The processing of actions and action-words in amyotrophic lateral sclerosis patients

Flexible and fine-grained simulation of speed in language processing

According to the embodied cognition theory, language comprehension is achieved through mental simulation. This account is supported by a number of studies reporting action simulations during language comprehension. However, which details of sensory-motor experience are included in these simulations is still controversial. Here, three experiments were carried out to examine the simulation of speed in action language comprehension. Experiment 1 adopted a lexical decision task and a semantic similarity judgment task on isolated fast and slow action verbs. It has been shown that fast action verbs were processed significantly faster than slow action verbs when deep semantic processing is required. Experiment 2 and Experiment 3 investigated the contextual influence on the simulation of speed, showing that the processing of verbs, either depicting fast actions or neutral actions, would be slowed down when embedded in the slow action sentences. These experiments together demonstrate that the fine-gained information, speed, is an important part of action representation and can be simulated but may not in an automatic way. Moreover, the speed simulation is flexible and can be modulated by the context.

Verbal and nonverbal fluency in amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is a multi-system disorder that commonly affects cognition and behaviour. Verbal fluency impairments are consistently reported in ALS patients, and we aimed to investigate whether this deficit extends beyond the verbal domain. We further aimed to determine whether deficits are underpinned by a primary intrinsic response generation impairment (i.e., a global reduction across tasks), potentially related to apathy, or an inability to maintain responding over time (i.e., a 'drop off' pattern). Twenty-two ALS patients and 21 demographically-matched controls completed verbal and nonverbal fluency tasks (phonemic/semantic word fluency, design fluency, gesture fluency and ideational fluency), requiring the generation of responses over a specified time period. Fluency performance was analysed in terms of the overall number of novel items produced, as well as the number of items produced in the first 'initiation' and the remaining 'maintenance' time periods. ALS patients' overall performance was not globally reduced across tasks. Patients were impaired only on meaningful gesture fluency, which requires the generation of gestures that communicate meaning (e.g., waving). On phonemic fluency, ALS patients showed a 'drop off' pattern of performance, where they had difficulty maintaining responding over time, but this pattern was not evident on the other fluency tasks. Apathy did not appear to be related to fluency performance. The selective meaningful gesture fluency deficit, in the context of preserved meaningless gesture fluency, highlights that the retrieval of action knowledge may be weakened in early ALS.

Grounded Cognition Entails Linguistic Relativity: A Neglected Implication of a Major Semantic Theory

According to the popular Grounded Cognition Model (GCM), the sensory and motor features of concepts, including word meanings, are stored directly within neural systems for perception and action. More precisely, the core claim is that these concrete conceptual features reuse some of the same modality-specific representations that serve to categorize experiences involving the relevant kinds of objects and events. Research in semantic typology, however, has shown that word meanings vary significantly across the roughly 6500 languages in the world. I argue that this crosslinguistic semantic diversity has significant yet previously unrecognized theoretical consequences for the GCM. In particular, to accommodate the typological data, the GCM must assume that the concrete features of word meanings are not merely stored within sensory/motor brain systems, but are represented there in ways that are, to a nontrivial degree, language-specific. Moreover, it must assume that these conceptual representations are also activated during the nonlinguistic processing of the relevant kinds of objects and events (e.g., during visual perception and action planning); otherwise, they would not really be grounded, which is to say, embedded inside sensory/motor systems. Crucially, however, such activations would constitute what is traditionally called linguistic relativity-that is, the influence of language-specific semantic structures on other forms of cognition. The overarching aim of this paper is to elaborate this argument more fully and explore its repercussions. To that end, I discuss in greater detail the key aspects of the GCM, the evidence for crosslinguistic semantic diversity, pertinent work on linguistic relativity, the central claim that the GCM entails linguistic relativity, some initial supporting results, and some important limitations and future directions.

Validation of and Normative Data of the DVAQ-30, a New Video-Naming Test for Assessing Verb Anomia

OBJECTIVE

Anomia is usually assessed using picture-naming tests. While many tests evaluate anomia for nouns, very few tests have been specifically designed for verb anomia. This article presents the DVAQ-30, a new naming test for detecting verb anomia in adults and elderly people.

METHOD

The article describes three studies. Study 1 focused on the DVAQ-30 development phase. In Study 2, healthy participants and individuals with post-stroke aphasia, mild cognitive impairment, Alzheimer's disease, or primary progressive aphasia were assessed using the DVAQ-30 to establish its convergent and discriminant validity, test-retest reliability, and internal consistency. In Study 3, a group of adults and elderly Quebec French-speaking adults were assessed to obtain normative data.

