Set-shifting and the on-line processing of relative clauses in Parkinson's disease: Results from a novel eye-tracking method

Voice Acoustic Instability During Spontaneous Speech in Parkinson's Disease

BACKGROUND

In people with Parkinson's disease (PwPD), both motor and cognitive deficits influence voice and other aspects of communication. PwPD demonstrate vocal instability, but acoustic declines over the course of speaking are not well characterized and the role of cognition on these declines is unknown. We examined voice acoustics related to speech motor instability by comparing the first and the last utterances within a speech task. Our objective was to determine if mild cognitive impairment (MCI) status was associated with different patterns of acoustic change during these tasks.

METHODS

Participants with PD (n = 44) were enrolled at University of Massachusetts Chan Medical School and classified by gold-standard criteria as normal cognition (PD-NC) or mild cognitive impairment (PD-MCI). The speech was recorded during the Rainbow Passage and a picture description task (Cookie Theft). We calculated the difference between first and last utterances in fo mean and standardized semitones (STSD), cepstral peak prominence-smoothed (CPPS), and low to high ratio (LH). We used t-tests to compare the declines in acoustic parameters between the task types and between participants with PD-NC versus PD-MCI.

RESULTS

Mean fo, fo variability (STSD) and CPPS declined from the first to the last utterance in both tasks, but there was no significant difference in these declines between the PD-NC and PD-MCI groups. Those with PD-MCI demonstrated lower fo variability on the whole in both tasks and lower CPPS in the picture description task, compared to those with PD-NC.

CONCLUSIONS

Mean and STSD fo as well as CPPS may be sensitive to PD-MCI status in reading and spontaneous speech tasks. Speech motor instability can be observed in these voice acoustic parameters over brief speech tasks, but the degree of decline does not depend on cognitive status. These findings will inform the ongoing development of algorithms to monitor speech and cognitive function in PD.

Language impairment in Parkinson’s disease: fMRI study of sentence reading comprehension

Parkinson’s disease (PD) affects the language processes, with a significant impact on the patients’ daily communication. We aimed to describe specific alterations in the comprehension of syntactically complex sentences in patients with PD (PwPD) as compared to healthy controls (HC) and to identify the neural underpinnings of these deficits using a functional connectivity analysis of the striatum. A total of 20 patients PwPD and 15 HC participated in the fMRI study. We analyzed their performance of a Test of sentence comprehension (ToSC) adjusted for fMRI. A task-dependent functional connectivity analysis of the striatum was conducted using the psychophysiological interaction method (PPI). On the behavioral level, the PwPD scored significantly lower (mean ± sd: 77.3 ± 12.6) in the total ToSC score than the HC did (mean ± sd: 86.6 ± 8.0), p = 0.02, and the difference was also significant specifically for sentences with a non-canonical word order (PD-mean ± sd: 69.9 ± 14.1, HC-mean ± sd: 80.2 ± 11.5, p = 0.04). Using PPI, we found a statistically significant difference between the PwPD and the HC in connectivity from the right striatum to the supplementary motor area [SMA, (4 8 53)] for non-canonical sentences. This PPI connectivity was negatively correlated with the ToSC accuracy of non-canonical sentences in the PwPD. Our results showed disturbed sentence reading comprehension in the PwPD with altered task-dependent functional connectivity from the right striatum to the SMA, which supports the synchronization of the temporal and sequential aspects of language processing. The study revealed that subcortical-cortical networks (striatal-frontal loop) in PwPD are compromised, leading to impaired comprehension of syntactically complex sentences.

Predictive language comprehension in Parkinson's disease

Verb and action knowledge deficits are reported in persons with Parkinson's disease (PD), even in the absence of dementia or mild cognitive impairment. However, the impact of these deficits on combinatorial semantic processing is less well understood. Following on previous verb and action knowledge findings, we tested the hypothesis that PD impairs the ability to integrate event-based thematic fit information during online sentence processing. Specifically, we anticipated persons with PD with age-typical cognitive abilities would perform more poorly than healthy controls during a visual world paradigm task requiring participants to predict a target object constrained by the thematic fit of the agent-verb combination. Twenty-four PD and 24 healthy age-matched participants completed comprehensive neuropsychological assessments. We recorded participants' eye movements as they heard predictive sentences (The fisherman rocks the boat) alongside target, agent-related, verb-related, and unrelated images. We tested effects of group (PD/control) on gaze using growth curve models. There were no significant differences between PD and control participants, suggesting that PD participants successfully and rapidly use combinatory thematic fit information to predict upcoming language. Baseline sentences with no predictive information (e.g., Look at the drum) confirmed that groups showed equivalent sentence processing and eye movement patterns. Additionally, we conducted an exploratory analysis contrasting PD and controls' performance on low-motion-content versus high-motion-content verbs. This analysis revealed fewer predictive fixations in high-motion sentences only for healthy older adults. PD participants may adapt to their disease by relying on spared, non-action-simulation-based language processing mechanisms, although this conclusion is speculative, as the analyses of high- vs. low-motion items was highly limited by the study design. These findings provide novel evidence that individuals with PD match healthy adults in their ability to use verb meaning to predict upcoming nouns despite previous findings of verb semantic impairment in PD across a variety of tasks.

Lexicality-Modulated Influence of Auditory Cortex on Subthalamic Nucleus During Motor Planning for Speech

Speech requires successful information transfer within cortical-basal ganglia loop circuits to produce the desired acoustic output. For this reason, up to 90% of Parkinson's disease patients experience impairments of speech articulation. Deep brain stimulation (DBS) is highly effective in controlling the symptoms of Parkinson's disease, sometimes alongside speech improvement, but subthalamic nucleus (STN) DBS can also lead to decreases in semantic and phonological fluency. This paradox demands better understanding of the interactions between the cortical speech network and the STN, which can be investigated with intracranial EEG recordings collected during DBS implantation surgery. We analyzed the propagation of high-gamma activity between STN, superior temporal gyrus (STG), and ventral sensorimotor cortices during reading aloud via event-related causality, a method that estimates strengths and directionalities of neural activity propagation. We employed a newly developed bivariate smoothing model based on a two-dimensional moving average, which is optimal for reducing random noise while retaining a sharp step response, to ensure precise embedding of statistical significance in the time-frequency space. Sustained and reciprocal neural interactions between STN and ventral sensorimotor cortex were observed. Moreover, high-gamma activity propagated from the STG to the STN prior to speech onset. The strength of this influence was affected by the lexical status of the utterance, with increased activity propagation during word versus pseudoword reading. These unique data suggest a potential role for the STN in the feedforward control of speech.

