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Baker C, Love T. Modulating Complex Sentence Processing in Aphasia Through Attention and Semantic Networks. J Speech Lang Hear Res 2023; 66:5011-5035. [PMID: 37934886 DOI: 10.1044/2023_jslhr-23-00298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
PURPOSE Lexical processing impairments such as delayed and reduced activation of lexical-semantic information have been linked to syntactic processing disruptions and sentence comprehension deficits in individuals with aphasia (IWAs). Lexical-level deficits can also preclude successful lexical encoding during sentence processing and amplify the processing costs of similarity-based interference during syntactic retrieval. We investigate whether two manipulations to engage attention and pre-activate semantic features of a target (to-be-retrieved) noun will (a) boost lexical activation during initial lexical encoding and (b) facilitate syntactic dependency linking through improved resolution of interference in IWAs and neurologically unimpaired age-matched controls (AMCs). METHOD Eye-tracking-while-listening with a visual world paradigm was used to investigate whether semantic and attentional manipulations modulated initial lexical processing and downstream syntactic retrieval of the direct-object noun in object-relative sentences. RESULTS In the attention and semantic manipulations, the AMC group showed no changes in initial lexical access levels; however, gaze patterns revealed clear facilitations in dependency linking and interference resolution. In the IWA group, the attentional cue increased and maintained activation of N1 with modest facilitations in dependency linking. In the semantic condition, IWA results showed a greater degree of facilitation during dependency linking. CONCLUSIONS The results suggest that attention and semantic activation are parameters that may be manipulated to strengthen encoding of lexical representations to facilitate retrieval (i.e., dependency linking) and mitigate similarity-based interference. In IWAs, these manipulations may help to reduce lexical processing deficits that can preclude successful encoding.
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Affiliation(s)
- Carolyn Baker
- SDSU/UCSD Joint Doctoral Program in Language & Communicative Disorders, San Diego, CA
| | - Tracy Love
- SDSU/UCSD Joint Doctoral Program in Language & Communicative Disorders, San Diego, CA
- School of Speech, Language, and Hearing Sciences, San Diego State University, CA
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Abbott N, Love T. Bridging the Divide: Brain and Behavior in Developmental Language Disorder. Brain Sci 2023; 13:1606. [PMID: 38002565 PMCID: PMC10670267 DOI: 10.3390/brainsci13111606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
Developmental language disorder (DLD) is a heterogenous neurodevelopmental disorder that affects a child's ability to comprehend and/or produce spoken and/or written language, yet it cannot be attributed to hearing loss or overt neurological damage. It is widely believed that some combination of genetic, biological, and environmental factors influences brain and language development in this population, but it has been difficult to bridge theoretical accounts of DLD with neuroimaging findings, due to heterogeneity in language impairment profiles across individuals and inconsistent neuroimaging findings. Therefore, the purpose of this overview is two-fold: (1) to summarize the neuroimaging literature (while drawing on findings from other language-impaired populations, where appropriate); and (2) to briefly review the theoretical accounts of language impairment patterns in DLD, with the goal of bridging the disparate findings. As will be demonstrated with this overview, the current state of the field suggests that children with DLD have atypical brain volume, laterality, and activation/connectivity patterns in key language regions that likely contribute to language difficulties. However, the precise nature of these differences and the underlying neural mechanisms contributing to them remain an open area of investigation.
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Affiliation(s)
- Noelle Abbott
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA 92182, USA;
- San Diego State University/University of California San Diego Joint Doctoral Program in Language and Communicative Disorders, San Diego, CA 92182, USA
| | - Tracy Love
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA 92182, USA;
- San Diego State University/University of California San Diego Joint Doctoral Program in Language and Communicative Disorders, San Diego, CA 92182, USA
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Akhavan N, Blumenfeld HK, Shapiro L, Love T. Using lexical semantic cues to mitigate interference effects during real-time sentence processing in aphasia. J Neurolinguistics 2023; 68:101159. [PMID: 37946740 PMCID: PMC10634522 DOI: 10.1016/j.jneuroling.2023.101159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
We examined the auditory sentence processing of neurologically unimpaired listeners and individuals with aphasia on canonical sentence structures in real-time using a visual-world eye-tracking paradigm. The canonical sentence constructions contained multiple noun phrases and an unaccusative verb, the latter of which formed a long-distance dependency link between the unaccusative verb and its single argument (which was base generated in the object position and then displaced to the subject position). To explore the likelihood of similarity-based interference during the real time linking of the verb and the sentence's subject noun, we manipulated the animacy feature of the noun phrases (matched or mismatched). The study's objectives were to examine whether (a) reducing the similarity-based interference by mismatching animacy features would modulate the encoding and retrieval dynamics of noun phrases in real-time; and (b) whether individuals with aphasia would demonstrate on time sensitivity to this lexical-semantic cue. Results revealed a significant effect of this manipulation in individuals both with and without aphasia. In other words, the mismatch in the representational features of the noun phrases increased the distinctiveness of the unaccusative verb's subject target at the time of syntactic retrieval (verb offset) for individuals in both groups. Moreover, individuals with aphasia were shown to be sensitive to the lexical-semantic cue, even though they appeared to process it slower than unimpaired listeners. This study extends to the cue-based retrieval model by providing new insight on the real-time mechanisms underpinning sentence comprehension.
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Affiliation(s)
- Niloofar Akhavan
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA, USA
- Joint Doctoral Program in Language and Communicative Disorders, San Diego State University/UC San Diego, San Diego, CA, USA
| | - Henrike K. Blumenfeld
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA, USA
- Joint Doctoral Program in Language and Communicative Disorders, San Diego State University/UC San Diego, San Diego, CA, USA
| | - Lewis Shapiro
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA, USA
- Joint Doctoral Program in Language and Communicative Disorders, San Diego State University/UC San Diego, San Diego, CA, USA
| | - Tracy Love
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA, USA
- Joint Doctoral Program in Language and Communicative Disorders, San Diego State University/UC San Diego, San Diego, CA, USA
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Poth LD, Love T, Mattson SN. Profiles of language and communication abilities in adolescents with fetal alcohol spectrum disorders. J Int Neuropsychol Soc 2023; 29:724-733. [PMID: 36325639 PMCID: PMC10154428 DOI: 10.1017/s1355617722000789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Language and communication are largely understudied among youth with fetal alcohol spectrum disorders (FASD). Findings have been mixed, and have generally focused on more severely affected (i.e., children with FAS alone) or younger children. This study aimed to elucidate the profiles of language (i.e., receptive, expressive, general language) and communication (i.e., functional, social) abilities in adolescents with FASD. METHOD Participants aged 12-17 years with (AE = 31) and without (CON = 29) prenatal alcohol exposure were included. Receptive and expressive language were measured by the Clinical Evaluation of Language Fundamentals - Fifth Edition (CELF-5). Parents or caregivers completed the Children's Communication Checklist - Second Edition as a subjective measure of general language skills. Functional communication was measured by the Student Functional Assessment of Verbal Reasoning and Executive Strategies and parents or caregivers completed the Social Skills Improvement System Rating Scales as a measure of social communication. Multivariate analysis of variance determined the overall profiles of language and communication and whether they differed between groups. RESULTS The AE group performed significantly lower than the CON group on receptive language and parent report of general language while groups did not significantly differ on expressive language. Groups did not significantly differ on functional communication while social communication was significantly lower in the AE group. CONCLUSIONS Results of this study provide important information regarding the overall profile of basic language abilities and higher-level communication skills of adolescents with FASD. Ultimately, improving communication skills of youth with FASD may translate to better overall functioning.
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Affiliation(s)
- Lauren D. Poth
- Center for Behavioral Teratology and Department of Psychology, San Diego State University, San Diego, CA 92120
| | - Tracy Love
- School of Speech, Language and Hearing Sciences, San Diego State University, San Diego, CA 92120
| | - Sarah N. Mattson
- Center for Behavioral Teratology and Department of Psychology, San Diego State University, San Diego, CA 92120
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Baker C, Love T. The effect of time on lexical and syntactic processing in aphasia. J Neurolinguistics 2023; 67:101142. [PMID: 37215754 PMCID: PMC10195109 DOI: 10.1016/j.jneuroling.2023.101142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Processing deficits at the lexical level, such as delayed and reduced lexical activation, have been theorized as the source of breakdowns in syntactic operations and thus contribute to sentence comprehension deficits in individuals with aphasia (IWA). In the current study, we investigate the relationship between lexical and syntactic processing in object-relative sentences using eye-tracking while listening in IWA. We explore whether manipulating the time available to process a critical lexical item (the direct-object noun) when it is initially heard in a sentence has an immediate effect on lexical access as well as a downstream effect on syntactic processing. To achieve this aim, we use novel temporal manipulations to provide additional time for lexical processing to occur. In addition to exploring these temporal effects in IWA, we also seek to understand the effect that additional time has on sentence processing in neurotypical age-matched adults (AMC). We predict that the temporal manipulations designed to provide increased processing time for critical lexical items will 1) enhance lexical processing of the target noun, 2) facilitate syntactic integration, and 3) improve sentence comprehension for both IWA and AMC. We demonstrate that strengthening lexical processing via the addition of time can affect lexical processing and facilitate syntactic retrieval of the target noun and lead to enhanced interference resolution in both unimpaired and impaired systems. In aphasia, additional time can mitigate impairments in spreading activation thereby improving lexical access and reducing interference during downstream dependency linking. However, individuals with aphasia may require longer additions of time to fully realize these benefits.
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Affiliation(s)
- Carolyn Baker
- SDSU/UCSD Joint Ph.D. Program in Language and Communicative Disorders, San Diego, USA
| | - Tracy Love
- SDSU/UCSD Joint Ph.D. Program in Language and Communicative Disorders, San Diego, USA
- SDSU, School of Speech, Language, and Hearing Sciences, San Diego, USA
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Wieser J, Chen A, Lee G, Baughman L, Pope E, Franco A, Verhave B, Johnson B, Love T, Beck L, Ryan Wolf J. 388 Impact of crisaborole & tacrolimus 0.03% on patient-reported outcomes and caregiver burden in children with atopic dermatitis. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Rogalsky C, Basilakos A, Rorden C, Pillay S, LaCroix AN, Keator L, Mickelsen S, Anderson SW, Love T, Fridriksson J, Binder J, Hickok G. The Neuroanatomy of Speech Processing: A Large-scale Lesion Study. J Cogn Neurosci 2022; 34:1355-1375. [PMID: 35640102 PMCID: PMC9274306 DOI: 10.1162/jocn_a_01876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The neural basis of language has been studied for centuries, yet the networks critically involved in simply identifying or understanding a spoken word remain elusive. Several functional-anatomical models of critical neural substrates of receptive speech have been proposed, including (1) auditory-related regions in the left mid-posterior superior temporal lobe, (2) motor-related regions in the left frontal lobe (in normal and/or noisy conditions), (3) the left anterior superior temporal lobe, or (4) bilateral mid-posterior superior temporal areas. One difficulty in comparing these models is that they often focus on different aspects of the sound-to-meaning pathway and are supported by different types of stimuli and tasks. Two auditory tasks that are typically used in separate studies-syllable discrimination and word comprehension-often yield different conclusions. We assessed syllable discrimination (words and nonwords) and word comprehension (clear speech and with a noise masker) in 158 individuals with focal brain damage: left (n = 113) or right (n = 19) hemisphere stroke, left (n = 18) or right (n = 8) anterior temporal lobectomy, and 26 neurologically intact controls. Discrimination and comprehension tasks are doubly dissociable both behaviorally and neurologically. In support of a bilateral model, clear speech comprehension was near ceiling in 95% of left stroke cases and right temporal damage impaired syllable discrimination. Lesion-symptom mapping analyses for the syllable discrimination and noisy word comprehension tasks each implicated most of the left superior temporal gyrus. Comprehension but not discrimination tasks also implicated the left posterior middle temporal gyrus, whereas discrimination but not comprehension tasks also implicated more dorsal sensorimotor regions in posterior perisylvian cortex.
