Fluent Aphasia Research Articles

Typical and atypical appearance of early‐onset Alzheimer's disease: A clinical, neuroimaging and neuropathological study

The International Working Group (IWG) has classified Alzheimer's disease (AD) as two different types, the typical form and the atypical form, but clinicopathological studies of atypical AD are limited. Because atypical AD cases usually present with early-onset dementia, we investigated 12 patients with early-onset AD, including two patients with typical AD and 10 patients with atypical AD. Of these patients, six had the posterior variant, three had the frontal variant and one had the logopenic variant mixed with semantic dementia. We reported MRI, single-photon emission CT and neuropathological findings in six representative cases. We also described a "left temporal variant" of AD presenting with transcortical cortical sensory aphasia, which has not been reported previously and is another subtype of the posterior variant of AD. We found a significant correlation between regional cerebral blood flow and counts of NFTs in the cerebral cortices. An atypical presentation with focal neuropsychological symptoms roughly correlated with the density of NFTs in the cerebral cortex and more directly related to spongiform changes in the superficial layers of these areas. In contrast, the distribution of amyloid depositions was diffuse and did not necessarily correlate with focal neuropsychological symptoms. Braak staging or ABC score is not necessarily appropriate to evaluate atypical AD, and instead, spongiform changes in addition to tau pathology in the association cortices better explain the diversity of atypical AD. Interestingly, another patient with a posterior variant of AD had a novel type of atypical plaque, which we referred to as "lucent plaque". They were recognizable with HE staining in the circumference and dystrophic neurites were abundant with Gallyas-Braak staining. These plaques demonstrated intense immunoreactivity to both tau AT-8 and amyloid β (Aβ), suggesting a peculiar coexistence pattern of amyloid and tau in these plaques. Clinicopathological studies of atypical AD will provide a new understanding of the pathophysiology of AD.

Zipf's Law in Aphasia Across Languages: A Comparison of English, Hungarian and Greek

We investigated Zipf’s law in fluent and non-fluent aphasics’ spontaneous speech in English, Hungarian, and Greek. A previous study showed that the word frequency distribution in Dutch non-fluent aphasic speech conforms to Zipf’s law, although with a different slope. In this project we investigated to what extent these results can be generalized to other languages and to fluent aphasic speech. The results suggest that both the fluent and the non-fluent aphasic speech of English, Hungarian and Greek conform to Zipf’s law, and that differences in slope can be related to a language’s morphological properties and a group’s particular language impairments.

Temporal plasticity in auditory cortex improves neural discrimination of speech sounds

BackgroundMany individuals with language learning impairments exhibit temporal processing deficits and degraded neural responses to speech sounds. Auditory training can improve both the neural and behavioral deficits, though significant deficits remain. Recent evidence suggests that vagus nerve stimulation (VNS) paired with rehabilitative therapies enhances both cortical plasticity and recovery of normal function. Objective/HypothesisWe predicted that pairing VNS with rapid tone trains would enhance the primary auditory cortex (A1) response to unpaired novel speech sounds. MethodsVNS was paired with tone trains 300 times per day for 20 days in adult rats. Responses to isolated speech sounds, compressed speech sounds, word sequences, and compressed word sequences were recorded in A1 following the completion of VNS-tone train pairing. ResultsPairing VNS with rapid tone trains resulted in stronger, faster, and more discriminable A1 responses to speech sounds presented at conversational rates. ConclusionThis study extends previous findings by documenting that VNS paired with rapid tone trains altered the neural response to novel unpaired speech sounds. Future studies are necessary to determine whether pairing VNS with appropriate auditory stimuli could potentially be used to improve both neural responses to speech sounds and speech perception in individuals with receptive language disorders.

