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Gallée J, Cartwright J, Grasso S, Jokel R, Lavoie M, McGowan E, Pozzebon M, Beber BC, Duboisdindien G, Montagut N, Norvik M, Sugimoto T, Townsend R, Unger N, Winsnes IE, Volkmer A. Global perspectives on the management of primary progressive aphasia. Sci Rep 2024; 14:19712. [PMID: 39181907 PMCID: PMC11344800 DOI: 10.1038/s41598-024-70156-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 08/13/2024] [Indexed: 08/27/2024] Open
Abstract
Speech-language therapists/pathologists (SLT/Ps) are key professionals in the management and treatment of primary progressive aphasia (PPA), however, there are gaps in education and training within the discipline, with implications for skills, confidence, and clinical decision-making. This survey aimed to explore the areas of need amongst SLT/Ps working with people living with PPA (PwPPA) internationally to upskill the current and future workforce working with progressive communication disorders. One hundred eighty-six SLT/Ps from 27 countries who work with PwPPA participated in an anonymous online survey about their educational and clinical experiences, clinical decision-making, and self-reported areas of need when working with this population. Best practice principles for SLT/Ps working with PwPPA were used to frame the latter two sections of this survey. Only 40.7% of respondents indicated that their university education prepared them for their current work with PwPPA. Competency areas of "knowing people deeply," "practical issues," "connectedness," and "preventing disasters" were identified as the basic areas of priority and need. Respondents identified instructional online courses (92.5%), sample tools and activities for interventions (64.8%), and concrete training on providing care for advanced stages and end of life (58.3%) as central areas of need in their current work. This is the first international survey to comprehensively explore the perspectives of SLT/Ps working with PwPPA. Based on survey outcomes, there is a pressing need to enhance current educational and ongoing training opportunities to better promote the well-being of PwPPA and their families, and to ensure appropriate preparation of the current and future SLT/P workforce.
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Affiliation(s)
- Jeanne Gallée
- Center for Psychometric Analyses of Aging and Neurodegeneration, Department of Medicine, University of Washington, Seattle, WA, USA.
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA, USA.
- School of Health Sciences, University of Tasmania, Launceston, Australia.
| | - Jade Cartwright
- School of Health Sciences, University of Tasmania, Launceston, Australia
| | - Stephanie Grasso
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin, Austin, TX, USA
| | - Regina Jokel
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Rotman Research Institute, Toronto, Canada
| | - Monica Lavoie
- The Chaire de recherche sur les aphasies primaires progressives - Fondation de la famille Lemaire, Université Laval, Quebec, Qc, Canada
- Clinique Interdisciplinaire de Mémoire, CHU de Québec-Université Laval, Quebec, QC, Canada
| | - Ellen McGowan
- Pennine Care NHS Foundation Trust, Greater Manchester, Derbyshire, UK
| | | | - Bárbara Costa Beber
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Guillaume Duboisdindien
- The Chaire de recherche sur les aphasies primaires progressives - Fondation de la famille Lemaire, Université Laval, Quebec, Qc, Canada
- Clinique Interdisciplinaire de Mémoire, CHU de Québec-Université Laval, Quebec, QC, Canada
| | - Núria Montagut
- Alzheimer's Disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clinic, Barcelona, Spain
- Institut d'Investigació Biomèdica August Pi I Sunyer, Barcelona, Spain
| | - Monica Norvik
- Department of Education, UiT The Arctic University of Norway, Tromsø, Norway
| | - Taiki Sugimoto
- Center for Psychometric Analyses of Aging and Neurodegeneration, Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Prevention and Care Science, National Center for Geriatrics and Gerontology, Research Institute, Obu, Japan
| | | | - Nina Unger
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Ingvild E Winsnes
- Department of Linguistics and Scandinavian Studies, University of Oslo, Oslo, Norway
| | - Anna Volkmer
- Department of Psychology and Language Science, University College London, London, UK
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Gallée J, Cartwright J, Grasso S, Jokel R, Lavoie M, McGowan E, Pozzebon M, Beber BC, Duboisdindien G, Montagut N, Norvik M, Sugimoto T, Townsend R, Unger N, Winsnes IE, Volkmer A. Global Perspectives on the Management of Primary Progressive Aphasia. RESEARCH SQUARE 2024:rs.3.rs-4100219. [PMID: 38562789 PMCID: PMC10984010 DOI: 10.21203/rs.3.rs-4100219/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Speech-language therapists/pathologists (SLT/Ps) are key professionals in the management and treatment of primary progressive aphasia (PPA), however, there are gaps in education and training within the discipline, with implications for skills, confidence, and clinical decision-making. This survey aimed to explore the areas of need amongst SLT/Ps working with people living with PPA (PwPPA) internationally to upskill the