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Beber S, Bontempi G, Miceli G, Tettamanti M. The Neurofunctional Correlates of Morphosyntactic and Thematic Impairments in Aphasia: A Systematic Review and Meta-analysis. Neuropsychol Rev 2024:10.1007/s11065-024-09648-0. [PMID: 39214956 DOI: 10.1007/s11065-024-09648-0] [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: 07/26/2023] [Accepted: 07/30/2024] [Indexed: 09/04/2024]
Abstract
Lesion-symptom studies in persons with aphasia showed that left temporoparietal damage, but surprisingly not prefrontal damage, correlates with impaired ability to process thematic roles in the comprehension of semantically reversible sentences (The child is hugged by the mother). This result has led to challenge the time-honored view that left prefrontal regions are critical for sentence comprehension. However, most studies focused on thematic role assignment and failed to consider morphosyntactic processes that are also critical for sentence processing. We reviewed and meta-analyzed lesion-symptom studies on the neurofunctional correlates of thematic role assignment and morphosyntactic processing in comprehension and production in persons with aphasia. Following the PRISMA checklist, we selected 43 papers for the review and 27 for the meta-analysis, identifying a set of potential bias risks. Both the review and the meta-analysis confirmed the correlation between thematic role processing and temporoparietal regions but also clearly showed the involvement of prefrontal regions in sentence processing. Exploratory meta-analyses suggested that both thematic role and morphosyntactic processing correlate with left prefrontal and temporoparietal regions, that morphosyntactic processing correlates with prefrontal structures more than with temporoparietal regions, and that thematic role assignment displays the opposite trend. We discuss current limitations in the literature and propose a set of recommendations for clarifying unresolved issues.
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Affiliation(s)
- Sabrina Beber
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Rovereto, TN, 38122, Italy.
| | - Giorgia Bontempi
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Rovereto, TN, 38122, Italy
| | - Gabriele Miceli
- Center for Mind/Brain Sciences (CIMeC), University of Trento, Rovereto, TN, 38122, Italy
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de Araújo CM, de Alcântara C, Alencar MA, da Gama NAS, Cruzeiro MM, França MC, Jaeger A, Camargos ST, Machado TH, de Souza LC. Language impairment in sporadic and familial (type 8) amyotrophic lateral sclerosis: A comparative study. Muscle Nerve 2024; 70:130-139. [PMID: 38738747 DOI: 10.1002/mus.28109] [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: 07/14/2023] [Revised: 04/20/2024] [Accepted: 04/24/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION/AIMS Language is frequently affected in patients with sporadic amyotrophic lateral sclerosis (sALS), with reduced performance in naming, syntactic comprehension, grammatical expression, and orthographic processing. However, the language profile of patients with familial type 8 ALS (ALS8), linked to p.P56S VAPB mutation, remains unclear. We investigated language in patients with ALS8 by examining their auditory comprehension and verbal production. METHODS We included three groups of participants: (1) patients with sALS (n = 20), (2) patients with familial ALS8 (n = 22), and (3) healthy controls (n = 21). The groups were matched for age, sex, and education level. All participants underwent a comprehensive language battery, including the Boston Diagnostic Aphasia Examination, the reduced Token test, letter fluency, categorical fluency (animals), word definition from the Cambridge Semantic Memory Research Battery, and a narrative discourse analysis. Participants also were evaluated using Addenbrooke's Cognitive Exam-Revised Version, the Hospital Anxiety and Depression Scale, and the ALS Functional Rating Scale-Revised. RESULTS Compared to controls, sALS and ALS8 patients had impaired performance on oral (syntactic and phonological processing) comprehension and inappropriate discourse cohesion. sALS and ALS8 did not differ in any language measure. There was no correlation between language scores and functional and psychiatric scales. DISCUSSION ALS8 patients exhibit language deficits that are independent of motor features. These findings are consistent with the current evidence suggesting that ALS8 has prominent non-motor features.
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Affiliation(s)
- Caroline M de Araújo
- Postgraduate Program in Neuroscience, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Cássia de Alcântara
- Postgraduate Program in Neuroscience, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | - Natália A S da Gama
- Postgraduate Program in Neuroscience, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Marcelo M Cruzeiro
- Department of Internal Medicine, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | | | - Antônio Jaeger
- Department of Psychology, Faculty of Philosophy and Human Sciences, UFMG, Belo Horizonte, Brazil
| | - Sarah T Camargos
- Postgraduate Program in Neuroscience, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Department of Internal Medicine, School of Medicine, UFMG, Belo Horizonte, Brazil
| | - Thais H Machado
- Department of Speech-Language-Hearing Sciences, School of Medicine, UFMG, Belo Horizonte, Brazil
- Programa de Pós-graduação em Ciências Fonoaudiológicas, Departamento de Fonoaudiologia, School of Medicine, UFMG, Belo Horizonte, Brazil
| | - Leonardo Cruz de Souza
- Postgraduate Program in Neuroscience, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Department of Internal Medicine, School of Medicine, UFMG, Belo Horizonte, Brazil
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Kasper E, Temp AGM, Köckritz V, Meier L, Machts J, Vielhaber S, Hermann A, Prudlo J. Verbal expressive language minimally affected in non-demented people living with amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:308-316. [PMID: 38306019 DOI: 10.1080/21678421.2024.2307512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024]
Abstract
Objective: Language dysfunction is one of the most common cognitive impairments in amyotrophic lateral sclerosis (ALS). Although discourse capacities are essential for daily functioning, verbal expressive language has not been widely investigated in ALS. The existing research available suggests that discourse impairments are prevalent. This study investigates verbal expressive language in people living with ALS (plwALS) in contrast to healthy controls (HC).Methods: 64 plwALS and 49 age, gender and education-matched healthy controls were ask to describe the Cookie Theft Picture Task. The recordings were analyzed for discourse productivity, discourse content, syntactic complexity, speech fluency and verb processing. We applied the Bayesian hypothesis-testing framework, incorporating the effects of dysarthria, cognitive impairment status (CIS), and premorbid crystalline verbal IQ.Results: Compared to HC, plwALS only showed a single impairment: speech dysfluency. Discourse productivity, discourse content, syntactic complexity and verb processing were not impaired. Cognition and dysarthria exceeded the influence of verbal IQ for total words spoken and content density. Cognition alone seemed to explain dysfluency. Body-agent verbs were produced at even higher rates than other verb types. For the remaining outcomes, verbal IQ was the most decisive factor.Conclusions: In contrast to existing research, our data demonstrates no discernible impairment in verbal expressive language in ALS. What our findings show to be decisive is accounting for the influence of dysarthria, cognitive impairment status, and verbal IQ as variables on spontaneous verbal expressive language. Minor impairments in verbal expressive language appear to be influenced to a greater degree by executive dysfunctioning and dysarthria than by language impairment.
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Affiliation(s)
- Elisabeth Kasper
- Department of Neurology, University Medical Centre, Rostock, Germany
- DZNE site Rostock, German Centre for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Anna G M Temp
- DZNE site Rostock, German Centre for Neurodegenerative Diseases (DZNE), Rostock, Germany
- Neurozentrum, Berufsgenossenschaftliches Klinikum Hamburg, Germany
| | - Verena Köckritz
- DZNE site Rostock, German Centre for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Lisa Meier
- Department of Neurology, University Medical Centre, Rostock, Germany
| | - Judith Machts
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Magdeburg, Germany, and
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
- German Centre for Neurodegenerative Diseases (DZNE), Magdeburg, Germany, and
| | - Andreas Hermann
- Department of Neurology, University Medical Centre, Rostock, Germany
- Translational Neurodegeneration Section "Albrecht Kossel", University Medical Centre, Rostock
| | - Johannes Prudlo
- Department of Neurology, University Medical Centre, Rostock, Germany
- DZNE site Rostock, German Centre for Neurodegenerative Diseases (DZNE), Rostock, Germany
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Jellinger KA. The Spectrum of Cognitive Dysfunction in Amyotrophic Lateral Sclerosis: An Update. Int J Mol Sci 2023; 24:14647. [PMID: 37834094 PMCID: PMC10572320 DOI: 10.3390/ijms241914647] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
Cognitive dysfunction is an important non-motor symptom in amyotrophic lateral sclerosis (ALS) that has a negative impact on survival and caregiver burden. It shows a wide spectrum ranging from subjective cognitive decline to frontotemporal dementia (FTD) and covers various cognitive domains, mainly executive/attention, language and verbal memory deficits. The frequency of cognitive impairment across the different ALS phenotypes ranges from 30% to 75%, with up to 45% fulfilling the criteria of FTD. Significant genetic, clinical, and pathological heterogeneity reflects deficits in various cognitive domains. Modern neuroimaging studies revealed frontotemporal degeneration and widespread involvement of limbic and white matter systems, with hypometabolism of the relevant areas. Morphological substrates are frontotemporal and hippocampal atrophy with synaptic loss, associated with TDP-43 and other co-pathologies, including tau deposition. Widespread functional disruptions of motor and extramotor networks, as well as of frontoparietal, frontostriatal and other connectivities, are markers for cognitive deficits in ALS. Cognitive reserve may moderate the effect of brain damage but is not protective against cognitive decline. The natural history of cognitive dysfunction in ALS and its relationship to FTD are not fully understood, although there is an overlap between the ALS variants and ALS-related frontotemporal syndromes, suggesting a differential vulnerability of motor and non-motor networks. An assessment of risks or the early detection of brain connectivity signatures before structural changes may be helpful in investigating the pathophysiological mechanisms of cognitive impairment in ALS, which might even serve as novel targets for effective disease-modifying therapies.
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Affiliation(s)
- Kurt A Jellinger
- Institute of Clinical Neurobiology, Alberichgasse 5/13, A-1150 Vienna, Austria
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Tröger J, Baltes J, Baykara E, Kasper E, Kring M, Linz N, Robin J, Schäfer S, Schneider A, Hermann A. PROSA-a multicenter prospective observational study to develop low-burden digital speech biomarkers in ALS and FTD. Amyotroph Lateral Scler Frontotemporal Degener 2023:1-10. [PMID: 37516990 DOI: 10.1080/21678421.2023.2239312] [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: 03/24/2023] [Accepted: 07/15/2023] [Indexed: 08/01/2023]
Abstract
Objective: There is a need for novel biomarkers that can indicate disease state, project disease progression, or assess response to treatment for amyotrophic lateral sclerosis (ALS) and associated neurodegenerative diseases such as frontotemporal dementia (FTD). Digital biomarkers are especially promising as they can be collected non-invasively and at low burden for patients. Speech biomarkers have the potential to objectively measure cognitive, motor as well as respiratory symptoms at low-cost and in a remote fashion using widely available technology such as telephone calls. Methods: The PROSA study aims to develop and evaluate low-burden frequent prognostic digital speech biomarkers. The main goal is to create a single, easy-to-perform battery that serves as a valid and reliable proxy for cognitive, respiratory, and motor domains in ALS and FTD. The study will be a multicenter 12-months observational study aiming to include 75 ALS and 75 FTD patients as well as 50 healthy controls and build on three established longitudinal cohorts: DANCER, DESCRIBE-ALS and DESCRIBE-FTD. In addition to the extensive clinical phenotyping in DESCRIBE, PROSA collects a comprehensive speech protocol in fully remote and automated fashion over the telephone at four time points. This longitudinal speech data, together with gold standard measures, will allow advanced speech analysis using artificial intelligence for the development of speech-based phenotypes of ALS and FTD patients measuring cognitive, motor and respiratory symptoms. Conclusion: Speech-based phenotypes can be used to develop diagnostic and prognostic models predicting clinical change. Results are expected to have implications for future clinical trial stratification as well as supporting innovative trial designs in ALS and FTD.
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Affiliation(s)
| | - Judith Baltes
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | | | - Elisabeth Kasper
- German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Rostock, Germany
- Department of Neurology, University Medical Center Rostock, Rostock, Germany
| | - Martha Kring
- German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Rostock, Germany
| | | | | | | | - Anja Schneider
- German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
- Department of Neurodegenerative Diseases and Geriatric Psychiatry, University Hospital Bonn, Bonn, Germany
| | - Andreas Hermann
- German Center for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Rostock, Germany
- Center for Transdisciplinary Neurosciences Rostock (CTNR), University Medical Center Rostock, Rostock, Germany, and
- Translational Neurodegeneration Section "Albrecht-Kossel", Department of Neurology, University Medical Center Rostock, Rostock, Germany
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Sensory Involvement in Amyotrophic Lateral Sclerosis. Int J Mol Sci 2022; 23:ijms232415521. [PMID: 36555161 PMCID: PMC9779879 DOI: 10.3390/ijms232415521] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/19/2022] [Accepted: 12/03/2022] [Indexed: 12/13/2022] Open
Abstract
Although amyotrophic lateral sclerosis (ALS) is pre-eminently a motor disease, the existence of non-motor manifestations, including sensory involvement, has been described in the last few years. Although from a clinical perspective, sensory symptoms are overshadowed by their motor manifestations, this does not mean that their pathological significance is not relevant. In this review, we have made an extensive description of the involvement of sensory and autonomic systems described to date in ALS, from clinical, neurophysiological, neuroimaging, neuropathological, functional, and molecular perspectives.
