1
|
Utianski RL, Meade G, Duffy JR, Clark HM, Botha H, Machulda MM, Dickson DW, Whitwell JL, Josephs KA. Longitudinal characterization of patients with progressive apraxia of speech without clearly predominant phonetic or prosodic speech features. BRAIN AND LANGUAGE 2023; 245:105314. [PMID: 37607419 PMCID: PMC10592101 DOI: 10.1016/j.bandl.2023.105314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/05/2023] [Accepted: 08/17/2023] [Indexed: 08/24/2023]
Abstract
Most recent studies of progressive apraxia of speech (PAOS) have focused on patients with phonetic or prosodic predominant PAOS to understand the implications of the presenting clinical phenotype. Patients without a clearly predominating speech quality, or mixed AOS, have been excluded. Given the implications for disease progression, it is important to understand these patients early in the disease course to inform appropriate education and prognostication. The aim of this study was to describe a cohort of ten patients with initially mixed PAOS and how their clinical course evolves. Four patients were rated prosodic predominant later on (mild AOS at first visit); five were later designated phonetic (four with more than mild AOS at first visit); one was judged mixed at all visits. The study suggests patients without a clear predominance of speech featuresshould still be included in PAOS studies and thought of on the continuum of the disease spectrum.
Collapse
Affiliation(s)
| | - Gabriela Meade
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Joseph R Duffy
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Mary M Machulda
- Department of Psychology and Psychiatry, Mayo Clinic, Rochester, MN, USA
| | | | | | | |
Collapse
|
2
|
Cera ML, Ortiz KZ, Bertolucci PHF, Tsujimoto T, Minett T. Speech and phonological impairment across Alzheimer's disease severity. JOURNAL OF COMMUNICATION DISORDERS 2023; 105:106364. [PMID: 37453160 DOI: 10.1016/j.jcomdis.2023.106364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION Phonetic-phonological impairments have been described in dementia due to Alzheimer's disease (AD). However, whether the likely phonological-linguistic changes progress with the evolution of the disease or whether phonetic-motor manifestations occur in all three stages of AD (mild, moderate, and severe) has not yet been clarified. Thus, the aim of this study was to verify whether phonological-linguistic and phonetic-motor speech manifestations occur in the mild, moderate, and severe stages of AD. METHODS Thirty participants in each stage of probable AD (mild, moderate, and severe) and 30 healthy older adults underwent cognitive, instrumental activities of daily living and phonetic-phonological assessments. Phonetic-phonological manifestations were classified into three types: likely phonetic-motor, likely phonological-linguistic, and manifestations that may occur in disorders of both phonetic and phonological origin. RESULTS The manifestations analyzed in this study occurred rarely. The manifestations that may occur in disorders of both phonetic and phonological origin were the most common in all stages of the disease. The likely phonetic-motor manifestations emerged during the mild stage of the disease (distortions, prolonged intersegment duration, and vowel prolongations), while the likely phonological-linguistic manifestations were present mainly in the moderate (substitutions and attempts at the word level) and severe stages (substitutions, attempts at the word level, self-corrections, and anticipations). The occurrence of phonetic-phonological manifestations increased with disease progression. CONCLUSIONS The type of phonological and phonetic manifestations in the individuals with AD differed according to the dementia stage and were statistically more frequent as dementia worsened.
Collapse
Affiliation(s)
| | - Karin Zazo Ortiz
- Department of Speech, Language, and Hearing Sciences, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Tamy Tsujimoto
- Department of Biostatistics, University of North Carolina, NC, United States of America
| | - Thaís Minett
- Department of Radiology, Cambridge University Hospitals, NHS Foundation Trust, UK
| |
Collapse
|
3
|
Utianski RL, Duffy JR, Martin PR, Clark HM, Stierwalt JAG, Botha H, Ali F, Whitwell JL, Josephs KA. Rate Modulation Abilities in Acquired Motor Speech Disorders. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023; 66:3194-3205. [PMID: 36780318 PMCID: PMC10555464 DOI: 10.1044/2022_jslhr-22-00286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/21/2022] [Accepted: 11/30/2022] [Indexed: 06/18/2023]
Abstract
PURPOSE The purpose of this study was to describe, compare, and understand speech modulation capabilities of patients with varying motor speech disorders (MSDs) in a paradigm in which patients made highly cued attempts to speak faster or slower. METHOD Twenty-nine patients, 12 with apraxia of speech (AOS; four phonetic and eight prosodic subtype), eight with dysarthria (six hypokinetic and two spastic subtype), and nine patients without any neurogenic MSD completed a standard motor speech evaluation where they were asked to repeat words and sentences, which served as their "natural" speaking rate. They were then asked to repeat lower complexity (counting 1-5; repeating "cat" and "catnip" 3 times each) and higher complexity stimuli (repeating "catastrophe" and "stethoscope" 3 times each and "My physician wrote out a prescription" once) as fast/slow as possible. Word durations and interword intervals were measured. Linear mixed-effects models were used to assess differences related to MSD subtype and stimuli complexity on bidirectional rate modulation capacity as indexed by word duration and interword interval. Articulatory accuracy was also judged and compared. RESULTS Patients with prosodic AOS demonstrated a reduced ability to go faster; while they performed similarly to patients with spastic dysarthria when counting, patients with spastic dysarthria were able to increase rate similar to controls during sentence repetition; patients with prosodic AOS could not and made increased articulatory errors attempting to increase rate. AOS patients made more articulatory errors relative to other groups, regardless of condition; however, their percentage of errors reduced with an intentionally slowed speaking rate. CONCLUSIONS The findings suggest comparative rate modulation abilities in conjunction with their impact on articulatory accuracy may support differential diagnosis between healthy and abnormal speech and among subtypes of MSDs (i.e., type of dysarthria or AOS). Findings need to be validated in a larger, more representative cohort encompassing several types of MSDs. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.22044632.
