For individuals with agrammatic aphasia, producing sentences with non-canonical word orders is a challenging feat. Studies on different languages report deficits in this area of sentence production: some citing problems related to retrieval of verb morphology while others pursue a more holistic approach by attributing the root of the deficit towards the process of thematic role assignment. It has been shown that agrammatic speakers of Standard Indonesian are relatively unimpaired in the use (in spontaneous speech) and comprehension of passive constructions. These studies suggest the high frequency of the passive structure in Standard Indonesian may play a role in its retrieval and processing. For the current study, we tested sentence production in agrammatic speakers of Standard Indonesian. The purpose of the present study is to assess the effects of syntactic frequency and word order on sentence production in agrammatic speakers of Standard Indonesian. Twelve agrammatic speakers were tested with a picture elicitation task. The participants had to produce active and passive, reversible and non-reversible sentences. No main effects of sentence type were observed; reversible and non-reversible active and passive sentences were produced with comparable accuracy. Despite this observation, the majority of errors produced were associated with role-reversals and verb inflection. Lack of a specific deficit in the production of structures with non-canonical word order suggests the impact of syntactic frequency on agrammatic sentence processing. As with previous studies on Indonesian sentence comprehension, the present results provide evidence for the preservation of the passive structure in agrammatic speakers of Standard Indonesian.

Aims: This systematic review investigates the effectiveness of verb production training in individuals with agrammatic Broca’s aphasia. It highlights verb retrieval and verb inflection treatments, evaluating their impact on naming accuracy, sentence production, and generalization. The ultimate goal of the present study is to systematically review and evaluate the effectiveness of verb production training methods—including both verb retrieval and verb inflection interventions—for improving communication outcomes in patients with agrammatic Broca’s aphasia. Methods: This review followed the PRISMA 2020 guidelines. Four databases (PubMed, Medline/EBSCOhost, Web of Science, and Google Scholar) were searched using PICO-based terms. Inclusion criteria consisted of peer-reviewed articles in English which exclusively focused on verb production training in agrammatic Broca’s aphasia with measurable outcomes. Exclusion criteria included studies on other aphasia types, non-intervention papers, and non-English or unavailable full texts. After removing duplicates and screening 1461 records, ten studies met the eligibility criteria. Results: Of the ten studies included, six focused on verb retrieval treatments and four on verb inflection treatment. Interventions varied widely, including semantic, gestural, and repetition-based methods for verb retrieval and morphosemantic and morphophonological treatments for verb inflection. While verb retrieval treatments improved naming of trained verbs, generalization to untrained items was inconsistent. Morphosemantic approaches to verb inflection outperformed morphophonological treatments and had broader generalization and improvements in narrative tasks, particularly with regular verb training. Overall, participant response varied depending on the nature of the impairment and treatment modality. Conclusion: Verb production training is effective in improving targeted linguistic abilities in agrammatic Broca’s aphasia, particularly when approaches are tailored to individual deficits. Morphosemantic and multimodal interventions demonstrate promising results. However, limited generalization to untrained contexts remains a key challenge, highlighting the need for future therapies that integrate semantic, syntactic, and real-life communicative components.

