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PubMedDate not supplied

Research priorities in speech.

The need for increased research activity in speech and its disorders is reviewed. Increasing interest in language and its disorders appears to have lessened research activity in areas commonly identified as speech disorders: articulation, voice and rhythm. Yet these areas, as well as all aspects of the total communication function, are little understood and some current understandings are even likely to be inaccurate. Thus, not only is additional new research needed but reinvestigation of current beliefs is also essential. Goals for communication research can be classified under five areas: better understanding of the speech mechanism, the communication processes, the individual as a communicator, disorders of speech, and prevention and remediation. Specific research needs as discussed in each of these five broad categories.

Humans↗
PubMed2002

Significance of abnormal chest radiograph findings in patients with HIV-1 infection without respiratory symptoms.

STUDY OBJECTIVES: Patients with HIV-1 infection or AIDS may present with abnormal chest radiograph (CXR) findings in the absence of symptoms specific to the lung. The objective was to determine the spectrum of disease and the diagnostic modalities employed in these patients. METHODS: From 1996 to 1998, we identified patients with HIV-1 infection presenting to the Bellevue Hospital Chest Service with abnormal CXR findings, and absence of specific pulmonary symptoms. Charts were reviewed for presence of constitutional symptoms, CD4 lymphocyte count, use of Pneumocystis carinii pneumonia (PCP) prophylaxis, eventual diagnosis, and all diagnostic modalities employed. CXR findings were classified according to their predominant abnormalities: nodules, infiltrates, cavity, mass, adenopathy, or effusion. RESULTS: Forty-four patients were eligible for inclusion. Eight-six percent of patients had a CD4 lymphocyte count < 200 cells/microL, and 57% were receiving PCP prophylaxis. Nodular disease was the most common radiographic abnormality (57%), followed by adenopathy (17%). A definitive diagnosis was obtained in 86% of the patients. The most common diagnosis was tuberculosis (26%), followed by nontuberculous mycobacteria (NTM; 23%) and Kaposi sarcoma (12%). No patients had PCP or bacterial pneumonia. Sixty-two percent of patients required an invasive modality to establish a diagnosis. Only 18% of patients with tuberculosis (2 of 11 patients) received diagnoses by sputum analysis. CONCLUSIONS: Patients with HIV-1 infection, abnormal CXR findings, and lack of pulmonary symptoms have a high incidence of infectious disorders, especially pulmonary tuberculosis and infection due to NTM. The high prevalence of treatable and potentially communicable disorders warrants an aggressive diagnostic approach in these patients.

AIDS-Related Opportunistic Infections↗
PubMed1991

Frequency and distribution of Alzheimer's disease in Europe: a collaborative study of 1980-1990 prevalence findings. The EURODEM-Prevalence Research Group.

We reanalyzed and compared current prevalence estimates of Alzheimer's disease in Europe. Studies characterized as follows qualified for comparison: dementia defined by the Diagnostic and Statistical Manual for Mental Disorders, 3rd edition, or equivalent criteria; Alzheimer's disease diagnosed by the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association or equivalent criteria; case-finding through direct individual examination; appropriate sample size; and inclusion of institutionalized persons. Of the 23 European surveys of dementia considered, six fulfilled the inclusion criteria. When age and sex were considered, there were no major geographic differences in the prevalence of Alzheimer's disease across Europe. Overall European prevalence (per 100 population) for the age groups 30 to 59, 60 to 69, 70 to 79, and 80 to 89 years was, respectively, 0.02, 0.3, 3.2, and 10.8. Prevalence increased exponentially with advancing age and, in some populations, was consistently higher in women. Prevalence remained stable over 15 years in one study.

Adult↗
PubMed1998

Prevalence of Alzheimer's disease and other dementias in rural India: the Indo-US study.