Reading Difficulties in Parkinson's Disease: A Stepped Care Model for Neurovisual Rehabilitation

BACKGROUND

People with Parkinson's disease (PD) frequently experience reading difficulties. Little is known about what functional impairments distinguish people with PD with and without reading difficulties and how these should guide rehabilitation.

OBJECTIVE

To provide concrete advice for an efficient stepped care model for reading difficulties in PD, based on extensive functional assessments.

METHODS

This study included 74 people with PD in a neurovisual rehabilitation setting who underwent assessment of visual, visuoperceptual, and cognitive functions. Outcomes were compared between those with frequent (RD+; N = 55) and infrequent reading difficulties (RD-; N = 19). Aids and advice provided during rehabilitation were registered.

RESULTS

Only a few functions appeared to distinguish RD+ and RD-. Visual functions (i.e., contrast sensitivity, g = 0.76; reading acuity, g = 0.66; visual acuity, g = 0.54) and visuoperceptual functions (i.e., visual attention, g = 0.58, visual motor speed, g = 0.56) showed significant worse scores in RD+ compared to RD-. Aids and advice applied consisted mainly of optimizing refraction, improving lighting, and optimizing text size and spacing.

CONCLUSION

The test battery showed significant differences between RD+ and RD-on only a few tests on visual and visuoperceptual functions. The applied aids and advice matched well with these impairments. Therefore, we recommend a stepped care model, starting with a short test battery on these functions. If this battery indicates functional impairments, this can be followed by standard aids and advice to improve reading. Only in case of insufficient effect additional testing should take place.

Task-based profiles of language impairment and their relationship to cognitive dysfunction in Parkinson's disease

Objective

Parkinson’s Disease (PD) is associated with both motor and non-motor problems, such as cognitive impairment. Particular focus in this area has been on the relationship between language impairment and decline in other cognitive functions, with the literature currently inconclusive on how the nature and degree of language impairment relate to cognition or other measures of disease severity. In addition, little information is available on how language problems identified in experimental task set-ups relate to competency in self-generated language paradigms such as picture description, monologues or conversations. This study aimed to inform clinical management of language impairment in PD by exploring (1) language performance across a range of experimental as well as self-generated language tasks, (2) how the relationship between these two aspects might be affected by the nature of the cognitive and language assessment; and (3) to what degree performance can be predicted across the language tasks.

Methods

22 non-demented people with PD (PwPD) and 22 healthy control participants performed a range of cognitive and language tasks. Cognitive tasks included a screening assessment in addition to tests for set shifting, short term memory, attention, as well as letter and category fluency. Language was investigated in highly controlled grammar tasks as well as a Sentence Generation and a Narrative.

Results

The study highlighted impaired ability in set-shifting and letter fluency in the executive function tasks, and a higher rate of grammatical and lexical errors across all language tasks in the PD group. The performance in the grammar task was linked to set shifting ability, but error rates in Sentence Generation and Narrative were independent of this. There was no relevant relationship between performances across the three language tasks.

Conclusions

Our results suggest that there is a link between executive function and language performance, but that this is task dependent in non-demented PwPD. This has implications for the management of language impairment in PD, both for assessment and for designing effective interventions.

Specific pattern of linguistic impairment in Parkinson's disease patients with subjective cognitive decline and mild cognitive impairment predicts dementia

OBJECTIVE

Parkinson's disease patients with subjective cognitive decline (PD-SCD) and mild cognitive impairment (PD-MCI) have an increased risk of dementia (PDD). Thus, the identification of early cognitive changes that can be useful predictors of PDD is a highly relevant challenge. Posterior cortically based functions, including linguistic processes, have been associated with PDD. However, investigations that have focused on linguistic functions in PD-MCI are scarce and none of them include PD-SCD patients. Our aim was to study language performance in PD-SCD and PD-MCI. Moreover, language subcomponents were considered as predictors of PDD.

METHOD

Forty-six PD patients and twenty controls were evaluated with a neuropsychological protocol. Patients were classified as PD-SCD and PD-MCI. Language production and comprehension was assessed. Follow-up assessment was conducted to a mean of 7.5 years after the baseline.

RESULTS

PD-MCI patients showed a poor performance in naming (actions and nouns), action generation, anaphora resolution and sentence comprehension (with and without center-embedded relative clause). PD-SCD showed a poor performance in action naming and action generation. Deficit in action naming was an independent risk factor for PDD during the follow-up. Moreover, the combination of deficit in action words and sentence comprehension without a center-embedded relative clause was associated with a greater risk.

CONCLUSIONS

The results are of relevance because they suggest that a specific pattern of linguistic dysfunctions, that can be present even in the early stages of the disease, can predict future dementia, reinforcing the importance of advancing in the knowledge of linguistic dysfunctions in predementia stages of PD.

Speech dysfunction, cognition, and Parkinson's disease

Communication difficulties are a ubiquitous symptom of Parkinson's disease and include changes to both motor speech and language systems. Communication challenges are a significant driver of lower quality of life. They are associated with decreased communication participation, social withdrawal, and increased risks for social isolation and stigmatization in persons with Parkinson's disease. Recent theoretical advances and experimental evidence underscore the intersection of cognition and motor processes in speech production and their impact on spoken language. This chapter overviews a growing evidence base demonstrating that cognitive impairments interact with motor changes in Parkinson's disease to negatively affect communication abilities in myriad ways, at all stages of the disease, both in the absence and presence of dementia. The chapter highlights common PD interventions (pharmacological, surgical, and non-pharmacological) and how cognitive influences on speech production outcomes are considered in each.

