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AbstractPatients with aphasia (PWA), particularly those with agrammatic aphasia, experience problems in sentence comprehension. Studies have found that Mapping Therapy (MT) can improve sentence processing in PWA. This paper aims to review the literature on therapeutic studies using MT for the treatment of sentence processing in PWA. All studies on the treatment of sentence comprehension using MT were found by searching Cochrane Library, ISI Web of Knowledge, Google Scholar, Pubmed, and Scopus from 1986 until December 2023, with the combination of these search keywords: ‘aphasia, sentence, comprehension, mapping therapy, treatment, rehabilitation’. All studies (single-subject or group design) on the treatment of sentence comprehension using MT in PWA were reviewed. An adaptation of the Cochrane Collaboration’s risk of bias (RoB) tool was used to assess the risk of bias (RoB) in the reviewed studies. A total of 14 studies on 81 participants were selected and reviewed. All studies (13 studies) had employed a single-subject design, except for one study that had used a group design. Twelve studies (86%) showed that MT is effective in the remediation of sentence comprehension in PWA. Generalization to untrained sentences similar to the trained structure was also observed in 12 studies (86%). Generalization to untrained structures (usually passive sentences) was limited. In addition, cross-modal improvement in sentence production was observed in 8 studies (57%). This review highlights the need for a more detailed investigation of the effect of MT on cross-modal generalization using elicited production of the sentence types trained during comprehension treatment. [ABSTRACT FROM AUTHOR]

Agrammatic aphasia poses challenges in assessing grammatical abilities due to language comprehension difficulties. The suitability of sMMN as an indicator of syntactic processing abilities in these individuals remains uncertain. Two ERP experiments were conducted to investigate whether early syntactic mismatch negativity (sMMN) could assess the syntactic processing ability of Chinese-speaking individuals with agrammatic aphasia. Prior to the ERP experiments, the Western Aphasia Battery (WAB) and the Northwestern Assessment of Verbs and Sentences-Chinese (NAVS-C) were used to screen people with agrammatism. ERP data were collected for both the agrammatic group (AG) (n = 12) and the control group (CG) (n = 12). The first experiment (Experiment 1) involved a passive tone oddball task to control for the influence of primary sound perception. The second experiment (Experiment 2: experiment 2a and experiment 2b) investigated syntactic processing through a passive speech oddball task. Experiment 2a examined the processing of correct sentences and syntactic violation sentences in context. In contrast, Experiment 2b assessed well-formed sequences and ill-formed sequences out of context. The results revealed that frontocentral distributed acoustic MMNs were recorded for the CG between 176 - 196ms in Experiment 1, but not for the AG. In Experiment 2, during the 143 - 173ms window, the left anterior sMMN was exclusively observed for the CG, while the left posterior sMMN was specific to the AG. Furthermore, the amplitudes of the left posterior sMMN (143-173ms) were found to have a negative correlation with scores on sentence comprehension tests: the more negative the sMMN, the lower the scores of people with agrammatic aphasia. Notably, this left posterior MMN was absent in Experiment 1. The early posterior sMMN, discovered for the first time in our study, appears to be more sensitive in detecting syntactic processing impairments in agrammatics compared to the early anterior sMMN. This finding has the potential to enhance the precision of aphasia assessment. [ABSTRACT FROM AUTHOR]

Deictic pronouns refer directly to the extralinguistic world (as in Stop her!), while anaphoric pronouns refer to elements introduced in discourse (as in My best friend is Mary. John adores her.). The distinction is central to linguistic theory and may be central also for understanding aphasia. This paper compares the production of deictic and anaphoric pronouns in fluent aphasia and non-fluent aphasia. It does so both for English and for Tagalog, which allows extensive omission of pronominal arguments. For both languages, the results show a dissociation between deictic and anaphoric pronouns. Non-fluent aphasic speech displays a lower proportion of anaphoric pronouns to non-pronouns than non-brain-damaged speech, while the proportion of deictic pronouns to non-pronouns is either not different (Tagalog) or higher (English). In contrast, fluent aphasic speech displays a higher proportion of deictic pronouns to non-pronouns, while the proportion of anaphoric pronouns is either not different (Tagalog) or lower (English). [ABSTRACT FROM AUTHOR]

BackgroundAimsMethods & ProceduresOutcomes & ResultsConclusionsNarrative production has been widely characterized as providing an ecologically valid way to assess language skills in post-stroke aphasia. Although narrative tasks have been instrumental in delineating patterns of lexical and syntactic production in individuals with agrammatic aphasia, our knowledge of how narrative skills are affected in agrammatic aphasia is still limited.The study’s aims were to (a) compare narrative performance between individuals with agrammatic aphasia and a language-unimpaired group, (b) investigate the contribution of lexical and syntactic skills in each group’s narrative organizational skills, and (c) explore the effects of executive functions on each group’s narrative performance.The study included 14 individuals with agrammatic aphasia and 14 age- and education-matched language unimpaired individuals as the control group. Both groups told the Cinderella story, and their narrative production was analyzed in terms of microstructure (lexical diversity, syntactic complexity, clause length) and macrostructure (story grammar, story structure complexity). Each group’s executive functions were evaluated through the One-Touch Stockings of Cambridge test that assesses working memory, and the Intra-Extra Dimensional Set Shift test that assesses cognitive flexibility.Regarding narrative microstructure, the individuals with agrammatism scored significantly lower than controls in syntactic complexity and clause length, but not in lexical diversity, but they performed lower than controls in both narrative macrostructural measurements. Also, the agrammatic group scored lower than controls in both executive function tasks. A series of linear regression models showed that microstructural skills significantly affected narrative macrostructural abilities in the cohort with agrammatic aphasia, while controls’ macrostructure was affected by both narrative microstructure and executive function skills.The individuals with agrammatic aphasia exhibited impairment in both low-level language features of narrative production, such as syntactic complexity and narrative length, and global measures of narrative organization. Their macrostructural performance critically relied on their language resources, while controls’ narrative macrostructure seemed to also draw on domain-general cognitive skills. These findings suggest that both low-level language and high-level discourse organizational skills are vulnerable in narrative production in agrammatic aphasia, and that macrostructural skills are mainly related to the individuals’ microstructural skills. [ABSTRACT FROM AUTHOR]

All common variants of primary progressive aphasia (PPA) exhibit naming deficits. Variants are distinguished by relative deficits in repetition (logopenic; lvPPA), object knowledge (semantic; svPPA), and agrammatism or articulation (non-fluent/agrammatic; nfavPPA; Gorno-Tempini et al., 2011). The Hopkins Action Naming Assessment (HANA) is a 30-item verb naming task that can distinguish between variants (Stockbridge et al., 2021). Item-level accuracy is driven by target verb frequency, semantic information density, and conceptual concreteness of the target word (Stockbridge, Venezia, et al., 2022). In this investigation, we examined whether word frequency, semantic density, concreteness, and age of acquisition (AoA) also shaped the incorrect responses patients provided. We hypothesised that error responses would vary in these dimensions as a function of PPA variant. The HANA was administered to 271 participants with PPA, resulting in 443 total administrations and 4,529 analysable error responses. Standardised differences between error and target responses for frequency, density, concreteness, and AoA were calculated and averaged for each patient. Analysis of variance (ANOVA) for correlated samples was used to compare variants and planned post-hoc analyses examined the effect of variant on each response quality. Participants were similar in age, sex, handedness, and education. There was a significant interaction between PPA variant and the standardised mean differences in lexical qualities (Pillai's Trace = 0.11, F(9, 747) = 3.19, p < 0.001). Univariate ANOVAs revealed significant differences in the semantic density of error responses relative to the target (F(3) = 7.91, p < 0.001, ηP2= 0.09), as individuals with lvPPA tended to produce error responses with greater semantic density than the target when compared to the words produced by individuals with nfavPPA (mean difference = 1.45, 95%CI = [0.60,2.29], p < 0.001; Figure 1). PPA variants also differed in the concreteness of their error responses relative to the target (F(3) = 5.99, p<0.001, ηP2 = 0.07), as error responses produced by individuals with nfavPPA were significantly more concrete than those with lvPPA (mean difference = 0.08, 95%CI = [0.02,0.13], p = 0.003) or svPPA (mean difference=0.08, 95%CI = [0.02,0.14], p = 0.007). Variants did not differ significantly in AoA or frequency of responses relative to their targets. All variants tended to produce more frequent words with a lower AoA than the target verb. Error responses tended to be more semantically dense, more concrete, higher frequency, and younger AoA than the target verb. However, PPA variants differed significantly in the extent to which these broader trends held true. These distinct patterns may be included as part of a larger diagnostic picture that to distinguish among PPA variants. [ABSTRACT FROM AUTHOR]