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Hellamand P, Van de Sande MGH, Midtbøll Ørnbjerg L, Klausch T, Trokovic N, Sokka-Isler T, Santos MJ, Vieira-Sousa E, Loft AG, Glintborg B, Østergaard M, Lindström U, Wallman JK, Michelsen B, Moeller B, Micheroli R, Codreanu C, Mogosan C, Laas K, Rotar Z, Fagerli KM, Tomsic M, Castrejon I, Pombo-Suarez M, Gudbjornsson B, Love T, Pavelka K, Zavada J, Kenar G, Yarkan-Tuğsal H, Hetland ML, Van der Horst-Bruinsma I. POS0077 SEX DIFFERENCES IN EFFECTIVENESS OF FIRST-LINE TUMOR NECROSIS FACTOR INHIBITORS IN PSORIATIC ARTHRITIS; RESULTS FROM THIRTEEN COUNTRIES IN THE EuroSpA RESEARCH COLLABORATION NETWORK. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundEvidence demonstrates sex differences in disease presentation, physical function, treatment response and drug retention in patients with psoriatic arthritis (PsA). Data from observational cohort studies indicate female sex is associated with reduced effectiveness of tumor necrosis factor inhibitors (TNFis)1,2. Although, conflicting results are also reported3,4. We sought to validate prior studies using data from a large multinational cohort based on real-life clinical practice.ObjectivesTo investigate sex differences in treatment response and drug retention rates in clinical practice among patients with PsA, treated with their first TNFi.MethodsData from biologic-naïve PsA patients initiating a TNFi in the EuroSpA registries were pooled. In the primary analysis, propensity-score weighting was applied to assess the causal effect of sex on low disease activity (LDA) according to DAS28-CRP at 6 months. A generalized linear regression model was used to estimate the causal risk difference (RD) and relative risk (RR) of sex on LDA. Possible covariates influencing the outcome were determined a priori and selected based on availability in the database (<20% missing). The final covariates included were country, age, conventional synthetic disease-modifying antirheumatic drug use at baseline and TNFi start year. In the secondary analysis, drug retention was assessed over 24 months of follow-up by Kaplan-Meier curves and log-rank test.ResultsIn total, 7,679 PsA patients with available data on DAS28-CRP at 6 months were assessed for treatment response. Baseline characteristics are shown in the Table 1. In the adjusted analysis, the probability for females to have LDA was 17% (RR, 0.83; 95% confidence interval [CI], 0.81 to 0.85) lower compared to males and the difference in probability for having LDA was 13 percentage points (RD, 0.13; 95% CI, 0.11 to 0.15). The survival analysis included 18,599 PsA patients with available data on retention rates. The TNFi 6/12/24-month retention rates were significantly lower in females (81%/68%/56%) compared to males (89%/80%/69%), see Figure 1.Table 1.Baseline characteristics of all biologic-naïve PsA patients treated with their first TNFi and available DAS28-CRP at 6 month, data pooled across all countriesFemaleMaleMean (SD), median [IQR] or percentagesMean (SD), median [IQR] or percentagesAge (years)49.7 (12.5)47.8 (11.9)Disease duration (years)4.0 [1.0, 10.0]4.0 [1.0, 10.0]TNFi start year 1999-200929%29% 2010-201326%27% 2014-201625%24% 2017-202020%20%Concomittant csDMARD75%77%DAS28-CRP4.4 (1.2)4.2 (1.2)DAPSA2832 (16)29 (16)CRP (mg/L)7.0 [3.0, 17.0]8.0 [3.3, 19.0]SJC (0-28)3.0 [1.0, 6.0]3.0 [1.0, 6.0]TJC (0-28)6.0 [2.0, 10.0]4.0 [2.0, 9.0]VAS pain, mm61 (23)55 (23)VAS fatigue, mm62 (26)53 (27)Data are as observed, mean (SD), median [IQR] or percentage. TNFi, tumor necrosis factor inhibitor; csDMARD, Conventional synthetic disease-modifying antirheumatic drugs; DAS28-CRP, Disease Activity Score 28-joint count C reactive protein; DAPSA28, Disease Activity in PsA 28; CRP, C-reactive protein; SJC, swollen joint count; TJC, tender joint count.ConclusionTreatment efficacy and retention rates are lower among female patients with PsA initiating their first TNFi. Females presented with higher 28-tender joint count and higher scores on patient reported outcomes at baseline, reflecting differences in disease expression. Recognizing these sex differences is of relevance for customized patient care and may improve patient education.References[1]Højgaard, et al. Rheumatology (Oxford). 2018 Sep 1;57(9):1651-1660.[2]Vieira-Sousa, et al. J Rheumatol. 2020 May 1;47(5):690-700.[3]Kristensen, et al. Ann Rheum. Dis. 2008 Mar;67(3):364-9.[4]Iervolino, et al. J Rheumatol. 2012 Mar;39(3):568-73.AcknowledgementsNovartis Pharma AG and IQVIA for supporting the EuroSpA collaboration.Disclosure of InterestsPasoon Hellamand Grant/research support from: Novartis, Marleen G.H. van de Sande Speakers bureau: UCB, Consultant of: Abbvie, Eli Lily, Novartis, UCB, Grant/research support from: Novartis, Janssen, UCB and Eli Lilly, Lykke Midtbøll Ørnbjerg Grant/research support from: Novartis, Thomas Klausch: None declared, Nina Trokovic: None declared, Tuulikki Sokka-Isler Consultant of: Abbvie, Amgen, BMS, Celgene, DiaGraphIT, Medac, MSD, Novartis, Orionpharma, Pfizer, Roche, Sandoz, and UCB, Maria Jose Santos Speakers bureau: Abbvie, AstraZeneca, Lilly, Novartis and Pfizer, Elsa Vieira-Sousa Speakers bureau: MSD, Celgene, Novartis, Janssen, Abbvie and Pfizer, Consultant of: MSD, Celgene, Novartis, Janssen, Abbvie and Pfizer, Grant/research support from: MSD, Celgene, Novartis, Janssen, Abbvie and Pfizer, Anne Gitte Loft Speakers bureau: AbbVie, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Consultant of: AbbVie, Janssen, Lilly, MSD, Novartis, Pfizer, Roche, and UCB, Grant/research support from: Novartis, Bente Glintborg Grant/research support from: Pfizer, Abbvie, BMS, Mikkel Østergaard Speakers bureau: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB, Consultant of: Abbvie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Hospira, Janssen, Merck, Novartis, Novo, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi and UCB, Grant/research support from: Abbvie, BMS, Merck, Celgene, Novartis, Ulf Lindström: None declared, Johan K Wallman Consultant of: AbbVie, Amgen, Celgene, Eli Lilly and Novartis, Brigitte Michelsen Grant/research support from: Novartis, Burkhard Moeller Speakers bureau: MSD, Synergy, Eli Lilly, Bristol-Myers-Squibb, Janssen-Cilag, AbbVie and Pfizer, Raphael Micheroli: None declared, Catalin Codreanu Speakers bureau: AbbVie, Amgen, Boehringer Ingelheim, Ewopharma, Lilly, Novartis and Pfizer, Consultant of: AbbVie, Amgen, Boehringer Ingelheim, Ewopharma, Lilly, Novartis and Pfizer, Corina Mogosan Speakers bureau: AbbVie, Ewopharma, Lilly, Novartis and Pfizer, Consultant of: AbbVie, Ewopharma, Lilly, Novartis and Pfizer, Karin Laas Speakers bureau: Amgen, Janssen, Novartis and Abbvie, Ziga Rotar Speakers bureau: Abbvie, Novartis, MSD, Medis, Biogen, Eli Lilly, Pfizer, Sanofi, Lek and Janssen, Consultant of: Abbvie, Novartis, MSD, Medis, Biogen, Eli Lilly, Pfizer, Sanofi, Lek and Janssen, Karen Minde Fagerli: None declared, Matija Tomsic Speakers bureau: Abbvie, Amgen, Biogen, Eli Lilly, Janssen, Medis, MSD, Novartis, Pfizer, Sanofi, Sandoz-Lek, Consultant of: Abbvie, Amgen, Biogen, Eli Lilly, Janssen, Medis, MSD, Novartis, Pfizer, Sanofi, Sandoz-Lek, Isabel Castrejon Speakers bureau: Lilly, BMS, Janssen, MSD and Abbvie, Consultant of: Lilly, BMS, Janssen, MSD and Abbvie, Manuel Pombo-Suarez Consultant of: Abbvie, MSD and Roche, Björn Gudbjornsson Speakers bureau: Amgen and Novartis, Consultant of: Amgen and Novartis, Thorvardur Love: None declared, Karel Pavelka Speakers bureau: Pfizer, MSD, BMS, UCB, Amgen, Egis, Roche and AbbVie, Consultant of: Pfizer, MSD, BMS, UCB, Amgen, Egis, Roche and AbbVie, Jakub Zavada Speakers bureau: Abbvie, Elli-Lilly, Sandoz, Novartis, Egis and UCB, Consultant of: Abbvie, Elli-Lilly, Sandoz, Novartis, Egis and UCB, Gökçe Kenar: None declared, Handan Yarkan-Tuğsal: None declared, Merete Lund Hetland Grant/research support from: Abbvie, Biogen, BMS, Celltrion, Eli Lilly, Janssen Biologics B.V, Lundbeck Fonden, MSD, Medac, Pfizer, Roche, Samsung Biopies, Sandoz and Novartis, Irene van der Horst-Bruinsma Speakers bureau: BMS, AbbVie, Pfizer and MSD, Consultant of: Abbvie, UCB, MSD, Novartis and Lilly, Grant/research support from: MSD, Pfizer, AbbVie and UCB
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Cordtz R, Askling J, Delcoigne B, Ekström Smedby K, Baecklund E, Ballegaard C, Isomäki P, Aaltonen K, Gudbjornsson B, Love T, Provan SA, Michelsen B, Sexton J, Dreyer L, Hellgren K. OP0257 RISK OF HAEMATOLOGICAL MALIGNANCY IN PATIENTS WITH PSORIATIC ARTHRITIS, OVERALL AND IN RELATION TO TNF INHIBITORS - A NORDIC COHORT STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundSeveral autoimmune inflammatory diseases, including rheumatoid arthritis (RA), are associated with increased risk of malignant lymphomas. There is also a longstanding concern of lymphoma development with tumour necrosis factor inhibitor (TNFi) treatment, but most studies in RA to date do not indicate an additionally increased risk. Corresponding studies in psoriatic arthritis (PsA), both with respect to the underlying risks, and risks in relation to treatment with TNFi, are limited. Data on myeloid malignancies in PsA are scarce.ObjectivesTo estimate the risk of haematological malignancy overall and by lymphoid and myeloid types in TNFi treated versus (vs.) biologics-naïve patients with PsA across the five Nordic countries. Additionally, we investigated the underlying risk of haematological malignancies in PsA as compared to the general population.MethodsWe identified patients with PsA starting a first ever TNFi from the clinical rheumatology registers (CRR) in Sweden (SE), Denmark (DK), Norway (NO), Finland (FI), and Iceland (ICE) from 2006 through 2019 (n=10 621). We identified biologics-naïve patients with PsA from a) the CRR (n=18 705, all countries) and b) the national patient registers (NPR, n=27 286, SE and DK only). To estimate the underlying risk of haematological malignancy in PsA, we randomly sampled general population comparators in SE and DK matched on year of birth, sex, and calendar year at start of follow-up, to the patients with PsA.Through linkage to the mandatory national cancer registers in all five countries, we collected information on haematological malignancy overall, and categorised into lymphoid or myeloid types. By applying a modified Poisson regression, we estimated pooled incidence rate ratio (IRR) with 95% confidence intervals (CI) for TNFi treated vs. biologics-naïve PsA and for PsA vs. the general population, adjusted for age (18-55, 56-65, 66-70, >70 years), sex, calendar period (2006-2010, 2011-2019) and country, and using robust standard errors.ResultsWe observed 40 events of haematological malignancies (during 59 827 person-years) among TNFi treated PsA, resulting in a crude incidence rate (IR) of 67 per 100 000 person-years. The corresponding IR was 91 (63 events) for biologics-naïve PsA from the CRR, and 118 (172 events) for biologics-naïve PsA from NPR. This resulted in a pooled IRR of 0.97 (0.69 to 1.37) for TNFi-treated vs. biologics-naïve PsA patients from the CRR, and 0.84 (0.64 to 1.10) vs. biologics-naïve PsA patients from the NPR. The pooled IRR of haematological malignancies in PsA overall vs. the general population was 1.35 (1.17 to 1.55). Throughout, the estimates were largely similar for lymphoid and myeloid malignancies (Figure 1). The crude IR of haematological malignancies were substantially akin across different TNFi agents.Figure 1.Pooled incidence rate ratios (IRRs) (95% CI) of haematological malignancy overall and by lymphoid and myeloid types, in first ever TNFi treated versus biologics-naïve patients with PsA, and versus general population comparators. Legend: Lymphoid malignancies include international classification of diseases (ICD) 10 codes C81-86, C88, C90-91. Myeloid malignancies include ICD10 codes C92-95, D45-D46, D47.1, D47.3-5. Incidence rate ratios adjusted for age (18-55, 56-65, 66-70, >70 years), sex, calendar period (2006-2010, 2011-2019) and country, and using robust standard errors.ConclusionIn this large five-country cohort study, we did not observe any increased risk of haematological malignancies overall, nor for lymphoid and myeloid types, in patients with PsA treated with TNFi. By contrast, there were signals of a moderately increased underlying risk of haematological malignancies, both of lymphoid and myeloid types, in patients with PsA overall as compared to the general population. The findings are of importance from a patient information perspective.AcknowledgementsWe would like to acknowledge the NordForsk and FOREUM, and especially the patient representatives of the NordForsk collaboration for their valuable contribution to this study.Disclosure of InterestsRené Cordtz: None declared, Johan Askling Consultant of: Abbvie, Astra-Zeneca, BMS, Eli Lilly, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, and UCB, Grant/research support from: Abbvie, Astra-Zeneca, BMS, Eli Lilly, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, and UCB, Bénédicte Delcoigne: None declared, Karin Ekström Smedby: None declared, Eva Baecklund: None declared, Christine Ballegaard: None declared, Pia Isomäki Speakers bureau: AbbVie, Eli Lilly and Pfizer, Consultant of: AbbVie, Eli Lilly, Pfizer, Roche and ViforPharma, Grant/research support from: Pfizer, Kalle Aaltonen: None declared, Björn Gudbjornsson Speakers bureau: Novartis, not related to this work, Consultant of: Novartis, not related to this work, Thorvardur Love Speakers bureau: Celgene, Sella Aa. Provan: None declared, Brigitte Michelsen Grant/research support from: Novartis, not related to this work, Joe Sexton: None declared, Lene Dreyer Speakers bureau: Eli Lilly, Galderma and Janssen, Grant/research support from: BMS not related to this work, Karin Hellgren: None declared
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Palsson O, Einarsson JT, Wallman JK, Love T, Gudbjornsson B, Kapetanovic MC. OP0262 PREVALENCE AND PREDICTORS OF ACHIEVING SUSTAINED REMISSION IN PSORIATIC ARTHRITIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.3724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundIncreased availability and a wide selection of b/tsDMARDs with different mode of action has made long-term remission a realistic treatment goal in psoriatic arthritis.ObjectivesTo estimate the prevalence and possible predictors of sustained remission in patients with psoriatic arthritis (PsA) treated with biologic or targeted synthetic disease-modifying anti-rheumatic drugs (bDMARD/tsDMARD) in Sweden.MethodsAll patients initiating treatment with bDMARDs or tsDMARDs for PsA in Sweden and registered in the national Swedish Rheumatology Quality Register (SRQ) were included. Data on disease and treatment characteristics from the start of the first b/tsDMARD (baseline) and all registered subsequent visits were extracted from SRQ. Sustained remission (SR) was defined as DAS28-CRP ≤ 2.6, DAPSA28 ≤ 4 or the evaluator’s global assessment of disease activity (0-4 on a Likert scale) = 0, during at least two consecutive visits over at least six months. To compensate for factors that may temporarily raise disease activity measures, such as concurrent infections, one visit with higher disease activity was allowed if the treatment regimen was not altered at that point and if less than two years between adjacent visits in remission. A sensitivity analysis was performed with a more stringent SR definition, not allowing any such visits with higher disease activity. Logistic regression was used to identify possible predictors of SR.Results5 459 PsA patients with 50 811 visits were included in the analysis. According to DAS28-CRP, 78% of patients achieved a state of remission at some point, and 49% achieved SR at least once. When the more stringent DAPSA28 remission criteria were applied, 27% of patients reached a state of remission at some point, and 11% ever achieved SR. Corresponding figures using the evaluator’s global assessment were 64% and 34% for ever reaching remission or SR, respectively (Figure 1). The sensitivity analysis rendered similar results with a ≤3% difference from the main results for all outcomes. Higher age at start of the first b/tsDMARD therapy was associated with a lower likelihood of SR, but males were significantly more likely to achieve SR than females (OR 1,79-2,63 for reaching SR depending on the remission criteria used).Figure 1.Proportion of patients achieving sustained and non-sustained remission at any point after SRQ registration.ConclusionDespite increased availability and a wider selection of b/tsDMARDs with different modes of action, a considerable proportion of PsA patients receiving such treatments never achieve a state of remission, and less than half ever achieve a more extended period of sustained remission. Males are more likely than females to enter sustained remission.Disclosure of InterestsOlafur Palsson: None declared, Jon Thorkell Einarsson: None declared, Johan K Wallman Consultant of: Consultancy fees from AbbVie, Amgen, Celgene, Eli Lilly and Novartis (unrelated to the present work)., Thorvardur Love: None declared, Björn Gudbjornsson Speakers bureau: Lecture fee from Amgen and Novartis (unrelated to the present work)., Meliha C Kapetanovic: None declared
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Akhavan N, Sen C, Baker C, Abbott N, Gravier M, Love T. Effect of Lexical-Semantic Cues during Real-Time Sentence Processing in Aphasia. Brain Sci 2022; 12:312. [PMID: 35326268 PMCID: PMC8946627 DOI: 10.3390/brainsci12030312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/13/2022] [Accepted: 02/22/2022] [Indexed: 02/01/2023] Open
Abstract
Using a visual world eye-tracking paradigm, we investigated the real-time auditory sentence processing of neurologically unimpaired listeners and individuals with aphasia. We examined whether lexical-semantic cues provided as adjectives of a target noun modulate the encoding and retrieval dynamics of a noun phrase during the processing of complex, non-canonical sentences. We hypothesized that the real-time processing pattern of sentences containing a semantically biased lexical cue (e.g., the venomous snake) would be different than sentences containing unbiased adjectives (e.g., the voracious snake). More specifically, we predicted that the presence of a biased lexical cue would facilitate (1) lexical encoding (i.e., boosted lexical access) of the target noun, snake, and (2) on-time syntactic retrieval or dependency linking (i.e., increasing the probability of on-time lexical retrieval at post-verb gap site) for both groups. For unimpaired listeners, results revealed a difference in the time course of gaze trajectories to the target noun (snake) during lexical encoding and syntactic retrieval in the biased compared to the unbiased condition. In contrast, for the aphasia group, the presence of biased adjectives did not affect the time course of processing the target noun. Yet, at the post-verb gap site, the presence of a semantically biased adjective influenced syntactic re-activation. Our results extend the cue-based parsing model by offering new and valuable insights into the processes underlying sentence comprehension of individuals with aphasia.
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Affiliation(s)
- Niloofar Akhavan
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA 92182, USA; (C.S.); (C.B.); (N.A.); (T.L.)
- Department of Cognitive Science, University of California San Diego, San Diego, CA 92122, USA
- Joint Doctoral Program in Language and Communicative Disorders, San Diego State University/University of California San Diego, San Diego, CA 92182, USA
| | - Christina Sen
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA 92182, USA; (C.S.); (C.B.); (N.A.); (T.L.)
- Department of Cognitive Science, University of California San Diego, San Diego, CA 92122, USA
- Joint Doctoral Program in Language and Communicative Disorders, San Diego State University/University of California San Diego, San Diego, CA 92182, USA
| | - Carolyn Baker
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA 92182, USA; (C.S.); (C.B.); (N.A.); (T.L.)
- Department of Cognitive Science, University of California San Diego, San Diego, CA 92122, USA
- Joint Doctoral Program in Language and Communicative Disorders, San Diego State University/University of California San Diego, San Diego, CA 92182, USA
| | - Noelle Abbott
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA 92182, USA; (C.S.); (C.B.); (N.A.); (T.L.)
- Department of Cognitive Science, University of California San Diego, San Diego, CA 92122, USA
- Joint Doctoral Program in Language and Communicative Disorders, San Diego State University/University of California San Diego, San Diego, CA 92182, USA
| | - Michelle Gravier
- Department of Speech, Language and Hearing Sciences, California State University East Bay, Hayward, CA 94542, USA;
| | - Tracy Love
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA 92182, USA; (C.S.); (C.B.); (N.A.); (T.L.)
