Showing papers on "Aphasia published in 2007"
TL;DR: Age at both onset and death was greater in the atypical AD cases than those with non-AD pathology, although survival was equivalent, and AD is a much commoner cause of focal cortical syndromes than previously recognised, particularly in PCA, PNFA and CBS, but rarely causes SD or bvFTD.
Abstract: To determine the frequency of Alzheimer's disease (AD) pathology in patients presenting with progressive focal cortical syndromes, notably posterior cortical atrophy (PCA), corticobasal syndrome (CBS), behavioural variant frontotemporal dementia (bvFTD), progressive non-fluent aphasia (PNFA) (or a mixed aphasia) and semantic dementia (SD); and to compare the age of onset, evolution and prognosis in patients with focal cortical presentations of AD versus more typical AD and those with non AD pathology. From a total of 200 patients with comprehensive prospective clinical and pathological data we selected 120 : 100 consecutive cases with focal cortical syndromes and 20 with clinically typical AD. Clinical files were reviewed blind to pathological diagnosis. Of the 100 patients with focal syndromes, 34 had AD as the primary pathological diagnosis with the following distribution across clinical subtypes: all 7 of the PCA (100%); 6 of 12 with CBS (50%); 2 of 28 with bvFTD (7.1%); 12 of 26 with PNFA (44.1%); 5 of 7 with mixed aphasia (71.4%) and 2 of 20 with SD (10%). Of 20 with clinically typical AD, 19 had pathological AD. Age at both onset and death was greater in the atypical AD cases than those with non-AD pathology, although survival was equivalent. AD is a much commoner cause of focal cortical syndromes than previously recognised, particularly in PCA, PNFA and CBS, but rarely causes SD or bvFTD. The focal syndrome may remain pure for many years. Patients with atypical AD tend to be older than those with non-AD pathology.
534 citations
TL;DR: Results indicate inconsistencies between the area originally identified by Broca and what is now called Broca's area, a finding with significant ramifications for both lesion and functional neuroimaging studies of this well-known brain area.
Abstract: In 1861, the French surgeon, Pierre Paul Broca, described two patients who had lost the ability to speak after injury to the posterior inferior frontal gyrus of the brain. Since that time, an infinite number of clinical and functional imaging studies have relied on this brain-behaviour relationship as their anchor for the localization of speech functions. Clinical studies of Broca's aphasia often assume that the deficits in these patients are due entirely to dysfunction in Broca's area, thereby attributing all aspects of the disorder to this one brain region. Moreover, functional imaging studies often rely on activation in Broca's area as verification that tasks have successfully tapped speech centres. Despite these strong assumptions, the range of locations ascribed to Broca's area varies broadly across studies. In addition, recent findings with language-impaired patients have suggested that other regions also play a role in speech production, some of which are medial to the area originally described by Broca on the lateral surface of the brain. Given the historical significance of Broca's original patients and the increasing reliance on Broca's area as a major speech centre, we thought it important to re-inspect these brains to determine the precise location of their lesions as well as other possible areas of damage. Here we describe the results of high resolution magnetic resonance imaging of the preserved brains of Broca's two historic patients. We found that both patients' lesions extended significantly into medial regions of the brain, in addition to the surface lesions observed by Broca. Results also indicate inconsistencies between the area originally identified by Broca and what is now called Broca's area, a finding with significant ramifications for both lesion and functional neuroimaging studies of this well-known brain area.
408 citations
TL;DR: The study suggests that the social exclusion of people who struggle to communicate could be addressed through training, for professional and lay carers, that promotes support for communication; opportunity and access; respect and acknowledgment; and attention to the environment.
Abstract: Background: Little is known about what happens to people with severe aphasia in the years after stroke when rehabilitation comes to an end, or about day‐to‐day life for this group. Aims: This study aimed to track the day‐to‐day life and experiences of people with severe aphasia, and to document levels of social inclusion and exclusion as they occurred in mundane settings. Methods and Procedures: Ethnography was chosen as the qualitative methodology most suitable for studying the experience of people with profoundly compromised language. 20 people who were judged to have severe aphasia following stroke agreed to be visited and observed three times in different domestic and care settings. The observer documented environments, protagonists, events, and interactions. Field notes were elaborated with personal, methodological, and interpretative notes. Written material (for example information leaflets) was also documented and described. Data were subject to thematic analysis. Outcomes and Results: The study re...
