Cognitive Intervention Strategies Directed to Speech and Language Deficits in Primary Progressive Aphasia: Practice-Based Evidence from 18 Cases

Abstract

Background: Practice-based evidence can inform and support clinical decision making. Case-report series about the implementation of programs in real-world clinical settings may contribute to verifying the effectiveness of interventions for treating PPA in specific contexts, as well as illustrating challenges that need to be overcome. Objective: To describe and provide practice-based evidence on the effectiveness of four cognitive rehabilitation programs designed for individuals with PPA and directed to speech and language impairments, which were implemented in a specialized outpatient clinic. Methods: Multiple single-case study. Eighteen individuals with different subtypes of PPA were each assigned to one out of four training programs based on comprehensive speech and language assessments. The treatments targeted naming deficits, sentence production, speech apraxia, and phonological deficits. Pre- and post-treatment assessments were undertaken to compare trained and untrained items. Gains were generalized to a different task in the first two types of intervention (naming and sentence production). A follow-up assessment was conducted 1–8 months after treatment among 7 participants. Results: All individuals presented better performance in the trained items at the post-test for each rehabilitation program accomplished, demonstrating that learning of the trained strategies was achieved during the active phase of treatment. For 13 individuals, statistical significance was reached; while for five, the results were maintained. Results about untrained items, generalization to other tasks, and follow-up assessments are presented. Conclusion: The positive results found in our sample bring some practice-based evidence for the benefits of speech and language treatment strategies for clinical management of individuals with PPA.

Treatment of dementia: recommendations of the Scientific Department of Cognitive Neurology and Aging of the Brazilian Academy of Neurology

“…Statistically significant clinical benefits were observed in 13 individuals, while for five, the results were maintained. However, generalization to untrained items or to other tasks were observed only in two individuals 91 .…”

“…Dement Neuropsychol 2022 September;16(3 Suppl. 1): [83][84][85][86][87][88][89][90][91][92][93][94][95] In current clinical practice, memantine is commonly added to ChEI in subjects with moderate or severe vascular dementia. However, the benefits of memantine are very limited or controversial for controlling cognitive and neuropsychiatric symptoms, as well as for slowing cognitive or functional decline 61 .…”

Tratamento da demência: recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia

“…Benefícios clínicos estatisticamente significativos foram observados em 13 indivíduos, enquanto para cinco, os resultados foram mantidos. No entanto, a generalização para itens não treinados ou para outras tarefas foi observada apenas em dois indivíduos 91 .…”

Advances in Primary Progressive Aphasia

“…In "Cognitive Intervention Strategies Directed to Speech and Language Deficits in Primary Progressive Aphasia: Practice-Based Evidence from 18 Cases" [10], the authors demonstrated the importance of symptom-targeted intervention in a group of patients with PPA, again with heterogeneous clinical presentations. While there was no control cohort or within-group comparison to determine the impact of alternative treatment ap-proaches, the patients showed improved performance in trained items at post-test, with an individualized focus on either naming, sentence production, motor speech functioning, or phonological functioning.…”