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McMillan CT, Wuu J, Rascovsky K, Cosentino S, Grossman M, Elman L, Quinn C, Rosario L, Stark JH, Granit V, Briemberg H, Chenji S, Dionne A, Genge A, Johnston W, Korngut L, Shoesmith C, Zinman L, Kalra S, Benatar M. Defining cognitive impairment in amyotrophic lateral sclerosis: an evaluation of empirical approaches. Amyotroph Lateral Scler Frontotemporal Degener 2022; 23:517-526. [PMID: 35253557 PMCID: PMC9448823 DOI: 10.1080/21678421.2022.2039713] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 01/17/2022] [Accepted: 01/30/2022] [Indexed: 11/01/2022]
Abstract
Objective: Amyotrophic lateral sclerosis (ALS) is a multi-system disorder characterized primarily by motor neuron degeneration, but may be accompanied by cognitive dysfunction. Statistically appropriate criteria for establishing cognitive impairment (CI) in ALS are lacking. We evaluate quantile regression (QR), that accounts for age and education, relative to a traditional two standard deviation (SD) cutoff for defining CI. Methods: QR of cross-sectional data from a multi-center North American Control (NAC) cohort of 269 healthy adults was used to model the 5th percentile of cognitive scores on the Edinburgh Cognitive and Behavioral ALS Screen (ECAS). The QR approach was compared to traditional two SD cutoff approach using the same NAC cohort (2SD-NAC) and to existing UK-based normative data derived using the 2SD approach (2SD-UK) to assess the impact of cohort selection and statistical model in identifying CI in 182 ALS patients. Results: QR-NAC models revealed that age and education impact cognitive performance on the ECAS. Based on QR-NAC normative cutoffs, the frequency of CI in the 182 PENN ALS patients was 15.9% for ALS specific, 12.6% for ALS nonspecific, and 15.4% for ECAS total. This frequency of CI is substantially more conservative in comparison to the 2SD-UK (20.3%-34.6%) and modestly more conservative to the 2SD-NAC (14.3%-16.5%) approaches for estimating CI. Conclusions: The choice of normative cohort has a substantial impact and choice of statistical method a modest impact on defining CI in ALS. This report establishes normative ECAS thresholds to identify whether ALS patients in the North American population have CI.
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Affiliation(s)
- Corey T. McMillan
- University of Pennsylvania Perelman School of Medicine, Department of Neurology, Philadelphia, PA, USA
| | - Joanne Wuu
- University of Miami Miller School of Medicine, Department of Neurology, Miami, FL, USA
| | - Katya Rascovsky
- University of Pennsylvania Perelman School of Medicine, Department of Neurology, Philadelphia, PA, USA
| | - Stephanie Cosentino
- Columbia University, The Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, New York, NY, USA
| | - Murray Grossman
- University of Pennsylvania Perelman School of Medicine, Department of Neurology, Philadelphia, PA, USA
| | - Lauren Elman
- University of Pennsylvania Perelman School of Medicine, Department of Neurology, Philadelphia, PA, USA
| | - Colin Quinn
- University of Pennsylvania Perelman School of Medicine, Department of Neurology, Philadelphia, PA, USA
| | - Luis Rosario
- University of Pennsylvania Perelman School of Medicine, Department of Neurology, Philadelphia, PA, USA
| | - Jessica H. Stark
- University of Miami Miller School of Medicine, Department of Neurology, Miami, FL, USA
| | - Volkan Granit
- University of Miami Miller School of Medicine, Department of Neurology, Miami, FL, USA
| | - Hannah Briemberg
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Sneha Chenji
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Annie Dionne
- Department of Medicine, Université Laval, Québec, Canada
| | - Angela Genge
- Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Wendy Johnston
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Lawrence Korngut
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | | | - Lorne Zinman
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | | | - Sanjay Kalra
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
- Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Canada
| | - Michael Benatar
- University of Miami Miller School of Medicine, Department of Neurology, Miami, FL, USA
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Paynter C, Mathers S, Gregory H, Vogel AP, Cruice M. The impact of communication on healthcare involvement for people living with motor neurone disease and their carers: A longitudinal qualitative study. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2022; 57:1318-1333. [PMID: 35860953 PMCID: PMC9796182 DOI: 10.1111/1460-6984.12757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Communication and cognitive impairments are known barriers to shared decision-making. Most people diagnosed with motor neurone disease (MND) will develop a motor speech impairment over the disease course. Some will develop cognitive, linguistic or behavioural disturbance. Despite this, the impact of communication and cognitive impairment on personal healthcare decision-making in MND is not well known. AIMS This exploratory, longitudinal study aimed to capture the perspectives of people living with MND (plwMND) and family members on managing their healthcare with, or in anticipation of, a communication impairment. METHODS & PROCEDURES Semi-structured interviews and functional assessments were conducted with plwMND and family members over one to three time points between December 2017 and January 2020. Participants were recruited from a specialist MND clinic using a maximum variation sampling approach. Interview transcripts were analysed using trajectory data analysis: a matrix-based approach for thematic analysis of longitudinal data. The study was underpinned by interpretive descriptive methodology. OUTCOMES & RESULTS A total of 19 plwMND with a range of MND phenotypes and 15 family members were recruited. Disease progression and participant withdrawal resulted in attrition, however 12 plwMND and seven family members participated at all three time points. Consistent cognitive screening was not feasible, which limited the opportunity to explore the impact of cognitive change. An overarching theme 'Communicating takes effort' was identified and illustrates the efforts required to compensate for, or circumnavigate, impairments to maintain involvement in healthcare. Assistance from family and accommodation from healthcare professionals (HCPs) was needed for ongoing engagement. Where plwMND were dependent on alternative communication devices, this assistance was essential and primarily carried out by family members. Despite these efforts, the quality, quantity and accuracy of communication were sometimes compromised. Participants equated good communication with receiving good healthcare, and some expressed anxiety in the anticipation of being unable to express their needs to healthcare workers. CONCLUSION & IMPLICATIONS Communication impairment has a direct impact on healthcare involvement. This study demonstrates the effort required by plwMND and their carers to maintain or maximize ongoing involvement. This effort may not always be visible to HCPs. This information may prompt clinicians to consider the best ways to conduct clinical consultations to accommodate patients' abilities. Compromised communication experiences can be moderated by accommodations and support from HCPs and appropriate adjustments in the health system. Asking patients about their communication preferences and needs, allowing extra time and conducting multidisciplinary sessions are examples of such support. WHAT THIS PAPER ADDS What is already known on this subject? Communication and cognitive impairments are known contributors to negative health outcomes and barriers to shared decision-making generally. The existing literature in decision-making in MND does not address the specific impact of these impairments on personal healthcare involvement for plwMND and their carers. What this paper adds to existing knowledge? This paper reports the findings of a research project that interviewed 19 plwMND and 15 carers on one to three occasions over a 26-month period to obtain their perspectives of the impact of communication on healthcare involvement. Whilst a priori the intention was to look at both communicative and cognitive decline, only the former was achieved. The effort and often 'invisible' activity undertaken to manage or maintain involvement in healthcare is identified. Communication impairment requires support and accommodation, otherwise healthcare involvement can be compromised. Results show participants may associate effective communication with good healthcare. What are the potential or actual clinical implications of the work? Clinicians may wish to use these insights from plwMND and their carers to guide adjustments to their professional practice to maximize healthcare involvement for their patients. Tailored education for different healthcare groups is needed to improve understanding of MND-related communication impairments and supportive strategies so that involvement in healthcare is not compromised.
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Affiliation(s)
- Camille Paynter
- Department of Audiology and Speech PathologyUniversity of MelbourneMelbourneVICAustralia
| | - Susan Mathers
- Calvary Health Care BethlehemMelbourneVICAustralia
- School of Clinical SciencesMonash UniversityMelbourneVICAustralia
| | - Heidi Gregory
- Calvary Health Care BethlehemMelbourneVICAustralia
- Eastern Health Clinical SchoolMonash UniversityMelbourneVICAustralia
| | - Adam P. Vogel
- Department of Audiology and Speech PathologyUniversity of MelbourneMelbourneVICAustralia
- RedenlabMelbourneVICAustralia
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Pinto-Grau M, Donohoe B, O'Connor S, Murphy L, Costello E, Heverin M, Vajda A, Hardiman O, Pender N. Patterns of Language Impairment in Early Amyotrophic Lateral Sclerosis. Neurol Clin Pract 2021; 11:e634-e644. [PMID: 34840877 DOI: 10.1212/cpj.0000000000001006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/07/2020] [Indexed: 11/15/2022]
Abstract
Objective To investigate the incidence and nature of language change and its relationship to executive dysfunction in a population-based incident amyotrophic lateral sclerosis (ALS) sample, with the hypothesis that patterns of frontotemporal involvement in early ALS extend beyond areas of executive control to regions associated with language processing. Methods One hundred seventeen population-based incident ALS cases without dementia and 100 controls matched by age, sex, and education were included in the study. A detailed assessment of language processing including lexical processing, word spelling, word reading, word naming, semantic processing, and syntactic/grammatical processing was undertaken. Executive domains of phonemic verbal fluency, working memory, problem-solving, cognitive flexibility, and social cognition were also evaluated. Results Language processing was impaired in this incident cohort of individuals with ALS, with deficits in the domains of word naming, orthographic processing, and syntactic/grammatical processing. Conversely, phonological lexical processing and semantic processing were spared. Although executive dysfunction accounted in part for impairments in grammatical and orthographic lexical processing, word spelling, reading, and naming, primary language deficits were also present. Conclusions Language impairment is characteristic of ALS at early stages of the disease and can develop independently of executive dysfunction, reflecting selective patterns of frontotemporal involvement at disease onset. Language change is therefore an important component of the frontotemporal syndrome associated with ALS.
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Affiliation(s)
- Marta Pinto-Grau
- Academic Unit of Neurology (MP-G, BD, SO, LM, EC, MH, AV, OH, NP), Trinity Biomedical Sciences Institute, Trinity College Dublin; and Department of Psychology (MP-G, BD, SO, LM, EC, NP), Beaumont Hospital, Dublin, Ireland
| | - Bronagh Donohoe
- Academic Unit of Neurology (MP-G, BD, SO, LM, EC, MH, AV, OH, NP), Trinity Biomedical Sciences Institute, Trinity College Dublin; and Department of Psychology (MP-G, BD, SO, LM, EC, NP), Beaumont Hospital, Dublin, Ireland
| | - Sarah O'Connor
- Academic Unit of Neurology (MP-G, BD, SO, LM, EC, MH, AV, OH, NP), Trinity Biomedical Sciences Institute, Trinity College Dublin; and Department of Psychology (MP-G, BD, SO, LM, EC, NP), Beaumont Hospital, Dublin, Ireland
| | - Lisa Murphy
- Academic Unit of Neurology (MP-G, BD, SO, LM, EC, MH, AV, OH, NP), Trinity Biomedical Sciences Institute, Trinity College Dublin; and Department of Psychology (MP-G, BD, SO, LM, EC, NP), Beaumont Hospital, Dublin, Ireland
| | - Emmet Costello
- Academic Unit of Neurology (MP-G, BD, SO, LM, EC, MH, AV, OH, NP), Trinity Biomedical Sciences Institute, Trinity College Dublin; and Department of Psychology (MP-G, BD, SO, LM, EC, NP), Beaumont Hospital, Dublin, Ireland
| | - Mark Heverin
- Academic Unit of Neurology (MP-G, BD, SO, LM, EC, MH, AV, OH, NP), Trinity Biomedical Sciences Institute, Trinity College Dublin; and Department of Psychology (MP-G, BD, SO, LM, EC, NP), Beaumont Hospital, Dublin, Ireland
| | - Alice Vajda
- Academic Unit of Neurology (MP-G, BD, SO, LM, EC, MH, AV, OH, NP), Trinity Biomedical Sciences Institute, Trinity College Dublin; and Department of Psychology (MP-G, BD, SO, LM, EC, NP), Beaumont Hospital, Dublin, Ireland
| | - Orla Hardiman
- Academic Unit of Neurology (MP-G, BD, SO, LM, EC, MH, AV, OH, NP), Trinity Biomedical Sciences Institute, Trinity College Dublin; and Department of Psychology (MP-G, BD, SO, LM, EC, NP), Beaumont Hospital, Dublin, Ireland
| | - Niall Pender
- Academic Unit of Neurology (MP-G, BD, SO, LM, EC, MH, AV, OH, NP), Trinity Biomedical Sciences Institute, Trinity College Dublin; and Department of Psychology (MP-G, BD, SO, LM, EC, NP), Beaumont Hospital, Dublin, Ireland
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Nash Y, Sitty M. Non-Motor Symptoms of Amyotrophic Lateral Sclerosis: A Multi-Faceted Disorder. J Neuromuscul Dis 2021; 8:699-713. [PMID: 34024773 DOI: 10.3233/jnd-210632] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Amyotrophic Lateral Sclerosis (ALS) is a fatal neurodegenerative disease characterized by progressive degeneration of motor pathways. A growing body of evidence from recent years suggests that ALS results in a wide range of non-motor symptoms as well, which can have a significant impact on patients' quality of life. These symptoms could also, in turn, provide useful information as biomarkers for disease progression, and can shed insight on ALS mechanisms. Here we aim to review a wide range of non-motor symptoms of ALS, with emphasis on their importance to research and clinical treatment of patients.
