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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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Neylan KD, Miller BL. New Approaches to the Treatment of Frontotemporal Dementia. Neurotherapeutics 2023; 20:1055-1065. [PMID: 37157041 PMCID: PMC10457270 DOI: 10.1007/s13311-023-01380-6] [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: 04/14/2023] [Indexed: 05/10/2023] Open
Abstract
Frontotemporal dementia (FTD) comprises a diverse group of clinical neurodegenerative syndromes characterized by progressive changes in behavior, personality, executive function, language, and motor function. Approximately 20% of FTD cases have a known genetic cause. The three most common genetic mutations causing FTD are discussed. Frontotemporal lobar degeneration refers to the heterogeneous group of neuropathology underlying FTD clinical syndromes. While there are no current disease-modifying treatments for FTD, management includes off-label pharmacotherapy and non-pharmacological approaches to target symptoms. The utility of several different drug classes is discussed. Medications used in the treatment of Alzheimer's disease have no benefit in FTD and can worsen neuropsychiatric symptoms. Non-pharmacological approaches to management include lifestyle modifications, speech-, occupational-, and physical therapy, peer and caregiver support, and safety considerations. Recent developments in the understanding of the genetics, pathophysiology, neuropathology, and neuroimmunology underlying FTD clinical syndromes have expanded possibilities for disease-modifying and symptom-targeted treatments. Different pathogenetic mechanisms are targeted in several active clinical trials, opening up exciting possibilities for breakthrough advances in treatment and management of FTD spectrum disorders.
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Affiliation(s)
- Kyra D Neylan
- University of California San Francisco Memory and Aging Center, San Francisco, USA.
| | - Bruce L Miller
- University of California San Francisco Memory and Aging Center, San Francisco, USA
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Battista P, Piccininni M, Montembeault M, Messina A, Minafra B, Miller BL, Henry ML, Gorno Tempini ML, Grasso SM. Access, referral, service provision and management of individuals with primary progressive aphasia: A survey of speech-language therapists in Italy. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:1046-1060. [PMID: 36636857 PMCID: PMC10613933 DOI: 10.1111/1460-6984.12843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 12/16/2022] [Indexed: 05/10/2023]
Abstract
BACKGROUND AND OBJECTIVES In Italy, approximately 650 individuals receive a diagnosis of primary progressive aphasia (PPA) every year. Unfortunately, the frequency with which patients are referred to speech-language services is suboptimal, likely due to skepticism regarding the value of speech-language therapy in the context of neurodegeneration. MATERIALS AND METHODS We conducted a virtual survey of speech and language therapists (SLTs) across Italy, to collect information about the assessment, intervention and management of patients with PPA. To ensure that as many SLTs as possible received the survey, the Italian Federation of SLTs (Federazione Logopedisti Italiani, FLI) aided in disseminating the survey. RESULTS In total, 336 respondents participated in the online survey, 140 of whom had previous experience with PPA patients. Respondents indicated having seen a total of 428 PPA patients in the previous 24 months (three patients on average, range: 0-40). SLTs who reported never working with PPA identified underdiagnoses, low referral rates and the rarity of the clinical syndrome as major reasons for their lack of experience with PPA. SLTs with experience working with PPA indicated that patients may not have accessed services because of service dysfunction and geographical barriers. Respondents reported using informal interviews during assessments and tests developed for post-stroke aphasia, while impairment-based/restitutive interventions were utilised most often. CONCLUSION Findings may serve to inform health policy organisations regarding the current shortcomings and needed recommendations for improving the care of individuals with PPA in Italy. Improving awareness of the utility of rehabilitation among SLTs and other clinical service providers may serve to facilitate access to intervention, which in turn will serve to better support individuals living with PPA. WHAT THIS PAPER ADDS What is already known on the subject Speech and language therapists (SLTs) play a crucial role in the assessment, diagnosis and treatment of people with primary progressive aphasia (PPA). However, the frequency with which individuals with PPA are referred for speech and language services is suboptimal due to skepticism regarding the value of speech and language therapy in the context of neurodegeneration, the scarcity of SLTs with expertise in the treatment of PPA and the lack of awareness of the SLT role amongst referrers. What this paper adds to existing knowledge In recognition of the lack of published information on the provision of speech and language therapy services and clinicians' approaches to the assessment and treatment of individuals with PPA in Italy, we conducted an online survey to evaluate the current referral patterns for speech and language therapy services and to examine the current barriers to access these services for individuals with PPA in Italy. What are the potential or actual clinical implications of this work? The data presented here support that SLTs view treatment as useful for individuals with PPA and other professional figures and may serve to improve access to intervention, which in turn will serve to better support individuals living with PPA. The results highlight the need to inform health policy organisations about current gaps and aid in developing recommendations for improving the care of individuals with PPA, in order to understand how SLTs can best support individuals with PPA and their families.
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Affiliation(s)
- Petronilla Battista
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Bari, Italy
| | - Marco Piccininni
- Institute of Public Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | | | - Annachiara Messina
- Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Brigida Minafra
- Istituti Clinici Scientifici Maugeri SpA SB, IRCCS, Institute of Bari, Bari, Italy
| | - Bruce L. Miller
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Maya L. Henry
- Department of Speech, Language, and Hearing Sciences, Moody College of Communication, Austin, Texas, USA
- Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Maria Luisa Gorno Tempini
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Stephanie M. Grasso
- Department of Speech, Language, and Hearing Sciences, Moody College of Communication, Austin, Texas, USA
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Cope TE, Sohoglu E, Peterson KA, Jones PS, Rua C, Passamonti L, Sedley W, Post B, Coebergh J, Butler CR, Garrard P, Abdel-Aziz K, Husain M, Griffiths TD, Patterson K, Davis MH, Rowe JB. Temporal lobe perceptual predictions for speech are instantiated in motor cortex and reconciled by inferior frontal cortex. Cell Rep 2023; 42:112422. [PMID: 37099422 DOI: 10.1016/j.celrep.2023.112422] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/23/2022] [Accepted: 04/05/2023] [Indexed: 04/27/2023] Open
Abstract
Humans use predictions to improve speech perception, especially in noisy environments. Here we use 7-T functional MRI (fMRI) to decode brain representations of written phonological predictions and degraded speech signals in healthy humans and people with selective frontal neurodegeneration (non-fluent variant primary progressive aphasia [nfvPPA]). Multivariate analyses of item-specific patterns of neural activation indicate dissimilar representations of verified and violated predictions in left inferior frontal gyrus, suggestive of processing by distinct neural populations. In contrast, precentral gyrus represents a combination of phonological information and weighted prediction error. In the presence of intact temporal cortex, frontal neurodegeneration results in inflexible predictions. This manifests neurally as a failure to suppress incorrect predictions in anterior superior temporal gyrus and reduced stability of phonological representations in precentral gyrus. We propose a tripartite speech perception network in which inferior frontal gyrus supports prediction reconciliation in echoic memory, and precentral gyrus invokes a motor model to instantiate and refine perceptual predictions for speech.
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Affiliation(s)
- Thomas E Cope
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK; Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK; Cambridge University Hospitals NHS Trust, Cambridge CB2 0QQ, UK.
