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Tetzloff KA, Martin PR, Duffy JR, Utianski RL, Clark HM, Botha H, Machulda MM, Thu Pham NT, Schwarz CG, Senjem ML, Jack CR, Lowe VJ, Josephs KA, Whitwell JL. Longitudinal flortaucipir, metabolism and volume differ between phonetic and prosodic speech apraxia. Brain 2024; 147:1696-1709. [PMID: 38217867 PMCID: PMC11068100 DOI: 10.1093/brain/awae016] [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: 03/13/2023] [Revised: 11/29/2023] [Accepted: 12/30/2023] [Indexed: 01/15/2024] Open
Abstract
Progressive apraxia of speech (PAOS) is a neurodegenerative motor-speech disorder that most commonly arises from a four-repeat tauopathy. Recent studies have established that progressive apraxia of speech is not a homogenous disease but rather there are distinct subtypes: the phonetic subtype is characterized by distorted sound substitutions, the prosodic subtype by slow and segmented speech and the mixed subtype by a combination of both but lack of predominance of either. There is some evidence that cross-sectional patterns of neurodegeneration differ across subtypes, although it is unknown whether longitudinal patterns of neurodegeneration differ. We examined longitudinal patterns of atrophy on MRI, hypometabolism on 18F-fluorodeoxyglucose-PET and tau uptake on flortaucipir-PET in a large cohort of subjects with PAOS that had been followed for many years. Ninety-one subjects with PAOS (51 phonetic, 40 prosodic) were recruited by the Neurodegenerative Research Group. Of these, 54 (27 phonetic, 27 prosodic) returned for annual follow-up, with up to seven longitudinal visits (total visits analysed = 217). Volumes, metabolism and flortaucipir uptake were measured for subcortical and cortical regions, for all scans. Bayesian hierarchical models were used to model longitudinal change across imaging modalities with PAOS subtypes being compared at baseline, 4 years from baseline, and in terms of rates of change. The phonetic group showed smaller volumes and worse metabolism in Broca's area and the striatum at baseline and after 4 years, and faster rates of change in these regions, compared with the prosodic group. There was also evidence of faster spread of hypometabolism and flortaucipir uptake into the temporal and parietal lobes in the phonetic group. In contrast, the prosodic group showed smaller cerebellar dentate, midbrain, substantia nigra and thalamus volumes at baseline and after 4 years, as well as faster rates of atrophy, than the phonetic group. Greater hypometabolism and flortaucipir uptake were also observed in the cerebellar dentate and substantia nigra in the prosodic group. Mixed findings were observed in the supplementary motor area and precentral cortex, with no clear differences observed across phonetic and prosodic groups. These findings support different patterns of disease spread in PAOS subtypes, with corticostriatal patterns in the phonetic subtype and brainstem and thalamic patterns in the prosodic subtype, providing insight into the pathophysiology and heterogeneity of PAOS.
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Affiliation(s)
| | - Peter R Martin
- Department of Quantitative Health Sciences (Biostatistics), Mayo Clinic, Rochester, MN 55905, USA
| | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Rene L Utianski
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Heather M Clark
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Mary M Machulda
- Department of Psychiatry (Neuropsychology), Mayo Clinic, Rochester, MN 55905, USA
| | | | | | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Information Technology, Mayo Clinic, Rochester, MN 55905, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
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Choi YNC, Martel-Sauvageau V, Breton M, Lavoie M, Laforce R, Bouvier L. Efficacy of LSVT LOUD ® on Phonatory Control and Voice Quality in Patients with Primary Progressive Apraxia of Speech: Case Studies. Brain Sci 2024; 14:417. [PMID: 38790396 PMCID: PMC11117832 DOI: 10.3390/brainsci14050417] [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: 02/16/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/26/2024] Open
Abstract
Primary progressive apraxia of speech (PPAOS) is a neurodegenerative syndrome characterized by the progressive and initially isolated or predominant onset of difficulties in the planning/programming of movements necessary for speech production and can be accompanied by dysarthria. To date, no study has used an evidence-based treatment to address phonation control in patients with PPAOS. The aim of this study was to evaluate the feasibility and efficacy of LSVT LOUD® as a treatment for phonatory control in speakers with PPAOS. Three speakers with PPAOS received LSVT LOUD® therapy, and changes in phonatory control, voice quality and prosody were measured immediately, and one, four and eight weeks after the end of the treatment. Overall, the results suggest that the treatment is feasible and could improve voice quality, intensity, and control in some patients with PPAOS. The generalization of the results is also discussed.