276 citations
TL;DR: Recovery from aphasia depends on restoration of tissue function or reorganization of the cognitive/neural network underlying language, which can be facilitated by a number of diverse interventions.
Abstract: In the last 25 years, characterization of aphasia has shifted from descriptions of the language tasks that are impaired by brain damage to identification of the disrupted cognitive processes underlying language. At the same time advances in technology, including functional imaging, electrophysiologic studies, perfusion imaging, diffusion tensor imaging, and transcranial magnetic stimulation, have led to new insights regarding the relationships between language and the brain. These insights, together with computational models of language processes, converge on the view that a given language task relies on a complex set of cognitive processes and representations carried out by an intricate network of neural regions working together. Recovery from aphasia depends on restoration of tissue function or reorganization of the cognitive/neural network underlying language, which can be facilitated by a number of diverse interventions. The original research by the author reported in this article was supported by NIH R01 DC05375.
265 citations
TL;DR: The authors used transcranial magnetic stimulation (TMS) to investigate speech production in pre-surgical epilepsy patients and in doing so, introduced a novel tool into language research, which can be used to non-invasively stimulate a specific cortical region and transiently disrupt information processing.
Abstract: Fifteen years ago, Pascual-Leone and colleagues used transcranial magnetic stimulation (TMS) to investigate speech production in pre-surgical epilepsy patients and in doing so, introduced a novel tool into language research. TMS can be used to non-invasively stimulate a specific cortical region and transiently disrupt information processing. These 'virtual lesion' studies offer not only the ability to explore causal relations between brain regions and language functions absent in functional neuroimaging, but also spatial and temporal precision not typically available in patient studies. For instance, TMS has been used to demonstrate functionally distinct sub-regions of the left inferior frontal gyrus; to clarify the relationship between pre-morbid language organization and susceptibility to unilateral lesions and to investigate the contribution of both left and right hemisphere language areas in recovery from aphasia. When TMS is used as a measure of functional connectivity, it demonstrates a close link between action words and motor programmes; it suggests a potential evolutionary link between hand gestures and language and it suggests a role in speech perception for the motor system underlying speech production. In combination with functional neuroimaging, it can elucidate the circuits responsible for this involvement. Finally, TMS may even be useful for enhancing recovery in aphasic patients. In other words, TMS has already become an important tool for studying language at both the cognitive and neural levels, and it is clear that further developments in TMS methodology are likely to result in even greater opportunities for language research.
238 citations
TL;DR: The topics of recent AAC technological advances, acceptance, use, limitations, and future needs of individuals with amyotrophic lateral sclerosis (ALS), traumatic brain injury (TBI), brainstem impairment, severe, chronic aphasia and apraxia of speech, primary progressive aphasa (PPA), and dementia are discussed.
Abstract: The purpose of this review is to describe the state of the science of augmentative and alternative communication (AAC) for adults with acquired neurogenic communication disorders. Recent advances in AAC for six groups of people with degenerative and chronic acquired neurological conditions are detailed. Specifically, the topics of recent AAC technological advances, acceptance, use, limitations, and future needs of individuals with amyotrophic lateral sclerosis (ALS), traumatic brain injury (TBI), brainstem impairment, severe, chronic aphasia and apraxia of speech, primary progressive aphasia (PPA), and dementia are discussed.
230 citations
TL;DR: Development of approaches for more comprehensive pre-surgical characterization of language cortex should build on basic neuroscience research, making use of parametric designs that allow functional mapping.
227 citations
Journal Article•
TL;DR: These procedures are safe, and easy to use in a clinical setting, and in future studies, patients should be stratified by degree of arm weakness and lesion site, also the unexpected aphasia improvement warrants following-up.
