scholarly journals Brain changes underlying progression of speech motor programming impairment

2021 ◽  
Author(s):  
Ramon Landin-Romero ◽  
Cheng T Liang ◽  
Penelope A Monroe ◽  
Yuichi Higashiyama ◽  
Cristian E Leyton ◽  
...  
Keyword(s):  
Speech Production ◽  
Primary Progressive Aphasia ◽  
Brain Regions ◽  
Motor Programming ◽  
Apraxia Of Speech ◽  
Progressive Aphasia ◽  
Primary Progressive ◽  
Word Duration ◽  
Variability Index ◽  
Speech Motor

Abstract Aquired apraxia of speech is a disorder that impairs speech production, despite intact peripheral neuromotor function. Its pathomechanism remains to be established. Neurodegenerative lesion models provide an unequalled opportunity to explore the neural correlates of apraxia of speech, which is present in a subset of patients diagnosed with non-semantic variants of primary progressive aphasia. The normalised pairwise variability index, an acoustic measure of speech motor programming, has shown high sensitivity and specificity for apraxia of speech in cross-sectional studies. Here, we aimed to examine the strength of the pairwise variability index and overall word duration (i.e. articulation rate) as markers of progressive motor programming deficits in primary progressive aphasia with apraxia of speech. Seventy-nine individuals diagnosed with primary progressive aphasia (39 with non-fluent variant, 40 with logopenic variant) and 40 matched healthy controls participated. Patients were followed-up annually (range 1–6 years, median number of visits = 2). All participants completed a speech assessment task and a high-resolution MRI. Our analyses investigated trajectories of speech production (e.g. pairwise variablity index and word duration) and associations with cortical atrophy in the patients. At first presentation, word duration differentiated the nonfluent and logopenic cases statistically, but the range of scores overlapped substantially across groups. Longitudinally, we observed progressive deterioration in pairwise variability index and word duration specific to the non-fluent group only. The pairwise variability index showed particularly strong associations with progressive atrophy in speech motor programming brain regions. Of novelty, our results uncovered a key role of the right frontal gyrus in underpinning speech motor programming changes in non-fluent cases, highlighting the importance of right brain regions in responding to progressive neurological changes in the speech motor network. Taken together, our findings validate the use of a new metric, the pairwise variability index, as a robust marker of apraxia of speech in contrast to more generic measures of speaking rate. Sensitive/specific neuroimaging biomarkers of the emergence and progression of speech impairments will be useful to inform theories of the pathomechanisms underpinning impaired speech motor control. Our findings justify developing more sensitive measures of rhythmic temporal control of speech that may enable confident detection of emerging speech disturbances and more sensitive tracking of intervention-related changes for pharmacological, neuromodulatory, and behavioural interventions. A more reliable detection of speech disturbances has relevance for patient care, with predominance of progressive apraxia of speech a high-risk factor for later diagnosis of progressive supranuclear palsy or corticobasal degeneration.

scholarly journals Treatment for Apraxia of Speech in Nonfluent Variant Primary Progressive Aphasia

2013 ◽  
Vol 26 (1-2) ◽  
pp. 77-88 ◽  
Author(s):  
M. L. Henry ◽  
M. V. Meese ◽  
S. Truong ◽  
M. C. Babiak ◽  
B. L. Miller ◽  
...  
Keyword(s):  
Speech Production ◽  
Oral Reading ◽  
Behavioral Treatment ◽  
Effective Means ◽  
Primary Progressive Aphasia ◽  
Treatment Method ◽  
Apraxia Of Speech ◽  
Progressive Aphasia ◽  
Primary Progressive ◽  
Novel Approach

There is a growing body of literature examining the utility of behavioral treatment in primary progressive aphasia (PPA). There are, however, no studies exploring treatment approaches to improve speech production in individuals with apraxia of speech (AOS) associated with the nonfluent variant of PPA. The purpose of this study was to examine a novel approach to treatment of AOS in nonfluent PPA. We implemented a treatment method using structured oral reading as a tool for improving production of multisyllabic words in an individual with mild AOS and nonfluent variant PPA. Our participant showed a reduction in speech errors during reading of novel text that was maintained at one year post-treatment. Generalization of improved speech production was observed on repetition of words and sentences and the participant showed stability of speech production over time in connected speech. Results suggest that oral reading treatment may offer an efficient and effective means of addressing multisyllabic word production in AOS associated with nonfluent PPA, with lasting and generalized treatment effects.

Word Fluency Test Performance in Primary Progressive Aphasia and Primary Progressive Apraxia of Speech

2021 ◽  
pp. 1-8
Author(s):  
Lucia Scheffel ◽  
Joseph R. Duffy ◽  
Edythe A. Strand ◽  
Keith A. Josephs
Keyword(s):  
Test Performance ◽  
Primary Progressive Aphasia ◽  
High Sensitivity ◽  
Clinical Group ◽  
Apraxia Of Speech ◽  
Word Fluency ◽  
Progressive Aphasia ◽  
Primary Progressive ◽  
The Relationship ◽  
Fluency Task

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.

scholarly journals Electroencephalography in primary progressive aphasia and apraxia of speech

Aphasiology ◽  
2018 ◽  
Vol 33 (11) ◽  
pp. 1410-1417 ◽  
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

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

2018 ◽  
Vol 25 (11) ◽  
pp. 1352-1357 ◽  
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

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

2016 ◽  
Vol 6 (3) ◽  
pp. 407-423 ◽  
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.

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

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.

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

2020 ◽  
Vol 29 (1S) ◽  
pp. 498-510 ◽  
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.

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

2018 ◽  
Vol 61 (9) ◽  
pp. 2337-2346 ◽  
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.

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