- Department of Cognitive Science, University of California San Diego, San Diego, CA 92122, USA
- Joint Doctoral Program in Language and Communicative Disorders, San Diego State University/University of California San Diego, San Diego, CA 92182, USA
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Baker C, Love T. It's about time! Time as a parameter for lexical and syntactic processing: an eye-tracking-while-listening investigation. Lang Cogn Neurosci 2021; 37:42-62. [PMID: 34957314 PMCID: PMC8697737 DOI: 10.1080/23273798.2021.1941147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 06/04/2021] [Indexed: 06/13/2023]
Abstract
We examined the time-course of lexical activation, deactivation, and the syntactic operation of dependency linking during the online processing of object-relative sentence constructions using eye-tracking-while-listening. We explored how manipulating temporal aspects of the language input affects the tight lexical and syntactic temporal constraints found in sentence processing. The three temporal manipulations were (1) increasing the duration of the direct object noun, (2) adding the disfluency uh after the noun, and (3) replacing the disfluency with a silent pause. The findings from this experiment revealed that the disfluent and silence temporal manipulations enhanced the processing of subject and object noun phrases by modulating activation and deactivation. The manipulations also changed the time-course of dependency linking (increased reactivation of the direct object). The modulated activation dynamics of these lexical items are thought to play a role in mitigating interference and suggest that deactivation plays a beneficial role in complex sentence processing.
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Affiliation(s)
- Carolyn Baker
- SDSU/UCSD Joint Doctoral Program in Language and Communicative Disorders, San Diego State University, San Diego, USA
| | - Tracy Love
- SDSU/UCSD Joint Doctoral Program in Language and Communicative Disorders, San Diego State University, San Diego, USA
- School of Speech, Language, and Hearing Sciences, SDSU, San Diego, USA
- Department of Cognitive Science, UCSD, San Diego, USA
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Christiansen SN, Midtbøll Ørnbjerg L, Rasmussen SH, Loft AG, Wallman JK, Iannone F, Michelsen B, Nissen MJ, Zavada J, Santos MJ, Pombo-Suarez M, Eklund K, Tomsic M, Gudbjornsson B, Sari İ, Codreanu C, DI Giuseppe D, Glintborg B, Sebastiani M, Fagerli KM, Moeller B, Pavelka K, Barcelos A, Sánchez-Piedra C, Relas H, Rotar Z, Love T, Akar S, Ionescu R, Macfarlane G, Van de Sande MGH, Hetland ML, Østergaard M. OP0220 SECULAR TRENDS IN BASELINE CHARACTERISTICS, TREATMENT RETENTION AND RESPONSE RATES IN 17453 BIONAÏVE PSORIATIC ARTHRITIS PATIENTS INITIATING TNFI – RESULTS FROM THE EUROSPA COLLABORATION. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Knowledge of changes over time in baseline characteristics and tumor necrosis factor inhibitor (TNFi) response in bionaïve psoriatic arthritis (PsA) patients treated in routine care is limited.Objectives:To investigate secular trends in baseline characteristics and retention, remission and response rates in PsA patients initiating a first TNFi.Methods:Prospectively collected data on bionaïve PsA patients starting TNFi in routine care from 15 European countries were pooled. According to year of TNFi initiation, three groups were defined a priori based on bDMARD availability: Group A (1999–2008), Group B (2009–2014) and Group C (2015–2018).Retention rates (Kaplan-Meier), crude and LUNDEX adjusted1 remission (Disease Activity Score (DAS28) <2.6, 28-joint Disease Activity index for PsA (DAPSA28) ≤4, Clinical Disease Activity Index (CDAI) ≤2.8) and ACR50 response rates were assessed at 6, 12 and 24 months. No statistical comparisons were made.Results:A total of 17453 PsA patients were included (4069, 7551 and 5833 in groups A, B and C).Patients in group A were older and had longer disease duration compared to B and C. Retention rates at 6, 12 and 24 months were highest in group A (88%/77%/64%) but differed little between B (83%/69%/55%) and C (84%/70%/56%).Baseline disease activity was higher in group A than in B and C (DAS28: 4.6/4.3/4.0, DAPSA28: 29.9/25.7/24.0, CDAI: 21.8/20.0/18.6), and this persisted at 6 and 12 months. Crude and LUNDEX adjusted remission rates at 6 and 12 months tended to be lowest in group A, although crude/LUNDEX adjusted ACR50 response rates at all time points were highest in group A. At 24 months, disease activity and remission rates were similar in the three groups (Table).Table 1.Secular trends in baseline characteristics, treatment retention, remission and response rates in European PsA patients initiating a 1st TNFiBaseline characteristicsGroup A(1999–2008)Group B(2009–2014)Group C(2015–2018)Age, median (IQR)62 (54–72)58 (49–67)54 (45–62)Male, %514847Years since diagnosis, median (IQR)5 (2–10)3 (1–9)3 (1–8)Smokers, %161717DAS28, median (IQR)4.6 (3.7–5.3)4.3 (3.4–5.1)4.0 (3.2–4.8)DAPSA28, median (IQR)29.9 (19.3–41.8)25.7 (17.2–38.1)24.0 (16.1–35.5)CDAI, median (IQR)21.8 (14.0–31.1)20.0 (13.0–29.0)18.6 (12.7–26.1)TNFi drug, % (Adalimumab / Etanercept / Infliximab / Certolizumab / Golimumab)27 / 43 / 30 / 0 / 036 / 31 / 14 / 5 / 1421 / 40 / 21 / 8 / 10Follow up6 months12 months24 monthsGr AGr BGr CGr AGr BGr CGr AGr BGr CRetention rates, % (95% CI)88 (87–89)83 (82–84)84 (83–85)79 (78–80)72 (71–73)72 (71–73)68 (67–69)60 (59–61)60 (59–62)DAS28, median (IQR)2.7 (1.9–3.6)2.4 (1.7–3.4)2.3 (1.7–3.2)2.5 (1.8–3.4)2.2 (1.6–3.1)2.1 (1.6–2.9)2.1 (1.6–3.1)2.0 (1.6–2.9)1.9 (1.5–2.6)DAPSA28, median (IQR)10.6 (4.8–20.0)9.5 (3.9–18.3)8.7 (3.6–15.9)9.1 (4.1–17.8)7.7 (3.1–15.4)7.6 (2.9–14.4)6.7 (2.7–13.7)6.6 (2.7–13.5)5.9 (2.4–11.8)CDAI, median (IQR)7.8 (3.0–15.2)8.0 (3.0–15.0)6.4 (2.6–12.2)6.4 (2.5–13.0)6.2 (2.5–12.1)5.8 (2.2–11.4)5.0 (2.0–11.0)5.5 (2.0–11.2)5.0 (2.0–9.0)DAS28 remission, %, c/L47 / 4255 / 4661 / 5153 / 4362 / 4566 / 4864 / 4268 / 3775 / 41DAPSA28 remission, %, c/L22 / 1926 / 2228 / 2325 / 2031 / 2232 / 2336 / 2334 / 1938 / 21CDAI remission, %, c/L23 / 2123 / 1926 / 2227 / 2127 / 2029 / 2134 / 2231 / 1735 / 19ACR50 response, %, c/L26 / 2322 / 1824 / 2027 / 2223 / 1721 / 1523 / 1518 / 1014 / 8Gr, Group; c/L, crude/LUNDEX.Conclusion:Over the past 20 years, patient age, disease duration and disease activity level at the start of the first TNFi in PsA patients have decreased. Furthermore, TNFi retention rates have decreased while remission rates have increased, especially remission rates within the first year of treatment. These findings may reflect a greater awareness of early diagnosis in PsA patients, a lowered threshold for initiating TNFi and the possibility for earlier switching in patients with inadequate treatment response.References:[1]Arthritis Rheum 2006; 54: 600-6.Acknowledgements:Novartis Pharma AG and IQVIA for supporting the EuroSpA Research Collaboration Network.Disclosure of Interests:Sara Nysom Christiansen Speakers bureau: BMS and GE, Grant/research support from: Novartis, Lykke Midtbøll Ørnbjerg Grant/research support from: Novartis, Simon Horskjær Rasmussen: None declared, Anne Gitte Loft Speakers bureau: AbbVie, Janssen, Lilly, MSD, Novartis, Pfizer, UCB, Consultant of: AbbVie, Janssen, Lilly, MSD, Novartis, Pfizer, UCB, Grant/research support from: Novartis, Johan K Wallman Consultant of: Celgene, Eli Lilly, Novartis, Florenzo Iannone Speakers bureau: Abbvie, MSD, Novartis, Pfizer and BMS, Brigitte Michelsen Consultant of: Novartis, Grant/research support from: Novartis, Michael J. Nissen Speakers bureau: Novartis, Eli Lilly, Celgene, and Pfizer, Consultant of: Novartis, Eli Lilly, Celgene, and Pfizer, Jakub Zavada: None declared, Maria Jose Santos Speakers bureau: AbbVie, Novartis, Pfizer, Manuel Pombo-Suarez: None declared, Kari Eklund: None declared, Matija Tomsic Speakers bureau: Abbvie, Amgen, Biogen, Medis, MSD, Novartis, Pfizer, Consultant of: Abbvie, Amgen, Biogen, Medis, MSD, Novartis, Pfizer, Björn Gudbjornsson Speakers bureau: Amgen and Novartis, İsmail Sari: None declared, Catalin Codreanu Speakers bureau: AbbVie, Amgen, Egis, Novartis, Pfizer, UCB, Grant/research support from: AbbVie, Amgen, Egis, Novartis, Pfizer, UCB, Daniela Di Giuseppe: None declared, Bente Glintborg Grant/research support from: Pfizer, Biogen, AbbVie, Marco Sebastiani: None declared, Karen Minde Fagerli: None declared, Burkhard Moeller: None declared, Karel Pavelka Speakers bureau: AbbVie, Roche, MSD, UCB, Pfizer, Novartis, Egis, Gilead, Eli Lilly, Consultant of: AbbVie, Roche, MSD, UCB, Pfizer, Novartis, Egis, Gilead, Eli Lilly, Anabela Barcelos: None declared, Carlos Sánchez-Piedra: None declared, Heikki Relas: None declared, Ziga Rotar Speakers bureau: Abbvie, Amgen, Biogen, Medis, MSD, Novartis, Pfizer, Consultant of: Abbvie, Amgen, Biogen, Medis, MSD, Novartis, Pfizer, Thorvardur Love: None declared, Servet Akar: None declared, Ruxandra Ionescu Speakers bureau: Abbvie, Amgen, Boehringer-Ingelheim Eli-Lilly,Novartis, Pfizer, Sandoz, UCB, Gary Macfarlane Grant/research support from: GlaxoSmithKline, Marleen G.H. van de Sande: None declared, Merete L. Hetland Speakers bureau: Abbvie, Biogen, BMS, Celltrion, Eli Lilly, Janssen Biologics B.V, Lundbeck Fonden, MSD, Pfizer, Roche, Samsung Biopies, Sandoz, Novartis., Mikkel Østergaard Speakers bureau: AbbVie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Centocor, GSK, Hospira, Janssen, Merck, Mundipharma, Novartis, Novo, Orion, Pfizer, Regeneron, Schering-Plough, Roche, Takeda, UCB and Wyeth, Consultant of: AbbVie, BMS, Boehringer-Ingelheim, Celgene, Eli-Lilly, Centocor, GSK, Hospira, Janssen, Merck, Mundipharma, Novartis, Novo, Orion, Pfizer, Regeneron, Schering-Plough, Roche, Takeda, UCB and Wyeth
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Ogdie A, Love T, Takeshita J, Gelfand J, Scher J, Choi H, Fitzsimmons R, Ritchlin CT, Merola JF. FRI0355 IMPACT OF BIOLOGIC THERAPY ON THE INCIDENCE OF PSA AMONG PATIENTS WITH PSORIASIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.3337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:One of the strongest known risk factors for the development of psoriatic arthritis (PsA) is psoriasis. A key question is whether treatment of psoriasis may prevent or delay onset of PsA.Objectives:To compare the incidence of PsA among patients with psoriasis treated with a biologic compared to those treated with a non-biologic therapy for psoriasisMethods:We performed a retrospective cohort study in the Optum de-identified Electronic Health Record dataset between 2006-2017. Patients with two or more ICD codes for psoriasis between the ages of 16 and 90, who were initiating an oral medication, a biologic therapy, or phototherapy (defined as no preceding codes for the therapy in the prior 12 months) were identified. Covariates at baseline were determined in the 12 months prior to therapy initiation. The outcome of interest was PsA as defined by one ICD code. The incidence of PsA was described overall and within each therapy group. We analyzed the data in two ways: a) a multivariable Cox model using a time varying exposure (once the patient was exposed to a biologic, they were considered always exposed) derived from automated stepwise regression and b) propensity score matching (greedy matching, caliper 0.1) between biologic-exposed patients and oral/phototherapy exposed patients.Results:Among 215,386 patients with psoriasis without PsA at baseline, 9,848 were excluded for prior biologic exposure, and among the remaining, 60,258 initiated phototherapy, oral or biologic therapy during follow up. Among 22,461 new biologic initiations, 29,121 oral therapy and 8,676 phototherapy initiations, the mean age was lower in the biologics group compared to the non-biologic groups (46.9 vs 50.8), with a similar proportion of females and Caucasians. Observational time was also similar. A total of 1,643, 1,813, and 122 new PsA cases occurred over 60,739, 85,670, and 28,528 person/years (PY) of follow up, respectively (incidence 27.1, 21.2 and 4.2 per 1,000 person years respectively). Using a traditional multivariable adjustment approach with time varying exposure, the age and sex adjusted and fully adjusted HR (95% CI) for biologic users were 1.01 (0.99-1.04) and 0.93 (0.91-0.95), respectively. However, after propensity score matching, the HR (95% CI) was 1.64 (1.51-1.77). Survival curves cross, however, at approximately 8 years (Figure 1) and most of the new diagnoses of PsA occurred shortly after therapy initiation (Figure 2).Conclusion:Confounding by indication or protopathic bias may explain the observed association of biologic therapy with the development of PsA among patients with psoriasis. Some patients may be receiving therapy because they have both psoriasis and early symptoms of PsA or their PsA diagnosis is not recorded appropriately. Given the directional discrepancy in the results between traditional modeling and propensity score analysis, further work is needed to understand the nature of this relationship.FigureFigure 3.Directed Acyclic Graphdescribing potential confounders in relationship between therapy prescription and diagnosis of PsADisclosure of Interests:Alexis Ogdie Grant/research support from: Pfizer, Novartis, Consultant of: Abbvie, Amgen, BMS, Celgene, Corrona, Janssen, Lilly, Pfizer, Novartis, Thorvardur Love: None declared, Junko Takeshita: None declared, Joel Gelfand Grant/research support from: grants (to the Trustees of the University of Pennsylvania) from Abbvie, Boehringer Ingelheim, Janssen, Novartis Corp, Celgene, Ortho Dermatologics, and Pfizer Inc., Consultant of: BMS, Boehringer Ingelheim, Janssen Biologics, Novartis Corp, UCB (DSMB), Neuroderm (DSMB), Dr. Reddy’s Labs, Pfizer Inc., and Sun Pharma, Paid instructor for: received payment for continuing medical education work related to psoriasis that was supported indirectly by Lilly, Ortho Dermatologics and Novartis., Jose Scher Consultant of: Novartis, Janssen, UCB, Sanofi., Hyon Choi Grant/research support from: Ironwood, Horizon, Consultant of: Takeda, Selecta, Horizon, Kowa, Vaxart, Ironwood, Robert Fitzsimmons: None declared, Christopher T. Ritchlin Grant/research support from: UCB Pharma, AbbVie, Amgen, Consultant of: UCB Pharma, Amgen, AbbVie, Lilly, Pfizer, Novartis, Gilead, Janssen, Joseph F. Merola Consultant of: Merck, AbbVie, Dermavant, Eli Lilly, Novartis, Janssen, UCB Pharma, Celgene, Sanofi, Regeneron, Arena, Sun Pharma, Biogen, Pfizer, EMD Sorono, Avotres and LEO Pharma
