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Wauters LD, Croot K, Dial HR, Duffy JR, Grasso SM, Kim E, Schaffer Mendez K, Ballard KJ, Clark HM, Kohley L, Murray LL, Rogalski EJ, Figeys M, Milman L, Henry ML. Behavioral Treatment for Speech and Language in Primary Progressive Aphasia and Primary Progressive Apraxia of Speech: A Systematic Review. Neuropsychol Rev 2024; 34:882-923. [PMID: 37792075 PMCID: PMC11473583 DOI: 10.1007/s11065-023-09607-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 06/13/2023] [Indexed: 10/05/2023]
Abstract
Primary progressive aphasia (PPA) and primary progressive apraxia of speech (PPAOS) are neurodegenerative syndromes characterized by progressive decline in language or speech. There is a growing number of studies investigating speech-language interventions for PPA/PPAOS. An updated systematic evaluation of the treatment evidence is warranted to inform best clinical practice and guide future treatment research. We systematically reviewed the evidence for behavioral treatment for speech and language in this population. Reviewed articles were published in peer-reviewed journals through 31 May 2021. We evaluated level of evidence, reporting quality, and risk of bias using a modified version of the American Speech-Language Hearing Association (ASHA) Levels of Evidence, an appraisal point system, additional reporting quality and internal/external validity items, and, as appropriate, the Single Case Experimental Design Scale or the Physiotherapy Evidence Database - PsycBITE Rating Scale for Randomized and Non-Randomized Controlled Trials. Results were synthesized using quantitative summaries and narrative review. A total of 103 studies reported treatment outcomes for 626 individuals with PPA; no studies used the diagnostic label PPAOS. Most studies evaluated interventions for word retrieval. The highest-quality evidence was provided by 45 experimental and quasi-experimental studies (16 controlled group studies, 29 single-subject designs). All (k = 45/45) reported improvement on a primary outcome measure; most reported generalization (k = 34/43), maintenance (k = 34/39), or social validity (k = 17/19) of treatment for at least one participant. The available evidence supports speech-language intervention for persons with PPA; however, treatment for PPAOS awaits systematic investigation. Implications and limitations of the evidence and the review are discussed.
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Affiliation(s)
- Lisa D Wauters
- Department of Speech, Language, and Hearing Sciences, University of Texas at Austin, 2504A Whitis Ave. (A1100), 78712, Austin, TX, USA
| | - Karen Croot
- School of Psychology, University of Sydney, 2006, Sydney, NSW, Australia
| | - Heather R Dial
- Department of Communication Sciences and Disorders, University of Houston, Houston, TX, 77204, USA
| | - Joseph R Duffy
- Department of Neurology, Division of Speech Pathology, Mayo Clinic, Rochester, MN, 55902, USA
| | - Stephanie M Grasso
- Department of Speech, Language, and Hearing Sciences, University of Texas at Austin, 2504A Whitis Ave. (A1100), 78712, Austin, TX, USA
| | - Esther Kim
- US Department of Communication Sciences and Disorders, Faculty of Rehabilitation Medicine, University of Alberta, T6G 2R3, Edmonton, AB, Canada
| | | | - Kirrie J Ballard
- Faculty of Medicine & Health and Brain & Mind Centre, University of Sydney, Sydney, NSW, 2006, Australia
| | - Heather M Clark
- Department of Neurology, Division of Speech Pathology, Mayo Clinic, Rochester, MN, 55902, USA
| | - Leeah Kohley
- Department of Speech, Language, and Hearing Sciences, University of Texas at Austin, 2504A Whitis Ave. (A1100), 78712, Austin, TX, USA
| | - Laura L Murray
- School of Communication Sciences and Disorders, Western University, London, ON, N6A 3K7, Canada
| | - Emily J Rogalski
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, 60611, Chicago, IL, USA
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University, Feinberg School of Medicine, 60611, Chicago, IL, USA
| | - Mathieu Figeys
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - Lisa Milman
- Department of Communicative Disorders and Deaf Education, Utah State University, Logan, UT, 84322, USA
| | - Maya L Henry
- Department of Speech, Language, and Hearing Sciences, University of Texas at Austin, 2504A Whitis Ave. (A1100), 78712, Austin, TX, USA.
- Department of Neurology, Dell Medical School, University of Texas at Austin, 78712, Austin, TX, USA.
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Volkmer A, Hausmann A, Paplikar A, Battista P, Jokel R. Group interventions for people with primary progressive aphasia and their care partners: Considerations for clinical practice. Neuropsychol Rehabil 2024:1-29. [PMID: 39213021 DOI: 10.1080/09602011.2024.2391338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 08/07/2024] [Indexed: 09/04/2024]
Abstract
Primary progressive aphasia (PPA) describes a group of language-led dementias. Speech and language therapy is the main available intervention for people with PPA. Despite best practice recommendations for speech and language therapy to include access to group therapies (Volkmer et al, 2023a), research evidence to date has predominantly focused on delivery in individual sessions. The aim of this study was to gather the collective intelligence of expert speech and language therapists/pathologists delivering group therapy for people with PPA to synthesize guidance for clinicians. This paper describes a qualitative study using narrative synthesis methods. Data were collected using the Template for Intervention Description and Replication - TIDiER. Eight respondents described a total of 17 different groups. Respondents worked across healthcare, research clinics and third sector organizations in Australia, Canada, Spain, the USA and the UK. For the purposes of analysis, groups were divided into two main types: (1) groups delivering specific therapy interventions; and (2) groups providing broader opportunities for conversational practice and support. This initial synthesis of the current state of the art in PPA therapy groups highlights several important considerations around candidacy, content and ecological validity of delivering group intervention for people with PPA.
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Affiliation(s)
- Anna Volkmer
- Psychology and Language Sciences, University College London, London, UK
| | - Alessa Hausmann
- Leenaards Memory Center, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Avanthi Paplikar
- Department of Speech Language Studies, Dr. S. R. Chandrasekhar Institute of Speech and Hearing, Bangalore, India
| | - Petronilla Battista
- Istituti Clinici Scientifici Maugeri IRCCS, Laboratory of Neuropsychology of Bari Institute, Bari, Italy
| | - Regina Jokel
- Baycrest Academy for Research and Education, Toronto, Canada
- Dept of Speech-Language Pathology, University of Toronto, Toronto, Canada
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Gallée J, Cartwright J, Grasso S, Jokel R, Lavoie M, McGowan E, Pozzebon M, Beber BC, Duboisdindien G, Montagut N, Norvik M, Sugimoto T, Townsend R, Unger N, Winsnes IE, Volkmer A. Global perspectives on the management of primary progressive aphasia. Sci Rep 2024; 14:19712. [PMID: 39181907 PMCID: PMC11344800 DOI: 10.1038/s41598-024-70156-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 08/13/2024] [Indexed: 08/27/2024] Open
Abstract
Speech-language therapists/pathologists (SLT/Ps) are key professionals in the management and treatment of primary progressive aphasia (PPA), however, there are gaps in education and training within the discipline, with implications for skills, confidence, and clinical decision-making. This survey aimed to explore the areas of need amongst SLT/Ps working with people living with PPA (PwPPA) internationally to upskill the current and future workforce working with progressive communication disorders. One hundred eighty-six SLT/Ps from 27 countries who work with PwPPA participated in an anonymous online survey about their educational and clinical experiences, clinical decision-making, and self-reported areas of need when working with this population. Best practice principles for SLT/Ps working with PwPPA were used to frame the latter two sections of this survey. Only 40.7% of respondents indicated that their university education prepared them for their current work with PwPPA. Competency areas of "knowing people deeply," "practical issues," "connectedness," and "preventing disasters" were identified as the basic areas of priority and need. Respondents identified instructional online courses (92.5%), sample tools and activities for interventions (64.8%), and concrete training on providing care for advanced stages and end of life (58.3%) as central areas of need in their current work. This is the first international survey to comprehensively explore the perspectives of SLT/Ps working with PwPPA. Based on survey outcomes, there is a pressing need to enhance current educational and ongoing training opportunities to better promote the well-being of PwPPA and their families, and to ensure appropriate preparation of the current and future SLT/P workforce.
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Affiliation(s)
- Jeanne Gallée
- Center for Psychometric Analyses of Aging and Neurodegeneration, Department of Medicine, University of Washington, Seattle, WA, USA.
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA, USA.
- School of Health Sciences, University of Tasmania, Launceston, Australia.
| | - Jade Cartwright
- School of Health Sciences, University of Tasmania, Launceston, Australia
| | - Stephanie Grasso
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin, Austin, TX, USA
| | - Regina Jokel
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Rotman Research Institute, Toronto, Canada
| | - Monica Lavoie
- The Chaire de recherche sur les aphasies primaires progressives - Fondation de la famille Lemaire, Université Laval, Quebec, Qc, Canada
- Clinique Interdisciplinaire de Mémoire, CHU de Québec-Université Laval, Quebec, QC, Canada
| | - Ellen McGowan
- Pennine Care NHS Foundation Trust, Greater Manchester, Derbyshire, UK
| | | | - Bárbara Costa Beber
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Guillaume Duboisdindien
- The Chaire de recherche sur les aphasies primaires progressives - Fondation de la famille Lemaire, Université Laval, Quebec, Qc, Canada
- Clinique Interdisciplinaire de Mémoire, CHU de Québec-Université Laval, Quebec, QC, Canada
| | - Núria Montagut
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clinic, Barcelona, Spain
- Institut d'Investigació Biomèdica August Pi I Sunyer, Barcelona, Spain
| | - Monica Norvik
- Department of Education, UiT The Arctic University of Norway, Tromsø, Norway
| | - Taiki Sugimoto
- Center for Psychometric Analyses of Aging and Neurodegeneration, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Prevention and Care Science, National Center for Geriatrics and Gerontology, Research Institute, Obu, Japan
| | | | - Nina Unger
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Ingvild E Winsnes
- Department of Linguistics and Scandinavian Studies, University of Oslo, Oslo, Norway
| | - Anna Volkmer
- Department of Psychology and Language Science, University College London, London, UK
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Volkmer A, Copland DA, Henry ML, Warren JD, Varley R, Wallace SJ, Hardy CJ. COS-PPA: protocol to develop a core outcome set for primary progressive aphasia. BMJ Open 2024; 14:e078714. [PMID: 38719304 PMCID: PMC11086495 DOI: 10.1136/bmjopen-2023-078714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 03/19/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION The term primary progressive aphasia (PPA) describes a group of language-led dementias. Disease-modifying treatments that delay, slow or reverse progression of PPA are currently lacking, though a number of interventions to manage the symptoms of PPA have been developed in recent years. Unfortunately, studies exploring the effectiveness of these interventions have used a variety of different outcome measures, limiting comparability. There are more constructs, apart from word retrieval, that are important for people with PPA that have not received much attention in the research literature. Existing core outcome sets (COS) for dementia and non-progressive aphasia do not meet the needs of people with PPA, highlighting a need to develop a specific COS for PPA. METHODS AND ANALYSIS This protocol describes a three-stage study to identify a COS for PPA interventions in research and clinical practice. The stage 1 systematic review will identify existing speech, language and communication measures used to examine the effectiveness of interventions for PPA in the research literature. Employing a nominal group technique, stage 2 will identify the most important outcomes for people with PPA and their families. The data collected in stages 1 and 2 will be jointly analysed with the project PPI group and will inform the stage 2 modified Delphi consensus study to identify a core outcome measurement set for PPA among a range of research disciplines undertaking intervention studies for people with PPA. ETHICS AND DISSEMINATION Ethical approval for stage 2 of the study has been sought individually in each country at collaborating institutions and is stated in detail in the manuscript. Stage 3 has been granted ethical approval by the Chairs of UCL Language and Cognition Department Ethics, Project ID LCD-2023-06. Work undertaken at stages 1, 2 and 3 will be published in open-access peer-reviewed journal articles and presented at international scientific conferences. PROSPERO REGISTRATION NUMBER CRD42022367565.
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Affiliation(s)
- Anna Volkmer
- Department of Psychology and Language Sciences, University College London, London, UK
| | - David A Copland
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, St Lucia, Queensland, Australia
| | - Maya L Henry
- Departments of Speech, Language, and Hearing Sciences and Neurology, The University of Texas at Austin, Austin, Texas, USA
| | - Jason D Warren
- Dementia Research Centre, University College London, London, UK
| | - Rosemary Varley
- Department of Psychology and Language Sciences, University College London, London, UK
| | - Sarah J Wallace
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, The University of Queensland, Saint Lucia, Queensland, Australia
- Surgical Treatment and Rehabilitation Service (STARS) Education and Research Alliance, The University of Queensland and Metro North Health, St Lucia, Queensland, Australia
| | - Chris Jd Hardy
- Dementia Research Centre, University College London, London, UK
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Watanabe M, Cartwright J, Pierce JE. Positive effects of speech and language therapy group interventions in primary progressive aphasia: A systematic review. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024. [PMID: 38602276 DOI: 10.1111/1460-6984.13031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/08/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND Primary progressive aphasia (PPA) is a neurodegenerative condition characterised by a prominent and progressive deterioration in language abilities, which significantly impacts quality of life and interpersonal relationships. Speech and language therapy plays a crucial role in offering interventions. Group intervention is one mode of delivery that could benefit communication functioning and overall wellbeing of people with PPA (pwPPA) and their care partners. Group interventions are also more efficient than one-to-one intervention and may facilitate peer support. AIMS The aim of this review was to systematically evaluate the current evidence for the effectiveness of speech and language therapy groups for pwPPA and their care partners. Specifically, this paper considered three questions: 1.What evidence-based speech and language therapy groups for pwPPA and their care partners have been reported to date? 2.Are group communication interventions effective in improving quality of life and communication function for pwPPA and their care partners? 3.Are group communication interventions that are designed for people with communication difficulties of other aetiologies (such as stroke) effective for pwPPA? In addition, this review aimed to describe the structure and content of groups, including aims, disciplines involved, size and frequency of group meetings, and outcome measures. METHODS MEDLINE, CINAHL and PsycINFO were used to retrieve articles of interest. A total of 10 studies published between 2009 and 2022 met the eligibility criteria and therefore were included in this study. Data were extracted from the articles regarding the structure and content of groups. MAIN CONTRIBUTION Although evidence is currently limited, results suggest that speech and language therapy group intervention can improve specific linguistic processes, the use of communication strategies and psychosocial well-being. The importance of multidisciplinary input and care partners' involvement in groups was highlighted, along with the benefits of creative non-verbal activities as tools for self-expression. There is also initial evidence that telehealth group provision and one-off group sessions may be feasible and can benefit psychosocial well-being. Lastly, intentional recruitment and explicit education on different aphasia types are described as important when pwPPA participate in groups with mixed diagnoses. CONCLUSIONS The literature on speech and language therapy group interventions for PPA shows promise of positive effects on communication function and psychosocial well-being of both pwPPA and their care partners. Speech and language therapists can consider these published interventions when designing and implementing similar groups, but more robust evidence is required to confirm the relative effectiveness of this approach. WHAT THIS PAPER ADDS What is already known on this subject Speech pathology led group intervention shows some promise in benefitting communication functioning and overall well-being of pwPPA and their carers, but there has been no systematic evaluation of all the evidence regarding the efficacy of speech and language therapy led groups. Establishing feasibility, acceptability and efficacy of speech and language therapy group interventions for pwPPA and their carers may present a valuable addition for managing this progressive language disability. What this paper adds to existing knowledge Although evidence is currently limited, results from this systematic review suggest that speech and language therapy led group intervention can improve specific linguistic processes, the use of communication strategies and psychosocial well-being for pwPPA and their carers. The importance of multidisciplinary input and carers' involvement in groups was highlighted, along with the benefits of creative non-verbal activities as tools for self-expression. There is also initial evidence that telehealth group provision for carers may be feasible and can benefit psychosocial wellbeing. Lastly, intentional recruitment and explicit education on different aphasia types are described as important when pwPPA participate in groups with mixed diagnoses. What are the potential or actual clinical implications of this work? A synthesis of the evidence base for speech and language therapy led PPA groups, as well as a description of the group components and formats, will be valuable for clinical service planning, and will guide future examination of group options for pwPPA and their carers. Speech and language therapists can also consider the research findings from this systematic review when designing and implementing similar groups in their local context.
