Nonfluent Aphasia Research Articles

Pembrolizumab-Induced Secondary Hypocorticism Manifesting as a Transitory Ischemic Attack.

Pembrolizumab is a monoclonal antibody directed against the programmed cell death-1 (PD1) receptor, which binds to PD1 receptors on T lymphocytes and blocks their inactivation by tumor cells. Pembrolizumab is not free from side effects, a rare one of which is hypocorticism. Here we present a patient with pembrolizumab-induced hypocorticism manifested by a cerebrovascular event. The patient is a 67-year-old male with a history of urothelial carcinoma of the left kidney and urothelial carcinoma of the urinary bladder. These malignancies were treated with resection and adjuvant chemotherapy. Pembrolizumab was added 6 months before admission. After the fifth cycle, he suffered loss of appetite, persistent nausea and recurrent vomiting, an itchy rash, expressive aphasia for a few seconds during which he was suddenly unable to pronounce words and sentences, and massive positional vertigo due to arterial hypotension. His serum cortisol level was significantly low. Hypocorticism was successfully treated with hydrocortisone. This case demonstrates that pembrolizumab can be complicated by hypocorticism even after uneventful previous administration and that hypocorticism can manifest with symptomatic arterial hypotension, cerebral hypoperfusion, and positional vertigo. Treating physicians should be aware that secondary hypocorticism is a potentially serious adverse reaction due to the cumulative toxicity of pembrolizumab.

Abstract 26: First-in-human Phase 1/2a Study of Intracerebral Transplantation using Embryonic-derived Neural Stem Cells (NR1) for Chronic Ischemic Stroke (NCT04631406): 12 Months Outcomes

Introduction: Except for vagal nerve stimulation, no treatment exists to restore function in chronic stroke patients. Several prior intracerebral stem cell trials were promising, but are not being further developed. Objective: NR1 is a human embryonic derived neural stem cell that improved motor-sensory function in rodent stroke models, and was expanded to produce GMP cryopreserved cell lots. The safety&efficacy of NR1 intracerebral transplantation in chronic stroke patients was assessed over 12 months. Methods: Inclusion Criteria: 18-75 yo; 6-60 mos post-ischemic subcortical MCA stroke; mRS 3-4. Subjects were transplanted with 2.5M, 5M, 10M or 20M. Primary Outcomes: Adverse events 0-12 mos; Change in total Fugl-Meyer motor score (FMMS, max 100) compared to baseline at 12 months (≥10 points improvement considered “clinically meaningful”). Other outcomes: UE FMMS, LE FMMS, Gait Speed test, Barthel Index (BI), NIHSS, MR FLAIR, Resting State fMRI and [18F]FDG PET. Results: 18 patients were transplanted. Adverse events included headache, worsened baseline expressive aphasia and asymptomatic chronic subdural hygroma, all resolving spontaneously. All 17 pts with f/u ≥3 mos demonstrated improved total FMMS and 11 of these 17 subjects showed clinically meaningful recovery in total FMMS. At 12 mos subjects increased 12.1 (+/- 1.8) points for total FMMS (p=0.00002), 7.4 (+/-1.6) points for UE FMMS (p=0.00057), 4.7 (+/-0.5) points for LE FMMS (p =0.0000009), 7.7 (+/-2.5) points for BI, while NIHSS improved by 1.77 (+/-0.47) and gait speed improved substantially. 14/18 pts demonstrated new transient FLAIR signal in premotor cortex at d7, that resolved by 2 mos, which was highly correlated with sustained neurologic recovery. Resting state fMRI showed improved functional brain connectivity in sensorimotor network, both ipsilesionally&contralesionally. FDG PET showed increased activity in the ipsilesional motor cortex&contralesional cerebellum. Conclusions: Intraparenchymal transplantation of NR1 cells in chronic stroke patients appears safe and well tolerated. Results suggest improved motor function starting at 1 mos and increasing to clinically meaningful recovery in most patients at 12 mos post-implant. UE FMMS improvement surpassed vagal nerve stimulation outcomes.

