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PubMedDate not supplied

Dysphagia in stroke: Development of a standard method to examine swallowing recovery.

This study began development of a standard method that uses the videofluoroscopic swallow study for evaluation of swallowing recovery after stroke based on a definition of dysphagia derived from three domains: bolus timing, bolus direction, and bolus clearance. Two experiments were conducted: one that defined normal versus disordered swallowing based on the range of scores in a sample of healthy adults (n = 13), and one that applied these thresholds to nine stroke patients to identify the presence of dysphagia. Results indicate that acute and protracted dysphagia may be more accurately detected by identifying abnormalities on multiple objective measures of swallowing rather than on laryngeal penetration or aspiration alone. Results indicate that our selected measures and use of healthy control subjects to establish normal thresholds may eventually contribute to the definition and differentiation of dysphagic and nondysphagic patients. Further research with a broader sample of healthy controls and stroke patients is mandatory.

Aged↗
PubMed1997

[Electrophysiological study of a case of clinically diagnosed corticobasal degeneration with rhythmic myoclonus].

A 66-year-old man with clinically diagnosed corticobasal degeneration was studied electrophysiologically. The patient had bilateral forced grasping, rigidity, bradykinesia and hyperreflexia which were predominant on the right side, motor aphasia, constructional apraxia, forced laughing, dysequilibrium and myoclonus of the right upper extremity. Several anti-parkinsonism drugs were ineffective. Brain MRI revealed cortical atrophy of the fronto-temporo-parietal lobes with left predominance. On single photon emission computed tomography, cerebral blood perfusion was decreased, especially on the left side in the fronto-temporal lobes, basal ganglia and thalamus. Myoclonus was distal dominant, worse on action or posture, and was rhythmic, mimicking a tremor. On surface EMG recording of the myoclonus, agonist and antagonist muscle pairs were activated simultaneously and rhythmic activities with frequencies ranging from 7 to 8 Hz were seen. The patient had an enhanced C reflex with a relatively short latency (41.0 ms) after median nerve stimulation only at the right wrist. Additionally, during voluntary contraction, the time-constant EMG silence lasting for about 80-90 ms followed the C reflexes. On somatosensory evoked potentials (SEPs) to the median nerve stimulation, N20 latencies were normal and P25 and N33 amplitudes were not giant. There was no premovement corticat spike when a jerk-locked averaging method was used. Regarding motor evoked potentials (MEPs) elicited by magnetic brain stimulation, central motor conduction times were normal. The estimated cortical delay between the arrival of a somatosensory volley and the motor cortical discharge responsible for C reflex was 1.0 ms, which was shorter than those (3.1 +/- 0.9 ms) estimated in five patients with typical cortical reflex myoclonus. A conditioning stimulation (C) of the right median nerve produced marked facilitation of MEPs following magnetic stimulation of the left motor cortex, at conditioning-test intervals (C-T intervals) of 20-22 ms, whereas a conditioning stimulation of the left median nerve did not produce the same effect. These C-T intervals were thought to be very short, considering that N20 latency was 19.6 ms in this patient. The duration of the EMG silence following the C reflex corresponded to that of the EMG silence between muscle activities during his rhythmic myoclonus, and also the myoclonus was reset by occurrence of the C reflex. These electrophysiological findings indicate that his myoclonus was based upon the enhancement of direct sensory input from the thalamus to the motor cortex. Moreover, it is suggested that the existence of the time-constant EMG silence following the C reflex was related to the myoclonal rhythm.

Aged↗
PubMed1999

Predictors of mortality in patients with Alzheimer's disease living in nursing homes.