ABSTRACT Background A key characteristic of the language of persons with post-stroke agrammatic aphasia (PSA-G) is difficulty with verb morphology, particularly for marking tense/aspect. The neurocognitive mechanisms underlying this deficit are poorly understood. Most prior investigations of this symptom have focused on testing syntactic theories of verb tense. But little is known about how lexical (morphophonological) factors influence the production of verb morphology. Investigating lexical factors will provide a deeper understanding of this deficit, in turn informing theories and future interventions of PSA-G. Aims The first aim was to delineate the effects of lexical (lemma frequency, lexeme frequency, noun homonymy, and verb regularity) and phonological (phonological complexity) properties on the accuracy and error patterns of verb inflections in PSA-G. The second aim was to examine if substitution errors were influenced by any verb properties. Methods & Procedures Sentences were elicited in three tenses (future, present and past) using three-picture sequences depicting an action before, during, and after completion. Accuracy and error patterns were examined in 20 English-speaking individuals with PSA-G. The effects of the following properties on accuracy were examined: two lexical frequency measures (lemma and lexeme), noun homonymy, regularity of the past tense, and number of phonemes in the verb form. Inaccurate verb tenses (substitution errors) were compared with the targets to examine the effects of lexical factors. Outcomes & Results The overall tense production accuracy was 12%. Production of verb tense was more accurate for stimuli with higher lexeme frequency, noun homonymy, irregular past, and shorter phoneme length. Morphological paraphasias were predominantly Verb-ing or Verb stems, and had higher lexeme frequency and longer phoneme length. Conclusions In addition to their well-documented tense encoding deficit, agrammatic speakers experience computational limitations during sentence planning, as evidenced by the negative effect of phoneme length, positive effect of lexeme frequency and noun homphony on tense production accuracy. The overuse of commonly occurring verb forms (Verb + ing, verb stems) in morphological paraphasias allows speakers to advance the verb phrase to the next stage of the speech production pipeline (that is, articulatory planning). The present study supports a multi-source view of agrammatic language, which integrates the core morphosyntactic deficit of PSA-G with two non-syntactic components: (a) other linguistic processes inherent in sentence planning such as lexical retrieval and phonological encoding, and (b) computational limitations.

Frontotemporal dementias (FTD) are a group of early-onset neurodegenerative disorders that primarily affect the frontal and temporal lobes, leading to changes in behavior, motor abilities, communication, and executive functions. Primary progressive aphasias (PPA), the language variant of FTD, specifically impair speech and language abilities. The heterogeneous presentation of FTD, particularly PPA, complicates differential diagnosis and treatment selection for healthcare professionals. These challenges are further exacerbated for patients in rural areas due to limited access to specialized healthcare services. This cross-sectional, descriptive case study examines a 76-year-old male patient diagnosed with agrammatic primary progressive aphasia (nfvPPA) living in a rural area in the U.S. We conducted a semi-structured interview with his caregiver to explore the lived experience of being diagnosed and treated for PPA in a rural setting and to identify challenges encountered during the diagnostic and therapeutic processes. Several critical barriers were identified, including poor interprofessional communication, inadequate practitioner-patient and caregiver communication, limited access to educational resources, inconsistent intervention and follow-ups, and restricted healthcare services. To improve the patient and caregiver experience, we propose a collaborative management model centered around speech-language pathologists with expertise in FTD/PPA. This model aims to facilitate smoother navigation of the healthcare system and improve patient outcomes. Effective care management requires clear and continuous communication among providers, patients, caregivers, and other professionals. Additionally, educating and supporting FTD/PPA patients and their families is essential. Research gaps in rural areas regarding diagnosis and treatment outcomes further hinder care, underscoring the need for targeted studies to enhance clinical practices and improve the quality of life for both patients and caregivers.

Treatment of Underlying Forms (TUF) is a training program grounded in linguistic theory and aiming to boost complex sentences production in people with agrammatism. Language treatment studies in aphasia confirmed TUF efficacy and led to the formulation of the Complexity Account of Treatment Efficacy (CATE). According to CATE, which relies on the primitive distinction between A- and A'-structures, training complex sentences induces an improvement on simpler structures, but no generalization occurs between different types of syntactic movement. This experiment provides the first adaptation of TUF in Italian and investigates the cross-linguistic validity of training efficacy and its generalization pattern. Using a single-subject experimental design, five participants with chronic poststroke agrammatism underwent intensive training for object relatives. Performance on trained and untrained object relatives (A'-structures), object clefts (simpler A'-structures), and passive sentences (A-structures) was measured at multiple time points, that is, pre- and posttreatment, during the training, and at follow-up. A standardized assessment of aphasia was also administered pre- and posttreatment. The results reported a robust improvement in the production of trained and untrained object relatives in all five participants, a generalization to object clefts in four participants, and, unexpectedly, a generalization to passives in three participants. All participants showed improved comprehension on all these structures. A general linguistic improvement was also found in the standardized testing of aphasia, especially in morphosyntactic abilities. The findings confirmed the efficacy of the Italian adaptation of TUF for object relatives supporting its use in the clinical practice. To explain the generalization to passives in Italian but not in the English version of TUF, we propose an amendment of CATE that takes the syntactic operation of Internal Merge as a primitive (keeping the A vs. A' distinction as a modulating factor).