How about that? Psycholinguistic characteristics of formulaic language that predict fluency in individuals with post-stroke aphasia

ABSTRACT Purpose Formulaic language is an under-explored area of research in the field of acquired language disorders as compared to propositional language. The primary purpose of this study was to explore the utility of a proposed theoretical formulaic language model (Van Lancker Sidtis, 2022) for individuals with post-stroke aphasia to inform research and clinical practice. Method The dataset included previously described formulaic language extracted from Aphasiabank speech samples produced by 144 individuals with fluent and non-fluent aphasias. Formulaic language items were coded according to six psycholinguistic characteristics from the theoretical model. Between-group comparisons and regression analyses were run to determine whether particular psycholinguistic characteristics of produced formulaic items could predict speaker fluency. Results Findings revealed formulaic language differences between fluent and nonfluent aphasias based on the theoretical model. Importantly, psycholinguistic characteristics of frequency and syntactic completeness along with presence of apraxia of speech predicted fluency status with high accuracy (88.4% of individuals with fluent and 70.3% with nonfluent aphasia). Conclusions Findings in this study illustrate how theoretically-driven analyses of formulaic language production may enhance diagnostic and intervention practices in post-stroke aphasia.

Syntactic Scrambling in Broca's Aphasia: Turkish Sample.

Broca's Aphasia (BA) is a language disorder that causes grammatical errors in the language production skills of patients. Contemporary studies revealed the fact that BA patients also have difficulty in analyzing the meaning of phrases and sentences and comprehending the real meaning of the discourse produced by the speaker. The purpose of this study is to investigate possible effect of syntactic movement by changing the word positions in the sentence with morphological markers in order to produce clauses without changing the meaning on the phrasal comprehension skills of Turkish speaking patients with BA. A total of 300 participants were divided as study (n= 150) and control (n= 150) groups between ages of 27 - 89. A test that included 20 relative clauses and 9 noun clauses (in total 29 phrases) was assigned to the BA patients and control group. Relative clause phrases originated from simple sentences by adding suffixes to the verb as a function of Turkish morphology. Each suffix indicated a specific noun, object or subject, and each figure in the test was related to one of them. A researcher asked participants to match the demanded clause with the 6 possiblly related pictures for relative clause and 3 for noun clauses. Findings indicated that BA patients in our study had a lack of comprehending relative clauses due to the syntactic movement of words in the object and subject positions. Compared to the responses of the control group, participants with BA had significantly lower scores when the object and subject positions have moved from their original positions. BA patients also obtained significantly lower scores in object type questions Conclusion: Our findings support the fact that comprehension processing in BA should be investigated profoundly to be able to understand the nature of the disorder in different languages. In Turkish, syntactic movement of words to form a relative clause caused the BA patients to have significant problems to assign the semantic roles to the words in the existance of movement or change in their original positions.

Decoding speech intent from non-frontal cortical areas.

Brain-machine interfaces (BMIs) have advanced greatly in decoding speech signals originating from the speech motor cortices. Primarily, these BMIs target individuals with intact speech motor cortices but who are paralyzed by disrupted connections between frontal cortices and their articulators due to brainstem stroke or motor neuron diseases such as amyotrophic lateral sclerosis. A few studies have shown some information outside the speech motor cortices, such as in parietal and temporal lobes, that also may be useful for BMIs. The ability to use information from outside the frontal lobes could be useful not only for people with locked-in syndrome but also to people with frontal lobe damage, which can cause nonfluent aphasia or apraxia of speech. However, temporal and parietal lobes are predominantly involved in perceptive speech processing and comprehension. Therefore, to be able to use signals from these areas in a speech BMI, it is important to ascertain that they are related to production. Here, using intracranial recordings, we sought evidence for whether, when and where neural information related to speech intention could be found in the temporal and parietal cortices. Causal information enabled us to distinguish speech intent from resting state and other processes involved in language processing or working memory. Information related to speech intent was distributed widely across the temporal and parietal lobes, including superior temporal, medial temporal, angular, and supramarginal gyri. This provides evidence of a decodable production-related signal in these areas. This insight may help in designing speech brain-machine interfaces that could benefit people with locked-in syndrome, aphasia or apraxia of speech.

The association between aphasia severity, naming, verbal fluency and demographic variables in nonfluent post-stroke aphasia