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Affiliation(s)
- Yuval Nash
- Tel Aviv Youth University, The Jaime and Joan Constantiner School of Education, Tel Aviv University, Tel Aviv, Israel
| | - Michal Sitty
- Clalit Health Services, Kiryat Ono, Israel.,Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Mahoney CJ, Ahmed RM, Huynh W, Tu S, Rohrer JD, Bedlack RS, Hardiman O, Kiernan MC. Pathophysiology and Treatment of Non-motor Dysfunction in Amyotrophic Lateral Sclerosis. CNS Drugs 2021; 35:483-505. [PMID: 33993457 DOI: 10.1007/s40263-021-00820-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2021] [Indexed: 12/21/2022]
Abstract
Amyotrophic lateral sclerosis is a progressive and fatal neurodegenerative disease typically presenting with bulbar or limb weakness. There is increasing evidence that amyotrophic lateral sclerosis is a multisystem disease with early and frequent impacts on cognition, behaviour, sleep, pain and fatigue. Dysfunction of normal physiological and metabolic processes also appears common. Evidence from pre-symptomatic studies and large epidemiological cohorts examining risk factors for the future development of amyotrophic lateral sclerosis have reported a high prevalence of changes in behaviour and mental health before the emergence of motor weakness. This suggests that changes beyond the motor system are underway at an early stage with dysfunction across brain networks regulating a variety of cognitive, behavioural and other homeostatic processes. The full impact of non-motor dysfunction continues to be established but there is now sufficient evidence that the presence of non-motor symptoms impacts overall survival in amyotrophic lateral sclerosis, and with up to 80% reporting non-motor symptoms, there is an urgent need to develop more robust therapeutic approaches. This review provides a contemporary overview of the pathobiology of non-motor dysfunction, offering readers a practical approach with regard to assessment and management. We review the current evidence for pharmacological and non-pharmacological treatment of non-motor dysfunction in amyotrophic lateral sclerosis and highlight the need to further integrate non-motor dysfunction as an important outcome measure for future clinical trial design.
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Affiliation(s)
- Colin J Mahoney
- Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, NSW, Australia.
| | - Rebekah M Ahmed
- Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, NSW, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - William Huynh
- Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, NSW, Australia
| | - Sicong Tu
- Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, NSW, Australia
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Richard S Bedlack
- Department of Neurology, Duke University Hospital, Durham, North Carolina, USA
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College, Dublin, Ireland
| | - Matthew C Kiernan
- Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, NSW, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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12
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Temp AGM, Prudlo J, Vielhaber S, Machts J, Hermann A, Teipel SJ, Kasper E. Cognitive reserve and regional brain volume in amyotrophic lateral sclerosis. Cortex 2021; 139:240-248. [PMID: 33892294 DOI: 10.1016/j.cortex.2021.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/07/2021] [Accepted: 03/04/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE We investigated whether cognitive reserve measured by education and premorbid IQ allows amyotrophic lateral sclerosis patients to compensate for regional brain volume loss. METHODS This was a cross-sectional study. We recruited sixty patients with amyotrophic lateral sclerosis from two specialist out-patient clinics. All participants underwent neuropsychological assessment; the outcomes were standardized z-scores reflecting verbal fluency, executive functions (shifting, planning, working memory), verbal memory and visuo-constructive ability. The predictor was regional brain volume. The moderating proxies of cognitive reserve were premorbid IQ (estimated by vocabulary) and educational years. We hypothesized that higher cognitive reserve would correlate with better performance on a cognitive test battery, and tested this hypothesis with Bayesian analysis of covariance. RESULTS The analyses provided moderate to very strong evidence in favor of our hypothesis with regard to verbal fluency functions, working memory, verbal learning and recognition, and visuo-constructive ability (all BF01 > 3): higher cognitive reserve was associated with a mild increase in performance. For shifting and planning ability, the evidence was anecdotal. CONCLUSIONS These results indicate that cognitive reserve moderates the effect of brain morphology on cognition in ALS. Patients draw small but meaningful benefits from higher reserve, preserving fluency, memory and visuo-constructive functions. Executive functions presented a dissociation: verbally assessed functions benefitted from cognitive reserve, non-verbally assessed functions did not. This motivates future research into cognitive reserve in ALS and practical implications, such as strengthening reserve to delay decline.
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Affiliation(s)
- Anna G M Temp
- German Centre for Neurodegenerative Diseases (DZNE), Rostock, Germany.
| | - Johannes Prudlo
- German Centre for Neurodegenerative Diseases (DZNE), Rostock, Germany; Department of Neurology, University of Rostock, Rostock, Germany.
| | - Stefan Vielhaber
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; German Centre for Neurodegenerative Diseases (DZNE), Magdeburg, Germany.
| | - Judith Machts
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany; German Centre for Neurodegenerative Diseases (DZNE), Magdeburg, Germany.
| | - Andreas Hermann
- German Centre for Neurodegenerative Diseases (DZNE), Rostock, Germany; Translational Neurodegeneration Section "Albrecht-Kossel", Department of Neurology, University of Rostock, Rostock, Germany.
| | - Stefan J Teipel
- German Centre for Neurodegenerative Diseases (DZNE), Rostock, Germany; Department of Psychosomatic Medicine, University of Rostock, Rostock, Germany.
| | - Elisabeth Kasper
- German Centre for Neurodegenerative Diseases (DZNE), Rostock, Germany; Department of Neurology, University of Rostock, Rostock, Germany.
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13
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Leite Neto L, França Júnior MC, Chun RYS. Amyotrophic lateral sclerosis, dysarthria, and language disorders - type of research and approaches in different areas: an integrative literature review. REVISTA CEFAC 2021. [DOI: 10.1590/1982-0216/20212318220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Purpose: to identify the knowledge produced in national and international researches on speech and language disorders in Amyotrophic Lateral Sclerosis, regarding the type of research and approach in different areas. Methods: an integrative review performed on databases, using the following descriptors: Amyotrophic Lateral Sclerosis, Dysarthria, Language Disorders, Speech Production Measurement and Speech Disorders. The inclusion criteria covered articles that addressed motor speech and language disorders from 2013 to 2018, excluding duplications, and categorizing valid articles for analysis. Results: 83 articles were selected, after screening the titles and abstracts. A large scientific production from different countries and areas, mainly Speech Therapy and Neurology, was found. Most of them was clinical research (65.06%), with a main focus on speech motor disorders (42.16%), speech and language motor disorders, cognition and behavior (27.71%), and language disorders (12.06%). Conclusion: researches found were mostly clinical and aimed at determining the diagnosis of disorders in different areas of knowledge. With regard to communication, few studies have been found in Brazil, and international studies addressed high technology. The results confirmed the heterogeneous nature of the disease, which shows, in addition to motor impairment of speech, cognitive, behavioral and language impairments.
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14
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Sakurai T, Hirano S, Abe M, Uji Y, Shimizu K, Suzuki M, Nakano Y, Ishikawa A, Kojima K, Shibuya K, Murata A, Kuwabara S. Dysfunction of the left angular gyrus may be associated with writing errors in ALS. Amyotroph Lateral Scler Frontotemporal Degener 2020; 22:267-275. [PMID: 33331163 DOI: 10.1080/21678421.2020.1861021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Language dysfunction is a feature of cognitive impairment in amyotrophic lateral sclerosis (ALS) that may compromise communication. Objective: To elucidate language dysfunction in patients with ALS and its relationship with other neuropsychological tests and to identify the brain regions associated with this dysfunction using perfusion image. Methods: Overall, 37 patients with ALS were included in this study. Their neuropsychological function was investigated using the Western Aphasia Battery (WAB), Frontal Assessment Battery and Behavioral Assessment of the Dysexecutive Syndrome. N-isopropyl-p-[123I] iodoamphetamine single-photon emission computed tomography was used to examine regional cerebral blood flow and its relationship with WAB scores was investigated using multiple regression analyses, controlled for age, sex and years of education. Results: Frequency of language abnormality in ALS was 8.5% for spontaneous speech, 25.7% for auditory verbal comprehension, 8.8% for repetition, 14.7% for naming, 17.6% for reading and 51.4% for writing. The writing error was mainly omission and substitution of kana letters. Executive tests were correlated with naming (r > 0.5, p < 0.001) and reading (r > 0.4, p < 0.01) scores. With respect to the writing sub-test, positive perfusional relationship was only detected in the left angular gyrus. Conclusions: The left angular gyrus is the region associated with the writing errors observed in ALS.
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Affiliation(s)
- Toru Sakurai
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shigeki Hirano
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Midori Abe
- Division of Rehabilitation, Chiba University Hospital, Chiba, Japan
| | - Yuriko Uji
- Division of Rehabilitation, Chiba University Hospital, Chiba, Japan
| | | | - Masahide Suzuki
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshikazu Nakano
- Department of Neurology, Chiba Saiseikai Narashino Hospital, Chiba, Japan
| | - Ai Ishikawa
- Department of Neurology, Chiba East Hospital, Chiba, Japan
| | - Kazuho Kojima
- Department of Neurology, Chiba Rosai Hospital, Chiba, Japan
| | - Kazumoto Shibuya
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Atsushi Murata
- Division of Rehabilitation, Chiba University Hospital, Chiba, Japan.,Department of Rehabilitation, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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15
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Ceslis A, Argall R, Henderson RD, McCombe PA, Robinson GA. The spectrum of language impairments in amyotrophic lateral sclerosis. Cortex 2020; 132:349-360. [PMID: 33031977 DOI: 10.1016/j.cortex.2020.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/31/2020] [Accepted: 09/03/2020] [Indexed: 12/13/2022]
Abstract
Language disorders are increasingly recognised in Amyotrophic lateral sclerosis (ALS), supporting the view of ALS as a multi-system disorder, impacting cognitive and motor function. However, the language impairments are heterogeneous and recent focus has been on determining the language profile across the ALS spectrum with little focus on spontaneous speech. The current study systematically investigated a wide range of language abilities in an unselected ALS sample (N = 22), including spontaneous speech. We analysed the ALS patients' performance as a group, compared to age-, education- and IQ-matched healthy controls (N = 21), and as a case series to identify dementia and specific language profiles. The ALS group was impaired on measures of spontaneous speech, word fluency and action naming. By contrast, object naming, semantic memory (object and actions), sentence comprehension and repetition (word and sentences) were comparable to healthy controls. In line with recent suggestions, our ALS patients' action naming (but not action semantic) deficit does not support the notion that action processing may be selectively impaired in ALS. The case series demonstrated that 14% of patients had probable dementia, 31% showed significant cognitive and/or language impairment and 55% were unimpaired, consistent with the spectrum of cognitive and language impairments reported in the literature. In addition, 36% of ALS patients produced significantly fewer words per minute on a spontaneous speech task than the control group, with this difference remaining when the ALS patients with frontotemporal dementia were excluded from the analysis. This pattern was observed across the ALS spectrum and in both limb and bulbar onset patients. The pattern of performance observed in the present study suggests that spontaneous speech is reduced across the ALS spectrum even in those with intact core language abilities.
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Affiliation(s)
- Amelia Ceslis
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, Australia.
| | - Rosemary Argall
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, Australia; Neurology, Royal Brisbane and Women's Hospital, Heston, Brisbane, QLD, Australia.
| | - Robert D Henderson
- Neurology, Royal Brisbane and Women's Hospital, Heston, Brisbane, QLD, Australia; Centre for Clinical Research, Faculty of Medicine, University of Queensland, Herston, Brisbane, Australia; Wesley Medical Research, The Wesley Hospital, Auchenflower, Brisbane, Australia.
| | - Pamela A McCombe
- Neurology, Royal Brisbane and Women's Hospital, Heston, Brisbane, QLD, Australia; Centre for Clinical Research, Faculty of Medicine, University of Queensland, Herston, Brisbane, Australia; Wesley Medical Research, The Wesley Hospital, Auchenflower, Brisbane, Australia.
| | - Gail A Robinson
- Neuropsychology Research Unit, School of Psychology, The University of Queensland, St Lucia, Brisbane, QLD, Australia; Neurology, Royal Brisbane and Women's Hospital, Heston, Brisbane, QLD, Australia; Queensland Brain Institute, The University of Queensland, St Lucia, Brisbane, Australia.