ABSTRACT Background Agrammatism can result in verb production deficits, affecting various types of verbs, verb morphology, and argument structure. Persian language is underrepresented in aphasia research. Aims This study aims to profile verb-related deficits in Persian speakers with agrammatism (PSWA), focusing on Persian’s linguistic features. Methods & procedures Forty-two individuals participated in this study, including 21 PSWA (9 female, 12 male; mean age = 54.23 years) and 21 age- and education-matched non-brain-damaged (NBD) controls (10 female, 11 male; mean age = 51.19 years). Discourse data were collected through narration, descriptive speech, and story retelling, and analyzed for verb types, morphology, and argument structure. Between- and within-group comparisons used T-tests, ANOVA, and mixed-effects models controlling for aphasia severity. Outcomes & results PSWA produced significantly fewer verbs, particularly lexical, auxiliary, and modal verbs, while copula and imperative forms were comparable to those of NBD speakers. NBD speakers favored two-argument verbs, whereas PSWA favored simpler one-argument structures. Error analysis revealed a hierarchy of verb production errors: verb deletion > tense errors > compound verb errors > subject-verb agreement (SVA) substitutions > inflectional omissions. Data consistency was confirmed with high inter- and intra-rater reliability (0.81–1). Conclusions Findings enhance our understanding of both universal and Persian-specific verb production deficits in agrammatism, highlighting a preference for simplified grammatical structures and unique challenges with complex verb forms and argument structures in PSWA.

Hearing loss is relatively common in older individuals, and individuals with frontotemporal lobar degeneration (FTLD) are no exception; this can exacerbate communication difficulties stemming from speech-language impairments. The co-occurrence of these symptoms can contribute to increased frustration and isolation for patients and their communication partners. The objective of this study was to evaluate the feasibility of self-administered hearing testing. Ultimately, this could be administered remotely, which would increase access to assessment and inform management for this population. Seventeen patients with underlying FTLD, clinically presenting with progressive apraxia of speech with and without agrammatic aphasia, independently completed the Home Hearing Test supervised while in office. Three patients self-reported hearing loss, but results for 100% recommended formal evaluation. Eleven patients demonstrated good test accuracy. Six patients had "poor" or not computable accuracy; among them, five had evidence of cognitive impairment and/or behavioral changes, and one had known severe hearing loss, although differences between those with good and poor test accuracy were not significant. Patients with poor test accuracy had more difficulty with limb praxis. Most participants independently completed the test, though some had reduced test accuracy that may have been associated with cognitive impairment and/or limb apraxia. This study supports the need for hearing screenings in all patients with progressive apraxia of speech and aphasia and highlights both the feasibility and caution required in implementing self-administered testing protocols. Further work should evaluate the feasibility of in-home hearing screenings in a broader range of FTLD phenotypes and directly compare sensitivity and specificity of hearing loss detection with in-clinic administration. https://doi.org/10.23641/asha.28306613.

Individuals with chronic agrammatic aphasia demonstrate real-time sentence processing difficulties at the lexical and structural levels. Research using time-sensitive measures, such as priming and eye-tracking, have associated these difficulties with temporal delays in accessing semantic representations that are needed in real time during sentence structure building. In this study, we examined the real-time processing effort linked to sentence processing in individuals with aphasia and neurotypical, age-matched control participants as measured through pupil reactivity (i.e., pupillometry). Specifically, we investigated whether a semantically biased lexical cue (i.e., adjective) influences the processing effort while listening to complex noncanonical sentences. In this eye-tracking while listening study (within-subjects design), participants listened to sentences that either contained biased or unbiased adjectives (e.g., venomous snake vs. voracious snake) while viewing four images, three related to nouns in the sentence and one unrelated, but a plausible match for the unbiased adjective. Pupillary responses were collected every 17 ms throughout the entire sentence. While age-matched controls demonstrated increased pupil response throughout the course of the sentence, individuals with aphasia showed a plateau in pupil response early on in the sentence. Nevertheless, both controls and individuals with aphasia demonstrated reduced processing effort in the biased adjective condition. Individuals with aphasia are sensitive to lexical-semantic cues despite impairments in real-time lexical activation during sentence processing.