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Affiliation(s)
- Yee Nam Candice Choi
- School of Communication Sciences and Disorders, McGill University, Montréal, QC H3A 0G4, Canada;
| | - Vincent Martel-Sauvageau
- Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada; (V.M.-S.); (R.L.J.)
- CIRRIS—Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec, QC G1M 2S8, Canada;
| | - Myriam Breton
- CIRRIS—Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec, QC G1M 2S8, Canada;
- CHU de Québec-Université Laval, Québec, QC G1V 0A6, Canada
| | - Monica Lavoie
- Clinique Interdisciplinaire de Mémoire, Hôpital de l’Enfant-Jésus, Québec, QC G1J 1Z4, Canada;
- Chaire de Recherche sur les Aphasies Primaires Progressives—Fondation de la Famille Lemaire, Université Laval, Québec, QC G1V 0A6, Canada
| | - Robert Laforce
- Faculté de Médecine, Université Laval, Québec, QC G1V 0A6, Canada; (V.M.-S.); (R.L.J.)
- Clinique Interdisciplinaire de Mémoire, Hôpital de l’Enfant-Jésus, Québec, QC G1J 1Z4, Canada;
- Chaire de Recherche sur les Aphasies Primaires Progressives—Fondation de la Famille Lemaire, Université Laval, Québec, QC G1V 0A6, Canada
| | - Liziane Bouvier
- School of Communication Sciences and Disorders, McGill University, Montréal, QC H3A 0G4, Canada;
- CRIR—Centre for Interdisciplinary Research in Rehabilitation, Montréal, QC H3S 1M9, Canada
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Utianski RL, Meade G, Duffy JR, Clark HM, Botha H, Machulda MM, Dickson DW, Whitwell JL, Josephs KA. Longitudinal characterization of patients with progressive apraxia of speech without clearly predominant phonetic or prosodic speech features. BRAIN AND LANGUAGE 2023; 245:105314. [PMID: 37607419 PMCID: PMC10592101 DOI: 10.1016/j.bandl.2023.105314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/05/2023] [Accepted: 08/17/2023] [Indexed: 08/24/2023]
Abstract
Most recent studies of progressive apraxia of speech (PAOS) have focused on patients with phonetic or prosodic predominant PAOS to understand the implications of the presenting clinical phenotype. Patients without a clearly predominating speech quality, or mixed AOS, have been excluded. Given the implications for disease progression, it is important to understand these patients early in the disease course to inform appropriate education and prognostication. The aim of this study was to describe a cohort of ten patients with initially mixed PAOS and how their clinical course evolves. Four patients were rated prosodic predominant later on (mild AOS at first visit); five were later designated phonetic (four with more than mild AOS at first visit); one was judged mixed at all visits. The study suggests patients without a clear predominance of speech featuresshould still be included in PAOS studies and thought of on the continuum of the disease spectrum.
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Affiliation(s)
| | - Gabriela Meade
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Mary M Machulda
- Department of Psychology and Psychiatry, Mayo Clinic, Rochester, MN, USA
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Utianski RL, Josephs KA. An Update on Apraxia of Speech. Curr Neurol Neurosci Rep 2023; 23:353-359. [PMID: 37269450 PMCID: PMC10629164 DOI: 10.1007/s11910-023-01275-1] [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] [Accepted: 05/08/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE OF REVIEW Apraxia of speech (AOS) is a motor speech disorder that has long been recognized to occur secondary to acute neurologic insults and, more recently, to neurodegenerative diseases as a harbinger for progressive supranuclear palsy and corticobasal syndrome. This article reviews recent findings regarding the clinic phenotypes of AOS, neuroimaging correlates, and the underlying disease processes. RECENT FINDINGS Two clinical subtypes of AOS map onto two underlying 4-repeat tauopathies. New imaging techniques have recently been applied to the study of progressive AOS. There is no data on the impact of behavioral intervention, although studies of nonfluent/agrammatic primary progressive aphasia that include patients with AOS suggest some benefit in speech intelligibility and maintenance. While recent findings suggest subtypes of AOS exist that are linked to molecular pathology and have important implications for disease progression, further research is needed to assess outcome of behavioral and other types of intervention.