| | - Ediz Sohoglu
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK; School of Psychology, University of Sussex, Brighton BN1 9RH, UK
| | - Katie A Peterson
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK; Department of Radiology, University of Cambridge, Cambridge CB2 0QQ, UK
| | - P Simon Jones
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Catarina Rua
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
| | - Luca Passamonti
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK
| | - William Sedley
- Biosciences Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Brechtje Post
- Theoretical and Applied Linguistics, Faculty of Modern & Medieval Languages & Linguistics, University of Cambridge, Cambridge CB3 9DA, UK
| | - Jan Coebergh
- Ashford and St Peter's Hospital, Ashford TW15 3AA, UK; St George's Hospital, London SW17 0QT, UK
| | - Christopher R Butler
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK; Faculty of Medicine, Department of Brain Sciences, Imperial College London, London W12 0NN, UK
| | - Peter Garrard
- St George's Hospital, London SW17 0QT, UK; Molecular and Clinical Sciences Research Institute, St. George's, University of London, London SW17 0RE, UK
| | - Khaled Abdel-Aziz
- Ashford and St Peter's Hospital, Ashford TW15 3AA, UK; St George's Hospital, London SW17 0QT, UK
| | - Masud Husain
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Timothy D Griffiths
- Biosciences Institute, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Karalyn Patterson
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK; Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
| | - Matthew H Davis
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 0SZ, UK; Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK; Cambridge University Hospitals NHS Trust, Cambridge CB2 0QQ, UK
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Roytman M, Chiang GC, Gordon ML, Franceschi AM. Multimodality Imaging in Primary Progressive Aphasia. AJNR Am J Neuroradiol 2022; 43:1230-1243. [PMID: 36007947 PMCID: PMC9451618 DOI: 10.3174/ajnr.a7613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 11/30/2021] [Indexed: 01/26/2023]
Abstract
Primary progressive aphasia is a clinically and neuropathologically heterogeneous group of progressive neurodegenerative disorders, characterized by language-predominant impairment and commonly associated with atrophy of the dominant language hemisphere. While this clinical entity has been recognized dating back to the 19th century, important advances have been made in defining our current understanding of primary progressive aphasia, with 3 recognized subtypes to date: logopenic variant, semantic variant, and nonfluent/agrammatic variant. Given the ongoing progress in our understanding of the neurobiology and genomics of these rare neurodegenerative conditions, accurate imaging diagnoses are of the utmost importance and carry implications for future therapeutic triaging. This review covers the diverse spectrum of primary progressive aphasia and its multimodal imaging features, including structural, functional, and molecular neuroimaging findings; it also highlights currently recognized diagnostic criteria, clinical presentations, histopathologic biomarkers, and treatment options of these 3 primary progressive aphasia subtypes.
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Affiliation(s)
- M Roytman
- From the Neuroradiology Division (M.R., G.C.C.), Department of Radiology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - G C Chiang
- From the Neuroradiology Division (M.R., G.C.C.), Department of Radiology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - M L Gordon
- Departments of Neurology and Psychiatry (M.L.G.), Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, The Litwin-Zucker Research Center, Feinstein Institutes for Medical Research, Manhasset, New York
| | - A M Franceschi
- Neuroradiology Division (A.M.F.), Department of Radiology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, New York
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Schaffer KM, Wauters L, Berstis K, Grasso SM, Henry ML. Modified script training for nonfluent/agrammatic primary progressive aphasia with significant hearing loss: A single-case experimental design. Neuropsychol Rehabil 2022; 32:306-335. [PMID: 33023372 PMCID: PMC8252664 DOI: 10.1080/09602011.2020.1822188] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Speech-language pathology caseloads often include individuals with hearing loss and a coexisting neurogenic communication disorder. However, specific treatment techniques and modifications designed to accommodate this population are understudied. Using a single-case experimental design, the current study investigated the utility of modified Video Implemented Script Training for Aphasia (VISTA) for an individual with nonfluent/agrammatic variant primary progressive aphasia and severe-to-profound, bilateral hearing loss. We analyzed the impact of this intervention, which incorporates orthographic input and rehearsal, on script production accuracy, speech intelligibility, grammatical complexity, mean length of utterance, and speech rate. Treatment resulted in comparable positive outcomes relative to a previous study evaluating script training in nonfluent/agrammatic primary progressive aphasia patients with functional hearing. Follow-up data obtained at three months, six months, and one year post-treatment confirmed maintenance of treatment effects for trained scripts. To our knowledge, this is the first study to investigate a modified speech-language intervention tailored to the needs of an individual with PPA and hearing loss, with findings confirming that simple treatment modifications may serve to broaden the range of treatment options available to those with concomitant sensory and communication impairments.
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Affiliation(s)
- Kristin M. Schaffer
- Department of Communication Sciences and Disorders, The University of Texas, Austin
| | - Lisa Wauters
- Department of Communication Sciences and Disorders, The University of Texas, Austin
| | - Karinne Berstis
- Department of Communication Sciences and Disorders, The University of Texas, Austin
| | - Stephanie M. Grasso
- Department of Communication Sciences and Disorders, The University of Texas, Austin
| | - Maya L. Henry
- Department of Communication Sciences and Disorders, The University of Texas, Austin
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Basilakos A, Fridriksson J. Types of motor speech impairments associated with neurologic diseases. HANDBOOK OF CLINICAL NEUROLOGY 2022; 185:71-79. [PMID: 35078611 DOI: 10.1016/b978-0-12-823384-9.00004-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Speech disturbances are common consequences of acquired brain injury or neurodegenerative impairment. Although sudden difficulties with speech may signal acute pathologic conditions such as cerebrovascular accidents, determining the etiology of insidious disruptions in communication can be less straightforward. The identification of motor speech impairment, independent of difficulties with language, can be useful for diagnosis since there are subtle, albeit distinct, patterns of speech production impairments associated with different neurologic conditions. Furthermore, the identification of impairments specific to speech production can help elucidate the suspected pathologic mechanisms or even the neuroanatomic structures compromised. During a routine clinical evaluation, early warning signs of motor speech impairment may go undetected if a clinician is unaccustomed to examining motor speech or is unaware of its manifestations. Accordingly, this chapter provides clinicians with a concise yet thorough guide for the practical assessment and differential diagnosis of motor speech disorders (MSDs)-apraxia of speech and dysarthrias. This chapter is divided into neurologic conditions associated with disorders of speech planning/programming, execution, and articulatory control. The underlying mechanisms associated with these impairments are presented both from a clinical perspective as well as through a scientific discussion of recent research in the field on MSDs.
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Affiliation(s)
- Alexandra Basilakos
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, United States
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, United States.
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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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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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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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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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12
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Rogalski E, Roberts A, Salley E, Saxon M, Fought A, Esparza M, Blaze E, Coventry C, Mesulam MM, Weintraub S, Mooney A, Khayum B, Rademaker A. Communication partner engagement: A relevant factor for functional outcomes in speech language therapy for aphasic dementia. J Gerontol B Psychol Sci Soc Sci 2021; 77:1017-1025. [PMID: 34528692 DOI: 10.1093/geronb/gbab165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Previous reports established the feasibility of a telehealth model for delivering speech-language therapy via Internet videoconferencing, which connects individuals with primary progressive aphasia (PPA) to an expert speech and language pathologist for treatment. This study reports feasibility of the same telehealth intervention in a larger set of progressive aphasia participants and explores factors potentially influencing functional intervention outcomes. METHODS Participants with PPA or progressive aphasia in the context of a neurodegenerative dementia syndrome and their communication partners were enrolled into an 8-session intervention, with 3 evaluations (Baseline, 2- and 6-months post-enrollment). Half of the participants were randomized into a "check-in" group and received three monthly half-hour sessions post-intervention. Mixed linear models with post hoc testing and percent change in area under the curve (AUC) were used to examine communication confidence over time, the primary patient reported outcome, as well as the influence of check-in sessions and role of communication partner engagement on communication confidence. RESULTS Communication confidence improved at the 2-month evaluation and showed no significant decline at the 6-month evaluation. Item-level analysis revealed gains in communication confidence across multiple communication contexts. Gains and maintenance of communication confidence were only present for the engaged communication partner group and were not bolstered by randomization to the check-in group. DISCUSSION Internet-based, person-centered interventions demonstrate promise as a model for delivering speech-language therapy to individuals living with PPA. Maintenance is possible for at least 6-months post-enrollment and is better for those with engaged communication partners, which supports the use of dyadic interventions.