OBJECTIVE: To determine the prevalence of AD and other dementias in a rural elderly Hindi-speaking population in Ballabgarh in northern India. DESIGN: The authors performed a community survey of a cohort of 5,126 individuals aged 55 years and older, 73.3% of whom were illiterate. Hindi cognitive and functional screening instruments, developed for and validated in this population, were used to screen the cohort. A total of 536 subjects (10.5%) who met operational criteria for cognitive and functional impairment and a random sample of 270 unimpaired control subjects (5.3%) underwent standardized clinical assessment for dementia using the Diagnostic and Statistical Manual of Mental Disorders-fourth edition diagnostic criteria, the Clinical Dementia Rating Scale (CDR), and National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria for probable and possible AD. RESULTS: We found an overall prevalence rate of 0.84% (95% CI, 0.61 to 1.13) for all dementias with a CDR score of at least 0.5 in the population aged 55 years and older, and an overall prevalence rate of 1.36% (95% CI, 0.96 to 1.88) in the population aged 65 years and older. The overall prevalence rate for AD was 0.62% (95% CI, 0.43 to 0.88) in the population aged 55+ and 1.07% (95% CI, 0.72 to 1.53) in the population aged 65+. Greater age was associated significantly with higher prevalence of both AD and all dementias, but neither gender nor literacy was associated with prevalence. CONCLUSIONS: In this population, the prevalence of AD and other dementias was low, increased with age, and was not associated with gender or literacy. Possible explanations include low overall life expectancy, short survival with the disease, and low age-specific incidence potentially due to differences in the underlying distribution of risk and protective factors compared with populations with higher prevalence.

Aged↗
PubMed1998

[From perception to symptom--from symptom to diagnosis. Somatoform disorders as a communication phenomenon between physician and patient].

Patients with somatoform disorders probably constitute the largest diagnostic group in daily medical practice. A major communication problem forms the core of somatoform disorders: patients report about complaints which their physicians do not understand; there is no sufficient biological reason for the patient's symptoms. This article discusses the multifactorial origin of somatoform disorders, consisting of minimal physiological changes, the perception of bodily sensations, and their interpretation as symptoms (non-normal perceptions), as well as ensuing emotional and behavioral consequences. Concerning the communication problem, it is important to realize that patients normally present symptoms, whereas the underlying bodily perceptions and the explanatory models are rarely communicated to the physician. On the physician's side, symptoms presented by patients are subjected to his or her explanatory concepts translating symptoms into indicators of certain diseases. Thus, the information introduced into physician-patient communication by the patient has usually passed several cognitive circuits within the patient or between the patients and other significant conversation partners thus shaping its specific components. It is recommended that physicians try to trace back their patients' symptoms to bodily sensations and explanatory models in order to base their diagnostic and therapeutic reasoning on the same kind of information. Empirical evidence is presented to support the inter-dependence of the components of the model, on both the patient's and the physician's side. Therapeutic interventions based upon the model are presented.

Awareness↗
PubMed1998

A dimensional classification of autism spectrum disorder by social communication domains.

OBJECTIVE: To investigate whether "social communication" could be used to assess severity of symptoms in autism spectrum disorder. Social communication refers to the communication of cognitive and emotional information through facial expression, gesture, and prosody and through implicit understanding of pragmatics and of theory of mind. METHOD: Subjects were evaluated by raters using the Autism Diagnostic interview-Revised and either the Autism Diagnostic Observation Schedule or the Pre-Linguistic Autism Diagnostic Observation Schedule. Two investigators independently diagnosed autism, Asperger's disorder, or pervasive developmental disorder-not otherwise specified in 63 subjects. Items from the Autism Diagnostic Interview-Revised that were judged to represent social communication behaviors were factor-analyzed. RESULTS: Three factors were identified: affective reciprocity, joint attention, and theory of mind. Comparing this new classification approach to DSM-IV led to suggestions for possible changes in the latter: (1) Vocabulary and grammar deficiencies in autistic persons should be coded under developmental language disorder, (2) The diagnosis of Asperger's disorder may not be needed. (3) Requiring that all persons with autism spectrum disorder have a symptom from the "restrictive, repetitive, and stereotypic" list may need to be reconsidered. CONCLUSIONS: The DSM-IV category of pervasive developmental disorder may be ideal for diagnosing "classic" autism, but it may be inadequate for diagnosing less severe forms of the disorder.