Abstract: Background and Purpose:Preliminary reports suggest that central stimulation may enhance the effect of conventional physical therapies after stroke. This pilot study examines the safety and methodology of using transcranial direct stimulation (tDCS) with robot-assisted arm training (AT), to inform planning a larger randomised controlled trial. Subjects: Ten patients, after an ischaemic stroke 4-8 weeks before study onset, no history of epilepsy, participated. Eight had a cortical lesion and 2 had subcortical lesions: all had severe arm paresis and, co-incidentally, 5 had severe aphasia. Methods: Over six weeks, they received thirty 20 min-sessions of AT. During the first 7 minutes, 1.5mA of tDCS was applied, with the anode over the lesioned hemisphere and the cathode above the contralateral orbit. Arm and language impairment were assessed with the Fugl-Meyer motor score (FM, full range 0-66) and the Aachener Aphasie Test. Results: No major side effects occurred. Arm function of three patients (two with a subcortical lesion) improved significantly, with FM scores increasing from 6 to 28, 10 to 49 and 11 to 48. In the remaining seven patients, all with cortical lesions, arm function changed little, FM scores did not increase more than 5 points. Unexpectedly, aphasia improved in 4 patients. Conclusions: These procedures are safe, and easy to use in a clinical setting. In future studies, patients should be stratified by degree of arm weakness and lesion site, also the unexpected aphasia improvement warrants following-up.
227 citations
TL;DR: Binge eating can occur despite reported satiety and is associated with damage to a right-sided orbitofrontal-insular-striatal circuit in humans, supporting a model in which ventral insular and orbitof prefrontal cortices serve as higher-order gustatory regions and cooperate with the striatum to guide appropriate feeding responses.
Abstract: Background: Neurophysiologic studies on human and nonhuman primates implicate an orbitofrontal-insular-striatal circuit in high-level regulation of feeding. However, the role of these areas in determining feeding disturbances in neurologic patients remains uncertain. Objective and Methods: To determine brain structures critical for control of eating behavior, we performed a prospective, laboratory-based, free-feeding study of 18 healthy control subjects and 32 patients with neurodegenerative disease. MR voxel-based morphometry (VBM) was used to identify regions of significant atrophy in patients who overate compared with those who did not. Results: Despite normal taste recognition, 6 of 32 patients compulsively binged, consuming large quantities of food after reporting appropriate satiety. All six patients who overate were clinically diagnosed with frontotemporal dementia (FTD), a disorder previously associated with disordered eating, while the nonovereaters were diagnosed with FTD, semantic dementia, progressive aphasia, progressive supranuclear palsy, and Alzheimer disease. VBM revealed that binge-eating patients had significantly greater atrophy in the right ventral insula, striatum, and orbitofrontal cortex. Conclusion: Binge eating can occur despite reported satiety and is associated with damage to a right-sided orbitofrontal-insular-striatal circuit in humans. These findings support a model in which ventral insular and orbitofrontal cortices serve as higher-order gustatory regions and cooperate with the striatum to guide appropriate feeding responses. Glossary: AD = Alzheimer disease; FTD = frontotemporal dementia; GCRC = General Clinical Research Center; MMSE = Mini-Mental State Examination; OFC = orbitofrontal cortex; PA = progressive aphasia; PSP = progressive supranuclear palsy; ROI = region of interest; SemD = semantic dementia; VBM = voxel-based morphometry.
221 citations
TL;DR: Six challenges for imaging language functions in aphasia with fMRI are covered, with an emphasis on language production, including selection of a baseline task, structure of language production trials, mitigation of motion-related artifacts, and the use of stimulus onset versus response onset in fMRI analyses.