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Affiliation(s)
| | - Jade Cartwright
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, Australia
| | - John E Pierce
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Victoria, Australia
- Speech Pathology, La Trobe University, Melbourne, Victoria, Australia
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Joubert S, Maquestiaux F, Enriquez-Rosas A, Villalpando JM, Brodeur C, Bier N. Smartphone use as an efficient tool to improve anomia in primary progressive aphasia. Neuropsychol Rehabil 2024; 34:362-387. [PMID: 36871267 DOI: 10.1080/09602011.2023.2181824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023]
Abstract
Cognitive interventions are helpful in the non-pharmacological management of Primary progressive aphasia (PPA) and other neurodegenerative disorders of cognition, by helping patients to compensate for their cognitive deficits and improve their functional independence. In this study, we examined the effectiveness of cognitive rehabilitation based on the use of mobile device technology in PPA. The aim of this research study was to determine if BL, a patient with semantic variant PPA (svPPA) and severe anomia, was able to learn using specific smartphone functions and an application to reduce her word finding difficulties. She was trained during the intervention sessions on a list of target pictures to measure changes in picture naming performance. Errorless learning was applied during learning. BL quickly learned to use smartphone functions and the application over the course of the intervention. She significantly improved her anomia for trained pictures, and to a lesser extent for untrained semantically related pictures. Picture naming performance was maintained six months after the intervention, and she continued to use her smartphone regularly to communicate with family members and friends. This study confirms that smartphone use can be learned in PPA, which can help reduce the symptoms of anomia and improve communication skills.
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Affiliation(s)
- Sven Joubert
- CIUSSS-CSMTL - Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Canada
- Département de psychologie, Université de Montréal, Montreal, Canada
| | - François Maquestiaux
- Centre de recherches sur les fonctionnements et dysfonctionnements psychologiques (CRFDP, EA 7475), université de Rouen Normandie, Rouen, France
- Laboratoire de recherches intégratives en neurosciences et psychologie cognitive (LINC, UR 481), université de Franche-Comté, Besançon, France
- Maison des sciences de l'homme et de l'environnement (MSHE) Ledoux, UFC, Besançon, France
| | | | - Juan Manuel Villalpando
- CIUSSS-CSMTL - Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Canada
- CIUSSS-CSMTL - Institut universitaire de gériatrie de Montréal (IUGM), Montreal, Canada
- Faculté de médecine, Université de Montréal, Montreal, Canada
| | - Catherine Brodeur
- CIUSSS-CSMTL - Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Canada
- CIUSSS-CSMTL - Institut universitaire de gériatrie de Montréal (IUGM), Montreal, Canada
- Faculté de médecine, Université de Montréal, Montreal, Canada
| | - Nathalie Bier
- CIUSSS-CSMTL - Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), Montreal, Canada
- Faculté de médecine, Université de Montréal, Montreal, Canada
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Gallée J, Cartwright J, Grasso S, Jokel R, Lavoie M, McGowan E, Pozzebon M, Beber BC, Duboisdindien G, Montagut N, Norvik M, Sugimoto T, Townsend R, Unger N, Winsnes IE, Volkmer A. Global Perspectives on the Management of Primary Progressive Aphasia. RESEARCH SQUARE 2024:rs.3.rs-4100219. [PMID: 38562789 PMCID: PMC10984010 DOI: 10.21203/rs.3.rs-4100219/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Speech-language therapists/pathologists (SLT/Ps) are key professionals in the management and treatment of primary progressive aphasia (PPA), however, there are gaps in education and training within the discipline, with implications for skills, confidence, and clinical decision-making. This survey aimed to explore the areas of need amongst SLT/Ps working with people living with PPA (PwPPA) internationally to upskill the current and future workforce working with progressive communication disorders. One hundred eighty-five SLT/Ps from 27 countries who work with PwPPA participated in an anonymous online survey about their educational and clinical experiences, clinical decision-making, and self-reported areas of need when working with this population. Best practice principles for SLT/Ps working with PwPPA were used to frame the latter two sections of this survey. Only 40.7% of respondents indicated that their university education prepared them for their current work with PwPPA. Competency areas of "Knowing people deeply," "Practical issues," "Connectedness," and "Preventing disasters" were identified as the basic areas of priority and need. Respondents identified instructional online courses (92.5%), sample tools and activities for interventions (64.8%), and concrete training on providing care for advanced stages and end of life (58.3%) as central areas of need in their current work. This is the first international survey to comprehensively explore the perspectives of SLT/Ps working with PwPPA. Based on survey outcomes, there is a pressing need to enhance current educational and ongoing training opportunities to better promote the well-being of PwPPA and their families, and to ensure appropriate preparation of the current and future SLT/P workforce.
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Affiliation(s)
- Jeanne Gallée
- Center for Psychometric Analyses of Aging and Neurodegeneration, Department of Medicine, University of Washington
| | | | - Stephanie Grasso
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
| | - Regina Jokel
- Temerty Faculty of Medicine, University of Toronto
| | - Monica Lavoie
- Chaire de recherche sur les aphasies primaires progressives - Fondation de la famille Lemaire, Université Laval
| | | | | | - Bárbara Costa Beber
- Department of Speech, Language, and Hearing Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA)
| | - Guillaume Duboisdindien
- Chaire de recherche sur les aphasies primaires progressives - Fondation de la famille Lemaire, Université Laval
| | - Núria Montagut
- Alzheimer's Disease and other Cognitive Disorders Unit, Neurology Service, Hospital Clinic Barcelona
| | - Monica Norvik
- Department of Linguistics and Scandinavian studies, University of Oslo
| | - Taiki Sugimoto
- Center for Psychometric Analyses of Aging and Neurodegeneration, Department of Medicine, University of Washington
| | | | - Nina Unger
- Department of Neurology, University Medicine Greifswald
| | - Ingvild E Winsnes
- Department of Linguistics and Scandinavian studies, University of Oslo
| | - Anna Volkmer
- Department of Psychology and Language Science, University College London
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Robinaugh G, Henry ML, Cavanaugh R, Grasso SM. Computer-Based Naming Treatment for Semantic Variant Primary Progressive Aphasia With History of Traumatic Brain Injury: A Single-Case Experimental Design. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2024; 67:524-544. [PMID: 38319636 PMCID: PMC11000793 DOI: 10.1044/2023_jslhr-23-00289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/28/2023] [Accepted: 10/27/2023] [Indexed: 02/07/2024]
Abstract
PURPOSE The purpose of this study was to investigate the effectiveness of a self-administered naming treatment for one individual, B.N., presenting with semantic variant primary progressive aphasia (svPPA) and a history of traumatic brain injury (TBI). METHOD Naming treatment included components of Lexical Retrieval Cascade Treatment and was self-administered using an adaptive spaced retrieval software, Anki. Using a multiple-baseline, single-case experimental design, naming accuracy probes were taken during pretreatment, treatment, posttreatment, and follow-up (through 12 months) for 60 trained words and 10 untrained words. Item-level Bayesian generalized mixed-effects models were used to estimate (a) the treatment effect for trained words, (b) change in untrained words, and (c) maintenance of treatment effects from posttreatment to each subsequent follow-up. RESULTS Statistical analyses revealed that a gain of 35 out of 60 trained words (35.3; 90% CI [30.6, 39.5]) was directly attributable to treatment. Following treatment, evidence of generalization to untrained words was not observed. During the follow-up period, there was gradual decline in naming accuracy of trained items. CONCLUSIONS The positive treatment results reported here support the use of self-administered naming treatments for those with svPPA and a history of TBI. Although the utility of this treatment approach is constrained by patient factors including motivation, self-administered naming treatments represent a unique opportunity to expand access to speech-language intervention for people with svPPA, including those with concomitant diagnoses. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25119080.
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Affiliation(s)
- Gary Robinaugh
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
| | - Maya L. Henry
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
- Department of Neurology, Dell Medical School, The University of Texas at Austin
| | | | - Stephanie M. Grasso
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
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Belder CRS, Marshall CR, Jiang J, Mazzeo S, Chokesuwattanaskul A, Rohrer JD, Volkmer A, Hardy CJD, Warren JD. Primary progressive aphasia: six questions in search of an answer. J Neurol 2024; 271:1028-1046. [PMID: 37906327 PMCID: PMC10827918 DOI: 10.1007/s00415-023-12030-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 09/27/2023] [Indexed: 11/02/2023]
Abstract
Here, we review recent progress in the diagnosis and management of primary progressive aphasia-the language-led dementias. We pose six key unanswered questions that challenge current assumptions and highlight the unresolved difficulties that surround these diseases. How many syndromes of primary progressive aphasia are there-and is syndromic diagnosis even useful? Are these truly 'language-led' dementias? How can we diagnose (and track) primary progressive aphasia better? Can brain pathology be predicted in these diseases? What is their core pathophysiology? In addition, how can primary progressive aphasia best be treated? We propose that pathophysiological mechanisms linking proteinopathies to phenotypes may help resolve the clinical complexity of primary progressive aphasia, and may suggest novel diagnostic tools and markers and guide the deployment of effective therapies.
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Affiliation(s)
- Christopher R S Belder
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
- UK Dementia Research Institute at UCL, UCL Queen Square Institute of Neurology, University College London, London, UK
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Charles R Marshall
- Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Jessica Jiang
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Salvatore Mazzeo
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Anthipa Chokesuwattanaskul
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
- Division of Neurology, Department of Internal Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Cognitive Clinical and Computational Neuroscience Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Anna Volkmer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Chris J D Hardy
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK.
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10
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Strunk K, Weiss S, Müller HM. High-Frequency Language Therapy with Semantic Feature Analysis (SFA) and Transcranial Direct Current Stimulation (tDCS): A Longitudinal Single-Case Report of Semantic Variant of Primary Progressive Aphasia (svPPA). Brain Sci 2024; 14:133. [PMID: 38391708 PMCID: PMC10886986 DOI: 10.3390/brainsci14020133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND The goal of this study was to investigate whether the combination of semantic feature analysis (SFA) and transcranial direct current stimulation (tDCS) is effective in treating word retrieval in the semantic variant of primary progressive aphasia (svPPA) and how long the potential effects last. METHODS A 56-year-old woman diagnosed with frontotemporal dementia (FTD) and svPPA participated in this longitudinal single-subject design. A total of four 2-week stimulation phases were conducted over a 14-month period, each of which was started depending on the participant's language performance. Follow-up testing was conducted shortly after the stimulation period, approximately 2 weeks, and approximately 4 weeks thereafter. RESULTS Significant improvement in word retrieval occurred after SFA and tDCS therapy. Two weeks after the end of each stimulation phase, approx. 80% of the trained words could be named correctly. For the untrained words, also significantly more words were correctly named at follow-ups compared to the baseline. Furthermore, the Boston Naming Test (BNT) demonstrated a significant increase in naming performance and showed that phonological cues facilitated word retrieval compared to semantic cues. CONCLUSION The combination of SFA and tDCS was able to counteract the expected language deterioration of a participant with svPPA. This effect increased until approximately 2 weeks after each intervention. In addition, a generalization of the effect to untrained words was shown.