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Affiliation(s)
- Rene L Utianski
- Department of Neurology, Mayo Clinic College of Medicine and Science, 200 1St Street S.W., Rochester, MN, 55905, USA
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic College of Medicine and Science, 200 1St Street S.W., Rochester, MN, 55905, USA.
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Gao R, Yuen JTW, Li XX, To CKS. Oral Diadochokinetic Performance on Perceptual and Acoustic Measures for Typically Developing Cantonese-Speaking Preschool Children. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:1445-1466. [PMID: 37040691 DOI: 10.1044/2023_jslhr-22-00426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
PURPOSE This study investigated native Cantonese-speaking preschool children's diadochokinetic performance, including rate, accuracy, and regularity. The second aim of this study was to examine whether language-specific patterns exist by comparing diadochokinetic rates with the average DKK rate for native English speakers. METHOD Sixty-four typically developing preschool children who were native Cantonese speakers participated. The diadochokinetic task administered to the children involved repetitions of monosyllabic, disyllabic, and trisyllabic words and nonsense words. The maximum performance of the children was compared by diadochokinetic rate (number of syllables per second), accuracy (percentage of matched production), and regularity (pairwise variability indexes, known as PVIs). RESULTS Monosyllabic units were produced faster, more accurately, and more regularly than multisyllabic units. Word repetition showed higher accuracy and generally lower regularity than nonsense words but similar rates. Older children were faster and more regular (higher raw PVI of initial consonants) than younger children, but younger children performed as accurately as them. When compared with data from English speakers, the diadochokinetic rates of Cantonese children were generally lower. CONCLUSIONS Developmental progression was evident in terms of rate and regularity. The distinctive accuracy and regularity patterns between word and nonsense word repetition suggest a clinical value for both stimulus types. Language typology plays a role in diadochokinetic rate, supporting the use of language-specific reference data in practice. The typical diadochokinetic profile obtained in this study could serve as a clinical reference for speech motor assessments.
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Affiliation(s)
- Ran Gao
- Faculty of Education, The University of Hong Kong
| | | | - Xin Xin Li
- Faculty of Arts, Hong Kong Baptist University
| | - Carol K S To
- Faculty of Education, The University of Hong Kong
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Bouvier L, Monetta L, Martel-Sauvageau V. Speech rate increase in primary progressive apraxia of speech and its cost on articulatory accuracy. CLINICAL LINGUISTICS & PHONETICS 2022; 36:849-869. [PMID: 34355627 DOI: 10.1080/02699206.2021.1960622] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 07/03/2021] [Accepted: 07/08/2021] [Indexed: 06/13/2023]
Abstract
Impaired articulation (e.g., articulatory accuracy) and prosody (e.g., slow speech rate) are considered primary diagnostic criterions for apraxia of speech both in neurodegenerative and post-stroke contexts. The primary aim of this study was to investigate the ability of participants with primary progressive apraxia of speech (PPAOS), a neurodegenerative disease characterised by initially isolated progressive apraxia of speech, to increase speech rate and the interaction between articulatory accuracy and speech rate. The secondary aim was to investigate the effect of syllable frequency and structure on this interaction. Four speakers with PPAOS, and four sex- and age-matched healthy speakers (HS) read eight two-syllable words embedded two times in a ten-syllable carrier phrase. Syllable frequency and structure were manipulated for the first syllable of the target words and controlled for the second syllable. All sentences were produced at three different target speech rates (conditions): habitual, regular (five syllables/second), and fast (seven syllables/second). Prosodic measures for target words and sentences were computed based on acoustic analysis of speech rate. Articulatory measures for words and sentences were rated based on a perceptual assessment of articulatory accuracy. Results show slower speech rate and reduced articulatory accuracy in speakers with PPAOS compared to HS. Results suggest that speakers with PPAOS also have limited ability to increase their speech rate. Finally, results suggest that articulatory complexity influences speech rate but that the cost of speech rate increase on articulatory accuracy varies greatly across speakers with PPAOS and is not necessarily related to the extent of the increase when measured in a highly structured sentence production task. Theoretical and clinical implications of these findings are discussed.