Abstract: Animal analogue studies show that damaged adult brains reorganize to accommodate compromised functions. In the human arena, functional magnetic resonance imaging (fMRI) and other functional neuroimaging techniques have been used to study reorganization of language substrates in aphasia. The resulting controversy regarding whether the right or the left hemisphere supports language recovery and treatment progress must be reframed. A more appropriate question is when left-hemisphere mechanisms and when right-hemisphere mechanisms support recovery of language functions. Small lesions generally lead to good recoveries supported by left-hemisphere mechanisms. However, when too much language eloquent cortex is damaged, right-hemisphere structures may provide the better substrate for recovery of language. Some studies suggest that recovery is particularly supported by homologues of damaged left-hemisphere structures. Evidence also suggests that under some circumstances, activity in both the left and right hemispheres can interfere with recovery of function. Further research will be needed to address these issues. However, daunting methodological problems must be managed to maximize the yield of future fMRI research in aphasia, especially in the area of language production. In this review, we cover six challenges for imaging language functions in aphasia with fMRI, with an emphasis on language production: (1) selection of a baseline task, (2) structure of language production trials, (3) mitigation of motion-related artifacts, (4) the use of stimulus onset versus response onset in fMRI analyses, (5) use of trials with correct responses and errors in analyses, and (6) reliability and stability of fMRI images across sessions. However, this list of methodological challenges is not exhaustive. Once methodology is advanced, knowledge from conceptually driven fMRI studies can be used to develop theoretically driven, mechanism-based treatments that will result in more effective therapy and to identify the best patient candidates for specific treatments. While the promise of fMRI in the study of aphasia is great, there is much work to be done before this technique will be a useful clinical tool.
199 citations
TL;DR: The results indicate that, in patients with no aphasia despite LGGs within Broca's area, the tumor can be removed while involving this “unresectable” structure without inducing sequelae and even improving the quality of life when intractable epilepsy is relieved on the condition that subcortical language connectivity is preserved.
Abstract: OBJECTIVE: Advances in functional mapping have enabled us to extend the indications of surgery for low-grade gliomas (LGGs) within eloquent regions. However, to our knowledge, no study has been specifically dedicated to the resection of LGGs within Broca's area. We report the first surgical series of LGGs involving this area by focusing on methodological and functional considerations. METHODS: Seven patients harboring an IGGin Broca's area (revealed by partial seizures) had a language functional magnetic resonance imaging scan and then under-went operation while awake using intrasurgical electrical mapping. RESULTS: The neurological examination was normal in all patients despite mild language disturbances shown using the Boston Diagnosis Aphasia Examination. Both pre-and intraoperative cortical mapping found language reorganization with recruitment of the ventral and dorsal premotor cortices, orbitofrontal cortex, and insula, whereas no or few language sites were detected within Broca's area. Subcorticalty, electrostirnulation allowed the identification and preservation of four structures still functional, including the arcuate fasciculus, fronto-occipilal fasciculus, fibers from the ventral premotor cortex, and head of the caudate. Postoperatively, after transient language worsening, all patients recovered and returned to a normal socioprofessional life. The resection was total in three cases, subtotal in three, and partial in one patient (operated twice). CONCLUSION: Our results indicate that, in patients with no aphasia despite LGGs within Broca's area, thanks to brain plasticity, the tumor can be removed while involving this "unresectable" structure without inducing sequelae and even improving the quality of life when intractable epilepsy is relieved on the condition that subcortical language connectivity is preserved.
TL;DR: A detailed analysis of motor speech errors in 18 patients with PNFA and neural correlates using voxel-based morphometry on magnetic resonance imaging scans demonstrated that patients with AOS-only and AOS plus dysarthria showed atrophy in the left posterior frontal, anterior insular, and basal ganglia regions when compared with controls.
