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Dalton, Sarah Grace Hudspeth, Christine Shultz, Maya L. Henry, Argye E. Hillis, and Jessica D. Richardson. "Describing Phonological Paraphasias in Three Variants of Primary Progressive Aphasia." American Journal of Speech-Language Pathology 27, no. 1S (2018): 336–49. http://dx.doi.org/10.1044/2017_ajslp-16-0210.
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Purpose The purpose of this study was to describe the linguistic environment of phonological paraphasias in 3 variants of primary progressive aphasia (semantic, logopenic, and nonfluent) and to describe the profiles of paraphasia production for each of these variants. Method Discourse samples of 26 individuals diagnosed with primary progressive aphasia were investigated for phonological paraphasias using the criteria established for the Philadelphia Naming Test (Moss Rehabilitation Research Institute, 2013). Phonological paraphasias were coded for paraphasia type, part of speech of the target word, target word frequency, type of segment in error, word position of consonant errors, type of error, and degree of change in consonant errors. Results Eighteen individuals across the 3 variants produced phonological paraphasias. Most paraphasias were nonword, followed by formal, and then mixed, with errors primarily occurring on nouns and verbs, with relatively few on function words. Most errors were substitutions, followed by addition and deletion errors, and few sequencing errors. Errors were evenly distributed across vowels, consonant singletons, and clusters, with more errors occurring in initial and medial positions of words than in the final position of words. Most consonant errors consisted of only a single-feature change, with few 2- or 3-feature changes. Importantly, paraphasia productions by variant differed from these aggregate results, with unique production patterns for each variant. Conclusions These results suggest that a system where paraphasias are coded as present versus absent may be insufficient to adequately distinguish between the 3 subtypes of PPA. The 3 variants demonstrate patterns that may be used to improve phenotyping and diagnostic sensitivity. These results should be integrated with recent findings on phonological processing and speech rate. Future research should attempt to replicate these results in a larger sample of participants with longer speech samples and varied elicitation tasks. Supplemental Materials https://doi.org/10.23641/asha.5558107
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Fargo, Jamison D., Bruce K. Schefft, Mario F. Dulay, Michael D. Privitera, and Hwa-Shain Yeh. "Confrontation Naming in Individuals With Temporal Lobe Epilepsy: A Quantitative Analysis of Paraphasic Error Subtypes." Neuropsychology 19, no. 5 (2005): 603–11. http://dx.doi.org/10.1037/0894-4105.19.5.603.
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Lee, Euijin, Jong-Ik Park, and Han-Yong Jung. "T110. CLINICAL CHARACTERISTICS OF FORMAL THOUGHT DISORDER IN SCHIZOPHRENIA." Schizophrenia Bulletin 46, Supplement_1 (2020): S273. http://dx.doi.org/10.1093/schbul/sbaa029.670.
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Abstract Background Our study aimed to present the distinctive correlates of formal thought disorder in patients with schizophrenia, using the Clinical Language Disorder Rating Scale (CLANG) Methods We compared the formal thought disorder and other clinical characteristics between schizophrenia patients with (n = 82) and without (n = 80) formal thought disorder. Psychometric scales including the CLANG, Brief Psychiatric Rating Scale (BPRS), Young Mania Rating Scale (YMRS), Calgery Depression Scale for Schizophrenia (CDSS) and Word Fluency Test (WFT) were used Results After adjusting the effects of age, sex and total scores on the BPRS, YMRS and WFT, the subjects with disorganized speech presented significantly higher score on the poverty of contents of abnormal syntax (F = 7.08, P = 0.01), lack of semantic association (F = 8.02, P =0.01), disclosure failure (F = 60.97, P < 0.001), pragmatics disorder (F = 11.94, P = 0.01), dysarthria (F = 13.61, P < 0.001), and paraphasic error (F = 8.25, P = 0.01) items than those without formal thought disorder. With defining the mentioned item scores as covariates, binary logistic regression model predicted that disclosure failure (adjusted odds ratio [aOR] = 5.88, P < 0.001) and pragmatics disorder (aOR = 2.17, P = 0.04) were distinctive correlates of formal thought disorder in patients with schizophrenia. Discussion Disclosure failure and pragmatics disorder might be used as the distinctive indexes for formal thought disorder in patients with schizophrenia.
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Collée, E., A. Vincent, C. Dirven, and D. Satoer. "OS10.7.A Localization patterns of language errors during direct electrical brain stimulation: a systematic review." Neuro-Oncology 23, Supplement_2 (2021): ii14. http://dx.doi.org/10.1093/neuonc/noab180.045.