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Affiliation(s)
- Katharina Strunk
- Experimental Neurolinguistics Group, Bielefeld University, Universitätsstrasse 25, 33615 Bielefeld, Germany
| | - Sabine Weiss
- Experimental Neurolinguistics Group, Bielefeld University, Universitätsstrasse 25, 33615 Bielefeld, Germany
- Center for Cognitive Interaction Technology (CITEC), Bielefeld University, Inspiration 1, 33619 Bielefeld, Germany
- Clinical Linguistics, Bielefeld University, Universitätsstrasse 25, 33615 Bielefeld, Germany
| | - Horst M Müller
- Experimental Neurolinguistics Group, Bielefeld University, Universitätsstrasse 25, 33615 Bielefeld, Germany
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11
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Linlin W, Ruofei J, Hudan C, Ruxuan T, Jing Y. Correlation analysis between insomnia symptoms and language function in patients with schizophrenia. Schizophr Res Cogn 2023; 34:100292. [PMID: 37841084 PMCID: PMC10571027 DOI: 10.1016/j.scog.2023.100292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/07/2023] [Accepted: 10/07/2023] [Indexed: 10/17/2023]
Abstract
Objective To explore the correlation between insomnia and language ability in patients with schizophrenia. Methods 120 patients with schizophrenia admitted to our hospital from June 2020 to January 2022 were enrolled as the research objects. According to the total score of the Pittsburgh Sleep Index (PSQI), they were divided into the insomnia group (PSQI total score > 10 points) and the non-insomnia group (PSQI total score ≤ 10 points). To compare the difference in verbal fluency scale between insomnia and non-insomnia groups and to understand the correlation between insomnia symptoms and language ability in patients with schizophrenia. Results There were no significant differences in age, gender, and years of education between the insomnia group and the non-insomnia group (P > 0.05). The total score of the verbal fluency test (VFT) in the insomnia group was significantly different from that in the non-insomnia group (P < 0.01). The total score of the insomnia group was lower than that of the non-insomnia group, and the factors (fluency animal, fluency fruit and vegetable, speech fluency, motor fluency) were lower than that of the non-insomnia group. Logistic regression analysis showed that the total verbal fluency score in schizophrenia patients was negatively correlated with insomnia symptoms (P < 0.05). Schizophrenia patients with insomnia symptoms had worse language ability than those without. Conclusion There is a significant difference in language ability between schizophrenia patients with insomnia and those without insomnia symptoms. This suggests that schizophrenia patients with insomnia have a greater probability of language ability disorder.
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Affiliation(s)
- Wu Linlin
- The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang 621000, Sichuan, China
| | - Ji Ruofei
- The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang 621000, Sichuan, China
| | - Chen Hudan
- The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang 621000, Sichuan, China
| | - Tang Ruxuan
- The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang 621000, Sichuan, China
| | - Yao Jing
- The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang 621000, Sichuan, China
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12
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Gallée J, Volkmer A. Role of the Speech-Language Therapist/Pathologist in Primary Progressive Aphasia. Neurol Clin Pract 2023; 13:e200178. [PMID: 37529299 PMCID: PMC10389170 DOI: 10.1212/cpj.0000000000200178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 05/18/2023] [Indexed: 08/03/2023]
Abstract
In recent years, the role of the speech-language therapist/pathologist (SLT/P) has become increasingly established in the assessment, care, and management of primary progressive aphasia (PPA). Throughout the progression of the condition, the role of SLT/P encompasses 5 notable domains: behavioral assessment, impairment-based intervention, compensatory strategy intervention, communication partner training, and informational counseling. The SLT/P brings a unique perspective and clinical arsenal to address the linguistic, functional, and psychosocial effects that PPA can have on a person's life. Ongoing training opportunities are warranted to deliver evidence-based and person-centered SLT/P services to people living with PPA. Therefore, in this commentary, our aim is to clarify the role of SLT/P to advocate for our patients and their options for care.
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Affiliation(s)
- Jeanne Gallée
- Department of Psychology (JG), Institute for Learning and Brain Sciences, University of Washington, Seattle; Department of Communication Sciences and Disorders (JG), MGH Institute of Health Professions, Charlestown, MA; and Division of Psychology and Language Sciences (AV), University College London, United Kingdom
| | - Anna Volkmer
- Department of Psychology (JG), Institute for Learning and Brain Sciences, University of Washington, Seattle; Department of Communication Sciences and Disorders (JG), MGH Institute of Health Professions, Charlestown, MA; and Division of Psychology and Language Sciences (AV), University College London, United Kingdom
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13
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Volkmer A, Walton H, Swinburn K, Spector A, Warren JD, Beeke S. Results from a randomised controlled pilot study of the Better Conversations with Primary Progressive Aphasia (BCPPA) communication partner training program for people with PPA and their communication partners. Pilot Feasibility Stud 2023; 9:87. [PMID: 37221614 PMCID: PMC10203671 DOI: 10.1186/s40814-023-01301-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/13/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND There has been a growing focus on functional communication interventions for primary progressive aphasia (PPA). These interventions aim to support individuals to participate in life situations. One such intervention, communication partner training (CPT) aims to change conversation behaviours in both the person with PPA and their communication partner (CP). CPT has a growing evidence base in stroke aphasia; however, these programmes are not designed to meet the needs of people with progressive communication difficulties. To address this, the authors developed a CPT program entitled Better Conversations with PPA (BCPPA) and undertook a pilot trial to establish for a future full trial; predicted recruitment rates, acceptability, an assessment of treatment fidelity and an appropriate primary outcome measure. METHODOLOGY This was a single-blind, randomised controlled pilot study comparing BCPPA to no treatment, delivered across 11 National Health Service Trusts in the UK. A random sample of eight recordings of local collaborators delivering the intervention were analysed to examine fidelity. Participants completed feedback forms reporting on acceptability. Pre- and post-intervention measures targeted conversation behaviours, communication goals and quality of life. RESULTS Eighteen people with PPA and their CPs (9 randomised to BCPPA, 9 randomised to no treatment) completed the study. Participants in the intervention group rated BCPPA positively. Treatment fidelity was 87.2%. Twenty-nine of 30 intervention goals were achieved or over-achieved and 16 of 30 coded conversation behaviours demonstrated change in the intended direction. The Aphasia Impact Questionnaire was identified as the preferred outcome measure. CONCLUSION The first randomised controlled UK pilot study of a CPT program for people with PPA and their families demonstrates BCPPA is a promising intervention. The intervention was acceptable, treatment fidelity high and an appropriate measure identified. Results of this study indicate a future RCT of BCPPA is feasible. TRIAL REGISTRATION Registered 28/02/2018 ISRCTN10148247 .
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Affiliation(s)
- A Volkmer
- Division of Psychology and Language Sciences, University College London, London, UK.
| | - H Walton
- Department of Applied Health Research, UCL, London, UK
| | - K Swinburn
- Division of Psychology and Language Sciences, University College London, London, UK
| | - A Spector
- Division of Psychology and Language Sciences, University College London, London, UK
| | - J D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology, University College London, London, UK
| | - S Beeke
- Division of Psychology and Language Sciences, University College London, London, UK
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14
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Loizidou M, Brotherhood E, Harding E, Crutch S, Warren JD, Hardy CJ, Volkmer A. 'Like going into a chocolate shop, blindfolded': What do people with primary progressive aphasia want from speech and language therapy? INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:737-755. [PMID: 36448629 PMCID: PMC10947572 DOI: 10.1111/1460-6984.12818] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/17/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND Primary progressive aphasia (PPA) describes a group of language-led dementias. PPAs are complex, diverse and difficult to diagnose, and therefore conventional models of aphasia and dementia treatment do not meet their needs. The research evidence on intervention for PPA is developing, but to date there are only a few case studies exploring the experiences of people with PPA (PwPPA) themselves. AIMS To explore the experiences and opinions of PwPPA and their communication partners (CPs) to understand how speech and language therapy (SLT) services can better meet their needs. METHODS & PROCEDURES A qualitative research approach was used whereby PwPPA and their friends or family members were recruited to participate in focus groups, via advertisements in the Rare Dementia Support PPA group newsletters. Consenting participants were allocated to attend one of four focus groups hosted on an online video conferencing platform. Participants were asked about their communication difficulties, and how SLT could address these needs. All meetings were transcribed, and data were examined using reflexive thematic analysis. OUTCOMES & RESULTS Six PwPPA and 14 CPs representing all three PPA variants and mixed PPA participated in the focus groups. Four main themes were identified during the analysis of the focus group discussions: (1) CPs' burden, (2) adjusting to the diagnosis, (3) communication abilities and difficulties and (4) beyond language. A further 10 subthemes were identified. CONCLUSIONS & IMPLICATIONS This study provides a greater understanding of the experiences and needs of PwPPA and their families in relation to SLT. This work underlines the importance of a person-centred approach that considers the broader needs of both the PwPPA and the people around them. This will enable service providers to deliver SLT that meets the needs of PwPPA and their families and will also inform future research in this field. WHAT THIS PAPER ADDS What is already known on this subject We know that PwPPA can maintain or even make improvements in word retrieval and speech fluency with SLT exercises. There is also developing evidence of the benefits of interventions such as CP training, communication aid support and other functional interventions. What this paper adds to existing knowledge This study provides an understanding of the experiences and opinions of people living with PPA and their families in relation to SLT. Results demonstrate that PwPPA and their families have to navigate a complex journey, identifying strategies to support communication but also the influence of personality and other cognitive symptoms. SLT was useful, but not always available. What are the potential or actual clinical implications of this work? This study will enable service providers to better plan, justify funding for and delivery of SLT that will meet the needs of PwPPA and their families. Most importantly this work underlines the importance of a person-centred approach, incorporating the broader needs of the person with PPA and those around them.
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Affiliation(s)
- Maria Loizidou
- Department of Neurodegenerative DiseaseDementia Research CentreUCL Institute ofNeurologyUniversity College LondonLondonUK
| | - Emilie Brotherhood
- Department of Neurodegenerative DiseaseDementia Research CentreUCL Institute ofNeurologyUniversity College LondonLondonUK
| | - Emma Harding
- Department of Neurodegenerative DiseaseDementia Research CentreUCL Institute ofNeurologyUniversity College LondonLondonUK
| | - Sebastian Crutch
- Department of Neurodegenerative DiseaseDementia Research CentreUCL Institute ofNeurologyUniversity College LondonLondonUK
| | - Jason D. Warren
- Department of Neurodegenerative DiseaseDementia Research CentreUCL Institute ofNeurologyUniversity College LondonLondonUK
| | - Chris J.D. Hardy
- Department of Neurodegenerative DiseaseDementia Research CentreUCL Institute ofNeurologyUniversity College LondonLondonUK
| | - Anna Volkmer
- Division of Psychology and Language SciencesUniversity College LondonLondonUK
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15
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Hardy CJD, Taylor-Rubin C, Taylor B, Harding E, Gonzalez AS, Jiang J, Thompson L, Kingma R, Chokesuwattanaskul A, Walker F, Barker S, Brotherhood E, Waddington C, Wood O, Zimmermann N, Kupeli N, Yong KXX, Camic PM, Stott J, Marshall CR, Oxtoby NP, Rohrer JD, Volkmer A, Crutch SJ, Warren JD. Symptom-led staging for primary progressive aphasia. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.03.13.23286972. [PMID: 36993460 PMCID: PMC10055437 DOI: 10.1101/2023.03.13.23286972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
The primary progressive aphasias (PPA) present complex and diverse challenges of diagnosis, management and prognosis. A clinically-informed, syndromic staging system for PPA would take a substantial step toward meeting these challenges. This study addressed this need using detailed, multi-domain mixed-methods symptom surveys of people with lived experience in a large international PPA cohort. We administered structured online surveys to caregivers of patients with a canonical PPA syndromic variant (nonfluent/agrammatic (nvPPA), semantic (svPPA) or logopenic (lvPPA)). In an 'exploratory' survey, a putative list and ordering of verbal communication and nonverbal functioning (nonverbal thinking, conduct and wellbeing, physical) symptoms was administered to 118 caregiver members of the UK national PPA Support Group. Based on feedback, we expanded the symptom list and created six provisional clinical stages for each PPA subtype. In a 'consolidation' survey, these stages were presented to 110 caregiver members of UK and Australian PPA Support Groups, and refined based on quantitative and qualitative feedback. Symptoms were retained if rated as 'present' by a majority (at least 50%) of respondents representing that PPA syndrome, and assigned to a consolidated stage based on majority consensus; the confidence of assignment was estimated for each symptom as the proportion of respondents in agreement with the final staging for that symptom. Qualitative responses were analysed using framework analysis. For each PPA syndrome, six stages ranging from 1 ('Very mild') to 6 ('Profound') were identified; earliest stages were distinguished by syndromic hallmark symptoms of communication dysfunction, with increasing trans-syndromic convergence and dependency for basic activities of daily living at later stages. Spelling errors, hearing changes and nonverbal behavioural features were reported at early stages in all syndromes. As the illness evolved, swallowing and mobility problems were reported earlier in nfvPPA than other syndromes, while difficulty recognising familiar people and household items characterised svPPA and visuospatial symptoms were more prominent in lvPPA. Overall confidence of symptom staging was higher for svPPA than other syndromes. Across syndromes, functional milestones were identified as key deficits that predict the sequence of major daily life impacts and associated management needs. Qualitatively, we identified five major themes encompassing 15 subthemes capturing respondents' experiences of PPA and suggestions for staging implementation. This work introduces a prototypical, symptom-led staging scheme for canonical PPA syndromes: the PPA Progression Planning Aid (PPA 2 ). Our findings have implications for diagnostic and care pathway guidelines, trial design and personalised prognosis and treatment for people living with these diseases.