Background: There are insufficiently clear and contradictory results in literature about how patient-related, stroke-related and language-related variables predict the aphasia severity after stroke and how these variables are interrelated. This study aimed to explore the association between aphasia severity and naming, verbal fluency, and demographic variables. Methods: 40 PwA with a left hemisphere stroke and nonfluent aphasia are included in this study. The entire battery of the Comprehensive Aphasia Test (CAT-HR, Swinburn et al., 2020), was administered to all subjects. Data on the severity of aphasia based on the total score on the Language Battery and performance on subtests Naming and Verbal fluency were extracted. Hierarchical regression model evaluated the association between Aphasia severity and Naming, Verbal fluency and demographic variables. Using nonparametric Spearman’s Rho coefficient, the correlations analyses between those variables and additional subtests of Verbal fluency (animals, sound) were conducted. Results: The results showed that demographic variables do not predict aphasia severity while naming explains most of the variance of aphasia severity. Additional correlation analysis showed significant correlation between aphasia severity and language variables, but not with demographic ones. Demographic variables Time post-stroke and Age were significantly correlated with Verbal fluency (sound). Conclusion: In this study, aphasia severity cannot be explained by used demographic variables. However, naming was found to be a strong predictor of aphasia severity. It is possible that the aphasia severity of nonfluent PwA is more dependent on stroke-related variables than demographic variables.

Transdiagnostic Network Localization of Social, Language, and Motor Symptoms in Patients With Frontotemporal Lobar Degeneration.

Frontotemporal lobar degeneration (FTLD) includes different clinical syndromes with distinct patterns of symptoms and neuroanatomical locations of neurodegeneration. However, FTLD is clinically heterogeneous (with overlapping symptoms across several domains) and neuroanatomically heterogeneous (with brain atrophy in different locations in different patients). Traditional methods struggle to fully account for this heterogeneity. In this study, we use a relatively new neuroimaging approach, atrophy network mapping, to localize clinical symptoms in patients with FTLD to specific brain networks transdiagnostically. Data were obtained from the Frontotemporal Lobar Degeneration Neuroimaging Initiative and 4-Repeat Tauopathy Neuroimaging Initiative. Inclusion required T1-weighted MRI and a diagnosis of behavioral-variant frontotemporal dementia (bvFTD), semantic-variant primary progressive aphasia (svPPA), nonfluent primary progressive aphasia (nfvPPA), progressive supranuclear palsy Richardson syndrome (PSP-rs), corticobasal syndrome (CBS), or normal cognition. Measures of social cognition (Interpersonal Reactivity Index, Revised Self-Monitoring Scale), language (Boston Naming Test, Animal Fluency), and motor function (Unified Parkinson Disease Rating Scale Part III, PSP Rating Scale) were correlated with neuroimaging measures, including cortical thickness, volume, and atrophy network mapping, a newer method that localizes regions connected to brain atrophy using a functional connectome from cognitively normal persons (n = 1,000). Fifty-seven patients with bvFTD (age 61.2 ± 6.8 years, 35% female), 41 PSP-rs (age 69.7 ± 7.4 years, 54% female), 39 CBS (age 66.2 ± 6.2 years, 51% female), 37 svPPA (age 63.0 ± 6.0 years, 46% female), and 36 nfvPPA (age 68.3 ± 7.3 years, 53% female) and 135 healthy age-matched controls (age 63.3 ± 7.4 years, 58% female) were included. Compared with atrophy alone, atrophy network mapping showed more consistent neuroimaging results across patients with the same clinical syndrome (Dice index mean 0.68 vs 0.11, paired t = 263.1, df = 4,452, p < 0.001), more strongly explained social cognition (F(1, 84) = 10.2, p = 0.002) and motor symptoms (F(1, 185) = 91.3, p < 0.001) across different syndromes, and showed novel neuroanatomical associations, with the temporal parietal junction relating to social cognition; Wernicke area relating to language symptoms; and association sensorimotor cortex, thalamus, and cerebellum relating to motor symptoms. Atrophy network mapping can improve understanding of brain-behavior relationships in clinically and neuroanatomically heterogeneous disorders such as FTLD.

Predictive Value of the Prehospital RACE Scale for Large Vessel Occlusion in Acute Stroke Patients