Abstract: Progressive nonfluent aphasia (PNFA) is a clinical le characterized by motor speech impairment and syndrome characterized by motor speech impairment and agrammatism, with relative sparing of single word comprehension and semantic memory. PNFA has been associated with the characteristic pattern of left anterior insular and posterior frontal atrophy, including the motor and premotor regions and Broca's area. Postmortem histopathologic evidence has shown that PNFA is usually associated with tau pathology, although focal Alzheimer disease pathology and tau-negative, ubiquitin-TDP-43 inclusions also have been reported in association with this clinical syndrome. We performed a detailed analysis of motor speech errors in 18 patients with PNFA and investigated their neural correlates using voxel-based morphometry on magnetic resonance imaging scans. Seven patients demonstrated only apraxia of speech (AOS) errors, whereas 11 showed AOS along with dysarthria. Slow rate of speech, effortful articulation with groping, and consonant distortions were the most common AOS errors. Hypernasality was the most represented dysarthric feature and dysarthria was most often classified as spastic, hypokinetic, or mixed spastic-hypokinetic. Neuroimaging results demonstrated that patients with AOS-only and AOS plus dysarthria showed atrophy in the left posterior frontal, anterior insular, and basal ganglia regions when compared with controls. Patients with AOS plus dysarthria showed greater damage than patients with AOS-only in the left face portion of primary motor cortex and left caudate. PNFA is a distinct frontotemporal lobar degeneration clinical syndrome associated with characteristic clinical, neuroimaging, and pathologic features. The clinical features are driven by the severity of left frontal and caudate damage.
TL;DR: The present study examined the HRF and SNR in five individuals with aphasia resulting from stroke and four unimpaired participants using a lexical decision task and a long trial event-related design and found that the SNR for BOLD signal detection may by insufficient in damaged areas.
TL;DR: For group comparisons, proxy respondents who are in frequent contact with people with chronic aphasia can reliably report on their health related quality of life, using the SAQOL-39.
Abstract: Background and purpose: Health related quality of life outcomes are increasingly used to measure the effectiveness of stroke interventions. People with severe aphasia after stroke may be unable to self-report on such measures, necessitating the use of proxy respondents. We explored the level of agreement between people with aphasia (PWA) and their proxies on the Stroke and Aphasia Quality of Life Scale (SAQOL-39) and whether this agreement is influenced by demographic variables and proxy levels of depression and carer strain. Methods: People with chronic aphasia (⩾6 months post stroke) were recruited through the UK national charity for PWA. They were interviewed on the SAQOL-39 and their nominated proxies were interviewed on the SAQOL-39, the General Health Questionnaire and the Caregiver Strain Index. Proxy respondents had to be ⩾18 years of age, see the person with aphasia at least twice a week and have no known severe mental health problems or cognitive decline. Results: 50 of 55 eligible pairs (91%) took part in the study. Proxies rated PWA as more severely affected than PWA rated themselves. The SDs of the difference scores were large and the difference was significant for three of the four SAQOL-39 domains and the overall mean (p⩽0.01). However, the bias as indicated by effect sizes was small to moderate (0.2–0.5). The strength of the agreement was excellent for the overall SAQOL-39 and the physical domain (intra-class correlation coefficient ICC 0.8), good for the psychosocial and communication domains (0.7) and fair for the energy domain (0.5). Demographic variables and proxy’s mood and carer strain did not affect the level of agreement. Conclusions: For group comparisons, proxy respondents who are in frequent contact with people with chronic aphasia can reliably report on their health related quality of life, using the SAQOL-39. Although there are significant differences between PWA and proxy responses, the magnitude of this difference is small to moderate.
TL;DR: Unlike patients with classical "semantic access impairment", the authors' semantically impaired stroke patients showed significant test-retest consistency, indicating that their difficulties did not result from an unpredictable failure of semantic access--instead, their deficits were interpreted as arising from failures of semantic control.
TL;DR: How ERPs are derived, the pros and cons of using ERPs for language-processing research, and a summary of the major ERP components relevant to research on speech perception, word and sentence comprehension, and word production are discussed.
Abstract: Since the publication of the first papers on event-related brain potentials (ERP) and language in the 1980s, the field of electrophysiology of language has evolved a great deal. This article is a brief overview of ERPs and languageprocessing research. It discusses how ERPs are derived, provides the pros and cons of using ERPs for language-processing research, and gives a summary of the major ERP components relevant to research on speech perception (mismatch negativity), word and sentence comprehension (N400, left anterior negativity, P600), and word production (lateralized readiness potential, N200). Additionally, it addresses current controversies concerning the interpretation of these components. Applications of the ERP technique are illustrated with research on first and second language acquisition, bilingualism, and aphasia.