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Affiliation(s)
- Chris JD Hardy
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Cathleen Taylor-Rubin
- Uniting War Memorial Hospital, Sydney, Australia
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Beatrice Taylor
- Centre for Medical Image Computing, Department of Computer Science, UCL, London, UK
| | - Emma Harding
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Aida Suarez Gonzalez
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Jessica Jiang
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | | | | | - Anthipa Chokesuwattanaskul
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
- Division of Neurology, Department of Internal Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
- Cognitive Clinical and Computational Neuroscience Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Suzie Barker
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Emilie Brotherhood
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Claire Waddington
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Olivia Wood
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Nikki Zimmermann
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Nuriye Kupeli
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK
| | - Keir XX Yong
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Paul M Camic
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Josh Stott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
- ADAPTlab, Research Department of Clinical, Educational and Health Psychology, UCL, London, UK
| | | | - Neil P. Oxtoby
- Centre for Medical Image Computing, Department of Computer Science, UCL, London, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Anna Volkmer
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
- Psychology and Language Sciences (PALS), UCL, London, UK
| | - Sebastian J Crutch
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
| | - Jason D Warren
- Dementia Research Centre, UCL Queen Square Institute of Neurology, UCL, London, UK
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16
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Volkmer A, Cartwright J, Ruggero L, Beales A, Gallée J, Grasso S, Henry M, Jokel R, Kindell J, Khayum R, Pozzebon M, Rochon E, Taylor-Rubin C, Townsend R, Walker F, Beeke S, Hersh D. Principles and philosophies for speech and language therapists working with people with primary progressive aphasia: an international expert consensus. Disabil Rehabil 2023; 45:1063-1078. [PMID: 35352609 DOI: 10.1080/09638288.2022.2051080] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE Primary progressive aphasia (PPA) is a language-led dementia associated with Alzheimer's pathology and fronto-temporal lobar degeneration. Multiple tailored speech and language interventions have been developed for people with PPA. Speech and language therapists/speech-language pathologists (SLT/Ps) report lacking confidence in identifying the most pertinent interventions options relevant to their clients living with PPA during their illness trajectory. MATERIALS AND METHODS The aim of this study was to establish a consensus amongst 15 clinical-academic SLT/Ps on best practice in selection and delivery of speech and language therapy interventions for people with PPA. An online nominal group technique (NGT) and consequent focus group session were held. NGT rankings were aggregated and focus groups video recorded, transcribed, and reflexive thematic analysis undertaken. RESULTS The results of the NGT identified 17 items. Two main themes and seven further subthemes were identified in the focus groups. The main themes comprised (1) philosophy of person-centredness and (2) complexity. The seven subthemes were knowing people deeply, preventing disasters, practical issues, professional development, connectedness, barriers and limitations, and peer support and mentoring towards a shared understanding. CONCLUSIONS This study describes the philosophy of expert practice and outlines a set of best practice principles when working with people with PPA.Implications for rehabilitationPrimary progressive aphasia (PPA) describes a group of language led dementias which deteriorate inexorably over time.Providing speech and language therapy for people with PPA is complex and must be person centred and bespoke.This study describes the philosophy of expert practice and outlines a set of best practice principles for speech and language therapists/pathologists working with people with people with PPA.
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Affiliation(s)
- A Volkmer
- Division of Psychology and Language Sciences, University College London, London, UK
| | - J Cartwright
- Curtin School of Allied Health, Curtin University, Perth, Australia
| | - L Ruggero
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - A Beales
- Curtin School of Allied Health, Curtin University, Perth, Australia
- Community Rehabilitation Unit, Hobart, Australia
| | - J Gallée
- Division of Medical Sciences, Program in Speech and Hearing Bioscience and Technology, Harvard University, Cambridge, MA, USA
- Evergreen Speech and Hearing Clinic, Redmond, WA, USA
| | - S Grasso
- Department of Speech, Language, and Hearing Sciences, Moody College of Communication, Austin, TX, USA
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - M Henry
- Department of Speech, Language, and Hearing Sciences, Moody College of Communication, Austin, TX, USA
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, TX, USA
| | - R Jokel
- Rotman Research Institute, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
- Baycrest Health Sciences, Toronto, Canada
| | - J Kindell
- Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UK
| | - R Khayum
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- MemoryCare Corporation, Aurora, IL, USA
| | - M Pozzebon
- Speech Pathology Department, Royal Melbourne Hospital - Royal Park Campus, Melbourne, Australia
| | - E Rochon
- Department of Speech-Language Pathology and Rehabilitation Sciences Institute, University of Toronto, KITE Research Institute, Toronto Rehab, University Health Network, Toronto, Canada
| | - C Taylor-Rubin
- Speech Pathology Department, War Memorial Hospital, Sydney, Australia
- Department of Cognitive Science, Macquarie University, Sydney, Australia
| | | | - F Walker
- Speech Pathology Department, Carrington Health, Melbourne, Australia
| | - S Beeke
- Division of Psychology and Language Sciences, University College London, London, UK
| | - D Hersh
- Speech Pathology, School of Allied Health, Curtin University, Perth, Australia
- Speech Pathology, School of Medical and Health Sciences, Edith Cowan University, Perth, Australia
- School of Allied Health Science and Practice, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
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17
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Grasso SM, Wagner Rodríguez CA, Montagut Colomer N, Marqués Kiderle SK, Sánchez-Valle R, Santos Santos MÁ. Bilingual Primary Progressive Aphasia: A Scoping Review of Assessment and Treatment Practices. J Alzheimers Dis 2023; 96:1453-1476. [PMID: 37980666 PMCID: PMC10900184 DOI: 10.3233/jad-230673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
BACKGROUND Primary progressive aphasia (PPA) is a neurodegenerative syndrome characterized by speech and/or language impairment with relatively spared cognition. Research investigating behavioral speech-language intervention and methods for cognitive-linguistic assessment in PPA has predominantly centered around monolingual speakers. This gap hinders the widespread adoption of evidence-based approaches and exacerbates the inequities faced by culturally and linguistically diverse populations living with PPA. OBJECTIVE This scoping review synthesizes the current evidence for assessment and treatment practices in bilingual PPA as well as the operationalization of bilingualism in PPA. METHODS Arksey & O'Malley's scoping review methodology was utilized. Information was extracted from each study and entered into a data-charting template designed to capture information regarding operationalization of bilingualism in PPA and assessment and treatment practices. RESULTS Of the 16 identified studies, 14 reported the results of assessments conducted in both languages. Three studies reported positive naming treatment outcomes. Thirteen studies included English-speaking participants, revealing linguistic bias. Most studies reported age of acquisition, proficiency, and patterns of language use rather than providing an operational definition for bilingualism. CONCLUSIONS Neither formal assessment measures nor clear guidelines for assessment of bilingual PPA currently exist; however, language-specific measures are emerging. Speech-language intervention in bilingual PPA has been relatively unexplored, representing a significant gap in the literature. In order to improve diagnostic and treatment options for bilingual PPA, targeted efforts to increase representation of bilinguals from various sociocultural contexts, as well as those who speak a variety of language pairs, is necessary.
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Affiliation(s)
- Stephanie M Grasso
- Department of Speech, Language and Hearing Sciences, University of Texas at Austin, Austin, TX, USA
| | | | - Núria Montagut Colomer
- Alzheimer's disease and other Cognitive Disorders Unit, Service of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Sonia-Karin Marqués Kiderle
- Sant Pau Memory Unit, Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau (IIB Sant Pau) -Hospital de la Santa Creu I Sant Pau (HSP), Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED), National Institute of Health Carlos III, Spain
| | - Raquel Sánchez-Valle
- Alzheimer's disease and other Cognitive Disorders Unit, Service of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Miguel Ángel Santos Santos
- Sant Pau Memory Unit, Department of Neurology, Institut d'Investigacions Biomèdiques Sant Pau (IIB Sant Pau) -Hospital de la Santa Creu I Sant Pau (HSP), Network Center for Biomedical Research in Neurodegenerative Diseases (CIBERNED), National Institute of Health Carlos III, Spain
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Dial HR, Europa E, Grasso SM, Mandelli ML, Schaffer KM, Hubbard HI, Wauters LD, Wineholt L, Wilson SM, Gorno-Tempini ML, Henry ML. Baseline structural imaging correlates of treatment outcomes in semantic variant primary progressive aphasia. Cortex 2023; 158:158-175. [PMID: 36577212 PMCID: PMC9904210 DOI: 10.1016/j.cortex.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 02/25/2022] [Accepted: 10/12/2022] [Indexed: 12/03/2022]
Abstract
Semantic variant primary progressive aphasia (svPPA) is a neurodegenerative disorder characterized by a loss of semantic knowledge in the context of anterior temporal lobe atrophy (left > right). Core features of svPPA include anomia and single-word comprehension impairment. Despite growing evidence supporting treatment for anomia in svPPA, there is a paucity of research investigating neural mechanisms supporting treatment-induced gains and generalization to untrained items. In the current study, we examined the relation between the structural integrity of brain parenchyma (tissue inclusive of gray and white matter) at pre-treatment and treatment outcomes for trained and untrained items in a group of 19 individuals with svPPA who completed lexical retrieval treatment. Two structural neuroimaging approaches were used: an exploratory, whole-brain, voxel-wise approach and an a priori region of interest (ROI) approach. Based on previous research, bilateral temporal (inferior, middle, and superior temporal gyri), parietal (supramarginal and angular gyri), frontal (inferior and middle frontal gyri) and medial temporal (hippocampus and parahippocampal gyri) ROIs were selected from the Automated Anatomical Labeling (AAL) atlas. Analyses revealed improved naming of trained items and generalization to untrained items following treatment, providing converging evidence that individuals with svPPA can benefit from treatment for anomia. Better post-treatment naming accuracy was associated with the structural integrity of inferior parietal cortex and the hippocampus. Specifically, improved naming of trained items was related to the left supramarginal (phonological processing) and angular gyri (phonological and semantic processing), and improved naming of trained and untrained items was related to the left hippocampus (episodic, context-based memory). Future research should examine treatment outcomes in relation to pre-treatment functional and structural connectivity as well as changes in network dynamics following speech-language intervention to further elucidate the neural mechanisms underlying treatment response in svPPA and related disorders.
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Affiliation(s)
- Heather R Dial
- Department of Communication Sciences and Disorders, University of Houston, 3871 Holman St, Houston, TX, USA; Department of Speech, Language and Hearing Sciences, University of Texas at Austin, 2504A Whitis Avenue (A1100), Austin, TX USA.
| | - Eduardo Europa
- Connie L. Lurie College of Education, San Jose State University, One Washington Square, San Jose, CA, USA
| | - Stephanie M Grasso
- Department of Speech, Language and Hearing Sciences, University of Texas at Austin, 2504A Whitis Avenue (A1100), Austin, TX USA
| | - Maria Luisa Mandelli
- Memory and Aging Center, University of California, San Francisco. 675 Nelson Rising Lane (Suite 190), San Francisco, CA USA
| | - Kristin M Schaffer
- Department of Speech, Language and Hearing Sciences, University of Texas at Austin, 2504A Whitis Avenue (A1100), Austin, TX USA
| | - H Isabel Hubbard
- College of Health Sciences, University of Kentucky, 900 S. Limestone, Lexington, KY, USA
| | - Lisa D Wauters
- Department of Speech, Language and Hearing Sciences, University of Texas at Austin, 2504A Whitis Avenue (A1100), Austin, TX USA
| | - Lindsey Wineholt
- Department of Speech, Language and Hearing Sciences, University of Texas at Austin, 2504A Whitis Avenue (A1100), Austin, TX USA
| | - Stephen M Wilson
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, 1215 21st Ave S, Nashville, TN, USA
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, University of California, San Francisco. 675 Nelson Rising Lane (Suite 190), San Francisco, CA USA
| | - Maya L Henry
- Department of Speech, Language and Hearing Sciences, University of Texas at Austin, 2504A Whitis Avenue (A1100), Austin, TX USA; Department of Neurology, Dell Medical School, University of Texas at Austin, 1601 Trinity St., Bldg. B, Stop Z0700, Austin, TX USA
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Jokel R. Maintenance and Generalization of Lexical Items in Primary Progressive Aphasia: Reflections From the Roundtable Discussion at the 2021 Clinical Aphasiology Conference. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:2395-2403. [PMID: 35623322 DOI: 10.1044/2022_ajslp-21-00275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Our capacity to engage in society and maintain meaningful relationships is dependent on intact communication skills. They are compromised in a neurodegenerative language disorder termed primary progressive aphasia (PPA). Behavioral interventions for PPA are sparse and often limited to impairment-based approaches or communication skills training, although various functional interventions have been also described. The slow but relentless language decline does not naturally support maintenance and/or generalization of treatment gains, which should be the ultimate goal of any therapy. However, in some cases and under certain conditions, maintenance and generalization may be accomplished. While each type of intervention has much to offer to the PPA population, the clinical and research realms can benefit from a collective professional discussion on aspects of intervention conducive to maintenance and/or generalization of treatment gains in PPA. Such a discussion took place at the 2021 Clinical Aphasiology Conference during two roundtable sessions. The aims of the sessions were to review the premises of successful treatment approaches in PPA and to discuss factors fostering or inhibiting maintenance and generalization in PPA. CONCLUSIONS Current literature delivers, albeit in small doses, encouraging evidence for clinicians providing language intervention to patients with PPA. Although PPA is a progressive disorder, both the immediate treatment effects and, in many cases, evidence of maintenance and generalization demonstrate that improvements may be long lasting and transferrable. Several factors may enhance maintenance and generalization effects, including repeated practice, working with multiple exemplars of treatment items, booster sessions, group programs with built-in individual sessions, spared semantics, and personal relevance, to name a few. With this evidence in hand, we need to become more diligent about measuring and reporting clinical outcomes and delivering interventions that support maintenance and generalization of therapeutic gains beyond the clinician's office. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.19836370.
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Affiliation(s)
- Regina Jokel
- Rotman Research Institute, Toronto, Ontario, Canada
- Baycrest Health Sciences, Toronto, Ontario, Canada
- University of Toronto, Ontario, Canada
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Caramelli P, Marinho V, Laks J, Coletta MVD, Stella F, Camargos EF, Smid J, Barbosa BJAP, Schilling LP, Balthazar MLF, Frota NAF, Souza LCD, Vale FAC, Chaves MLF, Brucki SMD, Nitrini R, Durgante HB, Bertolucci PHF. Treatment of dementia: recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology. Dement Neuropsychol 2022. [DOI: 10.1590/1980-5764-dn-2022-s106en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
ABSTRACT There is currently no cure for neurodegenerative or vascular dementias, but some pharmacological and non-pharmacological interventions may contribute to alleviate symptoms, slow disease progression and improve quality of life. Current treatment approaches are based on etiology, symptom profile and stage of dementia. This manuscript presents recommendations on pharmacological and non-pharmacological treatments of dementia due to Alzheimer’s disease, vascular cognitive impairment, frontotemporal dementia, Parkinson’s disease dementia, and dementia with Lewy bodies.
