Assessing and mapping language, attention and executive multidimensional deficits in stroke aphasia

Schumacher, Rahel; Halai, Ajay D.; Ralph, Matthew A. Lambon

doi:10.1093/brain/awz258

Cited by 104 publications

(132 citation statements)

References 82 publications

(145 reference statements)

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“…We could speculate that this result might reflect variation in another form of executive process (distinct from the executive process that seems to be captured by the second factor), which might be involved in (i) iteratively generating and assessing semantic associations (Camel and Cactus and synonym judgement); (ii) generating speech (words per minute and total words produced); and (iii) generating and monitoring ‘chunks’ to complete the backwards digit span task. Indeed, Schumacher et al (2019) found that the Camel and Cactus test loaded onto an ‘Inhibit-Generate’ executive component. However, without more measures of attention and executive function it is not possible to test these speculations.…”

Section: Resultsmentioning

confidence: 99%

“…These new approaches are based on the second source of individual differences noted above—namely, graded variations along continuous behavioural dimensions. Recent studies have reconceptualized the variations in PSA as forming an aphasic multidimensional space with each patient taking up a different position (typically varying in terms of phonology, semantics, speech fluency and, when assessed, non-language cognitive skills) ( Butler et al , 2014 ; Halai et al , 2017, 2018 a ; Schumacher et al , 2019 ). In this formulation, the classical aphasia labels (e.g.…”

Section: Introductionmentioning

confidence: 99%

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Graded, multidimensional intra- and intergroup variations in primary progressive aphasia and post-stroke aphasia

Ingram

Halai

Pobric

et al. 2020

Brain

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Language impairments caused by stroke (post-stroke aphasia, PSA) and neurodegeneration (primary progressive aphasia, PPA) have overlapping symptomatology, nomenclature and are classically divided into categorical subtypes. Surprisingly, PPA and PSA have rarely been directly compared in detail. Rather, previous studies have compared certain subtypes (e.g. semantic variants) or have focused on a specific cognitive/linguistic task (e.g. reading). This study assessed a large range of linguistic and cognitive tasks across the full spectra of PSA and PPA. We applied varimax-rotated principal component analysis to explore the underlying structure of the variance in the assessment scores. Similar phonological, semantic and fluency-related components were found for PSA and PPA. A combined principal component analysis across the two aetiologies revealed graded intra- and intergroup variations on all four extracted components. Classification analysis was used to test, formally, whether there were any categorical boundaries for any subtypes of PPA or PSA. Semantic dementia formed a true diagnostic category (i.e. within group homogeneity and distinct between-group differences), whereas there was considerable overlap and graded variations within and between other subtypes of PPA and PSA. These results suggest that (i) a multidimensional rather than categorical classification system may be a better conceptualization of aphasia from both causes; and (ii) despite the very different types of pathology, these broad classes of aphasia have considerable features in common.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Graded, multidimensional intra- and intergroup variations in primary progressive aphasia and post-stroke aphasia

Ingram

Halai

Pobric

et al. 2020

Brain

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“…Non-classical two-dimensional scaling was performed on this dissimilarity matrix (Shepard, 1980). Second, we looked for patterns of covariation in the presence or absence of clinical features (Perry et al, 2017;Grisanzio et al, 2018;Schumacher et al, 2019). We grouped the forty-five binary clinical features into twenty-four groups of related features by summing the number of present features in each group.…”

Section: Discussionmentioning

confidence: 99%

Redefining the multidimensional clinical phenotypes of frontotemporal lobar degeneration syndromes

