Fluency Deficits Research Articles

Executive Functioning in Different Types of Reading Disabilities.

Students with reading disabilities form a heterogeneous group: some struggle with accurate and fast reading (dysfluent readers), others with comprehension (poor comprehenders), and some face challenges in both areas (poor readers). Research has indicated a link between executive functioning skills and reading performance; yet, further studies are necessary to fully understand the executive profiles in various types of reading disabilities. The goal of this study was to examine differences in executive functioning among three types of reading disabilities, comparing their performance with that of children without difficulties in either skill (typical readers). Ninety-one students from schools in Portugal participated in the study. The results reveal specific deficits in naming speed and cognitive flexibility in poor readers and dysfluent readers compared to the other groups. Additionally, poor readers exhibited significantly slower processing speed and lower working memory. However, no significant differences were observed in planning. Discriminant function analysis results indicated that the examined executive functions are better at discriminating groups with fluency deficits than those with comprehension difficulties. In conclusion, these results suggest distinct deficit patterns in executive functioning skills across different types of reading disabilities. Taking into account these findings is crucial for effective assessment and intervention with these children.

The Big Five Personality Traits in Dyslexic Adults: An Exploratory Study.

Dyslexia is a neurodevelopmental disorder that causes a pattern of learning difficulties that can be characterized by deficits in word reading accuracy, speed or fluency, and reading comprehension. Due to all this damage, emotional difficulties have been described in the literature mainly for childhood and adolescence. Within this emotional component, personality can be included. In Brazil, at the time of carrying out this research, no research had been found that investigated the personality of dyslexic adults. Thus, the present study aimed to investigate the personality of Brazilian adults with dyslexia. A semi-structured interview was administered and the Factorial Personality Battery, based on the Big Five personality traits. The sample was composed of two groups: one with dyslexia and another control. The first was formed by nine participants, aged between 18 and 47 (M = 31.7; standard deviation (SD) = 11.8), six of whom were women. The control group was formed by 60 participants, aged between 18 and 45 years (M = 26.4; SD = 8.8), 38 of whom were women. The data did not show significant differences between the groups in most of the analyzed factors and subfactors. Increased rates of "passivity/lack of energy" and lowered rates of "openness to new ideas" were identified in the group with dyslexia. These results could be useful for describing personality profiles in dyslexic adults, with these descriptions possibly providing clinical support for diagnoses and intervention procedures.

Profiling people with Parkinson's disease at risk of cognitive decline: Insights from PPMI and ICICLE-PD data.

A subset of people with Parkinson's disease (PD) develop dementia faster than others. We aimed to profile PD cognitive subtypes at risk of dementia based on their rate of cognitive decline. Latent class mixed models stratified subtypes in Parkinson's Progression Markers Initiative (PPMI) (N=770) and ICICLE-PD (N=212) datasets based on their decline in the Montreal Cognitive Assessment over at least 4 years. Baseline demographic and cognitive data at diagnosis were compared between subtypes to determine their clinical profile. Four subtypes were identified: two with stable cognition, one with steady decline, and one with rapid decline. Performance on Judgement of Line Orientation, but not category fluency, was associated with a steady decline in the PPMI dataset, and deficits in category fluency, but not visuospatial function, were associated with a steady decline in the ICICLE-PD dataset. People with PD susceptible to cognitive decline demonstrate unique clinical profiles at diagnosis, although this differed between cohorts. Four cognitive subtypes were revealed in two Parkinson's disease samples.Unique profiles of cognitive impairment were related to cognitive decline.Judgement of Line Orientation/category fluency predictive of steady decline.Global deficits related to rapid cognitive decline and increased dementia risk.

Speech, voice, and language outcomes following deep brain stimulation: A systematic review.