Collapse
Affiliation(s)
| | | | - Peter R. Martin
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN
| | - Farwa Ali
- Department of Neurology, Mayo Clinic, Rochester, MN
| | | | | |
Collapse
|
4
|
Haley KL, Jacks A. Three-Dimensional Speech Profiles in Stroke Aphasia and Apraxia of Speech. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:1825-1834. [PMID: 36603554 PMCID: PMC10561969 DOI: 10.1044/2022_ajslp-22-00170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/02/2022] [Accepted: 10/04/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE Behaviorally, acquired apraxia of speech (AOS) is a multidimensional syndrome that the experienced clinician recognizes based on impaired articulation and abnormal temporal prosody. We conducted this study to determine the extent to which three core features of AOS-when defined quantitatively-distinguish categorically among aphasia with no or minimal speech sound involvement, aphasia with AOS, and aphasia with phonemic paraphasia (APP). METHOD The study involved retrospective analysis of 195 participants with stroke-induced aphasia. We used three quantitative measures (phonemic error frequency, distortion error frequency, and word syllable duration [WSD]) to divide the sample into four participant groups according to the most likely speech diagnosis: aphasia with minimal speech sound errors, AOS, APP, and a borderline group with mixed profiles. We then conducted nonparametric comparisons across groups for which the measures were not defined and visualized all three measures in a three-dimensional graph. RESULTS The measures distributed as multidimensional spectra rather than discrete diagnostic entities, and there was considerable behavioral overlap among participant groups. Thirty percent of participants presented with aphasia with minimal sound production difficulties, and they were statistically indistinguishable from the APP group on distortion frequency and WSD. Distortion frequency and WSD were in a borderline region between AOS and APP for 29% of participants. Compared to all other groups, participants with AOS produced significantly more errors that affected listeners' phonemic perception. CONCLUSIONS The results suggest that the current AOS-APP dichotomy has limited validity. We conclude that a continuous multidimensional view of speech variation would be a constructive perspective from which to understand how the left cerebral hemisphere produces speech and that quantitative and normed speech measures should be used to inform differential diagnosis in clinical settings. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21807609.
Collapse
Affiliation(s)
- Katarina L. Haley
- Division of Speech and Hearing Sciences, The University of North Carolina at Chapel Hill
| | - Adam Jacks
- Division of Speech and Hearing Sciences, The University of North Carolina at Chapel Hill
| |
Collapse
|
5
|
Rowe HP, Shellikeri S, Yunusova Y, Chenausky KV, Green JR. Quantifying articulatory impairments in neurodegenerative motor diseases: A scoping review and meta-analysis of interpretable acoustic features. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 25:486-499. [PMID: 36001500 PMCID: PMC9950294 DOI: 10.1080/17549507.2022.2089234] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
PURPOSE Neurodegenerative motor diseases (NMDs) have devastating effects on the lives of patients and their loved ones, in part due to the impact of neurologic abnormalities on speech, which significantly limits functional communication. Clinical speech researchers have thus spent decades investigating speech features in populations suffering from NMDs. Features of impaired articulatory function are of particular interest given their detrimental impact on intelligibility, their ability to encode a variety of distinct movement disorders, and their potential as diagnostic indicators of neurodegenerative diseases. The objectives of this scoping review were to identify (1) which components of articulation (i.e. coordination, consistency, speed, precision, and repetition rate) are the most represented in the acoustic literature on NMDs; (2) which acoustic articulatory features demonstrate the most potential for detecting speech motor dysfunction in NMDs; and (3) which articulatory components are the most impaired within each NMD. METHOD This review examined literature published between 1976 and 2020. Studies were identified from six electronic databases using predefined key search terms. The first research objective was addressed using a frequency count of studies investigating each articulatory component, while the second and third objectives were addressed using meta-analyses. RESULT Findings from 126 studies revealed a considerable emphasis on articulatory precision. Of the 24 features included in the meta-analyses, vowel dispersion/distance and stop gap duration exhibited the largest effects when comparing the NMD population to controls. The meta-analyses also revealed divergent patterns of articulatory performance across disease types, providing evidence of unique profiles of articulatory impairment. CONCLUSION This review illustrates the current state of the literature on acoustic articulatory features in NMDs. By highlighting the areas of need within each articulatory component and disease group, this work provides a foundation on which clinical researchers, speech scientists, neurologists, and computer science engineers can develop research questions that will both broaden and deepen the understanding of articulatory impairments in NMDs.