Cognitive deficits revealed with the Rus-BCoS and their relationships with language comprehension in fluent and nonfluent aphasia

Cognitive deficits revealed with the Rus-BCoS and their relationships with language comprehension in fluent and nonfluent aphasia

Investigation of Transcranial Direct Current Stimulation Combined with Conventional Speech Rehabilitation Therapy to Cure Non Fluent Aphasia after Stroke

Investigation of Transcranial Direct Current Stimulation Combined with Conventional Speech Rehabilitation Therapy to Cure Non Fluent Aphasia after Stroke

Estimulación eléctrica por corriente continua en el tratamiento de la afasia

Ictus is a medical condition with a high prevalence in Spanish population. One of its most common consequences is aphasia. Nowadays, aphasia is treated with both neuropsychological and pharmacological therapy. However, in recent years, transcranial direct current stimulation has been presented as a complement to classical therapies. To familiarize the reader with transcranial direct current stimulation and to critically review the evidence on the benefits of this technique in aphasia rehabilitation. The first part of this paper describes what transcranial electrical stimulation is. Subsequently, an analysis of the efficacy of this technique in the treatment of aphasia is presented. To achieve this, we searched in PubMed database and found 19 different scientific papers, published between 2008 and 2016, which used transcranial electrical stimulation in the treatment of aphasia. These studies suggest that, when it is used in conjunction with speech therapy, transcranial direct current electrical stimulation is effective in the treatment of aphasia. In addition, its benefits are observed when a minimum of five sessions with intensities higher than 1 mA, stimulating perilesional areas, and in those patients with fluent aphasias. However, the reviewed studies also suggest that this technique is not a substitutive of speech therapy, but a way to prime the brain to it.

A comparison of coherence in oral discourse between Cantonese speakers in Mainland China with cerebrovascular accident (CVA) and traumatic brain injury (TBI): A pilot study

A comparison of coherence in oral discourse between Cantonese speakers in Mainland China with cerebrovascular accident (CVA) and traumatic brain injury (TBI): A pilot study

Surgical treatment of eloquent brain area tumors using neurophysiological mapping of the speech and motor areas and conduction tracts

To evaluate the efficacy of intraoperative neurophysiological mapping in removing eloquent brain area tumors (EBATs). Sixty five EBAT patients underwent surgical treatment using intraoperative neurophysiological mapping at the Pirogov National Medical and Surgical Center in the period from 2014 to 2015. On primary neurological examination, 46 (71%) patients were detected with motor deficits of varying severity. Speech disorders were diagnosed in 17 (26%) patients. Sixteen patients with concomitant or isolated lesions of the speech centers underwent awake surgery using the asleep-awake-asleep protocol. Standard neurophysiological monitoring included transcranial stimulation as well as motor and, if necessary, speech mapping. The motor and speech areas were mapped with allowance for the preoperative planning data (obtained with a navigation station) synchronized with functional MRI. In this case, a broader representation of the motor and speech centers was revealed in 12 (19%) patients. During speech mapping, no speech disorders were detected in 7 patients; in 9 patients, stimulation of the cerebral cortex in the intended surgical area induced motor (3 patients), sensory (4), and amnesic (2) aphasia. In the total group, we identified 11 patients in whom the tumor was located near the internal capsule. Upon mapping of the conduction tracts in the internal capsule area, the stimulus strength during tumor resection was gradually decreased from 10 mA to 5 mA. Tumor resection was stopped when responses retained at a stimulus strength of 5 mA, which, when compared to the navigation data, corresponded to a distance of about 5 mm to the internal capsule. Completeness of tumor resection was evaluated (contrast-enhanced MRI) in all patients on the first postoperative day. According to the control MRI data, the tumor was resected totally in 60% of patients, subtotally in 24% of patients, and partially in 16% of patients. In the early postoperative period, the development or aggravation of a motor neurological deficit was detected in 18 patients: worsening of paresis was observed in 11 patients, and worsening of speech disorders occurred in 7 patients. After 4 months, motor and speech disorders regressed in 10 patients. Therefore, a persistent neurological deficit developed after surgery in 8 (12%) patients (motor deficit in 5 cases; speech deficit in 3 cases). Resection of eloquent brain area tumors using intraoperative neurophysiological monitoring enables complete resection of the tumor at a low risk of persistent neurological deficits, which ultimately improves the patient's life prognosis.

