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Remediating production of tense morphology improves verb retrieval in chronic aphasia.

Production of tense markers in C-VIC, a computerized visual communication system, was utilized as a treatment for three patients with severe expressive aphasia. Patients practiced constructing C-VIC tense marked sentences and then producing English equivalents. After training, all patients demonstrated significant improvements in English verb retrieval and production of correct tense morphology. Generalization of morphological rules for past tense production was seen for regular, but not irregular verbs. These results support the LaPointe and Dell (1989) extension of the Garrett (1975, 1992) model specifying a search through so-called verb phrase notion stores as a process mediating transition from functional to positional levels, but also suggest an additional constraint on the output of the verb notion store search.

Adult↗

Primary progressive aphasia: a review of 112 cases.

Primary progressive aphasia (PPA) was first recognized by Mesulam in 1982. Although dozens of cases have since been described, it has been difficult to place these cases into a coherent framework due to the wide variation in measures which have been reported. We review 170 contacts with 112 patients to provide a clinical, neuroanatomical, and neuropsychological profile of patients with the disorder. The progression of the disease is analyzed over a 10-year reporting period starting from symptom onset to show how progression affects five general linguistic skills: oral and written naming, reading, repetition, and general comprehension. The pattern of functional and neurological deficits in PPA is heterogeneous. Differences in the distribution of neurological anomalies between patients with bilateral and unilateral changes suggest that there may be two separate disease processes involved.

Aphasia↗

Single word production in nonfluent progressive aphasia.

We present an experiment investigation of the spoken single word production of two patients with nonfluent progressive aphasia. In Experiment 1, a task effect (reading > repetition > naming) suggested that phonological information available from task stimuli facilitated the patients' speech production; a length effect reflected the increased difficulty of phonological processing required for long words compared with that required for shorter words. Experiment 2 compared repetition, reading, copying, and writing to dictation tasks and demonstrated that a correspondence between input and output modality also facilitated performance. Experiment 3 showed that the patients' access to appropriate phonology in reading was positively related to the degree of correlation between orthographic and phonological forms. These results are discussed with reference to an account of pathologically weakened connections between nodes in an interactive spreading activation model of speech production of the type described by Dell (1986).

Aged↗

Gap-filling and end-of-sentence effects in real-time language processing: implications for modeling sentence comprehension in aphasia.

We present an on-line study showing different sources of lexical activation during sentence comprehension, distinguishing in this respect between reflexive syntactic and less temporarily constrained nonsyntactic sources. Specifically, we show that both the syntactic process of gap filling and a nonsyntactic end-of-sentence effect can be measurable in real time and can be temporally separated. The distinction between activation sources provides a new perspective on real-time sentence comprehension in aphasia and accounts for the disparate results reported in the literature.

Aged↗

Why does monitoring fail in jargon aphasia? comprehension, judgment, and therapy evidence.

Many people with jargon aphasia seem unaware of their speech disorder. The first section of this paper reports data from four subjects which indicate that self-monitoring can fail even when subjects' input skills are apparently adequate to detect their errors. Explanations for this dissociation have attributed monitoring failure to a deficit in auditory feedback, or to a resource limitation which prevents concurrent speaking and monitoring. Section 2 reports a series of naming and judging experiments with one of the subjects which rule out these explanations. These show that the subject can detect his neologisms when he is repeating, but not when he is naming. These results suggest that his monitoring difficulties arise when he is accessing phonology from semantics. Section 3 presents a study which supports this inference, since it shows that semantically focused intervention yields improvements in self-monitoring. It is concluded (1) that monitoring failure can arise from deficits within the production process which preclude comparison of actual with intended output, and (2) that this deficit is best explained within a connectionist model in which monitoring is performed by feedback mechanisms in the word production process.

Aged↗

The neuropsychological signature of primary progressive aphasia.

An effect size analysis incorporating meta-analytic principles was used to review neuropsychological findings in patients with primary progressive aphasia (PPA). Studies dating back to 1982 were gathered and the neuropsychological test results from a total of 55 patients with PPA and 162 healthy controls were synthesized using effect size analyses. The results indicate that patients with PPA are most deficient on tests of verbal skill, followed by performance on measures of delayed recall, cognitive flexibility and abstraction, memory acquisition, attention/concentration, and, finally, performance skill. A rank-order list of specific neuropsychological tasks and test variables in order of sensitivity to PPA is also provided to aid in the interpretation of the quantitative results and in the differentiation of PPA from other disorders with prominent features of dementia such as Alzheimer's disease.

