Neuroinflammation and flortaucipir PET in non‐fluent/agrammatic variant of primary progressive aphasia and/or apraxia of speech

Purpose This study compared performance on three-word fluency measures among individuals with primary progressive aphasia (PPA) and primary progressive apraxia of speech (PPAOS), and examined the relationship between word fluency and other measures of language and speech. Method This study included 106 adults with PPA and 30 adults with PPAOS. PPA participants were divided into three clinical subgroups: semantic (svPPA), logopenic (lvPPA), and nonfluent/agrammatic with or without apraxia of speech (nfPPA). Category fluency, letter fluency, and action/verb fluency tasks were administered to all participants. Results The four clinical groups performed abnormally on the word fluency measures, although not to a degree that represented high sensitivity to their PPA or PPAOS diagnosis. All PPA subgroups produced fewer words compared to individuals with PPAOS on all word fluency measures. Moderate correlations were found between word fluency and aphasia severity and naming performance in some of the clinical groups. Conclusions Word fluency measures are often challenging for individuals with PPA and PPAOS, but they are not of equal difficulty, with letter fluency being the most difficult. Differences among word fluency tests also vary to some degree as a function of the clinical group in question, with least impairment in PPAOS. However, the findings of this study do not support statistically significant differences in word fluency task performance among the PPA subgroups. Correlations suggest that word fluency performance in PPA is at least partly related to aphasia severity.

Download Full-text

Electroencephalography in primary progressive aphasia and apraxia of speech

Aphasiology ◽

10.1080/02687038.2018.1545991 ◽

2018 ◽

Vol 33 (11) ◽

pp. 1410-1417 ◽

Cited By ~ 4

Author(s):

Rene L. Utianski ◽

John N. Caviness ◽

Gregory A. Worrell ◽

Joseph R. Duffy ◽

Heather M. Clark ◽

...

Keyword(s):

Primary Progressive Aphasia ◽

Apraxia Of Speech ◽

Progressive Aphasia ◽

Primary Progressive

Download Full-text

Tau uptake in agrammatic primary progressive aphasia with and without apraxia of speech

European Journal of Neurology ◽

10.1111/ene.13733 ◽

2018 ◽

Vol 25 (11) ◽

pp. 1352-1357 ◽

Cited By ~ 7

Author(s):

R. L. Utianski ◽

J. L. Whitwell ◽

C. G. Schwarz ◽

J. R. Duffy ◽

H. Botha ◽

...

Keyword(s):

Primary Progressive Aphasia ◽

Apraxia Of Speech ◽

Progressive Aphasia ◽

Primary Progressive

Download Full-text

Lack of Frank Agrammatism in the Nonfluent Agrammatic Variant of Primary Progressive Aphasia

Dementia and Geriatric Cognitive Disorders Extra ◽

10.1159/000448944 ◽

2016 ◽

Vol 6 (3) ◽

pp. 407-423 ◽

Cited By ~ 6

Author(s):

Naida L. Graham ◽

Carol Leonard ◽

David F. Tang-Wai ◽

Sandra Black ◽

Tiffany W. Chow ◽

...

Keyword(s):

Primary Progressive Aphasia ◽

Diagnostic Feature ◽

Apraxia Of Speech ◽

Volumetric Mri ◽

Motor Speech ◽

Progressive Aphasia ◽

Primary Progressive ◽

Grammatical Morphemes ◽

Grammatical Errors ◽

Diagnosis Method

Background/Aims: Frank agrammatism, defined as the omission and/or substitution of grammatical morphemes with associated grammatical errors, is variably reported in patients with nonfluent variant primary progressive aphasia (nfPPA). This study addressed whether frank agrammatism is typical in agrammatic nfPPA patients when this feature is not required for diagnosis. Method: We assessed grammatical production in 9 patients who satisfied current diagnostic criteria. Although the focus was agrammatism, motor speech skills were also evaluated to determine whether dysfluency arose primarily from apraxia of speech (AOS), instead of, or in addition to, agrammatism. Volumetric MRI analyses provided impartial imaging-supported diagnosis. Results: The majority of cases exhibited neither frank agrammatism nor AOS. Conclusion: There are nfPPA patients with imaging-supported diagnosis and preserved motor speech skills who do not exhibit frank agrammatism, and this may persist beyond the earliest stages of the illness. Because absence of frank agrammatism is a subsidiary diagnostic feature in the logopenic variant of PPA, this result has implications for differentiation of the nonfluent and logopenic variants, and indicates that PPA patients with nonfluent speech in the absence of frank agrammatism or AOS do not necessarily have the logopenic variant.