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Abstract BACKGROUND Awake craniotomy with direct electrical stimulation (DES) is the standard treatment for patients with eloquent area gliomas. Language errors (paraphasias) are detected with DES and they indicate functional boundaries that need to be maintained to preserve quality of life. However, it is not fully clear in which brain locations paraphasias at different linguistic modalities and levels (production, comprehension, reading, writing, phonology, semantics, syntax) occur. MATERIALS AND METHODS A systematic review was conducted. We included 102 studies reporting on specific paraphasias and the corresponding brain locations during awake craniotomy with DES in adult glioma patients. RESULTS First, a wide distribution of brain locations for all paraphasias (n=930) was found, but patterns were observed. Cortically, paraphasias occurred most often in the precentral gyrus (22%), while subcortically, they occurred mainly at the inferior fronto-occipital fascicle (IFOF: 10%). Localization patterns for different paraphasia types and the corresponding language functions were also found: production/articulation (n=393)-precentral gyrus (41%), inferior frontal gyrus (9%), frontal aslant/striatal tract (4%), postcentral gyrus (3%); semantics (n=128)-IFOF (57%), superior temporal gyrus (9%); phonology (n=115)-arcuate fascicle (52%), superior longitudinal fascicle (10%), uncinate fascicle (3%); reading (n=25)-temporal lobe (48%), inferior longitudinal fascicle (32%); syntax (n=15)-inferior frontal gyrus (27%); speech initiation (n=9)-supplementary motor area (33%), frontal aslant tract (22%), frontal striatal tract (22%); writing (n=7)-superior parietal gyrus (71%). Second, 59% of all paraphasias occurred cortically, 40% subcortically and 1% at both levels. CONCLUSION The localization of most paraphasias are consistent with the assumed functionality of those brain locations as presented in the Dutch Linguistic Intraoperative Protocol model. However, new locations for production/articulation, phonology, reading and writing were found. This needs to be taken into consideration for future selection of pre, intra and postoperative language tasks at different language modalities and levels. Additionally, DES should always be applied at the subcortical level as a standard addition to the routine cortical mapping during awake craniotomy. In conclusion, this is the first systematic review on the localization of specific paraphasias during awake craniotomy. Based on the identified language localization patterns, language tasks could be selected more accurately. This could guide, and perhaps improve, pre, intra and postoperative language testing and monitoring, which in turn, may pave the way to a better postoperative language outcome. The possible relation between different intraoperative paraphasias and language outcome has yet to be determined.
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Haley, Katarina L., Adam Jacks, and Kevin T. Cunningham. "Error Variability and the Differentiation Between Apraxia of Speech and Aphasia With Phonemic Paraphasia." Journal of Speech, Language, and Hearing Research 56, no. 3 (2013): 891–905. http://dx.doi.org/10.1044/1092-4388(2012/12-0161).
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Purpose This study was conducted to evaluate the clinical utility of error variability for differentiating between apraxia of speech (AOS) and aphasia with phonemic paraphasia. Method Participants were 32 individuals with aphasia after left cerebral injury. Diagnostic groups were formed on the basis of operationalized measures of recognized articulatory and prosodic characteristics of AOS and phonemic paraphasia. Sequential repetitions of multisyllabic words were elicited as part of a motor speech evaluation and transcribed phonetically. Four metrics of variability at the syllable and word levels were derived from these transcripts. Results The measures yielded different magnitudes of variability. There were no group differences between participants who displayed speech profiles consistent with AOS and participants who displayed speech profiles indicative of aphasia with phonemic paraphasia. Rather, correlation coefficients and analyses of covariance showed that the variability metrics were significantly mediated by overall error rate. Additionally, variability scores for individuals with salient diagnoses of AOS and conduction aphasia were inconsistent with current diagnostic guidelines. Conclusions The results do not support diagnostic validity of error variability for differentiating between AOS and aphasia with phonemic paraphasia. Future research using error variability metrics should account for overall error rate in the analysis and matching of participant groups.
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van Dongen, H. R., and E. G. Visch-Brink. "Naming in aphasic children: Analysis of paraphasic errors." Neuropsychologia 26, no. 4 (1988): 629–32. http://dx.doi.org/10.1016/0028-3932(88)90119-4.
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Kuljic-Obradovic, Dragana, and Gordana Ocic. "Clinical patterns of speech-language disorders in thalamic aphasias." Vojnosanitetski pregled 59, no. 4 (2002): 369–75. http://dx.doi.org/10.2298/vsp0204369k.
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The aim of this study was to investigate the characteristic symptom cluster and the course of aphasia in 12 patients with single left thalamic lesion verified by CAT scan. The testing of language disorder was performed by standard linguistic tests for aphasia in the acute stage and one month after the insult. Although this clinical syndrome varied greatly it was possible to point out some common characteristics. Spontaneous speech was fluent, easily articulated, grammatically correct, with preserved melodic line. Word finding and understanding were impaired. The impaired comprehension and naming were prominent in all patients with different severity. Repetition skills were intact. During the naming testing patients accomplished better results after semantic help than after phonetic help. Verbal paraphasia errors appeared more frequently (9,78) than neologistic (2,22) and literal paraphasias (1,78). Results of the language fluency tests were worse during semantic categorization tests (5,50) than during animal naming (9,89). On the basis of these facts it was presumed that aphasia in patients with dominant thalamic lesion was the result of lexico-semantic language disorder. It was statistically proved that recovery from aphasia in these cases tended to be significant and rapid.
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Wood, S. E., W. J. Hardcastle, and F. E. Gibbon. "EPG patterns in a patient with phonemic paraphasic errors." Journal of Neurolinguistics 24, no. 2 (2011): 213–21. http://dx.doi.org/10.1016/j.jneuroling.2010.02.010.
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Pickell, Herbert, Edward S. Klima, Ursula Bellugi, and Gregory Hickok. "Patterns of paraphasic errors in a visual–gestural language." Brain and Language 103, no. 1-2 (2007): 238–39. http://dx.doi.org/10.1016/j.bandl.2007.07.022.
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Spielmann, Kerstin, Edith Durand, Karine Marcotte, and Ana Inés Ansaldo. "Maladaptive Plasticity in Aphasia: Brain Activation Maps Underlying Verb Retrieval Errors." Neural Plasticity 2016 (2016): 1–11. http://dx.doi.org/10.1155/2016/4806492.