Verb production impairments in aphasia have important implications for sentence production and communication in general. Verbs with low concreteness may be especially important for certain functional uses, and yet limited data regarding their response to treatment are available. This study was designed to examine a novel behavioral treatment approach to improve low concreteness verb naming in persons with aphasia. Three persons with nonfluent aphasia participated in a single-subject experimental design research study examining the feasibility of the novel treatment. The treatment was based on approaches that target the verb as the central node of meaning during sentence construction. The primary outcome measure was a sentence completion probe. Effects on untreated stimuli and on general language and naming assessments were also examined. Results indicated some limited changes associated with the treatment for two of the participants. Treatment performance data suggested possible improvements in verb processing that were not reflected in the primary outcome measure. Modest decreases in aphasia severity were noted for two of the participants. The findings provide further support for targeting verbal production of verbs with low concreteness in aphasia. Several lessons learned may benefit future researchers examining areas related to the topic. [ABSTRACT FROM AUTHOR]

Agrammatic aphasia has been widely associated with impairments with functional words and complex sentences. Speech errors of people with aphasia (PWA) have been reported to be selective, with patterns of omissions in functional words, most notably in the domain of tense inflection on verbs compared to agreement in morphologically rich languages. In languages like English, where tense and agreement are hard to disentangle in their inflectional paradigms, investigations of the inflectional domain in PWA are rare. In this study, we introduce a novel approach that allows the disentangling of inflectional errors in English through the patterns of copula omission of the verb to be. The inflectional system of the functional verb to be is richer, and its distribution in the sentence is based on the semantics of its predicate (stage-level vs. individual-level). Spontaneous productions of 16 PWA collated from AphasiaBank transcripts were analysed for violations of tense alongside other patterns of error that could suggest an impairment in the inflectional domain. Copula deletion was found to be modulated by the semantics of the predicate, showing a selective pattern of omission in stage-level predicates. Incorrect case assignment (accusative in place of nominative) was also observed as an indicator of impaired tense. The results confirm the effectiveness of copula to be to investigate the English inflectional system and substantiate previous studies on selective errors in the verbal domain in PWA in English. [ABSTRACT FROM AUTHOR]

Purpose: Adults with aphasia gesture more than adults without aphasia. However, less is known about the role of gesture in different discourse contexts for individuals with different types of aphasia. In this study, we asked whether patterns of speech and gesture production of individuals with aphasia vary by aphasia and discourse type and also differ from the speech and gestures produced by adults without aphasia. Method: We compared the amount, diversity, and complexity of speech and gesture production in adults with anomic or Broca's aphasia and adults with no aphasia (n = 20/group) in their first- versus third-person narratives. Results: Adults with Broca's aphasia showed the lowest performance in their amount, diversity, and complexity of speech production, followed by adults with anomic aphasia and adults without aphasia. This pattern was reversed for gesture production. Speech and gesture production also varied by discourse context. Adults with either type of aphasia used a lower amount of and less diverse speech in third-person than in first-person narratives; this pattern was also reversed for gesture production. Conclusions: Overall, our results provide evidence for a compensatory role of gesture in aphasia communication. Adults with Broca's aphasia, who showed the greatest speech production difficulties, also relied most on gesture, and this pattern was particularly pronounced in the third-person narrative context. [ABSTRACT FROM AUTHOR]

Purpose: We describe the communication challenges of four patients with a neurodegenerative disorder consistent with behavioral variant frontotemporal dementia (bvFTD), characterized by early behavioral and personality changes. By describing their clinical profiles, we identify common barriers to functional communication in this population and provide recommendations for how speech-language pathologists (SLPs) might contribute to minimizing them. Method: Four patients with bvFTD were selected from a cohort of patients with progressive communication impairments. Three of them returned for at least one follow-up visit. Case histories are presented along with the results of comprehensive speech and language, neuropsychological, and neurological testing. Results: At the time of initial evaluation, patients were between the ages of 54 and 66 years and had been experiencing symptoms for 1.5-6 years. Consistent with their bvFTD diagnoses, all patients had prominent behavioral and personality changes that impacted communication. Patients 1 and 2 also had mild aphasia at enrollment, primarily characterized by anomia and loss of word meaning. Patients 3 and 4 both had apraxia of speech and moderate-to-severe aphasia at enrollment with prominent anomia and agrammatism. All four patients had impaired executive functioning and relative sparing of visuospatial skills; episodic memory was also impaired for Patients 2 and 4. Even though functional communication was progressively limited for all patients, none of them received regular support from an SLP. Conclusions: This case series adds to a scant, but growing, literature demonstrating that patients with bvFTD have communication impairments. SLPs are uniquely positioned to identify barriers to functional communication and to provide tailored strategy training to the patients and their care partners over the course of their disease. Systematic evaluation of the efficacy of treatment in this population would be valuable. [ABSTRACT FROM AUTHOR]

The logopenic variant of primary progressive aphasia (lvPPA) is characterized mainly by anomia, production of phonological errors, and impairment in repetition of sentences. The functional origin of these language impairments is mainly attributed to the breakdown of phonological short-term memory. The present study examined the effects of phonological short-term memory impairment on language processing in lvPPA. In two studies, 11 participants with lvPPA and 11 healthy control participants were presented with repetition tasks in which the type and length of stimuli and the mode of administration were manipulated. Study 1 aimed to examine the influence of length and lexicality (words vs. pseudowords) on immediate and delayed repetition, whereas Study 2 aimed to examine the influence of length, syntactic complexity (nominalized vs. pronominalized sentences), and serial position on immediate sentence repetition. Study 1 showed that participants' performance with lvPPA was impaired only on immediate repetition of five-syllable pseudowords and on delayed repetition of words and pseudowords. Study 2 showed that participants' performance with lvPPA was impaired in the repetition of nominalized sentences where a recency effect was observed. Repetition of pronominalized sentences was also impaired in the lvPPA group. This study provides additional support for arguments regarding phonological short-term memory as a cause of language impairment in lvPPA. Clinically, the results of the study suggest that instruments for assessing repetition ability in lvPPA should include not only lists of short or long nominalized sentences, but also delayed repetition of words and pseudowords and pronominalized sentences. [ABSTRACT FROM AUTHOR]

BackgroundAimsMethods & ProceduresOutcomes & ResultsConclusionAgrammatism in agglutinative languages exhibits preservation of verb morphology due to their rich morphological paradigms. Tagalog, an agglutinative language mainly spoken in the Philippines, remains uncharacterized in agrammatism yet holds potential for future research that can challenge existing theories and help advance novel ones.The purpose of this study is to quantify and describe the characteristics of agrammatism in Tagalog in narrative spontaneous speech, to examine whether these patterns resemble those reported in other agglutinative languages, and to compare the results obtained to those emerging in literature for non-agglutinative languages.Narrative spontaneous speech was elicited from 10 individuals with non-fluent Broca’s aphasia and 12 matched controls. A series of parameters, both conventional and language-specific measures, were selected for analyses.Tagalog-speaking individuals with agrammatism exhibited slow and fragmented speech, with a strong preference for minor and simple constructions resulting to decrease in overall grammaticality and sentence complexity. Verb deficits were also found specifically in verbal predication, lexical diversity, and finiteness. There is a prevalent use of bare verb forms, consequently resulting to the decline of verb finiteness and inflections. Code-mixing is found to be extremely variable and statistically non-prominent between groups but patterns may be attributed to personal and sociolinguistic factors.Patterns of agrammatism in Tagalog majorly mirror the trends reported in other agglutinative and non-agglutinative languages. Where Tagalog agrammatism departs from other agglutinative languages is the increased use of bare verbs as opposed to the obligatory inflected forms. Although still many questions are unresolved, Tagalog offers an interesting testing ground for variety of topics and issues in agrammatic aphasia. [ABSTRACT FROM AUTHOR]

It is unclear whether individuals with agrammatic aphasia have particularly disrupted prosody, or in fact have relatively preserved prosody they can use in a compensatory way. A targeted literature review was undertaken to examine the evidence regarding the capacity of speakers with agrammatic aphasia to produce prosody. The aim was to answer the question, how much prosody can a speaker “do” with limited syntax? The literature was systematically searched for articles examining the production of grammatical prosody in people with agrammatism, and yielded 16 studies that were ultimately included in this review. Participant inclusion criteria, spoken language tasks, and analysis procedures vary widely across studies. The evidence indicates that timing aspects of prosody are disrupted in people with agrammatic aphasia, while the use of pitch and amplitude cues is more likely to be preserved in this population. Some, but not all, of these timing differences may be attributable to motor speech programming deficits (AOS) rather than aphasia, as these conditions frequently co-occur. Many of the included studies do not address AOS and its possible role in any observed effects. Finally, the available evidence indicates that even speakers with severe aphasia show a degree of preserved prosody in functional communication. [ABSTRACT FROM AUTHOR]

