scholarly journals Efficacy of Noninvasive Brain Stimulation (tDCS or TMS) Paired with Language Therapy in the Treatment of Primary Progressive Aphasia: An Exploratory Meta-Analysis

2020 ◽  
Vol 10 (9) ◽  
pp. 597
Author(s):  
Nicole R. Nissim ◽  
Paul J. Moberg ◽  
Roy H. Hamilton
Keyword(s):  
Brain Stimulation ◽  
Meta Analysis ◽  
Random Effect ◽  
Primary Progressive Aphasia ◽  
Language Outcomes ◽  
Language Therapy ◽  
Language Abilities ◽  
Noninvasive Brain Stimulation ◽  
Progressive Aphasia ◽  
Primary Progressive

Noninvasive brain stimulation techniques, such as transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS), paired with behavioral language therapy, have demonstrated the capacity to enhance language abilities in primary progressive aphasia (PPA), a debilitating degenerative neurological syndrome that leads to declines in communication abilities. The aim of this meta-analysis is to systematically evaluate the efficacy of tDCS and TMS in improving language outcomes in PPA, explore the magnitude of effects between stimulation modalities, and examine potential moderators that may influence treatment effects. Standard mean differences for change in performance from baseline to post-stimulation on language-related tasks were evaluated. Six tDCS studies and two repetitive TMS studies met inclusion criteria and provided 22 effects in the analysis. Random effect models revealed a significant, heterogeneous, and moderate effect size for tDCS and TMS in the enhancement of language outcomes. Findings demonstrate that naming ability significantly improves due to brain stimulation, an effect found to be largely driven by tDCS. Future randomized controlled trials are needed to determine long-term effectiveness of noninvasive brain stimulation techniques on language abilities, further delineate the efficacy of tDCS and TMS, and identify optimal parameters to enable the greatest gains for persons with PPA.

scholarly journals Contribution of the Cognitive Approach to Language Assessment to the Differential Diagnosis of Primary Progressive Aphasia

2021 ◽  
Vol 11 (6) ◽  
pp. 815
Author(s):  
Joël Macoir ◽  
Annie Légaré ◽  
Monica Lavoie
Keyword(s):  
Differential Diagnosis ◽  
Language Impairment ◽  
Primary Progressive Aphasia ◽  
Behavioral Management ◽  
Language Abilities ◽  
Cognitive Approach ◽  
Progressive Aphasia ◽  
Primary Progressive ◽  
Assessment Approach ◽  
Cognitive Neuropsychological

Diagnosis of primary progressive aphasia (PPA) is essentially based on the identification of progressive impairment of language abilities while other cognitive functions are preserved. The three variants of PPA are characterized by core and supportive clinical features related to the presence or absence of language impairment in different linguistic domains. In this article, we review the cognitive neuropsychological approach to the assessment of PPA and its contribution to the differential diagnosis of the three variants. The main advantage of this assessment approach is that it goes beyond the mere description and classification of clinical syndromes and identifies impaired and preserved cognitive and linguistic components and processes. The article is structured according to the main language domains: spoken production, language comprehension, and written language. Each section includes a brief description of the cognitive processes involved in the assessment tasks, followed by a discussion of typical characteristics for each PPA variant and common pitfalls in the interpretation of the results. In addition, the clinical benefit of the cognitive neuropsychological approach for the behavioral management of PPA is briefly sketched out in the conclusion.

Sleep as a predictor of tDCS and language therapy outcomes

SLEEP ◽  
2021 ◽  
Author(s):  
Olivia Herrmann ◽  
Bronte Ficek ◽  
Kimberly T Webster ◽  
Constantine Frangakis ◽  
Adam P Spira ◽  
...  
Keyword(s):  
Inferior Frontal Gyrus ◽  
Primary Progressive Aphasia ◽  
Sleep Time ◽  
Sleep Efficiency ◽  
Language Therapy ◽  
Double Blind ◽  
Progressive Aphasia ◽  
Primary Progressive ◽  
Time In Bed ◽  
Sham Condition

Abstract Study Objectives To determine whether sleep at baseline (before therapy) predicted improvements in language following either language therapy alone or coupled with transcranial direct current stimulation (tDCS) in individuals with primary progressive aphasia (PPA). Methods Twenty-three participants with PPA (mean age 68.13 ± 6.21) received written naming/spelling therapy coupled with either anodal tDCS over the left inferior frontal gyrus (IFG) or sham condition in a crossover, sham-controlled, double-blind design (ClinicalTrials.gov identifier: NCT02606422). The outcome measure was percent of letters spelled correctly for trained and untrained words retrieved in a naming/spelling task. Given its particular importance as a sleep parameter in older adults, we calculated sleep efficiency (total sleep time/time in bed x100) based on subjective responses on the Pittsburgh Sleep Quality Index (PSQI). We grouped individuals based on a median split: high versus low sleep efficiency. Results Participants with high sleep efficiency benefited more from written naming/spelling therapy than participants with low sleep efficiency in learning therapy materials (trained words). There was no effect of sleep efficiency in generalization of therapy materials to untrained words. Among participants with high sleep efficiency, those who received tDCS benefitted more from therapy than those who received sham condition. There was no additional benefit from tDCS in participants with low sleep efficiency. Conclusion Sleep efficiency modified the effects of language therapy and tDCS on language in participants with PPA. These results suggest sleep is a determinant of neuromodulation effects. Clinical Trial: tDCS Intervention in Primary Progressive Aphasia https://clinicaltrials.gov/ct2/show/NCT02606422