Aphasia↗

Grammatical encoding in aphasia: evidence from a "processing prosthesis".

Agrammatic aphasia is characterized by severely reduced grammatical structure in spoken and written language, often accompanied by apparent insensitivity to grammatical structure in comprehension. Does agrammatism represent loss of linguistic competence or rather performance factors such as memory or resource limitations? A considerable body of evidence supports the latter hypothesis in the domain of comprehension. Here we present the first strong evidence for the performance hypothesis in the domain of production: an augmentative communication system that markedly increases the grammatical structure of agrammatic speech while providing no linguistic information, functioning merely to reduce on-line processing demands.

Aphasia, Broca↗

Clinical and pathological characteristics of primary progressive aphasia and frontal dementia.

The recently described conditions of primary progressive aphasia and frontal lobe dementia overlap clinically and pathologically to a considerable extent with each other and with clinical and pathological descriptions of Pick's disease. Our clinical and neuropathological experience is summarized, leading us to the conclusion that the degree of overlap justifies the concept of "Pick complex" to include, in addition to the above, corticobasal ganglionic degeneration and some instances motor neuron disease with dementia.

Aphasia, Primary Progressive↗

Cerebral blood flow in thalamic aphasia.

A 59-year-old man is reported, who became aphasic after left thalamic infarction, shown by CT. His speech was fluent, with reduced voice volume, impaired auditory and reading comprehension, verbal paraphasias but intact repetition skills. A single photon emission computed tomography (SPECT) scan to measure regional cerebral flow (rCBF) showed a reduction of flow in the parietotemporal areas of the left hemisphere. It is suggested that thalamic aphasia could result from structural subcortical damage with a homolateral functional cortical deficit leading to the specific aphasic disturbance.

Aphasia↗

Aphasia and right hemiplegia after cervical myelography with metrizamide. A case report.

We report a case of aphasia and right hemiplegia, developing after myelography with metrizamide and lasting for an unusually long time. The neurological disorders, manifested 1 h after the examination was completed, were due to accidental passage of contrast medium into the basal cisterns. In the light of analogous case reports in the literature, as well as experimental data concerning the biochemical activity of metrizamide, possible aetiopathogenetic mechanisms responsible for such disturbances are indicated. The authors underline the lack of effective therapeutic measures after the onset of the disorders, and thus the importance of preventing such complications that behave functionally as true ictuses although with no anatomic substratum.

Aphasia↗

Recurrent aphasia with subclinical bioelectric status epilepticus during sleep.

We present a six years follow up of a 6 1/2 year-old boy with recurrent aphasia, sporadic emotional regression and a convulsive disorder. The electroencephalogram reading during sleep showed continuous, generalized, hypersynchronous activity without clinical evidence of seizure ("subclinical bioelectric status epilepticus"). Clinical, laboratory and instrumental data revealed no evidence of a morphological lesion of the brain, either space-occupying, inflammatory, degenerative, or autoimmune. Remissions occured with and without anticonvulsant and steroid therapy. The hypothetical location, type, and etiology of the process are discussed. The syndrome appears to represent a functional disorganisation of speech-controlling areas of the brain.

Adolescent↗

Neuroradiological findings in primary progressive aphasia: CT MRI and cerebral perfusion SPECT.

Primary progressive aphasia (PPA) is defined as progressive decline in language for 2 or more years with preservation of activities of daily living and general cognitive functions. Whereas the clinical features of this syndrome have been well documented, the neuroradiological findings have not been studied systematically. We studied 13 patients with PPA retrospectively: 10 underwent CT, 12 MRI and 12 cerebral perfusion studies using 99mTc-HMPAO SPECT.CT and MR images were scored for focal atrophy by two independent assessors. Initial qualitative assessment of SPECT images was confirmed by quantitative analysis. CT was normal in 5 patients. Focal atrophy, affecting predominantly the left temporal lobe, was seen in 4 of 10 patients on CT, and 10 of 12 on MRI. Atrophy was localised primarily to the superior and middle temporal gyri on MRI. All 12 patients who underwent SPECT had unilateral temporal lobe perfusion defects, in 2 patients of whom MRI was normal. CT is relatively insensitive to focal abnormalities in PPA; MRI and SPECT are the imaging modalities of choice. MRI allows accurate, specific localisation of atrophy within the temporal neocortex. SPECT may reveal a functional decrease in cerebral perfusion prior to establishment of structural change.