current and future workforce working with progressive communication disorders. One hundred eighty-five SLT/Ps from 27 countries who work with PwPPA participated in an anonymous online survey about their educational and clinical experiences, clinical decision-making, and self-reported areas of need when working with this population. Best practice principles for SLT/Ps working with PwPPA were used to frame the latter two sections of this survey. Only 40.7% of respondents indicated that their university education prepared them for their current work with PwPPA. Competency areas of "Knowing people deeply," "Practical issues," "Connectedness," and "Preventing disasters" were identified as the basic areas of priority and need. Respondents identified instructional online courses (92.5%), sample tools and activities for interventions (64.8%), and concrete training on providing care for advanced stages and end of life (58.3%) as central areas of need in their current work. This is the first international survey to comprehensively explore the perspectives of SLT/Ps working with PwPPA. Based on survey outcomes, there is a pressing need to enhance current educational and ongoing training opportunities to better promote the well-being of PwPPA and their families, and to ensure appropriate preparation of the current and future SLT/P workforce.
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Affiliation(s)
- Jeanne Gallée
- Center for Psychometric Analyses of Aging and Neurodegeneration, Department of Medicine, University of Washington
| | | | - Stephanie Grasso
- Department of Speech, Language, and Hearing Sciences, The University of Texas at Austin
| | - Regina Jokel
- Temerty Faculty of Medicine, University of Toronto
| | - Monica Lavoie
- Chaire de recherche sur les aphasies primaires progressives - Fondation de la famille Lemaire, Université Laval
| | | | | | - Bárbara Costa Beber
- Department of Speech, Language, and Hearing Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA)
| | - Guillaume Duboisdindien
- Chaire de recherche sur les aphasies primaires progressives - Fondation de la famille Lemaire, Université Laval
| | - Núria Montagut
- Alzheimer's Disease and other Cognitive Disorders Unit, Neurology Service, Hospital Clinic Barcelona
| | - Monica Norvik
- Department of Linguistics and Scandinavian studies, University of Oslo
| | - Taiki Sugimoto
- Center for Psychometric Analyses of Aging and Neurodegeneration, Department of Medicine, University of Washington
| | | | - Nina Unger
- Department of Neurology, University Medicine Greifswald
| | - Ingvild E Winsnes
- Department of Linguistics and Scandinavian studies, University of Oslo
| | - Anna Volkmer
- Department of Psychology and Language Science, University College London
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Suárez‐González A, Cassani A, Gopalan R, Stott J, Savage S. When it is not primary progressive aphasia: A scoping review of spoken language impairment in other neurodegenerative dementias. ALZHEIMER'S & DEMENTIA (NEW YORK, N. Y.) 2021; 7:e12205. [PMID: 34485677 PMCID: PMC8409087 DOI: 10.1002/trc2.12205] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Progressive difficulties with spoken language occur across the spectrum of degenerative dementia. When not a primary presenting and dominant symptom, language difficulties may be overlooked in favor of more prominent cognitive, behavior, or motor deficits. The aim of this scoping review is to examine the extent and nature of the research evidence describing (1) the spoken language impairments found in non-language led dementias, (2) their impact on everyday living, and (3) the reported language interventions. METHODS We searched PubMed, MEDLINE, OVID-EMBASE, PsycINFO, and SpeechBITE using terms related to spoken language for the following dementia types: Parkinson's disease dementia (PDD), dementia with Lewy bodies (DLB), progressive supranuclear palsy (PSP), cortico-basal syndrome (CBS), behavior variant frontotemporal dementia (bvFTD), early-onset Alzheimer's disease (EOAD), posterior cortical atrophy (PCA), and motor neuron disease associated with FTD (MND+FTD). Risk of bias was assessed with the QualSyst tool. RESULTS Seventy-three eligible studies were included. A wide range of spoken language impairments were reported, involving both linguistic (e.g., syntactic processing) and other cognitive (e.g., sustained attention) underlying mechanisms. Although the severity of these deficits was scarcely reported, in some cases they manifested as non-fluent, dynamic, and global aphasias. No papers in the review described either the impact of these language impairments on everyday living or language therapies to treat them. DISCUSSION There is a need to understand better the level of disability produced by language impairment in people living with non-language-led dementias. Our findings suggest three calls for action: (1) research studies should assess the clinical relevance of any spoken language deficits examined, (2) both linguistic and cognitive underlying mechanisms should be fully described (to inform the design of effective language and behavioral interventions), and (3) trials of language therapy should be conducted in those groups of individuals where significant language impairment is proved.