Collapse
Affiliation(s)
- Hannah P Rowe
- MGH Institute of Health Professions, Boston, MA, USA
| | - Sanjana Shellikeri
- Department of Speech-Language Pathology & Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
- Penn Frontotemporal Degeneration Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Yana Yunusova
- Department of Speech-Language Pathology & Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - Karen V Chenausky
- MGH Institute of Health Professions, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA, and
| | - Jordan R Green
- MGH Institute of Health Professions, Boston, MA, USA
- Speech and Hearing Biosciences and Technology Program, Harvard University, Cambridge, MA, USA
| |
Collapse
|
6
|
Utianski RL, Josephs KA. An Update on Apraxia of Speech. Curr Neurol Neurosci Rep 2023; 23:353-359. [PMID: 37269450 PMCID: PMC10629164 DOI: 10.1007/s11910-023-01275-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE OF REVIEW Apraxia of speech (AOS) is a motor speech disorder that has long been recognized to occur secondary to acute neurologic insults and, more recently, to neurodegenerative diseases as a harbinger for progressive supranuclear palsy and corticobasal syndrome. This article reviews recent findings regarding the clinic phenotypes of AOS, neuroimaging correlates, and the underlying disease processes. RECENT FINDINGS Two clinical subtypes of AOS map onto two underlying 4-repeat tauopathies. New imaging techniques have recently been applied to the study of progressive AOS. There is no data on the impact of behavioral intervention, although studies of nonfluent/agrammatic primary progressive aphasia that include patients with AOS suggest some benefit in speech intelligibility and maintenance. While recent findings suggest subtypes of AOS exist that are linked to molecular pathology and have important implications for disease progression, further research is needed to assess outcome of behavioral and other types of intervention.
Collapse
Affiliation(s)
- Rene L Utianski
- Department of Neurology, Mayo Clinic College of Medicine and Science, 200 1St Street S.W., Rochester, MN, 55905, USA
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic College of Medicine and Science, 200 1St Street S.W., Rochester, MN, 55905, USA.
| |
Collapse
|
7
|
Josephs KA, Duffy JR, Martin PR, Stephens YC, Singh NA, Clark HM, Botha H, Lowe VJ, Whitwell JL, Utianski RL. Acoustic Analysis and Neuroimaging Correlates of Diadochokinetic Rates in Mild-Moderate Primary Progressive Apraxia of Speech. BRAIN AND LANGUAGE 2023; 240:105254. [PMID: 37584042 PMCID: PMC10424909 DOI: 10.1016/j.bandl.2023.105254] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Speech rate can be judged clinically using diadochokinetic (DDK) tasks, such as alternating motion rates (AMR) and sequential motion rates (SMR). We evaluated whether acoustic AMR/SMR speech rates would differentiate primary progressive apraxia of speech (PPAOS) from healthy controls, and determined how DDK rates relate to phonetic and prosodic speech characteristics and brain metabolism on FDG-PET. Rate was calculated for each of three AMRs (repetitions of 'puh', 'tuh', and 'kuh') and for SMRs (repetitions of 'puhtuhkuh') for 27 PPAOS patients and 52 controls who underwent FDG-PET. PPAOS patients were slower than controls on all DDK tasks. All DDK rates correlated with apraxia of speech severity, with strongest associations with prosodic speech features. Slower DDK rates were associated with hypometabolism in the right cerebellar dentate and left supplementary motor area. Performance on AMR rate, not just SMR rate, may be impaired in mild PPAOS, but sensitivity and specificity require further study.
Collapse
Affiliation(s)
| | | | - Peter R. Martin
- Department of Quantitative Health Research, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Val J. Lowe
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | | |
Collapse
|
8
|
Duffy JR, Martin PR, Clark HM, Utianski RL, Strand EA, Whitwell JL, Josephs KA. The Apraxia of Speech Rating Scale: Reliability, Validity, and Utility. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2023; 32:469-491. [PMID: 36630926 PMCID: PMC10171845 DOI: 10.1044/2022_ajslp-22-00148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/17/2022] [Accepted: 10/11/2022] [Indexed: 05/12/2023]
Abstract
PURPOSE The purpose of this study was to examine the interrater reliability and validity of the Apraxia of Speech Rating Scale (ASRS-3.5) as an index of the presence and severity of apraxia of speech (AOS) and the prominence of several of its important features. METHOD Interrater reliability was assessed for 27 participants. Validity was examined in a cohort of 308 participants (120 with and 188 without progressive AOS) through item analysis; item-Total score correlations; correlations among ASRS Total score and component subscores and independent clinical ratings of AOS, dysarthria and aphasia severity, intelligibility, and articulatory errors, as well as years postonset and age; and regression models assessing item and Total score prediction of AOS presence. RESULTS Interrater reliability was good or excellent for most items and excellent for the Total score. Item and Total score analyses revealed good separation of participants with versus without AOS. Inter-item and item-Total score correlations were generally moderately high as were correlations between the ASRS Total score and independent ratings of AOS severity, intelligibility, and articulatory errors. The Total score was not meaningfully correlated with ratings of aphasia and dysarthria severity, years postonset, or age. Total scores below 7 and above 10 revealed excellent diagnostic sensitivity and specificity for AOS. The presence of eight or more abnormal features was also highly predictive of AOS presence. CONCLUSIONS The ASRS-3.5 is a reliable and valid scale for identifying the presence and severity of AOS and its predominant features. It has excellent sensitivity to AOS presence and excellent specificity relative to aphasia and dysarthria in patients with neurodegenerative disease. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21817584.