重度嚥下障害を伴う感覚性失語症患者における音声表出および経口摂取の回復

誤嚥に伴う頻回の肺炎発症や，吸引回数の過多などの問題は，患者や家族，介護者の負担となる一方，音声言語によるコミュニケーションは，たとえ重度の感覚性失語となって有意味語が使用できない状態に陥ったとしても，感情に伴う発声，咄嗟時の発声などの心情の表出が行えるものであれば，重要な機能として回復，もしくは保存すべきものであるといえる．したがって，音声を永続的に奪う誤嚥防止術を施行することは，たとえその結果，経口摂取が可能となるとしても，嚥下障害に対する治療を徹底的に行っても改善が得られない場合以外には，まず目指すべき望ましい方向性とはいえない．今回，わたしたちは，重度の嚥下障害を伴う感覚性失語症の患者に対して，音声表出および経口摂取の回復を行いえた症例を経験したので，その治療経過を報告したい．症例は48歳女性．1年前，左側中大脳動脈領域の動脈瘤破裂に対してクリッピングを受けるも，その2ヵ月後に施行された頭蓋形成術中に未破裂の小脳動脈瘤が破裂した．これに対して後頭蓋窩開放・減圧術が施行されるも重度の嚥下障害が発症・遷延したため気管切開，胃瘻造設が施行された．その後在宅療養中であったが，終日にわたり頻回な気管内吸引が必要な状態であったため，誤嚥防止術の適応として当科紹介．これに対して，本症例の嚥下障害の病態を解明し，それに対するアプローチを徹底的に行ったところ，気管孔閉鎖が可能となり，さらに経口摂取，音声表出の回復が得られた．

APPLICATION OF FUNCTIONAL NEUROMARKERS FOR CONSTRUCTING PROTOCOLS OF NEUROTHERAPY AND MONITORING THE SUCCESS OF TREATMENT IN CHRONIC CROSSED TRANSCORTICAL SENSORY APHASIA: A CASE STUDY

Background. The goal of the study was threefold: 1) to evaluate QEEG/ERPs in­dexes of functional brain impairment after a stroke associated with chronic crossed transcortical sensory aphasia, 2) to construct a neu­rotherapy protocol to compensate for this functional damage, and 3) to assess the changes in the functional neuromarkers induced by the neurotherapy sessions. Case study. A 72-year-old, strongly right-handed woman with atrial fibrillation sud­denly developed cerebral embolism of the right middle cerebral artery. She was treated conservatively, and the left hemiparesis, and aphasia – in a moderate degree, consequently existed. A CT-scan showed a large infarct lesion partially parallel to Wernicke’s area. After one year of ineffective aphasia therapy we constructed an experimental neuro­therapy protocol (TMS combined with comprehensive aphasia therapy) on the basis of an assessment of the spontaneous QEEG and event-related potentials (ERPs) in the cued GO/NOGO. The patient was assessed before and after the neurotherapy sessions by the same methodology. Conclusions.It was found that before the TMS treatment the temporal area (T6) generates a strong P2 wave in response to visual stimulus indicating a hyper-sensitivity of the neurons located at temporal areas of the right hemisphere. This was connected with crossed transcortical sensory aphasia found within the aphasia profile in the Polish version of the Western Aphasia Battery (K-WAB). The TMS sessions reduced this hyper-sensitivity substantially. The patient speech returned to the norm, she was to return to social life.

Contrast-induced encephalopathy following cardiac catheterization.

To describe the epidemiology, pathophysiology, clinical presentation, and management of contrast-induced encephalopathy (CIE) following cardiac catheterization. CIE is an acute, reversible neurological disturbance directly attributable to the intra-arterial administration of iodinated contrast medium. The PubMed database was searched and all cases in the literature were retrieved and reviewed. 52 reports of CIE following cardiac catheterization were found. Encephalopathy, motor and sensory disturbances, vision disturbance, opthalmoplegia, aphasia, and seizures have been reported. Transient cortical blindness is the most commonly reported neurological syndrome, occurring in approximately 50% of cases. The putative mechanism involves disruption of the blood brain barrier and direct neuronal injury. Contrast-induced transient vasoconstriction has also been implicated. Symptoms typically appear within minutes to hours of contrast administration and resolve entirely within 24-48 hr. Risk factors may include hypertension, diabetes mellitus, renal impairment, the administration of large volumes of iodinated contrast, percutaneous coronary intervention or selective angiography of internal mammary grafts, and previous adverse reaction to iodinated contrast. Characteristic findings on cerebral imaging include cortical and sub-cortical contrast enhancement on computed tomography (CT). Imaging findings in CIE may mimic subarachnoid hemorrhage or cerebral ischemia; the Hounsfield scale on CT and the apparent diffusion coefficient on magnetic resonance imaging (MRI) are useful imaging tools in distinguishing these entities. In some cases, brain imaging is normal. Prognosis is excellent with supportive management alone. CIE tends to recur, although re-challenge with iodinated contrast without adverse effects has been documented. CIE is an important clinical entity to consider in the differential diagnosis of stroke following cardiac catheterization. Given that prognosis is excellent with supportive management only, physicians should be aware of it, and consider it prior to initiating thrombolysis. © 2016 Wiley Periodicals, Inc.