scholarly journals Speech and language therapy approaches to managing primary progressive aphasia

2019 ◽  
Vol 20 (2) ◽  
pp. 154-161 ◽  
Author(s):  
Anna Volkmer ◽  
Emily Rogalski ◽  
Maya Henry ◽  
Cathleen Taylor-Rubin ◽  
Leanne Ruggero ◽  
...  
Keyword(s):  
Primary Progressive Aphasia ◽  
Therapeutic Interventions ◽  
Speech And Language ◽  
Language Therapy ◽  
Compensatory Strategies ◽  
Speech And Language Therapy ◽  
Progressive Aphasia ◽  
Primary Progressive ◽  
Evidence Based Guidelines ◽  
Improve Access

The term primary progressive aphasia (PPA) describes a group of neurodegenerative disorders with predominant speech and language dysfunction as their main feature. There are three main variants – the semantic variant, the nonfluent or agrammatic variant and the logopenic variant – each with specific linguistic deficits and different neuroanatomical involvement. There are currently no curative treatments or symptomatic pharmacological therapies. However, speech and language therapists have developed several impairment-based interventions and compensatory strategies for use in the clinic. Unfortunately, multiple barriers still need to be overcome to improve access to care for people with PPA, including increasing awareness among referring clinicians, improving training of speech and language therapists and developing evidence-based guidelines for therapeutic interventions. This review highlights this inequity and the reasons why neurologists should refer people with PPA to speech and language therapists.

scholarly journals Thinking Outside the Stroke: Treating Primary Progressive Aphasia (PPA)

2012 ◽  
Vol 17 (2) ◽  
pp. 37-49 ◽  
Author(s):  
Becky Khayum ◽  
Christina Wieneke ◽  
Emily Rogalski ◽  
Jaimie Robinson ◽  
Mary O’Hara
Keyword(s):  
Quality Of Life ◽  
Brain Injury ◽  
Cognitive Abilities ◽  
Speech Therapy ◽  
Primary Progressive Aphasia ◽  
Supportive Services ◽  
Language Abilities ◽  
Progressive Aphasia ◽  
Primary Progressive

In this article, we explore the symptoms, cause, treatment potential, and supportive services for individuals diagnosed with Primary Progressive Aphasia (PPA). Although it is possible to regain certain cognitive abilities with stroke or brain injury, in PPA, language abilities worsen and other symptoms emerge with time, shortening the lifespan. The goal of speech therapy for PPA is not to regain lost language, but rather to maximize communication for as long as possible. In this article, we offer information and tools for speech-language pathologists to help people living with PPA achieve these goals and improve overall quality of life.

Considerations in Subtyping and Monitoring of Symptom Progression in Primary Progressive Aphasia

2014 ◽  
Vol 24 (4) ◽  
pp. 122-127
Author(s):  
Daisy Sapolsky ◽  
Kimiko Domoto-Reilly ◽  
Bradford C. Dickerson
Keyword(s):  
Critical Role ◽  
Primary Progressive Aphasia ◽  
Family Counseling ◽  
Language Abilities ◽  
Language Preservation ◽  
Progressive Aphasia ◽  
Primary Progressive ◽  
Speech Language Pathologist ◽  
Initial Symptoms ◽  
Symptom Progression

A speech-language pathologist (SLP) may be one of the initial clinical providers for a patient with primary progressive aphasia (PPA), a group of neurodegenerative diseases involving the selective, progressive deterioration of speech and/or language abilities. While the three primary subtypes of PPA have distinct profiles of language preservation and impairment, the process of identifying the subtype can be challenging for many reasons, including subtle initial symptoms which can be difficult to detect on standard testing batteries. Early and accurate subtyping is important for clinical and research applications, which we will discuss here. The SLP plays a critical role in the initial subtyping process, as well as in helping to confirm that the course and presentation are consistent with a root diagnosis of PPA, as opposed to normal aging or other etiologies. The involvement of the SLP over time then focuses on monitoring symptom severity and progression, which is a particularly relevant issue for this population. The SLP can apply this information to inform treatment planning and patient/family counseling, and to assess potential benefits from interventions including conventional and novel speech therapies, and pharmaceutical treatments as they become available.

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