Collapse
Affiliation(s)
| | - Peter R. Martin
- Department of Quantitative Health Sciences (Biostatistics), Mayo Clinic, Rochester, MN
| | | | | | - Edythe A. Strand
- Department of Neurology, Mayo Clinic, Rochester, MN
- Department of Speech & Hearing Sciences, University of Washington, Seattle
| | | | | |
Collapse
|
9
|
Rowe HP, Gochyyev P, Lammert AC, Lowit A, Spencer KA, Dickerson BC, Berry JD, Green JR. The efficacy of acoustic-based articulatory phenotyping for characterizing and classifying four divergent neurodegenerative diseases using sequential motion rates. J Neural Transm (Vienna) 2022; 129:1487-1511. [PMID: 36305960 PMCID: PMC9859630 DOI: 10.1007/s00702-022-02550-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/13/2022] [Indexed: 01/25/2023]
Abstract
Despite the impacts of neurodegeneration on speech function, little is known about how to comprehensively characterize the resulting speech abnormalities using a set of objective measures. Quantitative phenotyping of speech motor impairments may have important implications for identifying clinical syndromes and their underlying etiologies, monitoring disease progression over time, and improving treatment efficacy. The goal of this research was to investigate the validity and classification accuracy of comprehensive acoustic-based articulatory phenotypes in speakers with distinct neurodegenerative diseases. Articulatory phenotypes were characterized based on acoustic features that were selected to represent five components of motor performance: Coordination, Consistency, Speed, Precision, and Rate. The phenotypes were first used to characterize the articulatory abnormalities across four progressive neurologic diseases known to have divergent speech motor deficits: amyotrophic lateral sclerosis (ALS), progressive ataxia (PA), Parkinson's disease (PD), and the nonfluent variant of primary progressive aphasia and progressive apraxia of speech (nfPPA + PAOS). We then examined the efficacy of articulatory phenotyping for disease classification. Acoustic analyses were conducted on audio recordings of 217 participants (i.e., 46 ALS, 52 PA, 60 PD, 20 nfPPA + PAOS, and 39 controls) during a sequential speech task. Results revealed evidence of distinct articulatory phenotypes for the four clinical groups and that the phenotypes demonstrated strong classification accuracy for all groups except ALS. Our results highlight the phenotypic variability present across neurodegenerative diseases, which, in turn, may inform (1) the differential diagnosis of neurological diseases and (2) the development of sensitive outcome measures for monitoring disease progression or assessing treatment efficacy.
Collapse
Affiliation(s)
- Hannah P Rowe
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Charlestown, Boston, MA, USA
| | - Perman Gochyyev
- School of Healthcare Leadership, MGH Institute of Health Professions, Boston, MA, USA
- Berkeley Evaluation and Assessment Research Center, University of California at Berkeley, Berkeley, CA, USA
| | - Adam C Lammert
- Department of Biomedical Engineering, Worchester Polytechnic Institute, Worcester, MA, USA
| | - Anja Lowit
- Department of Speech and Language Therapy, University of Strathclyde, Glasgow, Scotland, UK
| | - Kristie A Spencer
- Department of Speech and Hearing Sciences, University of Washington, Seattle, WA, USA
| | - Bradford C Dickerson
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - James D Berry
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Jordan R Green
- Department of Rehabilitation Sciences, MGH Institute of Health Professions, Charlestown, Boston, MA, USA.
| |
Collapse
|
10
|
Cordella C, Gutz SE, Eshghi M, Stipancic KL, Schliep M, Dickerson BC, Green JR. Acoustic and Kinematic Assessment of Motor Speech Impairment in Patients With Suspected Four-Repeat Tauopathies. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2022; 65:4112-4132. [PMID: 36306508 PMCID: PMC9940887 DOI: 10.1044/2022_jslhr-22-00177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE The aim of this study was to use acoustic and kinematic speech measures to characterize type of motor speech impairment-apraxia of speech (AOS) versus dysarthria-in individuals with four-repeat tauopathy (4RT)-associated syndromes, including nonfluent variant primary progressive aphasia (nfvPPA), primary progressive AOS (PPAOS), corticobasal syndrome (CBS), and progressive supranuclear palsy syndrome (PSPs). METHOD Twenty patient participants were recruited and stratified into two groups: (a) a motor-speech-impaired group of individuals with nfvPPA, PPAOS, CBS, or PSPs and suspected 4RT pathology ("MSI+") and (b) a non-motor-speech-impaired group of individuals with logopenic variant primary progressive aphasia ("MSI-"). Ten healthy, age-matched controls also participated in the study. Participants completed a battery of speech tasks, and 15 acoustic and kinematic speech measures were derived. Quantitative speech measures were grouped into feature categories ("AOS features," "dysarthria features," "shared features"). In addition to quantitative speech measures, two certified speech-language pathologists made independent, blinded auditory-perceptual ratings of motor speech impairment. A principal component analysis (PCA) was conducted to investigate the relative contributions of quantitative features. RESULTS Quantitative speech measures were generally concordant with independent clinician ratings of motor speech impairment severity. Hypothesis-driven groupings of quantitative measures differentiated predominantly apraxic from predominantly dysarthric presentations within the MSI+ group. PCA results provided additional evidence for differential profiles of motor speech impairment in the MSI+ group; heterogeneity across individuals is explained in large part by varying levels of overall severity-captured by the shared feature variable group-and degree of apraxia severity, as measured by the AOS feature variable group. CONCLUSIONS Quantitative features reveal heterogeneity of MSI in the 4RT group in terms of both overall severity and subtype of MSI. Results suggest the potential for acoustic and kinematic speech assessment methods to inform characterization of motor speech impairment in 4RT-associated syndromes. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.21401778.