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Anomia, or impaired word retrieval, is the most widespread symptom of aphasia, an acquired language impairment secondary to brain damage. In the last decades, functional neuroimaging techniques have enabled studying the neural basis underlying anomia and its recovery. The present study aimed to explore maladaptive plasticity in persistent verb anomia, in three male participants with chronic nonfluent aphasia. Brain activation maps associated with semantic verb paraphasia occurring within an oral picture-naming task were identified with an event-related fMRI paradigm. These maps were compared with those obtained in our previous study examining adaptive plasticity (i.e., successful verb naming) in the same participants. The results show that activation patterns related to semantic verb paraphasia and successful verb naming comprise a number of common areas, contributing to both maladaptive and adaptive neuroplasticity mechanisms. This finding suggests that the segregation of brain areas provides only a partial view of the neural basis of verb anomia and successful verb naming. Therefore, it indicates the importance of network approaches which may better capture the complexity of maladaptive and adaptive neuroplasticity mechanisms in anomia recovery.
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Béland, Renée, Carole Paradis, and Monique Bois. "Constraints and Repairs in Aphasic Speech: A Group Study." Canadian Journal of Linguistics/Revue canadienne de linguistique 38, no. 2 (1993): 279–302. http://dx.doi.org/10.1017/s000841310001478x.
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Aphasia refers to an impairment of language processing resulting from brain damage. A very common symptom observed in aphasic speech is the presence of phonemic paraphasias, i.e., phonemic errors involving the substitution, addition or syncope of one (or more) segment(s) in a word stimulus. Phonemic paraphasias can be found across multiple tasks (repetition, reading aloud, spontaneous speech, picture naming) that require a subject to produce a word sound. They are not specific to a particular type of aphasia since Broca’s aphasics, Wernicke’s aphasics, conduction aphasics, and mixed aphasics all produce phonemic paraphasias (see Lecours et al 1983).
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Forbes-McKay, Katrina, Mike Shanks, and Annalena Venneri. "Charting the decline in spontaneous writing in Alzheimer's disease: a longitudinal study." Acta Neuropsychiatrica 26, no. 4 (2014): 246–52. http://dx.doi.org/10.1017/neu.2014.2.
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ObjectiveThis study aims to document the nature and progression of the spontaneous writing impairment observed in patients with Alzheimer's disease (AD) over a 12-month period using both a cross-sectional and prospective longitudinal design.MethodsThirty-one minimal–moderate AD patients and 30 controls matched for age and socio-cultural background completed a simple and complex written description task at baseline. The AD patients then had follow-up assessments at 6 and 12 months.ResultsCross-sectional comparisons indicated that minimal–moderate AD patients produced more semantic paraphasias, phonological paraphasias, and empty and indefinite phrases, whilst producing fewer pictorial themes, repairing fewer errors, and producing shorter and less complex sentences than controls. The two groups could not be distinguished on visual paraphasias. Longitudinal follow-up, however, suggested that visual processing deteriorates over time, where the prevalence of visual errors increased over 12 months.DiscussionThe findings suggest that the deterioration of writing skills observed in the spontaneous writings of AD patients shows a pattern of impairment dominated by semantic errors with a secondary impairment in phonological processing, which is later joined by a disruption of visuospatial and graphomotor processing.
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Mizuta, Hideko. "Various naming errors in an anomic patient: Focusing on formal paraphasia." Higher Brain Function Research 26, no. 1 (2006): 8–15. http://dx.doi.org/10.2496/hbfr.26.8.
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Theron, Karin, Anita van der Merwe, Donald A. Robin, and Emily Groenewald. "Temporal parameters of speech production in bilingual speakers with apraxic or phonemic paraphasic errors." Aphasiology 23, no. 5 (2009): 557–83. http://dx.doi.org/10.1080/02687030701801717.
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Watanabe, Yoshihiro, Tomomi Suzuki, Kikuko Yokoi, Hisashi Okada, Satoshi Okuda, and Kazuhiko Kakehi. "A shift of the error pattern in phonemic paraphasias with conduction aphasia." Higher Brain Function Research 19, no. 4 (1999): 275–82. http://dx.doi.org/10.2496/apr.19.275.
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Haley, Katarina L., Adam Jacks, Jessica D. Richardson, and Julie L. Wambaugh. "Perceptually Salient Sound Distortions and Apraxia of Speech: A Performance Continuum." American Journal of Speech-Language Pathology 26, no. 2S (2017): 631–40. http://dx.doi.org/10.1044/2017_ajslp-16-0103.
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Purpose We sought to characterize articulatory distortions in apraxia of speech and aphasia with phonemic paraphasia and to evaluate the diagnostic validity of error frequency of distortion and distorted substitution in differentiating between these disorders. Method Study participants were 66 people with speech sound production difficulties after left-hemisphere stroke or trauma. They were divided into 2 groups on the basis of word syllable duration, which served as an external criterion for speaking rate in multisyllabic words and an index of likely speech diagnosis. Narrow phonetic transcriptions were completed for audio-recorded clinical motor speech evaluations, using 29 diacritic marks. Results Partial voicing and altered vowel tongue placement were common in both groups, and changes in consonant manner and place were also observed. The group with longer word syllable duration produced significantly more distortion and distorted-substitution errors than did the group with shorter word syllable duration, but variations were distributed on a performance continuum that overlapped substantially between groups. Conclusions Segment distortions in focal left-hemisphere lesions can be captured with a customized set of diacritic marks. Frequencies of distortions and distorted substitutions are valid diagnostic criteria for apraxia of speech, but further development of quantitative criteria and dynamic performance profiles is necessary for clinical utility.