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Affiliation(s)
| | | | - Jerson Laks
- Universidade Federal do Rio de Janeiro, Brasil; Universidade do Estado do Rio de Janeiro, Brasil
| | | | - Florindo Stella
- Universidade Estadual Paulista, Brasil; Universidade de São Paulo, Brasil
| | | | | | - Breno José Alencar Pires Barbosa
- Universidade de São Paulo, Brasil; Universidade Federal de Pernambuco, Brasil; Instituto de Medicina Integral Prof. Fernando Figueira, Brasil
| | - Lucas Porcello Schilling
- Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil
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21
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Caramelli P, Marinho V, Laks J, Coletta MVD, Stella F, Camargos EF, Smid J, Barbosa BJAP, Schilling LP, Balthazar MLF, Frota NAF, Souza LCD, Vale FAC, Chaves MLF, Brucki SMD, Nitrini R, Durgante HB, Bertolucci PHF. Tratamento da demência: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. Dement Neuropsychol 2022; 16:88-100. [DOI: 10.1590/1980-5764-dn-2022-s106pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/27/2022] [Accepted: 04/27/2022] [Indexed: 11/30/2022] Open
Abstract
RESUMO Atualmente não há tratamento curativo para as demências neurodegenerativas ou para a demência vascular, mas algumas intervenções farmacológicas e não farmacológicas podem contribuir para aliviar os sintomas, retardar a progressão da doença e melhorar a qualidade de vida. As abordagens terapêuticas atuais são baseadas na etiologia, no perfil dos sintomas e no estágio da demência. Neste artigo apresentamos recomendações sobre os tratamentos farmacológicos e não farmacológicos da demência devida à doença de Alzheimer, comprometimento cognitivo vascular, demência frontotemporal, demência da doença de Parkinson e demência com corpos de Lewy.
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Affiliation(s)
| | | | - Jerson Laks
- Universidade Federal do Rio de Janeiro, Brasil; Universidade do Estado do Rio de Janeiro, Brasil
| | | | - Florindo Stella
- Universidade Estadual Paulista, Brasil; Universidade de São Paulo, Brasil
| | | | | | - Breno José Alencar Pires Barbosa
- Universidade de São Paulo, Brasil; Universidade Federal de Pernambuco, Brasil; Instituto de Medicina Integral Prof. Fernando Figueira, Brasil
| | - Lucas Porcello Schilling
- Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil; Pontifícia Universidade do Rio Grande do Sul, Brasil
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22
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Association of Long-Term Speech Therapy and Neuromodulation in Primary Progressive Aphasia: Lessons from a Case Report. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2022. [DOI: 10.3390/ctn6030017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Primary progressive aphasia (PPA) is a neurodegenerative disorder with a progressive loss of language. Long-term support requires speech therapy but also individually set training programs. Here we propose an 8-month individualized speech-training program which alternates 3-week periods of transcranial direct current stimulation (tDCS) treatment with intensive daily language exercises and a 3-week period without tDCS treatment and a less intensive language exercise from home in a patient with non-fluent variant PPA (nfvPPA). The endpoints were the following: adherence to this program, language data after 8 months, questionnaires related to emotional valence, and brain volume changes. The results showed a persistent adherence after 8 months and a positive compliance reported by both the patient and the partner. The language evaluation showed a clinical stabilization. Moreover, a significant and positive influence of tDCS on mood was observed. This is, to our knowledge, the first ever published report of a combined neuromodulation and language training during the course of 8 months. Our finding suggests the feasibility of programs integrating hospital speech therapy, home training, and tDCS modulation in PPA. Further studies should be conducted in order to disentangle the contextual influences on language performance from the tDCS intervention effects and to address the observation of an initial improvement and a subsequent stabilization effect of language performances.
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Stockbridge MD, Tippett DC, Breining BL, Hillis AE. When words first fail: Predicting the emergence of primary progressive aphasia variants from unclassifiable anomic performance in early disease. APHASIOLOGY 2022; 37:1173-1185. [PMID: 37377938 PMCID: PMC10292722 DOI: 10.1080/02687038.2022.2084706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
Background The majority of patients with primary progressive aphasia (PPA) can be distinguished into one of three variants: semantic, non-fluent/agrammatic, or logopenic. However, many do not meet criteria for any one variant. Aim To identify aspects of cognitive-linguistic performance that yield an early unclassifiable PPA designation that predicted the later emergence of a given variant. Methods & Procedures Of 256 individuals with PPA evaluated, 19 initially were unclassifiable and later met criteria for a variant. Receiver operating characteristic curves were used to evaluate the binary ability of a given task to predict eventual classification as a given variant. Tasks with a high area under the curve were examined using regression analyses to determine their ability to predict variant. Outcomes & Results High mean predictive value was observed for multiple naming assessments targeting nouns and verbs. The Boston Naming Test (BNT) was the only test that, in isolation, resulted in a significant model and high classification accuracy. Conclusions Although naming impairment is common across PPA variants, very low initial BNT scores emerged as a uniquely accurate basis for predicting eventual semantic variant, and normal BNT scores predicted eventual nonfluent/agrammatic variant. High performance on picture-verb verification was useful in identifying future lvPPA.
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Affiliation(s)
- Melissa D. Stockbridge
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287
| | - Donna C. Tippett
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287
- Department of Otolaryngology – Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD 21287
| | - Bonnie L. Breining
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD 21287
- Department of Cognitive Science, Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD 21218
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24
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Stalpaert J, Standaert S, D’Helft L, Miatton M, Sieben A, Van Langenhove T, Duyck W, van Mierlo P, De Letter M. Therapy-Induced Electrophysiological Changes in Primary Progressive Aphasia: A Preliminary Study. Front Hum Neurosci 2022; 16:766866. [PMID: 35431838 PMCID: PMC9008202 DOI: 10.3389/fnhum.2022.766866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
AimsThis preliminary study aimed to investigate therapy-induced electrophysiological changes in persons with primary progressive aphasia (PPA). The investigated event-related potential (ERP) components associated with language processing were the mismatch negativity, P300, N400, and P600.MethodsA linguistic ERP test battery and standardized language assessment were administered in four patients with PPA of which two received speech-language therapy (SLT) and two did not receive therapy. The battery was administered twice with approximately 6 months in between in each patient. The results of the follow-up assessments were compared to the results of the initial assessments.ResultsAlthough the results of the behavioral language assessment remained relatively stable between the initial and follow-up assessments, changes in the mean amplitudes, onset latencies, and duration of the ERP components were found in the four patients. In the two patients that did not receive SLT, an increased delay in 50% and a decreased mean amplitude in 25% of the measured ERP components were found. The electrophysiological changes found in the patients that received SLT were variable. Interestingly, the mismatch negativity and the N400 effect elicited by the categorical priming paradigm were less delayed and had an increased mean amplitude at the follow-up assessment in the patient with the non-fluent variant who received SLT. In this patient, the P600 component was absent at the initial assessment but present at the follow-up assessment.ConclusionAlthough no clear patterns in electrophysiological changes between patients who received SLT and patients who did not receive SLT were found by our preliminary study, it seems like the SLT induced improvements or compensation mechanisms in some specific language comprehension processes in the patient with the NFV. The results of this study are still preliminary because only four heterogeneous patients were included. Future studies should include larger patient groups of the three clinical variants because the therapy-induced electrophysiological changes might differ depending on the clinical variant and the underlying pathology.
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Affiliation(s)
- Jara Stalpaert
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
- *Correspondence: Jara Stalpaert,
| | | | - Lien D’Helft
- Logopediepraktijk Bieke Van Waeyenberghe, Lievegem, Belgium
| | - Marijke Miatton
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Anne Sieben
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | | | - Wouter Duyck
- Department of Experimental Psychology, Ghent University, Ghent, Belgium
| | - Pieter van Mierlo
- Medical Image and Signal Processing Group, Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
| | - Miet De Letter
- Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
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25
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Sanches C, Amzallag F, Dubois B, Lévy R, Truong DQ, Bikson M, Teichmann M, Valero-Cabré A. Evaluation of the effect of transcranial direct current stimulation on language impairments in the behavioural variant of frontotemporal dementia. Brain Commun 2022; 4:fcac050. [PMID: 35356034 PMCID: PMC8963324 DOI: 10.1093/braincomms/fcac050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 12/05/2021] [Accepted: 03/24/2022] [Indexed: 11/30/2022] Open
Abstract
The behavioural variant of frontotemporal dementia is a neurodegenerative disease characterized by bilateral atrophy of the prefrontal cortex, gradual deterioration of behavioural and executive capacities, a breakdown of language initiation and impaired search mechanisms in the lexicon. To date, only a few studies have analysed the modulation of language deficits in the behavioural variant of frontotemporal dementia patients with transcranial direct current stimulation, yet with inconsistent results. Our goal was to assess the impact on language performance of a single session of transcranial direct current stimulation on patients with the behavioural variant of frontotemporal dementia. Using a sham-controlled double-blind crossover design in a cohort of behavioural frontotemporal dementia patients (n = 12), we explored the impact on language performance of a single transcranial direct current stimulation session delivering anodal or cathodal transcranial direct current stimulation, over the left and right dorsolateral prefrontal cortex, compared with sham stimulation. A Letter fluency and a Picture naming task were performed prior and following transcranial direct current stimulation, to assess modulatory effects on language. Behavioural frontotemporal dementia patients were impaired in all evaluation tasks at baseline compared with healthy controls. Computational finite element method (FEM) models of cortical field distribution corroborated expected impacts of left-anodal and right-cathodal transcranial direct current stimulation over the dorsolateral prefrontal cortex and showed lower radial field strength in case of atrophy. However, none of the two tasks showed statistically significant evidence of language improvement caused by active transcranial direct current stimulation compared with sham. Our findings do not argue in favour of pre-therapeutic effects and suggest that stimulation strategies evaluating the modulatory role of transcranial direct current stimulation in the behavioural variant of frontotemporal dementia must carefully weigh the influence of symptom severity and cortical atrophy affecting prefrontal regions to ensure clinical success.
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Affiliation(s)
- Clara Sanches
- Groupe de Dynamiques Cérébrales, Plasticité et Rééducation, FRONTLAB team, Institut du Cerveau et de la Moelle Epinière, CNRS UMR 7225, INSERM 1127, Sorbonne Université, Paris, France
| | - Fanny Amzallag
- Groupe de Dynamiques Cérébrales, Plasticité et Rééducation, FRONTLAB team, Institut du Cerveau et de la Moelle Epinière, CNRS UMR 7225, INSERM 1127, Sorbonne Université, Paris, France
| | - Bruno Dubois
- Groupe de Dynamiques Cérébrales, Plasticité et Rééducation, FRONTLAB team, Institut du Cerveau et de la Moelle Epinière, CNRS UMR 7225, INSERM 1127, Sorbonne Université, Paris, France
- Department of Neurology, National Reference Center for « PPA and rare dementias », Pitié Salpêtrière Hospital, AP-HP, Paris, France
| | - Richard Lévy
- Groupe de Dynamiques Cérébrales, Plasticité et Rééducation, FRONTLAB team, Institut du Cerveau et de la Moelle Epinière, CNRS UMR 7225, INSERM 1127, Sorbonne Université, Paris, France
- Department of Neurology, National Reference Center for « PPA and rare dementias », Pitié Salpêtrière Hospital, AP-HP, Paris, France
| | - Dennis Q. Truong
- Neural Engineering Laboratory, Department of Biomedical Engineering, The City College of City University of New York, New York, NY, USA
| | - Marom Bikson
- Neural Engineering Laboratory, Department of Biomedical Engineering, The City College of City University of New York, New York, NY, USA
| | - Marc Teichmann
- Groupe de Dynamiques Cérébrales, Plasticité et Rééducation, FRONTLAB team, Institut du Cerveau et de la Moelle Epinière, CNRS UMR 7225, INSERM 1127, Sorbonne Université, Paris, France
- Department of Neurology, National Reference Center for « PPA and rare dementias », Pitié Salpêtrière Hospital, AP-HP, Paris, France
| | - Antoni Valero-Cabré
- Groupe de Dynamiques Cérébrales, Plasticité et Rééducation, FRONTLAB team, Institut du Cerveau et de la Moelle Epinière, CNRS UMR 7225, INSERM 1127, Sorbonne Université, Paris, France
- Laboratory for Cerebral Dynamics Plasticity and Rehabilitation, Boston University School of Medicine, Boston, MA, USA
- Cognitive Neuroscience and Information Technology Research Program, Open University of Catalonia (UOC), Barcelona, Spain
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Rao LA, Roberts AC, Schafer R, Rademaker A, Blaze E, Esparza M, Salley E, Coventry C, Weintraub S, Mesulam MM, Rogalski E. The Reliability of Telepractice Administration of the Western Aphasia Battery-Revised in Persons With Primary Progressive Aphasia. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:881-895. [PMID: 35175852 PMCID: PMC9150668 DOI: 10.1044/2021_ajslp-21-00150] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/17/2021] [Accepted: 11/08/2021] [Indexed: 05/09/2023]
Abstract
PURPOSE The use of telepractice in the field of communication disorders offers an opportunity to provide care for those with primary progressive aphasia (PPA). The Western Aphasia Battery-Revised (WAB-R) is used for differential diagnosis, to assess severity of aphasia, and to identify a language profile of strengths and challenges. Telehealth administration of the WAB-R is supported for those with chronic aphasia due to stroke but has not yet been systematically explored in neurodegenerative dementia syndromes. To fill this gap, in-person and telehealth performance on the WAB-R from participants with mild to moderate PPA was compared. METHOD Nineteen participants with mild to moderate PPA were administered the WAB-R in person and over videoconferencing. Videoconferencing administration included modifications to the testing protocol to ensure smooth completion of the assessment. Subtest and Aphasia Quotient (WAB-AQ) summary scores were compared using concordance coefficients to measure the relationship between the administration modes. RESULTS In-person and telehealth scores showed strong concordance for the WAB-AQ, Auditory Verbal Comprehension subtest, and Naming & Word Finding subtest. The Spontaneous Speech test summary score had slightly lower concordance, indicating the need for caution when comparing these scores across administration modes. CONCLUSION These findings support extending the use of telehealth administration of the WAB-R via videoconferencing to those with mild to moderate PPA given appropriate modifications to testing protocol.