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16
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Pender N, Pinto-Grau M, Hardiman O. Cognitive and behavioural impairment in amyotrophic lateral sclerosis. Curr Opin Neurol 2020; 33:649-654. [PMID: 32833751 DOI: 10.1097/wco.0000000000000862] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The current review provides an up to date overview of the nature and progression of the cognitive and behavioural impairment in amyotrophic lateral sclerosis (ALS). Understanding these symptoms has implications for the management of the disease and the design of clinical trials, in addition to the support of patient and caregiver regarding mental capacity and end of life decision-making. RECENT FINDINGS Cognitive and behavioural change in ALS are best characterized as the consequence of extensive network dysfunction. 35-45% of ALS patients present with mild-moderate cognitive impairment and comorbid dementia occurs in approximately 14% of patients, the majority of these meeting diagnostic criteria for frontotemporal dementia (FTD). Cognitive change in ALS manifests most commonly as executive dysfunction and language impairment. Behavioural change in the form of apathy, disinhibition, loss of sympathy and empathy, stereotyped behaviours and dietary changes occur. SUMMARY Cognitive and behavioural impairment is an important feature of ALS, and reflects broad network dysfunction of frontostriatal and frontotemporal systems. Cognition and behaviour should be assessed early in the diagnostic process, and data driven approaches should be developed to enable reliable quantitative outcome assessment suitable for clinical trials.
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Affiliation(s)
- Niall Pender
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin.,Department of Psychology
| | - Marta Pinto-Grau
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin.,Department of Psychology
| | - Orla Hardiman
- Academic Unit of Neurology, Trinity Biomedical Sciences Institute, Trinity College Dublin.,Department of Neurology, Beaumont Hospital, Dublin, Ireland
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17
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Nevler N, Ash S, McMillan C, Elman L, McCluskey L, Irwin DJ, Cho S, Liberman M, Grossman M. Automated analysis of natural speech in amyotrophic lateral sclerosis spectrum disorders. Neurology 2020; 95:e1629-e1639. [PMID: 32675077 DOI: 10.1212/wnl.0000000000010366] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 04/06/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We implemented automated methods to analyze speech and evaluate the hypothesis that cognitive and motor factors impair prosody in partially distinct ways in patients with amyotrophic lateral sclerosis (ALS). METHODS We recruited 213 participants, including 67 with ALS (44 with motor ALS, 23 with ALS and frontotemporal degeneration [FTD]), 33 healthy controls, and neurodegenerative reference groups with behavioral variant FTD (n = 90) and nonfluent/agrammatic primary progressive aphasia (n = 23). Digitized, semistructured speech samples obtained from picture descriptions were automatically segmented with a Speech Activity Detector; continuous speech segments were pitch-tracked; and duration measures for speech and silent pause segments were extracted. Acoustic measures were calculated, including fundamental frequency (f0) range, mean speech and pause segment durations, total speech duration, and pause rate (pause count per minute of speech). Group comparisons related performance on acoustic measures to clinical scales of cognitive and motor impairments and explored MRI cortical thinning in ALS and ALS-FTD. RESULTS The f0 range was significantly impaired in ALS spectrum disorders and was related to bulbar motor disease, and regression analyses related this to cortical thickness in primary motor cortex and perisylvian regions. Impaired speech and pause duration measures were related to the degree of cognitive impairment in ALS spectrum disorders, and regressions related duration measures to bilateral frontal opercula and left anterior insula. CONCLUSION Automated analyses of acoustic speech properties dissociate motor and cognitive components of speech deficits in ALS spectrum disorders.
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Affiliation(s)
- Naomi Nevler
- From the Penn Frontotemporal Degeneration Center (N.N., S.A., C.M., D.J.I., M.G.), Department of Neurology (N.N., S.A., C.M., L.E., L.M., D.J.I., M.G.), and Linguistic Data Consortium (S.C., M.L.), Department of Linguistics, University of Pennsylvania, Philadelphia.
| | - Sharon Ash
- From the Penn Frontotemporal Degeneration Center (N.N., S.A., C.M., D.J.I., M.G.), Department of Neurology (N.N., S.A., C.M., L.E., L.M., D.J.I., M.G.), and Linguistic Data Consortium (S.C., M.L.), Department of Linguistics, University of Pennsylvania, Philadelphia
| | - Corey McMillan
- From the Penn Frontotemporal Degeneration Center (N.N., S.A., C.M., D.J.I., M.G.), Department of Neurology (N.N., S.A., C.M., L.E., L.M., D.J.I., M.G.), and Linguistic Data Consortium (S.C., M.L.), Department of Linguistics, University of Pennsylvania, Philadelphia
| | - Lauren Elman
- From the Penn Frontotemporal Degeneration Center (N.N., S.A., C.M., D.J.I., M.G.), Department of Neurology (N.N., S.A., C.M., L.E., L.M., D.J.I., M.G.), and Linguistic Data Consortium (S.C., M.L.), Department of Linguistics, University of Pennsylvania, Philadelphia
| | - Leo McCluskey
- From the Penn Frontotemporal Degeneration Center (N.N., S.A., C.M., D.J.I., M.G.), Department of Neurology (N.N., S.A., C.M., L.E., L.M., D.J.I., M.G.), and Linguistic Data Consortium (S.C., M.L.), Department of Linguistics, University of Pennsylvania, Philadelphia
| | - David J Irwin
- From the Penn Frontotemporal Degeneration Center (N.N., S.A., C.M., D.J.I., M.G.), Department of Neurology (N.N., S.A., C.M., L.E., L.M., D.J.I., M.G.), and Linguistic Data Consortium (S.C., M.L.), Department of Linguistics, University of Pennsylvania, Philadelphia
| | - Sunghye Cho
- From the Penn Frontotemporal Degeneration Center (N.N., S.A., C.M., D.J.I., M.G.), Department of Neurology (N.N., S.A., C.M., L.E., L.M., D.J.I., M.G.), and Linguistic Data Consortium (S.C., M.L.), Department of Linguistics, University of Pennsylvania, Philadelphia
| | - Mark Liberman
- From the Penn Frontotemporal Degeneration Center (N.N., S.A., C.M., D.J.I., M.G.), Department of Neurology (N.N., S.A., C.M., L.E., L.M., D.J.I., M.G.), and Linguistic Data Consortium (S.C., M.L.), Department of Linguistics, University of Pennsylvania, Philadelphia
| | - Murray Grossman
- From the Penn Frontotemporal Degeneration Center (N.N., S.A., C.M., D.J.I., M.G.), Department of Neurology (N.N., S.A., C.M., L.E., L.M., D.J.I., M.G.), and Linguistic Data Consortium (S.C., M.L.), Department of Linguistics, University of Pennsylvania, Philadelphia.
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18
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Chen QF, Zhang XH, Huang NX, Chen HJ. Identification of Amyotrophic Lateral Sclerosis Based on Diffusion Tensor Imaging and Support Vector Machine. Front Neurol 2020; 11:275. [PMID: 32411072 PMCID: PMC7198809 DOI: 10.3389/fneur.2020.00275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 03/24/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: White matter (WM) impairments involving both motor and extra-motor areas have been well-documented in amyotrophic lateral sclerosis (ALS). This study tested the potential of diffusion measurements in WM for identifying ALS based on support vector machine (SVM). Methods: Voxel-wise fractional anisotropy (FA) values of diffusion tensor images (DTI) were extracted from 22 ALS patients and 26 healthy controls and served as discrimination features. The revised ALS Functional Rating Scale (ALSFRS-R) was employed to assess ALS severity. Feature ranking and selection were based on Fisher scores. A linear kernel SVM algorithm was applied to build the classification model, from which the classification performance was evaluated. To promote classifier generalization ability, a leave-one-out cross-validation (LOOCV) method was adopted. Results: By using the 2,400~3,400 ranked features as optimal features, the highest classification accuracy of 83.33% (sensitivity = 77.27% and specificity = 88.46%, P = 0.0001) was achieved, with an area under receiver operating characteristic curve of 0.862. The predicted function value was positively correlated with patient ALSFRS-R scores (r = 0.493, P = 0.020). In the optimized SVM model, FA values from several regions mostly contributed to classification, primarily involving the corticospinal tract pathway, postcentral gyrus, and frontal and parietal areas. Conclusions: Our results suggest the feasibility of ALS diagnosis based on SVM analysis and diffusion measurements of WM. Additional investigations using a larger cohort is recommended in order to validate the results of this study.
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Affiliation(s)
- Qiu-Feng Chen
- College of Computer and Information Sciences, Fujian Agriculture and Forestry University, Fuzhou, China
| | - Xiao-Hong Zhang
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Nao-Xin Huang
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Hua-Jun Chen
- Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, China
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19
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Merico A, De Marco M, Berta G, Manca R, Giulietti G, Bozzali M, Venneri A. Right fronto-parietal white matter disruption contributes to speech impairments in amyotrophic lateral sclerosis. Brain Res Bull 2020; 158:77-83. [PMID: 32119965 DOI: 10.1016/j.brainresbull.2020.02.016] [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: 10/19/2019] [Revised: 01/13/2020] [Accepted: 02/27/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Non-linguistic properties of speech are widely heterogeneous and require complex neurological integration. The association between white matter integrity and the severity of dysarthria was investigated in a group of patients diagnosed with amyotrophic lateral sclerosis (ALS). METHODS Thirty-six patients diagnosed with amyotrophic lateral sclerosis completed a magnetic resonance imaging protocol inclusive of diffusion-weighted images. A clinical assessment of pneumo-phono-articulatory abilities was conducted for each patient, and a composite score of residual speech capacity was calculated. Tract-Based Spatial Statistics was carried out to model the potential association between residual speech capacity and microstructural properties of white matter (fractional anisotropy, mean and radial diffusivity). RESULTS A significant negative association was found between residual speech capacity and mean diffusivity in a large white matter cluster located in frontal, parietal and right temporal regions. These subcortical areas were characterised by pathological microstructural disruption, as revealed by post hoc analyses. CONCLUSIONS Non-linguistic aspects of speech are associated with microstructural integrity of frontal, parietal and right temporal white matter in amyotrophic lateral sclerosis. Such mapping is consistent with the centres responsible of volitional control of speech and sensory feedback during non-linguistic speech production.
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Affiliation(s)
- Antonio Merico
- Department of Physical Medicine and Rehabilitation, Azienda Sanitaria Locale, Lecce, Italy
| | - Matteo De Marco
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Giulia Berta
- IRCCS Fondazione Ospedale San Camillo, Venice Lido, Italy
| | - Riccardo Manca
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | | | - Marco Bozzali
- IRCCS Fondazione Santa Lucia, Rome, Italy; Department of Neuroscience, Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, University of Sussex, Brighton, East Sussex, United Kingdom
| | - Annalena Venneri
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom.
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20
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Paynter C, Cruice M, Mathers S, Gregory H, Vogel AP. Communication and cognitive impairments and health care decision making in MND: A narrative review. J Eval Clin Pract 2019; 25:1182-1192. [PMID: 31282612 DOI: 10.1111/jep.13219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/22/2019] [Accepted: 06/04/2019] [Indexed: 12/12/2022]
Abstract
RATIONALE Motor neurone disease (MND) is a neurodegenerative disease presenting with progressive weakness of voluntary muscles. For any condition, person-centred health care relies on the sharing of information and a mutual understanding of the person's needs and preferences. Decision making in MND becomes more complex as there is no cure and a high prevalence of co-morbid communication and/or cognitive difficulties. OBJECTIVE To identify the reported impact of communication and/or cognitive impairment on patient and carer involvement in health care decision making in MND. METHODS A review and synthesis of studies addressing issues of communication impairment and/or cognitive impairment in relation to decision making focussed on MND was conducted. Articles were excluded if they were reviews, case studies, conference papers, or commentaries. To be included studies needed to address issues of communication impairment or cognitive impairment specifically in relation to decision making. Relevant data were extracted verbatim and subjected to content analysis to support the narrative summary. RESULTS Seventy-six articles were identified, and 35 articles screened. Six articles met inclusion criteria each describing examples of decision making in MND. There was limited data related to communication and/or cognitive impairment, and the impact these impairments may have on decision making despite recognition that many people with MND may lose verbal communication or develop subtle cognitive impairments. The literature is primarily from the perspective of others. CONCLUSION This review highlights that the current body of literature exploring decision making within the MND population presents us with extremely limited insights into the impact of communication and/or cognitive impairments on health care decision making. Extant literature focuses on interventions (namely, ventilation and gastrostomy), the broad process of decision making, or cognitive assessment of decision-making ability. Whilst most studies acknowledge that deficits in communication or cognition impact the decision-making process, this issue is not the focus of any study.