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Riva, Marco, Enrica Fava, Marcello Gallucci, et al. "Monopolar high-frequency language mapping: can it help in the surgical management of gliomas? A comparative clinical study." Journal of Neurosurgery 124, no. 5 (2016): 1479–89. http://dx.doi.org/10.3171/2015.4.jns14333.
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OBJECT Intraoperative language mapping is traditionally performed with low-frequency bipolar stimulation (LFBS). High-frequency train-of-five stimulation delivered by a monopolar probe (HFMS) is an alternative technique for motor mapping, with a lower reported seizure incidence. The application of HFMS in language mapping is still limited. Authors of this study assessed the efficacy and safety of HFMS for language mapping during awake surgery, exploring its clinical impact compared with that of LFBS. METHODS Fifty-nine patients underwent awake surgery with neuropsychological testing, and LFBS and HFMS were compared. Frequency, type, and site of evoked interference were recorded. Language was scored preoperatively and 1 week and 3 months after surgery. Extent of resection was calculated as well. RESULTS High-frequency monopolar stimulation induced a language disturbance when the repetition rate was set at 3 Hz. Interference with counting (p = 0.17) and naming (p = 0.228) did not vary between HFMS and LFBS. These results held true when preoperative tumor volume, lesion site, histology, and recurrent surgery were considered. Intraoperative responses (1603) in all patients were compared. The error rate for both modalities differed from baseline values (p < 0.001) but not with one another (p = 0.06). Low-frequency bipolar stimulation sensitivity (0.458) and precision (0.665) were slightly higher than the HFMS counterparts (0.367 and 0.582, respectively). The error rate across the 3 types of language errors (articulatory, anomia, paraphasia) did not differ between the 2 stimulation methods (p = 0.279). CONCLUSIONS With proper setting adjustments, HFMS is a safe and effective technique for language mapping.
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Mattioli, Flavia. "The Relative Role of Semantic and Sublexical Processes in Reading, Writing and Repetition: Evidence from a Follow-Up Study." Behavioural Neurology 22, no. 1-2 (2010): 25–34. http://dx.doi.org/10.1155/2010/616910.
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The evolution in time of a number of language tasks in a longitudinal study of a 61-year-old aphasic patient is described. The patient, examined twice, in a 10 month follow-up, showed a dissociation between preserved reading with respect to impaired other modalities as well as a qualitative change in errors' type. A reduction of neologisms and phonologically based errors, with a concurrent increase of semantic paraphasias in naming and repetition, as well as an amelioration in reading, with a reduction of stress assignment errors was exhibited at the follow-up. The results are interpreted by postulating an improved performance of the phonological output processes, allowing non-phonologically based errors to emerge, thus revealing the underlying semantic damage. The Summation Hypothesis [14] seems a general framework better interpreting these findings, more than highly specialized production models, which could explain separately only different modalities’ impairments.
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Sierpowska, Joanna, Andreu Gabarrós, Alejandro Fernandez-Coello, et al. "Words are not enough: nonword repetition as an indicator of arcuate fasciculus integrity during brain tumor resection." Journal of Neurosurgery 126, no. 2 (2017): 435–45. http://dx.doi.org/10.3171/2016.2.jns151592.
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OBJECTIVE Subcortical electrical stimulation during brain surgery may allow localization of functionally crucial white matter fibers and thus tailoring of the tumor resection according to its functional limits. The arcuate fasciculus (AF) is a white matter bundle connecting frontal, temporal, and parietal cortical areas that is often disrupted by left brain lesions. It plays a critical role in several cognitive functions related to phonological processing, but current intraoperative monitoring methods do not yet allow mapping of this tract with sufficient precision. In the present study the authors aimed to test a new paradigm for the intraoperative monitoring of the AF. METHODS In this report, the authors studied 12 patients undergoing awake brain surgery for tumor resection with a related risk of AF damage. To preserve AF integrity and the cognitive processes sustained by this tract in the intraoperative context, the authors used real word repetition (WR) and nonword repetition (NWR) tasks as complements to standard picture naming. RESULTS Compared with the errors identified by WR or picture naming, the NWR task allowed the detection of subtle errors possibly related to AF alterations. Moreover, only 3 patients demonstrated phonological paraphasias in standard picture naming, and in 2 of these patients the paraphasias co-occurred with the total loss of WR and NWR ability. Before surgery, lesion volume predicted a patient's NWR performance. CONCLUSIONS The authors suggest that monitoring NWR intraoperatively may complement the standard naming tasks and could permit better preservation of the important language production functions subserved by the AF.
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Berg, Thomas. "Prelexical and postlexical features in language production." Applied Psycholinguistics 13, no. 2 (1992): 199–235. http://dx.doi.org/10.1017/s0142716400005567.