Deep brain stimulation (DBS) reliably ameliorates cardinal motor symptoms in Parkinson's disease (PD) and essential tremor (ET). However, the effects of DBS on speech, voice and language have been inconsistent and have not been examined comprehensively in a single study. We conducted a systematic analysis of literature by reviewing studies that examined the effects of DBS on speech, voice and language in PD and ET. A total of 675 publications were retrieved from PubMed, Embase, CINHAL, Web of Science, Cochrane Library and Scopus databases. Based on our selection criteria, 90 papers were included in our analysis. The selected publications were categorized into four subcategories: Fluency, Word production, Articulation and phonology and Voice quality. The results suggested a long-term decline in verbal fluency, with more studies reporting deficits in phonemic fluency than semantic fluency following DBS. Additionally, high frequency stimulation, left-sided and bilateral DBS were associated with worse verbal fluency outcomes. Naming improved in the short-term following DBS-ON compared to DBS-OFF, with no long-term differences between the two conditions. Bilateral and low-frequency DBS demonstrated a relative improvement for phonation and articulation. Nonetheless, long-term DBS exacerbated phonation and articulation deficits. The effect of DBS on voice was highly variable, with both improvements and deterioration in different measures of voice. This was the first study that aimed to combine the outcome of speech, voice, and language following DBS in a single systematic review. The findings revealed a heterogeneous pattern of results for speech, voice, and language across DBS studies, and provided directions for future studies.

Case-study: Patient with acquired epileptic aphasia in childhood

IntroductionAcquired epileptic aphasia or Landau-Kleffner syndrome (LKS) is a disorder with onset in the childhood between the ages of 2 and 8 years. The main defining psychopathological symptom of Landau-Kleffner syndrome is the acquired aphasia with epileptiform electroencephalographic abnormalities. The aphasia has both receptive and expressive features. The onset is usually subacute and the course is usually progressive with spontaneous improvements and exacerbations. The electroencephalographic abnormalities include pathological findings in the temporal and parieto-occipital brain regions.ObjectivesAn 11 year old girl with generalized tonic-clonic and partial seizures is referred to our child and adolescence outpatient service due to language impairment. Her first generalized seizure has been at the age of 11 months old, caused by high temperature. The presence of articulation difficulties has raised suspicion for intellectual disabilities. She has been diagnosed with Epilepsy, grand mal seizures and has had continuous treatment with sodium valproate since the age of 3 years.MethodsWe used medical history, EEG-recordings, clinical observation and psychological assessment.ResultsPatient`s language development has been normal till the age of 3 years old. She has started using single words properly at the age of 1 year and 6 months old. Her first simple sentences have appeared at the age of 2 years old. At the age of 3 years old after severe generalized tonic-clonic seizures she has stopped talking for a month. After this month she had started vocalizing and using simple words, but she had lost her ability to form sentences. She has had some mild difficulties in understanding verbal information and following instructions. Her speech has had bad articulation and deficits in the verbal fluency. Her gross and fine motor development, her social skills and problem-solving abilities have all been intact and age-appropriate. She has worked with speech therapist for 5 years and achieved partial recovery from the acquired aphasia. She continues to have problems with the articulation – the speech is still with mild dysarthria. We used WISC-IV to assess her IQ (IQ=108).ConclusionsThe patient has already developed age-appropriate speech prior to the onset of the language impairment. Considered as secondary or acquired, the observed aphasia together with the medical data for her epileptic seizures allows us to diagnose the patient with Acquired epileptic aphasia or Landau-Kleffner syndrome. Later development will be presented and discussed.Disclosure of InterestNone Declared

Lower-level oculomotor deficits in schizophrenia during multi-line reading: Evidence from return-sweeps.

Reading fluency deficits in schizophrenia (Sz) have been attributed to dysfunction in both lower-level, oculomotor processing and higher-level, lexical processing, according to the two-hit deficit model. Given that prior work examining reading deficits in individuals with Sz has primarily focused on single-line and single-word reading tasks, eye movements that are unique to passage reading, such as return-sweep saccades, have not yet been examined in Sz. Return-sweep saccades are large eye movements that are made when readers move from the end of one line to the beginning of the next line during natural passage reading. Examining return-sweeps provides an opportunity to examine lower-level, oculomotor deficits during reading under circumstances when upcoming higher-level, lexical information is not available for visual processing because visual acuity constraints do not permit detailed lexical processing of line-initial words when return-sweeps are programmed. To examine the source of reading deficits in Sz, we analysed an existing data set in which participants read multi-line passages with manipulations to line spacing. Readers with Sz made significantly more return-sweep targeting errors followed by corrective saccades compared with healthy controls. Both groups showed similar effects of line spacing on return-sweep targeting accuracy, suggesting similar sensitivities to visual crowding during reading. Furthermore, the patterns of fixation durations in readers with Sz corroborate prior work indicating reduced parafoveal processing of upcoming words. Together, these findings suggest that lower-level visual and oculomotor dysfunction contribute to reading deficits in Sz, providing support for the two-hit deficit model.