Collapse
Affiliation(s)
- Claire Cordella
- Department of Speech, Language & Hearing Sciences, Boston University, MA
| | - Sarah E. Gutz
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Cambridge, MA
| | - Marziye Eshghi
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | - Kaila L. Stipancic
- Department of Communicative Disorders and Sciences, University at Buffalo, NY
| | - Megan Schliep
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| | | | - Jordan R. Green
- Program in Speech and Hearing Bioscience and Technology, Harvard University, Cambridge, MA
- Department of Communication Sciences and Disorders, MGH Institute of Health Professions, Boston, MA
| |
Collapse
|
11
|
Zhao J, Li Y, Zhang X, Yuan Y, Cheng Y, Hou J, Duan G, Liu B, Wang J, Wu D. Alteration of network connectivity in stroke patients with apraxia of speech after tDCS: A randomized controlled study. Front Neurol 2022; 13:969786. [PMID: 36188376 PMCID: PMC9521848 DOI: 10.3389/fneur.2022.969786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 08/22/2022] [Indexed: 11/26/2022] Open
Abstract
Objective This study aimed to examine the changes in the functional connectivity of the cortical speech articulation network after anodal transcranial direct current stimulation (A-tDCS) over the left lip region of the primary motor cortex (M1) in subacute post-stroke patients with apraxia of speech (AoS), and the effect of A-tDCS on AoS. Methods A total of 24 patients with post-stroke AoS were randomized into two groups and received A-tDCS over the left lip region of M1 (tDCS group)/ sham tDCS (control group) as well as speech and language therapy two times per day for 5 days. Before and after the treatment, the AoS assessments and electroencephalogram (EEG) were evaluated. The cortical interconnections were measured using the EEG non-linear index of cross approximate entropy (C-ApEn). Results The analysis of EEG showed that, after the treatment, the activated connectivity was all in the left hemisphere, and not only regions in the speech articulation network but also in the dorsal lateral prefrontal cortex (DLPFC) in the domain-general network were activated in the tDCS group. In contrast, the connectivity was confined to the right hemisphere and between bilateral DLPFC and bilateral inferior frontal gyrus (IFG) in the control group. In AoS assessments, the tDCS group improved significantly more than the control group in four of the five subtests. The results of multivariate linear regression analyses showed that only the group was significantly associated with the improvement of word repetition (P = 0.002). Conclusion A-tDCS over the left lip region of M1 coupled with speech therapy could upregulate the connectivity of both speech-specific and domain-general networks in the left hemisphere. The improved articulation performance in patients with post-stroke AoS might be related to the enhanced connectivity of networks in the left hemisphere induced by tDCS. Clinical trial registration ChiCTR-TRC-14005072.
Collapse
Affiliation(s)
- Jiayi Zhao
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Science, Beijing, China
| | - Yuanyuan Li
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Science, Beijing, China
| | - Xu Zhang
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Science, Beijing, China
| | - Ying Yuan
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Yinan Cheng
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, China
| | - Jun Hou
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Science, Beijing, China
| | - Guoping Duan
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Science, Beijing, China
| | - Baohu Liu
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Science, Beijing, China
| | - Jie Wang
- Department of Rehabilitation, Xuanwu Hospital Capital Medical University, Beijing, China
- Jie Wang
| | - Dongyu Wu
- Department of Rehabilitation, Wangjing Hospital, China Academy of Chinese Medical Science, Beijing, China
- *Correspondence: Dongyu Wu
| |
Collapse
|
12
|
Speech quality differences between internally generated and externally presented contents in motor speech disorder. Acta Neurol Belg 2022; 122:827-832. [PMID: 35037227 DOI: 10.1007/s13760-022-01866-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 01/06/2022] [Indexed: 11/01/2022]
|
13
|
Utianski RL, Martin PR, Duffy JR, Botha H, Clark HM, Josephs KA. Assessing Change in Communication Limitations in Primary Progressive Apraxia of Speech and Aphasia: A 1-Year Follow-Up Study. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:2368-2378. [PMID: 34491800 PMCID: PMC9132068 DOI: 10.1044/2021_ajslp-20-00402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/11/2021] [Accepted: 05/26/2021] [Indexed: 06/13/2023]
Abstract
Purpose Individuals with primary progressive apraxia of speech have apraxia of speech (AOS) as the initial and predominant symptom. Many develop aphasia and/or dysarthria later in the disease course. It was previously demonstrated that patients with neurodegenerative AOS experience reduced participation in communication that is further exacerbated by co-occurring language deficits (Utianski et al., 2020). Measures of disease severity did not necessarily correlate with measures of participation restrictions. The aim of this follow-up study was to describe changes in communication limitations in these patients, again measured by (a) the patient via the Communicative Participation Item Bank (CPIB) and (b) the speech-language pathologist via the American Speech-Language-Hearing Association's (ASHA's) Functional Communication Measures (FCMs) and an adapted motor speech disorder (MSD) severity rating to determine if there are significant changes in these and other objective speech and language measures at follow-up after 1 year. Method Of the 24 patients reported in the study of Utianski et al. (2020), 17 (10 men, seven women) returned for a second visit approximately 1 year following the first visit. Identical procedures were utilized; the communication measures collected at each visit were statistically compared. Correlations were calculated between the participation ratings and other clinical assessment measures at the second visit and for the change in scores on those measures between the first and second visits. Results There were statistically significant differences in AOS and aphasia severity between visits. There were significant changes in clinical assessments, MSD severity rating, and all ASHA FCMs between visits, but not the CPIB. Correlation analyses suggest the relationships among clinical and participation measures are complex; overall, patients with more severe changes in AOS experienced greater changes in participation restrictions. Conclusions The findings of this study support the use of patient-reported outcome measures as they may better reflect the patient experience, including the influence of factors such as ongoing speech therapy and the emergence of neuropsychiatric features, and associated changes in day-to-day functioning, when other measures may simply index the progression of the disease. Supplemental Material https://doi.org/10.23641/asha.16528512.