Introduction: Apraxia of speech (AOS) is a motor speech disorder characterized by sound distortions, substitutions, deletions, and additions; slow speech rate; abnormal prosody; and/or segmentation between words and syllables. AOS can result from neurodegeneration, in which case it can be accompanied by the primary agrammatic aphasia (PAA), which when presenting together are called AOS+PAA. AOS can also be the sole manifestation of neurodegeneration, termed primary progressive AOS (PPAOS). Together these form the agrammatic-apractic spectrum disorders. Recent work has shown that agrammatic-apractic spectrum patients show reduced quantity of written language production on a picture description task versus controls. However, no study to date has investigated if there are differences in quantity (amount of writing) and quality (grammaticality) in the written language production between PPAOS and AOS+PAA patients, which was the aim of this study. Methods: Twenty-four AOS+PAA patients, 24 PPAOS patients, and 24 typical controls performed the Western Aphasia Battery (WAB) written picture description task. The total number of words and sentences, as well as the type-token frequency, mean length of utterance, proportion of nouns, and function words, and overall sentence grammaticality were compared among groups. Results: The PPAOS group showed significantly reduced number of words (β = −44.2, p < 0.0001) and sentences (β = −4.04, p < 0.0001) compared to typical controls, and the AOS+PAA group showed significantly reduced number of words compared to both PPAOS patients (β = −17.0, p = 0.02) and controls (β = −61.20, p < 0.0001), as well as reduced number of sentences compared to controls (β = −4.33, p < 0.0001). AOS+PAA patients also showed grammatical deficits consistent with their concomitant aphasia diagnosis. Conclusions: This study provides novel quantitative data showing that agrammatic-apractic spectrum disorder patients show decreased written language output on a written picture description task compared to controls, even when there is no overt evidence of aphasia (i.e., PPAOS). Furthermore, these data show that controls, PPAOS patients, and AOS+PAA patients can all be distinguished based on the quantity of information and grammatical errors in a written picture description task. Future studies will explore sources beyond language, such as motoric impairment, that may result in reduced written quantity in agrammatic-apractic spectrum disorders.

Abstract Primary Progressive Aphasia (PPA) is a young-onset neurological disorder that affects a person’s language, behavior, and executive function abilities, caused by a focal degeneration of the frontal and temporal lobes in the brain. It is considered a frontotemporal dementia (FTD) due to the neuroanatomical areas it affects and the similar etiology it has with other neurodegenerative disorders. Differential diagnosis is difficult for health professionals due to the recent description of clinical variants, and the limited options for clinical treatment. In this cross-sectional and descriptive study, we reviewed the case of a 76-year-old male patient diagnosed with agrammatic primary progressive aphasia (nfvPPA) who lives in a rural area in Nebraska, living with his caregiver. The objective of this case study was to analyze the difficulties experienced by the patient before and after he was diagnosed with nfvPPA, as well as his current progress with treatment. We identified the main challenges they encountered during the diagnostic and therapeutic processes were: a delayed differential diagnosis, inadequate communication from practitioners, inefficient interprofessional communication, and limited treatment/management options. In addition, they had limited access to educational and support group resources, a lack of intervention implementation, failed efforts in the follow-up of treatment by each care provider, and difficult access to health care services. Our findings highlight the necessary changes needed in the management of patients through a collaborative model, to provide sufficient and accessible resources to navigate this diagnosis, and the importance of following up on the therapeutic progress of patients.