TL;DR: Functional neuroimaging studies of recovery and treatment of patients with aphasia after stroke are discussed, suggesting that treatment of speech production difficulties, even years after stroke, may be effective and deserves further study.
Abstract: Purpose of reviewIn this review of papers published between May 2006 and May 2007, we discuss functional neuroimaging studies of recovery and treatment of patients with aphasia after stroke.Recent findingsStudies of recovery of aphasia have highlighted the importance of right inferior frontal gyrus
TL;DR: Intensive speech and language therapy did not improve the language impairment significantly more than the `standard' therapy which averaged 1.6 hours/week, and the improvement in aphasia was least in patients who were in the NHS group.
Abstract: Objective: To examine whether the amount of speech and language therapy influences the recovery from poststroke aphasia.Setting: A hospital stroke unit and community.Design: A prospective, randomized controlled trial.Intervention: Aphasic stroke patients were randomly allocated to receive 5 hours (intensive therapy group, n=51) or 2 hours (standard therapy group) of speech and language therapy per week for 12 consecutive weeks starting as soon as practicable after the stroke. Another 19 patients were recruited for 2 hours per week of therapy and were treated by National Health Service (NHS) staff (NHS group).Outcome measure and assessment: The Western Aphasia Battery. Assessments were made blind to randomization at baseline and 4, 8, 12 and 24 weeks after the start of therapy. Data were analysed by intention to treat.Results: The mean (SD) Western Aphasia Battery score at week 12 for the intensive, standard and NHS groups was 70.3 (26.9), 66.2 (26.2) and 58.1 (33.7), respectively. There was no treatment e...
TL;DR: Although discourse analyses have great potential for clinical application for individuals with TBI, their widespread use has been limited by time and training constraints and there is no empirical evidence to guide the treatment of discourse deficits.
Abstract: Currently, there is substantial evidence to support the assessment of communication, following traumatic brain injury (TBI), beyond what is included in standardized aphasia or child language batteries. The sensitivity of discourse analyses for delineating subtle cognitive-communicative deficits is well established in the research literature. A variety of useful monologic and conversational discourse measures have been identified including productivity, efficiency, content accuracy and organization, story grammar and coherence, and topic management. Disruption of discourse may persist for years after TBI and appears to have a negative impact on quality of life. Although discourse analyses have great potential for clinical application for individuals with TBI, their widespread use has been limited by time and training constraints. A further limitation is that there is no empirical evidence to guide the treatment of discourse deficits. There is need for the development and investigation of theoretically based interventions.
TL;DR: The results show that, even in the chronic stage, phonological strategies may improve impaired naming and induce cerebral reorganization.
Abstract: Background. The neural correlates of training-induced improvements of cognitive functions after brain damage remain still scarcely understood. In the specific case of aphasia, although several investigations have addressed the issue of the neural substrates of functional recovery, only a few studies have attempted to assess the impact of language training on the damaged brain.Aims. The main goal of this study was to examine the neurobiological correlates of improved picture-naming performance in 2 aphasic patients who received intensive and specific training for a chronic and severe phonological anomia.Methods. In both participants, picture-naming performance was assessed before and after phonological cueing training. Training-induced changes in patients’ performance were correlated to brain activity patterns as revealed by pre- and post-training event-related functional magnetic resonance imaging scanning.Results. Training-induced improvement was observed concurrently with changes in the brain activation...
TL;DR: Using complex language material as a starting point for treatment of sentence structural deficits in aphasia results in cascading generalization to simpler, linguistically related material and expands spontaneous language production in many language-disordered adults with aphasIA.
Abstract: Purpose This article addresses complexity in the context of treatment for sentence structural impairments in agrammatic aphasia, with emphasis on noncanonical sentences involving linguistic movemen...
TL;DR: Valuable data can be obtained from participants with aphasia when the interview method is altered appropriately to meet their communicative needs, and the study highlights implications for enhancing rigour in qualitative interviews with people withAphasia.