Motor aphasia has long been considered an agrammatic condition, characterized by the omission of functional items. Inquiries into the discourse of nonfluent aphasics from morphologically rich languages have caused researchers to reconsider the degree to which agrammatism characterizes motor aphasia. This article is a single-case study of a Romanian patient with motor aphasia. The speech is analyzed qualitatively, with particular emphasis on morphological errors. Contextualization is offered in order to understand the degree of agrammatic constructions in relation to the analyzed language. The article also presents a justification for single-case studies, a general description of the parameters of the subject's speech, and evidence for considering agrammatism in aphasic speech a result of the economy of effort hypothesis. [ABSTRACT FROM AUTHOR]

Purpose: People with aphasia have been shown to experience higher rates of depression and mental health issues than stroke survivors without aphasia. Narrative-based counseling approaches to therapy in communication disorders have shown promise in several areas, such as stuttering. Little is known regarding how these approaches can be implemented with individuals with aphasia. This study sought to uncover what therapeutic processes could be utilized to overcome barriers to utilizing this approach with people with aphasia. Method: A qualitative case study design was utilized. The primary data source included audio-recorded intervention sessions of a narrative-based counseling approach. Secondary data sources included reflection journals produced by the clinician and artifacts created by the client, including letter written as a part of the therapeutic process and other documents co-constructed by the clinician and client that detailed the client's journey. Data were analyzed inductively, in which transcripts were coded by the researchers and compared across the data set until patterns were apparent in the data that were later defined as themes. Results: Analysis of data suggests that adapting narrative counseling techniques for success with people with aphasia consists of allowing adequate time for client response, building a therapeutic alliance, reiteration and saturation of solution-focused language and narratives, and maintaining a topic of conversation centered around aphasia. Conclusion: This study argues for further consideration of how narrative-based counseling techniques can be adapted and flexibly used in aphasia intervention. [ABSTRACT FROM AUTHOR]

The primary goal of this study was to evaluate the treatment effects of semantic feature analysis (SFA) and phonological components analysis (PCA) on word retrieval processing in persons with aphasia (PWAs). After identifying the locus of the breakdown in lexical retrieval processing, 15 monolingual native Persian speakers with aphasia were divided into two groups. After three naming trials, participants with dominant semantic deficits received SFA, and participants with primary phonological deficits were provided with PCA three times a week for eight weeks. Both approaches improved participants' naming and performance on language tests, including spontaneous speech, repetition, comprehension, and semantic processing. However, the correct naming of treated and untreated items was higher in mild-to-moderate participants, with mostly circumlocution and semantic paraphasias in the SFA group. The same holds for mild-to-moderate participants with mostly phonemic paraphasia who received PCA therapy. Moreover, the results showed that participants' baseline naming performance and semantic abilities could be associated with the treatment outcomes. Although limited by a lack of a control group, this study provided evidence supporting the possible benefits of focusing on the locus of the breakdown for treating anomia through SFA and PCA approaches, specifically in participants with mild to moderate aphasia. However, for those with severe aphasia, the treatment choice may not be as straightforward because several variables are likely to contribute to this population's word-finding difficulties. Replication with larger, well-stratified samples, use of a within-subjects alternating treatment design and consideration of treatments' long-term effects are required to better ascertain the effects of focusing on the locus of breakdown for treatment of anomia. [ABSTRACT FROM AUTHOR]

Previous studies have demonstrated that people with nonfluent aphasia (PWNA) improve their language production after repeating personalized scripts, modeled by speech-language pathologists (SLPs). If PWNA could improve by using their own self-feedback, relying less on external feedback, barriers to aphasia treatment, such as a dearth of clinicians and mobility issues, can be overcome. Here we examine whether PWNA improve their language production through an automated procedure that exposes them to playbacks of their own speech, which are updated recursively, without any feedback from SLPs. We tested if recursive self-feedback could improve speech fluency in two persons with chronic nonfluent aphasia. We compared two treatments: script production with recursive self-feedback (a new technique) and a non-self-feedback training. We administered the treatments remotely to the participants through their smartphones using two versions of a mobile app we developed. Each participant engaged in each treatment for about three weeks. We estimated clinical improvements of script production through a quantitative trend analysis and nonoverlap of all pairs. Recursive self-feedback improved speaking rate and speech initiation latency of trained and untrained scripts in both participants. The control (non-self-feedback) training was also effective, but it induced a somewhat weaker improvement in speaking rate, and improved speech initiation latency in only one participant. Our findings provide preliminary evidence that PWNA can improve their speaking rate and speech initiation latency during production of scripts via fully automated recursive self-feedback. The beneficial effects of recursive self-feedback training suggest that speech unison and repeated exposures to written scripts may be optional ingredients of script-based treatments for aphasia. [ABSTRACT FROM AUTHOR]

Purpose: Verb tense production is known to be impaired in people with nonfluent aphasia. Selective past tense impairment in this population has been reported, but results are inconsistent and lacking at the discourse level. In addition, language production can be affected by discourse elicitation tasks depending on the cognitive linguistic demands and instructions unique to each task. There is limited evidence regarding whether verb tense production in people with nonfluent aphasia is impacted by discourse task demands. Understanding this potential impact is important for clinicians and researchers who are interested in assessing and then identifying effective clinical goals for this population. Therefore, this study aimed to investigate the trends of verb tense production across various discourse elicitation tasks in people with nonfluent aphasia compared to people without aphasia. Method: Language samples for 23 people with nonfluent aphasia and 27 people without aphasia were obtained for six discourse tasks from the AphasiaBank database. We calculated ratios of past tense, present tense, future tense, imperative, and unknown verb types to compare which tense was used most frequently within and across the tasks and groups. Results and Conclusions: Our findings revealed evidence of verb tense production deficits and a selective past tense impairment in people with nonfluent aphasia. Discourse task effects were shown for people without aphasia but were scarce in people with nonfluent aphasia. This finding could be explained by an overall reduction of verb production and overreliance on present tense production in nonfluent aphasia. These results suggest the potential methodological implications of using different discourse tasks to evaluate verb tense production in people with nonfluent aphasia. Future studies need to evaluate discourse task effects on other aspects of verb production (e.g., moods) and specific task factors (e.g., presence or absence of visual stimulus). [ABSTRACT FROM AUTHOR]

Analogical reasoning is central to thought and learning. However, previous neuroscience studies have focused mainly on neural substrates for visuospatial and semantic analogies. There has not yet been research on the neural correlates of analogical reasoning on syntactic patterns generated by the syntactic rules, a key feature of human language faculty. The present investigation took an initial step to address this paucity. Twenty-four participants, whose brain activity was monitored by fMRI, engaged in first-order and second-order relational judgments of syntactic patterns as well as simple and complex working memory tasks. After scanning, participants rated the difficulty of each step during analogical reasoning; these ratings were related to signal intensities in activated regions of interest using Spearman correlation analyses. After prior research, differences in activation levels during second-order and first-order relational judgments were taken as evidence of analogical reasoning. These analyses showed that analogical reasoning on syntactic patterns recruited brain regions consistent with those supporting visuospatial and semantic analogies, including the anterior and posterior parts of the left middle frontal gyrus, anatomically corresponding to the left rostrolateral pFC and the left dorsolateral pFC. The correlation results further revealed that the posterior middle frontal gyrus might be involved in analogical access and mapping with syntactic patterns. Our study is the first to investigate the process of analogical reasoning on syntactic patterns at the neurobiological level and provide evidence of the specific functional roles of related regions during subprocesses of analogical reasoning. [ABSTRACT FROM AUTHOR]

The article presents the discussion on agrammatism, primarily associated with nonfluent aphasias like Broca's aphasia, characterized by omission of function words and inflectional affixes, leading to telegraphic utterances. Topics include hypotheses explaining agrammatism, including phonological deficit, syntactic deficit, and lexical-semantic deficit, and aims to study agrammatic deficits in Malayalam-speaking Broca's aphasics.

