlated significantly with motor speech and linguistic features. Speech samples in patients with the non-fluent variant were characterized by slow rate, distortions, syntactic errors and reduced complexity. In contrast, patients with the semantic variant exhibited normal rate and very few speech or syntactic errors, but showed increased proportions of closed class words, pronouns and verbs, and higher frequency nouns, reflecting lexical retrieval deficits. In patients with the logopenic variant, speech rate (a common proxy for fluency) was intermediate between the other two variants, but distortions and syntactic errors were less common than in the non-fluent variant, while lexical access was less impaired than in the semantic variant. Reduced speech rate was linked with atrophy to a wide range of both anterior and posterior language regions, but specific deficits had more circumscribed anatomical correlates. Frontal regions were associated with motor speech and syntactic processes, anterior and inferior temporal regions with lexical retrieval, and posterior temporal regions with phonological errors and several other types of disruptions to fluency. These findings demonstrate that a multidimensional quantification of connected speech production is necessary to characterize the differences between the speech patterns of each primary progressive aphasic variant adequately, and to reveal associations between particular aspects of connected speech and specific components of the neural network for speech production.
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Affiliation(s)
- Stephen M Wilson
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, 350 Parnassus Avenue, Suite 905, San Francisco, CA 94143, USA.
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Price CJ, Seghier ML, Leff AP. Predicting language outcome and recovery after stroke: the PLORAS system. Nat Rev Neurol 2010; 6:202-10. [PMID: 20212513 PMCID: PMC3556582 DOI: 10.1038/nrneurol.2010.15] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The ability to comprehend and produce speech after stroke depends on whether the areas of the brain that support language have been damaged. Here, we review two different ways to predict language outcome after stroke. The first depends on understanding the neural circuits that support language. This model-based approach is a challenging endeavor because language is a complex cognitive function that involves the interaction of many different brain areas. The second approach, by contrast, does not require an understanding of why a lesion impairs language; instead, predictions are made on the basis of the recovery of previous patients with the same lesion. This approach requires a database that records the speech and language capabilities of a large population of patients who have, collectively, incurred a comprehensive range of focal brain lesions. In addition, a system is required that converts an MRI scan from a new patient into a three-dimensional description of the lesion and compares this lesion against all others on the database. The outputs of this system are the longitudinal language outcomes of corresponding patients in the database. This approach will provide the patient with a range of probable recovery patterns over a variety of language measures.
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Affiliation(s)
- Cathy J Price
- Wellcome Trust Center for Neuroimaging, Institute of Neurology, University College London, 12 Queen Square, London WC1N 3BG, UK.
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