Diagnostic Challenges in Progressive Supranuclear Palsy: Early Identification and Mimics

AbstractBackgroundProgressive supranuclear palsy (PSP) is an often‐undiagnosed neurodegenerative disorder. There are often delays in diagnosing PSP.MethodRetrospective chart review of all newly diagnosed PSP patients referred to an outpatient clinic. We conducted a review of all initial/new PSP cases in our geriatric clinic. The most common preliminary diagnosis the patients had been given included was idiopathic Parkinson’s disease. Other common diagnoses were vascular Parkinson’s, frontal lobe dementia, psychotic depression and late life psychosis.Clinical records with the subjective accounts, cognitive assessments and brain imaging reports of 23 PSP patients were reviewed.ResultsThe most common cognitive deficits were visuospatial changes (100%), semantic fluency deficits (80.4%), dysexecutive function. Sleep disruption with insomnia with intermittent awakening was also commonly reported.A propensity for falls and multiple falls were also reported. The interval from the onset of symptoms and initial presentation to a clinical provider to diagnosis ranged from 1 ‐ 7 years.ConclusionA high index of suspicion and recognition that PSP might not be as uncommon as previously thought is needed. A timely diagnosis and recognition of the various cognitive and behavioral changes is important.

Verbal and nonverbal fluency in amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis (ALS) is a multi-system disorder that commonly affects cognition and behaviour. Verbal fluency impairments are consistently reported in ALS patients, and we aimed to investigate whether this deficit extends beyond the verbal domain. We further aimed to determine whether deficits are underpinned by a primary intrinsic response generation impairment (i.e., a global reduction across tasks), potentially related to apathy, or an inability to maintain responding over time (i.e., a 'drop off' pattern). Twenty-two ALS patients and 21 demographically-matched controls completed verbal and nonverbal fluency tasks (phonemic/semantic word fluency, design fluency, gesture fluency and ideational fluency), requiring the generation of responses over a specified time period. Fluency performance was analysed in terms of the overall number of novel items produced, as well as the number of items produced in the first 'initiation' and the remaining 'maintenance' time periods. ALS patients' overall performance was not globally reduced across tasks. Patients were impaired only on meaningful gesture fluency, which requires the generation of gestures that communicate meaning (e.g., waving). On phonemic fluency, ALS patients showed a 'drop off' pattern of performance, where they had difficulty maintaining responding over time, but this pattern was not evident on the other fluency tasks. Apathy did not appear to be related to fluency performance. The selective meaningful gesture fluency deficit, in the context of preserved meaningless gesture fluency, highlights that the retrieval of action knowledge may be weakened in early ALS.

Functional and structural connectivity correlates of semantic verbal fluency deficits in first-episode psychosis

IntroductionSemantic verbal fluency (SVF) impairments are debilitating and present early in the course of psychotic illness. Deficits within frontal, parietal, and temporal brain regions contribute to this deficit, as long-range communication across this functionally integrated network is critical to SVF. This study sought to isolate disruptions in functional and structural connectivity contributing to SVF deficits during first-episode psychosis in the schizophrenia spectrum (FESz). MethodsThirty-three FESz and 34 matched healthy controls (HC) completed the Animal Naming Task to assess SVF. Magnetoencephalography was recorded during an analogous covert SVF task, and phase-locking value (PLV) used to measure functional connectivity between inferior frontal and temporoparietal structures bilaterally. Diffusion imaging was collected to measure fractional anisotropy (FA) of the arcuate fasciculus, the major tract connecting frontal and temporoparietal language areas. ResultsSVF scores were lower among FESz compared to HC. While PLV and FA did not differ between groups overall, FESz exhibited an absence of the left-lateralized nature of both measures observed in HC. Among FESz, larger right-hemisphere PLV was associated with worse SVF performance (ρ = −0.51) and longer DUP (ρ = −0.50). DiscussionIn addition to worse SVF, FESz exhibited diminished leftward asymmetry of structural and functional connectivity in fronto-temporoparietal SVF network. The relationship between theta-band hyperconnectivity and poorer performance suggests a disorganized executive network and may reflect dysfunction of frontal cognitive control centers. These findings illustrate an aberrant pattern across the distributed SVF network at disease onset and merit further investigation into development of asymmetrical hemispheric connectivity and its failure among high-risk populations.

