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Josephy-Hernandez S, Rezaii N, Jones A, Loyer E, Hochberg D, Quimby M, Wong B, Dickerson BC. Automated analysis of written language in the three variants of primary progressive aphasia. Brain Commun 2023; 5:fcad202. [PMID: 37539353 PMCID: PMC10396070 DOI: 10.1093/braincomms/fcad202] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 06/18/2023] [Accepted: 07/18/2023] [Indexed: 08/05/2023] Open
Abstract
Despite the important role of written language in everyday life, abnormalities in functional written communication have been sparsely investigated in primary progressive aphasia. Prior studies have analysed written language separately in each of the three variants of primary progressive aphasia-but have rarely compared them to each other or to spoken language. Manual analysis of written language can be a time-consuming process. We therefore developed a program that quantifies content units and total units in written or transcribed language samples. We analysed written and spoken descriptions of the Western Aphasia Battery picnic scene, based on a predefined content unit corpus. We calculated the ratio of content units to units as a measure of content density. Our cohort included 115 participants (20 controls for written, 20 controls for spoken, 28 participants with nonfluent variant primary progressive aphasia, 30 for logopenic variant and 17 for semantic variant). Our program identified content units with a validity of 99.7% (95%CI 99.5-99.8). All patients wrote fewer units than controls (P < 0.001). Patients with the logopenic variant (P = 0.013) and the semantic variant (0.004) wrote fewer content units than controls. The content unit-to-unit ratio was higher in the nonfluent and semantic variants than controls (P = 0.019), but no difference in the logopenic variant (P = 0.962). Participants with the logopenic (P < 0.001) and semantic (P = 0.04) variants produced fewer content units in written compared to spoken descriptions. All variants produced fewer units in written samples compared to spoken (P < 0.001). However, due to a relatively smaller decrease in written content units, we observed a larger content unit-to-unit ratio in writing over speech (P < 0.001). Written and spoken content units (r = 0.5, P = 0.009) and total units (r = 0.64, P < 0.001) were significantly correlated in patients with nonfluent variant, but this was not the case for logopenic or semantic. Considering all patients with primary progressive aphasia, fewer content units were produced in those with greater aphasia severity (Progressive Aphasia Severity Scale Sum of Boxes, r = -0.24, P = 0.04) and dementia severity (Clinical Dementia Rating scale Sum of Boxes, r = -0.34, P = 0.004). In conclusion, we observed reduced written content in patients with primary progressive aphasia compared to controls, with a preference for content over non-content units in patients with the nonfluent and semantic variants. We observed a similar 'telegraphic' style in both language modalities in patients with the nonfluent variant. Lastly, we show how our program provides a time-efficient tool, which could enable feedback and tracking of writing as an important feature of language and cognition.
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Affiliation(s)
- Sylvia Josephy-Hernandez
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA
| | - Neguine Rezaii
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA
| | - Amelia Jones
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA
| | - Emmaleigh Loyer
- Speech and Language Pathology Department, Spaulding Rehabilitation Hospital, Charlestown, MA 02129, USA
| | - Daisy Hochberg
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA
| | - Megan Quimby
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA
| | - Bonnie Wong
- Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA
| | - Bradford C Dickerson
- Correspondence to: Bradford C. Dickerson Frontotemporal Disorders Unit, Department of Neurology Massachusetts General Hospital & Harvard Medical School 149 13th Street, Suite 10.004, Charlestown, MA 02129, USA E-mail:
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Petrillo SM, Del Mauro M, Lambro BE, Occhigrossi C, Piccirilli M. Italian translation and cross-cultural adaptation of the Progressive Aphasia Severity Scale. Neurol Sci 2021; 43:3065-3070. [PMID: 34859332 DOI: 10.1007/s10072-021-05651-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/01/2021] [Indexed: 10/19/2022]
Abstract
Primary progressive aphasia (PPA) is a neurodegenerative disease characterised by a progressive decline in language and speech as the first clinical manifestation, which mostly spares other cognitive functions. However, the linguistic impairment of PPA shows different features than that resulting from cerebrovascular diseases. The major difference between the linguistic manifestations of PPA and the traditional classification of aphasias has led to the development of new, more specific methods of language assessment. Among the currently available tools, there has been great interest in the Progressive Aphasia Severity Scale (PASS). This quick and easy-to-use clinical tool allows to collect significant information from caregivers about the communicative, linguistic, and functional difficulties of patients affected by PPA. In addition to monitoring the severity and progression of deficits in 13 different language domains, this scale integrates the classic "clinically reported" assessment with a "caregiver-reported" analysis of the daily experience of the patient, which provides a better understanding of how the disease affects the quality of life of both the patient and the caregiver. In the present contribution, the PASS was translated and adapted into Italian according to the international guidelines for the cross-cultural adaptation of self-report measures. This version of the PASS can help clinicians and researchers in the diagnosis of PPA in Italian clinical populations. Furthermore, it could be particularly useful for the long-term evaluation of the disease, in order to monitor its evolution, and might represent an optimal means to verify the efficacy of speech/language therapy in delaying the progression of the disease.