A Mixed Statistical and Machine Learning Approach for the Analysis of Multimodal Trail Making Test Data

Eye-tracking can offer a novel clinical practice and a non-invasive tool to detect neuropathological syndromes. In this paper, we show some analysis on data obtained from the visual sequential search test. Indeed, such a test can be used to evaluate the capacity of looking at objects in a specific order, and its successful execution requires the optimization of the perceptual resources of foveal and extrafoveal vision. The main objective of this work is to detect if some patterns can be found within the data, to discern among people with chronic pain, extrapyramidal patients and healthy controls. We employed statistical tests to evaluate differences among groups, considering three novel indicators: blinking rate, average blinking duration and maximum pupil size variation. Additionally, to divide the three patient groups based on scan-path images—which appear very noisy and all similar to each other—we applied deep learning techniques to embed them into a larger transformed space. We then applied a clustering approach to correctly detect and classify the three cohorts. Preliminary experiments show promising results.

Visual Sequential Search Test Analysis: An Algorithmic Approach

In this work we present an algorithmic approach to the analysis of the Visual Sequential Search Test (VSST) based on the episode matching method. The data set included two groups of patients, one with Parkinson’s disease, and another with chronic pain syndrome, along with a control group. The VSST is an eye-tracking modified version of the Trail Making Test (TMT) which evaluates high order cognitive functions. The episode matching method is traditionally used in bioinformatics applications. Here it is used in a different context which helps us to assign a score to a set of patients, under a specific VSST task to perform. Experimental results provide statistical evidence of the different behaviour among different classes of patients, according to different pathologies.

Eye tracking metrics to screen and assess cognitive impairment in patients with neurological disorders

PURPOSE OF REVIEW

Eye tracking is a powerful method to investigate the relationship between behavior and neural mechanisms. In recent years, eye movement analysis has been used in patients with neurological disorders to assess cognitive function. In this review, we explore the latest eye tracking researches in neurological disorders that are commonly associated with cognitive deficits, specifically, amyotrophic lateral sclerosis (ALS), Alzheimer's disease (AD), Parkinson's disease (PD), multiple sclerosis (MS), and epilepsy. We focus on the application of ocular measures in these disorders, with the goal of understanding how eye tracking technology can be used in the clinical setting.

FINDINGS

Eye tracking tasks (especially saccadic tasks) are often used as an adjunct to traditional scales for cognitive assessment. Eye tracking data confirmed that executive dysfunction is common in PD and ALS, whereas AD and MS are characterized by attention deficits. Research in evaluating cognitive function in epilepsy using eye tracking is still in its early stages, but this approach has shown advantages as a sensitive quantitative method with high temporal and spatial resolution. Eye tracking technology can facilitate the assessment of cognitive impairment with higher temporal resolution and finer granularity than traditional cognitive assessment. Oculomotor data collected during cognitive tasks can provide insight into biological processes. Eye tracking provides a nonverbal and less cognitively demanding method of measuring disease progression in cognitively impaired patients.

A dissociation between syntactic and lexical processing in Parkinson's disease

Parkinson's disease (PD), which involves the degeneration of dopaminergic neurons in the basal ganglia, has long been associated with motor deficits. Increasing evidence suggests that language can also be impaired, including aspects of syntactic and lexical processing. However, the exact pattern of these impairments remains somewhat unclear, for several reasons. Few studies have examined and compared syntactic and lexical processing within subjects, so their relative deficits remain to be elucidated. Studies have focused on earlier stages of PD, so syntactic and lexical processing in later stages are less well understood. Research has largely probed English and a handful of other European languages, and it is unclear whether findings generalize more broadly. Finally, few studies have examined links between syntactic/lexical impairments and their neurocognitive substrates, such as measures of basal ganglia degeneration or dopaminergic processes. We addressed these gaps by investigating multiple aspects of Farsi syntactic and lexical processing in 40 Farsi native-speaking moderate-to-severe non-demented PD patients, and 40 healthy controls. Analyses revealed equivalent impairments of syntactic comprehension and syntactic judgment, across different syntactic structures. Lexical processing was impaired only for motor function-related objects (e.g., naming 'hammer', but not 'mountain'), in line with findings of PD deficits at naming action verbs as compared to objects, without the verb/noun confound. In direct comparisons between lexical and syntactic tasks, patients were better at naming words like 'mountain' (but not words like 'hammer') than at syntactic comprehension and syntactic judgment. Performance at syntactic comprehension correlated with the last levodopa equivalent dose. No other correlations were found between syntactic/lexical processing measures and either levodopa equivalent dose or hypokinesia, which reflects degeneration of basal ganglia motor-related circuits. All critical significant main effects, interactions, and correlations yielded large effect sizes. The findings elucidate the nature of syntactic and lexical processing impairments in PD.

Communication impairment in Parkinson's disease: Impact of motor and cognitive symptoms on speech and language

Communication impairment is common in Parkinson's disease (PD) and may have both motor speech control and cognitive-linguistic underpinnings. The neurobiology of communication impairment in PD is poorly understood, and work is needed to disentangle the relative contributions of motor and cognitive dysfunction. In clinical practice, cognitive-linguistic impairments are often overlooked despite the large body of research on this topic in neurocognitive and linguistics literature. In this review, we will discuss the roles of motor speech changes, cognitive and linguistic impairment, and other related functions in the communication disabilities of individuals with PD. We will describe the various types of communication difficulties in PD and tools for measuring these symptoms. We will discuss specific deficits that may further understanding of the neurobiology of communication impairment in PD, including voice and speech acoustic changes, linguistic processing and production difficulties, and pausing. We will emphasize the importance of an interdisciplinary approach and the patient perspective on daily communication in guiding future research.