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Affiliation(s)
- Emily Rogalski
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease Northwestern University, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Angela Roberts
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
| | - Elizabeth Salley
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease Northwestern University, Chicago, IL, USA
| | - Marie Saxon
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease Northwestern University, Chicago, IL, USA
| | - Angela Fought
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease Northwestern University, Chicago, IL, USA.,Department of Biostatistics and Informatics, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Marissa Esparza
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease Northwestern University, Chicago, IL, USA
| | - Erin Blaze
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease Northwestern University, Chicago, IL, USA
| | - Christina Coventry
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease Northwestern University, Chicago, IL, USA
| | - Marek-Marsel Mesulam
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease Northwestern University, Chicago, IL, USA
| | - Sandra Weintraub
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease Northwestern University, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Aimee Mooney
- Department of Biostatistics and Informatics, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA.,Oregon Health & Science University, Portland, OR, USA
| | - Becky Khayum
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease Northwestern University, Chicago, IL, USA
| | - Alfred Rademaker
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease Northwestern University, Chicago, IL, USA.,Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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13
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McKenna MC, Corcia P, Couratier P, Siah WF, Pradat PF, Bede P. Frontotemporal Pathology in Motor Neuron Disease Phenotypes: Insights From Neuroimaging. Front Neurol 2021; 12:723450. [PMID: 34484106 PMCID: PMC8415268 DOI: 10.3389/fneur.2021.723450] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/22/2021] [Indexed: 01/18/2023] Open
Abstract
Frontotemporal involvement has been extensively investigated in amyotrophic lateral sclerosis (ALS) but remains relatively poorly characterized in other motor neuron disease (MND) phenotypes such as primary lateral sclerosis (PLS), progressive muscular atrophy (PMA), spinal muscular atrophy (SMA), spinal bulbar muscular atrophy (SBMA), post poliomyelitis syndrome (PPS), and hereditary spastic paraplegia (HSP). This review focuses on insights from structural, metabolic, and functional neuroimaging studies that have advanced our understanding of extra-motor disease burden in these phenotypes. The imaging literature is limited in the majority of these conditions and frontotemporal involvement has been primarily evaluated by neuropsychology and post mortem studies. Existing imaging studies reveal that frontotemporal degeneration can be readily detected in ALS and PLS, varying degree of frontotemporal pathology may be captured in PMA, SBMA, and HSP, SMA exhibits cerebral involvement without regional predilection, and there is limited evidence for cerebral changes in PPS. Our review confirms the heterogeneity extra-motor pathology across the spectrum of MNDs and highlights the role of neuroimaging in characterizing anatomical patterns of disease burden in vivo. Despite the contribution of neuroimaging to MND research, sample size limitations, inclusion bias, attrition rates in longitudinal studies, and methodological constraints need to be carefully considered. Frontotemporal involvement is a quintessential clinical facet of MND which has important implications for screening practices, individualized management strategies, participation in clinical trials, caregiver burden, and resource allocation. The academic relevance of imaging frontotemporal pathology in MND spans from the identification of genetic variants, through the ascertainment of presymptomatic changes to the design of future epidemiology studies.
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Affiliation(s)
- Mary Clare McKenna
- Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland
| | - Philippe Corcia
- Department of Neurology-Neurophysiology, CRMR ALS, Tours, France.,UMR 1253 iBrain, University of Tours, Tours, France.,LITORALS, Federation of ALS Centres: Tours-Limoges, Limoges, France
| | - Philippe Couratier
- LITORALS, Federation of ALS Centres: Tours-Limoges, Limoges, France.,ALS Centre, Limoges University Hospital (CHU de Limoges), Limoges, France
| | - We Fong Siah
- Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland
| | | | - Peter Bede
- Computational Neuroimaging Group, Trinity College Dublin, Dublin, Ireland.,Pitié-Salpêtrière University Hospital, Sorbonne University, Paris, France
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14
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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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15
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Themistocleous C, Webster K, Tsapkini K. Effects of tDCS on Sound Duration in Patients with Apraxia of Speech in Primary Progressive Aphasia. Brain Sci 2021; 11:brainsci11030335. [PMID: 33800933 PMCID: PMC8000042 DOI: 10.3390/brainsci11030335] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 12/20/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) over the left inferior frontal gyrus (IFG) was found to improve oral and written naming in post-stroke and primary progressive aphasia (PPA), speech fluency in stuttering, a developmental speech-motor disorder, and apraxia of speech (AOS) symptoms in post-stroke aphasia. This paper addressed the question of whether tDCS over the left IFG coupled with speech therapy may improve sound duration in patients with apraxia of speech (AOS) symptoms in non-fluent PPA (nfvPPA/AOS) more than sham. Eight patients with non-fluent PPA/AOS received either active or sham tDCS, along with speech therapy for 15 sessions. Speech therapy involved repeating words of increasing syllable-length. Evaluations took place before, immediately after, and two months post-intervention. Words were segmented into vowels and consonants and the duration of each vowel and consonant was measured. Segmental duration was significantly shorter after tDCS compared to sham and tDCS gains generalized to untrained words. The effects of tDCS sustained over two months post-treatment in trained and untrained sounds. Taken together, these results demonstrate that tDCS over the left IFG may facilitate speech production by reducing segmental duration. The results provide preliminary evidence that tDCS may maximize efficacy of speech therapy in patients with nfvPPA/AOS.
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Affiliation(s)
| | - Kimberly Webster
- Department of Otolaryngology, Johns Hopkins Medicine, Baltimore, MD 21210, USA;
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21210, USA;
- Correspondence: ; Tel.: +1-410-7362940
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16
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FTLD Treatment: Current Practice and Future Possibilities. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1281:297-310. [PMID: 33433882 DOI: 10.1007/978-3-030-51140-1_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
While behavioral variant frontotemporal dementia (bvFTD) and primary progressive aphasia (PPA) remain unrelenting and universally fatal conditions, there is a framework for supportive treatment in patients diagnosed with these frontotemporal dementia (FTD) syndromes and the larger spectrum of clinical syndromes associated with frontotemporal lobar degeneration (FTLD) pathology on autopsy. A managing physician has an important role in weighing therapeutic options, organizing caregiver support, and framing long-term expectations for patients and caregivers. Additionally, a dedicated neurologist may assist patients and caregivers in navigating a growing range of FTD research, including exciting opportunities in clinical therapeutic trials. This chapter will review current therapeutic options for patients with bvFTD and PPA and detail the landscape of potential new disease-modifying therapies targeting the pathophysiology or FTLD.
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17
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Thompson CK, Barbieri E, Mack JE, Wilkins A, Xie KY. Plasticity of sentence processing networks: evidence from a patient with agrammatic variant of primary progressive aphasia (PPA). Neurocase 2021; 27:39-56. [PMID: 33378229 PMCID: PMC8026534 DOI: 10.1080/13554794.2020.1862241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 12/04/2020] [Indexed: 10/22/2022]
Abstract
This study reports the results of a longitudinal study examining the effects of treatment for sentence processing deficits for a 70-year-old gentleman (DK) with the agrammatic variant of Primary Progressive Aphasia (PPA). On entry into the study, he presented with a 2-year history of impaired verb and sentence processing and concomitant neural atrophy in primarily subcortical regions. Spanning an 18-month period, treatment focused on improving comprehension and production of syntactically complex, passive and object cleft, structures, consecutively. Results, derived from extensive behavioral and neurocognitive testing, showed not only improved ability to comprehend and produce both trained and untrained, less complex, linguistically related structures in offline tasks, but also improved online sentence processing strategies as revealed by partially normalized eye movements in online comprehension (i.e., emergence of thematic prediction and thematic integration) and production (i.e., use of incremental processing) tasks. Changes in neural activation from pre- to post-treatment of both structures also were found, with upregulation of tissue in both the left and right hemispheres, overlapping with regions recruited by neurotypical adults performing the same task. These findings indicate that Treatment of Underlying Forms (TUF) is effective for treatment of patients with the agrammatic variant of PPA (as it is for those with stroke-induced agrammatism), and show that unaffected neural tissue in patients with PPA is malleable and may be recruited to support language, providing evidence of experience-based plasticity in neurodegenerative disease.
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Affiliation(s)
- Cynthia K. Thompson
- Aphasia and Neurolinguistics Research Laboratory, Center for the Neurobiology of Language Recovery, Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
- Department of Neurology, Northwestern University, Chicago, IL, United States
- Cognitive Neurology and Alzheimer’s Disease Center, Northwestern University, Chicago, IL, United States
| | - Elena Barbieri
- Aphasia and Neurolinguistics Research Laboratory, Center for the Neurobiology of Language Recovery, Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
| | - Jennifer E. Mack
- Aphasia and Neurolinguistics Research Laboratory, Center for the Neurobiology of Language Recovery, Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
| | - Aaron Wilkins
- Center for Audiology, Speech, Language, and Learning, Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
| | - Kathy Y. Xie
- Aphasia and Neurolinguistics Research Laboratory, Center for the Neurobiology of Language Recovery, Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, United States
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18
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Coughlin DG, Dickson DW, Josephs KA, Litvan I. Progressive Supranuclear Palsy and Corticobasal Degeneration. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1281:151-176. [PMID: 33433875 DOI: 10.1007/978-3-030-51140-1_11] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD) are neurodegenerative tauopathies with neuronal and glial lesions composed of tau that is composed predominantly of isomers with four repeats in the microtubule-binding domain (4R tau). The brain regions vulnerable to pathology in PSP and CBD overlap, but there are differences, particularly with respect to distribution of neuronal loss, the relative abundance of neuronal and glial lesions, the morphologic features of glial lesions, and the frequency of comorbid pathology. Both PSP and CBD have a wide spectrum of clinical manifestations, including disorders of movement and cognition. Recognition of phenotypic diversity in PSP and CBD may improve antemortem diagnostic accuracy, which tends to be very good for the most common presentation of PSP (Richardson syndrome), but poor for the most characteristic presentation of CBD (corticobasal syndrome: CBS). Development of molecular and imaging biomarkers may improve antemortem diagnostic accuracy. Currently, multidisciplinary symptomatic and supportive treatment with pharmacological and non-pharmacological strategies remains the standard of care. In the future, experimental therapeutic trials will be important to slow disease progression.