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Affiliation(s)
- Aida Suárez‐González
- Dementia Research CentreUCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Alice Cassani
- Discipline of PsychologyWashington Singer LaboratoriesUniversity of ExeterExeterUK
| | - Ragaviveka Gopalan
- Discipline of PsychologyWashington Singer LaboratoriesUniversity of ExeterExeterUK
| | - Joshua Stott
- Research Department of ClinicalEducational and Health PsychologyUniversity College LondonLondonUK
| | - Sharon Savage
- School of PsychologyUniversity of NewcastleNewcastleNew South WalesAustralia
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Berthier ML, Hoet F, Beltrán-Corbellini Á, Santana-Moreno D, Edelkraut L, Dávila G. Case Report: Barely Able to Speak, Can't Stop Echoing: Echolalic Dynamic Aphasia in Progressive Supranuclear Palsy. Front Aging Neurosci 2021; 13:635896. [PMID: 34017242 PMCID: PMC8129544 DOI: 10.3389/fnagi.2021.635896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/08/2021] [Indexed: 11/13/2022] Open
Abstract
The diagnostic criteria for progressive supranuclear palsy (PSP) incorporate two speech-language disturbances (SLDs), non-fluent/agrammatic primary progressive aphasia and progressive apraxia of speech, but overlook the inclusion of other SLDs, including dynamic aphasia (DA). Thus, there is a need to reappraise the broad spectrum of SLDs in PSP to include other presenting phenotypes. Here we report findings from the study of two elderly patients with PSP presenting with DA and irrepressible echolalia. Both patients had markedly impoverished verbal production, but their performance in other tasks (repetition and naming) and auditory comprehension were preserved or only mildly impaired. Experimental tests of DA revealed impaired word and sentence generation in response to verbal and non-verbal stimuli. Additional language and cognitive testing revealed different types of echolalia (mitigated, automatic, and echoing approval) as well as impaired inhibitory control and social cognition (mentalizing). Both patients had negative neuropsychiatric alterations (i.e., apathy, aspontaneity, and indifference/emotional flatness). Brain magnetic resonance imaging in both patients showed atrophy of the midbrain tegmentum and superior medial frontal cortex suggestive of PSP, yet further evaluation of the neural correlates using multimodal neuroimaging and neuropathological data was not performed. However, based on the already known neural basis of DA and echolalia in PSP and stroke, we suggest that, in the present cases, neurodegeneration in the midbrain tegmentum, superior medial frontal lobe, and caudate nucleus was responsible for DA and that decreased activity in these regions may play a permissive role for eliciting verbal echoing via disinhibition of the perisylvian speech-language network.
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Affiliation(s)
- Marcelo L Berthier
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Málaga, Spain.,Research Laboratory on the Neuroscience of Language, Faculty of Psychology and Speech Therapy, University of Malaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga - IBIMA, Málaga, Spain
| | - Florencia Hoet
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Málaga, Spain.,Research Laboratory on the Neuroscience of Language, Faculty of Psychology and Speech Therapy, University of Malaga, Málaga, Spain.,Servicio de Otorrinolaringología, Sección Fonoaudiología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Lisa Edelkraut
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Málaga, Spain.,Research Laboratory on the Neuroscience of Language, Faculty of Psychology and Speech Therapy, University of Malaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga - IBIMA, Málaga, Spain.,Area of Psychobiology, Faculty of Psychology and Speech Therapy, University of Malaga, Málaga, Spain
| | - Guadalupe Dávila
- Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga, Málaga, Spain.,Research Laboratory on the Neuroscience of Language, Faculty of Psychology and Speech Therapy, University of Malaga, Málaga, Spain.,Instituto de Investigación Biomédica de Málaga - IBIMA, Málaga, Spain.,Area of Psychobiology, Faculty of Psychology and Speech Therapy, University of Malaga, Málaga, Spain
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