Introduction: Prehospital stroke scales have been developed to identify anterior large vessel occlusion (LVO) in acute ischemic stroke (AIS) patients for direct transport to thrombectomy-capable hospitals. However, its performance in a Vietnamese population remains unknown. We aimed to evaluate the predictive value of the Rapid Arterial oCclusion Evaluation (RACE) scale for LVO detection in patients with ischemic stroke presenting within 24 h in Vietnam. Methods: This was a prospective study of patients with AIS admitted at People’s 115 Hospital between May 2022 and October 2022. All patients were assessed with the RACE scale with five items: facial palsy (scored 0–2), arm motor function (0–2), leg motor function (0–2), gaze (0–1), and aphasia or agnosia (0–2). LVO was diagnosed by CTA or MRA. Receiver operating characteristic curve, sensitivity, specificity, and accuracy of the RACE scale were analyzed to evaluate its predictive value for LVO. Results: There were 318 patients included. LVO was detected in 121/318 patients (37.6%). The higher the RACE score, the higher the proportion of patients with LVO (p &lt; 0.001). Receiver operating characteristic curves showed capacity to predict LVO of the RACE scale with an area under the curve (AUC) of 0.767. The optimal RACE cutoff was ≥5 with sensitivity = 0.68, specificity = 0.79, positive predictive value = 0.67, negative predictive value = 0.80, and overall accuracy = 0.75. RACE ≥5 had higher sensitivity and same specificity for detecting LVO in AIS patients within 6-h versus 6–24-h window (AUC = 0.79 vs. 0.75, sensitivity = 0.74 vs. 0.65, specificity = 0.79 vs. 0.80, accuracy = 0.77 vs. 0.74). Conclusions: The RACE scale is a simple tool that can accurately identify AIS patients with LVO. This tool may be useful for early detection of LVO patients and should be validated in the prehospital setting in Vietnam.

Progressively complex neurorehabilitation: from a severe coma to a vegetative state, minimal consciousness ... and the Phoenix bird survives and is reborn from its ashes

Romania has the highest rate of car accidents and deaths per million inhabitants in the European Union, primarily due to poor driving and substandard road conditions. Victims of car accidents often present with complex medical cases involving multiple injuries across various organs, frequently leading to severe complications. Case report. With the approval of the patient's family and the Ethics Committee (no. 19348/25.04.2024) at the Neuromuscular Rehabilitation Clinic, Emergency Hospital "Bagdasar-Arseni," a case study was conducted. A 22-year-old man without a previous medical history suffered severe polytrauma as a result of a road accident. He was transferred to the Neuromuscular Rehabilitation Clinic in a vegetative state (after multiple fractures of the skull base and visceral cranium, with 3 points GCS), atlantoaxial subluxation (requiring cervical collar immobilization), rib fractures, drained hemothorax, near-complete atelectasis of the left lung, status post-pericardial effusion. The medical intervention involved a multifaceted pharmacological approach. Focal intramuscular injections of botulinum toxin targeted specific muscles significantly alleviated spasticity. Special robotic orthoses were used to correct postural abnormalities and maintain the favorable effects of the botulinum toxin. The patient received a personalized and complex nursing rehabilitation program including tracheal stoma management, nutritional support through IV infusions and percutanous gtrostomy (PEG) feeding, re-education of deglutition, intermittent urinary catheterization, and positioning on a special mattress to prevent pressure ulcers. The kinesiotherapy was progressively adapted to the neurologic and general condition. The patient had slight improvements in motor and cognitive abilities, resulting in simple voluntary gestures and affective response schemes. In time, he progressed to a minimally conscious state; he responded to verbal stimuli through blinking and reactive adequate affective mimic in the context of persistent expressive aphasia. He was safely discharged at home. Our main functional objective is the patient’s reinsertion into his family. Ad vitam prognosis and ad functionem outcomes are guarded. Ad laborem prognosis is nil. The patient was periodically reassessed for further rehabilitative care. This case emphasizes the importance of a complex multidisciplinary and patient-centered approach in managing post-traumatic vegetative status following a road traffic accident. The Phoenix symbolically takes steps toward fulfilling its destiny - to survive and gradually rise from its ashes.

Self-Improved Language Production in Nonfluent Aphasia Through Automated Recursive Self-Feedback.

Persons with nonfluent aphasia (PWNA) use feedback from external agents (e.g., speech-language pathologists) and self-feedback to improve their language production. The extent to which PWNA can improve their language production using their self-feedback alone is underexplored. In a proof-of-concept study, we developed an automated recursive self-feedback procedure to demonstrate the extent to which two PWNA who used self-feedback alone improved their production of sentences from trained and untrained scripts. In the current study, we use the Rehabilitation Response Specification System as a framework to replicate our initial findings. We tested the effects of two treatments: script production with recursive self-feedback and script production with external feedback in four persons with chronic nonfluent aphasia. We compared the effects of treatment by measuring percent script produced, speaking rate, and speech initiation latency of trained and untrained scripts. The participants received the treatments remotely through mini tablets using two versions of a mobile app we developed. All the participants received each treatment intensively for 14 sessions across 2-3 weeks. We estimated clinical improvements of production of sentences from trained and untrained scripts through nonoverlap of all pairs analysis of performance pretreatment and posttreatment. Both treatments improved PWNA's language production. Recursive self-feedback improved speaking rate and speech initiation latency, which generalized to untrained scripts in all participants. External feedback treatment did not generalize to improvement in speaking rate in two participants. Our findings confirm our initial evidence that PWNA can self-improve their sentence production from scripts through recursive self-feedback. This novel procedure enables PWNA to autonomously enhance their language production over time. Given the evidence and the mechanics of the procedure, we propose that its utility is not constrained by linguistic idiosyncrasies across cultures. Consequently, it has the potential to bypass linguistic barriers to aphasia care. https://doi.org/10.23641/asha.27007060.