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Affiliation(s)
| | | | | | - Irene Litvan
- UC San Diego Department of Neurosciences, La Jolla, CA, USA.
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19
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VandeVrede L, Ljubenkov PA, Rojas JC, Welch AE, Boxer AL. Four-Repeat Tauopathies: Current Management and Future Treatments. Neurotherapeutics 2020; 17:1563-1581. [PMID: 32676851 PMCID: PMC7851277 DOI: 10.1007/s13311-020-00888-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Four-repeat tauopathies are a neurodegenerative disease characterized by brain parenchymal accumulation of a specific isoform of the protein tau, which gives rise to a wide breadth of clinical syndromes encompassing diverse symptomatology, with the most common syndromes being progressive supranuclear palsy-Richardson's and corticobasal syndrome. Despite the lack of effective disease-modifying therapies, targeted treatment of symptoms can improve quality of life for patients with 4-repeat tauopathies. However, managing these symptoms can be a daunting task, even for those familiar with the diseases, as they span motor, sensory, cognitive, affective, autonomic, and behavioral domains. This review describes current approaches to symptomatic management of common clinical symptoms in 4-repeat tauopathies with a focus on practical patient management, including pharmacologic and nonpharmacologic strategies, and concludes with a discussion of the history and future of disease-modifying therapeutics and clinical trials in this population.
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Affiliation(s)
- Lawren VandeVrede
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA.
| | - Peter A Ljubenkov
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Julio C Rojas
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Ariane E Welch
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Adam L Boxer
- Memory and Aging Center, Department of Neurology, University of California San Francisco, San Francisco, California, USA
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20
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Nissim NR, Moberg PJ, Hamilton RH. Efficacy of Noninvasive Brain Stimulation (tDCS or TMS) Paired with Language Therapy in the Treatment of Primary Progressive Aphasia: An Exploratory Meta-Analysis. Brain Sci 2020; 10:E597. [PMID: 32872344 PMCID: PMC7563447 DOI: 10.3390/brainsci10090597] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/21/2020] [Accepted: 08/25/2020] [Indexed: 12/12/2022] Open
Abstract
Noninvasive brain stimulation techniques, such as transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS), paired with behavioral language therapy, have demonstrated the capacity to enhance language abilities in primary progressive aphasia (PPA), a debilitating degenerative neurological syndrome that leads to declines in communication abilities. The aim of this meta-analysis is to systematically evaluate the efficacy of tDCS and TMS in improving language outcomes in PPA, explore the magnitude of effects between stimulation modalities, and examine potential moderators that may influence treatment effects. Standard mean differences for change in performance from baseline to post-stimulation on language-related tasks were evaluated. Six tDCS studies and two repetitive TMS studies met inclusion criteria and provided 22 effects in the analysis. Random effect models revealed a significant, heterogeneous, and moderate effect size for tDCS and TMS in the enhancement of language outcomes. Findings demonstrate that naming ability significantly improves due to brain stimulation, an effect found to be largely driven by tDCS. Future randomized controlled trials are needed to determine long-term effectiveness of noninvasive brain stimulation techniques on language abilities, further delineate the efficacy of tDCS and TMS, and identify optimal parameters to enable the greatest gains for persons with PPA.
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Affiliation(s)
- Nicole R. Nissim
- Laboratory for Cognition and Neural Stimulation, Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA;
- Moss Rehabilitation Research Institute, Elkins Park, PA 19027, USA
| | - Paul J. Moberg
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104, USA;
- Department of Otorhinolaryngology: Head & Neck Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Roy H. Hamilton
- Laboratory for Cognition and Neural Stimulation, Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA;
- Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA
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21
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Duffy JR, Utianski RL, Josephs KA. Primary Progressive Apraxia of Speech: From Recognition to Diagnosis and Care. APHASIOLOGY 2020; 35:560-591. [PMID: 34219857 PMCID: PMC8247786 DOI: 10.1080/02687038.2020.1787732] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 06/16/2020] [Indexed: 05/12/2023]
Abstract
BACKGROUND Apraxia of speech (AOS) can be caused by neurodegenerative disease and sometimes is its presenting sign (i.e., primary progressive apraxia of speech, PPAOS). During the last several decades our understanding of PPAOS has evolved from clinical recognition to a fuller understanding of its core and associated clinical features, its distinction from but relationship with primary progressive aphasia, its temporal course and eventual progression to include other neurological deficits, and its neuroimaging correlates and underlying pathology. AIMS This paper provides a comprehensive summary of the literature that has built the current knowledge base about PPAOS and progressive AOS as it co-occurs with progressive aphasia. It reviews the history of its emergence as a recognized syndrome; its relationship with the agrammatic/nonfluent variant of primary progressive aphasia; its salient perceptual features and subtypes; the acoustic and structural/physiological imaging measures that index its presence, severity, and distinction from aphasia; and principles and available data regarding its management and care. MAIN CONTRIBUTION A broad summary of what is known about AOS as a manifestation of neurodegenerative disease. CONCLUSIONS Primary progressive apraxia of speech is a recognizable syndrome that can be distinguished from other neurodegenerative conditions that affect speech and language.
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Affiliation(s)
- Joseph R Duffy
- Departments of Neurology, Mayo Clinic, Rochester, MN, USA
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22
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Silva EBD, Delboni MCC, Fedosse E. Assessment of individuals with aphasia: an integrative literature review. REVISTA CEFAC 2020. [DOI: 10.1590/1982-0216/202022113218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to analyze which evaluations are used by occupational therapists, speech-language pathologists and physiotherapists on individuals presented with aphasia and what these evaluations address. Methods: the study conducted a national and international documental analysis of evaluations used by professionals working on the neurological rehabilitation of adults and/or elderly individuals with aphasia, published in the last ten years (January 2008/June 2018). This analysis was performed by an integrative review of databases LILACS, SciELO and PubMed, using the descriptors: Health Assessment or Testing, or Protocols, or Psychometrics, or Questionnaires and Rehabilitation, combined with the descriptors: Aphasia, Occupational Therapy, Speech-language Pathology and Physiotherapy. Results: 26 studies were included, most of which were scored as level VI of scientific evidence; the years of 2013 and 2016 presented publication peaks. The studies used 54 evaluation tools, among which 13 were recurrent in the studies, mostly analyzing aspects of communication/language. It is assumed that these data are related to the fact that speech-language pathologists provide care for individuals with aphasia; however, these individuals may present other needs beyond communication, such as those related to human occupation, requiring multiprofessional and integral health care. Among the protocols, the Stroke Impact Scale (SIS) was considered the most complete, since it addresses communication, linguistic, human occupation and psycho-affective aspects. Conclusion: this study identified the use of few instruments dedicated to individuals with aphasia related to all aspects that involve life, with predominance of protocols and evaluations that only address disabilities, highlighting the importance of assessments that address subjectivity, evaluating individuals with aphasia in all dimensions of their lives.