The relationship between feelings of tense, as a significant emotional distress, and dementia remains unclear. This study aimed to evaluate the association between feelings of tense and dementia. In UK Biobank, feelings of tense were measured with a standard item. The primary outcome was all cause of dementia (ACD) and its subtypes (Alzheimer's disease (AD), vascular dementia (VD), and other dementia). Cox regression models analyzed the association between feelings of tense and dementia risk, while linear regression examined the correlation with neuroimaging outcomes. The potential association and joint effects of AD and tenseness were evaluated based on the established genetic risk score (GRS). During a median follow-up of 12.7 years among 482,360 participants, 7331 dementia cases were identified. Individuals with feelings of tense had a significantly increased risk of ACD (HR, 1.194; 95 % CI: 1.115–1.278), VD (HR, 1.164; 95 % CI: 1.007–1.346), and other dementia (HR, 1.181; 95 % CI: 1.081–1.289), but not AD in multi-adjusted models. This association persisted across various sensitivity analyses and exhibited some heterogeneity in subgroup analyses. Furthermore, feelings of tense are associated with total brain volume shrinkage, higher white matter hyperintensities, and decreased partial subcortical volume, particularly in the hippocampus. No interaction between tenseness and AD genetic susceptibility was observed (P for interaction =0.346). Our study only considered feelings of tense measured at a one-time point. Our findings demonstrate a significant association between feeling of tense and elevated dementia risk, indicating that tenseness could serve as a modifiable psychological determinant for dementia. • Feelings of tense, a common sign of psychological distress, link to higher dementia risk. • Self-reported tenseness linked to higher all-cause and vascular dementia risk. • Neuroimaging findings on cognitive decline may explain the tense-dementia connection. • High genetic risk score individuals with tenseness face the highest Alzheimer's risk. [ABSTRACT FROM AUTHOR]

It is debated whether primary progressive apraxia of speech (PPAOS) and progressive agrammatic aphasia (PAA) belong to the same clinical spectrum, traditionally termed non-fluent/agrammatic variant primary progressive aphasia (nfvPPA), or exist as two completely distinct syndromic entities with specific pathologic/prognostic correlates. We analysed speech, language and disease severity features in a comprehensive cohort of patients with progressive motor speech impairment and/or agrammatism to ascertain evidence of naturally occurring, clinically meaningful non-overlapping syndromic entities (e.g. PPAOS and PAA) in our data. We also assessed if data-driven latent clinical dimensions with aetiologic/prognostic value could be identified. We included 98 participants, 43 of whom had 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 and cluster stability 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 using linear mixed-effects models. Of the participants included in this study, 93 conformed to previously reported clinical profiles (75 with AOS and agrammatism, 12 PPAOS and six PAA). The remaining five participants were characterized by non-fluent speech, executive dysfunction and dysarthria without apraxia of speech or frank agrammatism. No baseline clinical features differentiated between frontotemporal lobar degeneration neuropathological subgroups. The Hopkins statistic demonstrated a low cluster tendency in the entire sample (0.45 with values near 0.5 indicating random data). Cluster stability analyses showed that only two robust subgroups (differing in agrammatism, executive dysfunction and overall disease severity) could be identified. Three data-driven components accounted for 71% of the variance [(i) severity-agrammatism; (ii) prominent AOS; and (iii) prominent dysarthria]. None of these data-driven LCDs allowed an accurate prediction of neuropathology. The severity-agrammatism component was an independent predictor of a faster CDR-SB increase in all the participants. Higher dysarthria severity, reduced words per minute and expressive and receptive agrammatism severity at baseline independently predicted accelerated disease progression. Our findings indicate that PPAOS and PAA, rather than exist as completely distinct syndromic entities, constitute a clinical continuum. In our cohort, splitting the nfvPPA spectrum into separate clinical phenotypes did not improve clinical-pathological correlations, stressing the need for new biological markers and consensus regarding updated terminology and clinical classification. [ABSTRACT FROM AUTHOR]

Introduction: Among many grammatical problems affecting agrammatic patients, those of inflectional morphology, specifically tense, stand at the forefront. This study aimed to analyze tense properties in Mazandarani-speaking Broca patients to see which aspects of this inflectional system were more negatively affected. Materials and Methods: Utilizing inclusion/exclusion criteria, we chose 10 patients (mean age 47 years) in this descriptive-analytical research. To select our participants, some criteria including the results of the Persian aphasia test, monolingualism, and magnetic resonance imaging reports were considered which corroborated the involvement of the anterior frontal lobe, inferior anterior parietal lobe, Perisylvian, and Broca's areas as well as inferior frontal gyrus. To monitor our patients' performance in three separate tenses of present (progressive), future, and past (simple past, past perfect, and past continuous), we administered written sentence completion and sentence-to-picture matching tests. To investigate whether our patients' performance in diverse verb tenses was significantly different, we utilized Wilcoxon statistics to analyze our data. Results: The results demonstrated a significant difference between the performance of the patients in past progressive tense compared to other tenses (P=0.02). Furthermore, a significant difference was observed between the mean responses to past tenses and present-future tenses. Conclusion: Mazandarani-speaking agrammatic demonstrated selective poor performance in the past tense inflection. Regarding the crucial role of tense properties in verbal communication, specifically past tense, to talk about past events and memories, more attention is needed by clinicians and speech therapists to reinforce tense properties enhancing agrammatic communication capabilities. [ABSTRACT FROM AUTHOR]

Recent investigations on how people derive meaning from language have focused on task-dependent shifts between two cognitive systems. The symbolic (amodal) system represents meaning as the statistical relationships between words. The embodied (modal) system represents meaning through neurocognitive simulation of perceptual or sensorimotor systems associated with a word's referent. A primary finding of literature in this field is that the embodied system is only dominant when a task necessitates it, but in certain paradigms, this has only been demonstrated using nouns and adjectives. The purpose of this paper is to study whether similar effects hold with verbs. Experiment 1 evaluated a novel task in which participants rated a selection of verbs on their implied vertical movement. Ratings correlated well with distributional semantic models, establishing convergent validity, though some variance was unexplained by language statistics alone. Experiment 2 replicated previous noun-based location-cue congruency experimental paradigms with verbs and showed that the ratings obtained in Experiment 1 predicted reaction times more strongly than language statistics. Experiment 3 modified the location-cue paradigm by adding movement to create an animated, temporally decoupled, movement-verb judgment task designed to examine the relative influence of symbolic and embodied processing for verbs. Results were generally consistent with linguistic shortcut hypotheses of symbolic-embodied integrated language processing; location-cue congruence elicited processing facilitation in some conditions, and perceptual information accounted for reaction times and accuracy better than language statistics alone. These studies demonstrate novel ways in which embodied and linguistic information can be examined while using verbs as stimuli. [ABSTRACT FROM AUTHOR]

The present study examined the deficits of people with aphasia in tense (past, present, and future) and agreement (person, number, and gender) in Jordanian Arabic. Forty participants were selected and two tasks were administered for this study using Boston Diagnostic Aphasia Examination (BDAE)-Arabic version. The first task was sentence completion in which sentences have a blank and need to be filled by the participants. The second task was grammaticality judgment, in which participants should determine whether sentences are grammatically correct or not. Results indicated significantly that the Jordanian participants with aphasia violate gender aspect more than person and number in both sentence completion task (p = 0.025) and grammaticality judgment task (p = 0.000), it was also reported that past tense was violated significantly more than present and future in sentence completion task (p = 0.000) as well as grammaticality judgment task (p = 0.012). It is concluded that Arabic speakers with agrammatism were tested with reference to time and agreement and the results showed that they performed as hypothesized, showing a selective deficit for production of inflected forms of past tense. [ABSTRACT FROM AUTHOR]

Roughly 30% of stroke survivors suffer from aphasia—a communication disorder that affects the ability to communicate effectively—but little is known about their healthcare expenditure or how it varies between aphasia subtypes. This study evaluates the relative differential in healthcare expenditure of anomic, Broca's, Wernicke's and Conduction aphasia and assesses expenditure between demographic cohorts Individual level data from the 2010 Moss Aphasia Psycholinguistic Project Database was matched with the 2010 Medical Expenditure Panel Survey using a propensity score algorithm based on functional, health, and demographic characteristics. Multilevel, generalized, nonlinear regression models were applied to the resulting data set to assess the correlation between annual healthcare expenditure, time post onset (tpo), sex, race, family size, marital status, income, education, aphasia type, and region of residence. Results were used to predict expenditure by aphasia subtype, race, and sex. Multiple distributional specifications tested the sensitivity and ensured the robustness of estimates. Regression results indicate that individuals with Broca's aphasia had statistically higher healthcare expenditures paying an average of $10,896.45 annually when compared to anomic ($7,927.60), Wernicke's ($7,096.22), and Conduction ($9,447.19) aphasias. Additionally, healthcare expenditure increased with each year of age (β=0.004, SE=0.005), but decreased with each year after stroke (β=-0.002, SE=0.001). Females (β=0.358, SE=0.131) and Blacks (β=0.103, SE=0.200) paid significantly more annually compared to males and Whites, respectively. Neither region of residence, income, nor level of education were significantly correlated with healthcare expenditure. This study showed that, while individuals with Broca's aphasia had higher average healthcare expenditure than other subtypes, the differential was not statistically significant. Sex and race cohorts did, however, show statistically significant differences in healthcare expenditures. While causality is outside the scope of this analysis, additional work is needed to determine the best strategy to mitigate these disparities. [ABSTRACT FROM AUTHOR]