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Affiliation(s)
- Leela A. Rao
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Angela C. Roberts
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL
| | - Rhiana Schafer
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alfred Rademaker
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Preventative Medicine (Biostatistics), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Erin Blaze
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Marissa Esparza
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Elizabeth Salley
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Christina Coventry
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sandra Weintraub
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine
| | - M.-Marsel Mesulam
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Emily Rogalski
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine
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27
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Robinaugh G, Henry ML. Behavioral interventions for primary progressive aphasia. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:221-240. [PMID: 35078600 DOI: 10.1016/b978-0-12-823384-9.00011-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Primary progressive aphasia (PPA) is a neurodegenerative syndrome characterized by a gradual loss of communication ability. Due to the centrality of communication deficits, speech-language pathologists play a prominent role in the provision of care for individuals with PPA. In this chapter, we outline a person-centered approach to the management of PPA that aims to preserve independence for as long as possible while anticipating future decline in communication and other domains. A growing evidence base supports the utility of speech-language treatment approaches in PPA, including restitutive, compensatory, and communication partner-focused techniques. Restitutive interventions aim to rebuild lost communication skills, such as naming or fluent speech production. Compensatory approaches include training with high- and low-tech augmentative and alternative communication systems that provide complementary means of communication beyond speech. Communication partner interventions focus on education and strategy training in order to equip conversation partners as skilled communication facilitators. Throughout intervention, clinicians should aim to provide treatment that impacts functional communication and promotes social engagement. Given the documented benefits of speech-language intervention in PPA, we are optimistic that such treatment will become the standard of care and that additional research will continue to improve the quality and accessibility of behavioral interventions.
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Affiliation(s)
- Gary Robinaugh
- Department of Speech, Language, and Hearing Sciences, University of Texas, Austin, TX, United States
| | - Maya L Henry
- Department of Speech, Language, and Hearing Sciences, University of Texas, Austin, TX, United States.
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28
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Semantic Variant Primary Progressive Aphasia: Practical Recommendations for Treatment from 20 Years of Behavioural Research. Brain Sci 2021; 11:brainsci11121552. [PMID: 34942854 PMCID: PMC8699306 DOI: 10.3390/brainsci11121552] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 12/01/2022] Open
Abstract
People with semantic variant primary progressive aphasia (svPPA) present with a characteristic progressive breakdown of semantic knowledge. There are currently no pharmacological interventions to cure or slow svPPA, but promising behavioural approaches are increasingly reported. This article offers an overview of the last two decades of research into interventions to support language in people with svPPA including recommendations for clinical practice and future research based on the best available evidence. We offer a lay summary in English, Spanish and French for education and dissemination purposes. This paper discusses the implications of right- versus left-predominant atrophy in svPPA, which naming therapies offer the best outcomes and how to capitalise on preserved long-term memory systems. Current knowledge regarding the maintenance and generalisation of language therapy gains is described in detail along with the development of compensatory approaches and educational and support group programmes. It is concluded that there is evidence to support an integrative framework of treatment and care as best practice for svPPA. Such an approach should combine rehabilitation interventions addressing the language impairment, compensatory approaches to support activities of daily living and provision of education and support within the context of dementia.
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Savage SA, Lampe LF, Nickels L. No negative impact of word retraining on vocabulary use or clarity of communication in semantic dementia. Neuropsychol Rehabil 2021; 33:193-225. [PMID: 34775908 DOI: 10.1080/09602011.2021.1993934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Word retraining techniques can improve picture naming of treated items in people with semantic dementia (SD). The utility of this, however, has been questioned given the propensity for under- and overgeneralization errors in naming in SD. Few studies have investigated the occurrence of such errors. This study examined whether, following tailored word retraining: (1) misuse of words increases, (2) the type of naming errors changes, and/or (3) clarity of communication is reduced. Performance on trained and untrained word naming from nine participants with SD who completed a word retraining programme were analysed. Responses from baseline and post-intervention assessments were coded for misuse (i.e., trained word produced for another target item), error type, and communication clarity. All participants showed significant improvement for trained vocabulary. There was no significant increase in misuse of words, with such errors occurring rarely. At a group level, there was an increased tendency toward omission errors for untrained items, and a reduction in semantically related responses. However, this did not impact on clarity scores with no consistent change across participants. In sum, we found no negative impacts following tailored word retraining, providing further evidence of the benefit of these programmes for individuals with SD.
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Affiliation(s)
- Sharon A Savage
- School of Psychological Sciences, The University of Newcastle, Callaghan, Australia
| | - Leonie F Lampe
- Department of Cognitive Science, Macquarie University, Sydney, Australia.,International Doctorate for Experimental Approaches to Language and Brain (IDEALAB), Universities of Groningen (NL), Potsdam (DE), Newcastle (UK) and Macquarie University, Sydney (AU)
| | - Lyndsey Nickels
- Department of Cognitive Science, Macquarie University, Sydney, Australia
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Grasso SM, Peña ED, Kazemi N, Mirzapour H, Neupane R, Bonakdarpour B, Gorno-Tempini ML, Henry ML. Treatment for Anomia in Bilingual Speakers with Progressive Aphasia. Brain Sci 2021; 11:1371. [PMID: 34827370 PMCID: PMC8615710 DOI: 10.3390/brainsci11111371] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/09/2021] [Accepted: 10/09/2021] [Indexed: 11/17/2022] Open
Abstract
Anomia is an early and prominent feature of primary progressive aphasia (PPA) and other neurodegenerative disorders. Research investigating treatment for lexical retrieval impairment in individuals with progressive anomia has focused primarily on monolingual speakers, and treatment in bilingual speakers is relatively unexplored. In this series of single-case experiments, 10 bilingual speakers with progressive anomia received lexical retrieval treatment designed to engage relatively spared cognitive-linguistic abilities and promote word retrieval. Treatment was administered in two phases, with one language targeted per phase. Cross-linguistic cognates (e.g., rose and rosa) were included as treatment targets to investigate their potential to facilitate cross-linguistic transfer. Performance on trained and untrained stimuli was evaluated before, during, and after each phase of treatment, and at 3, 6, and 12 months post-treatment. Participants demonstrated a significant treatment effect in each of their treated languages, with maintenance up to one year post-treatment for the majority of participants. Most participants showed a significant cross-linguistic transfer effect for trained cognates in both the dominant and nondominant language, with fewer than half of participants showing a significant translation effect for noncognates. A gradual diminution of translation and generalization effects was observed during the follow-up period. Findings support the implementation of dual-language intervention approaches for bilingual speakers with progressive anomia, irrespective of language dominance.
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Affiliation(s)
- Stephanie M. Grasso
- Department of Speech, Language and Hearing Sciences, University of Texas, Austin, TX 78705, USA; (N.K.); (H.M.); (R.N.); (M.L.H.)
| | - Elizabeth D. Peña
- School of Education, University of California, Irvine, CA 92697, USA;
| | - Nina Kazemi
- Department of Speech, Language and Hearing Sciences, University of Texas, Austin, TX 78705, USA; (N.K.); (H.M.); (R.N.); (M.L.H.)
| | - Haideh Mirzapour
- Department of Speech, Language and Hearing Sciences, University of Texas, Austin, TX 78705, USA; (N.K.); (H.M.); (R.N.); (M.L.H.)
| | - Rozen Neupane
- Department of Speech, Language and Hearing Sciences, University of Texas, Austin, TX 78705, USA; (N.K.); (H.M.); (R.N.); (M.L.H.)
| | - Borna Bonakdarpour
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA;
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, CA 94143, USA;
| | - Maya L. Henry
- Department of Speech, Language and Hearing Sciences, University of Texas, Austin, TX 78705, USA; (N.K.); (H.M.); (R.N.); (M.L.H.)
- Department of Neurology, Dell Medical School, University of Texas, Austin, TX 78705, USA
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31
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Coemans S, Struys E, Vandenborre D, Wilssens I, Engelborghs S, Paquier P, Tsapkini K, Keulen S. A Systematic Review of Transcranial Direct Current Stimulation in Primary Progressive Aphasia: Methodological Considerations. Front Aging Neurosci 2021; 13:710818. [PMID: 34690737 PMCID: PMC8530184 DOI: 10.3389/fnagi.2021.710818] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022] Open
Abstract
A variety of tDCS approaches has been used to investigate the potential of tDCS to improve language outcomes, or slow down the decay of language competences caused by Primary Progressive Aphasia (PPA). The employed stimulation protocols and study designs in PPA are generally speaking similar to those deployed in post-stroke aphasic populations. These two etiologies of aphasia however differ substantially in their pathophysiology, and for both conditions the optimal stimulation paradigm still needs to be established. A systematic review was done and after applying inclusion and exclusion criteria, 15 articles were analyzed focusing on differences and similarities across studies especially focusing on PPA patient characteristics (age, PPA variant, language background), tDCS stimulation protocols (intensity, frequency, combined therapy, electrode configuration) and study design as recent reviews and group outcomes for individual studies suggest tDCS is an effective tool to improve language outcomes, while methodological approach and patient characteristics are mentioned as moderators that may influence treatment effects. We found that studies of tDCS in PPA have clinical and methodological and heterogeneity regarding patient populations, stimulation protocols and study design. While positive group results are usually found irrespective of these differences, the magnitude, duration and generalization of these outcomes differ when comparing stimulation locations, and when results are stratified according to the clinical variant of PPA. We interpret the results of included studies in light of patient characteristics and methodological decisions. Further, we highlight the role neuroimaging can play in study protocols and interpreting results and make recommendations for future work.
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Affiliation(s)
- Silke Coemans
- Clinical and Experimental Neurolinguistics, CLIEN, Vrije Universiteit Brussel, Brussels, Belgium
| | - Esli Struys
- Clinical and Experimental Neurolinguistics, CLIEN, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
| | - Dorien Vandenborre
- Department of Speech and Language Pathology, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Ineke Wilssens
- Department of Speech and Language Pathology, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Sebastiaan Engelborghs
- Center for Neurosciences (C4N), Vrije Universiteit Brussel, Brussels, Belgium
- Department of Neurology, Universitair Ziekenhuis Brussel, Brussels, Belgium
- Reference Center for Biological Markers of Dementia, BIODEM, Institute Born-Bunge, Universiteit Antwerpen, Antwerp, Belgium
| | - Philippe Paquier
- Clinical and Experimental Neurolinguistics, CLIEN, Vrije Universiteit Brussel, Brussels, Belgium
- Center for Research in Cognition and Neurosciences (CRCN), Université Libre de Bruxelles, Antwerp, Belgium
- Department of Translational Neurosciences (TNW), Universiteit Antwerpen, Antwerp, Belgium
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, United States
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, United States
| | - Stefanie Keulen
- Clinical and Experimental Neurolinguistics, CLIEN, Vrije Universiteit Brussel, Brussels, Belgium
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32
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Schaffer KM, Henry ML. Counseling and Care Partner Training in Primary Progressive Aphasia. PERSPECTIVES OF THE ASHA SPECIAL INTEREST GROUPS 2021; 6:1015-1025. [PMID: 35935167 PMCID: PMC9351599 DOI: 10.1044/2021_persp-20-00296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
PURPOSE Individuals with primary progressive aphasia (PPA) experience loss of communication abilities in the context of neurodegenerative disease. Consequently, many individuals with PPA endorse negative psychosocial effects, including social isolation, reduced communication confidence, and depression. Incorporating communication-centered counseling early and often within the speech-language pathology treatment framework is a vital component in holistically addressing the multifaceted ramifications of living with this devastating disorder. Additionally, care partners are key stakeholders in the treatment dynamic. Involving these individuals in the treatment paradigm through care partner training is crucial for facilitating optimal communication in daily life. The purpose of this narrative literature review is to discuss existing research regarding counseling and care partner training in PPA and to outline additional treatment considerations and future research needs in this understudied area. CONCLUSIONS Relative to studies that delineate restitutive speech-language interventions for PPA, the literature pertaining to counseling and care partner training is limited. Available evidence supports the utility of these approaches, which serve as complementary components to restitutive and compensatory speech-language intervention. Additional research is warranted to support generalizability and long-term benefit of these interventions, and to address facets of counseling and care partner training that have not been explored in PPA (e.g., counseling interventions drawing from specific psychotherapeutic traditions; multicultural counseling) or have only been explored to a limited degree (e.g., interventions that jointly provide counseling and partner training).
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Affiliation(s)
- Kristin M. Schaffer
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
| | - Maya L. Henry
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
- Dell Medical School, The University of Texas at Austin
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Montagut N, Borrego-Écija S, Castellví M, Rico I, Reñé R, Balasa M, Lladó A, Sánchez-Valle R. Errorless Learning Therapy in Semantic Variant of Primary Progressive Aphasia. J Alzheimers Dis 2021; 79:415-422. [PMID: 33285632 DOI: 10.3233/jad-200904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The semantic variant of primary progressive aphasia (svPPA) is characterized by a progressive loss of semantic knowledge impairing the ability to name and to recognize the meaning of words. OBJECTIVE We aimed to evaluate the immediate and short-term effect of errorless learning speech therapy on the naming and recognition of commonly used words in patients with svPPA. METHODS Eight participants diagnosed with svPPA received 16 sessions of intensive errorless learning speech therapy. Naming and word comprehension tasks were evaluated at baseline, immediately postintervention, and at follow-up after 1, 3, and 6 months. These evaluations were performed using two item sets (a trained list and an untrained list). RESULTS In the naming tasks, patients showed a significant improvement in trained items immediately after the intervention, but that improvement decayed progressively when therapy ended. No improvements were found either in trained comprehension or in untrained tasks. CONCLUSION Errorless learning therapy could improve naming ability in patients with svPPA. This effect may be due to the relative preservation of episodic memory, but the benefit is not maintained over time, presumably because there is no consolidation.