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23
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Rahul DR, Joseph Ponniah R. Language impairment in primary progressive aphasia and other neurodegenerative diseases. J Genet 2019. [DOI: 10.1007/s12041-019-1139-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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24
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Henry ML, Hubbard HI, Grasso SM, Dial HR, Beeson PM, Miller BL, Gorno-Tempini ML. Treatment for Word Retrieval in Semantic and Logopenic Variants of Primary Progressive Aphasia: Immediate and Long-Term Outcomes. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:2723-2749. [PMID: 31390290 PMCID: PMC6802912 DOI: 10.1044/2018_jslhr-l-18-0144] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 10/23/2018] [Accepted: 12/16/2018] [Indexed: 05/25/2023]
Abstract
Purpose Recent studies confirm the utility of speech-language intervention in primary progressive aphasia (PPA); however, long-term outcomes, ideal dosage parameters, and relative benefits of intervention across clinical variants warrant additional investigation. The purpose of this study was to determine whether naming treatment affords significant, lasting, and generalized improvement for individuals with semantic and logopenic PPA and whether dosage manipulations significantly affect treatment outcomes. Method Eighteen individuals with PPA (9 semantic and 9 logopenic variant) underwent lexical retrieval treatment designed to leverage spared cognitive-linguistic domains and develop self-cueing strategies to promote naming. One group (n = 10) underwent once-weekly treatment sessions, and the other group (n = 8) received the same treatment with 2 sessions per week and an additional "booster" treatment phase at 3 months post-treatment. Performance on trained and untrained targets/tasks was measured immediately after treatment and at 3, 6, and 12 months post-treatment. Results Outcomes from the full cohort of individuals with PPA showed significantly improved naming of trained items immediately post-treatment and at all follow-up assessments through 1 year. Generalized improvement on untrained items was significant up to 6 months post-treatment. The positive response to treatment was comparable regardless of session frequency or inclusion of a booster phase. Outcomes were comparable across PPA subtypes, as was maintenance of gains over the post-treatment period. Conclusion This study documents positive naming treatment outcomes for a group of individuals with PPA, demonstrating strong direct treatment effects, maintenance of gains up to 1 year post-treatment, and generalization to untrained items. Lexical retrieval treatment, in conjunction with daily home practice, had a strong positive effect that did not require more than 1 clinician-directed treatment session per week. Findings confirm that strategic training designed to capitalize on spared cognitive-linguistic abilities results in significant and lasting improvement, despite ongoing disease progression, in PPA.
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Affiliation(s)
- Maya L. Henry
- Department of Communication Sciences and Disorders, The University of Texas at Austin
| | - H. Isabel Hubbard
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
- Department of Communication Science and Disorders, University of Kentucky, Lexington
| | - Stephanie M. Grasso
- Department of Communication Sciences and Disorders, The University of Texas at Austin
| | - Heather R. Dial
- Department of Communication Sciences and Disorders, The University of Texas at Austin
| | - Pélagie M. Beeson
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson
| | - Bruce L. Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
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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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Henry ML, Hubbard HI, Grasso SM, Mandelli ML, Wilson SM, Sathishkumar MT, Fridriksson J, Daigle W, Boxer AL, Miller BL, Gorno-Tempini ML. Retraining speech production and fluency in non-fluent/agrammatic primary progressive aphasia. Brain 2019; 141:1799-1814. [PMID: 29718131 DOI: 10.1093/brain/awy101] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 02/19/2018] [Indexed: 12/14/2022] Open
Abstract
The non-fluent/agrammatic variant of primary progressive aphasia (nfvPPA) presents with a gradual decline in grammar and motor speech resulting from selective degeneration of speech-language regions in the brain. There has been considerable progress in identifying treatment approaches to remediate language deficits in other primary progressive aphasia variants; however, interventions for the core deficits in nfvPPA have yet to be systematically investigated. Further, the neural mechanisms that support behavioural restitution in the context of neurodegeneration are not well understood. We examined the immediate and long-term benefits of video implemented script training for aphasia (VISTA) in 10 individuals with nfvPPA. The treatment approach involved repeated rehearsal of individualized scripts via structured treatment with a clinician as well as intensive home practice with an audiovisual model using 'speech entrainment'. We evaluated accuracy of script production as well as overall intelligibility and grammaticality for trained and untrained scripts. These measures and standardized test scores were collected at post-treatment and 3-, 6-, and 12-month follow-up visits. Treatment resulted in significant improvement in production of correct, intelligible scripted words for trained topics, a reduction in grammatical errors for trained topics, and an overall increase in intelligibility for trained as well as untrained topics at post-treatment. Follow-up testing revealed maintenance of gains for trained scripts up to 1 year post-treatment on the primary outcome measure. Performance on untrained scripts and standardized tests remained relatively stable during the follow-up period, indicating that treatment helped to stabilize speech and language despite disease progression. To identify neural predictors of responsiveness to intervention, we examined treatment effect sizes relative to grey matter volumes in regions of interest derived from a previously identified speech production network. Regions of significant atrophy within this network included bilateral inferior frontal cortices and supplementary motor area as well as left striatum. Volumes in a left middle/inferior temporal region of interest were significantly correlated with the magnitude of treatment effects. This region, which was relatively spared anatomically in nfvPPA patients, has been implicated in syntactic production as well as visuo-motor facilitation of speech. This is the first group study to document the benefits of behavioural intervention that targets both linguistic and motoric deficits in nfvPPA. Findings indicate that behavioural intervention may result in lasting and generalized improvement of communicative function in individuals with neurodegenerative disease and that the integrity of spared regions within the speech-language network may be an important predictor of treatment response.
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Affiliation(s)
- Maya L Henry
- Department of Communication Sciences and Disorders, University of Texas, Austin, TX, USA
| | - H Isabel Hubbard
- Department of Neurology, Memory and Aging Center, University of California San Francisco, CA, USA.,Department of Communication Sciences and Disorders, University of Alberta, Canada
| | - Stephanie M Grasso
- Department of Communication Sciences and Disorders, University of Texas, Austin, TX, USA
| | - Maria Luisa Mandelli
- Department of Neurology, Memory and Aging Center, University of California San Francisco, CA, USA
| | - Stephen M Wilson
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Mithra T Sathishkumar
- Department of Communication Sciences and Disorders, University of Texas, Austin, TX, USA
| | - Julius Fridriksson
- Department of Communication Sciences and Disorders, University of South Carolina, Columbia, SC, USA
| | - Wylin Daigle
- Department of Communication Sciences and Disorders, University of Texas, Austin, TX, USA
| | - Adam L Boxer
- Department of Neurology, Memory and Aging Center, University of California San Francisco, CA, USA
| | - Bruce L Miller
- Department of Neurology, Memory and Aging Center, University of California San Francisco, CA, USA
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27
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Lagarde J, Hahn V, Sarazin M. Afasia primaria progressiva. Neurologia 2019. [DOI: 10.1016/s1634-7072(19)42020-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
PURPOSE OF REVIEW Knowledge on primary progressive aphasia (PPA) has expanded rapidly in the past few decades. Clinical characteristics, neuroimaging correlates, and neuropathological features of PPA are better delineated. This facilitates scientific studies on the disease pathophysiology and allows speech and language therapy to be more precisely targeted. This review article begins with a summary of the current understanding of PPA and discusses how PPA can serve as a model to promote scientific discovery in neurodegenerative diseases. RECENT FINDINGS Studies on the different variants of PPA have demonstrated the high compatibility between clinical presentations and neuroimaging features, and in turn, enhances the understanding of speech and language neuroanatomy. In addition to the traditional approach of lesion-based or voxel-based mapping, scientists have also adopted functional connectivity and network topology approaches that permits a more multidimensional understanding of neuroanatomy. As a result, pharmacological and cognitive therapeutic strategies can now be better targeted towards specific pathological/molecular and cognitive subtypes. SUMMARY Recent scientific advancement in PPA potentiates it to be an optimal model for studying brain network vulnerability, neurodevelopment influences and the effects of nonpharmacological intervention in neurodegenerative diseases.
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Affiliation(s)
- Boon Lead Tee
- Global Brain Health Institute, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
- Department of Neurology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Maria Luisa Gorno-Tempini
- Department of Neurology, Memory and Aging Center, University of California at San Francisco, San Francisco, California, USA
- Dyslexia Center, University of California at San Francisco, San Francisco, California, USA
- Global Brain Health Institute, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
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Marshall CR, Hardy CJD, Volkmer A, Russell LL, Bond RL, Fletcher PD, Clark CN, Mummery CJ, Schott JM, Rossor MN, Fox NC, Crutch SJ, Rohrer JD, Warren JD. Primary progressive aphasia: a clinical approach. J Neurol 2018; 265:1474-1490. [PMID: 29392464 PMCID: PMC5990560 DOI: 10.1007/s00415-018-8762-6] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/18/2018] [Accepted: 01/19/2018] [Indexed: 12/12/2022]
Abstract
The primary progressive aphasias are a heterogeneous group of focal 'language-led' dementias that pose substantial challenges for diagnosis and management. Here we present a clinical approach to the progressive aphasias, based on our experience of these disorders and directed at non-specialists. We first outline a framework for assessing language, tailored to the common presentations of progressive aphasia. We then consider the defining features of the canonical progressive nonfluent, semantic and logopenic aphasic syndromes, including 'clinical pearls' that we have found diagnostically useful and neuroanatomical and other key associations of each syndrome. We review potential diagnostic pitfalls and problematic presentations not well captured by conventional classifications and propose a diagnostic 'roadmap'. After outlining principles of management, we conclude with a prospect for future progress in these diseases, emphasising generic information processing deficits and novel pathophysiological biomarkers.