The Northwestern Assessment of Verbs and Sentences (NAVS) assesses verb and sentence production and comprehension in aphasia. Results from the original English version and from its adaptation to German have shown that the NAVS is able to capture effects of verb-argument structure (VAS) complexity (i.e., lower accuracy for two- and three-argument vs. one-argument verbs) and syntactic complexity (i.e., lower accuracy for non-canonical vs. canonical sentences) in both agrammatic participants and individuals with fluent forms of aphasia. The NAVS has been recently adapted to Italian (NAVS-I) and tested on a group of healthy participants, with results showing longer reaction times to complex vs. simple verbs and sentences. The present study aimed to test the ability of NAVS-I to i) capture verb/sentence production and comprehension deficits in Italian-speaking individuals with agrammatism or with fluent aphasia, and ii) differentiate individuals with aphasia from healthy age-matched participants, with the overall goal to validate its use in clinical practice. Forty-four healthy participants and 28 individuals with aphasia (10 with agrammatic speech production) were administered the NAVS-I, which includes tasks assessing production and comprehension of verbs requiring one, two or three arguments, as well as production and comprehension of canonical and non-canonical sentences. On the Verb Naming Task (VNT), better production of one- (vs. two- and three-) argument verbs was found in the agrammatic group, whereas, verb production in the fluent group was solely predicted by word length and imageability. No effects of argument optionality (i.e., greater difficulty for optionally transitive verbs than for 1-argument verbs) were found. Sentence-level tasks found no differences between the agrammatic and the fluent group in production or comprehension of both canonical and non-canonical sentences; rather, sentence comprehension accuracy was predicted by demographic variables and by aphasia severity. At the individual level, performance on the NAVS-I was significantly different from that of healthy speakers in 26/28 patients. Data show that the NAVS-I is able to capture effects of argument structure complexity in verb production, and effects of syntactic complexity in sentence production and comprehension. In addition, our results point to verb production as the task with greater capability to differentiate agrammatism from other (fluent) forms of aphasia. The study provides support for the use of the NAVS-I in the diagnosis of aphasia, as it is able to detect language deficits at the individual level, even in participants with mild (residual) forms of aphasia. [ABSTRACT FROM AUTHOR]

Limited research has been conducted in Malaysia on the characteristics of patients with aphasia. To address this gap, a retrospective study was conducted at Hospital Rehabilitasi Cheras (HRC). The study aimed to profile the demographic, clinical, and language characteristics of patients who underwent speech therapy for aphasia. Medical records from 2014 to 2017 were reviewed, focusing on 1,259 adult patients who were referred to the Speech Therapy Unit. Analysis included demographics, clinical aspects, and linguistic features. The Western Battery of Aphasia-Revised (WAB-R), a comprehensive assessment tool, was used to evaluate the language abilities. Among the patients' files analysed, a total of 211 contained WAB-R test results. The demographic profile revealed a higher proportion of male patients compared to females, with Malay patients comprising the majority, followed by Chinese and Indians. Age distribution included 41.7% older adults (aged 55 and above), 37.9% middle-aged (aged 36-55), and 20.4% younger adults (aged 18-35). Notably, 44.5% had completed high school education. Clinically, right-sided hemiparesis was prevalent as noted with 67.8% of patients, while 14.7% had left-sided hemiparesis. The primary cause of aphasia was stroke, accounting for 71.1% of cases, with ischemic stroke being the dominant subtype (56.9%). Fluent aphasia was presented in 50.2% of the cases, compared to 49.3% of non-fluent aphasia. Anomic aphasia was the most common subtype (35.5%), followed by global aphasia (27.5%) and Broca's aphasia (17.5%). The language profile provided a detailed description, encompassing linguistic aspects relevant to different aphasia types. These preliminary findings yielded valuable insights and hold significant implications for the clinical management of aphasia patients in Malaysia. [ABSTRACT FROM AUTHOR]

Time reference is used to build the temporal framework of discourse and is essential in ensuring efficient communication. Several studies have reported time reference deficits in fluent and non-fluent aphasia and have shown that tenses (past, present, future) are not all impaired to the same extent. However, there is little consensus on the dissociations between tenses, and the question of the influence of the type of aphasia (fluent vs. non-fluent) on time reference remains open. Therefore, a systematic review and an individual participant data meta-analysis (or mega-analysis) were conducted to determine (1) whether one tense is more impaired than another in fluent and non-fluent aphasia and, if so, (2) which task and speaker-related factors moderate tense effects. The systematic review resulted in 35 studies reporting the performance in time reference of 392 participants. The mega-analysis was then performed on 23 studies for a total of 232 participants and showed an alteration of past tense compared to present and future tenses in both types of aphasia. The analysis also showed a task and an age effect on time reference but no gender effect, independently of tenses. These results add to our knowledge of time reference in aphasia and have implications for future therapies. [ABSTRACT FROM AUTHOR]

The non-fluent/agrammatic variant of primary progressive aphasia (nfvPPA) is a neurodegenerative syndrome primarily defined by the presence of apraxia of speech (AoS) and/or expressive agrammatism. In addition, many patients exhibit dysarthria and/or receptive agrammatism. This leads to substantial phenotypic variation within the speech-language domain across individuals and time, in terms of both the specific combination of symptoms as well as their severity. How to resolve such phenotypic heterogeneity in nfvPPA is a matter of debate. 'Splitting' views propose separate clinical entities: 'primary progressive apraxia of speech' when AoS occurs in the absence of expressive agrammatism, 'progressive agrammatic aphasia' (PAA) in the opposite case, and 'AOS + PAA' when mixed motor speech and language symptoms are clearly present. While therapeutic interventions typically vary depending on the predominant symptom (e.g. AoS versus expressive agrammatism), the existence of behavioural, anatomical and pathological overlap across these phenotypes argues against drawing such clear-cut boundaries. In the current study, we contribute to this debate by mapping behaviour to brain in a large, prospective cohort of well characterized patients with nfvPPA (n = 104). We sought to advance scientific understanding of nfvPPA and the neural basis of speech-language by uncovering where in the brain the degree of MRI-based atrophy is associated with inter-patient variability in the presence and severity of AoS, dysarthria, expressive agrammatism or receptive agrammatism. Our cross-sectional examination of brain-behaviour relationships revealed three main observations. First, we found that the neural correlates of AoS and expressive agrammatism in nfvPPA lie side by side in the left posterior inferior frontal lobe, explaining their behavioural dissociation/association in previous reports. Second, we identified a 'left-right' and 'ventral-dorsal' neuroanatomical distinction between AoS versus dysarthria, highlighting (i) that dysarthria, but not AoS, is significantly influenced by tissue loss in right-hemisphere motor-speech regions; and (ii) that, within the left hemisphere, dysarthria and AoS map onto dorsally versus ventrally located motor-speech regions, respectively. Third, we confirmed that, within the large-scale grammar network, left frontal tissue loss is preferentially involved in expressive agrammatism and left temporal tissue loss in receptive agrammatism. Our findings thus contribute to define the function and location of the epicentres within the large-scale neural networks vulnerable to neurodegenerative changes in nfvPPA. We propose that nfvPPA be redefined as an umbrella term subsuming a spectrum of speech and/or language phenotypes that are closely linked by the underlying neuroanatomy and neuropathology. [ABSTRACT FROM AUTHOR]