6 Semantic and Phonemic Fluency in Alcohol Dependent Individuals

Objective:Verbal fluency consists of semantic and phonemic fluency and is often used to detect verbal ability and executive control (Shao et al., 2014). While research has found general verbal fluency impairments in chronic alcohol use, few studies have examined semantic and phonemic fluency separately (Stavro et al., 2012; Stephan et al., 2017). This meta-analytical study examines the performance of abstinent alcohol-dependent individuals on semantic fluency (categories) and phonemic fluency (letters).Participants and Methods:As part of a larger study, two researchers independently searched eight databases, extracted required data, and calculated effect sizes on neuropsychological data in alcohol dependent (AD) individuals. Inclusion criteria for articles were: (a) comparison of abstinent alcohol-dependent patients to healthy controls, (b) matched control group on age, education, or IQ, and (c) standardized neuropsychological testing. Exclusion criteria included: (a) diagnosis of Axis I disorders (other than alcohol dependence), (b) comorbidity with other disorders that impact neuropsychological functioning, or (c) not published or translated into English. A total of 31 articles (AD n=1,080 and HC n=1,090) was analyzed in this study.Results:Semantic fluency evidenced a statistically significant and medium effect size estimate (g = 0.632, p < 0.001). The heterogeneity for semantic fluency was statistically significant (Q=152.468, df=20, p=0.000). Phonemic fluency evidenced a statistically significant and medium effect size estimate (g = 0.572, p < 0.001). The heterogeneity for phonemic fluency was also statistically significant (Q=236.697, df=24, p=0.000).Conclusions:Deficits in semantic and phonemic fluency are both associated with alcohol dependence. Although some previous research has reported more frontal lobe impact of alcohol, which would be expected to impact phonemic more readily than semantic fluency, this is not evident in the current data. There are many possible reasons for this failure to observe this dissociation meta-analytically. Some potential reasons include the possibility that alcohol affects multiple regions of the brain, that both these measures are affected by alcohol but miss the subtlety associated with frontal damage, or the likelihood that when studies are aggregated in meta-analysis the heterogeneity results in a regression to the mean effect size. These and other reasons are not mutually exclusive and future research should attempt to examine these and other hypotheses.