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ABSTRACTThis study investigated the role of word class and gender during lexical access in language production. It was predicted that word class would constrain lexical access because it acts as the interface between the syntax and the lexicon. Gender, in contrast, should not constrain lexical access because it is a linguistic category that does not correlate with any semantic or syntactic information. These predictions were tested against contextual and noncontextual word substitution errors in a corpus of German slips of the tongue, as well as against verbal paraphasias produced by a German-speaking aphasic patient. The results indicated that in all three subsets, both word class and gender influenced the search through the mental lexicon to a reliable degree, with word class making a greater impact than gender. The model that best captured the empirical effects centered around the distinction between prelexical and postlexical features, assigning word class to the former and gender to the latter group. This distinction could be most naturally implemented in a parallel-interactive processing network. The creation of nodes and connections in this type of model was shown not only to respect functional principles, but also to occur on purely structural grounds. On the assumption that the information would be transmitted more or less reliably from one node to another, the aphasiological and speech error data could be readily accommodated within the same psycholinguistic model.
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Hirano, Aya, Naoko Okudaira, Hinako Kanai, and Keiko Mineshita. "A case of fluent aphasia with various paraphasias: Focusing on analysis of errors in oral naming tasks." Higher Brain Function Research 30, no. 3 (2010): 418–27. http://dx.doi.org/10.2496/hbfr.30.418.
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Kiran, Swathi, and Cynthia K. Thompson. "The Role of Semantic Complexity in Treatment of Naming Deficits." Journal of Speech, Language, and Hearing Research 46, no. 3 (2003): 608–22. http://dx.doi.org/10.1044/1092-4388(2003/048).
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The effect of typicality of category exemplars on naming was investigated using a single subject experimental design across participants and behaviors in 4 patients with fluent aphasia. Participants received a semantic feature treatment to improve naming of either typical or atypical items within semantic categories, while generalization was tested to untrained items of the category. The order of typicality and category trained was counterbalanced across participants. Results indicated that patients trained on naming of atypical exemplars demonstrated generalization to naming of intermediate and typical items. However, patients trained on typical items demonstrated no generalized naming effect to intermediate or atypical examples. Furthermore, analysis of errors indicated an evolution of errors throughout training, from those with no apparent relationship to the target to primarily semantic and phonemic paraphasias. Performance on standardized language tests also showed changes as a function of treatment. Theoretical and clinical implications regarding the impact of considering semantic complexity on rehabilitation of naming deficits in aphasia are discussed.
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Forbes-McKay, Katrina, Michael F. Shanks, and Annalena Venneri. "Profiling spontaneous speech decline in Alzheimer's disease: a longitudinal study." Acta Neuropsychiatrica 25, no. 6 (2013): 320–27. http://dx.doi.org/10.1017/neu.2013.16.
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ObjectiveThis study aims to document the nature and progression of spontaneous speech impairment suffered by patients with Alzheimer's disease (AD) over a 12-month period, using both cross-sectional and prospective longitudinal design.MethodsThirty one mild–moderate AD patients and 30 controls matched for age and socio-cultural background completed a simple and complex oral description task at baseline. The AD patients then underwent follow-up assessments at 6 and 12 months.ResultsCross-sectional comparisons indicated that mild–moderate AD patients produced more word-finding delays (WFDs) and empty and indefinite phrases, while producing fewer pictorial themes, repairing fewer errors, responding to fewer WFDs, produce shorter and less complex phrases and produce speech with less intonational contour than controls. However, the two groups could not be distinguished on the basis of phonological paraphasias. Longitudinal follow-up, however, suggested that phonological processing deteriorates over time, where the prevalence of phonological errors increased over 12 months.DiscussionConsistent with findings from neuropsychological, neuropathological and neuroimaging studies, the language deterioration shown by the AD patients shows a pattern of impairment dominated by semantic errors, which is later joined by a disruption in the phonological aspects of speech.
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Best, Wendy. "When Racquets Are Baskets But Baskets Are Biscuits, Where Do the Words Come From ? A Single Case Study of Formal Paraphasic Errors in Aphasia." Cognitive Neuropsychology 13, no. 3 (1996): 443–80. http://dx.doi.org/10.1080/026432996381971.
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E, Schultz, Churchill R, and Malina A. "A-174 Language Impairments Following Subcortical Infarct: An Aphasia Case Study." Archives of Clinical Neuropsychology 35, no. 6 (2020): 968. http://dx.doi.org/10.1093/arclin/acaa068.174.
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Abstract Objective Subcortical aphasia associated with internal capsule and adjacent structure lesions often involve impaired naming, grammatical but slow dysarthric speech, impaired syntactic comprehension, repetition impairments, and apraxia. Furthermore, neuropsychiatric disturbances, such as diminished motivation and emotional dysregulation are additionally expected given connections to frontal lobe circuits. Overall, the type and severity of aphasia varies following subcortical stroke and the pattern of symptoms associated with subcortical aphasia have not been fully explored. Method The present case is a 34-year-old right-handed African-American female who sustained an acute infarct involving the left splenium, thalamus, and internal capsule, who was evaluated at bedside. Results Upon initial exam, the patient was aphasic, exhibiting difficulties with expression, fluctuating comprehension and frequent paraphasic errors. Repetition and single-step command following were impaired and apraxia was evident. She demonstrated poor insight and awareness into her current deficits. She additionally demonstrated low motivation and mild emotional dysregulation with heightened anxiety and depression. During recovery she demonstrated improved comprehension, verbal output, and reduced emotionality. Conclusions Consistent with previous studies, this case demonstrates the extreme variability of subcortical lesions in their aphasic manifestations and may suggest that subcortical aphasias are generally milder than that of cortical aphasias with generally faster symptom recovery.