Action reading is thought to engage motor simulations, such as those involved during the generation of mental motor images. These simulations would yield modulations in activity of motor-related cortical regions and contribute to action language comprehension. To test these ideas, we measured corticospinal excitability during action reading, and reading comprehension ability, in individuals with normal and impaired imagery (i.e., phantasia and aphantasia, respectively). Thirty-four participants (17 phantasic and 17 aphantasic) were asked to read manual action sentences. By means of TMS, we triggered motor-evoked potentials in the target right index finger. Motor-evoked potential amplitude, a marker of corticospinal excitability, increased during action reading relative to rest for phantasic individuals, but not for aphantasic individuals. This result provides neurophysiological evidence that individuals living with aphantasia present a real neurophysiological deficit in motor system engagement during action reading. Furthermore, deep-level reading comprehension ability was impaired in individuals with aphantasia, who had difficulty selecting words that best fit the context of sentences. Altogether, these findings support the idea that motor simulations, along with the activation within the motor system, contribute to action language comprehension. [ABSTRACT FROM AUTHOR]

AbstractProduction of verb morphology, especially tense inflection, is usually impaired in individuals with agrammatism. There have been relatively few studies on treatment of verb tense inflection in agrammatic aphasia. In this study we adapted ACTION (a linguistically motivated treatment) to Persian language, to treat the production of regular and irregular verbs separately in sentence context. A single-subject multiple-baseline across behaviors design was used to establish the treatment effect. Using a non-probable convenience sampling, four Persian agrammatic patients with Broca’s aphasia resulting from cerebrovascular accident (CVA) were recruited for this study. Two participants received treatment first for regular verbs (Phase 1, 4 weeks), and then for irregular verbs (Phase 2, 4 weeks). The other two participants received treatment in reverse order. In the final phase of treatment (Phase 3, 4 weeks), all 4 participants underwent a sentence construction treatment. All participants showed improvement in the production of trained tenses. Treatment also generalized to production of untrained regular verbs while generalization to irregular verbs was modest. Furthermore, improvement was found on narrative scores (e.g. MLU) after treatment. These findings suggest that Persian individuals with agrammatism could be trained to correctly apply temporal information to verb inflection in elicited speech. [ABSTRACT FROM AUTHOR]

Background: The agrammatic variant of primary progressive aphasia (PAA), primary progressive apraxia of speech (PPAOS), or a combination of both (AOS-PAA) are neurodegenerative disorders characterized by speech-language impairments and together compose the AOS-PAA spectrum disorders. These patients typically have an underlying 4-repeat tauopathy, although they sometimes show evidence of amyloid-β and tau deposition on PET, suggesting Alzheimer's disease (AD). Given the growing number of pharmacologic treatment options for AD, it is important to better understand the incidence of AD pathology in these patients. Objective: This study aimed to evaluate the frequency of amyloid-β and tau positivity in AOS-PAA spectrum disorders. Sixty-five patients with AOS-PAA underwent a clinical speech-language battery and PiB PET and flortaucipir PET imaging. Methods: Global PiB PET standardized uptake value ratios (SUVRs) and flortaucipir PET SUVRs from the temporal meta region of interest were compared between patient groups. For 19 patients who had died and undergone autopsy, their PET and pathology findings were also compared. Results: The results showed that although roughly half of the patients are positive for at least one biomarker, their clinical symptoms and biomarker status were not related, suggesting that AD is not the primary cause of their neurodegeneration. All but one patient in the autopsy subset had a Braak stage of IV or less, despite four being positive on tau PET imaging. Conclusions: Inclusion criteria for clinical trials should specify clinical presentation or adjust the evaluation of such treatments to be specific to disease diagnosis beyond the presence of certain imaging biomarkers. [ABSTRACT FROM AUTHOR]

This study used the categorical perception (CP) paradigm, a fine-grained perceptual method, to investigate the perceptual performance of lexical tones in Chinese people with post-stroke aphasia (PWA). Twenty patients with post-stroke aphasia (10 Broca's and 10 Wernicke's) and ten neurologically intact age-matched control participants were recruited to complete both identification and discrimination tasks of the Mandarin Tone 1–2 continuum. In addition, all participants completed tests on their auditory comprehension ability and working memory. The results showed that both Broca's and Wernicke's patients exhibited reduced sensitivity to within-category and between-category information but preserved CP of lexical tones. The degree of CP of lexical tones related to working memory in aphasic patients. Furthermore, lower-level acoustic processing underpinned higher-level phonological processing on the CP of lexical tones since both patient groups' unbalanced pitch processing ability extended to their CP of lexical tones. These findings are significant for researchers and clinicians in speech-language rehabilitation, clinical psychology, and cognitive communication. [ABSTRACT FROM AUTHOR]

Speech of individuals with non-fluent, including Broca's, aphasia is often characterized as "agrammatic" because their output mostly consists of nouns and, to a lesser extent, verbs and lacks function words, like articles and prepositions, and correct morphological endings. Among the earliest accounts of agrammatic output in the early 1900s was the "economy of effort" idea whereby agrammatic output is construed as a way of coping with increases in the cost of language production. This idea resurfaced in the 1980s, but in general, the field of language research has largely focused on accounts of agrammatism that postulated core deficits in syntactic knowledge. We here revisit the economy of effort hypothesis in light of increasing emphasis in cognitive science on rational and efficient behavior. The critical idea is as follows: there is a cost per unit of linguistic output, and this cost is greater for patients with non-fluent aphasia. For a rational agent, this increase leads to shorter messages. Critically, the informative parts of the message should be preserved and the redundant ones (like the function words and inflectional markers) should be omitted. Although economy of effort is unlikely to provide a unifying account of agrammatic output in all patients—the relevant population is too heterogeneous and the empirical landscape too complex for any single-factor explanation—we argue that the idea of agrammatic output as a rational behavior was dismissed prematurely and appears to provide a plausible explanation for a large subset of the reported cases of expressive aphasia. The rational account of expressive agrammatism should be evaluated more carefully and systematically. On the basic research side, pursuing this hypothesis may reveal how the human mind and brain optimize communicative efficiency in the presence of production difficulties. And on the applied side, this construal of expressive agrammatism emphasizes the strengths of some patients to flexibly adapt utterances in order to communicate in spite of grammatical difficulties; and focusing on these strengths may be more effective than trying to "fix" their grammar. [ABSTRACT FROM AUTHOR]

BACKGROUND: Stroke has functional sequelae, including motor weakness, spasticity, dysphagia, and neurogenic bladder deteriorating activities of daily living. Speech therapy is more often an essential part of the rehabilitation program. Studies in aphasia have primarily focused on two major pathways: the arcuate fasciculus and the superior longitudinal fasciculus. The arcuate fasciculus is a major fiber bundle connecting Broca's area (associated with language production) and Wernicke's area (associated with language comprehension). Damage to this pathway can result in different types of aphasia, depending on the location and extent of the injury. CASE DESCRIPTION: Tractography is a neuroimaging technique used to map the white matter tracts in the brain. Our patient had an occlusion of the external carotid and left carotid siphon. The patient exhibited early complex language deficits involving both motor expressive and comprehensive abilities. After three months the patient presented conduction aphasia caused by damage to the inferior parietal lobule, which extends into the subcortical white matter and damages the arcuate fascicle. This patient was re-assessed for spasticity and language treatments needs, few months after the stroke. Considering first two months language improvement followed by any further language expressive improvement from 3rd to 6th month, a diffusion tensor imaging (DTI) tractography was requested to study interconnections between cortical and subcortical matter. The brain magnetic resonance imaging (MRI) performed in our hospital showed an extensive malacic gliotic area in the left temporal-frontal parietal site. CONCLUSION: Brain MRI is confirmed as a multimodal tool evaluating the damage, both from the point of structural and functional view. Tractography in aphasia allows focusing on major pathways. The involvement of the arcuate fascicle, whose lesion disconnects Broca's and Wernicke's areas, is related to clinical improvement, and represents a neural correlate of the brain injury recovery process that physicians and speech therapists might be aware of it, tailoring the plane of care of each patient. [ABSTRACT FROM AUTHOR]