This study had three objectives: (a) to verify if Grodzinsky et al.'s (1993) findings of worse comprehension of personal than reflexive pronouns can be replicated in a larger meta-analysis of individual participant data, (b) to examine if the heterogeneity found in the patterns of pronoun comprehension in agrammatism can be attributed to task effects, and (c) to evaluate the risk of bias in the reviewed studies. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic literature search was performed to identify studies examining the personal-reflexive pronoun dissociation in agrammatic comprehension. Seven studies met the search criteria and were included in the meta-analysis. For each participant, individual accuracy scores for the comprehension of personal and reflexive pronouns were extracted in addition to information on the study methods. Individual accuracy data were analyzed using the Fisher's exact test and the binomial test. The risk of bias in the studies was assessed using an adapted version of the Newcastle-Ottawa Quality Assessment Scale. The meta-analysis had three main findings: (a) The majority of the persons with agrammatic aphasia (89%) had no dissociation between the comprehension of personal and reflexive pronouns; (b) 8% revealed a pattern consistent with a neuropsychological dissociation, faring worse on the comprehension of personal than reflexive pronouns; and (c) 2% performed worse on reflexive than personal pronouns. The type of the task used affected pronoun comprehension accuracy and accounted for the heterogeneity in the patterns of pronoun comprehension attested across the different participants. Taken together, the meta-analysis did not support a dissociation between personal and reflexive pronoun comprehension in agrammatic comprehension. When confirmed, the dissociation was driven by task effects. The clinical implications of these findings were discussed together with implications to minimize the risk of bias in future examinations of the topic.

Abstract BackgroundDiscussion surrounding the nomenclature of the “nonfluent/agrammatic” spectrum of progressive speech‐language disorders has largely focused on the clinical‐pathological and neuroimaging correlations, with some attention paid to the prognostication afforded by differentiating clinical phenotypes. Progressive apraxia of speech (AOS), with or without agrammatic aphasia, is generally associated with an underlying tauopathy; however, patients have offered a unique perspective on the importance of distinguishing between difficulties with speech and language that extends beyond pathological specificity. This study aimed to provide insight into the experience of patients with primary progressive AOS (PPAOS), with particular attention to their diagnostic journey.MethodA qualitative research approach was used. Structured interviews were conducted with three prosodic and one phonetic predominant PPAOS patients, judged representative of our research cohort, who were previously received other diagnoses, including primary progressive aphasia (PPA). A current PPAOS diagnosis and willingness to discuss the details of their diagnostic workup and reflect upon their experience were the inclusion criteria. One patient preferred to provide written responses. Each interview was reviewed, and the collective contents were examined using thematic analysis.ResultThe primary themes were identity, community, and planning. Patients expressed: 1) the importance of the alignment of AOS with their difficulties, specifically that they had no difficulty with thinking of words or with comprehension (i.e., no aphasia); 2) not sharing attributes with PPA patients and their observed clinical presentations; and 3) the desire to capitalize upon their retained skills for treatment, for example “I intend to retain my ‘voice’ even as I lose my speaking ability.”ConclusionUnderstanding the experiences of PPAOS patients may inform future iterations of progressive speech‐language spectrum diagnostic criteria and the consistency of their use, along with intervention recommendations. The specificity of a PPAOS diagnosis is meaningful to patients as it relates to their identity, sense of community, and approach to future planning. Further work will evaluate the experience of patients with a broader spectrum of progressive speech‐language disorders along with their care partners. More work is underway to outline the predictive value of an AOS diagnosis, relative to co‐occurring aphasia severity, to inform better prognostication.