OBJECTIVES: To identify factors associated with mortality in patients with Alzheimer's disease, and to evaluate whether these factors vary according to severity of cognitive impairment. METHODS: Data were from the SAGE database which includes information on all residents admitted between 1992 and 1995 to all Medicare/ Medicaid certified nursing homes of five US states. We conducted a longitudinal follow up study (median 23 months) on 9264 patients aged 65 years and above with a diagnosis of Alzheimer's disease. Patient data including demographic characteristics, dementia severity, comorbidity, and other clinical and treatment variables were collected with the Minimum Data Set. Information on death was derived through linkage to Medicare files. Baseline characteristics were used to predict survival in univariate and multivariate Cox proportional hazard models. RESULTS: Overall mortality rate was 50%, with a first year rate of 25.7%. Increased age (risk ratio (RR) 1. 83; 95% confidence interval (95% CI) 1.65-2.03, for patients 85+ years), male sex (RR 1.81; 95% CI 1.70-1.94), limitation in physical function (RR 1.45; 95% CI 1.27-1.66), a condition of malnutrition (RR 1.31; 95%CI 1.23-1.39), the presence of pressure ulcers (RR 1.24; 95% CI 1.13-1.36), a diagnosis of diabetes mellitus (RR 1.32; 95% CI 1.21-1.43), and of cardiovascular diseases (RR 1.22; 95% CI 1. 14-1.30) were independent predictors of death, regardless of the severity of baseline dementia. Sensory problems (hearing and vision) and urinary incontinence were associated with increased mortality only among patients with less severe dementia. The presence of disruptive behaviour, aphasia, and a diagnosis of Parkinson's disease were not related to survival. African-Americans and other minority groups were less likely to die relative to white people. CONCLUSIONS: Age, sex, functional limitation, and malnutrition seem to be the strongest predictors of death for patients with Alzheimer's disease in nursing homes. Altogether, severity of dementia has no influence on survival, yet the predictive role of certain variables depends on the degree of impairment. Minority groups have a reduced risk of death relative to white people.

Aged↗
PubMed2003

Language following functional left hemispherectomy in a bilingual teenager.

A detailed language assessment was conducted with MM, a 17-year-old bilingual teenager with Rasmussen syndrome who had undergone a left functional hemispherectomy. Results revealed important deficits in French and English, affecting expressive and receptive language in both the written and the oral modality. MM's linguistic profile was coherent with previous description of language function following left hemispherectomy, and what is known of the linguistic potential of the right hemisphere (RH). The impairment pattern showed overall similarities between French and English, thus supporting the existence of a common underlying system for these two languages. However, the profiles in each language were not identical, implying that distinct subsystems may also be at play. These findings support previous descriptions of acquired language impairments and recovery in bilingual individuals.

Adolescent↗
PubMed1999

Speech timing subsequent to brain damage: effects of utterance length and complexity.

Acoustic analyses of syllable durations were conducted in order to address several hypotheses concerning deficits in the control of speech timing subsequent to focal brain damage. Groups of nonfluent and fluent aphasics, right-hemisphere-damaged patients, and normal controls produced monosyllabic root syllables in medial and final position in the context of short and long sentences and syntactically simple and complex sentences. Durations of the target syllable as a proportion of the utterance were compared across contexts and groups. Somewhat surprisingly, the results revealed relatively normal temporal patterns in all subject groups, with the main exception emerging for the nonfluent aphasic patients who failed to demonstrate normal phrase-final lengthening effects. Implications of the findings for theories of temporal control in brain-damaged patients are considered.

Aged↗
PubMed1991

Perceptual characteristics of vowel and prosody production in apraxic, aphasic, and dysarthric speakers.

Narrow phonetic transcriptions and prosodic judgments were made of single-word imitations by apraxic (AOS), conduction aphasic (CA), and ataxic dysarthric (AD) speakers. AOS and AD subjects showed similar vowel error patterns, particularly predominant errors in low, tense, and back vowels, more distortions than other types of vowel errors, and predominant errors in initial position of words and in monosyllabic words. The CA subjects displayed a different vowel error pattern, notably more substitutions than distortions, more errors in polysyllabic than monosyllabic words, and more errors in noninitial than initial positions of words. Analysis of prosodic features identifiable at the single-word level (e.g., syllabic stress, juncture, and struggles to initiate or complete productions) indicated that syllabic stress errors and more difficulty initiating than completing word production were characteristic of AOS and AD but not CA subjects.

Adult↗
PubMed2000

Radiosurgery for epilepsy associated with cavernous malformation: retrospective study in 49 patients.