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Affiliation(s)
- Charles R Marshall
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK.
| | - Chris J D Hardy
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Anna Volkmer
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Lucy L Russell
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Rebecca L Bond
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Phillip D Fletcher
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Camilla N Clark
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Catherine J Mummery
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Jonathan M Schott
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Martin N Rossor
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Nick C Fox
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Sebastian J Crutch
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Jonathan D Rohrer
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
| | - Jason D Warren
- Department of Neurodegenerative Disease, Dementia Research Centre, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK.
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Beber BC, Berbert MCB, Grawer RS, Cardoso MCDAF. Rate and rhythm control strategies for apraxia of speech in nonfluent primary progressive aphasia. Dement Neuropsychol 2018; 12:80-84. [PMID: 29682238 PMCID: PMC5901254 DOI: 10.1590/1980-57642018dn12-010012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The nonfluent/agrammatic variant of primary progressive aphasia is characterized by apraxia of speech and agrammatism. Apraxia of speech limits patients' communication due to slow speaking rate, sound substitutions, articulatory groping, false starts and restarts, segmentation of syllables, and increased difficulty with increasing utterance length. Speech and language therapy is known to benefit individuals with apraxia of speech due to stroke, but little is known about its effects in primary progressive aphasia. This is a case report of a 72-year-old, illiterate housewife, who was diagnosed with nonfluent primary progressive aphasia and received speech and language therapy for apraxia of speech. Rate and rhythm control strategies for apraxia of speech were trained to improve initiation of speech. We discuss the importance of these strategies to alleviate apraxia of speech in this condition and the future perspectives in the area.
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Affiliation(s)
- Bárbara Costa Beber
- Atlantic Fellow for Equity in Brain Health of the Global Brain Health Institute, Trinity College Dublin, Ireland.,Department of Speech and Language Pathology, Federal University of Health Sciences of Porto Alegre, RS, Brazil
| | | | - Ruth Siqueira Grawer
- Department of Speech and Language Pathology, Federal University of Health Sciences of Porto Alegre, RS, Brazil.,Irmandade Santa Casa de Misericórdia de Porto Alegre, RS, Brazil
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Gervits F, Ash S, Coslett HB, Rascovsky K, Grossman M, Hamilton R. Transcranial direct current stimulation for the treatment of primary progressive aphasia: An open-label pilot study. BRAIN AND LANGUAGE 2016; 162:35-41. [PMID: 27522537 PMCID: PMC5204261 DOI: 10.1016/j.bandl.2016.05.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 04/18/2016] [Accepted: 05/15/2016] [Indexed: 05/06/2023]
Abstract
Primary progressive aphasia (PPA) is a neurodegenerative condition characterized by gradual deterioration of language function. We investigated whether two weeks of daily transcranial direct current stimulation (tDCS) treatment would improve language abilities in six people with a non-fluent form of PPA. tDCS was applied in an unblinded trial at an intensity of 1.5mA for 20min/day over 10days. At the time of stimulation, patients were engaged in narrating one of several children's wordless picture stories. A battery of neuropsychological assessments was administered four times: at baseline, immediately following the 2-week stimulation period, and then 6-weeks and 12-weeks following the end of stimulation. We observed improvement in linguistic performance in the domains of speech production and grammatical comprehension. Our encouraging results indicate that larger, sham-controlled studies of tDCS as a potential intervention for PPA are warranted.
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Affiliation(s)
- Felix Gervits
- Laboratory for Cognition and Neural Stimulation, Center for Cognitive Neuroscience, University of Pennsylvania, United States; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Sharon Ash
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, United States; Penn Frontotemporal Degeneration Center, University of Pennsylvania, United States
| | - H Branch Coslett
- Laboratory for Cognition and Neural Stimulation, Center for Cognitive Neuroscience, University of Pennsylvania, United States; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Katya Rascovsky
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, United States; Penn Frontotemporal Degeneration Center, University of Pennsylvania, United States
| | - Murray Grossman
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, United States; Penn Frontotemporal Degeneration Center, University of Pennsylvania, United States
| | - Roy Hamilton
- Laboratory for Cognition and Neural Stimulation, Center for Cognitive Neuroscience, University of Pennsylvania, United States; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, United States.
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Lamb R, Rohrer JD, Lees AJ, Morris HR. Progressive Supranuclear Palsy and Corticobasal Degeneration: Pathophysiology and Treatment Options. Curr Treat Options Neurol 2016; 18:42. [PMID: 27526039 PMCID: PMC4985534 DOI: 10.1007/s11940-016-0422-5] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OPINION STATEMENT There are currently no disease-modifying treatments for progressive supranuclear palsy (PSP) or corticobasal degeneration (CBD), and no approved pharmacological or therapeutic treatments that are effective in controlling their symptoms. The use of most pharmacological treatment options are based on experience in other disorders or from non-randomized historical controls, case series, or expert opinion. Levodopa may provide some improvement in symptoms of Parkinsonism (specifically bradykinesia and rigidity) in PSP and CBD; however, evidence is conflicting and where present, benefits are often negligible and short lived. In fact, "poor" response to levodopa forms part of the NINDS-SPSP criteria for the diagnosis of PSP and consensus criteria for the diagnosis of CBD (Lang Mov Disord. 20 Suppl 1:S83-91, 2005; Litvan et al. Neurology. 48:119-25, 1997; Armstrong et al. Neurology. 80(5):496-503, 2013). There is some evidence that intrasalivery gland botulinum toxin is useful in managing problematic sialorrhea and that intramuscular botulinum toxin and baclofen are helpful in reducing dystonia, including blepharospasm. Benzodiazepines may also be useful in managing dystonia. Myoclonus may be managed using levetiracetam and benzodiazepines. Pharmacological agents licensed for Alzheimer's disease (such as acetylcholinesterase inhibitors and N-Methyl-D-aspartate receptor antagonists) have been used off-label in PSP, CBD, and other tauopathies with the aim of improving cognition; however, there is limited evidence that they are effective and risk of adverse effects may outweigh benefits. The use of atypical antipsychotics for behavioural symptoms is not recommended in the elderly or those with demetia associated conditions and most antipsychotics will worsen Parkinsonism. Antidepressants may be useful for behavioral symptoms and depression but are often poorly tolerated due to adverse effects. In the absence of an effective drug treatment to target the underlying cause of CBD and PSP, management should focus on optimizing quality of life, relieving symptoms and assisting patients with their activities of daily living (ADL). Patients should be managed by a multidisciplinary team consisting of neurologists, physiotherapists (PT), occupational therapists (OT), speech and language therapists (SALT), dieticians, ophthalmologists, psychologists, and palliative care specialists.
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Affiliation(s)
- Ruth Lamb
- Department of Clinical Neuroscience, UCL Institute of Neurology, Queen Square, London, UK
| | - Jonathan D. Rohrer
- Dementia Research Centre, UCL Institute of Neurology, University College London, London, UK
| | - Andrew J. Lees
- Department of Molecular Neuroscience, Queen Square Brain Bank for Neurological Disorders, University College London, London, UK
| | - Huw R. Morris
- Department of Clinical Neuroscience, UCL Institute of Neurology, Queen Square, London, UK
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Beber BC, Brandão L, Chaves MLF. A warning to the Brazilian Speech-Language Pathology and Audiology community about the importance of scientific and clinical activities in primary progressive aphasia. Codas 2016; 27:505-8. [PMID: 26648224 DOI: 10.1590/2317-1782/20152015081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 04/28/2015] [Indexed: 12/11/2022] Open
Abstract
This article aims to warn the Brazilian Speech-Language Pathology and Audiology scientific community about the importance and necessity of scientific and clinical activities regarding Primary Progressive Aphasia. This warning is based on a systematic literature review of the scientific production on Primary Progressive Aphasia, from which nine Brazilian articles were selected. It was observed that there is an obvious lack of studies on the subject, as all the retrieved articles were published in medical journals and much of it consisted of small samples; only two articles described the effectiveness of speech-language therapy in patients with Primary Progressive Aphasia. A perspective for the future in the area and characteristics of Speech-Language Therapy for Primary Progressive Aphasia are discussed. As a conclusion, it is evident the need for greater action by Speech-Language Pathology and Audiology on Primary Progressive Aphasia.