Features of therapy of localized scleroderma in a severe comorbid patient

Localized scleroderma is an autoimmune chronic connective tissue disease characterized by the appearance of foci of local inflammation in various areas of the skin, followed by the formation of sclerosis and/or atrophy of the skin and underlying tissues in them. Among systemic connective tissue diseases, scleroderma occupies the second place in terms of frequency, mainly female patients. The authors observed a severe comorbid patient S., 75 years old, who was hospitalized at the Federal Center of Brain Research and Neurotechnologies of the FMBA of Russia in the department of medical rehabilitation for patients with impaired central nervous system function № 1 from 02.11.2022 to 03.01.2022 with a diagnosis of the underlying disease: the consequences of an ischemic stroke in the basin of the left middle cerebral artery from 02.23.2021, cardioembolic pathogenetic variant. Right-sided hemiparesis. Complex motor aphasia. After consulting a dermatovenerologist, a diagnosis was added to the concomitant diseases: localized scleroderma. Limited plaque shape. Patient S. external treatment was carried out (fluticasone ointment 0.005 % applied to the affected areas of the skin 1 time a day in a thin layer for 4 weeks), upon discharge, a course of physiotherapy at the place of residence was recommended.

Kissing balloon treatment for stenosis of the internal and external carotid artery orifice associated with moyamoya disease: illustrative case.

Moyamoya disease (MMD) is a cerebrovascular disorder that is characterized by progressive stenosis in the terminal portions of the internal carotid artery (ICA). Although a substantial number of patients with MMD exhibit stenosis of the ICA orifice (ICAO), it infrequently occurs in patients with MMD with external carotid artery orifice (ECAO) stenosis. A 48-year-old female with no past medical history presented to the authors' hospital with right hemiparesis and motor aphasia. Head magnetic resonance imaging revealed bilateral acute cerebral infarctions in the left frontal lobe, and magnetic resonance angiography demonstrated bilateral ICA terminal stenosis. Digital subtraction angiography revealed severe stenosis in the right ICAO and left ICAO and ECAO, as well as bilateral ICA terminal stenosis; therefore, the authors diagnosed this case as MMD. They first performed percutaneous transluminal angioplasty (PTA) using the kissing balloon technique (KBT) for the stenosis in the left ICAO and ECAO, followed by PTA for the right ICAO stenosis. After that, they performed bilateral direct and indirect revascularization. The authors present a rare case of MMD with stenosis of the ICAO and ECAO, which was treated with PTA using the KBT, followed by direct and indirect revascularization. Although the strategy is controversial in terms of which treatment should be performed first, this method of anterograde revascularization was a promising strategy. https://thejns.org/doi/10.3171/CASE24425.

Transient cerebral ischemia in pituitary apoplexy-induced internal carotid artery occlusion: illustrative case.

Cerebral ischemia secondary to occlusion or vasospasm of adjacent large vessels is a rare but significant complication of pituitary apoplexy. Misdiagnosis can lead to delays in management and devastating neurological outcomes. This case is the first reported instance of an initial presentation with transient cerebral ischemic symptoms, in addition to a classic pituitary apoplexy syndrome, for this clinical entity of pituitary apoplexy with adjacent large vessel occlusion. A 49-year-old man presented with a classic pituitary apoplexy syndrome of headache, vomiting, and hemianopia, with transient preceding expressive dysphasia and right-hand numbness. Computed tomography (CT) and CT angiography of the brain demonstrated a large apoplectic pituitary tumor and associated occlusion of the left internal carotid artery. Subsequent CT perfusion studies revealed a threatening large ischemic penumbra in the left middle cerebral artery territory. He underwent urgent transsphenoidal resection of the pituitary tumor, resulting in symptom resolution and the prevention of cerebral infarction. The recognition of transient cerebral ischemic symptoms in pituitary apoplexy should encourage the exclusion of any large-vessel complications and resultant cerebral ischemia. Early assessment, particularly with angiography and perfusion studies, can assist in guiding management, which is usually surgical decompression, distinct from traditional treatment for cerebrovascular events. https://thejns.org/doi/10.3171/CASE24566.