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Affiliation(s)
- Camille Paynter
- Centre for Neuroscience of Speech, University of Melbourne, Carlton, Victoria, Australia
| | - Madeline Cruice
- Division of Language and Communication Sciences, City, University of London, London, UK
| | - Susan Mathers
- Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, Melbourne, Victoria, Australia.,School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Heidi Gregory
- Statewide Progressive Neurological Disease Service, Calvary Health Care Bethlehem, Melbourne, Victoria, Australia.,Department of Palliative Care, University of Notre Dame, Melbourne, Victoria, Australia
| | - Adam P Vogel
- Centre for Neuroscience of Speech, University of Melbourne, Carlton, Victoria, Australia.,Department of Neurodegeneration, Hertie Institute for Clinical Brain Research, Tubingen, Germany.,Science Department, Redenlab, Melbourne, Victoria, Australia
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21
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De Marchi F, Tondo G, Sarnelli MF, Corrado L, Solara V, D'Alfonso S, Cantello R, Mazzini L. A case of progressive non-fluent aphasia as onset of amyotrophic lateral sclerosis with frontotemporal dementia. Int J Neurosci 2019; 129:719-721. [PMID: 30146930 DOI: 10.1080/00207454.2018.1516657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The association between Amyotrophic Lateral Sclerosis (ASL) and FrontoTemporal Dementia (FTD) is well known. Most of reports describing ASL-FTD cases show a strong association between ALS and the behavioural form of FTD. Conversely, the association between ALS and pure Semantic Dementia or Progressive Non-Fluent Aphasia (PNFA) is extremely rare, ranging from 1 to 3%. A clinical phenotype characterized by a rapidly progressive aphasic dementia and motoneuron disease (MND) has been described in few case reports; since the updating of PNFA diagnostic criteria in 2011, no clinical report has been related. We want to describe a case of patient presented, at the onset, as PNFA who developed, one year later, ALS with bulbar onset. The patient was screened for the main genes causing or associated with MND and/or dementia but no variants with a pathogenetic effect were observed.
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Affiliation(s)
- F De Marchi
- a Department of Neurology , Eastern Piedmont University, "Maggiore della Carità" University Hospital , Novara , Italy
| | - G Tondo
- a Department of Neurology , Eastern Piedmont University, "Maggiore della Carità" University Hospital , Novara , Italy
| | - M F Sarnelli
- b ALS Center, Department of Neurology , "Maggiore della Carità" University Hospital , Novara , Italy
| | - L Corrado
- c Interdisciplinary Research Center of Autoimmune Disease (IRCAD), Eastern Piedmont University , Novara , Italy
| | - V Solara
- b ALS Center, Department of Neurology , "Maggiore della Carità" University Hospital , Novara , Italy
| | - S D'Alfonso
- c Interdisciplinary Research Center of Autoimmune Disease (IRCAD), Eastern Piedmont University , Novara , Italy
| | - R Cantello
- a Department of Neurology , Eastern Piedmont University, "Maggiore della Carità" University Hospital , Novara , Italy
| | - L Mazzini
- b ALS Center, Department of Neurology , "Maggiore della Carità" University Hospital , Novara , Italy
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22
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Long Z, Irish M, Piguet O, Kiernan MC, Hodges JR, Burrell JR. Clinical and neuroimaging investigations of language disturbance in frontotemporal dementia–motor neuron disease patients. J Neurol 2019; 266:921-933. [DOI: 10.1007/s00415-019-09216-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/24/2019] [Accepted: 01/25/2019] [Indexed: 01/06/2023]
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23
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Vinceti G, Olney N, Mandelli ML, Spina S, Hubbard HI, Santos-Santos MA, Watson C, Miller ZA, Lomen-Hoerth C, Nichelli P, Miller BL, Grinberg LT, Seeley WW, Gorno-Tempini ML. Primary progressive aphasia and the FTD-MND spectrum disorders: clinical, pathological, and neuroimaging correlates. Amyotroph Lateral Scler Frontotemporal Degener 2019; 20:146-158. [PMID: 30668155 DOI: 10.1080/21678421.2018.1556695] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective: Behavioral variant frontotemporal dementia (bvFTD), is commonly considered the cognitive presentation of the frontotemporal dementia-motor neuron disease (FTD-MND) spectrum disorder. We evaluated the prevalence of primary progressive aphasia in a series of pathologically confirmed cases of FTD-MND spectrum. Methods: Pathologically confirmed cases of frontotemporal lobar degeneration-motor neuron disease (FTLD-MND) were obtained from the UCSF brain bank. Cases were analyzed for presence of language impairment via retrospective chart review of research visits that include neurologic exam, in-depth cognitive testing and magnetic resonance imaging (MRI) imaging. Forty one cases were included. Thirty two were diagnosed with FTD-MND, while nine cases were diagnosed as MND-only from clinical evaluation. Results: Ten FTLD-MND cases (31%) presented with prominent or isolated language involvement consistent with a diagnosis of primary progressive aphasia (PPA), which we called progressive aphasia with motor neuron disease (PA-MND). Of these, three cases that mirrored the non-fluent variant of PPA (nfvPPA) were named nfvPA-MND. The imaging pattern of these nfvPA-MND showed atrophy strictly confined to the frontal and anterior temporal language cortical areas. Another group of seven cases that resembled patients with the semantic variant PPA (svPPA) were named svPA-MND. The group of svPPA-MND on imaging analysis showed selective atrophy of the temporal lobe and orbitofrontal cortex. Conclusions: Language impairment was a frequent phenotype of FTD-MND associated with focal atrophy patterns within the language networks. This data suggest patients with FTD-MND can present quite often with language phenotype of nfvPPA and svPPA, as opposed to exclusive bvFTD symptoms.
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Affiliation(s)
- Giulia Vinceti
- a Department of Neurology, Memory and Aging Center , University of California , San Francisco , CA , USA.,b Department of Biomedical, Metabolic and Neural Science , University of Modena and Reggio Emilia , Modena , Italy
| | - Nicholas Olney
- a Department of Neurology, Memory and Aging Center , University of California , San Francisco , CA , USA.,d UCSF ALS Center , University of California , San Francisco , CA , USA
| | - Maria Luisa Mandelli
- a Department of Neurology, Memory and Aging Center , University of California , San Francisco , CA , USA
| | - Salvatore Spina
- a Department of Neurology, Memory and Aging Center , University of California , San Francisco , CA , USA
| | - H Isabel Hubbard
- a Department of Neurology, Memory and Aging Center , University of California , San Francisco , CA , USA.,c Department of Communication Sciences and Disorders , University of Texas , Austin , TX, USA
| | - Miguel A Santos-Santos
- a Department of Neurology, Memory and Aging Center , University of California , San Francisco , CA , USA
| | - Christa Watson
- a Department of Neurology, Memory and Aging Center , University of California , San Francisco , CA , USA
| | - Zachary A Miller
- a Department of Neurology, Memory and Aging Center , University of California , San Francisco , CA , USA
| | | | - Paolo Nichelli
- b Department of Biomedical, Metabolic and Neural Science , University of Modena and Reggio Emilia , Modena , Italy
| | - Bruce L Miller
- a Department of Neurology, Memory and Aging Center , University of California , San Francisco , CA , USA
| | - Lea T Grinberg
- a Department of Neurology, Memory and Aging Center , University of California , San Francisco , CA , USA.,e Department of Pathology , University of California , San Francisco , CA , USA
| | - William W Seeley
- a Department of Neurology, Memory and Aging Center , University of California , San Francisco , CA , USA.,e Department of Pathology , University of California , San Francisco , CA , USA
| | - Maria Luisa Gorno-Tempini
- a Department of Neurology, Memory and Aging Center , University of California , San Francisco , CA , USA
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24
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Zhang Y, Qiu T, Yuan X, Zhang J, Wang Y, Zhang N, Zhou C, Luo C, Zhang J. Abnormal topological organization of structural covariance networks in amyotrophic lateral sclerosis. NEUROIMAGE-CLINICAL 2018; 21:101619. [PMID: 30528369 PMCID: PMC6411656 DOI: 10.1016/j.nicl.2018.101619] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 11/03/2018] [Accepted: 11/29/2018] [Indexed: 01/12/2023]
Abstract
Neuroimaging studies of patients with amyotrophic lateral sclerosis (ALS) have shown widespread alterations in structure, function, and connectivity in both motor and non-motor brain regions, suggesting multi-systemic neurobiological abnormalities that might impact large-scale brain networks. Here, we examined the alterations in the topological organization of structural covariance networks of ALS patients (N = 60) compared with normal controls (N = 60). We found that structural covariance networks of ALS patients showed a consistent rearrangement towards a regularized architecture evidenced by increased path length, clustering coefficient, small-world index, and modularity, as well as decreased global efficiency, suggesting inefficient global integration and increased local segregation. Locally, ALS patients showed decreased nodal degree and betweenness in the gyrus rectus and/or Heschl's gyrus, and increased betweenness in the supplementary motor area, triangular part of the inferior frontal gyrus, supramarginal gyrus and posterior cingulate cortex. In addition, we identified a different number and distribution of hubs in ALS patients, showing more frontal and subcortical hubs than in normal controls. In conclusion, we reveal abnormal topological organization of structural covariance networks in ALS patients, and provide network-level evidence for the concept that ALS is a multisystem disorder with a cerebral involvement extending beyond the motor areas.
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Affiliation(s)
- Yuanchao Zhang
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, PR China
| | - Ting Qiu
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, PR China
| | - Xinru Yuan
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, PR China
| | - Jinlei Zhang
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, PR China
| | - Yue Wang
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu 610054, PR China
| | - Na Zhang
- School of Mathematical Sciences, University of Jinan, Jinan 250022, Shandong Province, PR China
| | - Chaoyang Zhou
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing 400038, PR China
| | - Chunxia Luo
- Department of Neurology, Southwest Hospital, Third Military Medical University, Chongqing 400038, PR China
| | - Jiuquan Zhang
- Department of Radiology, Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing 400030, PR China; Key Laboratory for Biorheological Science and Technology of Ministry of Education (Chongqing University), Chongqing University Cancer Hospital, Chongqing Cancer Institute, Chongqing Cancer Hospital, Chongqing 400044, PR China.
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25
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Ye S, Rosenbohm A, Böhm S, Uttner I, Ji Y, Ludolph AC, Lulé D, Fan D. Cognitive and behavioral impairments in German and Chinese ALS populations - a post-hoc comparison of national study data. Amyotroph Lateral Scler Frontotemporal Degener 2018; 20:28-36. [PMID: 30472897 DOI: 10.1080/21678421.2018.1542535] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
This study aimed to clarify whether differences between German and Chinese studies using the standardized Edinburgh Cognitive and Behavioural ALS Screen (ECAS), might be explained by differences in translated versions of ECAS, by patient demographic or clinical characteristics or by population-specific factors. Comparisons were performed on data from two previous studies in Germany and China. We found except for spelling task (p = 0.05), no differences between control groups of two countries were detected after adjusting for demographics. In contrast, differences were observed in scores on total ECAS, ALS-specific function such as different executive functions (all p < 0.01) and language (p = 0.02), even after correcting for demographic and clinical variables. Chinese ALS cohort performed worse in executive subfunction scores for sentence completion, alternation, social cognition, digit span and language comprehension; they performed better in spelling. Chinese ALS cohort more frequently exhibited disinhibition (p = 0.02), whereas German cohort more frequently exhibited loss of sympathy (p = 0.01) and stereotyped behavior (p = 0.03). Chinese and German ALS cohorts showed a distinctly different pattern in executive and language function. Most of the differences might be related to distinct differences between populations as only spelling might be affected by different language versions of ECAS. Socio-cultural factors might explain behavioral profile differences.
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Affiliation(s)
- Shan Ye
- a Department of Neurology , Peking University Third Hospital , Beijing , China
| | | | - Sarah Böhm
- b Department of Neurology , University of Ulm , Ulm , Germany
| | - Ingo Uttner
- b Department of Neurology , University of Ulm , Ulm , Germany
| | - Ying Ji
- a Department of Neurology , Peking University Third Hospital , Beijing , China
| | | | - Dorothée Lulé
- b Department of Neurology , University of Ulm , Ulm , Germany
| | - Dongsheng Fan
- a Department of Neurology , Peking University Third Hospital , Beijing , China.,c Key Laboratory for Neuroscience, Ministry of Education/National Health & Commission , Peking University , Beijing , China
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26
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Christidi F, Karavasilis E, Rentzos M, Kelekis N, Evdokimidis I, Bede P. Clinical and Radiological Markers of Extra-Motor Deficits in Amyotrophic Lateral Sclerosis. Front Neurol 2018; 9:1005. [PMID: 30524366 PMCID: PMC6262087 DOI: 10.3389/fneur.2018.01005] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 11/06/2018] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is now universally recognized as a complex multisystem disorder with considerable extra-motor involvement. The neuropsychological manifestations of frontotemporal, parietal, and basal ganglia involvement in ALS have important implications for compliance with assistive devices, survival, participation in clinical trials, caregiver burden, and the management of individual care needs. Recent advances in neuroimaging have been instrumental in characterizing the biological substrate of heterogeneous cognitive and behavioral deficits in ALS. In this review we discuss the clinical and radiological aspects of cognitive and behavioral impairment in ALS focusing on the recognition, assessment, and monitoring of these symptoms.