RESULTS

The DVAQ-30 had good convergent validity and distinguished the performance of healthy participants from that of participants with pathological conditions. The test also had good internal consistency, and the test-retest analysis showed that the scores had good temporal stability. Furthermore, normative data were collected on the performance of 244 participants aged 50 years old and over.

CONCLUSIONS

The DVAQ-30 fills an important gap and has the potential to help clinicians and researchers better detect verb anomia associated with pathological aging and post-stroke aphasia.

Revisiting the relation between syntax, action, and left BA44

Among the many lines of research that have been exploring how embodiment contributes to cognition, one focuses on how the neural substrates of language may be shared, or at least closely coupled, with those of action. This paper revisits a particular proposal that has received considerable attention—namely, that the forms of hierarchical sequencing that characterize both linguistic syntax and goal-directed action are underpinned partly by common mechanisms in left Brodmann area (BA) 44, a cortical region that is not only classically regarded as part of Broca’s area, but is also a core component of the human Mirror Neuron System. First, a recent multi-participant, multi-round debate about this proposal is summarized together with some other relevant findings. This review reveals that while the proposal is supported by a variety of theoretical arguments and empirical results, it still faces several challenges. Next, a narrower application of the proposal is discussed, specifically involving the basic word order of subject (S), object (O), and verb (V) in simple transitive clauses. Most languages are either SOV or SVO, and, building on prior work, it is argued that these strong syntactic tendencies derive from how left BA44 represents the sequential-hierarchical structure of goal-directed actions. Finally, with the aim of clarifying what it might mean for syntax and action to have “common” neural mechanisms in left BA44, two different versions of the main proposal are distinguished. Hypothesis 1 states that the very same neural mechanisms in left BA44 subserve some aspects of hierarchical sequencing for syntax and action, whereas Hypothesis 2 states that anatomically distinct but functionally parallel neural mechanisms in left BA44 subserve some aspects of hierarchical sequencing for syntax and action. Although these two hypotheses make different predictions, at this point neither one has significantly more explanatory power than the other, and further research is needed to elaborate and test them.

Diagnostic accuracy of noun- and verb-naming tasks in detecting cognitive impairment in Parkinson's disease

BACKGROUND

In Parkinson's disease (PD), verb-naming tasks have been proposed as superior to noun-naming ones in detecting language deficits, although such an hypothesis is not supported at a statistical level.

OBJECTIVES

Providing diagnostic accuracy evidence for a verb- and noun-naming task in detecting cognitive impairment in PD patients.

METHOD

Thirty-three consecutive PD patients were subdivided into participants with (PD-CI; N=12) or without cognitive impairment (CI) (cognitively unimpaired, PD-CU; N=21), based on a raw score ≤25 or >25 on the Mini-Mental State Examination (MMSE), respectively. The Noun- and Verb-Naming Task (NNT, VNT) by Crepaldi et al. (2006) was administered. Diagnostic accuracy on the NNT and VNT was assessed through receiver-operating characteristics (ROC) analyses by comparing PD-CU to PD-CI patients. At the optimal cut-off, sensitivity, specificity, positive and negative predictive values (PPV, NPV) and likelihood ratios (LR+, LR-) were separately tested for the NNT and VNT against PD-CU vs. PD-CI classification.

RESULTS

Diagnostic accuracy was higher for the NNT (AUC =.85; p=.001) vs. the VNT (AUC =.68; p=.092). Consistently, the NNT yielded higher sensitivity, specificity and post-test features than the VNT (NNT: sensitivity =.75; specificity=.81; PPV =.69; NPV =.85; LR+ =3.94; LR- =.31; VNT: sensitivity=.67; specificity =.67; PPV =.53; NPV =.78; LR+ =2; LR- =.5).

CONCLUSIONS

In accordance with the Movement Disorders Society guidelines, noun-naming tasks are diagnostically sound psychometric instruments to discriminate PD patients with vs. without CI. However, these findings need replication by (1) employing a gold standard different from the MMSE, which does not capture the full range of cognitive impairment in this population and (2) sub-dividing PD patients into those with mild cognitive impairment and dementia.