Abstract BackgroundComorbid cognitive impairment in amyotrophic lateral sclerosis (i.e., ALS‐FTD), is associated with adverse clinical outcomes and survival. It often exhibits clinical features of behavioral variant frontotemporal dementia (bvFTD) and/or non‐fluent agrammatic primary progressive aphasia (naPPA). Traditional cognitive assessments, such as the Edinburgh Cognitive Assessment Scale (ECAS), require trained personnel for administration. An additional repeatable, objective approach involves automatic analysis of picture descriptions. Prior research identified acoustic and lexical‐semantic impairments in bvFTD, PPAs, and ALS‐FTD (acoustics). This study extends the analysis to the complete speech feature set (n=30) in ALS‐FTD spectrum disorders.MethodANCOVAs (FDR adjusted) compared picture descriptions in n=51 ALS, n=22 ALS‐FTD (n=10 bvFTD‐dominant, n=4 naPPA‐dominant), and n=12 ALS with ECAS‐defined mild cognitive/behavioural impairment (ALS‐MCI). Backward selection identified the best feature subset. Post‐hoc assessments examined associations with ECAS behavioral, language, and executive scores. Longitudinal analysis compared within‐individual change over time in n=11 ALS vs. n=9 ALS+cog (combining ALS‐MCI with ALS‐FTD) with available longitudinal data. All models adjusted for bulbar motor scores.ResultALS‐FTD significantly differed from ALS and ALS‐MCI on twelve features at first visit: slow speaking and articulatory rates, reduced word count, less percent speech time, shorter speech segments, and longer and more frequent pausing. ALS‐FTD also exhibited fewer adjectives and prepositions, more repetitions, lower lexical diversity, and words with a lower mean age of acquisition (AoA). The best model comprising three features (percent speech, prepositions, and lexical diversity) strongly distinguished ALS‐FTD from ALS (AUC=0.90). ALS‐MCI did not differ from ALS on any speech measure. Acoustic measures were all significantly associated with behavioral, language, and executive scores. Fewer prepositions related to worse behavioral and language scores, and more repetitions and lower lexical diversity related to worse language scores. Mean AoA and articulatory rate were not linked to any ECAS sub‐domains. Longitudinally, ALS+cog exhibited increased partial words and reduced word AoA, while ALS showed no significant change.ConclusionAutomated speech analysis strongly distinguishes ALS‐FTD from ALS, declines with cognitive severity, and captures distinctive longitudinal changes in ALS‐FTD. These results highlight the potential of automated speech analysis as an objective tool for assessing cognitive impairment in ALS.

ABSTRACT Background Narrative production has been widely characterized as providing an ecologically valid way to assess language skills in post-stroke aphasia. Although narrative tasks have been instrumental in delineating patterns of lexical and syntactic production in individuals with agrammatic aphasia, our knowledge of how narrative skills are affected in agrammatic aphasia is still limited. Aims The study’s aims were to (a) compare narrative performance between individuals with agrammatic aphasia and a language-unimpaired group, (b) investigate the contribution of lexical and syntactic skills in each group’s narrative organizational skills, and (c) explore the effects of executive functions on each group’s narrative performance. Methods & Procedures The study included 14 individuals with agrammatic aphasia and 14 age- and education-matched language unimpaired individuals as the control group. Both groups told the Cinderella story, and their narrative production was analyzed in terms of microstructure (lexical diversity, syntactic complexity, clause length) and macrostructure (story grammar, story structure complexity). Each group’s executive functions were evaluated through the One-Touch Stockings of Cambridge test that assesses working memory, and the Intra-Extra Dimensional Set Shift test that assesses cognitive flexibility. Outcomes & Results Regarding narrative microstructure, the individuals with agrammatism scored significantly lower than controls in syntactic complexity and clause length, but not in lexical diversity, but they performed lower than controls in both narrative macrostructural measurements. Also, the agrammatic group scored lower than controls in both executive function tasks. A series of linear regression models showed that microstructural skills significantly affected narrative macrostructural abilities in the cohort with agrammatic aphasia, while controls’ macrostructure was affected by both narrative microstructure and executive function skills. Conclusions The individuals with agrammatic aphasia exhibited impairment in both low-level language features of narrative production, such as syntactic complexity and narrative length, and global measures of narrative organization. Their macrostructural performance critically relied on their language resources, while controls’ narrative macrostructure seemed to also draw on domain-general cognitive skills. These findings suggest that both low-level language and high-level discourse organizational skills are vulnerable in narrative production in agrammatic aphasia, and that macrostructural skills are mainly related to the individuals’ microstructural skills.