Adolescent↗
PubMed1993

Competence in children at risk for psychopathology predicted from confirmatory and disconfirmatory family communication.

The relationship between confirmation/disconfirmation in parental and family communication and offspring social competence was examined in 59 families in which at least one of the parents had been hospitalized for a functional psychiatric disorder. Communication samples were obtained using the Consensus Rorschach procedure both with parental couples and with parent-child family units. The communication was analyzed using the Confirmation-Disconfirmation Coding System (CONDIS). The competence at school of 7-and 10-year-old boys was rated by both peers and teachers. Competence at home was rated by the parents. The results indicated that the more competent the high-risk children were, both at school and at home, the more their family communicated in confirmatory ways and the less they communicated in disconfirmatory ways. Furthermore, although the parental couple CONDIS score and the family CONDIS score were modestly correlated, each contributed separately to the prediction of offspring competence. These communication data were not significantly related to parental psychopathology, neither severity of parental impairment nor the diagnosis of the patient-parent.

Adult↗
PubMed2004

Autistic spectrum disorder associated with partial duplication of chromosome 15; three case reports.

Duplication of part or the entirety of chromosome 15 that involves the Prader-Willi/Angelman syndrome critical region (PWACR) is a genetic disorder which is associated with variable degrees of intellectual impairment, motor co-ordination problems and social and communication disorders. Published case reports indicate that phenotypic expression is dependent on parental origin of the duplication and implicate maternally derived duplications in the pathogenesis of autistic features. This article describes three individuals, two males and one female, aged between 5 and 8 years, all with partial duplication of chromosome 15. Autism (or autistic spectrum disorder) was present in all three instances with varying degrees of cognitive impairment. The aim of this paper is to describe the phenotypic characteristics of this genetic sequence and the possible associations between social and behavioural patterns on the one hand, and degree and nature of genetic impairment on the other.

Autistic Disorder↗
PubMed1993

A population-based study of dementia in 85-year-olds.

BACKGROUND: The aim of this study was to investigate the causes, severity, and prevalence of dementia in a representative sample of 494 85-year-olds living in Gothenburg, Sweden. METHODS: The study included a psychiatric interview, neuropsychological and physical examinations, comprehensive laboratory tests, electrocardiography, chest radiography, computed tomography (CT) of the head, and analysis of cerebrospinal fluid. A person close to each subject was also interviewed. Dementia was defined according to the criteria proposed in the Diagnostic and Statistical Manual of Mental Disorders (third edition, revised), Alzheimer's disease according to the criteria of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association, and vascular dementia according to recently proposed criteria that incorporate information from CT scanning and the patient's neurologic history. RESULTS: The prevalence of dementia was 29.8 percent (147 subjects). The condition was mild in 8.3 percent, moderate in 10.3 percent, and severe in 11.1 percent. There were no significant sex-related differences in prevalence or severity. Of the subjects with dementia, 43.5 percent had Alzheimer's disease, 46.9 percent had vascular dementia (multi-infarct dementia in 34.6 percent, dementia related to cerebral hypoperfusion in 4.1 percent, and mixed dementia in 8.2 percent), and 9.5 percent had dementia due to other causes. The three-year mortality rate was 23.1 percent in the subjects without dementia, 42.2 percent in the patients with Alzheimer's disease, and 66.7 percent in the patients with vascular dementia. Infarcts detected by CT scanning were significantly more common in the subjects with dementia than in those without it (27.9 percent vs. 12.6 percent). CONCLUSIONS: Dementia was present in nearly a third of unselected 85-year-olds in Sweden. Almost half these subjects appeared to have vascular dementia, which may currently be more amenable to prevention or treatment than Alzheimer's disease.