Frontotemporal Pathology in Motor Neuron Disease Phenotypes: Insights From Neuroimaging

Frontotemporal involvement has been extensively investigated in amyotrophic lateral sclerosis (ALS) but remains relatively poorly characterized in other motor neuron disease (MND) phenotypes such as primary lateral sclerosis (PLS), progressive muscular atrophy (PMA), spinal muscular atrophy (SMA), spinal bulbar muscular atrophy (SBMA), post poliomyelitis syndrome (PPS), and hereditary spastic paraplegia (HSP). This review focuses on insights from structural, metabolic, and functional neuroimaging studies that have advanced our understanding of extra-motor disease burden in these phenotypes. The imaging literature is limited in the majority of these conditions and frontotemporal involvement has been primarily evaluated by neuropsychology and post mortem studies. Existing imaging studies reveal that frontotemporal degeneration can be readily detected in ALS and PLS, varying degree of frontotemporal pathology may be captured in PMA, SBMA, and HSP, SMA exhibits cerebral involvement without regional predilection, and there is limited evidence for cerebral changes in PPS. Our review confirms the heterogeneity extra-motor pathology across the spectrum of MNDs and highlights the role of neuroimaging in characterizing anatomical patterns of disease burden in vivo. Despite the contribution of neuroimaging to MND research, sample size limitations, inclusion bias, attrition rates in longitudinal studies, and methodological constraints need to be carefully considered. Frontotemporal involvement is a quintessential clinical facet of MND which has important implications for screening practices, individualized management strategies, participation in clinical trials, caregiver burden, and resource allocation. The academic relevance of imaging frontotemporal pathology in MND spans from the identification of genetic variants, through the ascertainment of presymptomatic changes to the design of future epidemiology studies.

Non-Motor Symptoms of Amyotrophic Lateral Sclerosis: A Multi-Faceted Disorder

Amyotrophic Lateral Sclerosis (ALS) is a fatal neurodegenerative disease characterized by progressive degeneration of motor pathways. A growing body of evidence from recent years suggests that ALS results in a wide range of non-motor symptoms as well, which can have a significant impact on patients' quality of life. These symptoms could also, in turn, provide useful information as biomarkers for disease progression, and can shed insight on ALS mechanisms. Here we aim to review a wide range of non-motor symptoms of ALS, with emphasis on their importance to research and clinical treatment of patients.

The spectrum of language impairments in amyotrophic lateral sclerosis

Language disorders are increasingly recognised in Amyotrophic lateral sclerosis (ALS), supporting the view of ALS as a multi-system disorder, impacting cognitive and motor function. However, the language impairments are heterogeneous and recent focus has been on determining the language profile across the ALS spectrum with little focus on spontaneous speech. The current study systematically investigated a wide range of language abilities in an unselected ALS sample (N = 22), including spontaneous speech. We analysed the ALS patients' performance as a group, compared to age-, education- and IQ-matched healthy controls (N = 21), and as a case series to identify dementia and specific language profiles. The ALS group was impaired on measures of spontaneous speech, word fluency and action naming. By contrast, object naming, semantic memory (object and actions), sentence comprehension and repetition (word and sentences) were comparable to healthy controls. In line with recent suggestions, our ALS patients' action naming (but not action semantic) deficit does not support the notion that action processing may be selectively impaired in ALS. The case series demonstrated that 14% of patients had probable dementia, 31% showed significant cognitive and/or language impairment and 55% were unimpaired, consistent with the spectrum of cognitive and language impairments reported in the literature. In addition, 36% of ALS patients produced significantly fewer words per minute on a spontaneous speech task than the control group, with this difference remaining when the ALS patients with frontotemporal dementia were excluded from the analysis. This pattern was observed across the ALS spectrum and in both limb and bulbar onset patients. The pattern of performance observed in the present study suggests that spontaneous speech is reduced across the ALS spectrum even in those with intact core language abilities.

Feeling better: Tactile verbs speed up tactile detection

Embodiment of action-related language into the motor system has been extensively documented. Yet the case of sensory words, especially referring to touch, remains overlooked. We investigated the influence of verbs denoting tactile sensations on tactile perception. In Experiment 1, participants detected tactile stimulations on their forearm, preceded by tactile or non-tactile verbs by one of three delays (170, 350, 500 ms) reflecting different word processing stages. Results revealed shorter reaction times to tactile stimulations following tactile than non-tactile verbs, irrespective of delay. To ensure that priming pertained to tactile, and not motor, verb properties, Experiment 2 compared the impact of tactile verbs to both action and non-tactile verbs, while stimulations were delivered on the index finger. No priming emerged following action verbs, therefore not supporting the motor-grounded interpretation. Facilitation by tactile verbs was however not observed, possibly owing to methodological changes. Experiment 3, identical to Experiment 2 except that stimulation was delivered to participants' forearm, replicated the priming effect. Importantly, tactile stimulations were detected faster after tactile than after both non-tactile and action verbs, indicating that verbs' tactile properties engaged resources shared with sensory perception. Our findings suggest that language conveying tactile information can activate somatosensory representations and subsequently promote tactile detection.