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Affiliation(s)
- Stefania M Petrillo
- Speech and Language Therapy Degree, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.
| | - Marianna Del Mauro
- Speech and Language Therapy Degree, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Benedetta E Lambro
- Speech and Language Therapy Degree, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Chiara Occhigrossi
- Speech and Language Therapy Degree, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Massimo Piccirilli
- Speech and Language Therapy Degree, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Lombardi J, Mayer B, Semler E, Anderl‐Straub S, Uttner I, Kassubek J, Diehl‐Schmid J, Danek A, Levin J, Fassbender K, Fliessbach K, Schneider A, Huppertz H, Jahn H, Volk A, Kornhuber J, Landwehrmeyer B, Lauer M, Prudlo J, Wiltfang J, Schroeter ML, Ludolph A, Otto M. Quantifying progression in primary progressive aphasia with structural neuroimaging. Alzheimers Dement 2021; 17:1595-1609. [DOI: 10.1002/alz.12323] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/22/2021] [Accepted: 01/31/2021] [Indexed: 01/22/2023]
Affiliation(s)
| | - Benjamin Mayer
- Institute for Epidemiology and Medical Biometry University of Ulm Ulm Germany
| | - Elisa Semler
- Department of Neurology University Hospital Ulm Ulm Germany
| | | | - Ingo Uttner
- Department of Neurology University Hospital Ulm Ulm Germany
| | - Jan Kassubek
- Department of Neurology University Hospital Ulm Ulm Germany
| | - Janine Diehl‐Schmid
- Department of Psychiatry and Psychotherapy Technical University of Munich Munich Germany
- Munich Cluster for Systems Neurology (SyNergy) Munich Germany
| | - Adrian Danek
- Department of Neurology Ludwig‐Maximilians‐Universität München Munich Germany
| | - Johannes Levin
- Department of Neurology Ludwig‐Maximilians‐Universität München Munich Germany
- German Center for Neurodegenerative Diseases (DZNE) Munich Germany
- Munich Cluster for Systems Neurology (SyNergy) Munich Germany
| | - Klaus Fassbender
- Department of Neurology Saarland University Hospital Homburg Germany
| | - Klaus Fliessbach
- Department of Psychiatry and Psychotherapy University Hospital Bonn Bonn Germany
- German Center for Neurodegenerative Diseases (DZNE) Bonn Germany
| | - Anja Schneider
- Department of Psychiatry and Psychotherapy University Hospital Bonn Bonn Germany
- German Center for Neurodegenerative Diseases (DZNE) Bonn Germany
| | | | - Holger Jahn
- Department of Psychiatry and Psychotherapy University Hospital Hamburg Eppendorf Hamburg Germany
| | - Alexander Volk
- Institute for Human Genetics University Hospital Hamburg Eppendorf Hamburg Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy University Hospital Erlangen Erlangen Germany
| | | | - Martin Lauer
- Department of Psychiatry and Psychotherapy University Hospital Würzburg Würzburg Germany
| | - Johannes Prudlo
- Department of Neurology University Medicine Rostock Rostock Germany
- German Center for Neurodegenerative Diseases (DZNE) Rostock Germany
| | - Jens Wiltfang
- Department of Psychiatry and Psychotherapy Medical University Göttingen Göttingen Germany
| | - Matthias L. Schroeter
- Max‐Planck‐Institute for Human Cognitive and Brain Sciences and Clinic for Cognitive Neurology University Hospital Leipzig Leipzig Germany
| | - Albert Ludolph
- Department of Neurology University Hospital Ulm Ulm Germany
| | - Markus Otto
- Department of Neurology University Hospital Ulm Ulm Germany