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Michelsen B, Georgiadis S, DI Giuseppe D, Loft AG, Nissen M, Iannone F, Pombo-Suarez M, Mann H, Rotar Z, Eklund K, Kvien TK, Santos MJ, Gudbjornsson B, Codreanu C, Yilmaz S, Wallman JK, Brahe CH, Moeller B, Favalli EG, Sánchez-Piedra C, Nekvindova L, Tomsic M, Trokovic N, Kristianslund E, Santos H, Love T, Ionescu R, Pehlivan Y, Jones GT, Van der Horst-Bruinsma I, Midtbøll Ørnbjerg L, Ǿstergaard M, Hetland ML. SAT0430 SECUKINUMAB EFFECTIVENESS IN 1543 PATIENTS WITH PSORIATIC ARTHRITIS TREATED IN ROUTINE CLINICAL PRACTICE IN 13 EUROPEAN COUNTRIES IN THE EuroSpA RESEARCH COLLABORATION NETWORK. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:There is a lack of real-life evidence on secukinumab effectiveness in psoriatic arthritis (PsA) patients.Objectives:To assess the real-life 6- and 12-month secukinumab retention rates and proportions of patients in remission/low disease activity (LDA) overall, and by prior biologic disease-modifying anti-rheumatic drug (bDMARD)/targeted synthetic (ts)DMARD use.Methods:Data from PsA patients treated with secukinumab in routine care from 13 countries in the European Spondyloarthritis (EuroSpA) Research Collaboration Network were pooled. Patients started secukinumab ≥12 months before date of datacut. Crude and LUNDEX adjusted (crude value adjusted for drug retention) 28-joint Disease Activity index for PSoriatic Arthritis (DAPSA28) and 28-joint Disease Activity Score with CRP (DAS28CRP) remission and LDA rates were calculated. Group comparisons between b/tsDMARD naïve, 1 prior and ≥2 prior b/tsDMARD users were done with ANOVA, Kruskal-Wallis, Chi-square or Kaplan-Meier analyses with log-rank test, as appropriate.Results:A total of 1543 PsA patients were included (Table 1). b/tsDMARD naïve patients had shorter time since diagnosis, higher baseline disease activity, a higher proportion were men and a higher proportion achieved remission. Overall 6/12-month secukinumab retention rates were 86%/74% and significantly higher in b/tsDMARD naïve patients at 12, but not 6 months (Table 2, Figure). Overall, crude 6- and 12-month DAPSA28≤4/DAS28CRP<2.6 were achieved by 13%/34% and 11%/39% of the patients, respectively.Table 1.All patients (n=1543)b/tsDMARD naïve (n=287)1 prior b/tsDMARD (n=333)≥2 prior b/tsDMARDs (n=923)p *Age (years), mean (SD)52 (11)49 (12.3)51 (11)53 (11)<0.001Male, %42%49%46%39%0.003Years since diagnosis, mean (SD)9 (8)7 (8)8 (7)10 (8)<0.001Current smokers, %19%21%22%18%0.23CRP (mg/L), median (IQR)5 (2-12)7 (2-19)4 (2-8)5 (2-11)<0.001DAPSA28, median (IQR)26 (18-37)28 (19-38)22 (13-32)27 (19-38)<0.001DAS28CRP, median (IQR)4.2 (3.3-5.0)4.4 (3.5-5.2)3.8 (2.6-4.5)4.2 (3.4-5.0)<0.001*Comparisons across number of prior b/tsDMARD were done with ANOVA, Kruskal-Wallis or Chi-square test, as appropriateTable 2.MonthsAll patients (n=1543)b/tsDMARD naïve (n=287)1 prior b/tsDMARD (n=333)≥2 prior b/tsDMARDs (n=923)p *Secukinumab retention rate, % (95%CI)686% (84-87%)89% (86-93%)85% (81-89%)85% (82-87%)0.111274% (72-76%)81% (76-86%)76% (71-80%)72% (69-75%)0.006DAPSA28≤4 Crude613%25%11%11%<0.001 LUNDEX11%22%9%9%<0.001 Crude1211%22%11%8%<0.001 LUNDEX7%17%7%5%0.001DAS28CRP<2.6 Crude634%51%33%30%<0.001 LUNDEX29%45%27%24%<0.001 Crude1239%55%41%34%<0.001 LUNDEX26%41%27%21%<0.001DAPSA28 >4 and ≤14 Crude633%42%32%30%0.04 LUNDEX27%37%27%25%0.02 Crude1235%48%36%32%0.009 LUNDEX24%36%24%20%0.004DAS28CRP ≤3.2 Crude652%69%53%47%<0.001 LUNDEX43%61%45%38%<0.001 Crude1255%72%55%50%<0.001 LUNDEX37%54%37%32%<0.001*Comparisons across number of prior b/tsDMARDs were done with Kaplan-Meier with log-rank test or Chi-Square test, as appropriateConclusion:In this real-life study of 1543 patients with PsA in 13 European countries 12-month secukinumab retention was high, and significantly higher for b/tsDMARD naïve patients. Overall, a higher proportion of bionaïve than previous b/tsDMARD users achieved remission, regardless of remission criteria.Acknowledgments:Novartis and IQVIA for supporting the EuroSpA RCNDisclosure of Interests:Brigitte Michelsen Grant/research support from: Research support from Novartis, Consultant of: Consulting fees Novartis, Stylianos Georgiadis Grant/research support from: Novartis, Daniela Di Giuseppe: None declared, Anne Gitte Loft Grant/research support from: Novartis, Consultant of: AbbVie, MSD, Novartis, Pfizer and UCB, Speakers bureau: AbbVie, MSD, Novartis, Pfizer and UCB, Michael Nissen Grant/research support from: Abbvie, Consultant of: Novartis, Lilly, Abbvie, Celgene and Pfizer, Speakers bureau: Novartis, Lilly, Abbvie, Celgene and Pfizer, Florenzo Iannone Consultant of: Speaker and consulting fees from AbbVie, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, MSD, Speakers bureau: Speaker and consulting fees from AbbVie, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, MSD, Manuel Pombo-Suarez Consultant of: Janssen, Lilly, MSD and Sanofi., Speakers bureau: Janssen, Lilly, MSD and Sanofi., Heřman Mann: None declared, Ziga Rotar Consultant of: Speaker and consulting fees from Abbvie, Amgen, Biogen, Eli Lilly, Medis, MSD, Novartis, Pfizer, Roche, Sanofi., Speakers bureau: Speaker and consulting fees from Abbvie, Amgen, Biogen, Eli Lilly, Medis, MSD, Novartis, Pfizer, Roche, Sanofi., Kari Eklund Consultant of: Celgene, Lilly, Speakers bureau: Pfizer, Roche, Tore K. Kvien Grant/research support from: Received grants from Abbvie, Hospira/Pfizer, MSD and Roche (not relevant for this abstract)., Consultant of: Have received personal fees from Abbvie, Biogen, BMS, Celltrion, Eli Lily, Hospira/Pfizer, MSD, Novartis, Orion Pharma, Roche, Sandoz, UCB, Sanofi and Mylan (not relevant for this abstract)., Paid instructor for: Have received personal fees from Abbvie, Biogen, BMS, Celltrion, Eli Lily, Hospira/Pfizer, MSD, Novartis, Orion Pharma, Roche, Sandoz, UCB, Sanofi and Mylan (not relevant for this abstract)., Speakers bureau: Have received personal fees from Abbvie, Biogen, BMS, Celltrion, Eli Lily, Hospira/Pfizer, MSD, Novartis, Orion Pharma, Roche, Sandoz, UCB, Sanofi and Mylan (not relevant for this abstract)., Maria Jose Santos Speakers bureau: Novartis and Pfizer, Björn Gudbjornsson Speakers bureau: Novartis and Amgen, Catalin Codreanu Consultant of: Speaker and consulting fees from AbbVie, Accord Healthcare, Alfasigma, Egis, Eli Lilly, Ewopharma, Genesis, Mylan, Novartis, Pfizer, Roche, Sandoz, UCB, Speakers bureau: Speaker and consulting fees from AbbVie, Accord Healthcare, Alfasigma, Egis, Eli Lilly, Ewopharma, Genesis, Mylan, Novartis, Pfizer, Roche, Sandoz, UCB, Sema Yilmaz: None declared, Johan K Wallman Consultant of: AbbVie, Celgene, Eli Lilly, Novartis and UCB Pharma, Cecilie Heegaard Brahe Grant/research support from: Novartis, Burkhard Moeller: None declared, Ennio Giulio Favalli Consultant of: Consultant and/or speaker for BMS, Eli-Lilly, MSD, UCB, Pfizer, Sanofi-Genzyme, Novartis, and Abbvie, Speakers bureau: Consultant and/or speaker for BMS, Eli-Lilly, MSD, UCB, Pfizer, Sanofi-Genzyme, Novartis, and Abbvie, Carlos Sánchez-Piedra: None declared, Lucie Nekvindova: None declared, Matija Tomsic: None declared, Nina Trokovic: None declared, Eirik kristianslund: None declared, Helena Santos Speakers bureau: AbbVie, Eli-Lilly, Janssen, Pfizer, Novartis, Thorvardur Love: None declared, Ruxandra Ionescu Consultant of: Consulting fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz, Speakers bureau: Consulting and speaker fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz, Yavuz Pehlivan: None declared, Gareth T. Jones Grant/research support from: Pfizer, AbbVie, UCB, Celgene and GSK., Irene van der Horst-Bruinsma Grant/research support from: AbbVie, Novartis, Eli Lilly, Bristol-Myers Squibb, MSD, Pfizer, UCB Pharma, Consultant of: AbbVie, Novartis, Eli Lilly, Bristol-Myers Squibb, MSD, Pfizer, UCB Pharma, Lykke Midtbøll Ørnbjerg Grant/research support from: Novartis, Mikkel Ǿstergaard Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Merck, and Novartis, Consultant of: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Merete L. Hetland Grant/research support from: BMS, MSD, AbbVie, Roche, Novartis, Biogen and Pfizer, Consultant of: Eli Lilly, Speakers bureau: Orion Pharma, Biogen, Pfizer, CellTrion, Merck and Samsung Bioepis
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Hafthorsdottir R, Gunnarsdottir A, Love T, Gröndal G, Gudbjornsson B. OP0213 THE IMPACT OF TNFΑ INHIBITORS ON GLUCOCORTICOIDS USE AMONG PATIENTS WITH ARTHRITIS. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Glucocorticoid steroid (GC) use among patients with arthritis is common. The introduction of TNFα inhibitors (TNFi) has been a breakthrough in the treatment of arthritis leading to remission for many patients. However, there is scarce information on the impact of TNFi on the use of GC among patients with inflammatory joint diseases.Objectives:To explore oral GC use in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and axial spondyloarthritis (axSpA) before and after the initiation of TNFi therapy. Furthermore, to evaluate if patients on long term GC treatment were receiving active preventive osteoporosis treatment and how treatment with TNFi affected the use of topical steroids in patients with PsA.Methods:Clinical data on patients with RA, PsA and axSpA who initiated TNFi therapy with etanercept, infliximab, adalimumab or golimumab for the first time between 2005-2015 was collected from the ICEBIO registry. ICEBIO is a nationwide registry on all patients treated with biologics for rheumatologic disorders in Iceland. The use of oral GC, topical steroids and bisphosphonates was collected from the Icelandic Prescription Medicines Registry (IPMR) for a period of four years, two years before and after the initiation of TNFi. Medication use was then evaluated by counting the number of individuals receiving a medication in a given year, the total number of prescriptions, and the defined daily dose (DDD). Five controls were randomly selected from IPMR and matched on age, sex and time frame.Results:621 patients with RA, PsA or axSpA received 2630 prescriptions (4.2 prescription per patient; 3105 controls received 1337 prescriptions or 0.4 prescription per individual) for GC during the study period. GC use varied between patient groups (Figure 1). The total GC use (DDD) doubled over the two-year period leading up to TNFi treatment but decreased sharply after the initiation of TNFi. The number of individuals on GC decreased by one third after initiating TNFi therapy and the majority of those who continued GC treatment were patients with RA (Figure 1). Of those patients on long term GC treatment (>7.5 mg/day for three months) 38% were receiving bone protective therapy against corticosteroid induced osteoporosis. The use of topical steroids decreased by half among PsA patients and one third discontinued the treatment after initiating TNFi (Figure 2).Conclusion:TNFi therapy does impact GC use among patients with arthritides, however a large portion of RA patients are still on GC two years after initiating TNFi therapy. Better osteoporosis prophylaxis and treatment is warranted for those patients on long term GCDisclosure of Interests:Rebekka Hafthorsdottir: None declared, Anna Gunnarsdottir: None declared, Thorvardur Love: None declared, Gerdur Gröndal: None declared, Björn Gudbjornsson Speakers bureau: Novartis and Amgen
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Palsson O, Love T, Wallman JK, Kapetanovic MC, Gunnarsson PS, Gudbjornsson B. OP0088 INITIATING TNF INHIBITORS IN INFLAMMATORY ARTHRITIS DOES NOT DECREASE THE AVERAGE OPIOID ANALGESIC CONSUMPTION. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.2587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:TNFα-inhibitor (TNFi) therapy is effective in controlling several rheumatic diseases and has been shown to reduce pain in patients with arthritis. Opioids are often prescribed for chronic pain, a common issue in inflammatory joint disease.Objectives:To explore the impact of the initiation of TNFi therapy as a first-line biologic disease-modifying anti-rheumatic drug (DMARD) on the prescription rates of opioids in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS) and undifferentiated arthritis (UA) in Iceland.Methods:All patients receiving biologic DMARD therapy for rheumatic diseases in Iceland are registered in a nationwide database (ICEBIO). The Icelandic Directorate of Health operates a Prescription Medicines Register that includes over 90% of all drug prescriptions in Iceland. The study group included patients with RA, PsA, AS, and UA registered in ICEBIO and for each of them five randomly selected comparators from the general population matched on age, sex, and calendar time. On February 1st2016 we extracted data on all filled opioid analgesic prescriptions two years before and two years after the date of TNFi initiation.Results:Data from 359 RA, 217 AS, 251 PsA and 113 UA patients and 4700 comparators were collected. In total, 75% of patients compared to 43% of comparators received ≥1 opiate prescription during the study period. The proportion of patients using opioids (regardless of dose) two years prior to TNFi initiation was 41%, increasing to 49% the following year. After TNFi initiation the proportion returned to 40% (Figure 1). Despite this, the mean yearly opiate dose used by the patients followed a rising trajectory throughout the study period (Figure 2). In total, patients were prescribed nearly 6 times more opioids than the comparators, corresponding to a bootstrapped mean (95% CI) dose of 818 (601-1073) mg MED per patient and year compared to 139 (111-171) mg for comparators.Figure 1.Percental distributions of opioid analgesic use by dose (according to dispensed prescriptions) among patients with inflammatory arthritis (A) and matched comparators (B). All doses are oral morphine equivalent dose (MED) in milligrams.Figure 2.Bootstrapped mean oral morphine equivalent dose per person per year for patients with inflammatory arthritis (above) and age and sex matched comparators (below). Box edges represent 25-75thpercentiles and whiskers 95% confidence intervals.Conclusion:Three out of four patients with inflammatory arthritis in Iceland use opioid analgesics in the two years prior to and/or after the initiation of TNFi therapy and the mean doses were significantly higher than in matched comparators. The proportion of patients receiving opioids increased before TNFi therapy and then decreased again to the previous level. The initiation of the first-line TNFi did not reduce opioid consumption by dose at the group level. On the contrary, there was a trend towards increasing doses over time in both patients and comparators, possibly reflecting the development of opiate tolerance.Table 1.Baseline demographic data. Mean ± SD unless specified. * defined from diagnosis to baselAll patientsRheumatoid arthritisPsoriatic arthritisAnkylosing spondylitisUndifferentiated arthritisTotal n (%)940 (100)359 (38)251 (27)217 (23)113 (12)Age (years)49 ± 1453 ± 1449 ± 1343 ± 1344 ± 15Disease duration (years)*7.8 ± 8.58.2 ± 8.27.4 ± 7.88.3 ± 10.26.3 ± 6.6Female58%73%59%34%52%Disclosure of Interests:Olafur Palsson: None declared, Thorvardur Love: None declared, Johan K Wallman Consultant of: Consultant for AbbVie, Celgene, Eli Lilly, Novartis and UCB Pharma., Meliha C Kapetanovic: None declared, Petur S Gunnarsson: None declared, Björn Gudbjornsson Speakers bureau: Novartis and Amgen