Neurological Manifestations of Aortic Dissection: A Scoping Review.

Aortic dissection (AD) is the most prevalent aortic pathology, with an incidence of 2.6-3.5 cases per 100,000 inhabitants per year with mortality rates as high as 90% at 3 months without proper management. Despite the presence of typical symptoms, it has been reported that up to 38% of cases go unnoticed in the initial evaluation, either due to additional symptomatology or the absence of classic symptoms. In 28% of cases the diagnosis is made post-mortem, highlighting the severity and importance of timely diagnosis. The main goals of this study were to identify the primary neurological manifestations of acute AD and the frequency of these manifestations in type A and B AD according to the Stanford classification. A total of 2,734 records were retrieved from two databases, of which 2,611 were excluded. Therefore, 123 articles were obtained and 88 were evaluated for eligibility. Consequently, 79 articles were included in the review. The abstracts identified in the search were screened by seven blinded independent authors and excluded those who lacked relevance. The authors read the full texts independently to determine inclusion. A third reviewer adjudicated discrepancies when opinions were at odds. There were 169 patients diagnosed with Stanford type A, of which 43.8% displayed quantitative impairment of consciousness. Within this group, transient loss of consciousness was observed in 34.3% of cases. Motor syndrome was present in 54.5%, with 23.7% of patients presenting with hemiparesis or hemiplegia. 3.6% had facial paresis or paralysis and less frequently monoparesis, paraparesis, hyperreflexia, spasticity, and muscle spasms. 7.6% presented with language impairments including Broca's aphasia and dysarthria. Seizures were present in 3.6%. Neuro-ophthalmological symptoms were 2.9%, cortical or cognitive symptoms and headache were 2.3%, cerebellar syndrome was 1.8%, and sensory syndrome was 1.2%. Of 86 patients diagnosed with Stanford type B, 57.0% displayed motor syndrome, with 50.0% being paraparesis or paraplegia, 4.7% monoplegia, and 2.3% hemiplegia or hemiparesis. Additionally, impairment of consciousness was present in 26.7%, sensory syndrome in 12.8%, and language impairments in 3.5%. In the emergency department, understanding the neurological manifestations in both Stanford type A and B dissections emerges as a pivotal cornerstone for conducting precise assessments and efficient patient management. Given the wide spectrum of manifestations, we emphasize the importance of suspecting AD when neurological disorders are associated with the classic symptoms. In these cases, we encourage a complete neurological examination to be performed and a multidisciplinary group assembled to tackle this entity.

Investigating the Effectiveness of Neuropsychological Rehabilitation on Stroke Patients

Objectives: This study aimed to investigate neuropsychological rehabilitation’s effectiveness on stroke patients’ cognitive status. Methods: This quasi-experimental study examined 22 adults with ischemic stroke of the left hemisphere (with an average age of 64.31 years) before and after the intervention. The patients had fluent aphasia (10 people) and non-fluent aphasia (12 people), along with cognitive disorders such as memory or attention disorder. Medical examination and para-clinical diagnosis of magnetic resonance imaging (MRI) with different causes, along with the Persian diagnostic aphasia battery bedside version (P-DAB-AQ1, 2016), were conducted. The severity of language disorder and type of aphasia were investigated using the Persian diagnostic aphasia battery (P-DAB-1) and Persian picture naming battery tests. Also, the mini-mental state examination (MMSE) test checked the cognitive dimensions. Verb network strengthening therapy, treatment of underlying forms, Persian verb, and sentence production protocol, and semantic feature analysis (SFA) for patients were also used. Results: Findings show that the participants’ average aphasia quotient (AQ1) score increased from 74.80 to 80.12, and the average MMSE score increased from 17 to 22.59. The main variables do not follow a normal distribution (P&lt;0.05), but the difference between scores before and after the intervention follows a normal distribution (P&lt;0.05). Both the AQ1 and MMSE variables significantly differ before and after the intervention, according to the Wilcoxon test. The non-fluent aphasia group has a higher increase in MMSE scores than the fluent aphasia group. Discussion: Neuropsychological rehabilitation interventions can effectively improve AQ1 and MMSE. In addition, further research on neuropsychological rehabilitation interventions with two intervention and control groups and the treatment methods used during this study can be suggested for the treatment of stroke patients.

