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PubMed2003

Speech and language in progressive nonfluent aphasia compared with early Alzheimer's disease.

BACKGROUND: Progressive nonfluent aphasia (PA) is a slow deterioration of language that remains relatively isolated from other cognitive or behavioral deficits for at least 2 years. The differentiation of PA from early Alzheimer's disease (AD) is important, given the presence of early language changes in AD. METHODS: A language assessment was administered to 15 patients who met established criteria for PA, 15 patients with clinically probable AD and mild dementia, and 15 normal control subjects. The language battery included verbal fluency, the Boston Naming Test with cuing and recognition, and an aphasia test battery with a motor speech exam. RESULTS: Pronounced literal paraphasic errors distinguished the PA patients from the AD patients. The PA group had anomia, decreased letter fluency, neologisms, difficulty on phrase repetition, decreased phrase length, and a decreased rate of verbal output. Interference from paraphasic anomia accounted for much of their decreased fluency. CONCLUSION: Many patients with PA have a primary defect in accessing sound-based representation of speech (phonemes), similar to conduction aphasia, possibly as a consequence of disturbed white matter tracts in the left superior temporal region.

Aged↗
PubMed2005

Natural history of primary progressive aphasia.

OBJECTIVE: To characterize the natural history of primary progressive aphasia (PPA). METHODS: Forty-nine patients (28 women) with newly diagnosed with PPA presenting to a memory disorders clinic between 1992 and 2001 were prospectively evaluated. RESULTS: Median age at onset was 62 years (range 49 to 73 years) and at first visit was 66 years (52 to 80 years). The median duration of follow-up was 4 years (1 to 11 years). Impairments in activities of daily living developed a median of 6 to 7 (2 to 12) years post onset. Seventy-five percent of patients eventually met clinical diagnostic criteria for frontotemporal dementia (FTD), 14% met diagnostic criteria for dementia with Lewy bodies, and 8% developed signs of corticobasal degeneration; 60% of the patients died after a median course of 7 years (3 to 17 years) at a median age of 71 years (56 to 81 years). Patients showing high Mini-Mental State Examination scores, moderate aphasia, and fluent language at first visit subsequently retained greater autonomy in daily life. CONCLUSIONS: Although activities of daily living are well maintained during the first years of the disease, patients with primary progressive aphasia (PPA) may lose autonomy 6 to 7 years after onset. The majority of patients with PPA in the current study developed frontotemporal dementia.

Activities of Daily Living↗
PubMed1978

Broca aphasia: pathologic and clinical.

The speech disturbance resulting from infarction limited to the Broca area has been delineated; it differs from the speech disorder called Broca aphasia, which results from damage extending far outside the Broca area. Nor does Broca area infarction cause Broca aphasia. The lesions in 20 cases observed since 1972 were documented by autopsy, computerized tomography, or arteriogram; the autopsy records from the Massachusetts General hospital for the past 20 years and the published cases since 1820 were also reviewed. The findings suggest that infarction affecting the Broca area and its immediate environs, even deep into the brain, causes a mutism that is replaced by rapidly improving dyspraxic and effortful articulation, but that no significant distrubance in language function persists. The more complex syndrome traditionally referred to as Broca aphasia, including Broca's original case, is characterized by protracted mutism, verbal stereotypes, and agrammatism. It is associated with a considerably larger infarct which encompasses the operculum, including the Broca area, insula, and adjacent cerebrum, in the territory supplied by the upper division of the left middle cerebral artery.

Adult↗
PubMed1985

Aphasia in dementia of the Alzheimer type.

Speech and language assessment in 30 patients with dementia of the Alzheimer type and in 70 normal controls revealed that all Alzheimer patients were aphasic. Throughout most of the course, the language disorder resembled transcortical sensory aphasia, and increasing language impairment correlated with increasing severity of dementia. Aphasia was present regardless of age of onset or family history of dementia. Aphasia is an important diagnostic criterion of dementia of the Alzheimer type.

Adult↗
PubMed1989

Tumor-associated aphasia in left hemisphere primary brain tumors: the importance of age and tumor grade.

Although one-quarter of patients with primary brain tumors have language disturbances at the time of initial presentation, the factors contributing to their aphasia are not clear. A group of 32 patients with primary tumors of the left hemisphere was collected retrospectively and the relationship between clinical, radiographic, and pathologic factors and tumor-associated aphasia was examined. We assessed language function before beginning any treatment including steroids. The factor that best predicted language disturbance was greater patient age; the only other significant factor was tumor grade. Tumor size made a nearly significant impact, but tumor location within the left hemisphere did not correlate with aphasia.

Adult↗
PubMed1990

Progressive aphasia: a precursor of global dementia?