Download Full-text

Speech Metrics and Samples That Differentiate Between Nonfluent/Agrammatic and Logopenic Variants of Primary Progressive Aphasia

Journal of Speech Language and Hearing Research ◽

10.1044/2020_jslhr-20-00445 ◽

2021 ◽

pp. 1-22

Author(s):

Katarina L. Haley ◽

Adam Jacks ◽

Jordan Jarrett ◽

Taylor Ray ◽

Kevin T. Cunningham ◽

...

Keyword(s):

Large Scale ◽

Primary Progressive Aphasia ◽

Diagnostic Tools ◽

Future Research ◽

Apraxia Of Speech ◽

Connected Speech ◽

Progressive Aphasia ◽

Primary Progressive ◽

Syllable Duration ◽

Semantic Variant

Purpose Of the three currently recognized variants of primary progressive aphasia, behavioral differentiation between the nonfluent/agrammatic (nfvPPA) and logopenic (lvPPA) variants is particularly difficult. The challenge includes uncertainty regarding diagnosis of apraxia of speech, which is subsumed within criteria for variant classification. The purpose of this study was to determine the extent to which a variety of speech articulation and prosody metrics for apraxia of speech differentiate between nfvPPA and lvPPA across diverse speech samples. Method The study involved 25 participants with progressive aphasia (10 with nfvPPA, 10 with lvPPA, and five with the semantic variant). Speech samples included a word repetition task, a picture description task, and a story narrative task. We completed acoustic analyses of temporal prosody and quantitative perceptual analyses based on narrow phonetic transcription and then evaluated the degree of differentiation between nfvPPA and lvPPA participants (with the semantic variant serving as a reference point for minimal speech production impairment). Results Most, but not all, articulatory and prosodic metrics differentiated statistically between the nfvPPA and lvPPA groups. Measures of distortion frequency, syllable duration, syllable scanning, and—to a limited extent—syllable stress and phonemic accuracy showed greater impairment in the nfvPPA group. Contrary to expectations, classification was most accurate in connected speech samples. A customized connected speech metric—the narrative syllable duration—yielded excellent to perfect classification accuracy. Discussion Measures of average syllable duration in multisyllabic utterances are useful diagnostic tools for differentiating between nfvPPA and lvPPA, particularly when based on connected speech samples. As such, they are suitable candidates for automatization, large-scale study, and application to clinical practice. The observation that both speech rate and distortion frequency differentiated more effectively in connected speech than on a motor speech examination suggests that it will be important to evaluate interactions between speech and discourse production in future research.

Download Full-text

Western Aphasia Battery–Revised Profiles in Primary Progressive Aphasia and Primary Progressive Apraxia of Speech

American Journal of Speech-Language Pathology ◽

10.1044/2019_ajslp-cac48-18-0217 ◽

2020 ◽

Vol 29 (1S) ◽

pp. 498-510 ◽

Cited By ~ 2

Author(s):

Heather M. Clark ◽

Rene L. Utianski ◽

Joseph R. Duffy ◽

Edythe A. Strand ◽

Hugo Botha ◽

...