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Development of disease-modifying drugs for frontotemporal dementia spectrum disorders. Nat Rev Neurol 2020; 16:213-228. [PMID: 32203398 DOI: 10.1038/s41582-020-0330-x] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2020] [Indexed: 02/06/2023]
Abstract
Frontotemporal dementia (FTD) encompasses a spectrum of clinical syndromes characterized by progressive executive, behavioural and language dysfunction. The various FTD spectrum disorders are associated with brain accumulation of different proteins: tau, the transactive response DNA binding protein of 43 kDa (TDP43), or fused in sarcoma (FUS) protein, Ewing sarcoma protein and TATA-binding protein-associated factor 15 (TAF15) (collectively known as FET proteins). Approximately 60% of patients with FTD have autosomal dominant mutations in C9orf72, GRN or MAPT genes. Currently available treatments are symptomatic and provide limited benefit. However, the increased understanding of FTD pathogenesis is driving the development of potential disease-modifying therapies. Most of these drugs target pathological tau - this category includes tau phosphorylation inhibitors, tau aggregation inhibitors, active and passive anti-tau immunotherapies, and MAPT-targeted antisense oligonucleotides. Some of these therapeutic approaches are being tested in phase II clinical trials. Pharmacological approaches that target the effects of GRN and C9orf72 mutations are also in development. Key results of large clinical trials will be available in a few years. However, clinical trials in FTD pose several challenges, and the development of specific brain imaging and molecular biomarkers could facilitate the recruitment of clinically homogenous groups to improve the chances of positive clinical trial results.
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Panza F, Imbimbo BP, Lozupone M, Greco A, Seripa D, Logroscino G, Daniele A, Colosimo C. Disease-modifying therapies for tauopathies: agents in the pipeline. Expert Rev Neurother 2019; 19:397-408. [PMID: 30973276 DOI: 10.1080/14737175.2019.1606715] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Tauopathies are heterogeneous clinicopathological entities characterized by abnormal neuronal and/or glial inclusions of the microtubule-binding protein tau. Primary tauopathies considered to be diseases correspond to a major class of frontotemporal lobar degeneration (FTLD) neuropathology (FTLD-Tau), including several forms of frontotemporal dementia (FTD) clinical syndromes. Little progress has been made in the past 20 years in developing effective disease-modifying drugs for primary tauopathies and available symptomatic treatments have limited efficacy. Areas covered: Potential disease-modifying drugs in clinical development to slow neuropathological progression of primary tauopathies. Expert opinion: Since the underlying pathology of primary tauopathies consists of abnormal tau protein aggregates, treatments are being developed to interfere with the aggregation process or to promote the clearance of this protein. Unfortunately, disease-modifying treatments remain years away as demonstrated by the recent negative Phase III findings of a tau aggregation inhibitor (LMTM) for treating the behavioral variant of FTD. Further evidence will come from ongoing Phase I/II trials on novel drugs and immunotherapeutics with various targets - prevention of deposition or removal of tau aggregates, inhibition of tau phosphorylation/acetylation, modulation of O-GlcNAcylation, activation of autophagy or ubiquitin-proteasome system pathways, and rescue of selected tau loss of function or suppression of tau gene expression.