Aged↗
PubMedDate not supplied

Articulation rate in preschool children: a 3-year longitudinal study.

BACKGROUND: Speaking rate has implications for both clinical practice and an understanding of normal and disordered communication processes. Fundamental information on speaking rate is required by the clinician for the appropriate management of those disorders with disturbances of rate or those in which rate modification strategies are applied. One measure of speaking rate, articulation rate, excludes pause time and measures the speed with which articulators move. A developmental assessment of articulation rate is of particular interest because of its implications for changes in temporal motor aspects of speech production in development. AIMS: The fundamental aim was to provide longitudinal and normative data on articulation rate in a group of preschool children. The following questions were asked. What are the articulation rates and variability in rate at ages 4, 5 and 6, and is there a developmental trend? Are speaking context, utterance length and gender significant variables? METHODS & PROCEDURES: Speech samples from four speaking contexts, spontaneous, imitated, automatic (represented by nursery rhyme narration) and repetition, were elicited from 16 normally developing children (eight boys and eight girls) at ages 4, 5 and 6. Utterances were measured in syllables per second for runs of speech without pauses within each speaking context. OUTCOMES & RESULTS: In contrast to expectation, articulation rate did not increase significantly with age. Neither did variability of rate decrease with age. Results suggest that the course of development is non-linear. Automatic speech and repetition were significantly faster than imitated speech. An interaction between imitated speech and variability was found at age 4. Considerable individual differences in rate were identified. There were no gender differences and no correlations between articulation rate and utterance length. CONCLUSIONS: Unique information is provided on the development of speaking rate in preschool children together with additional normative data. The results have both theoretical and clinical implications. The data should assist the clinician in the assessment and diagnosis of rate and in rate modification management. Caution should be exercised in generalizing the results of the study in view of the small sample size and other factors.

Aging↗
PubMed1996

A population-based study on the incidence of dementia disorders between 85 and 88 years of age.

OBJECTIVE: To investigate the incidence of Alzheimer's disease, vascular dementia and other dementias in a population between 85 and 88 years of age. DESIGN: Prospective cohort study. Longitudinal population study of the very old. SETTING: Systematic sample of a birth cohort living in the community or in institutions in the city of Gothenburg, Sweden. PARTICIPANTS: A representative population sample of nondemented 85-year-old residents (n = 347). MEASUREMENTS: The study included neuropsychiatric, neuropsychological, and physical examinations, key informant interviews, comprehensive laboratory tests, electrocardiography, chest radiography and computed tomography (CT-scan) of the head. Information on subjects lost during the follow-up period as a result of death or refusal was traced in medical records. Dementia was defined according to the criteria proposed in the Diagnostic and Statistical Manual of Mental Disorders (3rd Edition, revised), Alzheimer's disease according to the criteria of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association, and vascular dementia according to criteria proposed by Erkinjuntti. RESULTS: Sufficient information was obtained about 92% of the subjects at risk. Sixty-three subjects (18.2%) became demented between ages 85 and 88, giving an incidence of 90.1/1000/year (61.3/1000/year for men and 102.7/1000/ year for women; P = .085). The incidence of Alzheimer's disease was 36.3/1000/year, vascular dementia 39.0/1000/ year (P = 1.000), and that of other dementias 9.1/1000/year. CONCLUSION: This study shows that almost one-tenth of nondemented persons between the ages of 85 and 88 become demented each year, emphasizing the magnitude of the dementia problem in the very old, the fastest growing segment of western populations.

Aged↗
PubMed1996

Discourse connectedness in manic and schizophrenic patients: associations with derailment and other clinical thought disorders.