A new test of action verb naming: normative data from 290 Italian adults

INTRODUCTION

Verbs and nouns can be selectively impaired, suggesting that they are processed, at least in part, by distinct neural structures. While several tests of object naming are available, tasks involving action verb naming with normative data are lacking. We report the construction and standardization of a new test for the assessment of picture naming of actions.

MATERIAL AND METHODS

The test includes 50 stimuli, strictly controlled for several confounding variables. Normative data on 290 Italian subjects pooled across homogenous subgroups for age, sex, and education are reported.

RESULTS

Multiple regression analyses revealed that age and education significantly correlated with the subject's score. In particular, increasing age negatively affected performance, while the performance increased with a higher education.

CONCLUSIONS

In the clinical practice, the availability of equivalent scores will help the comparison with performance in the picture naming of objects. This test allows investigating action naming deficits in aphasic patients, in Parkinson's disease patients and in further neurodegenerative disorders, in which a specific impairment of action verbs is expected, filling a gap in the clinical neuropsychological assessment.

Reduced Lexical Access to Verbs in Individuals With Subjective Cognitive Decline

The detection of cognitive impairment in individuals with subjective cognitive decline (SCD) may improve detection of the emergence of Alzheimer's disease (AD) pathology. This detection is challenging, however, given the lack of sensitive assessment tools. The main objective of this study was to determine the potential contribution of word production tasks to the detection of cognitive impairment in SCD. The performances of 20 individuals with SCD, healthy controls (HCs), and individuals with mild cognitive impairment (MCI) were compared on object and action naming and free fluency tasks. Participants with SCD performed similarly to HCs, while both groups differed significantly from participants with MCI in object naming and object fluency. Results showed that participants with SCD were at the midpoint between HCs and participants with MCI in action naming. They also revealed a HCs > SCD = MCI pattern in action fluency. This study provides evidence that verb production is impaired in SCD and that SCD is a pre-MCI condition.

Clinical and Radiological Markers of Extra-Motor Deficits in Amyotrophic Lateral Sclerosis

Amyotrophic lateral sclerosis (ALS) is now universally recognized as a complex multisystem disorder with considerable extra-motor involvement. The neuropsychological manifestations of frontotemporal, parietal, and basal ganglia involvement in ALS have important implications for compliance with assistive devices, survival, participation in clinical trials, caregiver burden, and the management of individual care needs. Recent advances in neuroimaging have been instrumental in characterizing the biological substrate of heterogeneous cognitive and behavioral deficits in ALS. In this review we discuss the clinical and radiological aspects of cognitive and behavioral impairment in ALS focusing on the recognition, assessment, and monitoring of these symptoms.

Considerations for Clinical Neuropsychological Evaluation in Amyotrophic Lateral Sclerosis

The clinical neuropsychologist has the opportunity to be uniquely involved in the evaluation and treatment of individuals with amyotrophic lateral sclerosis (ALS). We review the current literature that defines cognitive and behavioral symptoms in ALS, including current knowledge of the neuropathological and genetic underpinning for these symptoms. There are unique considerations for clinical neuropsychological evaluation and clinical research in ALS and we highlight these in this review. Specifically, we shed light on special factors that contribute to our understanding of cognitive and behavioral impairment in ALS, including co-morbid symptoms, differential diagnosis, and considerations for longitudinal tracking of phenotypes. We discuss the rationale for proposing a specific approach to such as cognitive screening, test selection, response modality consideration, and test-retest intervals. With this didactic overview, the clinical neuropsychologist has the potential to learn more about the heterogeneous presentation of motor and neuropsychological symptoms in ALS. Furthermore, the reader has the opportunity to understand what it takes to develop a valid assessment approach particularly when the phenotype of ALS remains undefined in some regards. This clinical practice review sets the stage for the clinical neuropsychologist to further contribute to our clinical and scientific understanding of ALS and cognition.

