Search

It is debated whether primary progressive apraxia of speech (PPAOS) and progressive agrammatic aphasia (PAA) belong to the same clinical spectrum traditionally termed nonfluent/agrammatic variant primary progressive aphasia (nfvPPA) or exist as two completely distinct syndromic entities with specific pathologic/prognostic correlates. We analyzed speech, language, and disease severity features in a comprehensive cohort of patients with a progressive motor speech impairment and/or agrammatism to ascertain any evidence of the existence of naturally occurring, non-overlapping syndromic entities (e.g., PPAOS and PAA) in our data. We also assessed if data-driven latent clinical dimensions with etiologic/prognostic value could be identified. We included 98 participants with progressive motor speech impairment and/or agrammatism, with 43 having an autopsy-confirmed neuropathological diagnosis. Speech pathologists assessed motor speech features indicative of dysarthria and apraxia of speech (AOS). Quantitative expressive/receptive agrammatism measures were obtained and compared with healthy controls. Baseline and longitudinal disease severity was evaluated using the Clinical Dementia Rating sum-of-boxes (CDR-SB). We investigated the data’s clustering tendency to form robust symptom clusters and employed principal component analysis to extract data-driven latent clinical dimensions (LCD). The longitudinal CDR-SB change was estimated utilizing linear mixed-effects models. Of the participants included in this study, 91 conformed to previously reported clinical profiles (69 with AOS and agrammatism, 18 PPAOS, and 4 PAA). The remaining seven participants were characterized by nonfluent speech and dysarthria without apraxia of speech or agrammatism. No baseline clinical features differentiated between FTLD neuropathological subgroups. Critically, the Hopkins statistic dismissed the presence of non-overlapping syndromic clusters in the entire sample (.45 with values near 0.5 indicating random data). Three data-driven components accounted for 71% of the variance ([i] severity-agrammatism, [ii] prominent AOS, and [iii] prominent dysarthria). The component typified by prominent dysarthria was more specific to patients with Progressive Supranuclear Palsy (4/5 [80%] participants with autopsy in this group had PSP), while the severity-agrammatism component predicted a faster CDR-SB increase. Higher dysarthria severity, reduced words per minute, and expressive and receptive agrammatism severity at baseline independently predicted accelerated disease progression (as measured by the CDR-SB score). Our findings indicate that PPAOS and PAA, rather than exist as completely distinct syndromic entities, constitute a clinical continuum strongly predictive of underlying Frontotemporal Lobar Degeneration (FTLD, 66% 4R tauopathy, 16% Pick’s disease, 9.3% FTLD TDP type A, and 12% other pathologies). While highlighting the graded distinctions (rather than sharp boundaries) that characterize the nfvPPA spectrum may be useful for establishing early clinical rehabilitation strategies, novel clinical and biological markers are needed to improve clinical-pathological correlations.

Speech-language pathology caseloads often include individuals with hearing loss and a coexisting neurogenic communication disorder. However, specific treatment techniques and modifications designed to accommodate this population are understudied. Using a single-case experimental design, the current study investigated the utility of modified Video Implemented Script Training for Aphasia (VISTA) for an individual with nonfluent/agrammatic variant primary progressive aphasia and severe-to-profound, bilateral hearing loss. We analyzed the impact of this intervention, which incorporates orthographic input and rehearsal, on script production accuracy, speech intelligibility, grammatical complexity, mean length of utterance, and speech rate. Treatment resulted in comparable positive outcomes relative to a previous study evaluating script training in nonfluent/agrammatic primary progressive aphasia patients with functional hearing. Follow-up data obtained at three months, six months, and one year post-treatment confirmed maintenance of treatment effects for trained scripts. To our knowledge, this is the first study to investigate a modified speech-language intervention tailored to the needs of an individual with PPA and hearing loss, with findings confirming that simple treatment modifications may serve to broaden the range of treatment options available to those with concomitant sensory and communication impairments.

Traumatic brain injury (TBI) leads to a wide array of behavioral and cognitive deficits. Individuals with TBI often demonstrate difficulties with the recognition and expression of emotion communicated through multiple modalities including facial expression, vocal prosody, and linguistic content. Deficits in emotional communication contribute to a pattern of social pragmatic communication problems, leading to decreased psychosocial function. Growing evidence supports intervention targeting affective processing. This article summarizes the current evidence for evaluation and treatment of affective processing disorders in TBI.

Objective The purpose of this study was to compare the performance of bilingual speakers on an emotional verbal fluency task to category and letter verbal fluency tasks. A second purpose was to compare performances on these tasks to language proficiency ratings. Method Twelve verbal fluency tasks were administered to 21 Spanish-English bilingual speakers. Results were analyzed for differences between fluency types (category, letter, and emotional) and languages (English and Spanish). Results Participants generated the most items in category fluency tasks and the least items in emotional fluency tasks. The number of items generated for letter and emotional fluency tasks were not significantly different, but both were significantly lower than the number of items generated in category fluency. More items were generated for positive emotions than for negative emotions. Differences between languages for category and letter fluency tasks were significantly correlated with differences in language proficiency ratings, but this finding was not found for emotional fluency tasks. Conclusions Self-ratings of proficiency and language dominance correlated significantly with performance on category and letter fluency tasks and may be useful predictors of differences between languages on these tasks. Emotional fluency was not significantly correlated with language proficiency ratings, suggesting that performance on emotional fluency may be more significantly affected by emotional processing ability. The emotional verbal fluency task has potential as a component of neuropsychological evaluations to screen easily and quickly for emotional processing deficits, including those associated with traumatic brain injury and depression. Additionally, results support a positivity bias in language and cognition processes.

This study investigated differences between healthy bilingual participants and bilingual participants with traumatic brain injury (TBI) on verbal fluency tasks. The performance of three Spanish-English bilingual speakers with traumatic brain injury was compared to the performance of 30 neurotypical bilingual speakers on tasks of category and letter verbal fluency in English and Spanish. Responses were analyzed for total number of correct productions, differences in correct productions between languages, average cluster size, total number of switches, and rates of language choice errors. The data were analyzed using predicted scores from regression equations based on neurotypical data and modified t-tests. Analyses revealed significantly lower total output than predicted by the regression equations for both task types and in both languages for one TBI participant. The same participant demonstrated significantly lower total number of switches than the neurotypical group. Two participants demonstrated higher rates of language choice errors than the neurotypical group. There were no significant differences between TBI participants and the neurotypical group for average cluster size. There were no significant differences between predicted and obtained values for differences between English and Spanish total number correct in each task type. Results are discussed in the context of individual cognitive and linguistic profiles of the TBI participants.