OBJECTIVE: Microsurgical resection of a cavernous malformation (CM) with or without associated cortical resection can provide efficient treatment of drug-resistant associated epilepsy. To explore the potential alternative role of radiosurgery and to evaluate its safety and efficacy for this indication, we conducted a retrospective multicenter study. METHODS: We retrospectively reviewed the files of patients with long-lasting drug-resistant epilepsy, presumably caused by CM, who were treated by gamma knife (GK) surgery for the control of their epilepsy in five centers (Marseilles, Komaki City, Prague, Graz, and Sheffield). A satisfactory follow-up was available for 49 patients (mean follow-up period, 23.66 +/- 13 mo). The mean duration of epilepsy before the GK procedure was 7.5 (+/-9.3) years. The mean frequency of seizures was 6.9/month (+/-14). The mean marginal radiation dose was 19.17 Gy +/- 4.4 (range, 11.25-36). Among the 49 patients, 17 (35%) had a CM located in or involving a highly functional area. RESULTS: At the last follow-up examination, 26 patients (53%) were seizure-free (Engel's Class I), including 24 in Class IA (49%) and 2 patients with occasional auras (Class IB, 4%). A highly significant decrease in the number of seizures was achieved in 10 patients (Class IIB, 20%). The remaining 13 patients (26%) showed little or no improvement. The mediotemporal site was associated with a higher risk of failure. One patient bled during the observation period, and another experienced radiation-induced edema with transient aphasia. Postradiosurgery excision was performed in five patients, and a second radiosurgical treatment was carried out in one patient. CONCLUSION: This series is the first to specifically evaluate the capability of GK surgery to safely and efficiently treat epilepsy associated with CM. Seizure control can be reached when a good electroclinical correlation exists between CM location and epileptogenic zone. Although we do not recommend GK surgery for prevention of bleeding for a CM that has not bled previously, our findings suggest that GK surgery can be proposed for the treatment of epilepsy when the CM is located in a highly functional area.

Adult↗
PubMed1985

Contrasting speech patterns in apraxia of speech and phonemic paraphasia.

This study was designed to determine if perceptual phonological analysis would reveal distinctions between patients with apraxia of speech and patients with phonemic paraphasic speech. Test findings from 10 Broca's aphasics with apraxia of speech were compared to findings from 10 paraphasic speakers (5 conduction and 5 Wernicke's aphasics). Several marked differences were revealed. Predominant locus of errors and relative difficulty of different classes of phonemic segments were significant discriminators. There was a nonsignificant trend for substituted phonemes to be further from target phonetically in the paraphasic patients. In addition, the two groups showed certain consistent differences in the types of errors they produced. Apraxic patients produced many errors of transitionalization, while sequencing errors were more typical of the patients with phonemic paraphasia. The findings are interpreted in relation to a neuropsychological model of speech. It is suggested that phonemic paraphasia represents a breakdown mainly in the retrieval of phonological word patterns, while apraxia of speech is characterized predominantly by a disturbance in encoding phonological patterns into appropriate speech movements.

Adult↗
PubMed1997

Magnetic mismatch fields elicited by vowels and consonants.

Auditory-evoked mismatch fields (MMFs) elicited by vowel contrasts and plosive stop consonant place-of-articulation contrasts were recorded over the left hemisphere of neurologically and audiologically normal subjects. Two experiments were conducted: vowels were presented in isolation in experiment 1 and embedded in consonant-vowel syllables in experiment 2. Bestfit equivalent MMF sources were obtained using the model of a single, spatiotemporal current dipole in a sphere. In both experiments, MMF sources activated by place-of-articulation contrasts were later in latency and smaller in dipole moment amplitude than MMF sources excited by vowel contrasts. There was evidence, albeit not unambiguous, for the vowel-contrast MMF sources being located more posteriorly than the consonant-contrast MMF sources in experiment 1 and more laterally in experiment 2. In both experiments, the MMF source excited by the contrast between /da/ and /ga/ was more anterior than the MMF source excited by the contrast between /da/ and /ba/. The effects on latency and dipole moment may be interpreted to mirror differences in perceptual discriminability and auditory memory decay between consonantal place-of-articulation contrasts and vowel contrasts. Similarly, the effects on location may be interpreted to reflect featural specificity of the mismatch response. Interestingly, the dipole source analysis results show a correspondence to the pattern of preservation and loss of the mismatch response to vowel and consonant place-of-articulation contrasts recently observed in Wernicke's aphasia.

Acoustic Stimulation↗
PubMed1994

The influence of topic and listener familiarity on aphasic discourse.