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Affiliation(s)
- Foteini Christidi
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstratios Karavasilis
- Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece
| | - Michail Rentzos
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kelekis
- Second Department of Radiology, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Evdokimidis
- First Department of Neurology, Aeginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Peter Bede
- Computational Neuroimaging Group, Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland
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27
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Linse K, Aust E, Joos M, Hermann A. Communication Matters-Pitfalls and Promise of Hightech Communication Devices in Palliative Care of Severely Physically Disabled Patients With Amyotrophic Lateral Sclerosis. Front Neurol 2018; 9:603. [PMID: 30100896 PMCID: PMC6072854 DOI: 10.3389/fneur.2018.00603] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 07/06/2018] [Indexed: 12/12/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is the most common motor neuron disease, leading to progressive paralysis, dysarthria, dysphagia, and respiratory disabilities. Therapy is mostly focused on palliative interventions. During the course of the disease, verbal as well as nonverbal communicative abilities become more and more impaired. In this light, communication has been argued to be “the essence of human life” and crucial for patients' quality of life. High-tech augmentative and alternative communication (HT-AAC) technologies such as eyetracking based computer devices and brain-computer-interfaces provide the possibility to maintain caregiver-independent communication and environmental control even in the advanced disease state of ALS. Thus, they enable patients to preserve social participation and to independently communicate end-of-life-decisions. In accordance with these functions of HT-AAC, their use is reported to strengthen self-determination, increase patients' quality of life and reduce caregiver burden. Therefore, HT-AAC should be considered as standard of (palliative) care for people with ALS. On the other hand, the supply with individually tailored HT-AAC technologies is limited by external and patient-inherent variables. This review aims to provide an overview of the possibilities and limitations of HT-AAC technologies and discuss their role in the palliative care for patients with ALS.
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Affiliation(s)
- Katharina Linse
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany
| | - Elisa Aust
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Markus Joos
- Interactive Minds Dresden GmbH, Dresden, Germany
| | - Andreas Hermann
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,German Center for Neurodegenerative Diseases (DZNE) Dresden, Dresden, Germany
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28
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Li W, Zhang J, Zhou C, Hou W, Hu J, Feng H, Zheng X. Abnormal Functional Connectivity Density in Amyotrophic Lateral Sclerosis. Front Aging Neurosci 2018; 10:215. [PMID: 30065647 PMCID: PMC6056617 DOI: 10.3389/fnagi.2018.00215] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 06/25/2018] [Indexed: 01/13/2023] Open
Abstract
Purpose: Amyotrophic lateral sclerosis (ALS) is a motor neuro-degenerative disorder that also damages extra-motor neural pathways. A significant proportion of existing evidence describe alterations in the strengths of functional connectivity, whereas the changes in the density of these functional connections have not been explored. Therefore, our study seeks to identify ALS-induced alternations in the resting-state functional connectivity density (FCD). Methods: Two groups comprising of 38 ALS patients and 35 healthy participants (age and gender matched) were subjected to the resting-state functional magnetic resonance imaging (MRI) scanning. An ultra-fast graph theory method known as FCD mapping was utilized to calculate the voxel-wise short- and long-range FCD values of the brain for each participant. FCD values of patients and controls were compared based on voxels in order to discern cerebral regions that possessed significant FCD alterations. For areas demonstrating a group effect of atypical FCD in ALS, seed-based functional connectivity analysis was then investigated. Partial correlation analyses were carried out between aberrant FCDs and several clinical variables, controlling for age, gender, and total intracranial volume. Results: Patients with ALS were found to have decreased short-range FCD in the primary motor cortex and increased long-range FCD in the premotor cortex. Extra-motor areas that also displayed extensive FCD alterations encompassed the temporal cortex, insula, cingulate gyrus, occipital cortex, and inferior parietal lobule. Seed-based correlation analysis further demonstrated that these regions also possessed disrupted functional connectivity. However, no significant correlations were identified between aberrant FCDs and clinical variables. Conclusion: FCD changes in the regions identified represent communication deficits and impaired functional brain dynamics, which might underlie the motor, motor control, language, visuoperceptual and high-order cognitive deficits in ALS. These findings support the fact that ALS is a disorder affecting multiple systems. We gain a deeper insight of the neural mechanisms underlying ALS.
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Affiliation(s)
- Weina Li
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Bioengineering College, Chongqing University, Chongqing, China.,Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Army Medical University, Chongqing, China.,Chongqing Collaborative Innovation Center for Brain Science, Chongqing, China
| | - Jiuquan Zhang
- Department of Radiology, Chongqing University Cancer Hospital, Chongqing, China
| | - Chaoyang Zhou
- Chongqing Collaborative Innovation Center for Brain Science, Chongqing, China.,Department of Radiology, Chongqing University Cancer Hospital, Chongqing, China
| | - Wensheng Hou
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Bioengineering College, Chongqing University, Chongqing, China.,Chongqing Collaborative Innovation Center for Brain Science, Chongqing, China
| | - Jun Hu
- Chongqing Collaborative Innovation Center for Brain Science, Chongqing, China.,Department of Neurology, Southwest Hospital, Third Military Medical University, Army Medical University, Chongqing, China
| | - Hua Feng
- Department of Neurosurgery, Southwest Hospital, Third Military Medical University, Army Medical University, Chongqing, China.,Chongqing Collaborative Innovation Center for Brain Science, Chongqing, China
| | - Xiaolin Zheng
- Key Laboratory of Biorheological Science and Technology, Ministry of Education, Bioengineering College, Chongqing University, Chongqing, China.,Chongqing Collaborative Innovation Center for Brain Science, Chongqing, China
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29
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Woolley SC, Rush BK. Considerations for Clinical Neuropsychological Evaluation in Amyotrophic Lateral Sclerosis. Arch Clin Neuropsychol 2018; 32:906-916. [PMID: 29028904 DOI: 10.1093/arclin/acx089] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 09/14/2017] [Indexed: 12/11/2022] Open
Abstract
The clinical neuropsychologist has the opportunity to be uniquely involved in the evaluation and treatment of individuals with amyotrophic lateral sclerosis (ALS). We review the current literature that defines cognitive and behavioral symptoms in ALS, including current knowledge of the neuropathological and genetic underpinning for these symptoms. There are unique considerations for clinical neuropsychological evaluation and clinical research in ALS and we highlight these in this review. Specifically, we shed light on special factors that contribute to our understanding of cognitive and behavioral impairment in ALS, including co-morbid symptoms, differential diagnosis, and considerations for longitudinal tracking of phenotypes. We discuss the rationale for proposing a specific approach to such as cognitive screening, test selection, response modality consideration, and test-retest intervals. With this didactic overview, the clinical neuropsychologist has the potential to learn more about the heterogeneous presentation of motor and neuropsychological symptoms in ALS. Furthermore, the reader has the opportunity to understand what it takes to develop a valid assessment approach particularly when the phenotype of ALS remains undefined in some regards. This clinical practice review sets the stage for the clinical neuropsychologist to further contribute to our clinical and scientific understanding of ALS and cognition.
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Affiliation(s)
| | - Beth K Rush
- Mayo Clinic Florida, Department of Psychiatry and Psychology, 4500 San Pablo Road, Jacksonville, FL 32224, USA
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30
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Consonni M, Contarino VE, Catricalà E, Dalla Bella E, Pensato V, Gellera C, Lauria G, Cappa SF. Cortical markers of cognitive syndromes in amyotrophic lateral sclerosis. NEUROIMAGE-CLINICAL 2018; 19:675-682. [PMID: 30023173 PMCID: PMC6046611 DOI: 10.1016/j.nicl.2018.05.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 12/12/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) can be associated with a spectrum of cognitive and behavioural symptoms, but the related patterns of focal cortical atrophy in non-demented ALS patients remain largely unknown. We enrolled 48 non-demented ALS patients and 26 healthy controls for a comprehensive neuropsychological assessment and a magnetic resonance exam. Behavioural and cognitive impairment was defined on the basis of a data-driven multi-domain approach in 21 ALS patients. Averaged cortical thickness of 74 bilateral brain regions was used as a measure of cortical atrophy. Cortical thinning in a fronto-parietal network, suggesting a disease-specific pattern of neurodegeneration, was present in all patients, independent of cognitive and behavioural status. Between-group and correlational analyses revealed that inferior frontal, temporal, cingular and insular thinning are markers for cognitive and behavioural deficits, with language impairment mainly related to left temporal pole and insular involvement. These specific correlates support the concept of a spectrum of deficits, with an overlap between the ALS cognitive phenotypes and the syndromes of frontotemporal dementia. Language, social cognition and executive dysfunctions are frequent symptoms in ALS. Fronto-parietal cortical thinning is present in non-demented ALS patients. Temporal, cingular and insular thinning are markers for cognitive impairment in ALS. Left temporal pole and insular thinning is linked to language impairment in ALS.
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Key Words
- ALS, amyotrophic lateral sclerosis
- ALSbi, ALS with mild behavioural impairment
- ALSci, ALS with mild cognitive impairment
- ALScn, cognitively-normal ALS
- ALSimp, ALS with cognitive and/or behavioural impairment
- Amyotrophic lateral sclerosis
- C9+ ALS, ALS harbouring C9orf72 repeat expansion
- C9– ALS, ALS without C9orf repeat expansion
- CT, cortical thickness
- Cognitive impairment
- Cognitive profiles
- Cortical thickness
- FTD, frontotemporal dementia
- GM, grey matter
- HC, healthy control
- MD, multi-domain
- Temporal lobe
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Affiliation(s)
- Monica Consonni
- 3rd Neurology Unit and Motor Neuron Diseases Centre, Department of Clinical Neurosciences, IRCCS Foundation "Carlo Besta" Neurological Institute, Via Celoria 11, 20133 Milan, Italy.
| | - Valeria E Contarino
- Neuroradiology Unit, IRCCS Foundation "Carlo Besta" Neurological Institute, Via Celoria 11, 20133 Milan, Italy
| | - Eleonora Catricalà
- Institute for Advanced Study-IUSS Pavia, Palazzo del Broletto e Piazza Vittoria 15, 27100 Pavia, Italy
| | - Eleonora Dalla Bella
- 3rd Neurology Unit and Motor Neuron Diseases Centre, Department of Clinical Neurosciences, IRCCS Foundation "Carlo Besta" Neurological Institute, Via Celoria 11, 20133 Milan, Italy
| | - Viviana Pensato
- Genetics of Neurodegenerative and Metabolic Diseases Unit and Motor Neuron Diseases Centre, Department of Clinical Neurosciences, IRCCS Foundation 'Carlo Besta' Neurological Institute, Via Celoria 11, 20133 Milan, Italy
| | - Cinzia Gellera
- Genetics of Neurodegenerative and Metabolic Diseases Unit and Motor Neuron Diseases Centre, Department of Clinical Neurosciences, IRCCS Foundation 'Carlo Besta' Neurological Institute, Via Celoria 11, 20133 Milan, Italy
| | - Giuseppe Lauria
- 3rd Neurology Unit and Motor Neuron Diseases Centre, Department of Clinical Neurosciences, IRCCS Foundation "Carlo Besta" Neurological Institute, Via Celoria 11, 20133 Milan, Italy; Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Italy
| | - Stefano F Cappa
- Institute for Advanced Study-IUSS Pavia, Palazzo del Broletto e Piazza Vittoria 15, 27100 Pavia, Italy; IRCCS S. Giovanni di Dio Fatebenefratelli, via Pilastroni 4, 25125 Brescia, Italy
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31
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Pinto-Grau M, Hardiman O, Pender N. The Study of Language in the Amyotrophic Lateral Sclerosis - Frontotemporal Spectrum Disorder: a Systematic Review of Findings and New Perspectives. Neuropsychol Rev 2018; 28:251-268. [DOI: 10.1007/s11065-018-9375-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 02/01/2018] [Indexed: 12/11/2022]
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32
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García AM, Ibáñez A. When embodiment breaks down: Language deficits as novel avenues into movement disorders. Cortex 2018; 100:1-7. [DOI: 10.1016/j.cortex.2017.12.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 12/14/2017] [Accepted: 12/18/2017] [Indexed: 12/12/2022]
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33
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Zhang Y, Fang T, Wang Y, Guo X, Alarefi A, Wang J, Jiang T, Zhang J. Occipital cortical gyrification reductions associate with decreased functional connectivity in amyotrophic lateral sclerosis. Brain Imaging Behav 2018; 11:1-7. [PMID: 26780240 DOI: 10.1007/s11682-015-9499-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease characterized by progressive muscular weakness and atrophy. Several morphometric studies have been conducted to investigate the gray matter volume or thickness changes in ALS, whereas the cortical folding pattern remains poorly understood. In the present study, we applied a surface-based local gyrification index (LGI) from high resolution MRI data to quantify the cortical folding in matched samples of 25 ALS patients versus 25 healthy controls. Using resting-state fMRI data, we further conducted seed-based functional connectivity analysis to explore the functional correlate of the cortical folding changes. We found that ALS patients had significantly reduced LGI in right occipital cortex and that abnormality in this region associated with decreased functional connectivity in the bilateral precuneus. This set of findings was speculated to result from disturbed white matter connectivity in ALS. In the patient group, we revealed significant negative correlations between disease duration and the LGIs of a cluster in the left superior frontal gyrus, which may reflect the cognitive deterioration in ALS. In summary, our results suggest that LGI may provide a useful means to assess ALS-related neurodegeneration and to study the pathophysiology of ALS.