Keyword(s):

Primary Progressive Aphasia ◽

Relative Performance ◽

Apraxia Of Speech ◽

Motor Speech ◽

Progressive Aphasia ◽

Primary Progressive ◽

R Classification ◽

The Mean ◽

Fluent Aphasia ◽

Speech And Language Disorders

Purpose The primary aim was to examine the utility of the Western Aphasia Battery–Revised (WAB-R; Kertesz, 2007 ) for classifying variants of primary progressive aphasia (PPA). Traditional WAB-R metrics of Aphasia Quotient (AQ), subtest scores, WAB-R classification, and several novel metrics were examined. A secondary aim was to examine these same WAB-R metrics in individuals with primary progressive apraxia of speech (PPAOS). Method A retrospective analysis of WAB-R records from 169 participants enrolled in a study of neurodegenerative speech and language disorders was conducted. PPA/PPAOS classification was determined by consensus review of speech, language, and cognitive profiles. Scores on each of the WAB-R subtests were obtained to derive AQ, WAB-R aphasia profile, and 3 ratios reflecting relative performance on subtests. Results Mean AQ was significantly higher in the PPAOS group compared to all PPA variants except primary fluent aphasia. AQ above the normal cutoff was observed for 20% of participants with PPA. Significant main effects of group were noted for each of the subtests. Follow-up comparisons most frequently discriminated PPAOS, primary agrammatic aphasia (PAA), and logopenic progressive aphasia. Primary fluent aphasia and semantic dementia (SD) subtest scores were less distinctive, with the exception of Naming for SD, which was significantly lower than for PAA and PPAOS. When the WAB-R AQ detected aphasia, a classification of anomic aphasia was most frequently observed; this pattern held true for each of the PPA variants. The mean Information Content:Naming ratio was highest for SD, and the mean Comprehension:Fluency ratio was highest for PAA. Conclusions In the current study, AQ underestimated the presence of PPA and WAB-R classification did not distinguish among PPA classification determined by consensus. Performance on individual subtests and relative performance across subtests demonstrated inconsistent alignment with PPA classification. We conclude the WAB-R in isolation is inadequate to detect or characterize PPA. We instead suggest utilizing the WAB-R as 1 component of a comprehensive language and motor speech assessment when PPA is suspected.

Download Full-text

Quantitative Analysis of Agrammatism in Agrammatic Primary Progressive Aphasia and Dominant Apraxia of Speech

Journal of Speech Language and Hearing Research ◽

10.1044/2018_jslhr-l-17-0474 ◽

2018 ◽

Vol 61 (9) ◽

pp. 2337-2346 ◽

Cited By ~ 3

Author(s):

Katerina A. Tetzloff ◽

Rene L. Utianski ◽

Joseph R. Duffy ◽

Heather M. Clark ◽

Edythe A. Strand ◽

...

Keyword(s):

Language Production ◽

Primary Progressive Aphasia ◽

Broca’S Area ◽

Apraxia Of Speech ◽

Broca's Area ◽

Progressive Aphasia ◽

Primary Progressive ◽

Semantic Errors ◽

Description Task ◽

Mean Length Of Utterance

Purpose The aims of the study were to assess and compare grammatical deficits in written and spoken language production in subjects with agrammatic primary progressive aphasia (agPPA) and in subjects with agrammatism in the context of dominant apraxia of speech (DAOS) and to investigate neuroanatomical correlates. Method Eight agPPA and 21 DAOS subjects performed the picture description task of the Western Aphasia Battery (WAB) both in writing and orally. Responses were transcribed and coded for linguistic analysis. agPPA and DAOS were compared to 13 subjects with primary progressive apraxia of speech (PPAOS) who did not have agrammatism. Spearman correlations were performed between the written and spoken variables. Patterns of atrophy in each group were compared, and relationships between the different linguistic measures and integrity of Broca's area were assessed. Results agPPA and DAOS both showed lower mean length of utterance, fewer grammatical utterances, more nonutterances, more syntactic and semantic errors, and fewer complex utterances than PPAOS in writing and speech, as well as fewer correct verbs and nouns in speech. Only verb ratio and proportion of grammatical utterances correlated between modalities. agPPA and DAOS both showed greater involvement of Broca's area than PPAOS, and atrophy of Broca's area correlated with proportion of grammatical and ungrammatical utterances and semantic errors in writing and speech. Conclusions agPPA and DAOS subjects showed similar patterns of agrammatism, although subjects performed differently when speaking versus writing. Integrity of Broca's area correlates with agrammatism.

Download Full-text