This study investigated the effects of listener and topic familiarity on verbal output. A total of 32 subjects were included: 5 Broca's, 7 conduction, and 10 anomic aphasics; and 10 normal controls. Subjects performed story retell and procedural discourse tasks containing familiar and unfamiliar topics. Tasks were completed with a familiar listener (spouse) and an unfamiliar listener (examiner). Results indicated that topic familiarity significantly influenced verbal output, however specific findings were dependent on task. In procedural discourse, the amount of verbal output (number of T-units) was significantly greater on familiar topics. In contrast, the complexity (number of words and clauses per T-unit) was significantly greater on unfamiliar topics. On story retell, verbal output (number of T-units) was also greater on familiar topics. However, grammatic complexity did not increase with unfamiliar topics. Words per T-unit remained higher on familiar topics. The variable of listener familiarity was not found to be significant.

Aged↗
PubMed1989

Progressive decline of picture naming in an aging Down syndrome man with dementia.

This study was conducted to monitor picture naming longitudinally in a 59-yr.-old Down syndrome man with diagnosed dementia. On the test, the subject was shown a series of 40 pictures, and his task was to speak their names. Correct naming responses were followed by pennies. The test was repeated periodically over the course of 20 mo. The subject initially achieved 100% correct scores and maintained accuracy until the tenth month. Thereafter, his scores declined, gradually at first and then precipitously, until the subject scored less than 30% correct on the final test. Error analysis showed that low scores generally reflected loss of stimulus control by relevant characteristics of the test pictures; control apparently shifted to irrelevant features of the task. The results suggest that naming tests may ultimately prove useful in defining and documenting the nature of deterioration in Down dementia.

Age Factors↗
PubMed1993

Comparison of morphology and syntax in free narrative and structured tests: fluent vs. nonfluent aphasics.

Seven agrammatic Broca's and seven paragrammatic conduction aphasics were evaluated on a free narrative story elicitation test and on a structured, cross-modal morphology and syntax battery (MSB). The latter permitted comparison of the same set of morphosyntactic forms in both production and comprehension. Results suggests distinctive oral production profiles, with agrammatics inferior to paragrammatics in use of auxiliaries, verb inflection and passive word order. Only agrammatics commonly omitted articles or main verbs. The use of noun plurals and possessives did not discriminate between the groups. The two groups did not differ in level of performance on MSB comprehension subtests, and the order of difficulty among the comprehension subtests was unrelated to their difficulty for production. This suggests that the source of agrammatic production errors is independent of comprehension errors. The production of targeted constructions on the MSB, an easily scored instrument, closely paralleled production in free narrative.

Aged↗
PubMed2006

Neural substrates of linguistic prosody: evidence from syntactic disambiguation in the productions of brain-damaged patients.

The present investigation focussed on the neural substrates underlying linguistic distinctions that are signalled by prosodic cues. A production experiment was conducted to examine the ability of left- (LHD) and right- (RHD) hemisphere-damaged patients and normal controls to use temporal and fundamental frequency cues to disambiguate sentences which include one or more Intonational Phrase level prosodic boundaries. Acoustic analyses of subjects' productions of three sentence types-parentheticals, appositives, and tags-showed that LHD speakers, compared to RHD and normal controls, exhibited impairments in the control of temporal parameters signalling phrase boundaries, including inconsistent patterns of pre-boundary lengthening and longer-than-normal pause durations in non-boundary positions. Somewhat surprisingly, a perception test presented to a group of normal native listeners showed listeners experienced greatest difficulty in identifying the presence or absence of boundaries in the productions of the RHD speakers. The findings support a cue lateralization hypothesis in which prosodic domain plays an important role.

Aged↗
PubMed2003

Sensitivity to prosodic structure in left- and right-hemisphere-damaged individuals.

An experiment was conducted in order to determine whether left- (LHD) and right-hemisphere-damaged (RHD) patients exhibit sensitivity to prosodic information that is used in syntactic disambiguation. Following the work of, a cross-modal lexical decision task was performed by LHD and RHD subjects, as well as by adults without brain pathology (NC). Subjects listened to sentences with attachment ambiguities with either congruent or incongruent prosody, while performing a visual lexical decision task. Results showed that each of the unilaterally damaged populations differed from each other, as well as from the NCs in terms of sensitivity regarding prosodic cues. Specifically, the RHD group was insensitive to sentence prosody as a whole. This was in contrast to the LHD patients, who responded to the prosodic manipulation, but in the unexpected direction. Results are discussed in terms of current hypotheses regarding the hemispheric lateralization of prosodic cues.

Aged↗
PubMed1999

Effect of sentence length on the production of linguistic stress by left- and right-hemisphere-damaged patients.