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Lindström U, Glintborg B, DI Giuseppe D, Schjødt Jørgensen T, Gudbjornsson B, Grøn KL, Aarrestad Provan S, Michelsen B, Hetland ML, Wallman JK, Nordström D, Trokovic N, Love T, Steen Krogh N, Askling J, Jacobsson LTH, Kristensen LE. THU0394 COMPARISON OF TREATMENT RETENTION OF SECUKINUMAB AND TNF-INHIBITORS IN PSORIATIC ARTHRITIS. OBSERVATIONAL DATA FROM A NORDIC COLLABORATION. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:A head-to-head trial (EXCEED) has indicated similar effectiveness of secukinumab (SEC) and the tumor necrosis factor inhibitor (TNFi) adalimumab (ADA) in psoriatic arthritis (PsA). In the clinical setting, treatment retention serves as a combined measure of overall effectiveness and tolerability.Objectives:To explore baseline patient characteristics, and compare treatment retention rates for SEC and each of etanercept (ETN), infliximab (IFX), golimumab (GOL), certolizimab (CZP) and ADA in PsA.Methods:Patients starting SEC or any TNFi in 2015-2018, in the 5 Nordic countries, were identified in clinical rheumatology registers. Data were pooled for analysis and stratified by 1st, 2ndand ≥3rdline of treatment. One year treatment retention was compared by crude Kaplan-Meier curves and a proportional hazard model for risk of discontinuation, censored at 1 year and adjusted for sex, age, country and baseline CRP, patient global and use of csDMARD, with ADA as reference.Results:In total, 6062 patients with PsA were included, contributing 8172 treatment starts (table 1). SEC was mainly used as 2ndor ≥3rdline treatment. The survival curves and 1-year treatment retention rates, stratified by line of treatment, were similar for SEC compared to the TNFis, with some differences between the different TNFi (fig 1, table 2). Adjusted hazard ratios (HR) also indicated similar risk of SEC withdrawal compared to ADA (table 2).Table 1.Patient characteristics at treatment start1stline2ndline≥3rdlineSECN=164TNFiN=3808SECN=273TNFiN=1767SECN=767TNFiN=1393Females48%47%44%42%36%39%Age, years52 (13)49 (13)50 (12)50 (13)52 (12)51 (12)Disease duration, years12 (10)10 (10)13 (10)13 (10)16 (10)16 (10)Swollen joint count 283 (4)2 (3)2 (3)2 (3)3 (4)2 (3)CRP, mg/L10 (18)10 (17)7 (11)9 (17)13 (22)11 (20)Patient global score57 (24)58 (24)60 (25)59 (26)68 (23)65 (24)Concomitant therapycsDMARD30%60%41%57%49%53% Methotrexate24%49%31%48%40%44% Sulphasalazine2%9%5%5%4%6%Numbers are mean (SD) unless noted otherwiseTable 2.One year treatment retention and hazard of discontinuation for SEC and TNFiLine of treatmentDrugN1 year treatment retention % (95% CI)Adjusted HR (95% CI) for discontinuation1stlineADA56973 (69-76)RefCZP27366 (60-72)1.2 (0.9-1.6)ETN174773 (71-75)0.9 (0.7-1.1)GOL21267 (60-73)1.2 (0.9-1.7)IFX100762 (59-65)1.4 (1.1-1.7)SEC16472 (63-78)1.0 (0.7-1.4)2ndlineADA41569 (63-73)RefCZP17651 (43-58)1.6 (1.2-2.2)ETN70163 (59-66)1.2 (0.9-1.5)GOL15169 (61-76)0.9 (0.6-1.2)IFX32465 (59-70)1.0 (0.8-1.4)SEC27369 (62-74)0.9 (0.7-1.2)≥3rdlineADA34667 (62-72)RefCZP22149 (42-56)1.5 (1.2-2.0)ETN37262 (57-67)1.1 (0.9-1.5)GOL20656 (49-63)1.3 (1.0-1.8)IFX24857 (50-63)1.3 (1.0-1.8)SEC76763 (59-67)1.0 (0.8-1.3)Conclusion:In this large study of bDMARD treatment of PsA in clinical practice, SEC was most often used as 2ndor ≥3rdline treatment, and the treatment retention of SEC was comparable with that of TNFi. Further analyses, taking into account other comorbidities, channeling and effectiveness will be presented.Acknowledgments:UL and BG are shared first, and LJ and LEK shared last authors.Partly funded by Nordforsk and FOREUM.Disclosure of Interests:Ulf Lindström: None declared, Bente Glintborg Grant/research support from: Grants from Pfizer, Biogen and Abbvie, Daniela Di Giuseppe: None declared, Tanja Schjødt Jørgensen Speakers bureau: Abbvie, Pfizer, Roche, Novartis, UCB, Biogen, and Eli Lilly, Björn Gudbjornsson Speakers bureau: Novartis and Amgen, Kathrine L. Grøn Grant/research support from: BMS, Sella Aarrestad Provan Consultant of: Novartis, Brigitte Michelsen: None declared, Merete L. Hetland Grant/research support from: BMS, MSD, AbbVie, Roche, Novartis, Biogen and Pfizer, Consultant of: Eli Lilly, Speakers bureau: Orion Pharma, Biogen, Pfizer, CellTrion, Merck and Samsung Bioepis, Johan K Wallman Consultant of: AbbVie, Celgene, Eli Lilly, Novartis and UCB Pharma, Dan Nordström Consultant of: Abbvie, Celgene, Lilly, Novartis, Pfizer, Roche and UCB., Speakers bureau: Abbvie, Celgene, Lilly, Novartis, Pfizer, Roche and UCB., Nina Trokovic: None declared, Thorvardur Love: None declared, Niels Steen Krogh: None declared, Johan Askling Grant/research support from: JA acts or has acted as PI for agreements between Karolinska Institutet and the following entities, mainly in the context of the ARTIS national safety monitoring programme of immunomodulators in rheumatology: Abbvie, BMS, Eli Lilly, Merck, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, and UCB Pharma, Lennart T.H. Jacobsson Consultant of: AbbVie, Eli Lilly, Janssen, Novartis and Pfizer, Lars Erik Kristensen Consultant of: UCB Pharma (Advisory Board), Sannofi (Advisory Board), Abbvie (Advisory Board), Biogen (Advisory Board), Speakers bureau: AbbVie, Amgen, Biogen, Bristol-Myers Squibb,Celgene, Eli Lilly, Gilead, Forward Pharma, Janssen Pharmaceuticals, MSD, Novartis, Pfizer, and UCB Pharma
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Lindström U, DI Giuseppe D, Delcoigne B, Glintborg B, Moeller B, Pombo-Suarez M, Sánchez-Piedra C, Eklund K, Relas H, Gudbjornsson B, Love T, Jones GT, Ciurea A, Codreanu C, Ionescu R, Nekvindova L, Zavada J, Atas N, Yolbaş S, Fagerli K, Michelsen B, Rotar Z, Tomsic M, Iannone F, Santos MJ, Ávila-Ribeiro P, Midtbøll Ørnbjerg L, Ǿstergaard M, Jacobsson LTH, Askling J, Nissen M. FRI0283 CO-MEDICATION WITH CSDMARD HAS LITTLE EFFECT ON THE RETENTION OF TNF INHIBITORS IN PSORIATIC ARTHRITIS, RESULTS FROM THE EUROSPA COLLABORATION. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Previous studies have suggested similar effectiveness, but longer treatment retention, for tumor necrosis factor inhibitors (TNFi), when used in combination with a conventional synthetic disease modifying anti-rheumatic drug (csDMARD) in psoriatic arthritis (PsA).Objectives:To describe patients with PsA initiating a first TNFi as monotherapy compared to combination therapy, and to explore 1-year treatment retention of TNFi in the two groups.Methods:Patients with PsA starting a first TNFi (2006-2017) were identified in biologics registers of 13 European countries, and data were pooled for analysis. Co-medication with csDMARD was determined at TNFi start.Because of large inter-country variation in TNFi retention, countries were split into two strata, depending on each country’s 1-year retention rate for TNFi being above (stratum A) or below (stratum B) the average 1-year retention rate.TNFi treatment retention was compared through Kaplan-Meier curves; the proportion remaining on the TNFi at one year; and hazard ratios (HR) during the first year: (i) crude; adjusted for (ii) country-strata, and (iii) country-strata, sex, age, calendar year, DAS28 and disease duration. In model (iii) only registers contributing >1000 patients or <33% missing data for DAS28 were included.Results:A total of 14778 patients with PsA starting a first TNFi were included. Baseline disease activity was similar within stratum B, but higher for the combination treatment group in stratum A (table 1).Table 1.Baseline characteristicsCountry strataStratum AStratum BTNFimonotherapyN=2120TNFi/csDMARDcombinationN=2128TNFimonotherapyN=3369TNFi/csDMARDcombinationN=7161Females52%51%53%51%Age, years49.7 (12.2)48.7 (11.8)48.8 (13.0)48.9 (12.2)Disease duration, yrs6.4 (7.0)6.8 (6.8)5.9 (7.5)5.9 (7.1)Tender joints 285.5 (6.3)8.0 (6.3)5.6 (6.0)5.6 (5.7)Swollen joints 282.8 (4.3)5.6 (5.0)3.0 (3.8)3.3 (3.8)VAS pain54 (29)62 (24)59 (23)56 (24)DAPSA-2824.6 (18.6)36.2 (17.6)27.3 (15.6)27.2 (15.2)DAS28 (CRP)3.5 (1.4)4.7 (1.3)4.0 (1.2)4.0 (1.1)Concomitant csDMARDMethotrexate-76%-79%Sulfasalazine-15%-15%Other csDMARD-49%-25%Numbers are means (sd) unless otherwise stated.The Kaplan-Meier curves for the treatment groups were similar within each stratum (fig 1), as were the proportions remaining on TNFi after one year, stratum A: monotherapy 86% (95%CI: 85-88) vs. combination 86% (84-87), stratum B: 71% (69-72) vs. 73% (72-74). The HRs for TNFi discontinuation (ref=TNFi monotherapy) were: (i) 1.06 (0.98-1.13), (ii) 0.94 (0.87-1.01), (iii) 0.89 (0.83-0.96), including 13078 patients (9 countries) for model (iii).Conclusion:In this exploratory study no benefit in TNFi retention was observed for csDMARD combination therapy in crude analyses, while in adjusted analyses an 11% lower risk of TNFi discontinuation was found. These preliminary results offer limited support for use of combination therapy in PsA. Further analyses will explore to what extent the results are affected by inter-country heterogeneity and differences between TNFi.Acknowledgments:UL and DDG contributed equally.Novartis Pharma AG and IQVIA support the EuroSpA collaboration.Disclosure of Interests:Ulf Lindström: None declared, Daniela Di Giuseppe: None declared, Bénédicte Delcoigne: None declared, Bente Glintborg Grant/research support from: Grants from Pfizer, Biogen and Abbvie, Burkhard Moeller: None declared, Manuel Pombo-Suarez Consultant of: Janssen, Lilly, MSD and Sanofi., Speakers bureau: Janssen, Lilly, MSD and Sanofi., Carlos Sánchez-Piedra: None declared, Kari Eklund Consultant of: Celgene, Lilly, Speakers bureau: Pfizer, Roche, Heikki Relas Grant/research support from: Abbvie., Consultant of: Abbvie, Celgene, and Pfizer., Speakers bureau: Abbvie, Celgene, and Pfizer., Björn Gudbjornsson Speakers bureau: Novartis and Amgen, Thorvardur Love: None declared, Gareth T. Jones Grant/research support from: Pfizer, AbbVie, UCB, Celgene and GSK., Adrian Ciurea Consultant of: Consulting and/or speaking fees from AbbVie, Bristol-Myers Squibb, Celgene, Eli Lilly, Merck Sharp & Dohme, Novartis and Pfizer., Catalin Codreanu Consultant of: Speaker and consulting fees from AbbVie, Accord Healthcare, Alfasigma, Egis, Eli Lilly, Ewopharma, Genesis, Mylan, Novartis, Pfizer, Roche, Sandoz, UCB, Speakers bureau: Speaker and consulting fees from AbbVie, Accord Healthcare, Alfasigma, Egis, Eli Lilly, Ewopharma, Genesis, Mylan, Novartis, Pfizer, Roche, Sandoz, UCB, Ruxandra Ionescu Consultant of: Consulting fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz, Speakers bureau: Consulting and speaker fees from Abbvie, Eli-Lilly, Novartis, Pfizer, Roche, Sandoz, Lucie Nekvindova: None declared, Jakub Zavada Speakers bureau: Abbvie, UCB, Sanofi, Elli-Lilly, Novartis, Zentiva, Accord, Nuh Atas: None declared, Servet Yolbaş: None declared, Karen Fagerli: None declared, Brigitte Michelsen Grant/research support from: Research support from Novartis, Consultant of: Consulting fees Novartis, Ziga Rotar Consultant of: Speaker and consulting fees from Abbvie, Amgen, Biogen, Eli Lilly, Medis, MSD, Novartis, Pfizer, Roche, Sanofi., Speakers bureau: Speaker and consulting fees from Abbvie, Amgen, Biogen, Eli Lilly, Medis, MSD, Novartis, Pfizer, Roche, Sanofi., Matija Tomsic: None declared, Florenzo Iannone Consultant of: Speaker and consulting fees from AbbVie, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, MSD, Speakers bureau: Speaker and consulting fees from AbbVie, Eli Lilly, Novartis, Pfizer, Roche, Sanofi, UCB, MSD, Maria Jose Santos Speakers bureau: Novartis and Pfizer, Pedro Ávila-Ribeiro Grant/research support from: Novartis, Lykke Midtbøll Ørnbjerg Grant/research support from: Novartis, Mikkel Ǿstergaard Grant/research support from: AbbVie, Bristol-Myers Squibb, Celgene, Merck, and Novartis, Consultant of: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Speakers bureau: AbbVie, Bristol-Myers Squibb, Boehringer Ingelheim, Celgene, Eli Lilly, Hospira, Janssen, Merck, Novartis, Novo Nordisk, Orion, Pfizer, Regeneron, Roche, Sandoz, Sanofi, and UCB, Lennart T.H. Jacobsson Consultant of: AbbVie, Eli Lilly, Janssen, Novartis and Pfizer, Johan Askling Grant/research support from: JA acts or has acted as PI for agreements between Karolinska Institutet and the following entities, mainly in the context of the ARTIS national safety monitoring programme of immunomodulators in rheumatology: Abbvie, BMS, Eli Lilly, Merck, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, and UCB Pharma, Michael Nissen Grant/research support from: Abbvie, Consultant of: Novartis, Lilly, Abbvie, Celgene and Pfizer, Speakers bureau: Novartis, Lilly, Abbvie, Celgene and Pfizer
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20
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Abstract
A number of research studies have shown that the unique need in bilinguals to manage both of their languages positively impacts their cognitive control processes. Yet, due to a dearth of studies at the sentence level, it is still unclear if this benefit extends to sentence processing. In monolinguals and bilinguals, cognitive control helps in reinterpretation of garden path sentences but it is still unknown how it supports the real-time resolution of interference during parsing, such as the type of interference seen in the processing of object relative (OR) sentences. In this study, we compared monolinguals and bilinguals during online spoken OR sentence processing and examined if both groups used cognitive control to resolve interference. In this eye-tracking visual world (ETL-vw) study, OR sentences were aurally presented to 19 monolingual and 21 Spanish-English bilingual adults while gaze patterns were captured throughout the time course of the sentence. Of particular interest was the post-verb position, where the listener connects the verb to its direct object. In OR constructions (e.g., "The man that the boy pushes__ has a red shirt."), the verb ('pushes') links to its syntactically licensed direct object ('the man') at verb offset. During syntactic linking, the parser crosses over an intervening noun phrase (NP, 'the boy') and the two NP activations create interference. The nature of this paradigm allows us to measure interference and its resolution between the intervening NP and the displaced object in real-time. By relating sentence processing patterns with cognitive control measures, high- and no- conflict N-Back tasks, we investigated group differences in the use of cognitive control during sentence processing. Overall, bilinguals showed less interference than monolinguals from the intervening NP during the real time processing of OR sentences. This interference effect and its resolution was significantly predicted by cognitive control skills for bilingual, but not monolingual listeners. This enhanced effect in bilinguals extends previous findings of interference resolution to real time spoken sentence processing suggesting that bilinguals are more efficient than monolinguals at managing interference during complex sentence processing.
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Affiliation(s)
- Niloofar Akhavan
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA, United States
- Center for Research in Language, University of California, San Diego, San Diego, CA, United States
- Joint Doctoral Program in Language and Communicative Disorders, San Diego State University/University of California, San Diego, San Diego, CA, United States
| | - Henrike K. Blumenfeld
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA, United States
- Joint Doctoral Program in Language and Communicative Disorders, San Diego State University/University of California, San Diego, San Diego, CA, United States
| | - Tracy Love
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA, United States
- Center for Research in Language, University of California, San Diego, San Diego, CA, United States
- Joint Doctoral Program in Language and Communicative Disorders, San Diego State University/University of California, San Diego, San Diego, CA, United States
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21
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Silkes JP, Baker C, Love T. The time course of priming in aphasia: An exploration of learning along a continuum of linguistic processing demands. Top Lang Disord 2020; 40:54-80. [PMID: 32103849 PMCID: PMC7043795 DOI: 10.1097/tld.0000000000000205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study investigates learning in aphasia as manifested through automatic priming effects. There is growing evidence that people with aphasia have impairments beyond language processing that could affect their response to treatment. Therefore, better understanding these mechanisms would be beneficial for improving methods of rehabilitation. This study assesses semantic and repetition priming effects at varied interstimulus intervals, using stimuli that are both non-linguistic and linguistic in tasks that range from requiring nearly no linguistic processing to requiring both lexical and semantic processing. Results indicate that people with aphasia maintain typical patterns of learning across both linguistic and non-linguistic tasks as long as the implicit prime-target relationship does not depend on deep levels of linguistic processing. As linguistic processing demands increase, those with agrammatic aphasia may require more time to take advantage of learning through implicit prime-target relationships, and people with both agrammatic and non-agrammatic aphasia are more susceptible to breakdown of the semantic networks as processing demands on that system increase.