Adult↗

Focal abnormalities of P3 ERPs unveiled in patients with cortical lesions and primary progressive aphasia by average reference recordings.

Event related potentials (ERPs) to an auditory odd-ball paradigm were recorded with the linked earlobe reference (LER) and with a computer calculated average reference (AR), excluding the two linked earlobe derivations. The study was performed in 30 patients with lesions of frontal, parietal, occipital cortex, unilateral and bilateral lesions of the medial temporal lobe (MTL), in four patients affected by Primary Progressive Aphasia (PPA) and in 56 age matched controls. Latencies, amplitudes and scalp distribution of the earlier ERP components (P1, N1, P2, N2) were within normal limits for both LER and AR recordings. P3 scalp distribution in patients was normal when LER was used, with the exception of two patients affected by bilateral MTL lesions. When P3 was recorded using AR, the scalp distribution was statistically different from normal distributions in all patients. A negativity, instead of the positive P3 observed in controls, was recorded in patients from leads corresponding to the affected areas. This finding might have clinical applications, and confirms earlier studies suggesting that P3 is generated simultaneously from different cortical areas.

Aged↗

Primary progressive aphasia: description of a clinical case with nine years of follow-up.

We describe the case of a woman with primary progressive aphasia who, over a period of nine years, has shown no signs of clinical deterioration and has only a symptomatic language disturbance. Neuropsychological follow-up has revealed progressive language impairment, with the integrity of praxis, visuoperceptive gnosia and short term visuospatial memory remaining intact; the only impairment was that revealed by long-term memory tests.

Aged↗

Progressive neuropsychological and extrapyramidal deterioration resembling progressive supranuclear palsy: is aphasia relevant for correct diagnosis?

We describe the case of a woman presenting with a clinical syndrome closely resembling progressive supranuclear palsy, who also showed some progressive neuropsychological defects (aphasia and apraxia) not consistent with a simple loss of timing and activation as is generally postulated in this pathology. The case is discussed with regard to the definition of subcortical dementia and the possible alternative diagnosis of corticobasal degeneration.

Aged↗

[Global aphasia. The clinical picture and a consideration of the neurolinguistic structure (author's transl)].

Global aphasia is described as a unitary syndrome which is characterized by a severe impairment of all linguistic capabilities. Speech production is extremely limited and consists of stereotyped phrases, recurring utterances or a few isolated words which are usually neologistically distorted. The patients are unable to express their thoughts in a situationally adequate manner. Language comprehension is restricted to simple questions and commands. A clinical description of the syndrome is given and the neurolinguistic structure of the disorders is discussed.

Aphasia↗

[Primary progressive aphasia].

Primary progressive aphasia is a rare disease characterised by slow deterioration of language, which remains the leading symptom whereas other cognitive functions such as memory, orientation, judgement, and visual-spatial skills are relatively spared and mostly not affected until 5 to 7 years after disease onset. Structural imaging displays atrophy of the left temporal region which can also affect the frontal region or both hemispheres. Reduced neuronal activity in the left temporal lobe can be seen using functional imaging even before structural anomalies are detected. Neuropathological examination reveals neuronal cell loss and gliosis in the regions of atrophy which are sometimes accompanied by spongiform changes. T-positive neurons or plaques and neurofibrillary tangles are present in rare cases. A specific therapy is not known. Logopaedic therapy focussed on the main symptoms seems to stabilise linguistic abilities.

Aphasia, Primary Progressive↗

Prominent hypometabolism of the right temporoparietal and frontal cortex in two left-handed patients with primary progressive aphasia.

Primary progressive aphasia (PPA) is characterized by progressive deterioration of language function with relative preservation of other cognitive functions. Previous studies based on neuroimaging and histology point to predominantly left temporal pathology in PPA patients. Here we report two left-handed subjects with typical symptoms of the nonfluent form of PPA in whom 18F-FDG PET revealed an asymmetric right-hemispheric pattern of reduced glucose metabolism in the frontal and temporoparietal cortex. These findings support the hypothesis that PPA can be considered as a symptom complex rather than a disease entity.

Aged↗