Collapse
Affiliation(s)
| | - Peter R. Martin
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Hugo Botha
- Department of Neurology, Mayo Clinic, Rochester, MN
| | | | | |
Collapse
|
14
|
Bouvier L, Monetta L, Vitali P, Laforce R, Martel-Sauvageau V. A Preliminary Look Into the Clinical Evolution of Motor Speech Characteristics in Primary Progressive Apraxia of Speech in Québec French. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2021; 30:1459-1476. [PMID: 33719528 DOI: 10.1044/2020_ajslp-20-00162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Purpose This study aimed to track changes in acoustical and perceptual features of motor speech in patients with phonetic and prosodic primary progressive apraxia of speech (PPAOS) in Québec French over an 18-month period. Method A prospective multiple-case series with multiple testing periods, including four participants with a diagnosis of PPAOS, was conducted. Participants were 0.5-4 years postonset of disease at baseline. They underwent comprehensive motor speech and language assessments and cognitive screening every 6 months for up to 18 months. Acoustical and perceptual analyses of motor speech were conducted. Results Results showed a considerable impairment in motor speech abilities for patients with PPAOS at all time points and a significant decrease in performance for almost all articulatory and prosodic measures over time. Passage reading and diadochokinesis seemed particularly promising for the tracking of changes in PPAOS motor speech characteristics and PPAOS classification. Quantifying length of speech runs made it possible to distinguish phonetic from prosodic PPAOS. Finally, the patients who evolved to phonetic PPAOS developed aphasia, and the two with prosodic PPAOS showed greater motor symptoms such as unequivocal dysarthria. Conclusion This study extends the growing literature on PPAOS and its subtypes by describing specific changes in articulatory and prosodic abilities over a period of at least 6 months, which are important for the diagnosis and management of PPAOS.
Collapse
Affiliation(s)
- Liziane Bouvier
- Département de réadaptation, Faculté de Médecine, Université Laval, Québec, Canada
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec, Canada
- Centre de recherche CERVO Research Centre, Québec, Canada
| | - Laura Monetta
- Département de réadaptation, Faculté de Médecine, Université Laval, Québec, Canada
- Centre de recherche CERVO Research Centre, Québec, Canada
| | - Paolo Vitali
- McGill University Research Centre for Studies in Aging, Montréal, Canada
- CIUSSS Nord-de-l'Île-de-Montréal, Canada
| | - Robert Laforce
- Département des Sciences Neurologiques, Clinique Interdisciplinaire de Mémoire, CHU de Québec, Canada
| | - Vincent Martel-Sauvageau
- Département de réadaptation, Faculté de Médecine, Université Laval, Québec, Canada
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale, Québec, Canada
| |
Collapse
|
15
|
Dang J, Graff-Radford J, Duffy JR, Utianski RL, Clark HM, Stierwalt JA, Whitwell JL, Josephs KA, Botha H. Progressive apraxia of speech: delays to diagnosis and rates of alternative diagnoses. J Neurol 2021; 268:4752-4758. [PMID: 33945003 DOI: 10.1007/s00415-021-10585-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Progressive apraxia of speech (PAOS) is a neurodegenerative disorder of speech programming distinct from aphasia and dysarthria, most commonly associated with a 4-repeat tauopathy. Our objective was to better understand the reasons for possible delays or diagnostic errors for patients with PAOS. METHODS Seventy-seven consecutive PAOS research participants from the Neurodegenerative Research Group were included in this study. The medical records for these patients were reviewed in detail. For each speech-related visit, data such as the chief complaint, clinical findings, and neuroimaging findings were recorded. RESULTS Apraxia of speech was the initial diagnosis in 20.1% of participants at first evaluation noted in the historical record. Other common diagnoses included primary progressive aphasia (PPA) (20.1%), dysarthria (18.18%), MCI/Dementia (6.5%), and motor neuron disease (3.9%). It took a median of 2.02 (range: 0.16-8.18) years from symptoms onset for participants to receive an initial diagnosis and 3.00 (range: 0.49-9.42) years to receive a correct diagnosis. Those who were seen by a speech-language pathologist (SLP) during their first documented encounter were more likely to be correctly diagnosed with PAOS (37/48) after SLP consultation than those who were not seen by an SLP on initial encounter (5/29) (p < 0.001). CONCLUSION Approximately 80% of patients with PAOS were imprecisely diagnosed at their first visit, with it taking a median of 3 years from symptom onset to receiving a diagnosis of PAOS. Being seen by a speech-language pathologist during the initial evaluation increased the likelihood of a correct apraxia of speech diagnosis.