Murley

Coyle‐Gilchrist

Rouse

et al. 2019

Preprint

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The syndromes caused by frontotemporal lobar degeneration (FTLD) have highly heterogenous and overlapping clinical features. There has been great progress in the refinement of clinical diagnostic criteria in the last decade, but we propose that a better understanding of aetiology, pathophysiology and symptomatic treatments can arise from a transdiagnostic approach to clinical phenotype and brain morphometry. In a cross-sectional epidemiological study, we examined 310 patients with a syndrome likely to be caused by frontotemporal lobar degeneration, including behavioural variant frontotemporal dementia (bvFTD), the non-fluent (nfvPPA), semantic (svPPA) variants of primary progressive aphasia, progressive supranuclear palsy (PSP) and corticobasal syndrome (CBS). We also included patients with logopenic primary progressive aphasia (lvPPA) and those who met criteria for PPA but not one of the three subtypes. To date, forty-nine patients have a neuropathological diagnosis. A principal component analysis identified symptom dimensions that broadly recapitulated the core features of the main clinical syndromes. However, the subject-specific scores on these dimensions showed considerable overlap across the diagnostic groups. Sixty-two percent of participants had phenotypic features that met the diagnostic criteria for more than one syndrome. Behavioural disturbance was prevalent in all groups. Forty-four percent of patients with CBS had PSP-like features and thirty percent of patients with PSP had CBS-like features. Many patients with PSP and CBS had language impairments consistent with nfvPPA while patients with bvFTD often had semantic impairments. Using multivariate source-based morphometry on a subset of patients (n=133), we identified patterns of co-varying brain atrophy that were represented across the diagnostic groups. Canonical correlation analysis of clinical and imaging components found three key brain-behaviour relationships that revealed a continuous spectrum across the cohort rather than discrete diagnostic entities. In the forty-six patients with longitudinal follow up (mean 3.6 years) syndromic overlap increased with time. Together, these results show that syndromes associated with FTLD do not form discrete mutually exclusive categories from their clinical features or structural brain changes, but instead exist in a multidimensional spectrum. Patients often manifest diagnostic features of multiple disorders and deficits in behaviour, movement and language domains are not confined to specific diagnostic groups. It is important to recognise individual differences in clinical phenotype, both for clinical management and to understand pathogenic mechanisms. We suggest that the adoption of a transdiagnostic approach to the spectrum of FTLD syndromes provides a useful framework with which to understand disease progression, heterogeneity and treatment.

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“…Post-stroke aphasia (PSA) is prevalent (Engelter et al, 2006) and debilitating (Tsouli et al, 2009), and there is increasing awareness that deficits in non-verbal cognitive processing might contribute to language performance in such individuals (Robson et al, 2013;Geranmayeh et al, 2014;Schumacher et al, 2019). Indeed, there is evidence from multiple aetiologies including congenital amusia (Foxton et al, 2004;Foxton et al, 2006), developmental dyslexia (Witton et al, 1998), specific language impairment (Corriveau et al, 2007), children who stutter (Wieland et al, 2015) and primary progressive aphasia (Goll et al, 2010;Grube et al, 2016) that language impairment can co-occur with more fundamental deficits in auditory processing, just as auditory processing abilities associate with language performance in healthy children (Grube et al, 2012) and adults .…”

Section: Introductionmentioning

confidence: 99%

Auditory beat perception is related to speech output fluency in post-stroke aphasia

Stefaniak

Ralph

Pérez

et al. 2020

Preprint

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Aphasia affects at least one third of stroke survivors, and there is increasing awareness that more fundamental deficits in auditory processing might contribute to impaired language performance in such individuals. We performed a comprehensive battery of psychoacoustic tasks assessing the perception of tone pairs and sequences across the domains of pitch, rhythm and timbre in 17 individuals with post-stroke aphasia and 17 controls. At the group level, we showed a significant difference in auditory perception in only one test (Dynamic Modulation detection). At the level of individual differences we demonstrated a correlation between metrical pattern (beat) perception and speech output fluency with strong effect (Spearman's rho = 0.72). This was specific in terms of the auditory tests and dissociated from more basic auditory timing perception, which did not correlate with output fluency. This was also specific in terms of the language and cognitive measures, amongst which phonological, semantic and executive function did not correlate with beat detection. We interpret the data in terms of a requirement for the analysis of the metrical structure of sound to construct fluent output, with both being a function of higher-order "temporal scaffolding". The beat perception task herein allows measurement of timing analysis without any need to account for motor output deficit, and could be a potential clinical tool to examine this. This work suggests strategies to improve fluency after stroke by training in metrical pattern perception.

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Assessing and mapping language, attention and executive multidimensional deficits in stroke aphasia

Cited by 104 publications

References 82 publications

Graded, multidimensional intra- and intergroup variations in primary progressive aphasia and post-stroke aphasia

Graded, multidimensional intra- and intergroup variations in primary progressive aphasia and post-stroke aphasia

Redefining the multidimensional clinical phenotypes of frontotemporal lobar degeneration syndromes

Auditory beat perception is related to speech output fluency in post-stroke aphasia

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