Abstract: Background: An increasing number of researchers are using qualitative methods to study the impact of aphasia. However, there is a paucity of published research outlining if and how qualitative interview methods are altered with participants with aphasia, and how potential modifications impact on the rigour of such research. Aims: In a qualitative, pilot study we investigated (1) What services do males in Victoria with mild chronic aphasia perceive could be provided by the Australian Aphasia Association? (2) How is qualitative in‐depth interviewing method altered to accommodate the communicative difficulties experienced by people with aphasia? This paper reports on the second aim. Methods and Procedures: A qualitative phenomenological approach was adopted. Purposeful sampling was used to obtain four participants with mild chronic aphasia across the variables of geographical location and employment status at time of stroke. An interview guide was devised and refined with a fifth pilot participant. Interview...
TL;DR: The aim of this article is to describe aphasia using the framework provided by the World Health Organization's International Classification of Functioning, Disability and Health (ICF).
Abstract: The aim of this article is to describe aphasia using the framework provided by the World Health Organization's International Classification of Functioning, Disability and Health (ICF). The key constructs of ICF are described in relation to the ultimate goal of intervention in aphasia-maximizing quality of life. Aphasic impairments as well as activity limitations and participation restrictions are discussed. In addition, the impact of contextual factors on the experience of aphasia and participation in life are addressed. Finally, a case example is presented to depict the use of the ICF as an organizational framework for approaching management of impairments and consequences of aphasia.
TL;DR: The findings suggest that arithmetic and language comprehension are mediated by partially overlapping brain networks, and are discussed in light of previous work on the neural basis of arithmetic ability and its relationship to language.
TL;DR: Changes in neural recruitment associated with phonologic and semantic-based naming treatments are compared and imply that cortical areas not traditionally related to language processing may support anomia recovery in some patients with chronic aphasia.
TL;DR: Increases in verbal productivity and informativeness in discourse production were associated with the treatment of a semantic feature training procedure on retrieval of action names in a participant with anomic aphasia.
Abstract: INTRODUCTION Anomia, or difficulty with word-finding, is a defining feature of aphasia that crosses aphasia type [1]. Word-retrieval deficits may be observed with all grammatical word forms (e.g., nouns, verbs, adjectives), and persons with aphasia may have more difficulty with retrieval of one grammatical class relative to another [2-4]. Retrieval of object names has received significantly more focus than retrieval of other grammatical form classes in terms of rehabilitation research. However, an increasing number of investigations have addressed treatment of verb retrieval [5-9]. Targeting verb retrieval is potentially an important component of aphasia rehabilitation because verbs not only carry critical meaning but also have important functions in the structural formulation of sentences [10]. Although a limited number of participants have been studied across relatively few investigations, it appears that action-naming may be improved by therapies similar to those used in the treatment of object-name retrieval. For example, McNeil and colleagues applied Lexical-Semantic Activation Inhibition Treatment (L-SAIT) to retrieval of verbs, nouns, and adjectives with a participant with anomic aphasia [11]. L-SAIT, which entailed production of antonyms and synonyms with semantic, gestural, written, and phonologic cueing, improved retrieval of antonyms for all trained grammatical forms, with no generalization to untrained items within and across grammatical forms. Cueing treatments have also been studied by Wambaugh and colleagues in the treatment of object names [12-13] and action names [8,14]. Positive treatment effects were found for both a phonological cueing treatment (PCT) and a semantic cueing treatment (SCT), with increases in naming accuracy being observed more consistently in the treatment of object names. More specifically, participants whose verb-retrieval deficits appeared to stem from relatively severe semantic processing deficits did not benefit from either PCT or SCT. The investigators suggested that the relatively limited information provided by the cues may have been insufficient to improve verb retrieval for participants with severe deficits. The positive effects of treatments for verb retrieval in aphasia have largely been restricted to improvements in naming of trained items. This has been the case for therapies designed specifically to treat verbs [5-6,9,15], and for those treatments derived from or applied to different grammatical form classes [11,14,16]. This lack of generalization to untrained verbs, even to semantically related verbs, concurs with findings from studies of treatment of object name retrieval, in which response generalization has been a relatively rare occurrence [17]. Although improvements in naming have been restricted to trained verbs, changes in the production of sentences and/or discourse have been reported following verb-retrieval training [6-7,9,18]. However, findings regarding such changes have been mixed, both within and across studies examining pre- and posttreatment discourse abilities. For example, Marshall combined semantic tasks, orthographic cueing, gestural tasks, and verbal production tasks in treating a patient with a phonological-level impairment of verb production (unimpaired written verb production) [18]. Following treatment, limited improvements in verb retrieval and production of verb-plusargument structure in response to questions were noted, but similar changes were not observed in story-retelling tasks. Marshall et al. reported statistically significant improvements in sentence production following a semantically oriented treatment with a participant with Broca's aphasia and a selective verb-retrieval deficit [6]. Similarly, Raymer and Ellsworth found improvements in sentence production accuracy in response to a semantic verb-retrieval treatment with a participant with nonfluent aphasia and mild verb-retrieval impairment [7]. …
TL;DR: It is suggested that agrammatic aphasic individuals may process wh- questions similarly to unimpaired individuals, but that this process often fails to facilitate off-line comprehension of sentences with wh- movement.
TL;DR: The present case results demonstrate use and/or training-dependent differential recovery of expressive language functions and an enhanced pattern of brain activation as a function of the rehabilitation efforts that were focussed exclusively on the patient's German language abilities.
TL;DR: Frontotemporal dementia (FTD) is the term now preferred over Picks disease to describe the spectrum of non-Alzheimers dementias characterized by focal atrophy of the frontal and anterior temporal regions of the brain.
Abstract: Dementia is a clinical state characterized by loss of function in multiple cognitive domains. It is a costly disease in terms of both personal suffering and economic loss. Frontotemporal dementia (FTD) is the term now preferred over Picks disease to describe the spectrum of non-Alzheimers dementias characterized by focal atrophy of the frontal and anterior temporal regions of the brain. The prevalence of FTD is considerable, though specific figures vary among different studies. It occurs usually in an age range of 35–75 and it is more common in individuals with a positive family history of dementia. The risk factors associated with this disorder include head injury and family history of FTD. Although there is some controversy regarding the further syndromatic subdivision of the different types of FTD, the three major clinical presentations of FTD include: 1) a frontal or behavioral variant (FvFTD), 2) a temporal, aphasic variant, also called Semantic dementia (SD), and 3) a progressive aphasia (PA). These different variants differ in their clinical presentation, cognitive deficits, and affected brain regions. Patients with FTD should have a neuropsychiatric assessment, neuropsychological testing and neuroimaging studies to confirm and clarify the diagnosis. Treatment for this entity consists of behavioral and pharmacological approaches. Medications such as serotonin reuptake inhibitors, antipsychotics, mood stabilizer and other novel treatments have been used in FTD with different rates of success. Further research should be directed at understanding and developing new diagnostic and therapeutic modalities to improve the patients' prognosis and quality of life.
TL;DR: This article explored the relevance of both neuropsychological and conversational approaches to the assessment of aphasia and presented the executive battery that was designed and administered to a single participant (MS) to assess various aspects of EF.
Abstract: Background: Lack of communicative success for people with aphasia is no longer seen as purely a linguistic deficit. Instead, the integrity of the executive functions (EF) is thought to be at least partly responsible for successful communication, particularly during conversation. In order to inform clinicians regarding both conversation and EF, a merging of two paradigms—conversational and neuropsychological approaches—is proposed. This paper was presented at the Clinical Aphasiology Conference, Ghent, Belgium, May 2006. Aims: First, we explore the relevance of both neuropsychological and conversational approaches to the assessment of aphasia. Second, we present the executive battery that was designed and administered to a single participant (MS) to assess various aspects of EF. The results of a Conversation Analysis (CA) undertaken on an excerpt of MS's conversation are given. Results of the EF analysis are presented with the CA in order to highlight proposed relationships that may impact on conversationa...