Evaluation of Linguistic Markers of Word-Finding Difficulty and Cognition in Parkinson's Disease

PURPOSE

Early cognitive symptoms such as word-finding difficulty (WFD) in daily conversation are common in Parkinson's disease (PD), but studies have been limited by a lack of feasible, quantitative measures. Linguistic analysis, focused on pauses in speech, may yield markers of impairment of cognition and communication in PD. The objective of this study was to evaluate the relationship of linguistic markers in semistructured speech to WFD symptoms and cognitive function in PD.

METHOD

Speech recordings of description of the Cookie Theft picture in 53 patients with PD without dementia and 23 elderly controls were analyzed with Praat software. Montreal Cognitive Assessment (MoCA; Nasreddine et al., 2005), category naming fluency, and confrontation naming tests were administered. Questionnaires rating WFD symptoms and cognitive instrumental activities of daily living were completed. We determined the relationships between (a) pause length and location, (b) MoCA score, and (c) WFD symptoms, using Pearson's correlations and multivariate regression models.

RESULTS

Compared with controls, patients with PD had more pauses within utterances as well as fewer words per minute and a lower percentage of well-formed sentences. Pauses within utterances differed significantly between PD-mild cognitive impairment and normal cognition (p < .001). Words per minute and percentage of well-formed sentences were predictive of MoCA in multivariate regression models. Pauses before verbs were associated with patient-reported severity of WFD symptoms (p = .006).

CONCLUSIONS

Linguistic markers including pauses within utterances distinguish patients with PD with mild cognitive symptoms from elderly controls. These markers are associated with global cognitive function before the onset of dementia. Pauses before verbs and grammatical markers may index early cognitive symptoms such as WFD that may interfere with functional communication.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.6615401.

Verbal short-term memory capacities and executive function in semantic and syntactic interference resolution during sentence comprehension: Evidence from aphasia

This study examined the role of verbal short-term memory (STM) and executive function (EF) underlying semantic and syntactic interference resolution during sentence comprehension for persons with aphasia (PWA) with varying degrees of STM and EF deficits. Semantic interference was manipulated by varying the semantic plausibility of the intervening NP as subject of the verb and syntactic interference was manipulated by varying whether the NP was another subject or an object. Nine PWA were assessed on sentence reading times and on comprehension question performance. PWA showed exaggerated semantic and syntactic interference effects relative to healthy age-matched control subjects. Importantly, correlational analyses showed that while answering comprehension questions, PWA' semantic STM capacity related to their ability to resolve semantic but not syntactic interference. In contrast, PWA' EF abilities related to their ability to resolve syntactic but not semantic interference. Phonological STM deficits were not related to the ability to resolve either type of interference. The results for semantic interference are consistent with prior findings indicating a role for semantic but not phonological STM in sentence comprehension, specifically with regard to maintaining semantic information prior to integration. The results for syntactic interference are consistent with the recent findings suggesting that EF is critical for syntactic processing.

Sentence production in Parkinson's disease

While growing evidence reports changes in language use in non-demented individuals with Parkinson's disease (PD), the presence and nature of the deficits remain largely unclear. Researchers have proposed that dysfunctioning fronto-basal ganglia circuit results in impaired grammatical processes, predicting qualitatively similar language impairments between individuals with PD and agrammatic Broca's aphasia, whereas others suggest that PD is not associated with language-specific grammatical impairment. In addition, there is a paucity of research examining syntactic production in PD at the sentence-level. This study examined sentence production of individuals with PD, healthy older adults, and individuals with agrammatic Broca's aphasia. In Experiment 1, using a Cinderella story-telling task, proportion of grammatical sentences, number of embedded clauses and production of verb arguments in sentences were examined. In Experiment 2, a structured sentence elicitation task was used in which syntactic complexity of sentences (canonical vs. non-canonical word order) was systematically manipulated while minimizing demands for non-syntactic processing. Only the participants with agrammatic Broca's aphasia showed significantly impaired syntactic production in both experiments. Participants with PD did not show impaired syntactic production in either task, despite impairments in lexical retrieval, repetition of words and sentences, and speech production. These findings suggest that impaired syntactic processing may not be a core deficit underlying the changes in language use in non-demented PD. Changes in language use in PD are qualitatively different from language deficits in aphasia.

Time Course of Lexicalization During Sentence Production in Parkinson's Disease: Eye-Tracking While Speaking

PURPOSE

Growing evidence suggests that sentence formulation is affected in Parkinson's disease (PD); however, how speakers with PD coordinate sentence planning and speaking remains unclear. Within 2 competing models of sentence production, this study examined whether speakers with PD show advanced buffering of words to minimize disfluencies and increased demands during speech or whether they plan one word at a time, compromising accuracy and fluency of speech.

METHOD

Participants described 3 computer-displayed pictures using the sentence "the A and the B are above the C." Name agreement (codability) was varied to be high (clock) or low (sofa/couch) for each object position (A, B, C), affecting difficulty of lexical selection. Participants' gaze durations to each object were recorded.

RESULTS

Speakers with PD showed incremental word-by-word planning, retrieving only the first lexical item (A) before speech onset, similar to controls. However, they produced greater word-finding errors and disfluencies compared to controls for the low-codable pictures, but not for high-codable pictures.

CONCLUSIONS

These findings suggest that by following word-by-word incremental production, speakers with PD compromise fluency and accuracy of speech to a greater extent than healthy older speakers and that PD is associated with impaired inhibitory control during lexical selection.

Tracking sentence comprehension: Test-retest reliability in people with aphasia and unimpaired adults

PURPOSE

Visual-world eyetracking is increasingly used to investigate online language processing in normal and language impaired listeners. Tracking changes in eye movements over time also may be useful for indexing language recovery in those with language impairments. Therefore, it is critical to determine the test-retest reliability of results obtained using this method.