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Affiliation(s)
- Yuanchao Zhang
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 610054, China
| | - Tao Fang
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 610054, China
| | - Yue Wang
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 610054, China
| | - Xin Guo
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 610054, China
| | - Abdulqawi Alarefi
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 610054, China
| | - Jian Wang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China
| | - Tianzi Jiang
- Key Laboratory for NeuroInformation of Ministry of Education, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, 610054, China. .,National Laboratory of Pattern Recognition, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China.
| | - Jiuquan Zhang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, 400038, China.
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Birba A, García-Cordero I, Kozono G, Legaz A, Ibáñez A, Sedeño L, García AM. Losing ground: Frontostriatal atrophy disrupts language embodiment in Parkinson’s and Huntington’s disease. Neurosci Biobehav Rev 2017; 80:673-687. [DOI: 10.1016/j.neubiorev.2017.07.011] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 12/13/2022]
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Ash S, Jester C, York C, Kofman OL, Langey R, Halpin A, Firn K, Dominguez Perez S, Chahine L, Spindler M, Dahodwala N, Irwin DJ, McMillan C, Weintraub D, Grossman M. Longitudinal decline in speech production in Parkinson's disease spectrum disorders. BRAIN AND LANGUAGE 2017; 171:42-51. [PMID: 28527315 PMCID: PMC5512868 DOI: 10.1016/j.bandl.2017.05.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 05/05/2017] [Accepted: 05/08/2017] [Indexed: 05/08/2023]
Abstract
We examined narrative speech production longitudinally in non-demented (n=15) and mildly demented (n=8) patients with Parkinson's disease spectrum disorder (PDSD), and we related increasing impairment to structural brain changes in specific language and motor regions. Patients provided semi-structured speech samples, describing a standardized picture at two time points (mean±SD interval=38±24months). The recorded speech samples were analyzed for fluency, grammar, and informativeness. PDSD patients with dementia exhibited significant decline in their speech, unrelated to changes in overall cognitive or motor functioning. Regression analysis in a subset of patients with MRI scans (n=11) revealed that impaired language performance at Time 2 was associated with reduced gray matter (GM) volume at Time 1 in regions of interest important for language functioning but not with reduced GM volume in motor brain areas. These results dissociate language and motor systems and highlight the importance of non-motor brain regions for declining language in PDSD.
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Affiliation(s)
- Sharon Ash
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, United States.
| | - Charles Jester
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Collin York
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Olga L Kofman
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Rachel Langey
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Amy Halpin
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Kim Firn
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Sophia Dominguez Perez
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Lama Chahine
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Meredith Spindler
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Nabila Dahodwala
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - David J Irwin
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Corey McMillan
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Daniel Weintraub
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, United States
| | - Murray Grossman
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, United States
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Strong MJ, Abrahams S, Goldstein LH, Woolley S, Mclaughlin P, Snowden J, Mioshi E, Roberts-South A, Benatar M, HortobáGyi T, Rosenfeld J, Silani V, Ince PG, Turner MR. Amyotrophic lateral sclerosis - frontotemporal spectrum disorder (ALS-FTSD): Revised diagnostic criteria. Amyotroph Lateral Scler Frontotemporal Degener 2017; 18:153-174. [PMID: 28054827 DOI: 10.1080/21678421.2016.1267768.amyotrophic] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
This article presents the revised consensus criteria for the diagnosis of frontotemporal dysfunction in amyotrophic lateral sclerosis (ALS) based on an international research workshop on frontotemporal dementia (FTD) and ALS held in London, Canada in June 2015. Since the publication of the Strong criteria, there have been considerable advances in the understanding of the neuropsychological profile of patients with ALS. Not only is the breadth and depth of neuropsychological findings broader than previously recognised - - including deficits in social cognition and language - but mixed deficits may also occur. Evidence now shows that the neuropsychological deficits in ALS are extremely heterogeneous, affecting over 50% of persons with ALS. When present, these deficits significantly and adversely impact patient survival. It is the recognition of this clinical heterogeneity in association with neuroimaging, genetic and neuropathological advances that has led to the current re-conceptualisation that neuropsychological deficits in ALS fall along a spectrum. These revised consensus criteria expand upon those of 2009 and embrace the concept of the frontotemporal spectrum disorder of ALS (ALS-FTSD).
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Affiliation(s)
- Michael J Strong
- a Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry , London , Ontario , Canada
| | - Sharon Abrahams
- b Department of Psychology, School of Philosophy, Psychology & Language Sciences , Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh , Edinburgh , UK
| | - Laura H Goldstein
- c King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience , London , UK
| | - Susan Woolley
- d Forbes Norris MDA/ALS Research Centre, California Pacific Medical Centre , San Francisco , CA , USA
| | - Paula Mclaughlin
- e Western University , Schulich School of Medicine & Dentistry , London , ON , Canada
| | - Julie Snowden
- f Greater Manchester Neuroscience Centre , Salford Royal NHS Trust and University of Manchester , Manchester , UK
| | - Eneida Mioshi
- g Faculty of Medicine and Health Sciences , University of East Anglia , Norwich , UK
| | - Angie Roberts-South
- h Northwestern University , Roxelyn and Richard Pepper Department of Communication Sciences and Disorders , Evanston , IL , USA
| | - Michael Benatar
- i Department of Neurology , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Tibor HortobáGyi
- j Department of Neuropathology , Institute of Pathology, University of Debrecen , Debrecen , Hungary
| | - Jeffrey Rosenfeld
- k Department of Neurology , Loma Linda University School of Medicine , Loma Linda , CA , USA
| | - Vincenzo Silani
- l Department of Neurology and Laboratory Neuroscience - IRCCS Istituto Auxologico Italiano, Department of Pathophysiology and Transplantation , 'Dino Ferrari' Centre, Università degli Studi di Milano , Milan , Italy
| | - Paul G Ince
- m Sheffield Institute for Translational Neuroscience, Department of Neuroscience , The University of Sheffield , Sheffield , UK , and
| | - Martin R Turner
- n Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , UK
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Strong MJ, Abrahams S, Goldstein LH, Woolley S, Mclaughlin P, Snowden J, Mioshi E, Roberts-South A, Benatar M, HortobáGyi T, Rosenfeld J, Silani V, Ince PG, Turner MR. Amyotrophic lateral sclerosis - frontotemporal spectrum disorder (ALS-FTSD): Revised diagnostic criteria. Amyotroph Lateral Scler Frontotemporal Degener 2017; 18:153-174. [PMID: 28054827 PMCID: PMC7409990 DOI: 10.1080/21678421.2016.1267768] [Citation(s) in RCA: 563] [Impact Index Per Article: 80.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 11/15/2016] [Accepted: 11/18/2016] [Indexed: 10/20/2022]
Abstract
This article presents the revised consensus criteria for the diagnosis of frontotemporal dysfunction in amyotrophic lateral sclerosis (ALS) based on an international research workshop on frontotemporal dementia (FTD) and ALS held in London, Canada in June 2015. Since the publication of the Strong criteria, there have been considerable advances in the understanding of the neuropsychological profile of patients with ALS. Not only is the breadth and depth of neuropsychological findings broader than previously recognised - - including deficits in social cognition and language - but mixed deficits may also occur. Evidence now shows that the neuropsychological deficits in ALS are extremely heterogeneous, affecting over 50% of persons with ALS. When present, these deficits significantly and adversely impact patient survival. It is the recognition of this clinical heterogeneity in association with neuroimaging, genetic and neuropathological advances that has led to the current re-conceptualisation that neuropsychological deficits in ALS fall along a spectrum. These revised consensus criteria expand upon those of 2009 and embrace the concept of the frontotemporal spectrum disorder of ALS (ALS-FTSD).
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Affiliation(s)
- Michael J Strong
- a Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry , London , Ontario , Canada
| | - Sharon Abrahams
- b Department of Psychology, School of Philosophy, Psychology & Language Sciences , Euan MacDonald Centre for Motor Neurone Disease Research, University of Edinburgh , Edinburgh , UK
| | - Laura H Goldstein
- c King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience , London , UK
| | - Susan Woolley
- d Forbes Norris MDA/ALS Research Centre, California Pacific Medical Centre , San Francisco , CA , USA
| | - Paula Mclaughlin
- e Western University , Schulich School of Medicine & Dentistry , London , ON , Canada
| | - Julie Snowden
- f Greater Manchester Neuroscience Centre , Salford Royal NHS Trust and University of Manchester , Manchester , UK
| | - Eneida Mioshi
- g Faculty of Medicine and Health Sciences , University of East Anglia , Norwich , UK
| | - Angie Roberts-South
- h Northwestern University , Roxelyn and Richard Pepper Department of Communication Sciences and Disorders , Evanston , IL , USA
| | - Michael Benatar
- i Department of Neurology , University of Miami Miller School of Medicine , Miami , FL , USA
| | - Tibor HortobáGyi
- j Department of Neuropathology , Institute of Pathology, University of Debrecen , Debrecen , Hungary
| | - Jeffrey Rosenfeld
- k Department of Neurology , Loma Linda University School of Medicine , Loma Linda , CA , USA
| | - Vincenzo Silani
- l Department of Neurology and Laboratory Neuroscience - IRCCS Istituto Auxologico Italiano, Department of Pathophysiology and Transplantation , 'Dino Ferrari' Centre, Università degli Studi di Milano , Milan , Italy
| | - Paul G Ince
- m Sheffield Institute for Translational Neuroscience, Department of Neuroscience , The University of Sheffield , Sheffield , UK , and
| | - Martin R Turner
- n Nuffield Department of Clinical Neurosciences , University of Oxford , Oxford , UK
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Siciliano M, Trojano L, Trojsi F, Greco R, Santoro M, Basile G, Piscopo F, D'Iorio A, Patrone M, Femiano C, Monsurrò M, Tedeschi G, Santangelo G. Edinburgh Cognitive and Behavioural ALS Screen (ECAS)-Italian version: regression based norms and equivalent scores. Neurol Sci 2017; 38:1059-1068. [PMID: 28332040 DOI: 10.1007/s10072-017-2919-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 03/14/2017] [Indexed: 12/11/2022]
Abstract
Cognitive assessment for individuals with Amyotrophic Lateral Sclerosis (ALS) can be difficult because of frequent occurrence of difficulties with speech, writing, and drawing. The Edinburgh Cognitive and Behavioural ALS Screen (ECAS) is a recent multi-domain neuropsychological screening tool specifically devised for this purpose, and it assesses the following domains: executive functions, social cognition, verbal fluency and language (ALS-specific), but also memory and visuospatial abilities (Non-ALS specific). ECAS total score ranges from 0 (worst performance) to 136 (best performance). Moreover, a brief caregiver interview provides an assessment of behaviour changes and psychotic symptoms usually associated with ALS patients. The aim of the present study was to provide normative values for ECAS total score and sub-scores in a sample of Italian healthy subjects. Two hundred and seventy-seven Italian healthy subjects (151 women and 126 men; age range 30-79 years; educational level from primary school to university) underwent ECAS and Montreal Cognitive Assessment (MoCA). Multiple linear regression analysis revealed that age and education significantly influenced performance on ECAS total score and sub-scale scores. From the derived linear equation, a correction grid for raw scores was built. Inferential cut-off scores were estimated using a non-parametric technique and equivalent scores (ES) were computed. Correlation analysis showed a good significant correlation between adjusted ECAS total scores with adjusted MoCA total scores (r rho = 0.669, p < 0.0001). The present study provided normative data for the ECAS in an Italian population useful for both clinical and research purposes.