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Affiliation(s)
| | - Lenisa Brandão
- Departamento de Saúde e Comunicação Humana, Instituto de Psicologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Márcia Lorena Fagundes Chaves
- Departamento de Medicina Interna, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
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Meyer AM, Getz HR, Brennan DM, Hu TM, Friedman RB. Telerehabilitation of Anomia in Primary Progressive Aphasia. APHASIOLOGY 2016; 30:483-507. [PMID: 27087732 PMCID: PMC4831866 DOI: 10.1080/02687038.2015.1081142] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND The efficacy of telerehabilitation-based treatment for anomia has been demonstrated in post-stroke aphasia, but the efficacy of this method of anomia treatment delivery has not been established within the context of degenerative illness. AIMS The current study evaluated the feasibility and efficacy of a telerehabilitation-based approach to anomia treatment within the three subtypes of primary progressive aphasia (PPA). METHODS & PROCEDURES Each of the three telerehabilitation participants represented a distinct subtype of PPA. Following a baseline evaluation of language and cognition, a phonological treatment and an orthographic treatment were administered to all participants over the course of six months. One month after the end of treatment, a post-treatment evaluation began. All treatment sessions and the majority of the evaluation sessions were administered via telerehabilitation. Treatment effects were examined within each subject, and treatment effects were also compared between each telerehabilitation participant and a group of in-person participants who had the same subtype of PPA. OUTCOMES & RESULTS All three telerehabilitation participants exhibited positive treatment effects. CGR (nonfluent/agrammatic variant PPA) and WCH (logopenic variant PPA) showed maintenance of naming for prophylaxis items in both treatment conditions, while ACR (semantic variant PPA) demonstrated increased naming of remediation items in the phonological treatment condition. Compared to in-person participants with the same subtype of PPA, each of the telerehabilitation participants typically showed effects that were either within the expected range or larger than expected. CONCLUSIONS Telerehabilitation-based anomia treatment is feasible and effective in all three subtypes of PPA.
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Affiliation(s)
- Aaron M. Meyer
- Center for Aphasia Research and Rehabilitation, Georgetown University Medical Center
| | - Heidi R. Getz
- Center for Aphasia Research and Rehabilitation, Georgetown University Medical Center
| | | | | | - Rhonda B. Friedman
- Center for Aphasia Research and Rehabilitation, Georgetown University Medical Center
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Abstract
OPINION STATEMENT Primary progressive aphasia (PPA) is a neurodegenerative disease that primarily affects language functions and often begins in the fifth or sixth decade of life. The devastating effects on work and home life call for the investigation of treatment alternatives. In this paper, we present a review of the literature on treatment approaches for this neurodegenerative disease. We also present new data from two intervention studies we have conducted, a behavioral one and a neuromodulatory one using transcranial direct current stimulation (tDCS) combined with written production intervention. We show that speech-language intervention improves language outcomes in individuals with PPA, and especially in the short term, tDCS augments generalization and maintenance of positive language outcomes. We also outline current issues and challenges in intervention approaches in PPA.
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Affiliation(s)
- Donna C Tippett
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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36
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Wang FJ. Effect of picture-book reading on anxiety, depression and loneliness in hospitalized children with gastrointestinal disease. Shijie Huaren Xiaohua Zazhi 2015; 23:2174-2179. [DOI: 10.11569/wcjd.v23.i13.2174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the effect of picture-book reading on anxiety, depression and loneliness in hospitalized children with gastrointestinal disease.
METHODS: One hundred and two children with gastrointestinal disease treated from January 2013 and November 2014 at our hospital were selected and randomly divided into an observation group and a control group, with 51 cases in each group. Cases in the control group were given conventional treatment and psychological nursing. Based on these, children in the observation group were additionally guided by a trained nurse to conduct picture-book reading. The scores of Screen for Children Anxiety Related Emotional Disorders (SEARED), Depression Self-rating Scale for Children (DSRSC), Children's Loneliness Scale (CLS) and satisfaction of children's families were compared between the two groups before and after intervention.
RESULTS: The total scores of SEARD, DSRSC and CLS were, respectively, 17.63 ± 4.72, 10.09 ± 4.51 and 21.54 ± 4.49 in the observation group after intervention, which were statistically lower than 23.51 ± 4.93, 13.26 ± 4.78 and 23.96 ± 4.58 in the control group (t = 6.152, 3.445, 2.695; P < 0.05). The degree of satisfaction of children's families in the observation group was significant higher than that in the control group (χ2 = 11.304, P < 0.05).
CONCLUSION: The picture-book reading introduced into the psychological nursing of hospitalized children with gastrointestinal disease could significantly reduce the levels of anxiety and depression and improve their sense of loneliness.
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Abstract
In recent years there has been an increase in research describing the behavioral characteristics and underlying pathology of primary progressive aphasia (PPA). One of the earliest and most prominent features of PPA, particularly for the logopenic and semantic variants, is anomia, and this is often the symptom that prompts individuals with PPA to seek treatment. However, speech-language pathologists who encounter individuals with PPA on their clinical caseloads often have questions about how best to manage progressive language decline in these patients. A small body of literature suggests that treatment for anomia in PPA is indeed warranted, and that item-specific improvement can be expected for a majority of individuals receiving treatment. Although generalization and maintenance of treatment gains are variable in the face of progressive decline, there are some emerging themes as to treatment approaches and patient characteristics that may promote more generalized and relatively durable treatment outcomes. Ultimately, treatment that engages residual semantic, phonologic and orthographic skills, using both strategic training and stimulation, may be appropriate for PPA patients with mild-moderate anomia.
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Affiliation(s)
- Kindle Rising
- Department of Speech, Language and Hearing Sciences, University of ArizonaTucson, AZ
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38
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Duffy JR, Strand EA, Josephs KA. Motor Speech Disorders Associated with Primary Progressive Aphasia. APHASIOLOGY 2014; 28:1004-1017. [PMID: 25309017 PMCID: PMC4191906 DOI: 10.1080/02687038.2013.869307] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Primary progressive aphasia (PPA) and conditions that overlap with it can be accompanied by motor speech disorders. Recognition and understanding of motor speech disorders can contribute to a fuller clinical understanding of PPA and its management as well as its localization and underlying pathology. AIMS To review the types of motor speech disorders that may occur with PPA, its primary variants, and its overlap syndromes (progressive supranuclear palsy syndrome, corticobasal syndrome, motor neuron disease), as well as with primary progressive apraxia of speech. MAIN CONTRIBUTION The review should assist clinicians' and researchers' understanding of the relationship between motor speech disorders and PPA and its major variants. It also highlights the importance of recognizing neurodegenerative apraxia of speech as a condition that can occur with little or no evidence of aphasia. CONCLUSION Motor speech disorders can occur with PPA. Their recognition can contribute to clinical diagnosis and management of PPA and to understanding and predicting the localization and pathology associated with PPA variants and conditions that can overlap with them.