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Affiliation(s)
- Núria Montagut
- Alzheimer's disease and other cognitive disorders Unit, Neurology Service, Hospital Clinic, Barcelona, Spain
| | - Sergi Borrego-Écija
- Alzheimer's disease and other cognitive disorders Unit, Neurology Service, Hospital Clinic, Barcelona, Spain.,Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona, Spain
| | - Magdalena Castellví
- Alzheimer's disease and other cognitive disorders Unit, Neurology Service, Hospital Clinic, Barcelona, Spain
| | - Immaculada Rico
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Ramón Reñé
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain.,University of Barcelona, Barcelona, Spain
| | - Mircea Balasa
- Alzheimer's disease and other cognitive disorders Unit, Neurology Service, Hospital Clinic, Barcelona, Spain.,Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona, Spain
| | - Albert Lladó
- Alzheimer's disease and other cognitive disorders Unit, Neurology Service, Hospital Clinic, Barcelona, Spain.,Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona, Spain
| | - Raquel Sánchez-Valle
- Alzheimer's disease and other cognitive disorders Unit, Neurology Service, Hospital Clinic, Barcelona, Spain.,Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona, Spain.,University of Barcelona, Barcelona, Spain
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34
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Machado TH, Carthery-Goulart MT, Campanha AC, Caramelli P. Cognitive Intervention Strategies Directed to Speech and Language Deficits in Primary Progressive Aphasia: Practice-Based Evidence from 18 Cases. Brain Sci 2021; 11:brainsci11101268. [PMID: 34679333 PMCID: PMC8533834 DOI: 10.3390/brainsci11101268] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/16/2021] [Accepted: 09/18/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Practice-based evidence can inform and support clinical decision making. Case-report series about the implementation of programs in real-world clinical settings may contribute to verifying the effectiveness of interventions for treating PPA in specific contexts, as well as illustrating challenges that need to be overcome. OBJECTIVE To describe and provide practice-based evidence on the effectiveness of four cognitive rehabilitation programs designed for individuals with PPA and directed to speech and language impairments, which were implemented in a specialized outpatient clinic. METHODS Multiple single-case study. Eighteen individuals with different subtypes of PPA were each assigned to one out of four training programs based on comprehensive speech and language assessments. The treatments targeted naming deficits, sentence production, speech apraxia, and phonological deficits. Pre- and post-treatment assessments were undertaken to compare trained and untrained items. Gains were generalized to a different task in the first two types of intervention (naming and sentence production). A follow-up assessment was conducted 1-8 months after treatment among 7 participants. RESULTS All individuals presented better performance in the trained items at the post-test for each rehabilitation program accomplished, demonstrating that learning of the trained strategies was achieved during the active phase of treatment. For 13 individuals, statistical significance was reached; while for five, the results were maintained. Results about untrained items, generalization to other tasks, and follow-up assessments are presented. CONCLUSIONS The positive results found in our sample bring some practice-based evidence for the benefits of speech and language treatment strategies for clinical management of individuals with PPA.
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Affiliation(s)
- Thais Helena Machado
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil;
- Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil;
- Av Prudente de Morais, 290-Sala 1106, Belo Horizonte 30380-002, MG, Brazil
- Correspondence:
| | - Maria Teresa Carthery-Goulart
- Grupo de Estudos em Neurociência da Linguagem e Cognição, Núcleo Interdisciplinar de Neurociência Aplicada, Centro de Matemática, Computação e Cognição da Universidade Federal do ABC, São Bernardo do Campo 09210-580, SP, Brazil;
- Grupo de Neurologia Cognitiva e do Comportamento, Divisão de Clínica Neurológica, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo 05403-000, SP, Brazil
- INCT-ECCE (Instituto Nacional de Ciência e Tecnologia sobre Comportamento, Cognição e Ensino), Rodovia Washington Luís, Km 235, São Carlos 13565-905, SP, Brazil
| | - Aline Carvalho Campanha
- Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil;
| | - Paulo Caramelli
- Programa de Pós-Graduação em Ciências Aplicadas à Saúde do Adulto, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil;
- Grupo de Pesquisa em Neurologia Cognitiva e do Comportamento, Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil;
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35
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Schaffer KM, Evans WS, Dutcher CD, Philburn C, Henry ML. Embedding Aphasia-Modified Cognitive Behavioral Therapy in Script Training for Primary Progressive Aphasia: A Single-Case Pilot Study. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2053-2068. [PMID: 34314249 PMCID: PMC8759527 DOI: 10.1044/2021_ajslp-20-00361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/25/2021] [Accepted: 03/25/2021] [Indexed: 06/13/2023]
Abstract
Purpose This study sought to determine the initial feasibility and benefit of a novel intervention that combines speech-language treatment with counseling treatment for an individual with the nonfluent/agrammatic variant of primary progressive aphasia (PPA). Method Using a single-case experimental design, we evaluated the utility of modified script training paired with aphasia-modified cognitive behavioral therapy. The study employed a multiple baseline design across scripts for the primary linguistic outcome measure and a mixed methods approach for analyzing counseling outcomes. Psychosocial and communicative functioning scales were administered in conjunction with a phenomenological analysis of semi-structured interviews. Results The participant completed all study phases and participated in all treatment components. She met the criterion of 90% correct, intelligible scripted words on all trained scripts through 12 months post-treatment. Treatment outcomes were comparable to a comparison cohort that received script training without counseling (Henry et al., 2018). At post-treatment, the participant demonstrated stability or improvement on all measures of psychosocial and communicative functioning, with stability documented on seven out of 11 scales at follow-ups through 12 months post-treatment. A phenomenological analysis revealed pervasive themes of loss and resilience at both time points, and emerging themes of positive self-perception, sense of agency, and emotional attunement following treatment. Conclusions Results indicate that script training with aphasia-modified cognitive behavioral therapy is a feasible treatment for an individual with the nonfluent/agrammatic variant of PPA, with immediate and lasting benefits to speech-language production and psychosocial functioning. These findings are the first to support the integration of personal adjustment counseling techniques within a speech-language treatment paradigm for PPA. Supplemental Material https://doi.org/10.23641/asha.14925330.
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Affiliation(s)
- Kristin M. Schaffer
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
| | - William S. Evans
- Department of Communication Sciences and Disorders, University of Pittsburgh, PA
| | | | | | - Maya L. Henry
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
- Dell Medical School, The University of Texas at Austin
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36
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Pagnoni I, Gobbi E, Premi E, Borroni B, Binetti G, Cotelli M, Manenti R. Language training for oral and written naming impairment in primary progressive aphasia: a review. Transl Neurodegener 2021; 10:24. [PMID: 34266501 PMCID: PMC8282407 DOI: 10.1186/s40035-021-00248-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary progressive aphasia (PPA) is a neurodegenerative disorder characterized by a gradual, insidious and progressive loss of language abilities, with naming difficulties being an early and persistent impairment common to all three variants. In the absence of effective pharmacological treatments and given the progressive nature of the disorder, in the past few decades, many studies have investigated the effectiveness of language training to minimize the functional impact of word-finding difficulties in daily life. MAIN BODY We review language treatments most commonly used in clinical practice among patients with different variants of PPA, with a focus on the enhancement of spoken and written naming abilities. Generalization of gains to the ability to name untrained stimuli or to other language abilities and the maintenance of these results over time are also discussed. Forty-eight studies were included in this literature review, identifying four main types of language treatment: a) lexical retrieval treatment, b) phonological and/or orthographic treatment, c) semantic treatment, and d) a multimodality approach treatment. Overall, language training is able to induce immediate improvements of naming abilities in all variants of PPA. Moreover, despite the large variability among results, generalization and long-term effects can be recorded after the training. The reviewed studies also suggest that one factor that determines the choice of a particular approach is the compromised components of the lexical/semantic processing system. CONCLUSION The majority of studies have demonstrated improvements of naming abilities following language treatments. Given the progressive nature of PPA, it is essential to apply language treatment in the early stages of the disease.
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Affiliation(s)
- Ilaria Pagnoni
- 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
| | - Enrico Premi
- Vascular Neurology Unit, Department of Neurological and Vision Sciences, ASST Spedali Civili, Brescia, Italy
| | - Barbara Borroni
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giuliano Binetti
- MAC Memory Clinic and Molecular Markers Laboratory, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Maria Cotelli
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
| | - Rosa Manenti
- Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
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37
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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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38
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Macoir J, Légaré A, Lavoie M. Contribution of the Cognitive Approach to Language Assessment to the Differential Diagnosis of Primary Progressive Aphasia. Brain Sci 2021; 11:brainsci11060815. [PMID: 34205444 PMCID: PMC8234372 DOI: 10.3390/brainsci11060815] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 11/17/2022] Open
Abstract
Diagnosis of primary progressive aphasia (PPA) is essentially based on the identification of progressive impairment of language abilities while other cognitive functions are preserved. The three variants of PPA are characterized by core and supportive clinical features related to the presence or absence of language impairment in different linguistic domains. In this article, we review the cognitive neuropsychological approach to the assessment of PPA and its contribution to the differential diagnosis of the three variants. The main advantage of this assessment approach is that it goes beyond the mere description and classification of clinical syndromes and identifies impaired and preserved cognitive and linguistic components and processes. The article is structured according to the main language domains: spoken production, language comprehension, and written language. Each section includes a brief description of the cognitive processes involved in the assessment tasks, followed by a discussion of typical characteristics for each PPA variant and common pitfalls in the interpretation of the results. In addition, the clinical benefit of the cognitive neuropsychological approach for the behavioral management of PPA is briefly sketched out in the conclusion.
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Affiliation(s)
- Joël Macoir
- Département de Réadaptation, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada;
- Centre de Recherche CERVO (CERVO Brain Research Centre), Québec, QC G1J 2G3, Canada
- Correspondence: ; Tel.: +1-418-656-2131 (ext. 412190)
| | - Annie Légaré
- Département de Réadaptation, Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada;
| | - Monica Lavoie
- Chaire de Recherche sur les Aphasies Primaires Progressives—Fondation de la Famille Lemaire, Québec, QC G1J 1Z4, Canada;
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39
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Lasaponara S, Marson F, Doricchi F, Cavallo M. A Scoping Review of Cognitive Training in Neurodegenerative Diseases via Computerized and Virtual Reality Tools: What We Know So Far. Brain Sci 2021; 11:528. [PMID: 33919244 PMCID: PMC8143131 DOI: 10.3390/brainsci11050528] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 11/17/2022] Open
Abstract
Most prevalent neurodegenerative diseases such as Alzheimer's disease, frontotemporal dementia, Parkinson's disease and multiple sclerosis are heterogeneous in their clinical profiles and underlying pathophysiology, although they typically share the presence of cognitive impairment that worsens significantly during the course of the disease. Viable pharmacological options for cognitive symptoms in these clinical conditions are currently lacking. In recent years, several studies have started to apply Computerized Cognitive Training (CCT) and Virtual Reality (VR) tools to try and contrast patients' cognitive decay over time. However, no in-depth literature review of the contribution of these promising therapeutic options across main neurodegenerative diseases has been conducted yet. The present paper reports the state-of-the-art of CCT and VR studies targeting cognitive impairment in most common neurodegenerative conditions. Our twofold aim is to point out the scientific evidence available so far and to support health professionals to consider these promising therapeutic tools when planning rehabilitative interventions, especially when the access to regular and frequent hospital consultations is not easy to be provided.
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Affiliation(s)
- Stefano Lasaponara
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy; (S.L.); (F.D.)
- Department of Human Sciences, LUMSA University, 00193 Rome, Italy
| | - Fabio Marson
- Research Institute for Neuroscience, Education and Didactics, Fondazione Patrizio Paoletti, 06081 Assisi, Italy;
- Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy
| | - Fabrizio Doricchi
- Department of Psychology, Sapienza University of Rome, 00185 Rome, Italy; (S.L.); (F.D.)
- Department of Neuropsychology, IRCCS Fondazione Santa Lucia, 00179 Rome, Italy
| | - Marco Cavallo
- Faculty of Psychology, eCampus University, 22060 Novedrate, Italy
- Clinical Psychology Service, Saint George Foundation, 12030 Cavallermaggiore, Italy
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Taylor-Rubin C, Croot K, Nickels L. Speech and language therapy in primary progressive aphasia: a critical review of current practice. Expert Rev Neurother 2021; 21:419-430. [PMID: 33641570 DOI: 10.1080/14737175.2021.1897253] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Primary progressive aphasia (PPA) is a complex language-led dementia syndrome whereby disproportionate deterioration of speech and language occurs subsequent to neurodegenerative disease in the early to mid-stages of the condition. As no effective pharmacotherapies are currently available, speech and language therapies are the optimum treatment to maximize communication for as long as possible. AREAS COVERED The authors present an overview of current speech-language therapy practices in PPA, highlighting recent research on effective treatments. EXPERT OPINION The challenges in this complex field of practice are described. We highlight the challenge of improving access to speech-language therapy by advocating for increased referral rates. The authors also suggest effective incorporation of innovative technologies in treatment and an enhanced evidence base for the utility of lexical retrieval treatment in improving everyday communication as challenges for the future. Finally, increased provision of PPA-specific education and support for individuals and their families is required.
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Affiliation(s)
- Cathleen Taylor-Rubin
- Department of Cognitive Science, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 3, Australian Hearing Hub, 16 University Road, Macquarie University, Sydney, NSW, Australia.,Department of Speech Pathology, Uniting War Memorial Hospital, South Eastern Sydney Local Health District War Memorial Hospital, Waverley, NSW, Australia
| | - Karen Croot
- Department of Cognitive Science, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 3, Australian Hearing Hub, 16 University Road, Macquarie University, Sydney, NSW, Australia.,Faculty of Science, School of Psychology, Brennan MacCallum Building, Camperdown, NSW, Australia
| | - Lyndsey Nickels
- Department of Cognitive Science, Faculty of Medicine, Health and Human Sciences, Macquarie University, Level 3, Australian Hearing Hub, 16 University Road, Macquarie University, Sydney, NSW, Australia
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Taylor-Rubin C, Nickels L, Croot K. Exploring the effects of verb and noun treatment on verb phrase production in primary progressive aphasia: A series of single case experimental design studies. Neuropsychol Rehabil 2021; 32:1121-1163. [PMID: 33557713 DOI: 10.1080/09602011.2021.1879174] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Evidence of generalization to connected speech following lexical retrieval treatment in Primary Progressive Aphasia (PPA) is scarce. Consequently, this study systematically investigated changes in verb phrase production following lexical retrieval treatment in a series of single case experimental design studies. Four individuals with PPA (three semantic- and one logopenic variant PPA) who had previously demonstrated that they could integrate verbs and nouns into sentence structures in a cueing paradigm, undertook a sequence of verb and noun lexical retrieval treatments using Repetition and Reading in the Presence of a Picture. Production of treated nouns- and/or verbs-in-isolation significantly improved following treatment for three of the four participants. Verb phrase production did not improve for one of these participants (logopenic PPA), perhaps due to the relatively small treatment dose. Two participants (semantic variant PPA) did, however, demonstrate across-level generalization, with improvement in treated verbs and using those verbs in (untreated) verb phrases. Their verb phrase production improved most after lexical retrieval treatment for both nouns and verbs, suggesting this combined approach may benefit across-level generalization for some individuals in clinical practice.