We studied 8 subjects longitudinally in whom isolated language dysfunction had developed gradually at a mean age of 62.8 years. The language deficits initially displayed by the subjects were characteristic of the syndrome of "progressive aphasia without dementia." By 5 years after onset of progressive aphasia, however, 7 of the 8 subjects additionally had developed mild dementia as diagnosed by clinical means, and the remaining subject demonstrated declining performance in both verbal and nonverbal psychometric measures. Thus, generalized cognitive impairment occurred in all. Neuropathologic evidence of a diffuse dementing disorder was present in the 2 subjects studied postmortem. One had Alzheimer's disease with disproportionate involvement of the left inferior parietal cortex, and the other displayed widespread neocortical neuronal loss and microvacuolation in the absence of specific histopathologic markers. In this series, progressive aphasia was a precursor of global dementia.

Aged↗
PubMed1992

Aphasia in multiple sclerosis: clinical and radiologic correlations.

Aphasia is not commonly reported in multiple sclerosis (MS). We report on two clinically definite MS patients, with a remitting-relapsing course, who presented with acute onset of aphasia. MRI demonstrated giant plaques in the left frontal region in one and in the left centrum semiovale in the other. These lesions were not evident in MRI performed several months previously, and may account for the aphasia. In both patients, language functions markedly improved within several weeks. In one patient, follow-up MRI 3 months later revealed a moderate reduction in the size of the plaque.

Adult↗
PubMed1995

Bromocriptine treatment of nonfluent aphasia.

Using a double-blind, placebo-controlled, crossover design, we studied the effect of bromocriptine (15 mg daily) in 20 men with chronic nonfluent aphasia. The study was conducted over a 28-week period in two phases. In phase I, the patients received either bromocriptine or placebo; in phase II the treatments were crossed over. We evaluated each patient's language and nonverbal cognitive skills at the beginning and end of each phase and 6 weeks after completion of phase II. When compared with placebo treatment, bromocriptine did not significantly improve the patient's speech fluency, language content, overall degree of aphasia severity, or nonverbal cognitive abilities. Based on these results, bromocriptine is not recommended as monotherapy for the treatment of chronic nonfluent aphasia.

Adult↗
PubMed1995

Aphasia secondary to partial status epilepticus of the basal temporal language area.

We present a patient with aphasia of several days' duration that was secondary to spontaneous partial status epilepticus arising from the left basal temporal region. Evidence from MRI, EEG, and PET confirmed the origin of the seizures in the basal temporal area. Both the seizure discharges and the aphasia resolved after antiepileptic therapy. This case, to our knowledge, is the first documented example of epileptic aphasia secondary to spontaneous partial status epilepticus originating from the basal temporal area.

Aphasia↗
PubMed1996

Conduction aphasia in multiple sclerosis: a case report with MRI findings.

Aphasia is an uncommon manifestation of MS, which is somewhat surprising because various disconnection syndromes, such as conduction aphasia, would be expected to occur with some regularity in this white matter disease. We present a case study of an MS patient with conduction aphasia associated with a large white matter lesion underlying the left supramarginal gyrus.

Adult↗
PubMed1998

Correlations of flow velocity changes during mental activity and recovery from aphasia in ischemic stroke.

Mean flow velocity in the middle cerebral arteries (MCAs) during a rest period and during execution of a word-fluency task were measured by means of bilateral transcranial Doppler ultrasonography in 26 stroke patients with Broca's aphasia and in 25 healthy controls. Changes in flow velocity were calculated as percentage of increase from rest to mental activity. In patients, the evaluation was made within 21 days from onset of symptoms and after 2 months of speech therapy, when they were classified into two groups on the basis of extent of recovery from aphasia: absent or slight recovery (group 1, 10 patients) and good recovery (group 2, 16 patients). During the word-fluency task in the first evaluation, the increase in flow velocity in the left MCA was similar in controls and in group 2 patients. In both groups the increase was higher than in group 1 patients (p < 0.0001). Changes in mean flow velocity on the right side were slight and comparable in the three groups of study subjects. After speech therapy, group 1 patients showed a hemodynamic pattern on both sides similar to that observed in the first examination. In group 2 patients, comparison between values of the first and second evaluations showed that the increase of flow velocity in the left MCA was similar. On the right side, the increase was higher in the second than in the first examination (p < 0.01). These data further support the involvement of cerebral areas contralateral to the lesion in functional recovery after stroke. Moreover, the presence of an activation of areas in the lesioned hemisphere, soon after stroke onset, seems to be a predictor of recovery from aphasia.

Aged↗
PubMed2000

The corticobasal degeneration syndrome overlaps progressive aphasia and frontotemporal dementia.