Delayed Deep White Matter Ischemia After Resection of Gliomas by Awake Surgery

BACKGROUND AND OBJECTIVES: Deep white matter (DWM) is perfused by the medullary arteries from the cortex, and ischemia sometimes occurs after glioma resection. However, the clinical significance of postoperative medullary artery–related ischemia has not been well studied. We retrospectively reviewed cases of delayed DWM ischemia after awake craniotomy to elucidate the clinical characteristics, mechanisms, and management of delayed ischemia. METHODS: We identified 4 cases of intra-axial brain tumors, mainly gliomas, that underwent tumor resection by awake craniotomy at our hospital and developed DWM ischemic symptoms after surgery, despite no worsening of neurological symptoms at the end of surgery. RESULTS: Four patients (3 men and 1 woman) presented with glioblastoma, oligodendroglioma, astrocytoma, and brain metastasis. The median age at surgery was 47.5 years (41-73 years). The tumors were located in the watershed area in the frontal lobe (n = 2) and the parietal lobe (n = 2), all of which were left-sided (n = 4). DWM ischemic symptoms, such as motor dysfunction, aphasia, dysarthria, and dysgraphia, developed at an average of 24 hours (14-48 hours) after resection by awake craniotomy. All 4 patients showed symptom improvement within a week after surgery and completely recovered within a month. CONCLUSION: DWM ischemia is caused by sacrifice of the medullary artery, which feeds the tumor and adjacent brain tissue during tumor resection, and should be considered when delayed aphasia or paralysis occurs postoperatively. These symptoms are often transient and recovery usually occurs. Tumors located in the frontal or parietal lobes, particularly in the watershed area, should be carefully monitored for postoperative ischemia.

Preliminary Validation of a Structural Magnetic Resonance Imaging Metric for Differential Diagnosis of Frontotemporal Lobe Dementias

AbstractBackgroundAD‐NeuroScore is a validated metric that summarizes Alzheimer’s disease (AD)‐specific atrophy and can detect AD early, benchmark disease severity, predict and monitor AD progression, and can aid in testing the efficacy of therapeutic interventions using a single number (Kress, 2023). It meets criteria for translatability by using clinically available regional brain volumes as input (Ahdidan, 2015; Cavedo, 2022) and having patient and model‐level interpretability (Pinto, 2022). Also, features can be reviewed by a neuroradiologist (Larson, 2019). Scores are harmonized for intracranial volume, age, sex, and scanner model, improving workflows for longitudinal patient tracking. The objective of this study is to examine whether AD‐NeuroScore can be used in the differential diagnosis of AD and FTD dementia subtypes.MethodCognitively normal (CN) individuals and patients with a mild cognitive impairment (MCI), AD, behavioral variant (bv)‐FTD, semantic variant (sv)‐FTD, and progressive nonfluent aphasia (pnfa)‐FTD diagnoses were drawn from the ADNI and NIFD cohort studies. Eighty‐four cortical and subcortical regional volumes were estimated from T1‐weighted MR images using FreeSurfer. AD‐NeuroScore uses a modified Euclidean‐inspired distance function to calculate differences between individuals and a CN template based on regional brain volumes associated with cognitive decline (Kress, 2023). Validation used an experimental cohort (Table 1) and tested sensitivity to differentiating CN, MCI, and AD from FTD‐subtypes (bv, sv, and pnfa) using pairwise t‐tests and an alpha=0.001, Bonferroni corrected. Area under the curve (AUC) was calculated. Results were benchmarked against adjusted hippocampal volume (AHV), an NIA‐AA diagnostic biomarker for AD (Jack, 2018), which was also harmonized for intracranial volume, age, sex, and scanner.ResultBoth AD‐NeuroScore and AHV distinguished between AD and svFTD and pnfaFTD variants. AD‐NeuroScore better differentiated svFTD from AD than AHV (Table 2; Figure 1). AHV performed as well or qualitatively better than AD‐NeuroScore at distinguishing AD from pnfaFTD. Neither AD‐NeuroScore nor AHV differentiated AD and bv‐FTD.ConclusionAD‐NeuroScore differentiated between AD, svFTD, and pnfaFTD and overall, performed equivalently to or better than AHV. Performance and utility in longitudinal tracking may be improved by creating FTD variant scores using with a focus on regions specific to FTD subtypes.