Objective: Nonfluent aphasia is characterized by simplified sentence structures and word‐level abnormalities, including reduced use of verbs and function words. The predominant belief about the disease mechanism is that a core deficit in syntax processing causes both structural and word‐level abnormalities. Here, we propose an alternative view based on information theory to explain the symptoms of nonfluent aphasia. We hypothesize that the word‐level features of nonfluency constitute a distinct compensatory process to augment the information content of sentences to the level of healthy speakers. We refer to this process as lexical condensation. Methods: We use a computational approach based on language models to measure sentence information through surprisal, a metric calculated by the average probability of occurrence of words in a sentence, given their preceding context. We apply this method to the language of patients with nonfluent primary progressive aphasia (nfvPPA; n = 36) and healthy controls (n = 133) as they describe a picture. Results: We found that nfvPPA patients produced sentences with the same sentence surprisal as healthy controls by using richer words in their structurally impoverished sentences. Furthermore, higher surprisal in nfvPPA sentences correlated with the canonical features of agrammatism: a lower function‐to‐all‐word ratio, a lower verb‐to‐noun ratio, a higher heavy‐to‐all‐verb ratio, and a higher ratio of verbs in ‐ing forms. Interpretation: Using surprisal enables testing an alternative account of nonfluent aphasia that regards its word‐level features as adaptive, rather than defective, symptoms, a finding that would call for revisions in the therapeutic approach to nonfluent language production. ANN NEUROL 2023;94:647–657 [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate how people with nonfluent aphasia produce semantically weighted verbs compared to people without aphasia, as well as how a discourse elicitation task affects verb production in people with nonfluent aphasia and people without aphasia. Method: This study included 30 people with nonfluent aphasia and 32 age-matched people without aphasia from AphasiaBank. Language samples of five different discourse tasks were obtained and coded for heavy, light, and becopular verbs. The number of verbs per utterance and the proportion of heavy, light, and be-copular verbs were compared between groups and between tasks. Results: People with nonfluent aphasia showed a similar proportion of heavy verbs but reduced verbs per utterance and proportion of light verbs compared to people without aphasia. With regard to discourse task effects, we found a trend for a higher proportion of heavy verbs in sequential picture descriptions, and a higher proportion of be-copular verbs and lower proportion of heavy verbs for a recount compared to other tasks in people without aphasia. The discourse task effects were minimally found in people with nonfluent aphasia. Conclusions: Our results suggest that people with nonfluent aphasia present with relatively preserved heavy verb production but with impaired production of light verbs in discourse. In addition, it appears that discourse tasks do not significantly influence the type of verbs produced by people with nonfluent aphasia possibly due to the floor effects and wide range of individual variability. This study is a preliminary effort to evaluate methodological factors that impact verb production; future studies are needed to develop a framework for clinical decision making when selecting a discourse elicitation task for people with aphasia. [ABSTRACT FROM AUTHOR]

Time reference is used to build the temporal framework of discourse and is essential in ensuring efficient communication. Several studies have reported time reference deficits in fluent and non-fluent aphasia and have shown that tenses (past, present, future) are not all impaired to the same extent. However, there is little consensus on the dissociations between tenses, and the question of the influence of the type of aphasia (fluent vs. non-fluent) on time reference remains open. Therefore, a systematic review and an individual participant data meta-analysis (or mega-analysis) were conducted to determine (1) whether one tense is more impaired than another in fluent and non-fluent aphasia and, if so, (2) which task and speaker-related factors moderate tense effects. The systematic review resulted in 35 studies reporting the performance in time reference of 392 participants. The mega-analysis was then performed on 23 studies for a total of 232 participants and showed an alteration of past tense compared to present and future tenses in both types of aphasia. The analysis also showed a task and an age effect on time reference but no gender effect, independently of tenses. These results add to our knowledge of time reference in aphasia and have implications for future therapies.

Introduction: Among many grammatical problems affecting agrammatic patients, those of inflectional morphology, specifically tense, stand at the forefront. This study aimed to analyze tense properties in Mazandarani-speaking Broca patients to see which aspects of this inflectional system were more negatively affected. Materials and Methods: Utilizing inclusion/exclusion criteria, we chose 10 patients (mean age 47 years) in this descriptive-analytical research. To select our participants, some criteria including the results of the Persian aphasia test, monolingualism, and magnetic resonance imaging reports were considered which corroborated the involvement of the anterior frontal lobe, inferior anterior parietal lobe, Perisylvian, and Broca’s areas as well as inferior frontal gyrus. To monitor our patients’ performance in three separate tenses of present (progressive), future, and past (simple past, past perfect, and past continuous), we administered written sentence completion and sentence-to-picture matching tests. To investigate whether our patients’ performance in diverse verb tenses was significantly different, we utilized Wilcoxon statistics to analyze our data. Results: The results demonstrated a significant difference between the performance of the patients in past progressive tense compared to other tenses (P=0.02). Furthermore, a significant difference was observed between the mean responses to past tenses and present-future tenses. Conclusion: Mazandarani-speaking agrammatic demonstrated selective poor performance in the past tense inflection. Regarding the crucial role of tense properties in verbal communication, specifically past tense, to talk about past events and memories, more attention is needed by clinicians and speech therapists to reinforce tense properties enhancing agrammatic communication capabilities.

Cross-linguistic studies on agrammatism have provided evidence that tense inflection is severely impaired while agreement inflection is relatively preserved (Friedmann & Grodzinsky 1997, Benedet et al., 1998). More recent evidence has suggested that the tense deficit is central, affecting comprehension as well. To account for this pattern of performance, a number of hypotheses have been suggested, making different predictions about the nature of the tense deficit in agrammatism. The purpose of this study was (1) to examine the centrality of a tense-agreement dissociation in Moroccan Arabic agrammatism, and (2) to determine task effects on agrammatic performance. We presented results from a picture description, two sentence completion and a grammaticality judgement task with five Moroccan Arabic-speaking agrammatic patients and five matched neurologically normal adults. Control participants performed at ceiling across all the experimental tasks used. PWAA revealed different patterns of performance. Findings from both picture description and sentence completion tasks indicated a dissociation between tense and agreement production, with tense being more error-prone than agreement. The tense-agreement dissociation found in production extended to the comprehension modality in the sense that patients were less sensitive to tense than to agreement violations. Findings indicated task effects on performance with patients performing differently across different experimental tasks. Findings of the present study argue in disfavour of a structural or representational account of the tense deficit in agrammatism. The interaction between task effects and tense accuracy suggests that the deficit can best be characterized in processing terms, particularly being a manifestation of limited working memory capacity. [ABSTRACT FROM AUTHOR]

COVID-19 has globally impacted both physical and mental health. This study aimed to explore the impact of Second Chance Schools (SCS) and the COVID-19 pandemic on the mental health and self-image of Greek SCS students. A total of 251 SCS students from two consecutive study cycles participated, completing the research instruments at the beginning and end of their studies. Participants' anxiety, depressive symptomatology, well-being, self-esteem and self-efficacy were evaluated by means of the GAD-7, PHQ-8, WHO-5 Well-being Index, Rosenberg Self-Esteem Scale and Generalized Self-Efficacy Scale, respectively. The research spanned three years, including a year of universal lockdown, a year with protective measures and a year without anti-COVID-19 measures. Factor analysis, regression analyses and two two-way repeated measures ANOVAs were applied to the collected data. All five psychological dimensions measured by the study's instruments were grouped into two factors, namely mental health and self-image. Well-being positively influenced mental health, while anxiety and depression had a negative impact. On the other hand, self-efficacy and self-esteem positively contributed to self-image. Mental health and self-image were moderately correlated. Pre-SCS values of mental health and self-image predicted a higher percentage of variance in post-SCS values compared to anxiety, depression, well-being, self-efficacy and self-esteem. Moreover, mental health improved after the completion of SCS, but only for participants after the lifting of anti-COVID-19 measures. Conversely, self-image improved for all participants regardless of the presence of anti-COVID-19 measures. Overall, the SCS had a considerable impact on the participants' mental health and self-image, although the effect was influenced by COVID-19. [ABSTRACT FROM AUTHOR]

Melodic Intonation Therapy (MIT) is an evidence-based treatment for persons with non-fluent aphasia. The contribution of rhythm within MIT has been frequently studied, though little research has been completed to determine the role melodic intervals play in this therapy. The purpose of this study was to evaluate the effects of melodic intervals on the efficacy of MIT by using two different melodic intervals to intone target phrases: the consonant minor third and the dissonant tritone. These researchers hypothesized that participants would have greater success in therapy when phrases were intoned on the minor third due to the interval's familiarity and perceived pleasantness as opposed to the unfamiliar and perceptually unpleasant tritone. Using a single-subject, multiple-baseline design, two participants with expressive aphasia were exposed to phrases intoned on both intervals while participating in MIT across eight weeks. Spoken probe phrases were elicited and quantitatively scored on intelligibility prior to, during, and after treatment to measure progress made for phrases intoned on each interval. An effect size was calculated for each interval using a formula created for single-subject, multiple baseline aphasia research studies (Beeson & Robey, 2006). The effect size of the tritone was greater than the effect size of the minor third for both participants: this was contrary to the researchers' hypothesis. Due to COVID-19, treatment was completed via teletherapy, the first time this method has been used to conduct an MIT treatment study. It was determined that MIT provided in this format resulted in improvement in trained phrases. This research suggests that contrary to the MIT protocol, therapy may be more efficacious if phrases are sung using dissonant or unfamiliar melodic intervals rather than pleasant, familiar intervals. However, generalization of this study is restricted due to several limitations. Further research should be completed to evaluate the effects of various intervals within MIT and the complex interaction between rhythm and pitch. [ABSTRACT FROM AUTHOR]