The language performance of hospitalised manic ( n = 12) and schizophrenic (n=15) patients was compared in order to test hypotheses based on previous models of communication disorder in these patient groups. It was hypothesised that the derailments of manic and schizophrenic patients were discriminable by virtue of differences in the level of connectedness of the speech during this type of language disorder. Previous hypotheses have suggested that manics derail because they discuss multiple concurrent topics and schizophrenics derail as a pattern of general vagueness and poorly interconnected speech. These hypotheses were supported by the finding that manic patients manifested a higher level of overall discourse connectedness during derailments, even when the overall increased amount of speech was accounted for. Manics were not simply more competent overall, because they failed to differ from schizophrenics in their discourse connectedness during nondisordered segments. These results are discussed in terms of their implications for clinical and linguistic differentiation of the language of psychotic patients.

Journal Article↗
PubMed2000

Ten-year incidence of dementia in a rural elderly US community population: the MoVIES Project.

OBJECTIVE: To determine incidence rates by age, sex, and education of overall dementia and probable/ possible AD in a largely rural community. METHODS: Ten-year prospective study of a randomly selected community sample aged 65+; biennial cognitive screening followed by standardized clinical evaluation. Incidence rates were estimated for overall dementia (Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., revised, criteria and Clinical Dementia Rating [CDR]) and for probable/possible AD (National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria). RESULTS: The cohort consisted of 1,298 individuals free of dementia at study entry. Among these, 199 incident (new) cases of overall (all-cause) dementia with CDR stage > or = 0.5, including 110 with CDR > or = 1, were detected during follow-up. Among the incident cases, 153 (76.9%) had probable/ possible AD. Age-specific incidence rates are reported for all dementia and for probable/possible AD, by sex and CDR stage. Among all-cause dementias with CDR = 0.5, controlling for age and education, men had a higher incidence rate than women. In the same group, those with less than high school education had significantly higher incidence rates than those with more education. Rates did not vary significantly by sex or education for probable/possible AD or for dementia with CDR > or = 1. CONCLUSIONS: Incidence rates of all dementias and of AD increased with age; men and those with lesser education had higher rates of possible/incipient dementia (CDR = 0.5) in this community. Potential explanations for these sex and education effects are discussed.

Aged↗
PubMed2005

[Large-scale genotyping in research into autism spectrum disorders and attention deficit hyperactivity disorder].

INTRODUCTION AND DEVELOPMENT: Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are two neuropsychiatric disorders beginning in childhood that present a high degree of familial aggregation. ASD is characterised by social interaction and communication disorders, whereas patients with ADHD display persistent inattention and/or hyperactive-impulsive behaviour. With the exception of a few cases of autism in which cytogenetic anomalies or mutations have been reported in specific genes, the aetiology of these diseases remains unknown. This is a group of multifactorial diseases with several genes having a lesser effect and there is also an environmental component. Genetic linkage studies have pointed to about 20 chromosomal regions that could well contain genes that grant susceptibility to autism, to ADHD or to both disorders. The challenge to researchers lies in the clinical characterisation, recruitment of patients with ASD and ADHD, gene dosage quantification studies, comparative genomic methylation and hybridisation in order to identify chromosomal rearrangements in patients with autism and severe mental retardation. CONCLUSIONS: Genotyping large SNP-type collections that are potentially functional in genes that are candidates for these disorders, based on pharmacological, biochemical and neuropathological data together with that coming from animal models and linkage studies in a wide collection of samples from patients and controls, will enable us to identify the genetic components of these pathologies and to define their biological foundations.

Attention Deficit Disorder with Hyperactivity↗
PubMed2007

Speech and articulatory rates of school-age children in conversation and narrative contexts.

PURPOSE: This study provides preliminary reference data for speech and articulatory rates of school-age children in conversational and narrative speaking contexts. METHOD: Participants included 36 typically developing children in 3 groups of 12 participants at ages 7, 9, and 11 years. Conversational and narrative speech rates were measured in words per minute, syllables per minute, and syllables per second. RESULTS: Speaking rates increased with age between ages 7 and 9, but rates were similar between ages 9 and 11. Between contexts, only the words per minute measure was significantly higher (faster) in narrative than in conversation. IMPLICATIONS: These results are important to the assessment, treatment, and management of children with communication disorders in clinical or school settings.

Child↗