Isolated expressive aphasia caused by acute subdural hematoma: case report and literature review

The occurrence of aphasia as an isolated and dominant clinical feature of acute subdural hematoma (aSDH) has been rarely mentioned in the available literature. Being the most common focal intracranial lesion, subdural hematomas (SDH) pose a clinical challenge, especially when presented with unorthodox clinical features. We report a case of a patient with a traumatic aSDH, presenting with intense frontal headaches and normal neurological examination. On the 3rd postadmission day, he developed expressive dysphasia which progressed to aphasia, with neurological examination findings of an upper motor neuron lesion (UMNL), without hematoma expansion, verified via head CT (computed tomography). The patient underwent decompressive craniotomy and hematoma evacuation. Early speech improvements were noted immediately postoperatively, and at hospital discharge the patient had no evident clinical features of speech disorder and neurological deficits or tests suggesting UMNL. Speech disorders in the setting of an aSDH need to be further investigated and potentially considered as an indication for surgical management, especially in rare instances where they present as an isolated clinical feature and conservative treatment is initially considered.

Recursive self-feedback improves spontaneous speech in chronic aphasia within real-world settings

ABSTRACT Background Spontaneous speech generation, often impaired in chronic nonfluent aphasia, is essential for natural communication. Treatments aiming to optimize spontaneous speech in real-world settings are critical for improving the quality of life for persons with nonfluent aphasia (PWNA). Traditional treatments frequently rely on models and feedback from external agents, which may not be sustainable in the long-term. Preliminary evidence suggests that PWNA can use self-feedback alone, through recursive self-feedback, to improve their production of scripted sentences. This study developed and examined the impact of spontaneous speech with recursive self-feedback on enabling PWNA to self-improve their spontaneous speech in real-world settings. Method Using a cross-over design, 3 participants received 2 treatments at their homes: spontaneous speech with recursive self-feedback and spontaneous speech with speech model. Recursive self-feedback treatment involved iterative self-monitoring and minimization/correction of errors during spontaneous speech response to narrative prompts. The speech model treatment provided corrective model responses to prompts from an external source which served as reference frames to help improve the participants’ responses. Participants utilized a mobile app to practice the treatments intensively at home for 2 hours each day over a period of 12 to 14 days, spanning 2 to 3 weeks. Direct and generalized treatment effects on microlinguistic measures of spontaneous speech were determined using general linear mixed effects model and standardized mean difference. Results Both treatments led to significant improvements in microlinguistic measures of spontaneous speech, with recursive self-feedback treatment showing broader post-treatment effects on treated prompts and generalization effects. to untreated prompts. Conclusion Recursive self-feedback is a promising procedure for enhancing spontaneous speech in PWNA, providing a simple and flexible self-directed treatment option. This procedure relies primarily on speech-auditory stimulations and self-feedback loops to improve spontaneous speech, suggesting its potential applicability across various spoken language cultures. To validate these findings and assess their broader relevance, further research is recommended.

Caregiver perspectives enable accurate diagnosis of neurodegenerative disease.

The history from a relative or caregiver is an important tool for differentiating neurodegenerative disease. We characterized patterns of caregiver questionnaire responses, at diagnosis and follow-up, on the Cambridge Behavioural Inventory (CBI). Data-driven multivariate analysis (n=4952 questionnaires) was undertaken for participants (n=2481) with Alzheimer's disease (typical/amnestic n=543, language n=50, and posterior cortical n=50 presentations), Parkinson's disease (n =740), dementia with Lewy bodies (n=55), multiple system atrophy (n=55), progressive supranuclear palsy (n=422), corticobasal syndrome (n =176), behavioral variant frontotemporal dementia (n=218), semantic (n=125) and non-fluent variant progressive aphasia (n=88), and motor neuron disease (n=12). Item-level support vector machine learning gave high diagnostic accuracy between diseases (area under the curve mean 0.83), despite transdiagnostic changes in memory, behavior, and everyday function. There was progression in CBI subscores over time, which varied by diagnosis. Our results highlight the differential diagnostic information for a wide range of neurodegenerative diseases contained in a simple, structured collateral history. We analyzed 4952 questionnaires from caregivers of 2481 participants with neurodegenerative disease. Behavioral and neuropsychiatric manifestations of neurodegenerative disease had overlapping diagnostic boundaries. Simple questionnaire response patterns were sufficient for accurate diagnosis of each disease. We reinforce the value of a collateral history to support a diagnosis of dementia. The Cambridge Behavioural Inventory is sensitive to change over time and suitable as an outcome measure in clinical trials.