Word selection processing in Parkinson's disease: When nouns are more difficult than verbs

Patients with Parkinson's disease (PD) are impaired in verb production. Interpretations range from grammatical deficits to semantic-conceptual decay of action representation. The verb production deficit in PD can also be considered a dysexecutive disorder, specifically, a deficit of selection processing during word production, due to corticostriatal damage. Producing verbs is "more difficult" than producing nouns, because verb-forms must be selected from a large set of word-forms which share the verb-root, and the set of possible verb-forms is larger than the set of possible noun-forms when a noun has to be produced. However, if we devise a condition in which a noun must be selected from a set of alternatives larger than the set of alternative forms from which a verb must be selected, we expect an opposite pattern, with nouns becoming more difficult than verbs. We used morphological tasks varying in the number of alternative responses during word production. Fourteen PD patients and 14 healthy Controls participated in the study. Participants performed a noun-from-verb ('observation' from 'to observe') and a noun-from adjective derivation task ('kindness' from 'kind'), and a verb-from-noun ('to observe' from 'observation') and an adjective-from-noun generation task ('kind' from 'kindness'). Input-stimuli were presented singularly on a screen and participants produced the response as fast as possible. Response latencies were longer in derivation tasks (several alternative responses) than in generation tasks (one possible response), irrespective of the grammatical class of the target word, with no difference between groups. PD patients were significantly less accurate than Controls only in the noun-from-verb derivation task, that is, in the task with the highest number of alternative responses (PD: 60%; Controls: 81%). Results suggest that the verb production disorder in PD patients may reflect disturbed selection processes among competitors: the higher the number of alternative responses the more severe the impairment.

Developmental Coordination Disorder Affects the Processing of Action-Related Verbs

Processing action-language affects the planning and execution of motor acts, which suggests that the motor system might be involved in action-language understanding. However, this claim is hotly debated. For the first time, we compared the processing of action-verbs in children with Developmental Coordination Disorder (DCD), a disease that specifically affects the motor system, with children with a typical development (TD). We administered two versions of a go/no-go task in which verbs expressing either hand, foot or abstract actions were presented. We found that only when the semantic content of a verb has to be retrieved, TD children showed an increase in reaction times if the verb involved the same effector used to give the response. In contrast, DCD patients did not show any difference between verb categories irrespective of the task. These findings suggest that the pathological functioning of the motor system in individuals with DCD also affects language processing.

Amyotrophic lateral sclerosis - frontotemporal spectrum disorder (ALS-FTSD): Revised diagnostic criteria

This article presents the revised consensus criteria for the diagnosis of frontotemporal dysfunction in amyotrophic lateral sclerosis (ALS) based on an international research workshop on frontotemporal dementia (FTD) and ALS held in London, Canada in June 2015. Since the publication of the Strong criteria, there have been considerable advances in the understanding of the neuropsychological profile of patients with ALS. Not only is the breadth and depth of neuropsychological findings broader than previously recognised - - including deficits in social cognition and language - but mixed deficits may also occur. Evidence now shows that the neuropsychological deficits in ALS are extremely heterogeneous, affecting over 50% of persons with ALS. When present, these deficits significantly and adversely impact patient survival. It is the recognition of this clinical heterogeneity in association with neuroimaging, genetic and neuropathological advances that has led to the current re-conceptualisation that neuropsychological deficits in ALS fall along a spectrum. These revised consensus criteria expand upon those of 2009 and embrace the concept of the frontotemporal spectrum disorder of ALS (ALS-FTSD).

Formal Semantics in the Neurology Clinic: Atypical Understanding of Aspectual Coercion in ALS Patients

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease of the motor system with subtle adverse effects on cognition. It is still unclear whether ALS also affects language and semantics, and if so, what aspects and processes exactly. We investigated how ALS patients understand verb phrases modified by temporal preposition phrases, e.g., "To watch TV for half an hour." Interpretation here requires operations such as aspectual coercion that add or delete elements from event structures, depending on temporal modifiers, and constraints on coercion, which make combinations with certain modifiers not viable. Using a theoretically-motivated experimental design, we observed that acceptance rates for aspectual coercion were abnormally high in ALS patients. The effect was largest for the more complex cases of coercion: not those that involve enrichment of event structures ("To switch on the TV in half an hour," where a number of failed attempts must be included in the interpretation) but those that, if applied, would result in deletion of event structure elements ("To repair the TV for half an hour"). Our experimental results are consistent with a deficit of constraints on coercion, and not with impaired semantic processes or representations, in line with recent studies suggesting that verb semantics is largely spared in ALS.