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Affiliation(s)
| | - Carolyn Baker
- San Diego State University, University of California San Diego
| | - Tracy Love
- San Diego State University, University of California San Diego
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22
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Sheppard SM, Love T, Midgley KJ, Shapiro LP, Holcomb PJ. Using prosody during sentence processing in aphasia: Evidence from temporal neural dynamics. Neuropsychologia 2019; 134:107197. [PMID: 31542361 PMCID: PMC6911311 DOI: 10.1016/j.neuropsychologia.2019.107197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 04/17/2019] [Accepted: 09/18/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Shannon M Sheppard
- San Diego State University, USA; University of California, San Diego, USA.
| | - Tracy Love
- San Diego State University, USA; University of California, San Diego, USA
| | | | - Lewis P Shapiro
- San Diego State University, USA; University of California, San Diego, USA
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23
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Kim K, Adams L, Keator LM, Sheppard SM, Breining BL, Rorden C, Fridriksson J, Bonilha L, Rogalsky C, Love T, Hickok G, Hillis AE. Neural processing critical for distinguishing between speech sounds. Brain Lang 2019; 197:104677. [PMID: 31442633 PMCID: PMC6726570 DOI: 10.1016/j.bandl.2019.104677] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/29/2019] [Accepted: 08/04/2019] [Indexed: 06/10/2023]
Abstract
We aimed to identify neural regions where ischemia acutely after stroke is associated with impairment in phoneme discrimination, and to determine whether such deficits are associated with impairment of spoken word comprehension. We evaluated 33 patients within 48 h of left hemisphere ischemic stroke onset with tests of phoneme discrimination and word-picture matching. We identified Pearson correlations between accuracy in phoneme discrimination and accuracy of word comprehension and identified areas where the percentage of infarcted tissue was associated with severity of phoneme discrimination deficit. We found that 54% had deficits in phoneme discrimination relative to healthy controls. Accuracy in phoneme discrimination correlated with accuracy on word comprehension tests. Damage to left intraparietal sulcus and hypoperfusion and/or infarct of left superior temporal gyrus were associated with phoneme discrimination deficits acutely, although patients with these lesions showed improvement or resolution of the deficit by six months.
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Affiliation(s)
- Kevin Kim
- Department of Neurology, Johns Hopkins University School of Medicine, United States
| | - Luke Adams
- Department of Neurology, Johns Hopkins University School of Medicine, United States.
| | - Lynsey M Keator
- Department of Neurology, Johns Hopkins University School of Medicine, United States
| | - Shannon M Sheppard
- Department of Neurology, Johns Hopkins University School of Medicine, United States
| | - Bonnie L Breining
- Department of Neurology, Johns Hopkins University School of Medicine, United States
| | - Chris Rorden
- Department of Psychology, University of South Carolina, United States
| | - Julius Fridriksson
- Department of Communication Disorders, University of South Carolina, United States
| | - Leonardo Bonilha
- Department of Neurology, Medical University of South Carolina, United States
| | - Corianne Rogalsky
- Department of Speech & Hearing Science, Arizona State University, United States
| | - Tracy Love
- University of California San Diego, United States; San Diego State University, United States
| | - Gregory Hickok
- Departments of Cognitive Sciences & Language Science, University of California, Irvine, United States
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, United States
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24
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Hendrickson K, Love T, Walenski M, Friend M. The organization of words and environmental sounds in the second year: Behavioral and electrophysiological evidence. Dev Sci 2018; 22:e12746. [PMID: 30159958 DOI: 10.1111/desc.12746] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 05/18/2018] [Indexed: 11/30/2022]
Abstract
The majority of research examining early auditory-semantic processing and organization is based on studies of meaningful relations between words and referents. However, a thorough investigation into the fundamental relation between acoustic signals and meaning requires an understanding of how meaning is associated with both lexical and non-lexical sounds. Indeed, it is unknown how meaningful auditory information that is not lexical (e.g., environmental sounds) is processed and organized in the young brain. To capture the structure of semantic organization for words and environmental sounds, we record event-related potentials as 20-month-olds view images of common nouns (e.g., dog) while hearing words or environmental sounds that match the picture (e.g., "dog" or barking), that are within-category violations (e.g., "cat" or meowing), or that are between-category violations (e.g., "pen" or scribbling). Results show both words and environmental sounds exhibit larger negative amplitudes to between-category violations relative to matches. Unlike words, which show a greater negative response early and consistently to within-category violations, such an effect for environmental sounds occurs late in semantic processing. Thus, as in adults, the young brain represents semantic relations between words and between environmental sounds, though it more readily differentiates semantically similar words compared to environmental sounds.
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Affiliation(s)
- Kristi Hendrickson
- Department of Communication Sciences & Disorders, University of Iowa, Iowa City, Iowa
| | - Tracy Love
- Center for Research in Language, University of California, San Diego, California.,School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, California
| | - Matthew Walenski
- School of Communication, Northwestern University, Evanston, Illinois
| | - Margaret Friend
- Department of Psychology, San Diego State University, San Diego, California
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25
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Abstract
PURPOSE To evaluate processing and comprehension of pronouns and reflexives in individuals with agrammatic (Broca's) aphasia and age-matched control participants. Specifically, we evaluate processing and comprehension patterns in terms of a specific hypothesis -- the Intervener Hypothesis - that posits that the difficulty of individuals with agrammatic (Broca's) aphasia results from similarity-based interference caused by the presence of an intervening NP between two elements of a dependency chain. METHODS We used an eye tracking-while-listening paradigm to investigate real-time processing (Experiment 1) and a sentence-picture matching task to investigate final interpretive comprehension (Experiment 2) of sentences containing proforms in complement phrase and subject relative constructions. RESULTS Individuals with agrammatic aphasia demonstrated a greater proportion of gazes to the correct referent of reflexives relative to pronouns and significantly greater comprehension accuracy of reflexives relative to pronouns. CONCLUSIONS These results provide support for the Intervener Hypothesis, previous support for which comes from studies of Wh- questions and unaccusative verbs, and we argue that this account provides an explanation for the deficits of individuals with agrammatic aphasia across a growing set of sentence constructions. The current study extends this hypothesis beyond filler-gap dependencies to referential dependencies and allows us to refine the hypothesis in terms of the structural constraints that meet the description of the Intervener Hypothesis.
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Affiliation(s)
- Samantha Engel
- SDSU/UCSD Joint Doctoral Program in Language and Communicative Disorders
| | - Lewis P. Shapiro
- SDSU/UCSD Joint Doctoral Program in Language and Communicative Disorders
- School of Speech Language and Hearing Sciences, San Diego State University
| | - Tracy Love
- SDSU/UCSD Joint Doctoral Program in Language and Communicative Disorders
- School of Speech Language and Hearing Sciences, San Diego State University
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26
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Sheppard SM, Midgley KJ, Love T, Shapiro LP, Holcomb PJ. Electrophysiological evidence for the interaction of prosody and thematic fit during sentence comprehension. Lang Cogn Neurosci 2017; 33:547-562. [PMID: 29904641 PMCID: PMC5997268 DOI: 10.1080/23273798.2017.1390143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 09/26/2017] [Indexed: 06/08/2023]
Abstract
This study investigated the interaction of prosody and thematic fit/plausibility information during the processing of sentences containing temporary early closure (correct) or late closure (incorrect) syntactic ambiguities using event-related potentials (ERPs). Early closure sentences with congruent and incongruent prosody were presented where the temporarily ambiguous NP was either a plausible or an implausible continuation for the subordinate verb (e.g. "While the band played the song/beer pleased all the customers."). N400 and P600 components were examined at critical points in each condition. The CPS was examined in sentences with congruent prosody. Prosodic and thematic fit cues interacted immediately (N400-P600) at the implausible NP (beer), when it was paired with incongruent prosody. Incongruent prosody paired with a plausible NP (song) resulted in garden-path effects (N400-P600) at the critical verb (pleased). These findings provide strong evidence that prosodic and thematic fit/plausibility cues interact to aid the parser in syntactic structure building.
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Affiliation(s)
- Shannon M Sheppard
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA, USA
| | | | - Tracy Love
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA, USA
- Center for Research in Language, University of California, San Diego, La Jolla, CA, USA
| | - Lewis P Shapiro
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA, USA
- Center for Research in Language, University of California, San Diego, La Jolla, CA, USA
| | - Phillip J Holcomb
- Department of Psychology, San Diego State University, San Diego, CA, USA
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27
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Rogalsky C, LaCroix AN, Chen KH, Anderson SW, Damasio H, Love T, Hickok G. The Neurobiology of Agrammatic Sentence Comprehension: A Lesion Study. J Cogn Neurosci 2017; 30:234-255. [PMID: 29064339 DOI: 10.1162/jocn_a_01200] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Broca's area has long been implicated in sentence comprehension. Damage to this region is thought to be the central source of "agrammatic comprehension" in which performance is substantially worse (and near chance) on sentences with noncanonical word orders compared with canonical word order sentences (in English). This claim is supported by functional neuroimaging studies demonstrating greater activation in Broca's area for noncanonical versus canonical sentences. However, functional neuroimaging studies also have frequently implicated the anterior temporal lobe (ATL) in sentence processing more broadly, and recent lesion-symptom mapping studies have implicated the ATL and mid temporal regions in agrammatic comprehension. This study investigates these seemingly conflicting findings in 66 left-hemisphere patients with chronic focal cerebral damage. Patients completed two sentence comprehension measures, sentence-picture matching and plausibility judgments. Patients with damage including Broca's area (but excluding the temporal lobe; n = 11) on average did not exhibit the expected agrammatic comprehension pattern-for example, their performance was >80% on noncanonical sentences in the sentence-picture matching task. Patients with ATL damage ( n = 18) also did not exhibit an agrammatic comprehension pattern. Across our entire patient sample, the lesions of patients with agrammatic comprehension patterns in either task had maximal overlap in posterior superior temporal and inferior parietal regions. Using voxel-based lesion-symptom mapping, we find that lower performances on canonical and noncanonical sentences in each task are both associated with damage to a large left superior temporal-inferior parietal network including portions of the ATL, but not Broca's area. Notably, however, response bias in plausibility judgments was significantly associated with damage to inferior frontal cortex, including gray and white matter in Broca's area, suggesting that the contribution of Broca's area to sentence comprehension may be related to task-related cognitive demands.
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Affiliation(s)
| | | | - Kuan-Hua Chen
- University of Iowa.,University of California, Berkeley
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28
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Sheppard SM, Love T, Midgley KJ, Holcomb PJ, Shapiro LP. Electrophysiology of prosodic and lexical-semantic processing during sentence comprehension in aphasia. Neuropsychologia 2017; 107:9-24. [PMID: 29061490 DOI: 10.1016/j.neuropsychologia.2017.10.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 08/11/2017] [Accepted: 10/18/2017] [Indexed: 11/26/2022]
Abstract
Event-related potentials (ERPs) were used to examine how individuals with aphasia and a group of age-matched controls use prosody and themattic fit information in sentences containing temporary syntactic ambiguities. Two groups of individuals with aphasia were investigated; those demonstrating relatively good sentence comprehension whose primary language difficulty is anomia (Individuals with Anomic Aphasia (IWAA)), and those who demonstrate impaired sentence comprehension whose primary diagnosis is Broca's aphasia (Individuals with Broca's Aphasia (IWBA)). The stimuli had early closure syntactic structure and contained a temporary early closure (correct)/late closure (incorrect) syntactic ambiguity. The prosody was manipulated to either be congruent or incongruent, and the temporarily ambiguous NP was also manipulated to either be a plausible or an implausible continuation for the subordinate verb (e.g., "While the band played the song/the beer pleased all the customers."). It was hypothesized that an implausible NP in sentences with incongruent prosody may provide the parser with a plausibility cue that could be used to predict syntactic structure. The results revealed that incongruent prosody paired with a plausibility cue resulted in an N400-P600 complex at the implausible NP (the beer) in both the controls and the IWAAs, yet incongruent prosody without a plausibility cue resulted in an N400-P600 at the critical verb (pleased) only in healthy controls. IWBAs did not show evidence of N400 or P600 effects at the ambiguous NP or critical verb, although they did show evidence of a delayed N400 effect at the sentence-final word in sentences with incongruent prosody. These results suggest that IWAAs have difficulty integrating prosodic cues with underlying syntactic structure when lexical-semantic information is not available to aid their parse. IWBAs have difficulty integrating both prosodic and lexical-semantic cues with syntactic structure, likely due to a processing delay.
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Affiliation(s)
- Shannon M Sheppard
- Johns Hopkins University School of Medicine, United States; San Diego State University, United States.
| | - Tracy Love
- San Diego State University, United States; University of California, San Diego, United States
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29
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Kim E, Jones P, Richards CT, Prabhakaran S, Love T, Cranick L, O’Neill K, Sednew R, Scharnott M, Peysakhovich M, Meixner A, Mirostaw J, Alberts MJ. Abstract WP272: Impact of Stroke Legislation on Developing Stroke Systems of Care and Improving Acute Therapy. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.wp272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Stroke is the 4th leading cause of death in Illinois and the leading cause of disability. In 2009, Illinois passed stroke legislation to establish a Stroke Advisory Sub-committee to advise the State EMS Advisory Council. Legislation also created 11 multidisciplinary EMS Regional Stroke Advisory Subcommittees, recognition of certified Primary Stroke Centers, state designation of Emergent Stroke Ready hospitals and updating of EMS routing protocols. In 2014, updated legislation was passed to include state recognition of nationally certified Comprehensive Stroke Centers (CSC), updating of EMS routing protocols to include CSC’s and establish a state stroke fund created from hospital designation fees.
Hypothesis:
Implementation of Illinois’s stroke legislation by EMS region enhances systems of care collaboration between hospitals and EMS providers and improves timely intervention for patients with acute ischemic stroke.
Methods:
We queried the state-wide AHA’s Get With The Guideline stroke registry, which captured 72% of Illinois stroke discharges from 2009 through 2015. In total, 90 hospitals entered data, 57 from PSCs, 8 from CSCs, and 25 from Emergent Stroke Ready hospitals. All patients included in the registry as confirmed stroke were included for analysis. Hospital time and treatment data were recorded in an aggregate manner. Descriptive statistics were used to report results.
Results:
The total number of confirmed stroke patients treated was 123,859 Median door-to-needle (DTN) times for IV tPA therapy went from 85 minutes in 2009 to 56 in 2015 . The percent of acute ischemic stroke patients with a door-to-needle time of 60 minutes or less increased from 18.0% in 2009 to 62.9% in 2015.
Conclusions:
The decrease in DTN from 2009 to 2015 is an indicator of improved care due to the Illinois stroke system of care model. This is a good example of all system stakeholders including state government and EMS working collaboratively to improve care. Which elements of a stroke system are responsible for this improvement (hospital designation, routing, EMS training) will require further research. Regional coordination of resources and state hospital designation may impact prehospital routing of suspected strokes and may improve patient outcomes.
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Affiliation(s)
| | - Peggy Jones
- Illinois Critical Access Hosp Network, Princeton, IL
| | - Christopher T Richards
- Dept of Emergency Medicine & Cntr for Healthcare Studies, Northwestern Feinberg Sch of Medicine, Chicago, IL
| | | | - Tracy Love
- Neurology, Freeport Hosp Network, Freeport, IL
| | - Lesley Cranick
- Neurology, Southern IL Healthcare- Retired, Carbondale, IL
| | | | - Renee Sednew
- Quality & Systems Improvement, American Heart Association, Midwest Affiliate, Chicago, IL
| | | | - Mark Peysakhovich
- Advocacy, American Heart Association, Midwest Affiliate, Chicago, IL
| | - Alex Meixner
- American Heart Association, Midwest Affiliate, Chicago, IL
| | - Julie Mirostaw
- Advocacy, American Heart Association, Midwest Affiliate, Chicago, IL
| | - Mark J Alberts
- Dept of Neurology and Neurotherapeutics, Univ of Texas Southwestern Med Cntr, Dallas, TX
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30
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Abstract
BACKGROUND Individuals with agrammatic Broca's aphasia (IWBA) exhibit a delay in lexical activation in S-V-O word order sentences and delayed lexical reactivation in sentences that contain syntactic dependencies. This pattern is in contrast to neurologically unimpaired individuals who immediately evince lexical reactivation at the gap in sentences that contain syntactic dependencies. However, in the case of sentences that contain unaccusative verbs, neurologically unimpaired individuals also exhibit a delay in lexical reactivation. This delay provides a unique opportunity to further examine lexical delays in IWBA. AIM The purpose of the current studies is to investigate the online comprehension of sentences that contain unaccusative verbs in IWBA and in a group of age-matched control (AMC) individuals. METHODS AND PROCEDURES Cross-modal picture priming was used to test for priming of a displaced lexical item (direct object noun) immediately after the unaccusative verb (at the gap) during the ongoing auditory stream and at three additional time points downstream from the verb (500 ms, 750 ms, and 1,250 ms). OUTCOMES AND RESULTS Delayed reactivation of the displaced lexical item downstream from the gap (similar to prior reports of delayed reactivation with younger unimpaired listeners) for both the AMCs and the IWBA was found. CONCLUSION These results provide support that IWBA do not evince a delayed time course of lexical reactivation for unaccusative verbs compared to neurologically unimpaired individuals.