Arterial spin labelling shows functional depression of non-lesion tissue in chronic Wernicke's aphasia

Behavioural impairment post-stroke is a consequence of structural damage and altered functional network dynamics. Hypoperfusion of intact neural tissue is frequently observed in acute stroke, indicating reduced functional capacity of regions outside the lesion. However, cerebral blood flow (CBF) is rarely investigated in chronic stroke. This study investigated CBF in individuals with chronic Wernicke's aphasia (WA) and examined the relationship between lesion, CBF and neuropsychological impairment.Arterial spin labelling CBF imaging and structural MRIs were collected in 12 individuals with chronic WA and 13 age-matched control participants. Joint independent component analysis (jICA) investigated the relationship between structural lesion and hypoperfusion. Partial correlations explored the relationship between lesion, hypoperfusion and language measures.Joint ICA revealed significant differences between the control and WA groups reflecting a large area of structural lesion in the left posterior hemisphere and an associated area of hypoperfusion extending into grey matter surrounding the lesion. Small regions of remote cortical hypoperfusion were observed, ipsilateral and contralateral to the lesion. Significant correlations were observed between the neuropsychological measures (naming, repetition, reading and semantic association) and the jICA component of interest in the WA group. Additional ROI analyses found a relationship between perfusion surrounding the core lesion and the same neuropsychological measures.This study found that core language impairments in chronic WA are associated with a combination of structural lesion and abnormal perfusion in non-lesioned tissue. This indicates that post-stroke impairments are due to a wider disruption of neural function than observable on structural T1w MRI.

Right sensory-motor functional networks subserve action observation therapy in aphasia.

Recent studies have shown that the systematic and repetitive observation of actions belonging to the experiential human motor repertoire without verbal facilitation enhances the recovery of verbs in non fluent aphasia. However, it is still an open question whether this approach extends its efficacy also on discourse productivity by improving the retrieval of other linguistic units (i.e. nouns, sentences, content words). Moreover, nothing is known regarding the neural substrates which support the language recovery process due to action observation treatment.In the present study, ten non fluent aphasics were presented with two videoclips (real everyday life context vs. familiar pantomimed context), each video for six consecutive weeks (Monday to Friday, weekend off). During the treatment, they were asked to observe each video and to describe it without verbal facilitation from the therapist. In all patients, language measures were collected before and at the end of treatment. Before and after each treatment condition (real vs. pantomimed context), each subject underwent a resting state fMRI. After the treatment, significant changes in functional connectivity were found in right sensory-motor networks which were accompanied by a significant improvement for the different linguistic units in the real context condition. On the contrary, the language recovery obtained in the pantomimed context did not match any functional modification. The evidence for a recruitment of the sensory-motor cortices during the observation of actions embedded in real context suggests to potentially enhance language recovery in non fluent aphasia through a simulation process related to the sensory-motor properties of actions.

The Localization of Long-Distance Dependency Components: Integrating the Focal-lesion and Neuroimaging Record.