OBJECTIVE: To provide evidence for the hypothesis that the corticobasal degeneration syndrome (CBDs) overlaps significantly with primary progressive aphasia and frontotemporal dementia, and that CBDs is part of the Pick complex. BACKGROUND: Corticobasal degeneration has been mainly described as a movement disorder, but cognitive impairment is also increasingly noted. METHODS: Thirty-five cases of clinically diagnosed CBDs were followed-up with clinical, neuropsychological, and neuroimaging investigations. Twenty-nine patients were seen prospectively in movement disorder and cognitive neurology clinics; five of these came to autopsy. Six other autopsied cases that fulfilled the clinical criteria of CBDs were added with retrospective review of records. RESULTS: All 15 patients presenting with movement disorders developed behavioral, cognitive, or language deficits shortly after onset or after several years. Patients presenting with cognitive problems (n = 20), progressive aphasia (n = 13), or frontotemporal dementia (n = 7) developed the movement disorder subsequently. Eleven cases with autopsy had CBD or other forms of the Pick complex. CONCLUSIONS: There is a clinical overlap between CBD, frontotemporal dementia, and primary progressive aphasia. There is also a pathologic overlap between these clinical syndromes. The recognition of this overlap will facilitate the diagnosis and avoid consideration of CBD as "heterogenous."

Aphasia↗
PubMed2006

Finding messages in bottles: living successfully with stroke and aphasia.

The question "What does it take to live successfully with stroke and aphasia?" was posed and answers were sought within already published accounts written by people living with aphasia. Published accounts that were identified as eligible and included in the study had to meet the following criteria: they had to be a published book or journal article that would be nationally available; they had to be authored or co-authored by a person with chronic aphasia due to stroke; and they had to be a personal narrative of some type. 28 publications meeting these criteria were identified through a search of bibliographic databases and websites, and 20 were available for analysis. 4 themes emerged. First, social support was identified as a critical factor in living successfully. Second, successful living appears to require an adaptation of one's perception of self. Third, most of the writers of the accounts looked to the future and set new goals. Finally, all of the published accounts noted the importance of taking charge of one's own continued communication improvement. Characteristics of the writers are discussed. The 4 themes are linked to the professional literature, and implications for future clinical work are explored. The potential bias of the interpreter is acknowledged.

Adaptation, Physiological↗
PubMed2006

Is informed consent a "yes or no" response? Enhancing the shared decision-making process for persons with aphasia.

Respect for patient autonomy and the need to have a comprehensive discussion of the risks and benefits of a medical intervention are two important issues involved in the process of obtaining informed consent. In dealing with individuals with aphasia, there may be particular challenges in balancing these two ethical imperatives. Although decision-making capacity may be preserved with aphasia, the patients' ability to fully participate in a dialogue regarding a proposed medical intervention is frequently impaired. We propose a process of enhancing informed consent for persons with aphasia while continuing to respect and enhance patient autonomy and the exercise of decision making for these patients. The use of a patient-selected "helper" during the informed consent process can improve the quality of the informed consent, while reserving final decision-making authority for the patient.

Aphasia↗
PubMed1980

[Aphasia caused by paramedian lesion of the dominant hemisphere: report of a case].

A 41 year old woman with a ruptured left pericalosal artery aneurysm and hematoma in the inter-hemispheric fissure and paramedian region of the left hemisphere presented with mutism which turned to aphasia characterized by absent spontaneous speech, lack of paraphasias, relative preservation of repetition and evident preservation of comprehension. This picture conforms to the so called "trans-cortical motor aphasia". The fact that lesions of the paramedian region of the dominant hemisphere, in and around the secondary motor area, can produce aphasia is unknown to many neurologists and several such cases are probably misdiagnosed due to the transience of the major symptoms and to confusion with non-specific dementia.

Adult↗
PubMed1989

Slowly progressive aphasia followed by Alzheimer's dementia: a case report.

Slowly progressive aphasia has been found in 8 published cases, 2 of whom progressed over a period of years to generalized dementia. Positron emission tomography demonstrated decreased glucose metabolism in the left perisylvian region in 2 cases. We describe a patient who had slowly progressive aphasia and developed generalized Alzheimer's dementia 7 years after presentation. There was no clinical or laboratory evidence of concomitant disease. Computerized tomography showed generalized atrophy more marked on the left perisylvian region late in the disease, when EEG showed generalized slowing more marked on the same area. Slowly progressive aphasia of old age should be considered a separate entity until further studies elucidate its relation to Alzheimer's dementia.

Aged↗
PubMed2003

Comprehension of indirect requests by persons with fluent aphasia.

This study examined the judgments and response latencies of 10 participants with aphasia and 10 participants without aphasia for responses to indirect requests. Modals such as can and should were drawn from 5 indirect request categories. There was a significant difference in judgment errors and response latency between participants with and without aphasia. There were no significant differences between aphasic participants' judgments for literal versus nonliteral contrasts. There was a significant effect among the modals and among the categories of indirect requests. Response latency reflected aphasic participants' understanding of these indirect requests.

Adult↗
PubMed1984

Neurobiological aspects of recovery from aphasia in stroke.

The rate, duration and the predictability of natural recovery, the effect of therapy, and major contributory factors are reviewed, with special emphasis on aphasia. The most likely mechanism of second-stage recovery is physiological and functional substitution by connected areas in the brain. Recovery from aphasia shows a predictable time course. Aphasia type overlaps severity to a great extent and language components depend on the test method and patient selection. Comprehension probably recovers better than other modalities. The pattern of evolution of aphasic syndromes and an overall prognostic guide are presented.

Age Factors↗