(1) Background: Frontotemporal lobar degeneration (FTLD) is a generic term which refers to multiple pathologies, including FTLD-tau. The most common FTLD-tau diseases are Pick's disease (PiD), progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). These diseases share four major syndromes: behavioral variant frontotemporal dementia (bvFD), Richardson syndrome (RS), corticobasal syndrome (CBS) and non-fluent agrammatic primary progressive aphasia (nfa-PPA). The primary aim of this meta-analysis was to examine the diagnostic performance of CSF total (t-tau) and phosphorylated (p-tau) protein in bvFTD, RS, CBS, nfa-PPA and pathologically or genetically defined tauopathy. (2) Methods: A systematic review and meta-analysis was performed on all studies with >10 subjects in a bvFTD/RS/CBS/nfa-PPA group and control group and available data on CSF t-tau or p-tau (mean, SD). Cohen's d was used to quantify the effect size of each study (3) Results: The PSP/tauopathy patients exhibited decreased levels of CSF p-tau compared to the control subjects. The CBS/bvFTD/nfa-PPA cohorts exhibited an increase in t-tau compared to the control groups. (4) Conclusions: Tauopathies may exhibit an inherent decrease in CSF p-tau. The admixture of AD patients in FTD cohorts and high heterogeneity among studies on rare diseases are significant confounding factors in FTLD studies.

ABSTRACT Background Agrammatism in agglutinative languages exhibits preservation of verb morphology due to their rich morphological paradigms. Tagalog, an agglutinative language mainly spoken in the Philippines, remains uncharacterized in agrammatism yet holds potential for future research that can challenge existing theories and help advance novel ones. Aims The purpose of this study is to quantify and describe the characteristics of agrammatism in Tagalog in narrative spontaneous speech, to examine whether these patterns resemble those reported in other agglutinative languages, and to compare the results obtained to those emerging in literature for non-agglutinative languages. Methods & Procedures Narrative spontaneous speech was elicited from 10 individuals with non-fluent Broca’s aphasia and 12 matched controls. A series of parameters, both conventional and language-specific measures, were selected for analyses. Outcomes & Results Tagalog-speaking individuals with agrammatism exhibited slow and fragmented speech, with a strong preference for minor and simple constructions resulting to decrease in overall grammaticality and sentence complexity. Verb deficits were also found specifically in verbal predication, lexical diversity, and finiteness. There is a prevalent use of bare verb forms, consequently resulting to the decline of verb finiteness and inflections. Code-mixing is found to be extremely variable and statistically non-prominent between groups but patterns may be attributed to personal and sociolinguistic factors. Conclusion Patterns of agrammatism in Tagalog majorly mirror the trends reported in other agglutinative and non-agglutinative languages. Where Tagalog agrammatism departs from other agglutinative languages is the increased use of bare verbs as opposed to the obligatory inflected forms. Although still many questions are unresolved, Tagalog offers an interesting testing ground for variety of topics and issues in agrammatic aphasia.

This paper presents the results of an elicitation task run with Italian-speaking people with agrammatic aphasia (PWAgr). Linguistic theories of aphasia have analysed the production of PWAgr as stemming either from a deterioration of grammatical knowledge or a limitation of extra-linguistic capacities which affect language. Among the former, the Tree Pruning Hypothesis (Friedmann and Grodzinsky, 1997) relates the height of the projections involved in the production of a structure with the chances of it being produced: the stronger the impairment in the speaker, the less likely they are to produce a structure involving higher nodes. Alternatively, syntactic knowledge may be preserved but its use is compromised by Working Memory (WM) limitations (e.g., Miyake et al., 1994; Jakubowicz, 2005). The two approaches make different predictions with respect to question production in Italian: according to the TPH, the production rates of yes/no-questions and who-questions should be comparable in moderate and mild aphasia. Why-questions involve a higher node and should thus not be available. Under a WM-limitation approach, the production rates of why-questions and yes/no-questions should be comparable and higher than those of who-questions. To determine which, if any, of the two approaches makes the correct predictions, three adult Italian speakers diagnosed with Broca’s aphasia and one with anomia performed an elicitation task targeting these three types of structures. Overall, yes/no-questions were the most frequent structures to be produced. The lack of who-questions, as opposed to the production of yes/no-questions, can be accounted for only if derivational complexity is taken into account, but the scarcity of why-questions suggests that the height of the nodes involved may play a role as well.