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Affiliation(s)
- Cathleen Taylor-Rubin
- Department of Cognitive Science, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.,Department of Speech Pathology, South East Sydney Local Health District, Uniting War Memorial Hospital, Sydney, Australia
| | - Lyndsey Nickels
- Department of Cognitive Science, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Australia
| | - Karen Croot
- School of Psychology, University of Sydney, Sydney, Australia
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Ruksenaite J, Volkmer A, Jiang J, Johnson JC, Marshall CR, Warren JD, Hardy CJ. Primary Progressive Aphasia: Toward a Pathophysiological Synthesis. Curr Neurol Neurosci Rep 2021; 21:7. [PMID: 33543347 PMCID: PMC7861583 DOI: 10.1007/s11910-021-01097-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW The term primary progressive aphasia (PPA) refers to a diverse group of dementias that present with prominent and early problems with speech and language. They present considerable challenges to clinicians and researchers. RECENT FINDINGS Here, we review critical issues around diagnosis of the three major PPA variants (semantic variant PPA, nonfluent/agrammatic variant PPA, logopenic variant PPA), as well as considering 'fragmentary' syndromes. We next consider issues around assessing disease stage, before discussing physiological phenotyping of proteinopathies across the PPA spectrum. We also review evidence for core central auditory impairments in PPA, outline critical challenges associated with treatment, discuss pathophysiological features of each major PPA variant, and conclude with thoughts on key challenges that remain to be addressed. New findings elucidating the pathophysiology of PPA represent a major step forward in our understanding of these diseases, with implications for diagnosis, care, management, and therapies.
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Affiliation(s)
- Justina Ruksenaite
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Anna Volkmer
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Jessica Jiang
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Jeremy Cs Johnson
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Charles R Marshall
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK
| | - Chris Jd Hardy
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, 8 - 11 Queen Square, London, WC1N 3BG, UK.
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Bogolepova A, Vasenina E, Gomzyakova N, Gusev E, Dudchenko N, Emelin A, Zalutskaya N, Isaev R, Kotovskaya Y, Levin O, Litvinenko I, Lobzin V, Martynov M, Mkhitaryan E, Nikolay G, Palchikova E, Tkacheva O, Cherdak M, Chimagomedova A, Yakhno N. Clinical Guidelines for Cognitive Disorders in Elderly and Older Patients. Zh Nevrol Psikhiatr Im S S Korsakova 2021. [DOI: 10.17116/jnevro20211211036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Volkmer A, Spector A, Meitanis V, Warren JD, Beeke S. Effects of functional communication interventions for people with primary progressive aphasia and their caregivers: a systematic review. Aging Ment Health 2020; 24:1381-1393. [PMID: 31134821 DOI: 10.1080/13607863.2019.1617246] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Primary progressive aphasia (PPA) is a language led dementia characterised by progressive speech and language difficulties. Impairment focused PPA interventions that seek to remediate, alleviate or improve symptoms, dominate the research literature. Yet speech and language therapists (SLTs) report prioritising functional communication interventions (FCIs), which target engagement in an activity and participation in life situations. This systematic review investigates the research literature on FCIs for PPA to identify the key components of these interventions and their effectiveness.Method: A systematic search of databases identified 19 studies published between 1998 and 2018. Data were extracted from the articles using the Intervention Taxonomy adaptation (ITAX).Results: Results show that the two most common components of FCIs are to build on communication strategies people currently use, and to practise these strategies with a communication partner. There are variations in the interventions, such as location and dosage. All 19 studies report improvements, of which eight report statistically significant results. Forty-two different measures are used across the 19 studies.Conclusion: This study highlights that building on existing strategies and practising these with a CP, are key components of FCIs for people with PPA, yet there remains a lack of clarity around optimal dosage. Further rigorous research using a core set of outcome measures is a priority in this area.
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Affiliation(s)
- Anna Volkmer
- Division of Psychology and Language Sciences, Language and Cognition, UCL, London, UK
| | - Aimee Spector
- Division of Psychology and Language Sciences, Clinical, Educational and Health Psychology, UCL, London, UK
| | - Vanessa Meitanis
- Division of Psychology and Language Sciences, Language and Cognition, UCL, London, UK
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Institute of Neurology & The National Hospital, London, UK
| | - Suzanne Beeke
- Division of Psychology and Language Sciences, Language and Cognition, UCL, London, UK
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Cotelli M, Manenti R, Ferrari C, Gobbi E, Macis A, Cappa SF. Effectiveness of language training and non-invasive brain stimulation on oral and written naming performance in Primary Progressive Aphasia: A meta-analysis and systematic review. Neurosci Biobehav Rev 2020; 108:498-525. [DOI: 10.1016/j.neubiorev.2019.12.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 10/11/2019] [Accepted: 12/03/2019] [Indexed: 12/14/2022]
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Volkmer A, Spector A, Warren JD, Beeke S. Speech and language therapy for primary progressive aphasia across the UK: A survey of current practice. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2019; 54:914-926. [PMID: 31364253 DOI: 10.1111/1460-6984.12495] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 06/25/2019] [Accepted: 06/29/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Primary progressive aphasia (PPA) describes a heterogeneous group of language-led dementias. People with this type of dementia are increasingly being referred to speech and language therapy (SLT) services. Yet, there is a paucity of research evidence focusing on PPA interventions and little is known about SLT practice in terms of assessment and provision of intervention. AIMS To survey the practices of SLTs in the areas of assessment and intervention for people with PPA. METHODS & PROCEDURES A 37-item, pilot-tested survey was distributed electronically through the Royal College of Speech and Language Therapists (RCSLT), Clinical Excellence Networks (CENs) and social media networks. Survey items included questions on care pathways, assessment and intervention approaches, and future planning. Analysis was conducted using descriptive statistics and thematic analysis. OUTCOMES & RESULTS A total of 105 SLTs completed the survey. Respondents reported more frequently using formal assessment tools designed for stroke-related aphasia than for dementia. Informal interviews were reportedly always used during assessment by almost 80% of respondents. Respondents were significantly more likely to use communication partner training than impairment-focused interventions. Goal attainment was the most commonly used outcome measure. Respondents provided 88 goal examples, which fell into six themes: communication aid; conversation; functional communication; impairment focused; specific strategy; and communication partner. Additionally, respondents reported addressing areas such as future deterioration in communication and cognition, decision-making and mental capacity, and driving. Ten (9.4%) respondents reported the existence of a care pathway for people with PPA within their service. CONCLUSIONS & IMPLICATIONS This survey highlights the range of current PPA assessment and intervention practices in use by the respondents. Communication partner training is commonly used by the surveyed SLTs, despite the lack of research evidence examining its effectiveness for PPA. There is a need to develop evidence-based care pathways for people with PPA in order to advocate for further commissioning of clinical services.
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Affiliation(s)
- Anna Volkmer
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Aimee Spector
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Jason D Warren
- Dementia Research Centre, University College London, London, UK
| | - Suzanne Beeke
- Division of Psychology and Language Sciences, University College London, London, UK
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Volkmer A, Rogalski E, Henry M, Taylor-Rubin C, Ruggero L, Khayum R, Kindell J, Gorno-Tempini ML, Warren JD, Rohrer JD. Speech and language therapy approaches to managing primary progressive aphasia. Pract Neurol 2019; 20:154-161. [PMID: 31358572 DOI: 10.1136/practneurol-2018-001921] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2019] [Indexed: 12/20/2022]
Abstract
The term primary progressive aphasia (PPA) describes a group of neurodegenerative disorders with predominant speech and language dysfunction as their main feature. There are three main variants - the semantic variant, the nonfluent or agrammatic variant and the logopenic variant - each with specific linguistic deficits and different neuroanatomical involvement. There are currently no curative treatments or symptomatic pharmacological therapies. However, speech and language therapists have developed several impairment-based interventions and compensatory strategies for use in the clinic. Unfortunately, multiple barriers still need to be overcome to improve access to care for people with PPA, including increasing awareness among referring clinicians, improving training of speech and language therapists and developing evidence-based guidelines for therapeutic interventions. This review highlights this inequity and the reasons why neurologists should refer people with PPA to speech and language therapists.
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Affiliation(s)
- Anna Volkmer
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Emily Rogalski
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University (NU) Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University (NU) Feinberg School of Medicine, Chicago, Illinois, USA
| | - Maya Henry
- Department of Communication Sciences and Disorders, University of Texas at Austin, Austin, Texas, USA
| | - Cathleen Taylor-Rubin
- Department of Cognitive Science, Macquarie University, Sydney, New South Wales, Australia.,Speech Pathology Department, War Memorial Hospital, Sydney, New South Wales, Australia
| | - Leanne Ruggero
- Department of Cognitive Science, Macquarie University, Sydney, New South Wales, Australia
| | - Rebecca Khayum
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University (NU) Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jackie Kindell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Maria Luisa Gorno-Tempini
- Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, California, USA.,Dyslexia Center, University of California at San Francisco, San Francisco, California, USA
| | - Jason D Warren
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
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Croot K, Raiser T, Taylor-Rubin C, Ruggero L, Ackl N, Wlasich E, Danek A, Scharfenberg A, Foxe D, Hodges JR, Piguet O, Kochan NA, Nickels L. Lexical retrieval treatment in primary progressive aphasia: An investigation of treatment duration in a heterogeneous case series. Cortex 2019; 115:133-158. [DOI: 10.1016/j.cortex.2019.01.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 09/21/2018] [Accepted: 01/09/2019] [Indexed: 10/27/2022]
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Lavoie M, Bier N, Laforce R, Macoir J. Improvement in functional vocabulary and generalization to conversation following a self-administered treatment using a smart tablet in primary progressive aphasia. Neuropsychol Rehabil 2019; 30:1224-1254. [PMID: 30714482 DOI: 10.1080/09602011.2019.1570943] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Currently, public services in speech-language pathology for primary progressive aphasia (PPA) are very limited, although several interventions have been shown to be effective. In this context, new technologies have the potential to enable people with PPA to improve their communication skills. The main aim of this study was to investigate the efficacy of a self-administered therapy using a smart tablet to improve naming of functional words and to assess generalization to an ecological conversation task. Five adults with PPA completed the protocol. Using an ABA design with multiple baselines, naming performance was compared across four equivalent lists: (1) trained with functional words; (2) trained with words from a picture database; (3) exposed but not trained; and (4) not exposed (control). Treatment was self-administered four times a week for a period of four consecutive weeks. A significant improvement for trained words was found in all five participants, and gains were maintained two months post-treatment in four of them. Moreover, in three participants, evidence of generalization was found in conversation. This study supports the efficacy of using a smart tablet to improve naming in PPA and suggests the possibility of generalization to an ecological context.
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Affiliation(s)
- Monica Lavoie
- Département de réadaptation, Université Laval, Québec, QC, Canada.,Centre de recherche CERVO - Brain Research Centre, Québec, QC, Canada
| | - Nathalie Bier
- École de réadaptation, Université de Montréal, Montréal, QC, Canada.,Centre de recherche, Institut universitaire de gériatrie de Montréal, Montréal, QC, Canada
| | - Robert Laforce
- Clinique interdisciplinaire de mémoire, CHU de Québec-Hôpital de l'Enfant-Jésus, Québec, QC, Canada.,Département de médecine, Université Laval, Québec, QC, Canada
| | - Joël Macoir
- Département de réadaptation, Université Laval, Québec, QC, Canada.,Centre de recherche CERVO - Brain Research Centre, Québec, QC, Canada
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Krajenbrink T, Croot K, Taylor-Rubin C, Nickels L. Treatment for spoken and written word retrieval in the semantic variant of primary progressive aphasia. Neuropsychol Rehabil 2018; 30:915-947. [PMID: 30198389 DOI: 10.1080/09602011.2018.1518780] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study investigated whether a treatment programme for spoken word retrieval, supplemented with written naming, was beneficial for an individual with right-hemisphere dominant semantic variant of PPA (svPPA). Assessment and treatment were delivered remotely through Skype. Treatment consisted of two phases of lexical retrieval therapy (Repetition and Reading in the Presence of a Picture: RRIPP), with and without written responses (Phases 1 and 2 respectively), and a third treatment phase based on the procedures of Conceptual Enrichment (COEN) therapy. The first two phases of treatment resulted in short-lasting improvements in spoken and written word retrieval, with greater improvement in Phase 2 when written production was also required. Both treatment phases resulted in gains only for treated items, but generalised to different depictions to those treated. However, Phase 2 also resulted in significant improvement of treated items on a comprehension task. COEN treatment did not result in significant gains in word retrieval or comprehension. This study reinforces the value of a simple lexical retrieval treatment delivered remotely. It adds to the current evidence that anomia in svPPA can be responsive to treatment, but also shows that challenges remain regarding maintenance effects and the generalisation of treatment effects to connected speech.
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Affiliation(s)
- Trudy Krajenbrink
- ARC Centre of Excellence in Cognition and its Disorders, Department of Cognitive Science, Macquarie University, Sydney, Australia
| | - Karen Croot
- ARC Centre of Excellence in Cognition and its Disorders, Department of Cognitive Science, Macquarie University, Sydney, Australia.,The School of Psychology, University of Sydney, Sydney, Australia
| | - Cathleen Taylor-Rubin
- ARC Centre of Excellence in Cognition and its Disorders, Department of Cognitive Science, Macquarie University, Sydney, Australia.,Speech Pathology Department, War Memorial Hospital, Sydney, Australia
| | - Lyndsey Nickels
- ARC Centre of Excellence in Cognition and its Disorders, Department of Cognitive Science, Macquarie University, Sydney, Australia
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