In the sentence “The captain who the sailor greeted is tall,” the connection between the relative pronoun and the object position of greeted represents a long-distance dependency (LDD), necessary for the interpretation of “the captain” as the individual being greeted. Whereas the lesion-based record shows preferential involvement of only the left inferior frontal (LIF) cortex, associated with Broca's aphasia, during real-time comprehension of LDDs, the neuroimaging record shows additional involvement of the left posterior superior temporal (LPST) and lower parietal cortices, which are associated with Wernicke's aphasia. We test the hypothesis that this localization incongruence emerges from an interaction of memory and linguistic constraints involved in the real-time implementation of these dependencies and which had not been previously isolated. Capitalizing on a long-standing psycholinguistic understanding of LDDs as the workings of an active filler, we distinguish two linguistically defined mechanisms: GAP-search, triggered by the retrieval of the relative pronoun, and GAP-completion, triggered by the retrieval of the embedded verb. Each mechanism is hypothesized to have distinct memory demands and given their distinct linguistic import, potentially distinct brain correlates. Using fMRI, we isolate the two mechanisms by analyzing their relevant sentential segments as separate events. We manipulate LDD-presence/absence and GAP-search type (direct/indirect) reflecting the absence/presence of intervening islands. Results show a direct GAP-search—LIF cortex correlation that crucially excludes the LPST cortex. Notably, indirect GAP-search recruitment is confined to supplementary-motor and lower-parietal cortex indicating that GAP presence alone is not enough to engage predictive functions in the LIF cortex. Finally, GAP-completion shows recruitment implicating the dorsal pathway including: the supplementary motor cortex, left supramarginal cortex, precuneus, and anterior/dorsal cingulate. Altogether, the results are consistent with previous findings connecting GAP-search, as we define it, to the LIF cortex. They are not consistent with an involvement of the LPST cortex in any of the two mechanisms, and therefore support the view that the LPST cortex is not crucial to LDD implementation. Finally, results support neurocognitive architectures that involve the dorsal pathway in LDD resolution and that distinguish the memory commitments of the LIF cortex as sensitive to specific language-dependent constraints beyond phrase-structure building considerations.

Recipient participation in conversations involving participants with fluent or non-fluent aphasia

ABSTRACTThe present study compares the ways in which conversational partners manage expressive linguistic problems produced by participants with fluent vs. non-fluent aphasia. Both everyday conversations with family members and institutional conversations with speech-language therapists were examined. The data consisted of 110 conversational sequences in which the conversational partners addressed expressive aphasic problems. Most problems of the speaker with fluent aphasia were locally restricted phonological and word-finding errors, which were immediately repaired. In contrast, the sparse expression of the speaker with non-fluent aphasia was co-constructed by conversational partners in long negotiation sequences to establish shared understanding. Some differences between recipient participation in everyday and institutional conversation were found. The results emphasise the relevance of the nature of the expressive linguistic problems on participation in interaction. They also add to the clinical knowledge of handling aphasic problems in conversation. This knowledge can be used for developing interaction-focused intervention.

Treatment of IgG4-related pachymeningitis in a patient with steroid intolerance: The role of early use of rituximab

IgG4-related pachymeningitis is a serious inflammatory condition that can present with symptoms of mass effect and focal deficits. The first-line therapy is steroids and second-line is chemotherapy (methotrexate, azathioprine, etc.). We describe a patient with IgG4-related pachymeningitis in whom steroid use was contraindicated and methotrexate was ineffective. During the course of treatment, the patient presented to the emergency department with receptive and expressive aphasia, slurred speech, right-sided neglect, and loss of sensation. After a single infusion of rituximab and anticonvulsants, her symptoms resolved. Our unique case suggests that patients with IgG4-related pachymeningitis might benefit from early initiation of rituximab.

EP 78. Loss of vision following severe subarachnoid hemorrhage – Diagnostic bedside optic nerve sonography on intensive care unit