To introduce the first case in which primary progressive apraxia of speech (PPAOS) is associated with TAR DNA-binding protein 43 (TDP-43) instead of 4-repeat tau. This patient was identified through a postmortem autopsy. Following an initial diagnostic evaluation, he participated in 3 annual research visits during which speech, language, cognitive, and neurologic assessments were administered. Neuroimaging was also acquired. Apraxia of speech was diagnosed at his initial visit with a comprehensive neurologic examination further revealing subtle motor findings in the right hand. At subsequent visits, agrammatic aphasia and motor symptoms consistent with corticobasal syndrome were evident. Cognition and behavior remained relatively intact until advanced stages. FDG-PET revealed hypometabolism in the right temporoparietal cortex and left premotor and motor cortices. There was also low-level signal in the right temporoparietal cortex on tau-PET. A sequence variation in the progranulin gene was identified (GRN c.1A>C, p.Met1). Pathologic diagnosis was TDP-43 Type A with an atypical distribution of inclusions in premotor and motor cortices. This case report demonstrates that TDP-43 Type A inclusions in an atypical distribution can present clinically as PPAOS. The sequence variation in the progranulin gene and asymmetric temporoparietal cortex involvement were the strongest indications of the unusual neuropathophysiology prior to autopsy.

ABSTRACT Background Agrammatic aphasia poses challenges in assessing grammatical abilities due to language comprehension difficulties. The suitability of sMMN as an indicator of syntactic processing abilities in these individuals remains uncertain. Aims Two ERP experiments were conducted to investigate whether early syntactic mismatch negativity (sMMN) could assess the syntactic processing ability of Chinese-speaking individuals with agrammatic aphasia. Methods & Procedures Prior to the ERP experiments, the Western Aphasia Battery (WAB) and the Northwestern Assessment of Verbs and Sentences-Chinese (NAVS-C) were used to screen people with agrammatism. ERP data were collected for both the agrammatic group (AG) (n = 12) and the control group (CG) (n = 12). The first experiment (Experiment 1) involved a passive tone oddball task to control for the influence of primary sound perception. The second experiment (Experiment 2: experiment 2a and experiment 2b) investigated syntactic processing through a passive speech oddball task. Experiment 2a examined the processing of correct sentences and syntactic violation sentences in context. In contrast, Experiment 2b assessed well-formed sequences and ill-formed sequences out of context. Outcomes & Results The results revealed that frontocentral distributed acoustic MMNs were recorded for the CG between 176 - 196ms in Experiment 1, but not for the AG. In Experiment 2, during the 143 - 173ms window, the left anterior sMMN was exclusively observed for the CG, while the left posterior sMMN was specific to the AG. Furthermore, the amplitudes of the left posterior sMMN (143-173ms) were found to have a negative correlation with scores on sentence comprehension tests: the more negative the sMMN, the lower the scores of people with agrammatic aphasia. Notably, this left posterior MMN was absent in Experiment 1. Conclusions The early posterior sMMN, discovered for the first time in our study, appears to be more sensitive in detecting syntactic processing impairments in agrammatics compared to the early anterior sMMN. This finding has the potential to enhance the precision of aphasia assessment.

Production of verb morphology, especially tense inflection, is usually impaired in individuals with agrammatism. There have been relatively few studies on treatment of verb tense inflection in agrammatic aphasia. In this study we adapted ACTION (a linguistically motivated treatment) to Persian language, to treat the production of regular and irregular verbs separately in sentence context. A single-subject multiple-baseline across behaviors design was used to establish the treatment effect. Using a non-probable convenience sampling, four Persian agrammatic patients with Broca’s aphasia resulting from cerebrovascular accident (CVA) were recruited for this study. Two participants received treatment first for regular verbs (Phase 1, 4 weeks), and then for irregular verbs (Phase 2, 4 weeks). The other two participants received treatment in reverse order. In the final phase of treatment (Phase 3, 4 weeks), all 4 participants underwent a sentence construction treatment. All participants showed improvement in the production of trained tenses. Treatment also generalized to production of untrained regular verbs while generalization to irregular verbs was modest. Furthermore, improvement was found on narrative scores (e.g. MLU) after treatment. These findings suggest that Persian individuals with agrammatism could be trained to correctly apply temporal information to verb inflection in elicited speech.