Collapse
Affiliation(s)
- Johnny Dang
- Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.,Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Joseph R Duffy
- Department Neurology Division of Speech Pathology, Mayo Clinic, Rochester, MN, USA
| | - Rene L Utianski
- Department Neurology Division of Speech Pathology, Mayo Clinic, Rochester, MN, USA
| | - Heather M Clark
- Department Neurology Division of Speech Pathology, Mayo Clinic, Rochester, MN, USA
| | - Julie A Stierwalt
- Department Neurology Division of Speech Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Keith A Josephs
- Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Hugo Botha
- Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
| |
Collapse
|
16
|
Bouvier L, Monetta L, Laforce RJ, Vitali P, Bocti C, Martel-Sauvageau V. Progressive apraxia of speech in Quebec French speakers: A case series. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2021; 56:528-548. [PMID: 33570823 DOI: 10.1111/1460-6984.12606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND The term progressive apraxia of speech (PAOS) is used to describe speakers presenting with isolated or dominant apraxia of speech in the context of a neurodegenerative syndrome, including primary progressive apraxia of speech (PPAOS) and dominant progressive apraxia of speech (DAOS), respectively. Its motor speech profile has been increasingly explored in the last decade, but description remains vague and very English oriented, although the effect of speakers' language on motor speech phenotypes is increasingly recognized. Although some studies suggest that speakers presenting with isolated PAOS (PPAOS) versus dominant PAOS with concomitant aphasia (DAOS) should be differentiated, distinct characteristics of the two presentations are unclear. Furthermore, a careful description of their clinical presentation in languages other than English is required. AIMS To describe the motor speech characteristics of Quebec French-speaking participants with prominent PAOS and to explore the communication profile of those presenting more specifically with isolated PAOS (PPAOS), and with dominant PAOS and concomitant aphasia (DAOS). METHODS & PROCEDURES A thorough effort to recruit all speakers presenting with PAOS in the larger population areas of the province of Quebec was conducted over a 3-year span. A total of nine participants with PAOS (pwPAOS; PPAOS = 5, DAOS = 4) underwent a comprehensive language and motor speech assessment, and a cognitive screening. Their performance was compared with 30 matched healthy controls. OUTCOMES & RESULTS As a group, pwPAOS differed from healthy speakers on all acoustic and perceptual measures. The PPAOS and PAOS subgroups were similar on several measures, but participants from the PPAOS subgroup tended to perform better on articulatory measures and maximum speech rate tasks. CONCLUSIONS & IMPLICATIONS This study provides an in-depth analysis of motor speech characteristics of PAOS in Quebec French speakers and adds further evidence for the differentiation of PPAOS and DAOS. Combining simple perceptual and acoustic analyses represent a promising approach to distinguish the two variants and identify treatment targets. What this paper adds What is already known on this subject Progressive apraxia of speech (PAOS) is a neurodegenerative syndrome characterized by progressive and initially isolated or dominant apraxia of speech (primary progressive apraxia of speech [PPAOS] and dominant progressive apraxia of speech [DAOS], respectively). Studies mostly report articulatory and prosodic deficits in PAOS, but concomitant deficits such as dysarthria and executive dysfunction are also reported. The description of motor speech skills in PAOS remains vague and English-oriented. Studies suggest that speakers presenting with isolated PAOS vs dominant PAOS with concomitant aphasia should be differentiated, but distinct characteristics of the two presentations are unclear. What this study adds to existing knowledge To the best of the authors' knowledge, this study is the first to report transversal data of Quebec-French participants with PPAOS and DAOS. Moreover, this study is a first step towards identifying potential characteristics that could facilitate the diagnosis of PPAOS and DAOS in Quebec French. It makes a significant contribution to our understanding of progressive apraxia of speech in different cultural languages. What are the potential or actual clinical implications of this work? This study also initiates the search for sensitive tasks for the diagnosis of those speakers (which is an important process), in addition to identifying the core characteristics of PAOS, DAOS, and PPAOS in the development of an assessment battery for this population.
Collapse
Affiliation(s)
- Liziane Bouvier
- Faculté de médecine, Université Laval, Quebec, QC, Canada
- Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Quebec, QC, Canada
- Centre de recherche CERVO Research Centre, Quebec, QC, Canada
| | - Laura Monetta
- Faculté de médecine, Université Laval, Quebec, QC, Canada
- Centre de recherche CERVO Research Centre, Quebec, QC, Canada
| | - Robert Jr Laforce
- Faculté de médecine, Université Laval, Quebec, QC, Canada
- Clinique Interdisciplinaire de Mémoire, Département des Sciences Neurologiques, CHU de Québec, Quebec, QC, Canada
| | - Paolo Vitali
- CIUSSS Nord-de-l'Île-de-Montréal, Montreal, QC, Canada
- Department of Neurology and Neurosurgery, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Christian Bocti
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
- Service de Neurologie, Département de Médecine, CHUS, Sherbrooke, QC, Canada
- Clinique de la Mémoire et Centre de Recherche sur le Vieillissement, CIUSSS de l'Estrie-CHUS, Sherbrooke, QC, Canada
| | - Vincent Martel-Sauvageau
- Faculté de médecine, Université Laval, Quebec, QC, Canada
- Service de Neurologie, Département de Médecine, CHUS, Sherbrooke, QC, Canada
| |
Collapse
|
17
|
Motor speech disorders in the nonfluent, semantic and logopenic variants of primary progressive aphasia. Cortex 2021; 140:66-79. [PMID: 33933931 DOI: 10.1016/j.cortex.2021.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/12/2021] [Accepted: 03/22/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Motor speech disorders (MSDs) are characteristic for nonfluent primary progressive aphasia (nfvPPA). In primary progressive aphasia (PPA) of the semantic (svPPA) and of the logopenic type (lvPPA), speech motor function is considered typically intact. However, knowledge on the prevalence of MSDs in svPPA and lvPPA is mainly based on studies with a priori knowledge of PPA syndrome diagnosis. This fully blinded retrospective study aims to provide data on the prevalence of all types of MSDs in a large sample of German-speaking patients with different subtypes of PPA. METHOD Two raters, blinded for PPA subtype, independently evaluated connected speech samples for MSD syndrome and severity from 161 patients diagnosed with nfvPPA, svPPA or lvPPA in the database of the German Consortium of Frontotemporal Lobar Degeneration (FTLDc). In case of disagreement, a third experienced rater re-evaluated the speech samples, followed by a consensus procedure. Consensus was reached for 160 patients (74 nfvPPA, 49 svPPA, 37 lvPPA). MAIN RESULTS Across all PPA syndromes, 43.8% of the patients showed MSDs. Patients with nfvPPA demonstrated the highest proportion of MSDs (62.2%), but MSDs were also identified in svPPA (26.5%) and lvPPA (29.7%), respectively. Overall, dysarthria was the most common class of MSDs, followed by apraxia of speech. In addition, we identified speech abnormalities presenting as "syllabic speech", "dysfluent speech", and "adynamic speech". DISCUSSION Our study confirmed MSDs as frequently occurring in PPA. The study also confirmed MSDs to be most common in patients with nfvPPA. However, MSDs were also found in substantial proportions of patients with svPPA and lvPPA. Furthermore, our study identified speech motor deficits that have not received attention in previous studies on PPA. The results are discussed against the background of the existing literature on MSDs in PPA, including theoretical considerations of the neuroanatomical conditions described for each of the different subtypes of PPA.