METHODS

Unimpaired young adults and people with aphasia took part in two eyetracking sessions spaced about one week apart. In each session, participants completed a sentence-picture matching task in which they listened to active and passive sentences (e.g., The [N1+Auxwoman was] [Vvisiting/visited] [NP/PP2(by) the man]) and selected between two pictures with reversed thematic roles. We used intraclass correlations (ICCs) to examine the test-retest reliability of response measures (accuracy, reaction time (RT)) and online eye movements (i.e., the likelihood of fixating the target picture in each region of the sentence) in each participant group.

RESULTS

In the unimpaired adults, accuracy was at ceiling (thus ICCs were not computed), with moderate ICCs for RT (i.e., 0.4 - 0.58) for passive sentences and low (<0.4) for actives. In individuals with aphasia, test-retest reliability was strong (0.590.75) for RT for both sentence types. Similarly, for the unimpaired listeners, reliability of eye movements was moderate for passive sentences (NP/PP2 region) and low in all regions for active sentences. But, for the aphasic participant group, eye movement reliability was excellent for passive sentences (in the first second after sentence end) and strong for active sentences (V and NP/PP2 regions).

CONCLUSION

Results indicated moderate-to-low reliability for unimpaired listeners; however, reliable eye movement patterns were detected for processes specific to passive sentences (e.g., thematic reanalysis). In contrast, individuals with aphasia exhibited strong and stable performance across sentence types in response measures and online eye movements. These findings indicate that visual-world eyetracking provides a reliable measure of online sentence comprehension, and thus may be useful for investigating sentence processing changes over time.

Abnormal eye movement behavior during reading in Parkinson's disease

INTRODUCTION

Reading difficulties are common in Parkinson's disease (PD) but not well studied. We report a case of reading difficulties in a 40-year-old man with 6-year history of PD on dopamine replacement therapy.

METHODS

We performed detailed neuro-ophthalmic examination and assessment of reading with and without infrared oculography.

RESULTS

Clinical examination revealed visual acuity of 20/20, no evidence of vision loss, and normal eye movement and ocular alignment with normal saccades, pursuit, and normal convergence. During King-Devick test, a rapid number reading task performed on a book, patient had normal number reading speed. More detailed study of number and word reading using infrared oculography revealed that while this patient had normal speed and eye movement behavior during number reading, he had dramatic slowing and eye movement abnormality during word reading. The slower reading speed during word reading was due to increased number of progressive saccades, smaller saccade amplitudes, increased number of regressive saccades, and longer fixation durations.

CONCLUSIONS

This case nicely illustrated the importance of comprehensive neuro-ophthalmic evaluations in Parkinson's disease and shows that reading difficulties can arise even when there is good visual acuity, ocular motor abilities necessary to read, and accommodation. In this case, reading difficulty was due to higher order ocular motor planning or cognitive abilities involved in word reading since the patient had no difficulty with ocular motor planning while reading numbers. These findings may have important implications towards our understanding of PD and can serve to spark further research in this important area.

Cue Recognition and Integration - Eye Tracking Evidence of Processing Differences in Sentence Comprehension in Aphasia

Purpose

We aimed at further elucidating whether aphasic patients’ difficulties in understanding non-canonical sentence structures, such as Passive or Object-Verb-Subject sentences, can be attributed to impaired morphosyntactic cue recognition, and to problems in integrating competing interpretations.

Methods

A sentence-picture matching task with canonical and non-canonical spoken sentences was performed using concurrent eye tracking. Accuracy, reaction time, and eye tracking data (fixations) of 50 healthy subjects and 12 aphasic patients were analysed.

Results

Patients showed increased error rates and reaction times, as well as delayed fixation preferences for target pictures in non-canonical sentences. Patients’ fixation patterns differed from healthy controls and revealed deficits in recognizing and immediately integrating morphosyntactic cues.

Conclusion

Our study corroborates the notion that difficulties in understanding syntactically complex sentences are attributable to a processing deficit encompassing delayed and therefore impaired recognition and integration of cues, as well as increased competition between interpretations.

Corticostriatal response selection in sentence production: Insights from neural network simulation with reservoir computing

Language production requires selection of the appropriate sentence structure to accommodate the communication goal of the speaker - the transmission of a particular meaning. Here we consider event meanings, in terms of predicates and thematic roles, and we address the problem that a given event can be described from multiple perspectives, which poses a problem of response selection. We present a model of response selection in sentence production that is inspired by the primate corticostriatal system. The model is implemented in the context of reservoir computing where the reservoir - a recurrent neural network with fixed connections - corresponds to cortex, and the readout corresponds to the striatum. We demonstrate robust learning, and generalization properties of the model, and demonstrate its cross linguistic capabilities in English and Japanese. The results contribute to the argument that the corticostriatal system plays a role in response selection in language production, and to the stance that reservoir computing is a valid potential model of corticostriatal processing.

Reading comprehension in Parkinson's disease

PURPOSE

Although individuals with Parkinson's disease (PD) self-report reading problems and experience difficulties in cognitive-linguistic functions that support discourse-level reading, prior research has primarily focused on sentence-level processing and auditory comprehension. Accordingly, the authors investigated the presence and nature of reading comprehension in PD, hypothesizing that (a) individuals with PD would display impaired accuracy and/or speed on reading comprehension tests and (b) reading performances would be correlated with cognitive test results.

METHOD

Eleven adults with PD and 9 age- and education-matched control participants completed tests that evaluated reading comprehension; general language and cognitive abilities; and aspects of attention, memory, and executive functioning.

RESULT

The PD group obtained significantly lower scores on several, but not all, reading comprehension, language, and cognitive measures. Memory, language, and disease severity were significantly correlated with reading comprehension for the PD group.

CONCLUSION

Individuals in the early stages of PD without dementia or broad cognitive deficits can display reading comprehension difficulties, particularly for high- versus basic-level reading tasks. These reading difficulties are most closely related to memory, high-level language, and PD symptom severity status. The findings warrant additional research to delineate further the types and nature of reading comprehension impairments experienced by individuals with PD.