A 52 year old female patient suffered a subarachnoid hemorrhage Hunt and Hess V (Fisher IV) caused by an aneurysm of the left anterior choroid artery. Interventional treatment by coiling was successfull. A left hemispheric borderzone infarction has been shown on follow up CT due to prolonged vasospasms. CSF malabsorption with hydrocephalus required a ventriculo-peritoneal shunt. While the weaning phase on the early rehabilitation ward, there was a strong suspicion that the patient had a cortical blindness. Clinical judgement was affected by sensory aphasia and fluctuating conciousness. CT scan showed no bilateral infarction oft he posterior circulation. Bedside sonography of the ocular bulb including the optic nerve showed subhyaloidal bleedings and bleedings in the vitreos body bilaterally. These are typical lesions of the Terson-syndrome. After the weaning process two stage pars plana vitrectomy on both eyes was performed successfully. Visual capability strongly increased and patient was abled to take part on linguistic therapy in an effective manner. After a 5 month rehabilitation period patient was independent in activities of daily living. There was only a slight impairment on vision. Terson Syndrome occured in about 15% of subarachnoid hemorrhages. The frequency is higher in patients with markedly elevated cerebral pressure. To detect these lesions in unconcious patients or those with suspicion of blindness optic nerve sonography is well suitable an may help to plan ophtalmologic treatment as early as possible.

Case Report:Recombinant Tissue Plasminogen Activator Thrombolysis in Acute Ischemic Stroke First Case Report in Manipur

Cerebrovascular disease represents an enormous burden of disease and disability to mankind. Intravenous thrombolysis with recombinant tissue plasminogen activator(rtpa) within 3hr of symptomonset is currently approved for treatment of acute ischaemic stroke. Though it is widely used in western countries, the use of IV(intravenous) thrombolysis in peripherally located hospital is still a problem because for its short window period of 3hr of stroke onset.Here we are reporting the first case of IV thrombolysis in RIMS with recombinant tissue plasminogen activator(rtpa) recently. 78 years old man presented to us with right hemiparesis, power (1/5), global aphasia and altered sensorium. Patient presented to us at around one and half hour of stroke. At the time of presentation patient National institute of health stroke scale(NIHSS) score was 12 and Barthel index was 0. CT head done show no infraction, patient was thrombolysedwith 50mgActilyse(alteplase) within 30 minute of arrival to the hospital. Patient started improvement within 30 minute of starting thrombolysis, after 12hr of thrombolysis patient had power(4/5) with mild sensory aphasia. Repeat CT shows large left Middle cerebral artery(MCA) infract and CT angiography shows normal circle of willis.

Recovering two languages with the right hemisphere

Converging evidence suggests that the right hemisphere (RH) plays an important role in language recovery from aphasia after a left hemisphere (LH) lesion. In this longitudinal study we describe the neurological, cognitive, and linguistic profile of A.C., a bilingual who, after a severe traumatic brain injury, developed a form of fluent aphasia that affected his two languages (i.e., Romanian and Italian). The trauma-induced parenchymal atrophy led to an exceptional ventricular dilation that, gradually, affected the whole left hemisphere. A.C. is now recovering both languages relying only on his right hemisphere. An fMRI experiment employing a bilingual covert verb generation task documented the involvement of the right middle temporal gyrus in processes of lexical selection and access. This case supports the hypothesis that the RH plays a role in language recovery from aphasia when the LH has suffered massive lesions.

Análise do discurso de indivíduos afásicos fluentes e com leve dificuldade de compreensão oral

RESUMO: Objetivo: analisar os discursos narrativo, descritivo, conversacional e procedural de indivíduos afásicos fluentes e compará-los com indivíduos saudáveis. Métodos: foram selecionados, por meio de amostragem sistemática, 22 indivíduos afásicos fluentes com queixas de dificuldade discursiva e que apresentam alteração de linguagem pós-acometimento em Sistema Nervoso Central decorrente de Acidente Vascular Encefálico, que estão ou já estiveram em tratamento na instituição de origem. Estes foram pareados a indivíduos saudáveis de mesma idade e escolaridade e ambos os grupos foram submetidos a um protocolo de tarefas discursivas orais para avaliação dos discursos narrativo, explicativo, conversacional e procedural. Resultados: houve diferenças estatisticamente significantes na maioria das variáveis investigadas em todos os tipos de discursos tanto na análise quantitativa quanto na qualitativa. Conclusão: indivíduos afásicos apresentaram maior facilidade no discurso narrativo e maior dificuldade nos demais discursos, porém comparando-os aos indivíduos saudáveis apresentaram maior dificuldade em todos os gêneros discursivos orais.