13 Reduced Left Orbitofrontal Volume Correlates with Semantic Verbal Fluency Performance Among Veterans with TBI

Objective:Semantic verbal fluency (SVF) has traditionally been correlated with activity in the left anterior temporal lobe. Damage to the anterior temporal lobe, such as from a traumatic brain injury (TBI) or neurodegenerative disease, can result in impairments in semantic fluency and language expression. Although the orbitofrontal cortex (OFC) is not well studied as being correlated to this process, its functional connectivity to language-related brain regions, such as the inferior frontal gyrus (Broca’s area), suggests it may also play a role in SVF. In fact, preliminary research has shown that lesions in the OFC are associated with semantic fluency deficits (Almairac et al. 2015). As such, the goal of this study was to investigate whether OFC volume correlates with SVF in a population of Veterans with a prior TBI.Participants and Methods:Thirty-five Veterans who sustained TBIs were included in this study (11% female, age M = 41.77, SD = 11.27; years of education M =14.94, SD = 1.62). All participants underwent a magnetic resonance imaging (MRI) and regional normative volumes were standardized to account for differences in brain size (volume of brain area/total brain volume). Participants were given the Delis Kaplan Executive Function System (D-KEFS) verbal fluency subtest to measure verbal generativity. A Pearson correlation was conducted to investigate the relationship between OFC volume and SVF performance. Post hoc analysis was conducted with Veterans who met the criteria for a TBI sustained by a blast to the head (n = 25).Results:A significant positive correlation emerged between left OFC volume and semantic fluency (category subtest; p = .03, r = .35). Additional analyses with Veterans with blast-related TBIs indicated a significant correlation between the volume of the OFC and performance on the category (p = .02, r = .45), and switching (p = .02, r = .43) subtests of the D-KEFS verbal fluency test.Conclusions:These findings demonstrate a correlation between the volume of the left OFC and SVF performance. Specifically, Veterans with TBIs had decreased volume of the OFC which correlated with deficits on a SVF task. Among Veterans with blast-related TBIs, both category and category switching subtests correlated with OFC volume. Given the functional connectivity between the OFC and language areas of the brain, this study highlights the importance of analyzing associated cortical regions beyond the anterior temporal lobe when studying SVF performance.

Serotonin Degeneration and Amyloid-β Deposition in Mild Cognitive Impairment: Relationship to Cognitive Deficits.

Neuropathological and neuroimaging studies have demonstrated degeneration of the serotonin system in Alzheimer's disease (AD). Neuroimaging studies have extended these observations to the preclinical stages of AD, mild cognitive impairment (MCI). Serotonin degeneration has been observed also in transgenic amyloid mouse models, prior to widespread cortical distribution of amyloid-β (Aβ). The present study evaluated the regional distribution of the serotonin transporter (5-HTT) and of Aβ in individuals with MCI and healthy older controls, as well as the contribution of 5-HTT and Aβ to cognitive deficits. Forty-nine MCI participants and 45 healthy older controls underwent positron emission tomography (PET) imaging of 5-HTT and Aβ, structural magnetic resonance imaging and neuropsychological assessments. Lower cortical, striatal, and limbic 5-HTT and higher cortical Aβ was observed in MCIs relative to healthy controls. Lower 5-HTT, mainly in limbic regions, was correlated with greater deficits in auditory-verbal and visual-spatial memory and semantic, not phonemic fluency. Higher cortical A β was associated with greater deficits in auditory-verbal and visual-spatial memory and in semantic, not phonemic fluency. When modeling the association between cognition, gray matter volumes and Aβ, inclusion of 5-HTT in limbic and in select cortical regions significantly improved model fit for auditory-verbal and visual-spatial memory and semantic, but not phonemic fluency. These results support the role of serotonin degeneration in the memory and semantic fluency deficits observed in MCI.

Neuropsychological impairment in amyotrophic lateral sclerosis-frontotemporal spectrum disorder.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease with a rapid course, characterized by motor neuron dysfunction, leading to progressive disability and death. This Review, which is aimed at neurologists, psychologists and other health professionals who follow evidence-based practice relating to ALS and frontotemporal dementia (FTD), examines the neuropsychological evidence that has driven the reconceptualization of ALS as a spectrum disorder ranging from a pure motor phenotype to ALS-FTD. It focuses on changes in cognition and behaviour, which vary in severity across the spectrum: around 50% individuals with ALS are within the normal range, 15% meet the criteria for ALS-FTD, and the remaining 35% are in the mid-spectrum range with milder and more focal impairments. The cognitive impairments include deficits in verbal fluency, executive functions, social cognition and language, and apathy is the most prevalent behavioural change. The pattern and severity of cognitive and behavioural change predicts underlying regional cerebral dysfunction from brain imaging and post-mortem pathology. Our increased recognition of cognition and behaviour as part of the ALS phenotype has led to the development and standardization of assessment tools, which have been incorporated into research and clinical care. Measuring change over the course of the disease is vital for clinical trials, and neuropsychology is proving to be a biomarker for the earliest preclinical changes.

A - 34 A Suspected Case of Early-Onset Frontal Variant of Alzheimer's Disease in a 64-Year-Old Male.