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Affiliation(s)
- Mattia Siciliano
- Department of Psychology, Second University of Naples, 81100, Caserta, Italy.,Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples (SUN), 80138, Naples, Italy.,Department of Neuroscience, Reproductive and Odontostomatologic Sciences, University "Federico II", 80131, Naples, Italy
| | - Luigi Trojano
- Department of Psychology, Second University of Naples, 81100, Caserta, Italy. .,Salvatore Maugeri Foundation, Scientific Institute of Telese, 82037, Telese Terme, BN, Italy.
| | - Francesca Trojsi
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples (SUN), 80138, Naples, Italy
| | - Roberta Greco
- Department of Psychology, Second University of Naples, 81100, Caserta, Italy
| | - Manuela Santoro
- Department of Psychology, Second University of Naples, 81100, Caserta, Italy
| | - Giuseppe Basile
- Department of Psychology, Second University of Naples, 81100, Caserta, Italy
| | - Fausta Piscopo
- Department of Psychology, Second University of Naples, 81100, Caserta, Italy
| | - Alfonsina D'Iorio
- Department of Psychology, Second University of Naples, 81100, Caserta, Italy
| | - Manila Patrone
- Department of Psychology, Second University of Naples, 81100, Caserta, Italy
| | - Cinzia Femiano
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples (SUN), 80138, Naples, Italy
| | - Mariarosaria Monsurrò
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples (SUN), 80138, Naples, Italy
| | - Gioacchino Tedeschi
- Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples (SUN), 80138, Naples, Italy
| | - Gabriella Santangelo
- Department of Psychology, Second University of Naples, 81100, Caserta, Italy.,IDC-Hermitage-Capodimonte, 80131, Naples, Italy
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Boschi V, Catricalà E, Consonni M, Chesi C, Moro A, Cappa SF. Connected Speech in Neurodegenerative Language Disorders: A Review. Front Psychol 2017; 8:269. [PMID: 28321196 PMCID: PMC5337522 DOI: 10.3389/fpsyg.2017.00269] [Citation(s) in RCA: 136] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 02/10/2017] [Indexed: 12/12/2022] Open
Abstract
Language assessment has a crucial role in the clinical diagnosis of several neurodegenerative diseases. The analysis of extended speech production is a precious source of information encompassing the phonetic, phonological, lexico-semantic, morpho-syntactic, and pragmatic levels of language organization. The knowledge about the distinctive linguistic variables identifying language deficits associated to different neurodegenerative diseases has progressively improved in the last years. However, the heterogeneity of such variables and of the way they are measured and classified limits any generalization and makes the comparison among studies difficult. Here we present an exhaustive review of the studies focusing on the linguistic variables derived from the analysis of connected speech samples, with the aim of characterizing the language disorders of the most prevalent neurodegenerative diseases, including primary progressive aphasia, Alzheimer's disease, movement disorders, and amyotrophic lateral sclerosis. A total of 61 studies have been included, considering only those reporting group analysis and comparisons with a group of healthy persons. This review first analyzes the differences in the tasks used to elicit connected speech, namely picture description, story narration, and interview, considering the possible different contributions to the assessment of different linguistic domains. This is followed by an analysis of the terminologies and of the methods of measurements of the variables, indicating the need for harmonization and standardization. The final section reviews the linguistic domains affected by each different neurodegenerative disease, indicating the variables most consistently impaired at each level and suggesting the key variables helping in the differential diagnosis among diseases. While a large amount of valuable information is already available, the review highlights the need of further work, including the development of automated methods, to take advantage of the richness of connected speech analysis for both research and clinical purposes.
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Affiliation(s)
- Veronica Boschi
- NETS, Center for Neurocognition, Epistemology and Theoretical Syntax, Institute for Advanced Study-Pavia Pavia, Italy
| | - Eleonora Catricalà
- NETS, Center for Neurocognition, Epistemology and Theoretical Syntax, Institute for Advanced Study-Pavia Pavia, Italy
| | - Monica Consonni
- Third Neurology Unit and Motor Neuron Diseases Center, IRCCS Foundation "Carlo Besta" Neurological Institute Milan, Italy
| | - Cristiano Chesi
- NETS, Center for Neurocognition, Epistemology and Theoretical Syntax, Institute for Advanced Study-Pavia Pavia, Italy
| | - Andrea Moro
- NETS, Center for Neurocognition, Epistemology and Theoretical Syntax, Institute for Advanced Study-Pavia Pavia, Italy
| | - Stefano F Cappa
- NETS, Center for Neurocognition, Epistemology and Theoretical Syntax, Institute for Advanced Study-PaviaPavia, Italy; IRCCS S. Giovanni di Dio FatebenefratelliBrescia, Italy
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Fisher F, Philpott A, Andrews SC, Maule R, Douglas J. Characterizing social communication changes in amyotrophic lateral sclerosis. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2017; 52:137-142. [PMID: 27363686 DOI: 10.1111/1460-6984.12267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/21/2016] [Accepted: 04/25/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Speech and language impairments are well-established in individuals with amyotrophic lateral sclerosis (ALS). However, knowledge about particular aspects of social communication and everyday conversational abilities is limited. AIMS To investigate self- and informant-report ratings of social communicative abilities in ALS participants and matched healthy controls. METHODS & PROCEDURES Thirty-two participants with ALS and 24 controls completed the La Trobe Communication Questionnaire (LCQ). Participants nominated a close other to provide an informant report on the LCQ. Demographic and clinical information was also collected. OUTCOMES & RESULTS Informant ratings indicated greater difficulties in conversational initiation, effectiveness and partner sensitivity for ALS participants compared with controls. ALS participants did not rate their social communicative abilities as poorer than controls and self-reports only differed from informant ratings in the control group. LCQ scores were not significantly correlated with clinical/functional variables. CONCLUSIONS & IMPLICATIONS Social communication can be reduced in ALS and individuals may lack insight into these difficulties. In order to understand and provide targeted interventions for such difficulties, clinical speech and language assessment should incorporate social communication assessment, including both a self- and informant-report format.
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Affiliation(s)
- Fiona Fisher
- Calvary Health Care Bethlehem, Caulfield South, VIC, Australia
| | - April Philpott
- Calvary Health Care Bethlehem, Caulfield South, VIC, Australia
| | - Sophie C Andrews
- Calvary Health Care Bethlehem, Caulfield South, VIC, Australia
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Clayton, VIC, Australia
| | - Roxanne Maule
- Calvary Health Care Bethlehem, Caulfield South, VIC, Australia
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Baggio G, Granello G, Verriello L, Eleopra R. Formal Semantics in the Neurology Clinic: Atypical Understanding of Aspectual Coercion in ALS Patients. Front Psychol 2016; 7:1733. [PMID: 27867369 PMCID: PMC5095610 DOI: 10.3389/fpsyg.2016.01733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 10/20/2016] [Indexed: 12/11/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease of the motor system with subtle adverse effects on cognition. It is still unclear whether ALS also affects language and semantics, and if so, what aspects and processes exactly. We investigated how ALS patients understand verb phrases modified by temporal preposition phrases, e.g., "To watch TV for half an hour." Interpretation here requires operations such as aspectual coercion that add or delete elements from event structures, depending on temporal modifiers, and constraints on coercion, which make combinations with certain modifiers not viable. Using a theoretically-motivated experimental design, we observed that acceptance rates for aspectual coercion were abnormally high in ALS patients. The effect was largest for the more complex cases of coercion: not those that involve enrichment of event structures ("To switch on the TV in half an hour," where a number of failed attempts must be included in the interpretation) but those that, if applied, would result in deletion of event structure elements ("To repair the TV for half an hour"). Our experimental results are consistent with a deficit of constraints on coercion, and not with impaired semantic processes or representations, in line with recent studies suggesting that verb semantics is largely spared in ALS.
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Affiliation(s)
- Giosuè Baggio
- Language Acquisition and Language Processing Lab, Norwegian University of Science and TechnologyTrondheim, Norway
| | - Giulia Granello
- Neurology Unit, Azienda Ospedaliero Universitaria Ospedali RiunitiTrieste, Italy
| | - Lorenzo Verriello
- Neurology Unit, Azienda Ospedaliero Universitaria Santa Maria della MisericordiaUdine, Italy
| | - Roberto Eleopra
- Neurology Unit, Azienda Ospedaliero Universitaria Santa Maria della MisericordiaUdine, Italy
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The Edinburgh Cognitive and Behavioural ALS Screen in a Chinese Amyotrophic Lateral Sclerosis Population. PLoS One 2016; 11:e0155496. [PMID: 27195772 PMCID: PMC4873026 DOI: 10.1371/journal.pone.0155496] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 04/30/2016] [Indexed: 11/19/2022] Open
Abstract
Objective The existing screening batteries assessing multiple neuropsychological functions are not specific to amyotrophic lateral sclerosis (ALS) patients and are limited to their physical dysfunctions, whereas category cognitive tests are too time-consuming to assess all the domains. The Edinburgh Cognitive and Behavioural ALS Screen (ECAS) was recently developed as a fast and easy cognitive screening tool specifically designed for patients. The purpose of the study was to validate the effectiveness of the Chinese version in Chinese ALS populations. Methods Eighty-four ALS patients and 84 age-, gender- and education-matched healthy controls were included in this cross-sectional study. All the participants took the ECAS, Mini-Mental State Examination (MMSE) and Frontal Assessment Battery (FAB). Primary caregivers of patients were interviewed for behavioural and psychiatric changes. Results Significant differences were noted in language (p = 0.01), fluency, executive function, ALS-specific functions, and ECAS total score (p<0.01) between ALS patients and controls. The cut-off value of the total ECAS score was 81.92. Cognitive impairment was observed in 35.71% of patients, and 27.38% exhibited behavioural abnormalities. The ECAS total score had a medium correlation with education year. Memory was more easily impaired in the lower education group, whereas verbal fluency and language function tended to be preserved in the higher education group. The average time of ECAS was only 18 minutes. Conclusion The Chinese version of the ECAS is the first screening battery assessing multiple neuropsychological functions specially designed for the ALS population in China, which provides an effective and rapid tool to screen cognitive and behavioural impairments.
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44
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Woolley SC, Strong MJ. Frontotemporal Dysfunction and Dementia in Amyotrophic Lateral Sclerosis. Neurol Clin 2015; 33:787-805. [PMID: 26515622 DOI: 10.1016/j.ncl.2015.07.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Although amyotrophic lateral sclerosis (ALS) is classically considered a disorder exclusively affecting motor neurons, there is substantial clinical, neuroimaging, and neuropathologic evidence that more than half of patients have an associated syndrome of frontotemporal dysfunction. These syndromes range from frontotemporal dementia to behavioral or cognitive syndromes. Neuroimaging and neuropathologic findings are consistent with frontotemporal lobar degeneration that underpins alterations in network connectivity. Future clinical trials need to be stratified based on the presence or absence of frontotemporal dysfunction on the disease course of ALS.
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Affiliation(s)
- Susan C Woolley
- Forbes Norris MDA/ALS Research Center, California Pacific Medical Center, 2324 Sacramento Street, Suite 111, San Francisco, CA 94115, USA
| | - Michael J Strong
- Department of Clinical Neurological Sciences, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
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Tsermentseli S, Leigh PN, Taylor LJ, Radunovic A, Catani M, Goldstein LH. Syntactic processing as a marker for cognitive impairment in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener 2015; 17:69-76. [PMID: 26312952 PMCID: PMC4732449 DOI: 10.3109/21678421.2015.1071397] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/01/2015] [Indexed: 11/13/2022]
Abstract
Despite recent interest in cognitive changes in patients with amyotrophic lateral sclerosis (ALS), investigations of language function looking at the level of word, sentence and discourse processing are relatively scarce. Data were obtained from 26 patients with sporadic ALS and 26 healthy controls matched for age, education, gender, anxiety, depression and executive function performance. Standardized language tasks included confrontation naming, semantic access, and syntactic comprehension. Quantitative production analysis (QPA) was used to analyse connected speech samples of the Cookie Theft picture description task. Results showed that the ALS patients were impaired on standardized measures of grammatical comprehension and action/verb semantics. At the level of discourse, ALS patients were impaired on measures of syntactic complexity and fluency; however, the latter could be better explained by disease related factors. Discriminant analysis revealed that syntactic measures differentiated ALS patients from controls. In conclusion, patients with ALS exhibit deficits in receptive and expressive language on tasks of comprehension and connected speech production, respectively. Our findings suggest that syntactic processing deficits seem to be the predominant feature of language impairment in ALS and that these deficits can be detected by relatively simple language tests.
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Affiliation(s)
- Stella Tsermentseli
- Faculty of Education and Health, Department of Psychology, Social Work and Counselling, University of Greenwich, London, UK
| | - P. Nigel Leigh
- Brighton and Sussex Medical School, Trafford Centre for Biomedical Research, University of Sussex, Falmer, UK
| | - Lorna J. Taylor
- The Michael Rutter Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Marco Catani
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, Natbrainlab, Department of Forensic and Neurodevelopmental Sciences, London, UK
| | - Laura H. Goldstein
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, London, UK
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