Connected speech assessment is essential to characterize the language features in primary progressive aphasia (PPA). This is especially true for the non-fluent/agrammatic variant (nfvPPA) in which one of the core features is agrammatism. Identification of agrammatism typically involves the analysis of sentence production, as in connected speech, in order to detect syntactic deficits. However, little is known about the longitudinal changes occurring in connected speech of individuals with non-fluent PPA. The aim of this study was to assess changes in connected speech over a one-year span in participants with nfvPPA using semi-structured interviews. We conducted a prospective group study including participants with nfvPPA (n=9) and age- and education-matched healthy controls (n=9). For each individual, connected speech was obtained using topic-directed interviews at two testing rounds, each approximately one year apart. Production on each task was recorded, transcribed and analyzed according to the Quantitative Production Analysis (QPA) protocol, a tool developed by Berndt and colleagues (2000) for the analysis of sentence production in aphasia. For each group, the probability of deterioration between the two testing rounds was estimated using Bayesian analysis. For individuals with nfvPPA, statistical evidence of deterioration from the first testing round to the second was found for five variables, namely the proportion of pronouns, the proportion of verbs, the proportion of closed class words, the inflection index and the proportion of well-formed sentences. Results from the present study suggest that variables relating to word-finding and morphology are more vulnerable to time and therefore may be relevant potential targets for intervention. [ABSTRACT FROM AUTHOR]

The right posterolateral portions of the cerebellum (crus-I/II) are involved in language processing. However, their functional role in language remains unknown. The cerebellum is hypothesized to acquire an internal model that is a functional copy of mental representations in the cerebrum and to contribute to cognitive function. In this research, based on the cerebellar internal model hypothesis, we conducted task-based and resting-state functional magnetic resonance imaging (fMRI) experiments to investigate the role of the cerebellum in the syntactic and semantic aspects of comprehension of sentences. In a syntactic task, participants read sentences with center-embedded hierarchical structures. The hierarchical level-dependent activity was found in the right crus-I as well as Broca's area (p < 0.05, voxel-based small volume correction (SVC)). In a semantic task, the participants read three types of sentences for investigation of sentence-level, phrase-level, and word-level semantic processing. The semantic level-dependent activity was found in the right crus-II as well as in the left anterior temporal lobe and the left angular gyrus (p < 0.05, voxel-based SVC). Moreover, the right crus-I/II showed significant activity when the cognitive load was high. Resting-state fMRI demonstrated intrinsic functional connectivity between the right crus-I/II and language-related regions in the left cerebrum (p < 0.05, voxel-based SVC). These findings suggest that the right crus-I and crus-II are involved, respectively, in the syntactic and semantic aspects of sentence processing. The cerebellum assists processing of language in the cerebrum when the cognitive load is high. [ABSTRACT FROM AUTHOR]

Frontotemporal dementia is clinically and neuropathologically heterogeneous, but neuroinflammation, atrophy and cognitive impairment occur in all of its principal syndromes. Across the clinical spectrum of frontotemporal dementia, we assess the predictive value of in vivo neuroimaging measures of microglial activation and grey-matter volume on the rate of future cognitive decline. We hypothesized that inflammation is detrimental to cognitive performance, in addition to the effect of atrophy. Thirty patients with a clinical diagnosis of frontotemporal dementia underwent a baseline multimodal imaging assessment, including [11C]PK11195 PET to index microglial activation and structural MRI to quantify grey-matter volume. Ten people had behavioural variant frontotemporal dementia, 10 had the semantic variant of primary progressive aphasia and 10 had the non-fluent agrammatic variant of primary progressive aphasia. Cognition was assessed at baseline and longitudinally with the revised Addenbrooke's Cognitive Examination, at an average of 7-month intervals (for an average of ∼2 years, up to ∼5 years). Regional [11C]PK11195 binding potential and grey-matter volume were determined, and these were averaged within four hypothesis-driven regions of interest: bilateral frontal and temporal lobes. Linear mixed-effect models were applied to the longitudinal cognitive test scores, with [11C]PK11195 binding potentials and grey-matter volumes as predictors of cognitive performance, with age, education and baseline cognitive performance as covariates. Faster cognitive decline was associated with reduced baseline grey-matter volume and increased microglial activation in frontal regions, bilaterally. In frontal regions, microglial activation and grey-matter volume were negatively correlated, but provided independent information, with inflammation the stronger predictor of the rate of cognitive decline. When clinical diagnosis was included as a factor in the models, a significant predictive effect was found for [11C]PK11195 BPND in the left frontal lobe (−0.70, P = 0.01), but not for grey-matter volumes (P > 0.05), suggesting that inflammation severity in this region relates to cognitive decline regardless of clinical variant. The main results were validated by two-step prediction frequentist and Bayesian estimation of correlations, showing significant associations between the estimated rate of cognitive change (slope) and baseline microglial activation in the frontal lobe. These findings support preclinical models in which neuroinflammation (by microglial activation) accelerates the neurodegenerative disease trajectory. We highlight the potential for immunomodulatory treatment strategies in frontotemporal dementia, in which measures of microglial activation may also improve stratification for clinical trials. [ABSTRACT FROM AUTHOR]

Several interventions for acquired apraxia of speech (AOS) involve models, imitation, or repetition to elicit production of words. Early researchers wrote about anecdotal experiences, in which sentence completion facilitated speech production for individuals with AOS. The use of sentence completion to elicit production of words during intervention has not been systematically researched. The purpose of this research was to evaluate the effectiveness of sentence completion to elicit correct productions of words, as part of an intervention for one individual with aphasia and AOS. Training occurred three times a week for six weeks. In each session, the participant answered 20 simple questions, for which the answer was one of 20 target words. Ten of these 20 words were used for training, while the other set of 10 words remained untrained. During training, the participant produced words, as the final word of a sentence. The participant improved production of the trained target words. By the end of training, the participant produced more words, as the final word in a sentence and as the answer to a simple question. For this case study, an individual with severe Broca's aphasia and severe AOS increased the number of personally-relevant words produced following training using sentence completion to elicit production. [ABSTRACT FROM AUTHOR]

The use of pictographic images to elicit spoken language productions is common in aphasia therapy. However, investigations on the treatment effects of using video stimuli are limited. People with aphasia are likely to want to be able to communicate better about content depicted in video-clip segments, especially with the growing popularity of video sharing between friends and family on social media. The aim of this study was to examine the effects of utilising video-clip segments in the provision of Response Elaboration Training (RET; Kearns, 1985) in the Persian language. Specifically, the study addressed four questions: (1) Will the provision of RET with video-clips as the treatment stimuli increase the number of correct information units (CIUs; Nicholas and Brookshire, 1993) Persian speakers with aphasia produce in response to trained stimuli? (2) Will there be an increase in the number of CIUs participants produce in response to untrained stimuli? (3) Will treatment gains be maintained over time? (4) Will the participants exhibit improved scores on the Persian Western Aphasia Battery (Nilipour et al., 2014) from pre- to posttreatment? Two participants with moderately severe chronic Broca's aphasia due to a left-hemisphere stroke received treatment three times a week. A single-case multiple-probe design consisting of two consecutive treatment phases, periodic generalisation probes, and three posttreatment follow-up probes (one-week, three-weeks, and six-weeks) was used. Treatment sessions consisted of two rounds of RET applied to 10 video-clip stimuli. Participant 1 reached the treatment termination criteria after six therapy sessions in the first phase of treatment and after seven treatment sessions in the second phase. Participant 2 reached the termination criteria for the first and second treatment phases after 12 and eight treatment sessions, respectively. Large positive treatment effects were found for the participants for trained items. Treatment effects were maintained above baseline performance for trained items on all follow-up measures. Generalisation to untrained items was limited. Both participants exhibited an Aphasia Quotient increase posttreatment on the Persian Western Aphasia Battery, with the largest improvement identified on the spontaneous speech subtest. Although preliminary, this study provides support for the use of video stimuli in the provision of RET in the Persian language to individuals with chronic Broca's aphasia. The study encourages further exploration on the topic and discusses clinical implications of the research. [ABSTRACT FROM AUTHOR]