Recurrent temporal networks and language acquisition-from corticostriatal neurophysiology to reservoir computing

One of the most paradoxical aspects of human language is that it is so unlike any other form of behavior in the animal world, yet at the same time, it has developed in a species that is not far removed from ancestral species that do not possess language. While aspects of non-human primate and avian interaction clearly constitute communication, this communication appears distinct from the rich, combinatorial and abstract quality of human language. So how does the human primate brain allow for language? In an effort to answer this question, a line of research has been developed that attempts to build a language processing capability based in part on the gross neuroanatomy of the corticostriatal system of the human brain. This paper situates this research program in its historical context, that begins with the primate oculomotor system and sensorimotor sequencing, and passes, via recent advances in reservoir computing to provide insight into the open questions, and possible approaches, for future research that attempts to model language processing. One novel and useful idea from this research is that the overlap of cortical projections onto common regions in the striatum allows for adaptive binding of cortical signals from distinct circuits, under the control of dopamine, which has a strong adaptive advantage. A second idea is that recurrent cortical networks with fixed connections can represent arbitrary sequential and temporal structure, which is the basis of the reservoir computing framework. Finally, bringing these notions together, a relatively simple mechanism can be built for learning the grammatical constructions, as the mappings from surface structure of sentences to their meaning. This research suggests that the components of language that link conceptual structure to grammatical structure may be much simpler that has been proposed in other research programs. It also suggests that part of the residual complexity is in the conceptual system itself.

Real-time parallel processing of grammatical structure in the fronto-striatal system: a recurrent network simulation study using reservoir computing

Sentence processing takes place in real-time. Previous words in the sentence can influence the processing of the current word in the timescale of hundreds of milliseconds. Recent neurophysiological studies in humans suggest that the fronto-striatal system (frontal cortex, and striatum--the major input locus of the basal ganglia) plays a crucial role in this process. The current research provides a possible explanation of how certain aspects of this real-time processing can occur, based on the dynamics of recurrent cortical networks, and plasticity in the cortico-striatal system. We simulate prefrontal area BA47 as a recurrent network that receives on-line input about word categories during sentence processing, with plastic connections between cortex and striatum. We exploit the homology between the cortico-striatal system and reservoir computing, where recurrent frontal cortical networks are the reservoir, and plastic cortico-striatal synapses are the readout. The system is trained on sentence-meaning pairs, where meaning is coded as activation in the striatum corresponding to the roles that different nouns and verbs play in the sentences. The model learns an extended set of grammatical constructions, and demonstrates the ability to generalize to novel constructions. It demonstrates how early in the sentence, a parallel set of predictions are made concerning the meaning, which are then confirmed or updated as the processing of the input sentence proceeds. It demonstrates how on-line responses to words are influenced by previous words in the sentence, and by previous sentences in the discourse, providing new insight into the neurophysiology of the P600 ERP scalp response to grammatical complexity. This demonstrates that a recurrent neural network can decode grammatical structure from sentences in real-time in order to generate a predictive representation of the meaning of the sentences. This can provide insight into the underlying mechanisms of human cortico-striatal function in sentence processing.

The epidemiology and clinical manifestations of dysexecutive syndrome in Parkinson's disease

This mini-review summarizes the evidence of the cognitive and behavioral features of dysexecutive syndrome in Parkinson’s disease (PD). Deficits in response inhibition, set-shifting, mental flexibility, and strategy have been frequently described from the earliest stages of PD, although there are inconsistencies in study findings due to the complexity of the executive function (EF) construct and methodological limitations. Behavioral disorders of PD, e.g., apathy, distractibility, perseverative behavior, and impulse-control disorders, may be viewed as the other side of dysexecutive syndrome. Despite the interrelationship between the cognitive and behavioral domains, some reports reveal that the two syndromes may be dissociated, suggesting that both aspects must be clinically assessed. EFs are widely associated with the prefrontal areas, although dysexecutive syndrome may be observed in patients with damage to other brain regions. EFs drive numerous abilities essential to daily life, such as prospective remembering and language comprehension, which may be impaired in PD subjects. Considering the impact of dysexecutive syndrome on independence and quality of life, early detection of executive impairment is crucial in the management of PD.

Impact of typical aging and Parkinson's disease on the relationship among breath pausing, syntax, and punctuation

PURPOSE

The present study examines the impact of typical aging and Parkinson's disease (PD) on the relationship among breath pausing, syntax, and punctuation.

METHOD

Thirty young adults, 25 typically aging older adults, and 15 individuals with PD participated. Fifteen participants were age- and sex-matched to the individuals with PD. Participants read a passage aloud 2 times. Utterance length, location of breath pauses relative to punctuation and syntax, and number of disfluencies and mazes were measured.

RESULTS

Older adults produced shorter utterances, a smaller percentage of breaths at major boundaries, and a greater percentage of breaths at minor boundaries than did young adults, but there was no significant difference between older adults and individuals with PD on these measures. Individuals with PD took a greater percentage of breaths at locations unrelated to a syntactic boundary than did control participants. Individuals with PD produced more mazes than did control participants. Breaths were significantly correlated with punctuation for all groups.

CONCLUSIONS

Changes in breath-pausing patterns in older adults are likely due to changes in respiratory physiology. However, in individuals with PD, such changes appear to result from a combination of changes to respiratory physiology and cognition.

Quantitative analysis of language production in Parkinson's disease using a cued sentence generation task

The present study examined language production skills in Parkinson's disease (PD) patients. A unique cued sentence generation task was created in order to reduce demands on memory and attention. Differences in sentence production abilities according to disease severity and cognitive impairments were assessed. Language samples were obtained from 20 PD patients and 20 healthy control participants matched for age, sex and educational level. In addition, a cognitive test for verbal memory and resistance to cognitive interference was administered. Statistical comparisons revealed significant language changes in an advanced stage of the disease. Advanced PD patients showed a reduction in lexical diversity in notional verbs, which was absent in nouns. Cognitive dysfunctions such as impaired verbal memory are suggested to contribute to the typical noun/verb dissociation in PD patients. In addition, advanced PD patients produced more semantic perseverations, which may be related to set-switching problems. In conclusion, whether language disturbances in PD are the result of non-linguistic cognitive dysfunctions or reflect pure language deficits exacerbated by cognitive impairments, remains a matter of debate. However, the negative impact of cognitive dysfunctions may be important.