An acoustical/perceptual study of phonemic stress (e.g., HOTdog vs. hot DOG) was conducted to evaluate the effect of sentence length on stress production after brain damage. Productions of phonemic stress pairs were elicited in sentence contexts of increasing length from eight left-hemisphere-damaged nonfluent (LHD-NFL), fluent LHD-FL), right-hemisphere-damaged (RHD), and normal speakers (n = 32). Tape recordings of subjects' productions were presented to naïve listeners for perceptual identification of stress placement. Acoustic analysis focused on fundamental frequency, duration, and intensity of the initial and final syllables as well as pause duration between syllables. Perceptual tests indicated that regardless of sentence length, all brain-damaged groups exhibited an impairment in the production of linguistic stress when compared to normals. The LHD-NFL group experienced the greatest difficulty in signaling stress contrasts, followed in order by the LHD-FL and RHD groups. In medium-length sentences, the LHD-FL group's performance was degraded by comparison to short-length sentences. Acoustic analysis showed that pause duration was the strongest predictor of phonemic stress for all groups. Acoustic profiles of the RHD group were similar qualitatively to those of normals, but differed quantitatively in terms of magnitude of effect associated with shifts in stress patterns. Findings are brought to bear on the nature of the stress production deficit after unilateral brain damage, the role of the right hemisphere in linguistic prosody, and the concept of "subtle phonetic deficit" in fluent aphasia.

Acoustics↗
PubMed2003

Temporal parameters as cues to phrasal boundaries: a comparison of processing by left- and right-hemisphere brain-damaged individuals.

Two experiments were conducted to examine the ability of left- (LHD) and right-hemisphere-damaged (RHD) patients and normal controls to use temporal cues in rendering phrase grouping decisions. The phrase "pink and black and green" was manipulated to signal a boundary after "pink" or after "black" by altering pre-boundary word durations and pause durations at the boundary in a stepwise fashion. Stimuli were presented to listeners auditorily along with a card with three alternative groupings of colored squares from which to select the presented alternative. Results revealed that normal controls were able to use both temporal cues to identify the intended grouping. In contrast, LHD patients required longer than normal pause durations to consistently identify the intended grouping, suggesting a higher than normal threshold for perception of temporal prosodic cues. Surprisingly, the RHD patients exhibited great difficulty with the task, perhaps due to the limited acoustic cues available in the stimuli.

Aged↗
PubMedDate not supplied

Predictors of mortality and institutionalization in Alzheimer disease patients 1 year after discharge from an Alzheimer dementia unit.

Several factors have been reported to predict death and institutionalization in demented patients, even if the results of the studies are often conflicting. We conducted a study on a group of 86 consecutive noninstitutionalized probable Alzheimer disease (AD) patients, to evaluate clinical and social factors predicting mortality and institutionalization 1 year after discharge from the Alzheimer Dementia Unit at 'Sacro Cuore Fatebenefratelli' Hospital, Brescia, Italy. The 1-year mortality rate was 13.9% and the 1-year rate of admission to a nursing home was 34%. Our data indicate that the number of lost functions on the Activity of Daily Living scale is the most important predictor of short-term mortality, independently of the degree of cognitive impairment, the duration of the dementia, the age of the patients and the number of chronic diseases. Our data also demonstrate that, in a short period of observation, behavioral disturbances (and in particular insomnia) and availability of social services play a major role in the decision to institutionalize AD patients.

Age Factors↗
PubMed1994

Sequences of phonemic approximations in a Thai conduction aphasic.

Sequences of phonemic approximations (SPAs) to a single target word on a picture naming task were investigated in a Thai-speaking conduction aphasic. A corpus of 207 SPAs was analyzed with an adaptation of Valdois, Joanette, and Nespoulous's (1989) methodology to a tone language. Measures included the length of SPAs, overall degree of approximation to the target of the last attempt and each of the preceding attempts, as well as degree of approximation to the target in terms of number of syllables, syllable structure, segments (consonants/vowels), and tones. Results indicated that there was a steady progression toward the target regardless of eventual outcome or length of sequence. Number of syllables of the target word was better preserved than syllable structure, and tones better than segments. In the course of SPAs, tonal information was accessed earlier than segmental, and syllabic length information earlier than syllabic structure. Within SPAs, tonal information was more stable than segmental across successive approximations. Findings are discussed in relation to a functional model of single word production and multidimensional phonological representations.

Aphasia↗