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Farivar, Masumeh, Zahra Ghayoumi Anaraki, Fatemeh Derakhshandeh, Nahid Baharloei, and Marziyeh Poorjavad. "Narrative discourse in Persian-speaking patients with mild Alzheimer’s disease." Dementia & Neuropsychologia 13, no. 2 (2019): 225–31. http://dx.doi.org/10.1590/1980-57642018dn13-020012.
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ABSTRACT. Despite the significance of discourse impairments, they have not been thoroughly investigated in Persian-speaking patients with Alzheimer’s disease (AD). Objective: the aim of this study was to perform a multi-level analysis of narrative discourse in Persian-speaking patients with mild AD and to compare them with healthy elderly. Methods: the study included 14 older adults with mild AD and a matched group of 14 healthy elderly. Using a storytelling task based on serial pictures, both macro- and micro-linguistic aspects of narrative discourse were assessed. Cohesion ratio and coherence were investigated as macrolinguistic dimensions of discourse. The studied microlinguistic features included syntactic complexity and verbal errors (mostly involving phonological and semantic paraphasias and mazes). Severity of AD was determined using the Cognitive Dementia Rating (CDR). Results: there were significant differences between the groups regarding cohesion ratio (0.9 ± 0.34 vs. 1.29 ± 0.45, p = 0.02) and coherence scores (2.43 ± 0.41 vs. 3.02 ± 0.81, p = 0.03). Verbal errors and syntactic complexity did not differ significantly between the groups. Conclusion: Persian-speaking patients with mild AD show macrolinguistic impairments in producing discourses based on picture description. Therefore, intervention protocols should focus on the ability to organize information on a specific subject and also to connect sentences produced using appropriate cohesive ties.
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Postman-Caucheteux, Whitney Anne, Rasmus M. Birn, Randall H. Pursley, et al. "Single-trial fMRI Shows Contralesional Activity Linked to Overt Naming Errors in Chronic Aphasic Patients." Journal of Cognitive Neuroscience 22, no. 6 (2010): 1299–318. http://dx.doi.org/10.1162/jocn.2009.21261.
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We used fMRI to investigate the roles played by perilesional and contralesional cortical regions during language production in stroke patients with chronic aphasia. We applied comprehensive psycholinguistic analyses based on well-established models of lexical access to overt picture-naming responses which were evaluated using a single trial design that permitted distinction between correct and incorrect responses on a trial-by-trial basis. Although both correct and incorrect naming responses were associated with left-sided perilesional activation, incorrect responses were selectively associated with robust right-sided contralesional activity. Most notably, incorrect responses elicited overactivation in the right inferior frontal gyrus that was not observed in the contrasts for patients' correct responses or for responses of age-matched control subjects. Errors were produced at slightly later onsets than accurate responses and comprised predominantly semantic paraphasias and omissions. Both types of errors were induced by pictures with greater numbers of alternative names, and omissions were also induced by pictures with late acquired names. These two factors, number of alternative names per picture and age of acquisition, were positively correlated with activation in left and right inferior frontal gyri in patients as well as control subjects. These results support the hypothesis that some right frontal activation may normally be associated with increasing naming difficulty, but in patients with aphasia, right frontal overactivation may reflect ineffective effort when left hemisphere perilesional resources are insufficient. They also suggest that contralesional areas continue to play a role—dysfunctional rather than compensatory—in chronic aphasic patients who have experienced a significant degree of recovery.
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Caffarra, Paolo, Simona Gardini, Stefano Cappa, et al. "Degenerative Jargon Aphasia: Unusual Progression of Logopenic/Phonological Progressive Aphasia?" Behavioural Neurology 26, no. 1-2 (2013): 89–93. http://dx.doi.org/10.1155/2013/965782.
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Primary progressive aphasia (PPA) corresponds to the gradual degeneration of language which can occur as nonfluent/agrammatic PPA, semantic variant PPA or logopenic variant PPA. We describe the clinical evolution of a patient with PPA presenting jargon aphasia as a late feature. At the onset of the disease (ten years ago) the patient showed anomia and executive deficits, followed later on by phonemic paraphasias and neologisms, deficits in verbal short-term memory, naming, verbal and semantic fluency. At recent follow-up the patient developed an unintelligible jargon with both semantic and neologistic errors, as well as with severe deficit of comprehension which precluded any further neuropsychological assessment. Compared to healthy controls, FDG-PET showed a hypometabolism in the left angular and middle temporal gyri, precuneus, caudate, posterior cingulate, middle frontal gyrus, and bilaterally in the superior temporal and inferior frontal gyri. The clinical and neuroimaging profile seems to support the hypothesis that the patient developed a late feature of logopenic variant PPA characterized by jargonaphasia and associated with superior temporal and parietal dysfunction.
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Evans, William S., Robert Cavanaugh, Yina Quique, Emily Boss, Jeffrey J. Starns, and William D. Hula. "Playing With BEARS: Balancing Effort, Accuracy, and Response Speed in a Semantic Feature Verification Anomia Treatment Game." Journal of Speech, Language, and Hearing Research 64, no. 8 (2021): 3100–3126. http://dx.doi.org/10.1044/2021_jslhr-20-00543.