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Affiliation(s)
- Liziane Bouvier
- Department of Rehabilitation, Université Laval, Québec, Canada
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Québec, Canada
- Centre de Recherche CERVO Research Centre, Québec, Canada
| | - Laura Monetta
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Québec, Canada
- Centre de Recherche CERVO Research Centre, Québec, Canada
| | - Vincent Martel-Sauvageau
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Québec, Canada
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Kent RD, Kim Y, Chen LM. Oral and Laryngeal Diadochokinesis Across the Life Span: A Scoping Review of Methods, Reference Data, and Clinical Applications. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:574-623. [PMID: 34958599 DOI: 10.1044/2021_jslhr-21-00396] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE The aim of this study was to conduct a scoping review of research on oral and laryngeal diadochokinesis (DDK) in children and adults, either typically developing/developed or with a clinical diagnosis. METHOD Searches were conducted with PubMed/MEDLINE, Google Scholar, CINAHL, and legacy sources in retrieved articles. Search terms included the following: DDK, alternating motion rate, maximum repetition rate, sequential motion rate, and syllable repetition rate. RESULTS Three hundred sixty articles were retrieved and included in the review. Data source tables for children and adults list the number and ages of study participants, DDK task, and language(s) spoken. Cross-sectional data for typically developing children and typically developed adults are compiled for the monosyllables /pʌ/, /tʌ/, and /kʌ/; the trisyllable /pʌtʌkʌ/; and laryngeal DDK. In addition, DDK results are summarized for 26 disorders or conditions. DISCUSSION A growing number of multidisciplinary reports on DDK affirm its role in clinical practice and research across the world. Atypical DDK is not a well-defined singular entity but rather a label for a collection of disturbances associated with diverse etiologies, including motoric, structural, sensory, and cognitive. The clinical value of DDK can be optimized by consideration of task parameters, analysis method, and population of interest.
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Affiliation(s)
- Ray D Kent
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison
| | - Yunjung Kim
- School of Communication Sciences & Disorders, Florida State University, Tallahassee
| | - Li-Mei Chen
- Department of Foreign Languages and Literature, National Cheng Kung University, Tainan, Taiwan
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Bouvier L, Monetta L, Vitali P, Laforce R, Martel-Sauvageau V. A Preliminary Look Into the Clinical Evolution of Motor Speech Characteristics in Primary Progressive Apraxia of Speech in Québec French. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1459-1476. [PMID: 33719528 DOI: 10.1044/2020_ajslp-20-00162] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose This study aimed to track changes in acoustical and perceptual features of motor speech in patients with phonetic and prosodic primary progressive apraxia of speech (PPAOS) in Québec French over an 18-month period. Method A prospective multiple-case series with multiple testing periods, including four participants with a diagnosis of PPAOS, was conducted. Participants were 0.5-4 years postonset of disease at baseline. They underwent comprehensive motor speech and language assessments and cognitive screening every 6 months for up to 18 months. Acoustical and perceptual analyses of motor speech were conducted. Results Results showed a considerable impairment in motor speech abilities for patients with PPAOS at all time points and a significant decrease in performance for almost all articulatory and prosodic measures over time. Passage reading and diadochokinesis seemed particularly promising for the tracking of changes in PPAOS motor speech characteristics and PPAOS classification. Quantifying length of speech runs made it possible to distinguish phonetic from prosodic PPAOS. Finally, the patients who evolved to phonetic PPAOS developed aphasia, and the two with prosodic PPAOS showed greater motor symptoms such as unequivocal dysarthria. Conclusion This study extends the growing literature on PPAOS and its subtypes by describing specific changes in articulatory and prosodic abilities over a period of at least 6 months, which are important for the diagnosis and management of PPAOS.
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Affiliation(s)
- Liziane Bouvier
- Département de réadaptation, Faculté de Médecine, Université Laval, Québec, Canada
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec, Canada
- Centre de recherche CERVO Research Centre, Québec, Canada
| | - Laura Monetta
- Département de réadaptation, Faculté de Médecine, Université Laval, Québec, Canada
- Centre de recherche CERVO Research Centre, Québec, Canada
| | - Paolo Vitali
- McGill University Research Centre for Studies in Aging, Montréal, Canada
- CIUSSS Nord-de-l'Île-de-Montréal, Canada
| | - Robert Laforce
- Département des Sciences Neurologiques, Clinique Interdisciplinaire de Mémoire, CHU de Québec, Canada
| | - Vincent Martel-Sauvageau
- Département de réadaptation, Faculté de Médecine, Université Laval, Québec, Canada
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec, Canada
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