Collapse
|
18
|
Mailend ML, Maas E. To Lump or to Split? Possible Subtypes of Apraxia of Speech. APHASIOLOGY 2020; 35:592-613. [PMID: 33981126 PMCID: PMC8112072 DOI: 10.1080/02687038.2020.1836319] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/17/2020] [Indexed: 05/09/2023]
Abstract
BACKGROUND The speculation that apraxia of speech (AOS) is not a unitary diagnosis, but consists of different subtypes instead, has been around for decades. However, attempts to empirically substantiate such a notion remain few and far between. AIMS The primary objective of this article is to consider the different bases for identifying subtypes of AOS, review existing evidence regarding subtypes under each classification basis, and provide discussion and implications for future research. MAIN CONTRIBUTION AOS subtypes have been proposed on the basis of clinical symptomatology, theoretical constructs, and an analogy to limb apraxia. Different possible subtypes of AOS are reviewed, along with their empirical support and limitations. Empirical evidence, particularly in the context of a progressive disease, supports the idea that AOS diagnosis may capture different underlying impairments of speech motor planning. Future research to advance our understanding of AOS should carefully consider the basis for subtype classification, and include large sample sizes to differentiate individual variability from possible subtypes. CONCLUSIONS Several proposed AOS subtypes have found some support in the literature. Further research is needed to determine the validity, coherence and utility of possible AOS subtypes for theoretical and clinical purposes.
Collapse
|
19
|
Duffy JR, Utianski RL, Josephs KA. Primary Progressive Apraxia of Speech: From Recognition to Diagnosis and Care. APHASIOLOGY 2020; 35:560-591. [PMID: 34219857 PMCID: PMC8247786 DOI: 10.1080/02687038.2020.1787732] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 06/16/2020] [Indexed: 05/12/2023]
Abstract
BACKGROUND Apraxia of speech (AOS) can be caused by neurodegenerative disease and sometimes is its presenting sign (i.e., primary progressive apraxia of speech, PPAOS). During the last several decades our understanding of PPAOS has evolved from clinical recognition to a fuller understanding of its core and associated clinical features, its distinction from but relationship with primary progressive aphasia, its temporal course and eventual progression to include other neurological deficits, and its neuroimaging correlates and underlying pathology. AIMS This paper provides a comprehensive summary of the literature that has built the current knowledge base about PPAOS and progressive AOS as it co-occurs with progressive aphasia. It reviews the history of its emergence as a recognized syndrome; its relationship with the agrammatic/nonfluent variant of primary progressive aphasia; its salient perceptual features and subtypes; the acoustic and structural/physiological imaging measures that index its presence, severity, and distinction from aphasia; and principles and available data regarding its management and care. MAIN CONTRIBUTION A broad summary of what is known about AOS as a manifestation of neurodegenerative disease. CONCLUSIONS Primary progressive apraxia of speech is a recognizable syndrome that can be distinguished from other neurodegenerative conditions that affect speech and language.
Collapse
Affiliation(s)
- Joseph R Duffy
- Departments of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | |
Collapse
|
20
|
Miller HE, Guenther FH. Modelling speech motor programming and apraxia of speech in the DIVA/GODIVA neurocomputational framework. APHASIOLOGY 2020; 35:424-441. [PMID: 34108793 PMCID: PMC8183977 DOI: 10.1080/02687038.2020.1765307] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/03/2020] [Indexed: 05/24/2023]
Abstract
BACKGROUND The Directions Into Velocities of Articulators (DIVA) model and its partner, the Gradient Order DIVA (GODIVA) model, provide neurobiologically grounded, computational accounts of speech motor control and motor sequencing, with applications for the study and treatment of neurological motor speech disorders. AIMS In this review, we provide an overview of the DIVA and GODIVA models and how they explain the interface between phonological and motor planning systems to build on previous models and provide a mechanistic accounting of apraxia of speech (AOS), a disorder of speech motor programming. MAIN CONTRIBUTION Combined, the DIVA and GODIVA models account for both the segmental and suprasegmental features that define AOS via damage to (i) a speech sound map, hypothesized to reside in left ventral premotor cortex, (ii) a phonological content buffer hypothesized to reside in left posterior inferior frontal sulcus, and/or (iii) the axonal projections between these regions. This account is in line with a large body of behavioural work, and it unifies several prior theoretical accounts of AOS. CONCLUSIONS The DIVA and GODIVA models provide an integrated framework for the generation and testing of both behavioural and neuroimaging hypotheses about the underlying neural mechanisms responsible for motor programming in typical speakers and in speakers with AOS.
Collapse
Affiliation(s)
- Hilary E. Miller
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA
| | - Frank H. Guenther
- Department of Speech, Language, & Hearing Sciences, Boston University, Boston, MA
- Department of Biomedical Engineering, Boston University, Boston, MA
- The Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA
| |
Collapse
|