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Purpose The purpose of this study was to develop and pilot a novel treatment framework called BEARS (Balancing Effort, Accuracy, and Response Speed). People with aphasia (PWA) have been shown to maladaptively balance speed and accuracy during language tasks. BEARS is designed to train PWA to balance speed–accuracy trade-offs and improve system calibration (i.e., to adaptively match system use with its current capability), which was hypothesized to improve treatment outcomes by maximizing retrieval practice and minimizing error learning. In this study, BEARS was applied in the context of a semantically oriented anomia treatment based on semantic feature verification (SFV). Method Nine PWA received 25 hr of treatment in a multiple-baseline single-case series design. BEARS + SFV combined computer-based SFV with clinician-provided BEARS metacognitive training. Naming probe accuracy, efficiency, and proportion of “pass” responses on inaccurate trials were analyzed using Bayesian generalized linear mixed-effects models. Generalization to discourse and correlations between practice efficiency and treatment outcomes were also assessed. Results Participants improved on naming probe accuracy and efficiency of treated and untreated items, although untreated item gains could not be distinguished from the effects of repeated exposure. There were no improvements on discourse performance, but participants demonstrated improved system calibration based on their performance on inaccurate treatment trials, with an increasing proportion of “pass” responses compared to paraphasia or timeout nonresponses. In addition, levels of practice efficiency during treatment were positively correlated with treatment outcomes, suggesting that improved practice efficiency promoted greater treatment generalization and improved naming efficiency. Conclusions BEARS is a promising, theoretically motivated treatment framework for addressing the interplay between effort, accuracy, and processing speed in aphasia. This study establishes the feasibility of BEARS + SFV and provides preliminary evidence for its efficacy. This study highlights the importance of considering processing efficiency in anomia treatment, in addition to performance accuracy. Supplemental Material https://doi.org/10.23641/asha.14935812
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Guillouët, Elodie, Mélanie Cogné, Elisabeth Saverot, et al. "Impact of Combined Transcranial Direct Current Stimulation and Speech-language Therapy on Spontaneous Speech in Aphasia: A Randomized Controlled Double-blind Study." Journal of the International Neuropsychological Society 26, no. 1 (2020): 7–18. http://dx.doi.org/10.1017/s1355617719001036.
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AbstractObjective:Aphasia recovery depends on neural reorganization, which can be enhanced by speech-language therapy and noninvasive brain stimulation. Several studies suggested that transcranial direct current stimulation (tDCS) associated with speech-language therapy may improve verbal performance evaluated by analytic tests, but none focused on spontaneous speech. We explored the effect of bihemispheric tDCS on spontaneous speech in patients with poststroke aphasia.Methods:In this multicentric controlled randomized cross-over double-blind study, we included 10 patients with poststroke aphasia (4 had aphasia >6 months and 6 with aphasia <6 months). We combined the sessions of speech-language therapy and bihemispheric tDCS (2 mA, 20 min). After three baseline speech evaluations (1/week), two different conditions were randomly consecutively proposed: active and sham tDCS over 3 weeks with 1 week of washout in between. The main outcome measure was the number of different nouns used in 2 min to answer the question “what is your job.”Results:There was no significant difference between conditions concerning the main outcome measure (p = .47) nor in the number of verbs, adjectives, adverbs, pronouns, repetitions, blank ideas, ideas, utterances with grammatical errors or paraphasias used. Other cognitive functions (verbal working memory, neglect, or verbal fluency) were not significantly improved in the tDCS group. No adverse events occurred.Conclusion:Our results differed from previous studies using tDCS to improve naming in patients with poststroke aphasia possibly due to bihemispheric stimulation, rarely used previously. The duration of the rehabilitation period was short given the linguistic complexity of the measure. This negative result should be confirmed by larger studies with ecological measures.
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Bukhari, Khulood, and Marjorie Pennant. "Mitochondrial Diabetes: The Clinical Spectrum of MIDD and MELAS in Association With the A3243G Mutation." Journal of the Endocrine Society 5, Supplement_1 (2021): A392—A393. http://dx.doi.org/10.1210/jendso/bvab048.799.
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Abstract Introduction: Maternally inherited diabetes and deafness (MIDD) is a multisystem disorder characterized by insulinopenia and sensorineural hearing loss. This rare form of monogenic diabetes is most commonly associated with the A3243G mutation of mitochondrial DNA (mtDNA). The same mutation is seen in 80 percent of patients with MELAS (Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes). MIDD and MELAS have overlapping features suggesting a continuum of expression for the A3243G mutation. Clinical Case: A 41-year-old male was referred for genetic testing and counseling by his ophthalmologist following detection of bilateral punched-out retinal pigment epithelium (RPE) lesions on routine exam. His medical history was significant for type 1 diabetes mellitus (T1DM) diagnosed at the age of 21 and bilateral sensorineural hearing loss diagnosed at the age of 38. The referral was triggered by patient reported family history of MELAS in two of his brothers who were both diagnosed at the age of 10 and died at the ages of 20 and 27. Whether the patient was previously tested during early childhood remains unclear. His medical history was negative for stroke-like episodes or seizures. Neurologic evaluation revealed mild fluent aphasia with paraphasic errors and some comprehension difficulties. MRI of the brain without contrast showed no focus of restricted diffusion. Mitochondrial DNA sequence analysis was performed. A pathogenic variant (m.3243 A&gt;G) was detected in the MT-TL1 gene at approximately 25% heteroplasmy. The patient was advised to avoid metformin given increased risk for lactic acidosis. He was also instructed against use of statins. At the age of 45, the patient presented to the emergency department (ED) with a complaint of headache, vertigo and incoordination. Physical examination revealed left homonymous hemianopsia, right horizontal nystagmus and bilateral upper extremity dysmetria. MRI of the brain without contrast showed a large area of predominantly cortical restricted diffusion involving the right temporal and occipital region with associated T2/FLAIR hyper-intensity. Cross over between the PCA and MCA territories was suggestive of a stroke-like episode related to MELAS. The patient received a bolus of IV arginine at 0.5 g/kg followed by an IV infusion of 0.5 g/kg/day for 3 days. He was later transitioned to oral arginine 5g three times daily and was discharged to a rehab facility. Clinical Lesson: This case demonstrates the evolution of MIDD to MELAS, supporting the concept that both syndromes represent a spectrum of the same disease. A few case reports describe the progression of MIDD to MELAS. Why some patients develop MELAS and others develop MIDD is unclear but may be related to heteroplasmy. Early identification of MIDD and MELAS is crucial given associated comorbidities and unique management issues.