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Affiliation(s)
- Francesco Panza
- a Neurodegenerative Disease Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs , University of Bari "Aldo Moro" , Bari , Italy.,b Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain , University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico" , Lecce , Italy.,c Geriatric Unit, Fondazione IRCCS , "Casa Sollievo della Sofferenza" , Foggia , Italy
| | - Bruno P Imbimbo
- d Department of Research and Development , Chiesi Farmaceutici , Parma , Italy
| | - Madia Lozupone
- a Neurodegenerative Disease Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs , University of Bari "Aldo Moro" , Bari , Italy
| | - Antonio Greco
- c Geriatric Unit, Fondazione IRCCS , "Casa Sollievo della Sofferenza" , Foggia , Italy
| | - Davide Seripa
- c Geriatric Unit, Fondazione IRCCS , "Casa Sollievo della Sofferenza" , Foggia , Italy
| | - Giancarlo Logroscino
- a Neurodegenerative Disease Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs , University of Bari "Aldo Moro" , Bari , Italy.,b Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain , University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico" , Lecce , Italy
| | - Antonio Daniele
- e Institute of Neurology , Catholic University of Sacred Heart , Rome , Italy.,f Institute of Neurology , Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Carlo Colosimo
- g Department of Neurological Sciences , Santa Maria University Hospital , Terni , Italy
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Logroscino G, Imbimbo BP, Lozupone M, Sardone R, Capozzo R, Battista P, Zecca C, Dibello V, Giannelli G, Bellomo A, Greco A, Daniele A, Seripa D, Panza F. Promising therapies for the treatment of frontotemporal dementia clinical phenotypes: from symptomatic to disease-modifying drugs. Expert Opin Pharmacother 2019; 20:1091-1107. [PMID: 31002267 DOI: 10.1080/14656566.2019.1598377] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Frontotemporal dementia (FTD) is a heterogeneous clinical entity that includes several disorders characterized by different cellular mechanisms. Distinctive clinical features in FTD include behavioral, affective, and cognitive symptoms. Unfortunately, little progress has been made over the past 20 years in terms of the development of effective disease-modifying drugs with the currently available symptomatic treatments having limited clinical utility. AREAS COVERED This article reviews the principal pharmacological intervention studies for FTD. These are predominantly randomized clinical trials and include symptomatic treatments and potential disease-modifying drugs. EXPERT OPINION There is insufficient evidence on effective treatments for FTD and studies with better methodological backgrounds are needed. Most studies reporting therapeutic benefits were conducted with selective serotonin reuptake inhibitors, while anti-dementia drugs have been ineffective in FTD. Since the underlying pathology of FTD mostly consists of abnormal tau protein or TDP-43 aggregates, treatments are being developed to interfere with their aggregation process or with the clearance of these proteins. Furthermore, disease-modifying treatments remain years away as demonstrated by the recent negative Phase III findings of a tau aggregation inhibitor (LMTM) for treating the behavioral variant of FTD. The results from current ongoing Phase I/II trials will hopefully give light to future treatment options.
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Affiliation(s)
- Giancarlo Logroscino
- a Neurodegenerative Disease Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs , University of Bari "Aldo Moro" , Bari , Italy.,b Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain , University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico" , Lecce , Italy
| | - Bruno P Imbimbo
- c Department of Research and Development , Chiesi Farmaceutici , Parma , Italy
| | - Madia Lozupone
- a Neurodegenerative Disease Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs , University of Bari "Aldo Moro" , Bari , Italy
| | - Rodolfo Sardone
- d National Institute of Gastroenterology "Saverio de Bellis" , Research Hospital , Castellana Grotte Bari , Italy
| | - Rosa Capozzo
- b Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain , University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico" , Lecce , Italy
| | - Petronilla Battista
- e Istituti Clinici Scientifici Maugeri SPA SB, IRCCS , Institute of Cassano Murge , Bari , Italy
| | - Chiara Zecca
- b Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain , University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico" , Lecce , Italy