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Affiliation(s)
- Joseph R Duffy
- Dept. of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, U.S.A
| | - Edythe A Strand
- Dept. of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, U.S.A
| | - Keith A Josephs
- Dept. of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, U.S.A
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Abstract
OPINION STATEMENT Corticobasal degeneration is a pathologic entity. Presenting clinical phenotypes include corticobasal syndrome (CBS), frontal behavioral spatial syndrome, aphasia, progressive supranuclear palsy-like syndrome (PSPS), and a predominantly cognitive phenotype often mistaken for Alzheimer's disease (AD). Treatment of CBD is symptomatic, particularly given recently negative neuroprotective studies. Given the relentless progression in CBD, all interested patients should be offered the opportunity to enroll in clinical neuroprotective trials as they arise. For symptomatic therapy, treatment options are necessarily based on evidence from other disorders given the lack of studies in CBD. In patients with CBS and PSPS, parkinsonism is treated with levodopa/carbidopa. This generally has modest and transient benefits at best and often results in no improvement. Botulinum toxin injections are the treatment of choice for limb dystonia. Clonazepam and levetiracetam are commonly used for myoclonus. Physical therapy is an important part of motor treatment, particularly for fall prevention strategies and assist device assessment. Whether medications such as cholinesterase inhibitors or memantine have any role in CBD is unclear given the various responses described in related phenotypes and diseases. Treating the behavioral symptoms associated with CBD is critical in an attempt to treat symptoms for which we have good pharmacologic interventions and to hopefully improve quality of life. General supportive care is important, including assessing for sores related to dystonia or immobility, monitoring dysphagia, and identifying needs for support services. Finally, as with other relentlessly progressive neurodegenerative diseases, it is critical to provide family and caregiver support and to assess for when palliative care services will serve the patient best.
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Affiliation(s)
- Melissa J Armstrong
- Division of Movement Disorders, Department of Neurology, University of Maryland School of Medicine, 110 S. Paca Street, 3rd Floor, Baltimore, MD, 21201, USA,
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40
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Tsapkini K, Frangakis C, Gomez Y, Davis C, Hillis AE. Augmentation of spelling therapy with transcranial direct current stimulation in primary progressive aphasia: Preliminary results and challenges. APHASIOLOGY 2014; 28:1112-1130. [PMID: 26097278 PMCID: PMC4470615 DOI: 10.1080/02687038.2014.930410] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Primary progressive aphasia (PPA) is a neurodegenerative disease that primarily affects language functions and often begins in the fifth or sixth decade of life. The devastating effects on work and family life call for the investigation of treatment alternatives. In this article, we present new data indicating that neuromodulatory treatment, using transcranial direct current stimulation (tDCS) combined with a spelling intervention, shows some promise for maintaining or even improving language, at least temporarily, in PPA. AIMS The main aim of the present article is to determine whether tDCS plus spelling intervention is more effective than spelling intervention alone in treating written language in PPA. We also asked whether the effects of tDCS are sustained longer than the effects of spelling intervention alone. METHODS & PROCEDURES We present data from six PPA participants who underwent anodal tDCS or sham plus spelling intervention in a within-subject crossover design. Each stimulation condition lasted 3 weeks or a total of 15 sessions with a 2-month interval in between. Participants were evaluated on treatment tasks as well as on other language and cognitive tasks at 2-week and 2-month follow-up intervals after each stimulation condition. OUTCOMES & RESULTS All participants showed improvement in spelling (with sham or tDCS). There was no difference in the treated items between the two conditions. There was, however, consistent and significant improvement for untrained items only in the tDCS plus spelling intervention condition. Furthermore, the improvement lasted longer in the tDCS plus spelling intervention condition compared to sham plus spelling intervention condition. CONCLUSIONS Neuromodulation with tDCS offers promise as a means of augmenting language therapy to improve written language function at least temporarily in PPA. The consistent finding of generalisation of treatment benefits to untreated items and the superior sustainability of treatment effects with tDCS justifies further investigations. However, the small sample size still requires caution in interpretation. Present interventions need to be optimised, and particular challenges, such as ways to account for the variable effect of degeneration in each individual, are discussed.
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Affiliation(s)
- Kyrana Tsapkini
- Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Constantine Frangakis
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yessenia Gomez
- Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Cameron Davis
- Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, USA
- Department of Physical Medicine & Rehabilitation, Johns Hopkins Medicine, Baltimore, MD, USA
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD, USA
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Kortte KB, Rogalski EJ. Behavioural interventions for enhancing life participation in behavioural variant frontotemporal dementia and primary progressive aphasia. Int Rev Psychiatry 2013; 25:237-45. [PMID: 23611353 PMCID: PMC3659798 DOI: 10.3109/09540261.2012.751017] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Primary progressive aphasia (PPA) and behavioural-variant frontotemporal dementia (bvFTD) are clinical syndromes under the umbrella term 'frontotemporal dementia' (FTD) and are caused by a neurodegenerative disease with an onset most typically in the productive years of adulthood. The cognitive and behavioural impairments associated with FTD interfere with successful engagement in typical life roles, such as parenting, working, and maintenance of interpersonal relationships. There are currently no treatments to stop or slow the degenerative process and there are only very limited medication options for the management of the cognitive-behavioural symptoms. However, alternative, non-pharmacological interventions may offer significant benefit to the quality of life of the diagnosed individual. The goal of this paper is to provide an overview of the approaches available through neurorehabilitation and community-based services that facilitate successful engagement in life activities and promote optimal quality of life for the individuals and families living with FTD. It is hoped that as medical providers become more familiar with behavioural interventions, referrals for services will increase thereby allowing individuals with FTD and their caregivers to learn ways to adapt, adjust, and participate in life to the fullest despite the impairments from this progressive disease.
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Affiliation(s)
- Kathleen B. Kortte
- Department of Physical Medicine and Rehabilitation The Johns Hopkins University School of Medicine
| | - Emily J. Rogalski
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University Feinberg School of Medicine
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Carthery-Goulart MT, da Silveira ADC, Machado TH, Mansur LL, Parente MADMP, Senaha MLH, Brucki SMD, Nitrini R. Nonpharmacological interventions for cognitive impairments following primary progressive aphasia: a systematic review of the literature. Dement Neuropsychol 2013; 7:122-131. [PMID: 29213828 PMCID: PMC5619554 DOI: 10.1590/s1980-57642013dn70100018] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This study provided a systematic review on nonpharmacological interventions applied to patients diagnosed with Primary Progressive Aphasia (PPA) and its variants: Semantic (SPPA), Nonfluent (NFPPA) and Logopenic (LPPA) to establish evidence-based recommendations for the clinical practice of cognitive rehabilitation for these patients. METHODS A PubMed and LILACS literature search with no time restriction was conducted with the keywords PPA (and its variants) AND rehabilitation OR training OR intervention OR therapy OR treatment OR effectiveness. To develop its evidence-based recommendations, a research committee identified questions to be addressed and determined the level of evidence for each study according to published criteria (Cicerone et al., 2000). Overall evidence for treatments was summarized and recommendations were derived. RESULTS Our search retrieved articles published from 1995 to 2013: 21 for SPPA, 8 for NFPPA, 3 for LPPA and 8 for PPA with no specification. Thirty-five studies were rated as Class III, consisting of studies with results obtained from one or more single-cases and that used appropriate single-subject methods with adequate quantification and analysis of results. The level of evidence of three functional interventions could not be established. One study was rated as Class II and consisted of a nonrandomized case-control investigation. CONCLUSION Positive results were reported in all reviewed studies. However, in order to be recommended, some investigation regarding the intervention efficacy was required. Results of the present review allows for recommendation of some nonpharmacological interventions for cognitive deficits following PPA as Practice Options. Suggestions for further studies on PPA interventions and future research are discussed.
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Affiliation(s)
- Maria Teresa Carthery-Goulart
- Núcleo de Cognição e Sistemas Complexos e Centro de Matemática, Computação e Cognição da Universidade Federal do ABC, Santo André SP, Brazil. Grupo de Neurologia Cognitiva e do Comportamento, Departamento de Neurologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo SP, Brazil
| | - Amanda da Costa da Silveira
- Núcleo de Cognição e Sistemas Complexos e Centro de Matemática, Computação e Cognição da Universidade Federal do ABC, Santo André SP, Brazil
| | - Thais Helena Machado
- Grupo de Neurologia Cognitiva e do Comportamento da Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte MG, Brazil
| | - Leticia Lessa Mansur
- Curso de Fonoaudiologia da Faculdade de Medicina da Universidade de São Paulo, São Paulo SP, Brazil
| | | | - Mirna Lie Hosogi Senaha
- Grupo de Neurologia Cognitiva e do Comportamento, Departamento de Neurologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo SP, Brazil
| | - Sonia Maria Dozzi Brucki
- Grupo de Neurologia Cognitiva e do Comportamento, Departamento de Neurologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo SP, Brazil
| | - Ricardo Nitrini
- Grupo de Neurologia Cognitiva e do Comportamento, Departamento de Neurologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo SP, Brazil
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