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Fergadiotis, Gerasimos, Kyle Gorman, and Steven Bedrick. "Algorithmic Classification of Five Characteristic Types of Paraphasias." American Journal of Speech-Language Pathology 25, no. 4S (2016). http://dx.doi.org/10.1044/2016_ajslp-15-0147.
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Purpose This study was intended to evaluate a series of algorithms developed to perform automatic classification of paraphasic errors (formal, semantic, mixed, neologistic, and unrelated errors). Method We analyzed 7,111 paraphasias from the Moss Aphasia Psycholinguistics Project Database (Mirman et al., 2010) and evaluated the classification accuracy of 3 automated tools. First, we used frequency norms from the SUBTLEXus database (Brysbaert & New, 2009) to differentiate nonword errors and real-word productions. Then we implemented a phonological-similarity algorithm to identify phonologically related real-word errors. Last, we assessed the performance of a semantic-similarity criterion that was based on word2vec (Mikolov, Yih, & Zweig, 2013). Results Overall, the algorithmic classification replicated human scoring for the major categories of paraphasias studied with high accuracy. The tool that was based on the SUBTLEXus frequency norms was more than 97% accurate in making lexicality judgments. The phonological-similarity criterion was approximately 91% accurate, and the overall classification accuracy of the semantic classifier ranged from 86% to 90%. Conclusion Overall, the results highlight the potential of tools from the field of natural language processing for the development of highly reliable, cost-effective diagnostic tools suitable for collecting high-quality measurement data for research and clinical purposes.
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Wabnitz, Ashley, Barbara Marebwa, Alexandra Basilakos, Chris Rorden, Julius Fridriksson, and Leonardo Bonilha. "Abstract WP169: Patients With Aphasia Demonstrate Variability in Regional Functional Recruitment in Correct Naming Task." Stroke 48, suppl_1 (2017). http://dx.doi.org/10.1161/str.48.suppl_1.wp169.
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Approximately 20-40% of stroke survivors suffer from aphasia, the partial or complete loss of language processing. It has been observed that patients with aphasia will typically make the same number of naming errors every time tested, but the objects that are named correctly or incorrectly will vary. These errors are therefore not linked to specific objects, but are instead related to faulty language processing. It remains poorly understood how the language processing can vary between right or wrong to enable correct naming. Here, we use functional imaging to identify processing patterns that lead to successful language production in patients with chronic aphasia. This could provide a potentially meaningful target for future rehabilitation methods. Methods: We analyzed data from 36 individuals with chronic aphasia who completed a picture-naming task while undergoing functional neuroimaging. After mapping the functional data to the AICHA atlas, regional activation signal was analyzed for each response type (correct, semantic paraphasia, or phonemic paraphasia). We performed a ttest looking for significant differences in activation at particular regions of interest for correct naming compared to semantic and phonemic paraphasias for each individual. Results: Individuals recruit variable regions for correctly named objects. There are some regions that stand out as being statistically significant (p ≤ 0.05) for correct productions compared to semantic and phonemic paraphasias across several subjects (e.g., insular regions were statistically significant for 8/36 subjects and superior temporal sulcus for 9/36 subjects). Also, there is variability in whether the regions that were statistically different were peri-lesional or in unaffected, healthy tissue. Discussion: There is evidence that individualized functional recruitment utilized by people with chronic aphasia allows for correctly naming objects. This pattern is unique and widely variable across subjects, due in large part to differences in lesion size and location. However, individuals recruit a particular network of peri-lesional and preserved brain tissue that is different for correctly naming objects compared to incorrectly naming objects (with semantic or phonemic paraphasias)
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Watanabe, Hiroyuki, Manabu Ikeda, and Etsuro Mori. "Logopenic progressive aphasia with neologisms: a case report." BMC Neurology 19, no. 1 (2019). http://dx.doi.org/10.1186/s12883-019-1524-y.
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Abstract Background Neologisms are commonly encountered in patients with acute cerebrovascular diseases, particularly in those with Wernicke’s aphasia. However, few studies have investigated primary progressive aphasia with neologisms in neurodegenerative disease. Case presentation We describe the case of a 74-year-old, right-handed man who developed logopenic progressive aphasia (LPA) with neologisms. He was assessed with neuropsychological tests, magnetic resonance imaging, and single-photon emission computed tomography. Neologisms accounted for a relatively large portion of the paraphasic errors in the naming tests performed during the neuropsychological assessment. He had all the diagnostic features of LPA. Notably, the unique feature of this patient was the presentation of neologisms, which are seldom observed in typical LPA. Conclusions Neologisms are considered rare symptoms in patients with early-stage LPA. Our findings in this case report provide new insights into the spectrum of clinical features in LPA.