| | - Vittorio Dibello
- d National Institute of Gastroenterology "Saverio de Bellis" , Research Hospital , Castellana Grotte Bari , Italy.,f Interdisciplinary Department of Medicine (DIM), Section of Dentistry , University of Bari AldoMoro , Bari , Italy
| | - Gianluigi Giannelli
- d National Institute of Gastroenterology "Saverio de Bellis" , Research Hospital , Castellana Grotte Bari , Italy
| | - Antonello Bellomo
- g Psychiatric Unit, Department of Clinical and Experimental Medicine , University of Foggia , Foggia , Italy
| | - Antonio Greco
- h Geriatric Unit , Fondazione IRCCS "Casa Sollievo della Sofferenza" , Foggia , Italy
| | - Antonio Daniele
- i Institute of Neurology , Catholic University of Sacred Heart , Rome , Italy.,j Institute of Neurology, Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - Davide Seripa
- h Geriatric Unit , Fondazione IRCCS "Casa Sollievo della Sofferenza" , Foggia , Italy
| | - Francesco Panza
- a Neurodegenerative Disease Unit, Department of Basic Medical Sciences, Neuroscience and Sense Organs , University of Bari "Aldo Moro" , Bari , Italy.,b Department of Clinical Research in Neurology, Center for Neurodegenerative Diseases and the Aging Brain , University of Bari "Aldo Moro", "Pia Fondazione Cardinale G. Panico" , Lecce , Italy.,d National Institute of Gastroenterology "Saverio de Bellis" , Research Hospital , Castellana Grotte Bari , Italy.,h Geriatric Unit , Fondazione IRCCS "Casa Sollievo della Sofferenza" , Foggia , Italy
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Rogalski EJ, Sridhar J, Martersteck A, Rader B, Cobia D, Arora AK, Fought AJ, Bigio EH, Weintraub S, Mesulam MM, Rademaker A. Clinical and cortical decline in the aphasic variant of Alzheimer's disease. Alzheimers Dement 2019; 15:543-552. [PMID: 30765195 DOI: 10.1016/j.jalz.2018.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/18/2018] [Accepted: 12/02/2018] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Primary progressive aphasia (PPA) displays variable progression trajectories that require further elucidation. METHODS Longitudinal quantitation of atrophy and language over 12 months was completed for PPA patients with and without positive amyloid PET (PPAAβ+ and PPAAβ-), an imaging biomarker of underlying Alzheimer's disease. RESULTS Over 12 months, both PPA groups showed significantly greater cortical atrophy rates in the left versus right hemisphere, with a more widespread pattern in PPAAβ+. The PPAAβ+ group also showed greater decline in performance on most language tasks. There was no obligatory relationship between the logopenic PPA variant and amyloid status. Effect sizes from quantitative MRI data were more robust than neuropsychological metrics. DISCUSSION Preferential language network neurodegeneration is present in PPA irrespective of amyloid status. Clinical and anatomical progression appears to differ for PPA due to Alzheimer's disease versus non-Alzheimer's disease neuropathology, a distinction that may help to inform prognosis and the design of intervention trials.
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Affiliation(s)
- Emily Joy Rogalski
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University (NU) Feinberg School of Medicine, Chicago, IL, USA; NU Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL, USA.
| | - Jaiashre Sridhar
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University (NU) Feinberg School of Medicine, Chicago, IL, USA
| | - Adam Martersteck
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University (NU) Feinberg School of Medicine, Chicago, IL, USA
| | - Benjamin Rader
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University (NU) Feinberg School of Medicine, Chicago, IL, USA
| | - Derin Cobia
- Department of Psychology, Brigham Young University, Provo, UT, USA
| | - Anupa K Arora
- Avid Radiopharmaceuticals Inc, Philadelphia, PA, USA
| | - Angela J Fought
- NU Feinberg School of Medicine, Department of Preventive Medicine, Chicago, IL, USA
| | - Eileen H Bigio
- NU Feinberg School of Medicine, Department of Pathology, Chicago, IL, USA
| | - Sandra Weintraub
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University (NU) Feinberg School of Medicine, Chicago, IL, USA; NU Feinberg School of Medicine, Department of Psychiatry and Behavioral Sciences, Chicago, IL, USA
| | - Marek-Marsel Mesulam
- Cognitive Neurology and Alzheimer's Disease Center, Northwestern University (NU) Feinberg School of Medicine, Chicago, IL, USA; NU Feinberg School of Medicine, Department of Neurology, Chicago, IL, USA
| | - Alfred Rademaker
- NU Feinberg School of Medicine, Department of Preventive Medicine, Chicago, IL, USA
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