Communication and pragmatic breakdowns in amyotrophic lateral sclerosis patients

While there is increasing attention toward cognitive changes in amyotrophic lateral sclerosis (ALS), the domain of pragmatics, defined as the ability to integrate language and context to engage in successful communication, remains unexplored. Here we tested pragmatic abilities in 33 non-demented ALS patients and 33 healthy controls matched for age and education through 6 different tasks, ranging from discourse organization to the comprehension of figurative language, further grouped in three composite measures for pragmatic production, pragmatic comprehension and global pragmatic abilities. For a subgroup of patients, assessment included executive functions and social cognition skills. ALS patients were impaired on all pragmatic tasks relative to controls, with 45% of the patients performing below cut-off in at least one pragmatic task, and 36% impaired on the global pragmatic score. Pragmatic breakdowns were more common than executive deficit as defined by the consensus criteria, and approximately as prevalent as deficits in social cognition. Multiple regression analyses support the idea of an interplay of executive and social cognition abilities in determining the pragmatic performance, although all these domains show some degree of independence. These findings shed light on pragmatic impairment as a relevant dimension of ALS, which deserves further consideration in defining the cognitive profile of the disease, given its vital role for communication and social interaction in daily life.

Visual objects speak louder than words: motor planning and weight in tool use and object transport

For theories of embodied cognition, reading a word activates sensorimotor representations in a similar manner to seeing the physical object the word represents. Thus, reading words representing objects of different sizes interfere with motor planning, inducing changes in grip aperture. An outstanding issue is whether word reading can also evoke sensorimotor information about the weight of objects. This issue was addressed in two experiments wherein participants have first to read the name of an object (Experiment 1)/observe the object (Experiment 2) and then to transport versus use bottles of water. The objects presented as primes were either lighter or heavier than the bottles to be grasped. Results indicated that the main parameters of motor planning recorded (initiation times and finger contact points) were not affected by the presentation of words as primes (Experiment 1). By contrast, the presentation of visual objects as primes induced significant changes in these parameters (Experiment 2). Participants changed their way of grasping the bottles, particularly in the use condition. Taken together, these results suggest that the activation of concepts does not automatically evoke sensorimotor representations about the weight of objects, but visual objects do.

Controlled processing during sequencing

Longstanding evidence has identified a role for the frontal cortex in sequencing within both linguistic and non-linguistic domains. More recently, neuropsychological studies have suggested a specific role for the left premotor-prefrontal junction (BA 44/6) in selection between competing alternatives during sequencing. In this study, we used neuroimaging with healthy adults to confirm and extend knowledge about the neural correlates of sequencing. Participants reproduced visually presented sequences of syllables and words using manual button presses. Items in the sequence were presented either consecutively or concurrently. Concurrent presentation is known to trigger the planning of multiple responses, which might compete with one another. Therefore, we hypothesized that regions involved in controlled processing would show greater recruitment during the concurrent than the consecutive condition. Whole-brain analysis showed concurrent > consecutive activation in sensory, motor and somatosensory cortices and notably also in rostral-dorsal anterior cingulate cortex. Region of interest analyses showed increased activation within left BA 44/6 and correlation between this region’s activation and behavioral response times. Functional connectivity analysis revealed increased connectivity between left BA 44/6 and the posterior lobe of the cerebellum during the concurrent than the consecutive condition. These results corroborate recent evidence and demonstrate the involvement of BA 44/6 and other control regions when ordering co-activated representations.

Syntactic processing as a marker for cognitive impairment in amyotrophic lateral sclerosis

Despite recent interest in cognitive changes in patients with amyotrophic lateral sclerosis (ALS), investigations of language function looking at the level of word, sentence and discourse processing are relatively scarce. Data were obtained from 26 patients with sporadic ALS and 26 healthy controls matched for age, education, gender, anxiety, depression and executive function performance. Standardized language tasks included confrontation naming, semantic access, and syntactic comprehension. Quantitative production analysis (QPA) was used to analyse connected speech samples of the Cookie Theft picture description task. Results showed that the ALS patients were impaired on standardized measures of grammatical comprehension and action/verb semantics. At the level of discourse, ALS patients were impaired on measures of syntactic complexity and fluency; however, the latter could be better explained by disease related factors. Discriminant analysis revealed that syntactic measures differentiated ALS patients from controls. In conclusion, patients with ALS exhibit deficits in receptive and expressive language on tasks of comprehension and connected speech production, respectively. Our findings suggest that syntactic processing deficits seem to be the predominant feature of language impairment in ALS and that these deficits can be detected by relatively simple language tests.