The role of the striatum in sentence processing: disentangling syntax from working memory in Huntington's disease

The role of sub-cortical structures in language processing remains controversial. In particular, it is unclear whether the striatum subserves language-specific processes such as syntax or whether it solely affects language performance via its significant role in executive functioning and/or working memory. Here, in order to address this issue, we attempted to equalize working memory constraints while varying syntactic complexity, to study sentence comprehension in 15 patients with striatal damage, namely Huntington's disease at early stage, and in 15 healthy controls. More particularly, we manipulated the syntactic relation between a name and a pronoun while holding the distance between them constant. We exploited a formal principle of syntactic theory called Principle C. This principle states that whereas in a sentence such as "Paul smiled when he entered" Paul and he can be a single person, this interpretation is blocked in sentences such as "He smiled when Paul entered". In a second experiment we varied working memory load using noun-adjective gender agreement in center-embedded and right-branching relatives (e.g., "the girl who watches the dog is green" vs. "the girl watches the dog which is green"). The results show that HD patients correctly establish name-pronoun co-reference but they fail to block it when Principle C should apply. Furthermore, they have good performance with both center-embedded and right-branching relatives, suggesting that their difficulties in sentence comprehension do not arise from memory load impairment during sentence processing. Taken together, our findings indicate that the striatum holds a genuine role in syntactic processing, which cannot be reduced to its involvement in working memory. However, it only impacts on particular aspects of syntax that may relate to complex computations whereas other operations appear to be preserved. Hypotheses about the role of the striatum in syntactic processing are discussed.

Speech, voice and language in Parkinson’s disease: changes and interventions

SUMMARY This article covers recent developments in the understanding of communication changes in idiopathic Parkinson’s disease and selected issues in intervention. By contrast to earlier narrow considerations of voice and speech, the effects on communication of cognitive–linguistic and prosody perception and production are also highlighted. Decline can occur from the earliest stages, even when listeners perceive no frank changes. Communication may be relatively trouble-free in one-to-one quiet clinical situations but declines in multi-talker, dual/competing task situations. Assessment should reflect this to gain more accurate insights into daily living performance. Currently, therapies focusing on attention-to-effort in voice production and on monitoring the sense of effort and loudness production appear to be most successful. Medical and surgical treatments have little effect on intelligibility and communication and may even exacerbate the situation.

The organization and anatomy of narrative comprehension and expression in Lewy body spectrum disorders

OBJECTIVE

Patients with Lewy body spectrum disorders (LBSD) such as Parkinson's disease, Parkinson's disease with dementia, and dementia with Lewy bodies exhibit deficits in both narrative comprehension and narrative expression. The present research examines the hypothesis that these impairments are due to a material-neutral deficit in organizational executive resources rather than to impairments of language per se. We predicted that comprehension and expression of narrative would be similarly affected and that deficits in both expression and comprehension of narrative would be related to the same anatomic distribution of prefrontal disease.

METHOD

We examined 29 LBSD patients and 26 healthy seniors on their comprehension and expression of narrative discourse. For comprehension, we measured accuracy and latency in judging events with high and low associativity from familiar scripts such as "going fishing." The expression task involved maintaining the connectedness of events while narrating a story from a wordless picture book.

RESULTS

LBSD patients were impaired on measures of narrative organization during both comprehension and expression relative to healthy seniors. Measures of organization during narrative expression and comprehension were significantly correlated with each other. These measures both correlated with executive measures but not with neuropsychological measures of lexical semantics or grammar. Voxel-based morphometry revealed overlapping regressions relating frontal atrophy to narrative comprehension, narrative expression, and measures of executive control.

CONCLUSIONS

Difficulty with narrative discourse in LBSD stems in part from a deficit of organization common to comprehension and expression. This deficit is related to prefrontal cortical atrophy in LBSD.

Impairments of speech fluency in Lewy body spectrum disorder

Few studies have examined connected speech in demented and non-demented patients with Parkinson's disease (PD). We assessed the speech production of 35 patients with Lewy body spectrum disorder (LBSD), including non-demented PD patients, patients with PD dementia (PDD), and patients with dementia with Lewy bodies (DLB), in a semi-structured narrative speech sample in order to characterize impairments of speech fluency and to determine the factors contributing to reduced speech fluency in these patients. Both demented and non-demented PD patients exhibited reduced speech fluency, characterized by reduced overall speech rate and long pauses between sentences. Reduced speech rate in LBSD correlated with measures of between-utterance pauses, executive functioning, and grammatical comprehension. Regression analyses related non-fluent speech, grammatical difficulty, and executive difficulty to atrophy in frontal brain regions. These findings indicate that multiple factors contribute to slowed speech in LBSD, and this is mediated in part by disease in frontal brain regions.

Sentence processing in Lewy body spectrum disorder: the role of working memory

Prior work has related sentence processing to executive deficits in non-demented patients with Parkinson's disease (PD). We extended this investigation to patients with dementia with Lewy bodies (DLB) and PD dementia (PDD) by examining grammatical and working memory components of sentence processing in the full range of patients with Lewy body spectrum disorder (LBSD). Thirty-three patients with LBSD were given a two-alternative, forced-choice sentence-picture matching task. Sentence type, working memory, and grammatical structure were systematically manipulated in the sentences. We found that patients with PDD and DLB were significantly impaired relative to non-demented PD patients and healthy controls. The deficit in PDD/DLB was most pronounced for sentences lengthened by the strategic placement of an additional prepositional phrase and for sentences with an additional proposition due to a center-embedded clause. However, there was no effect for subject-relative versus object-relative grammatical structure. An MRI voxel-based morphometry analysis in a subset of patients showed significant gray matter thinning in the frontal lobe bilaterally, and this extended to temporal, parietal and occipital regions. A regression analysis related sentence processing difficulty in LBSD to frontal neocortex, including inferior prefrontal, premotor, and dorsolateral prefrontal regions, as well as right superior temporal cortex. These findings are consistent with the hypothesis that patients with PDD and DLB have difficulty processing sentences with increased working memory demands and that this deficit is related in part to their frontal disease.