Early-onset frontal variant of Alzheimer's disease (fvAD) is characterized by apathy, disinhibition, and executive dysfunction. As such, fvAD is often difficult to clinically distinguish from behavioral variant frontotemporal dementia (bvFTD). However, research suggests that a differentiating feature among the two conditions is that fvAD typically presents with more pronounced memory impairment. Therefore, neuropsychological testing in the context of a comprehensive multidisciplinary assessment can be a valuable tool to aid with differential diagnosis. A 64-year-old male with gradually progressive difficulties in cognition and behavioral-emotional functioning over the past 8-9years presented to a multidisciplinary neurology clinic. MRI showed mild atrophy in the frontal, temporal, and parietal lobe regions. Concerns were raised by his neurologist for early-onset ad versus bvFTD so the patient was referred for neuropsychological evaluation. Neuropsychological testing showed a largely amnestic memory profile along with deficits in executive functioning and semantic fluency. His spouse endorsed concerns for apathy and executive dysfunction on a frontal system rating questionnaire in addition to concerns for disinhibition during the clinical interview. Taken together, the patient's profile appeared to be consistent with early-onset fvAD. Follow-up FDG-PET scan showed decreased uptake in the anteromesial temporal lobes, posterior cingulate cortices, and posterior temporoparietal regions which was consistent with an ad profile. Early-onset fvAD and bvFTD are often difficult to clinically distinguish from each other. However, neuropsychological testing in conjunction with comprehensive multidisciplinary assessment can serve an important role in helping to facilitate differential diagnosis for these two neurodegenerative disorders with overlapping features.

B - 05 Intervention Resistant Dyslexia: a Neuropsychological Profile.

Dyslexia is a brain based neurodevelopmental disorder marked by deficits in phonemic awareness and fluency. Brain structures implicated include the left superior temporal gyrus, planum temporal, and frontal regions. Convergent research supports the efficacy of multisensory, systematic, hierarchically organized, phonics-based instruction This study examines a bright, severely dyslexic youngster who, despite seven years of intensive intervention, has made little appreciable progress. Co-morbid neuropsychological weaknesses are implicated in his failure to respond to intervention. The subject is a 13-year-old, 8th grade boy who presented for neuropsychological evaluation subsequent to a history of dyslexia. He attends a specialized school employing evidence-based reading interventions in a small classroom. Despite intellectual functions in the high average range and seven years of consistent intervention, he continues to read at a first to second grade level. Findings from a comprehensive neuropsychological assessment revealed a complex profile characteristic of dyslexia with multiple unexpected deficits in several neurocognitive processes. Data revealed weaknesses in processing speed, verbal working memory, retention, and executive functions. There is little empirical research examining response to intervention in severely dyslexic children. In this case study, the cumulative impact of underlying cognitive weaknesses in speed, working memory, verbal retention, and executive functions are thought to have negatively impacted progress. This youngster is among a small population of individuals with severe dyslexia who do not respond well to intervention. There is a need for awareness of such youngsters and both neuropsychological assessment and research to determine the impact of co-occurring neurocognitive deficits contributing to poor progress.

Low cognitive functioning and depressive symptoms in patients with rheumatoid arthritis and systemic sclerosis: a clinical study

BackgroundRecently, cognitive deficits occurring in rheumatic diseases have attracted scientific attention. Cognitive symptoms in patients with Rheumatoid Arthritis (RA) and Systemic Sclerosis (SSc) have not been thoroughly studied. This study aimed to assess cognitive function and its relationship with depressive symptoms in RA and SSc and compare it to mild neurocognitive disorder due to Alzheimer’s disease (MiND) and to individuals without cognitive impairment.MethodsCognitive function and depressive symptoms were tapped with the Cognitive Telephone Screening Instrument plus (COGTEL+), the Serial Seven Test (SST), the Mini-Mental State Examination (MMSE) and the Geriatric Depression scale-15 (GDS), respectively. Statistical analyses included between groups-, correlation- and regression analyses. Demographic characteristics were considered in the regression models.ResultsThe study included 30 individuals with RA, 24 with SSc, 26 adults without cognitive impairment and 33 individuals with MiND. Lower performance in verbal short-term memory, concentration/attention, verbal fluency and MMSE in patients with RA compared to individuals without cognitive impairment was detected. Of note, performance on verbal fluency, concentration/attention, inductive reasoning and MMSE was lower in RA compared to MiND. Individuals with SSc performed worse in verbal fluency and in MMSE in comparison to adults without cognitive deficits. Verbal fluency deficits in SSc exceeded that in MiND. Performance on MMSE, COGTEL+, prospective memory, working memory, verbal fluency and concentration/attention was related to GDS scores, which did not vary across the groups.ConclusionsPatients with RA and SSc encountered cognitive dysfunction, which partially pertains to depressive symptoms. Of note, the severity of cognitive dysfunction in many cases exceeded that of MiND.