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Affiliation(s)
- Natalie Sullivan
- SDSU/UCSD Joint Doctoral Program in Language and Communicative Disorders, School of Speech, Language, and Hearing Sciences, San Diego, CA, USA
| | - Matthew Walenski
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA, USA
| | - Tracy Love
- SDSU/UCSD Joint Doctoral Program in Language and Communicative Disorders, School of Speech, Language, and Hearing Sciences, San Diego, CA, USA
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA, USA
| | - Lewis P. Shapiro
- SDSU/UCSD Joint Doctoral Program in Language and Communicative Disorders, School of Speech, Language, and Hearing Sciences, San Diego, CA, USA
- School of Speech, Language, and Hearing Sciences, San Diego State University, San Diego, CA, USA
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31
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Walenski M, Love T. The Real-Time Comprehension of Idioms by Typical Children, Children with Specific Language Impairment and Children with Autism. J Speech Pathol Ther 2017; 3. [PMID: 29877517 PMCID: PMC5986079 DOI: 10.4172/2472-5005.1000130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Objective We examined on-line auditory idiom comprehension in typically developing (TD) children, children with specific language impairment (SLI), and children with autism. Theories of idiom processing in adults agree on a reliance on lexical/semantic memory for these forms, but differ in their specifics. The Lexical Representation hypothesis claims that literal and non-literal meanings are activated in parallel. The Configuration hypothesis claims that a non-literal meaning will take precedence, such that a literal meaning may not be activated at all. Method Children aged 6–16 years listened to sentences containing idioms for a cross-modal priming task. The idioms were ambiguous between an idiomatic and a literal meaning. We looked at priming for both meanings at the offset of the idiom. Results TD children (n=14) and children with SLI (n=7) primed for the idiomatic but not literal meaning of the idiom. Children with autism (n=5) instead primed for the literal but not idiomatic meaning. Conclusions TD children showed an adult-like pattern, consistent with predictions of the Configuration Hypothesis. Children with SLI showed the typical pattern, whereas the atypical pattern observed for children with autism may reflect a particular deficit with complex material in semantic memory.
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Affiliation(s)
- Matthew Walenski
- Department of Communication Sciences and Disorders, Northwestern University, USA
| | - Tracy Love
- School of Speech Language and Hearing Sciences, San Diego State University, USA.,Center for Research in Language, University of California San Diego, USA
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Abstract
A variety of biological evidence has identified a frontal-parietal circuit underlying spatial working memory for visual stimuli. But the question remains, how do these neural regions accomplish the goal of maintaining location information on-line? We tested the hypothesis that the active rehearsal of spatial information in working memory is accomplished by means of focal shifts of spatial selective attention to memorized locations. Spatial selective attention has been shown to cause changes in the early visual processing of stimuli that appear in attended locations. Thus, the hypothesis of attention-based rehearsal predicts similar modulations of visual processing at memorized locations. We used functional magnetic resonance imaging to observe posterior visual activations during the performance of a spatial working memory task. In line with the hypothesis, spatial rehearsal led to enhanced activation in the early visual areas contralateral to the memorized locations.
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Affiliation(s)
- Edward Awh
- Department of Psychology, University of Oregon
| | - John Jonides
- Department of Psychology, University of Michigan
| | | | | | - Larry R. Frank
- Department of Radiology, University of California, San Diego
| | - Tracy Love
- Department of Psychology, University of California, San Diego
| | - Eric C. Wong
- Department of Radiology, University of California, San Diego
| | - Leon Gmeindl
- Department of Psychology, University of Michigan
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Sullivan N, Walenski M, Love T, Shapiro LP. The comprehension of sentences with unaccusative verbs in aphasia: a test of the intervener hypothesis. Aphasiology 2016; 31:67-81. [PMID: 27909354 PMCID: PMC5125727 DOI: 10.1080/02687038.2016.1154499] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND It is well accepted that individuals with agrammatic Broca's aphasia have difficulty comprehending some sentences with filler-gap dependencies. While investigations of these difficulties have been conducted with several different sentence types (e.g., object relatives, Wh-questions), we explore sentences containing unaccusative verbs, which arguably have a single noun phrase (NP) that is base-generated in object position but then is displaced to surface subject position. Unaccusative verbs provide an ideal test case for a particular hypothesis about the comprehension disorder-the Intervener Hypothesis-that posits that the difficulty individuals with agrammatic Broca's aphasia have comprehending sentences containing filler-gap dependencies results from similarity-based interference caused by the presence of an intervening NP between the two elements of a syntactic chain. AIM To assess a particular account of the comprehension deficit in agrammatic Broca's aphasia-the Intervener Hypothesis. METHODS & PROCEDURES We used a sentence-picture matching task to determine if listeners with agrammatic Broca's aphasia (LWBA) and age-matched neurologically unimpaired controls (AMC) have difficulty comprehending unaccusative verbs when placed in subject relative and complement phrase (CP) constructions. OUTCOMES & RESULTS We found above-chance comprehension of both sentence constructions with the AMC participants. In contrast, we found above-chance comprehension of CP sentences containing unaccusative verbs but poor comprehension of subject relative sentences containing unaccusative verbs for the LWBA. CONCLUSIONS These results provide support for the Intervener Hypothesis, wherein the presence of an intervening NP between two elements of a filler-gap dependency adversely affects sentence comprehension.
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Affiliation(s)
- Natalie Sullivan
- SDSU/UCSD Joint Doctoral Program in Language and Communicative Disorders, San Diego, CA, USA
| | - Matthew Walenski
- School of Speech Language and Hearing Sciences, San Diego State University, San Diego, CA, USA
| | - Tracy Love
- SDSU/UCSD Joint Doctoral Program in Language and Communicative Disorders, San Diego, CA, USA
- School of Speech Language and Hearing Sciences, San Diego State University, San Diego, CA, USA
| | - Lewis P. Shapiro
- SDSU/UCSD Joint Doctoral Program in Language and Communicative Disorders, San Diego, CA, USA
- School of Speech Language and Hearing Sciences, San Diego State University, San Diego, CA, USA
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Sheppard SM, Walenski M, Love T, Shapiro LP. The Auditory Comprehension of Wh-Questions in Aphasia: Support for the Intervener Hypothesis. J Speech Lang Hear Res 2015; 58:781-97. [PMID: 25675427 PMCID: PMC4490095 DOI: 10.1044/2015_jslhr-l-14-0099] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 07/08/2014] [Accepted: 01/10/2015] [Indexed: 05/20/2023]
Abstract
PURPOSE This study examines 3 hypotheses about the processing of wh-questions in both neurologically healthy adults and adults with Broca's aphasia. METHOD We used an eye tracking while listening method with 32 unimpaired participants (Experiment 1) and 8 participants with Broca's aphasia (Experiment 2). Accuracy, response time, and online gaze data were collected. RESULTS In Experiment 1, we established a baseline for how unimpaired processing and comprehension of 4 types of wh-question (subject- and object-extracted who- and which-questions) manifest. There was no unambiguous support found for any of the 3 hypotheses in Experiment 1. In Experiment 2 with the Broca's participants, however, we found significantly lower accuracy, slower response times, and increased interference in our gaze data in the object-extracted which-questions relative to the other conditions. CONCLUSIONS Our results provide support for the intervener hypothesis, which states that sentence constructions that contain an intervener (a lexical noun phrase) between a displaced noun phrase and its gap site result in a significant processing disadvantage relative to other constructions. We argue that this hypothesis offers a compelling explanation for the comprehension deficits seen in some participants with Broca's aphasia.
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Affiliation(s)
| | | | - Tracy Love
- San Diego State University, CA
- University of California, San Diego, CA
| | - Lewis P. Shapiro
- San Diego State University, CA
- University of California, San Diego, CA
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Rogalsky C, Poppa T, Chen KH, Anderson SW, Damasio H, Love T, Hickok G. Speech repetition as a window on the neurobiology of auditory-motor integration for speech: A voxel-based lesion symptom mapping study. Neuropsychologia 2015; 71:18-27. [PMID: 25777496 DOI: 10.1016/j.neuropsychologia.2015.03.012] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 03/11/2015] [Accepted: 03/12/2015] [Indexed: 10/23/2022]
Abstract
For more than a century, speech repetition has been used as an assay for gauging the integrity of the auditory-motor pathway in aphasia, thought classically to involve a linkage between Wernicke's area and Broca's area via the arcuate fasciculus. During the last decade, evidence primarily from functional imaging in healthy individuals has refined this picture both computationally and anatomically, suggesting the existence of a cortical hub located at the parietal-temporal boundary (area Spt) that functions to integrate auditory and motor speech networks for both repetition and spontaneous speech production. While functional imaging research can pinpoint the regions activated in repetition/auditory-motor integration, lesion-based studies are needed to infer causal involvement. Previous lesion studies of repetition have yielded mixed results with respect to Spt's critical involvement in speech repetition. The present study used voxel-based lesion symptom mapping (VLSM) to investigate the neuroanatomy of repetition of both real words and non-words in a sample of 47 patients with focal left hemisphere brain damage. VLSMs identified a large voxel cluster spanning gray and white matter in the left temporal-parietal junction, including area Spt, where damage was significantly related to poor non-word repetition. Repetition of real words implicated a very similar dorsal network including area Spt. Cortical regions including Spt were implicated in repetition performance even when white matter damage was factored out. In addition, removing variance associated with speech perception abilities did not alter the overall lesion pattern for either task. Together with past functional imaging work, our results suggest that area Spt is integral in both word and non-word repetition, that its contribution is above and beyond that made by white matter pathways, and is not driven by perceptual processes alone. These findings are highly consistent with the claim that Spt is an area of sensory-motor translation in speech processing.
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Affiliation(s)
- Corianne Rogalsky
- Department of Speech and Hearing Science, Arizona State University, USA.
| | - Tasha Poppa
- Center for Cognitive Neuroscience & Department of Cognitive Sciences, University of California, Irvine, USA
| | | | | | - Hanna Damasio
- Brain & Creativity Institute & Dana and David Dornsife Cognitive Neuroscience Imaging Center, University of Southern California, USA
| | - Tracy Love
- School of Speech, Language and Hearing Sciences, San Diego State University & Department of Psychology, University of California, San Diego, USA
| | - Gregory Hickok
- Center for Cognitive Neuroscience & Department of Cognitive Sciences, University of California, Irvine, USA
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Oskarsdottir T, Gunnarsdottir AI, Gunnarsson PS, Love T, Gudbjornsson B. INT-004 Patient adherence to TNFα inhibitors in patients with rheumatoid arthritis and psoriatic arthritis. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2015-000639.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Oskarsdottir T, Gunnarsdottir AI, Gunnarsson PS, Love T, Gudbjornsson B. INT-004 Patient adherence to TNFα inhibitors in patients with rheumatoid arthritis and psoriatic arthritis. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2015-000639.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Love T, Schneiderman J. Abstract T P349: Pre-Hospital Notification by Emergency Medical Services and Improved Stroke Care. Stroke 2015. [DOI: 10.1161/str.46.suppl_1.tp349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
In rural settings, distance is a factor when medical assistance is critical. Every minute can make a difference in treatment and recovery of a stroke patient. Early recognition and notification of a possible stroke are key elements in the chain of survival for stroke victims. Emergency Medical Services (EMS) involvement in pre-hospital notification of a stroke patient can improve assessment and diagnostic times and use of alteplase.
Purpose:
The purpose of this study was to compare times of specific assessments, diagnostics, and treatments with EMS stroke alert activation prior to arrival compared to stroke alert activation by hospital personnel after patient arrival.
Methods:
In the setting of a rural, community hospital, the local fire department/paramedics were trained to use a screening tool and to provide pre-hospital activation of a stroke alert. The trial demonstrated positive results. Subsequently, education was disseminated to EMS providers throughout the five county service area. Data was collected from January to December 2013, with 30 alerts activated by Emergency Department (ED) personnel and 22 activated by EMS pre-hospital (n=52). Data consisted of times from door to: physician, Computer Tomography (CT) scan, CT read, laboratory, stroke team, decision for alteplase, and needle time.
Results:
The average time from door to physician yielded a decrease by 13 minutes for an EMS alert compared to ED alert. Average door to CT scan time were decreased by 6 minutes using the EMS alert. Average times from door to laboratory completion decreased by 5 minutes using the EMS alert. Average time for door to stroke team was decreased by 9 minutes using the EMS alert. Door to needle times did not differ between groups, but the percentage of patients receiving alteplase increased in the EMS alert group (18.2% with EMS alert compared to 3.3% with an ED alert).
Conclusion:
In conclusion, the findings of this study suggest times for assessment are improved through EMS pre-notification and early initiation of the hospital stroke-alert system. It also shows an increase in the use of alteplase when there is pre-hospital notification of a potential stroke patient.
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Hendrickson K, Walenski M, Friend M, Love T. The organization of words and environmental sounds in memory. Neuropsychologia 2015; 69:67-76. [PMID: 25624059 DOI: 10.1016/j.neuropsychologia.2015.01.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 11/21/2014] [Accepted: 01/23/2015] [Indexed: 11/24/2022]
Abstract
In the present study we used event-related potentials to compare the organization of linguistic and meaningful nonlinguistic sounds in memory. We examined N400 amplitudes as adults viewed pictures presented with words or environmental sounds that matched the picture (Match), that shared semantic features with the expected match (Near Violation), and that shared relatively few semantic features with the expected match (Far Violation). Words demonstrated incremental N400 amplitudes based on featural similarity from 300-700ms, such that both Near and Far Violations exhibited significant N400 effects, however Far Violations exhibited greater N400 effects than Near Violations. For environmental sounds, Far Violations but not Near Violations elicited significant N400 effects, in both early (300-400ms) and late (500-700ms) time windows, though a graded pattern similar to that of words was seen in the mid-latency time window (400-500ms). These results indicate that the organization of words and environmental sounds in memory is differentially influenced by featural similarity, with a consistently fine-grained graded structure for words but not sounds.
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Affiliation(s)
- Kristi Hendrickson
- Center for Research in Language, University of California, San Diego, USA; School of Speech, Language, and Hearing Sciences, San Diego State University, USA; Joint Doctoral Program in Language and Communicative Disorders, San Diego State University, USA.
| | - Matthew Walenski
- School of Speech, Language, and Hearing Sciences, San Diego State University, USA.
| | | | - Tracy Love
- Center for Research in Language, University of California, San Diego, USA; School of Speech, Language, and Hearing Sciences, San Diego State University, USA.
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Kimes K, Love T, Bingham J, Marquart J. Repair of an unwanted navel piercing. Dermatol Surg 2014; 41:180-1. [PMID: 25533162 DOI: 10.1097/dss.0000000000000222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Kate Kimes
- Department of Dermatology, Walter Reed National Military Medical Center, Bethesda, Maryland
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Tomasson G, Peloquin C, Mohammad A, Love T, Zhang Y, Choi H, Merkel P. Risk of cardiovascular disease early and late after a diagnosis of giant cell arteritis. Presse Med 2013. [DOI: 10.1016/j.lpm.2013.02.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Callahan SM, Walenski M, Love T. The processing and interpretation of verb phrase ellipsis constructions by children at normal and slowed speech rates. J Speech Lang Hear Res 2012; 55:710-725. [PMID: 22223886 PMCID: PMC3703828 DOI: 10.1044/1092-4388(2011/10-0281)] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE To examine children's comprehension of verb phrase (VP) ellipsis constructions in light of their automatic, online structural processing abilities and conscious, metalinguistic reflective skill. METHOD Forty-two children ages 5 through 12 years listened to VP ellipsis constructions involving the strict/sloppy ambiguity (e.g., "The janitor untangled himself from the rope and the fireman in the elementary school did too after the accident.") in which the ellipsis phrase ("did too") had 2 interpretations: (a) strict ("untangled the janitor") and (b) sloppy ("untangled the fireman"). We examined these sentences at a normal speech rate with an online cross-modal picture priming task (n = 14) and an offline sentence-picture matching task (n = 11). Both tasks were also given with slowed speech input (n = 17). RESULTS Children showed priming for both the strict and sloppy interpretations at a normal speech rate but only for the strict interpretation with slowed input. Offline, children displayed an adultlike preference for the sloppy interpretation with normal-rate input but a divergent pattern with slowed speech. CONCLUSIONS Our results suggest that children and adults rely on a hybrid syntax-discourse model for the online comprehension and offline interpretation of VP ellipsis constructions. This model incorporates a temporally sensitive syntactic process of VP reconstruction (disrupted with slow input) and a temporally protracted discourse effect attributed to parallelism (preserved with slow input).