Difficulty processing temporary syntactic ambiguities in Lewy body spectrum disorder

While grammatical aspects of language are preserved, executive deficits are prominent in Lewy body spectrum disorder (LBSD), including Parkinson's disease (PD), Parkinson's dementia (PDD) and dementia with Lewy bodies (DLB). We examined executive control during sentence processing in LBSD by assessing temporary structural ambiguities. Using an on-line word detection procedure, patients heard sentences with a syntactic structure that has high-compatibility or low-compatibility with the main verb's statistically preferred syntactic structure, and half of the sentences were lengthened strategically between the onset of the ambiguity and its resolution. We found selectively slowed processing of lengthened ambiguous sentences in the PDD/DLB subgroup. This correlated with impairments on measures of executive control. Regression analyses related the working memory deficit during ambiguous sentence processing to significant cortical thinning in frontal and parietal regions. These findings emphasize the role of prefrontal disease in the executive limitations that interfere with processing ambiguous sentences in LBSD.

Sentence comprehension and its association with executive functions in patients with Parkinson's disease

Coexistent impairments in executive functions and language comprehension in patients with Parkinson's disease (PD) have been repeatedly observed. In this study, the aim was to provide insights into the interaction between linguistic representation and processing and executive functioning. Therefore, sentence comprehension and executive functions were assessed in 28 Dutch-speaking PD patients and 28 healthy control subjects. Three aspects of the sentence materials were varied: (1) phrase structure complexity, (2) sentence length, and (3) picture congruence. PD patients with mild-to-moderate disease severity showed decreased sentence comprehension compared to healthy control subjects. The difficulties encountered by PD patients were not limited to one aspect of the sentence materials. The same pattern of results was present in healthy control subjects. Deficits in set-switching were specifically associated with the comprehension of passive sentences. Generally, our study confirms that there does not appear to be a language faculty encapsulated from the influence of executive functions.

The organization of narrative discourse in Lewy body spectrum disorder

Narrative discourse is an essential component of day-to-day communication, but little is known about narrative in Lewy body spectrum disorder (LBSD), including Parkinson's disease (PD), Parkinson's disease with dementia (PDD), and dementia with Lewy bodies (DLB). We performed a detailed analysis of a semi-structured speech sample in 32 non-aphasic patients with LBSD, and we related their narrative impairments to gray matter (GM) atrophy using voxel-based morphometry. We found that patients with PDD and DLB have significant difficulty organizing their narrative speech. This was correlated with deficits on measures of executive functioning and speech fluency. Regression analyses associated this deficit with reduced cortical volume in inferior frontal and anterior cingulate regions. These findings are consistent with a model of narrative discourse that includes executive as well as language components and with an impairment of the organizational component of narrative discourse in patients with PDD and DLB.

Current tests and trends in single-case neuropsychology

In this issue of Cortex, Crawford, Garthwaite and Ryan publish bayesian statistical tests that will enable researchers to take account of covariates when comparing single patients to control samples. In this article, we provide some context for this development, from an audit of the Cortex archives. We suggest that single-case research is alive and well, and more rigorous than ever, and that current practice has been shaped considerably by Crawford and colleagues' statistical refinements over the past 12 years. However, there is scope for further tightening and standardisation of statistical methods and reporting standards. The advantages offered by the new bayesian tests should promote the even wider use of appropriate statistical methods, with benefits for the validity of individual studies, and for cross-comparability in the single-case literature.

High-level language production in Parkinson's disease: a review

This paper discusses impairments of high-level, complex language production in Parkinson's disease (PD), defined as sentence and discourse production, and situates these impairments within the framework of current psycholinguistic theories of language production. The paper comprises three major sections, an overview of the effects of PD on the brain and cognition, a review of the literature on language production in PD, and a discussion of the stages of the language production process that are impaired in PD. Overall, the literature converges on a few common characteristics of language production in PD: reduced information content, impaired grammaticality, disrupted fluency, and reduced syntactic complexity. Many studies also document the strong impact of differences in cognitive ability on language production. Based on the data, PD affects all stages of language production including conceptualization and functional and positional processing. Furthermore, impairments at all stages appear to be exacerbated by impairments in cognitive abilities.

Use of sensitive devices to assess the effect of medication on attentional demands of precision and power grips in individuals with Parkinson disease

Deficits in fine motor control are a common early symptom in people with Parkinson disease (PD) and may serve as an ideal marker for the response to therapeutic interventions and progression of the disease. The long-term goal of this research is to develop sensitive clinical markers that can be used to accurately assess disease progression and the response to therapeutic interventions. The purpose of this preliminary study was to examine the effects of medication on the attentional demands of precision (Pre) and power (Pow) grips in individuals with PD. In order to assess force control during precision and power grip, we used an instrumented twist-cap device. Performance on the motor task was quantified using peak force levels (PF) and the time to reach peak force (TTP). To assess attentional demands of the motor task, participants performed an auditory analog of the Stroop test while performing the motor task. Dual-task cost (DTC) for all outcome variables was calculated. Dual-task cost for response latency (RL DTC) for both grips were greater (P < 0.005) when participants were on medications('ONMeds'). Mean [95%CI]: Pre = 25.7[14.7-36.7], Pow = 37.08[26.5-47.7]) compared with off medications('OFFMeds') (Pre = 12.6[1.5-23.6], Pow = 10.98[0.4-21.6]), suggesting that force control during both grip tasks may remain attentionally demanding even on medications.