Neuropsychological Function in Traumatic Brain Injury and the Influence of Chronic Pain.

Cognitive dysfunction, pain, and psychological morbidity all present unique challenges to those living with traumatic brain injury (TBI). In this study we examined (a) the impact of pain across domains of attention, memory, and executive function, and (b) the relationships between pain and depression, anxiety, and post-traumatic stress disorder (PTSD) in persons with chronic TBI. Our sample included 86 participants with a TBI and chronic pain (n = 26), patients with TBI and no chronic pain (n = 23), and a pain-free control group without TBI (n = 37). Participants visited the laboratory and completed a comprehensive battery of neuropsychological tests as part of a structured interview. Multivariate analysis of covariance using education as a covariate, failed to detect a significant group difference for neuropsychological composite scores of attention, memory, and executive function (p = .165). A follow-up analysis using multiple one-way analysis of variance (ANOVA) was conducted for individual measures of executive function. Post-hoc testing indicated that those in both TBI groups preformed significantly worse on measures of semantic fluency when compared to controls (p < 0.001, ηρ2 = .16). Additionally, multiple ANOVAs indicated that those with TBI and pain scored significantly worse across all psychological assessments (p < .001). We also found significant associations between measures of pain and most psychological symptoms. A follow-up stepwise linear regression among those in the TBI pain group indicated that post concussive complaints, pain severity, and neuropathic pain symptoms differentially contributed to symptoms of depression, anxiety, and PTSD. These findings suggest deficits in verbal fluency among those living with chronic TBI, with results also reinforcing the multidimensional nature of pain and its psychological significance in this population.

160 The Neurosurgical Anatomy of Deficits in Speech Production

INTRODUCTION: Why do similar neurosurgical lesions cause a range of deficits in speech production? We investigated Broca’s aphasia as a disorder of fluency and apraxia of speech (AOS) as a disorder of articulatory coordination to dissociate the anatomy and lesional etiology of these syndromes. METHODS: Patients were prospectively tested with a standardized speech paradigm. Resections were outlined into 3D regions of interest and transformed into a common brainspace (MNI brain). Recordings of speech were retrospectively review by speech language experts to assess apraxia of speech. A voxel-based lesion-mapping (VLSM) algorithm was used to associate resection areas with acute postoperative aphasia or apraxia of speech. Averages of white-matter tracts were overlaid onto MNI reconstructions for analyses of white-matter tract involvement. Pre-operative diffusion tensor imaging reconstructions were created using peri-lesional regions of interest for seeds to investigate perilesional white matter tracts in these cohorts. RESULTS: Of 289 patients with left sided craniotomies and prospective language evaluation, 19 had Broca’s aphasia. 255 of these patients had recordings available for expert review, of whom 28 had apraxia of speech. VLSM analysis found Broca’s aphasia and fluency deficits were not associated with classic anatomic Broca’s area (pars opercularis and triangularis). Rather, they were associated with ventral sensorimotor cortex (SMC) and supramarginal gyrus (P &lt; 0.001). Apraxia of speech was associated the most ventral aspects of SMC (P &lt; 0.001). SLF III reconstructions terminated in the areas associated with Broca’s aphasia and fluency deficits, but had more limited overlap with the VLSM regions associated with apraxia of speech. CONCLUSIONS: Lesions leading to AOS and Broca’s aphasia after neurosurgical resection do not correlate with Broca's area. Rather, they cluster in ventral sensorimotor cortex. Subcortical white-matter tract injury may explain disparate non-fluent aphasia subtypes in patients with anatomically similar lesions.