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Affiliation(s)
- Sarah M. Callahan
- School of Speech, Language, and Hearing Sciences, San Diego State University
| | - Matthew Walenski
- School of Speech, Language, and Hearing Sciences, San Diego State University
- Center for Research in Language, University of California, San Diego
| | - Tracy Love
- School of Speech, Language, and Hearing Sciences, San Diego State University
- Center for Research in Language, University of California, San Diego
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Abstract
PURPOSE To investigate the time-course of processing of lexical items in auditorily presented canonical (subject-verb-object) constructions in young, neurologically unimpaired control participants and participants with left-hemisphere damage and agrammatic aphasia. METHOD A cross modal picture priming (CMPP) paradigm was used to test 114 control participants and 8 participants with agrammatic aphasia for priming of a lexical item (direct object noun) immediately after it is initially encountered in the ongoing auditory stream and at 3 additional time points at 400-ms intervals. RESULTS The control participants demonstrated immediate activation of the lexical item, followed by a rapid loss (decay). The participants with aphasia demonstrated delayed activation of the lexical item. CONCLUSION This evidence supports the hypothesis of a delay in lexical activation in people with agrammatic aphasia. The delay in lexical activation feeds syntactic processing too slowly, contributing to comprehension deficits in people with agrammatic aphasia.
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Affiliation(s)
- Michelle Ferrill
- San Diego State University, CA
- University of California, San Diego
| | - Tracy Love
- San Diego State University, CA
- University of California, San Diego
| | - Matthew Walenski
- San Diego State University, CA
- University of California, San Diego
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Lane BR, Russo P, Uzzo R, Hernandez AV, Boorjian SA, Thompson RH, Fergany AF, Love T, Campbell S. Use of comparison of cold and warm ischemia during partial nephrectomy in 660 solitary kidneys to investigate the role of nonmodifiable factors in determining ultimate renal function. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.7_suppl.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
321 Background: Factors that determine renal function after partial nephrectomy (PN) are not well defined, including the impact of cold vs. warm ischemia and the relative importance of modifiable and non-modifiable factors. We studied these determinants in a large cohort of patients with a solitary functioning kidney undergoing PN. Methods: In 1980–2009, 660 PN were performed at 4 centers for tumor in a solitary-functioning kidney under cold (n=300) or warm (n=360) ischemia. Data were collected in IRB-approved registries; follow- up averaged 4.5 years. Pre- and postoperative glomerular filtration rates (GFR) were estimated via CKD-EPI equation. Results: At 3 months after PN, median GFR decreased by equivalent amounts with cold or warm ischemia (21% vs. 22%, respectively, p=0.7) although median cold ischemic times were much longer (45 vs. 22 min. respectively, p<0.001). In multivariable analyses, increasing age, larger tumor size, lower preoperative GFR, and longer ischemia time were associated with decreased postoperative GFR (p<0.05). When percentage of parenchyma spared was incorporated into the analysis, this factor and preoperative GFR proved to be the primary determinants of ultimate renal function, and duration of ischemia lost statistical significance. Conclusions: This non-randomized comparative study suggests that long-term renal function after PN is determined primarily by the quantity and quality of renal parenchyma that can be preserved. Within the relatively strict parameters of conventional practice, i.e. predominantly short ischemic intervals and liberal use of hypothermia, ischemia time was not an independent predictor of ultimate renal function after PN. Nevertheless, type and duration of ischemia remain the most important modifiable factors during PN, and mandate further study. [Table: see text]
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Affiliation(s)
- B. R. Lane
- Spectrum Health, Michigan State University, Grand Rapids, MI; Memorial Sloan-Kettering Cancer Center, New York, NY; Fox Chase Cancer Center, Philadelphia, PA; Cleveland Clinic, Cleveland, OH; Mayo Clinic, Rochester, MN; MetroHealth Medical Center, Cleveland, OH; Glickman Urological and Kidney Institute Cleveland Clinic, Cleveland, OH
| | - P. Russo
- Spectrum Health, Michigan State University, Grand Rapids, MI; Memorial Sloan-Kettering Cancer Center, New York, NY; Fox Chase Cancer Center, Philadelphia, PA; Cleveland Clinic, Cleveland, OH; Mayo Clinic, Rochester, MN; MetroHealth Medical Center, Cleveland, OH; Glickman Urological and Kidney Institute Cleveland Clinic, Cleveland, OH
| | - R. Uzzo
- Spectrum Health, Michigan State University, Grand Rapids, MI; Memorial Sloan-Kettering Cancer Center, New York, NY; Fox Chase Cancer Center, Philadelphia, PA; Cleveland Clinic, Cleveland, OH; Mayo Clinic, Rochester, MN; MetroHealth Medical Center, Cleveland, OH; Glickman Urological and Kidney Institute Cleveland Clinic, Cleveland, OH
| | - A. V. Hernandez
- Spectrum Health, Michigan State University, Grand Rapids, MI; Memorial Sloan-Kettering Cancer Center, New York, NY; Fox Chase Cancer Center, Philadelphia, PA; Cleveland Clinic, Cleveland, OH; Mayo Clinic, Rochester, MN; MetroHealth Medical Center, Cleveland, OH; Glickman Urological and Kidney Institute Cleveland Clinic, Cleveland, OH
| | - S. A. Boorjian
- Spectrum Health, Michigan State University, Grand Rapids, MI; Memorial Sloan-Kettering Cancer Center, New York, NY; Fox Chase Cancer Center, Philadelphia, PA; Cleveland Clinic, Cleveland, OH; Mayo Clinic, Rochester, MN; MetroHealth Medical Center, Cleveland, OH; Glickman Urological and Kidney Institute Cleveland Clinic, Cleveland, OH
| | - R. H. Thompson
- Spectrum Health, Michigan State University, Grand Rapids, MI; Memorial Sloan-Kettering Cancer Center, New York, NY; Fox Chase Cancer Center, Philadelphia, PA; Cleveland Clinic, Cleveland, OH; Mayo Clinic, Rochester, MN; MetroHealth Medical Center, Cleveland, OH; Glickman Urological and Kidney Institute Cleveland Clinic, Cleveland, OH
| | - A. F. Fergany
- Spectrum Health, Michigan State University, Grand Rapids, MI; Memorial Sloan-Kettering Cancer Center, New York, NY; Fox Chase Cancer Center, Philadelphia, PA; Cleveland Clinic, Cleveland, OH; Mayo Clinic, Rochester, MN; MetroHealth Medical Center, Cleveland, OH; Glickman Urological and Kidney Institute Cleveland Clinic, Cleveland, OH
| | - T. Love
- Spectrum Health, Michigan State University, Grand Rapids, MI; Memorial Sloan-Kettering Cancer Center, New York, NY; Fox Chase Cancer Center, Philadelphia, PA; Cleveland Clinic, Cleveland, OH; Mayo Clinic, Rochester, MN; MetroHealth Medical Center, Cleveland, OH; Glickman Urological and Kidney Institute Cleveland Clinic, Cleveland, OH
| | - S. Campbell
- Spectrum Health, Michigan State University, Grand Rapids, MI; Memorial Sloan-Kettering Cancer Center, New York, NY; Fox Chase Cancer Center, Philadelphia, PA; Cleveland Clinic, Cleveland, OH; Mayo Clinic, Rochester, MN; MetroHealth Medical Center, Cleveland, OH; Glickman Urological and Kidney Institute Cleveland Clinic, Cleveland, OH
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Rogalsky C, Love T, Driscoll D, Anderson SW, Hickok G. Are mirror neurons the basis of speech perception? Evidence from five cases with damage to the purported human mirror system. Neurocase 2011; 17:178-87. [PMID: 21207313 PMCID: PMC3681806 DOI: 10.1080/13554794.2010.509318] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The discovery of mirror neurons in macaque has led to a resurrection of motor theories of speech perception. Although the majority of lesion and functional imaging studies have associated perception with the temporal lobes, it has also been proposed that the 'human mirror system', which prominently includes Broca's area, is the neurophysiological substrate of speech perception. Although numerous studies have demonstrated a tight link between sensory and motor speech processes, few have directly assessed the critical prediction of mirror neuron theories of speech perception, namely that damage to the human mirror system should cause severe deficits in speech perception. The present study measured speech perception abilities of patients with lesions involving motor regions in the left posterior frontal lobe and/or inferior parietal lobule (i.e., the proposed human 'mirror system'). Performance was at or near ceiling in patients with fronto-parietal lesions. It is only when the lesion encroaches on auditory regions in the temporal lobe that perceptual deficits are evident. This suggests that 'mirror system' damage does not disrupt speech perception, but rather that auditory systems are the primary substrate for speech perception.
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Affiliation(s)
- Corianne Rogalsky
- Dana and David Dornsife Cognitive Neuroscience Imaging Center, Brain & Creativity Institute, University of Southern California, Los Angeles, USA
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Cornew L, Carver L, Love T. There's more to emotion than meets the eye: A processing bias for neutral content in the domain of emotional prosody. Cogn Emot 2010; 24:1133-1152. [PMID: 21552425 DOI: 10.1080/02699930903247492] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Research on emotion processing in the visual modality suggests a processing advantage for emotionally salient stimuli, even at early sensory stages; however, results concerning the auditory correlates are inconsistent. We present two experiments that employed a gating paradigm to investigate emotional prosody. In Experiment 1, participants heard successively building segments of Jabberwocky "sentences" spoken with happy, angry, or neutral intonation. After each segment, participants indicated the emotion conveyed and rated their confidence in their decision. Participants in Experiment 2 also heard Jabberwocky "sentences" in successive increments, with half discriminating happy from neutral prosody, and half discriminating angry from neutral prosody. Participants in both experiments identified neutral prosody more rapidly and accurately than happy or angry prosody. Confidence ratings were greater for neutral sentences, and error patterns also indicated a bias for recognising neutral prosody. Taken together, results suggest that enhanced processing of emotional content may be constrained by stimulus modality.
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Love T, Swinney D, Wong E, Buxton R. Perfusion imaging and stroke: A more sensitive measure of the brain bases of cognitive deficits. Aphasiology 2010; 16:873-883. [PMID: 30906100 PMCID: PMC6428076 DOI: 10.1080/02687030244000356] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
AIMS We provide evidence that the use of perfusion imaging reveals the neuroanatomical basis for a behaviourally demonstrated cognitive deficit that is not revealed via standard neuroradiological imaging techniques. METHODS & PROCEDURES We present a case study of a 52-year-old female stroke survivor (16 years post onset) whose speech was fluent and grammatical with some word-finding difficulties that were typically overcome with common circumlocution strategies. Based on standardised measures, the patient's clinical diagnosis was anomie aphasia. In addition to word-finding deficits, it was discovered that this patient also demonstrated difficulties in reading; while able to eventually read and understand text, there was extreme difficulty in completing such tasks. A series of experimental findings exploring this reading deficit are presented. This patient's lesion, as revealed via structural brain imaging, did not involve a brain region typically implicated in reading dysfunction. This behaviour-lesion inconsistency was explored via perfusion MRI technology as a means of assessing whether other neural regions not directly implicated in the structural scans (such as the angular gyros) could in fact show some level of dysfunction. OUTCOMES & RESULTS BEHAVIOURAL Analysis of the patient's overall reading time demonstrated that as compared to a matched control, this patient took significantly more time in reading paragraphs both silently and aloud. In addition, the patient produced more errors (fillers, pauses, elongations) than the matched control during the reading paragraphs aloud and story-retelling conditions. There were no differences exhibited between the patient and control with respect to content accuracy produced during these conditions. OUTCOMES & RESULTS NEURORADIOLOGICAL Structural images demonstrate damage to the left basal ganglia and surrounding white matter with sparing of the left insular cortex. Collection of perfusion images (pulsed arterial spin labelling) clearly demonstrates hypoperfusion in the seemingly intact brain regions of the left angular gyros and the left supramarginal gyrus. CONCLUSIONS This paper presents evidence from a detailed case study that the use of perfusion imaging successfully reveals the neural basis for a reading deficit in a stroke survivor that is not revealed via standard "structural" neuroradiological imaging techniques. We argue for more standardised use of perfusion imaging, in that it reveals a brain basis for "functional lesions", which less sensitive neuroimaging measures often fail to capture.
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Affiliation(s)
- Tracy Love
- University of California, San Diego, USA
| | | | - Eric Wong
- University of California, San Diego, USA
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Brumm K, Walenski M, Haist F, Robbins SL, Granet DB, Love T. Functional magnetic resonance imaging of a child with Alice in Wonderland syndrome during an episode of micropsia. J AAPOS 2010; 14:317-22. [PMID: 20598927 PMCID: PMC2928409 DOI: 10.1016/j.jaapos.2010.03.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 03/09/2010] [Accepted: 03/29/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND Alice in Wonderland syndrome is a perceptual disorder involving brief, transient episodes of visual distortions (metamorphopsia) and can occur in conjunction with certain viral infections. We used functional magnetic resonance imaging to examine visual processing in a 12-year-old boy with viral-onset Alice in Wonderland syndrome during an episode of micropsia (reduction in the perceived size of a form). METHODS Functional magnetic resonance imaging was conducted in response to a passive viewing task (reversing checkerboard) and an active viewing task (line-length decisions in the context of the Ponzo illusion). RESULTS In both tasks, the child with Alice in Wonderland syndrome showed reduced activation in primary and extrastriate visual cortical regions but increased activation in parietal lobe cortical regions as compared with a matched control participant. CONCLUSIONS The active experience of micropsia in viral-onset Alice in Wonderland syndrome reflects aberrant activity in primary and extrastriate visual cortical regions as well as parietal cortices. The disparate patterns of activity in these regions are discussed in detail.
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Affiliation(s)
- Kathleen Brumm
- Joint Doctoral Program in Language and Communicative Disorders, San Diego State University/University of California-San Diego, 5500 Campanile Drive, San Diego, CA 92182-1518, USA
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Brumm KP, Perthen JE, Liu TT, Haist F, Ayalon L, Love T. An arterial spin labeling investigation of cerebral blood flow deficits in chronic stroke survivors. Neuroimage 2010; 51:995-1005. [PMID: 20211268 PMCID: PMC2879883 DOI: 10.1016/j.neuroimage.2010.03.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 01/29/2010] [Accepted: 03/02/2010] [Indexed: 10/19/2022] Open
Abstract
Although the acute stroke literature indicates that cerebral blood flow (CBF) may commonly be disordered in stroke survivors, limited research has investigated whether CBF remains aberrant in the chronic phase of stroke. A directed study of CBF in stroke is needed because reduced CBF (hypoperfusion) may occur in neural regions that appear anatomically intact and may impact cognitive functioning in stroke survivors. Hypoperfusion in neurologically-involved individuals may also affect BOLD signal in FMRI studies, complicating its interpretation with this population. The current study measured CBF in three chronic stroke survivors with ischemic infarcts (greater than 1 year post-stroke) to localize regions of hypoperfusion, and most critically, examine the CBF inflow curve using a methodology that has never, to our knowledge, been reported in the chronic stroke literature. CBF data acquired with a Pulsed Arterial Spin Labeling (PASL) flow-sensitive alternating inversion recovery (FAIR) technique indicated both delayed CBF inflow curve and hypoperfusion in the stroke survivors as compared to younger and elderly control participants. Among the stroke survivors, we observed regional hypoperfusion in apparently anatomically intact neural regions that are involved in cognitive functioning. These results may have profound implications for the study of behavioral deficits in chronic stroke, and particularly for studies using neuroimaging methods that rely on CBF to draw conclusions about underlying neural activity.
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Affiliation(s)
- Kathleen P Brumm
- San Diego State University/University of California, San Diego Joint Doctoral Program in Language and Communicative Disorders, San Diego, CA, USA.
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