Phonological Verbal Fluency Test for Russian-Speaking Children

Introduction: Verbal fluency tasks are mainly used for assessment of verbal fluency and have proven useful for differential diagnosis. The first objective of the study was to provide normative data on phonemic verbal fluency (for letters “Π” [p], “O” [o], “C” [s]) in children population. The second objective of the study was to establish diagnostic validity of the present task and to collect normative data on participants who survived posterior fossa tumor (PFT) and participants with treated hemoblastosis. Method: For diagnostics, we used verbal fluency test. The normative sample consisted of 746 participants aged 7–16 years. A linear multiple regression analysis was implemented for each dependent variable with age, gender, disease for all participants and academic achievement as predictors in normative sample. The performance of 746 healthy participants was compared to the performance of 118 participants who survived PFT and 492 participants who survived hemoblastosis using one-way ANOVA analysis. Results: Healthy children have better verbal fluency than their peers who survived cancer. In the group of healthy children, we assessed the relationship between verbal fluency and school performance. A significant correlation with the “Russian language” subject (r = 0.127; p < 0.001) emerged. In all three groups of children, age and gender turned out to be significant factors that affected the characteristics of verbal fluency. Conclusion: Our data will contribute to increasing the accuracy of verbal fluency deficit detection in Russian speakers and will be useful for differential diagnosis of cognitive impairment for children who have survived oncological diseases of various geneses.

Impact of Cognitive Disturbances and Clinical Symptoms on Disability in Patients with Paranoid Schizophrenia: A Study of a Bulgarian Clinical Sample.

108 patients with schizophrenia were included (66 male and 42 female). Their average age was 38.86 ± 10.02 years and the disease duration was 12.80 ± 8.20 years, with mean disease onset of 24 years. Clinical symptoms were assessed with the PANSS, and cognitive performance was measured using a seven-item neurocognitive battery. The disability level of the subjects was assessed using the World Health Organization-Disability Assessment Schedule 2.0 (WHO-DAS 2.0). The relation between the variables studied was assessed using Spearman's rank correlation coefficient (rs) at a probability level of p < 0.05. An increase in symptom severity resulted in worsening of the "participation in society" (r = 0.56, p < 0.01), "life activities-household" (r = 0.55, p < 0.01), and "getting along with people" (r = 0.59, p < 0.01) WHO-DAS 2.0 domains. Positive symptoms (13.89 ± 3.48) correlated strongly with "getting along with people" (r = 0.55, p < 0.01), "life activities-household" (r = 0.58, p < 0.01), and "participation in society" (r = 0.62, p < 0.01), and negative symptoms (14.25 ± 4.16) with "participation in society" (r = 0.53, p < 0.01) and "life activities-household" (r = 0.48, p < 0.01). Symptoms of disorganization (15.67 ± 4.16) had the highest impact on "life activities-household" (r = 0.81, p < 0.01), "getting along with people" (r = 0.56, p < 0.05), and "participation in society" (r = 0.65, p < 0.01). Episodic memory (r = -0.28, p < 0.01) was remotely related to comprehension and communication. The information processing speed (rs = 0.38, p < 0.01), visual memory (rs = -0.30, p < 0.01), and focused executive functions showed moderate correlations with all domains on the WHO-DAS 2.0 scale (rs = 0.38, p < 0.01). Attention (rs = -0.33, p < 0.01) was moderately related to community activities. Semantic (rs = -0.29, p < 0.01) and literal (rs = -0.27, p < 0.01) verbal fluency demonstrated weak correlations with "cognition-understanding", "getting along with people", and "participation in society". Symptoms of disorganization and disturbed executive functions contribute most to disability in patients with schizophrenia through impairment of real-world functioning, especially in social interactions and communication. Severe clinical symptoms (negative and disorganization-related ones) as well as deficits in executive function, verbal memory, and verbal fluency cause the biggest problems in the functional domains of interaction with other people and participation in society.