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Singh NA, Graff-Radford J, Machulda MM, Carlos AF, Schwarz CG, Senjem ML, Jack CR, Lowe VJ, Josephs KA, Whitwell JL. Atypical Alzheimer's disease: new insights into an overlapping spectrum between the language and visual variants. J Neurol 2024; 271:3571-3585. [PMID: 38551740 DOI: 10.1007/s00415-024-12297-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 05/30/2024]
Abstract
Overlap between language and visual variants of atypical Alzheimer's disease (AD) has been reported. However, the extent, frequency of overlap, and its neuroanatomical underpinnings remain unclear. Eighty-two biomarker-confirmed AD patients who presented with either predominant language (n = 34) or visuospatial/perceptual (n = 48) deficits underwent detailed clinical examinations, MRI, and [18F]flortaucipir-PET. Subgroups were defined based on language/visual testing and patterns of volume loss and tau uptake were assessed. 28% of the language group had visual dysfunction (marked in 8%), and 47% of the visual group had language impairment (marked in 26%). Progressive involvement of the parieto-occipital and frontal lobes was noted with greater visual impairment in the language group, and greater left parieto-temporal and frontal involvement with worsening language impairment in the visual group. Only 25% of our cohort showed a pure language or visual presentation, highlighting the high frequency of syndromic overlap in atypical AD and the diagnostic challenge of categorical phenotyping.
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Affiliation(s)
| | | | - Mary M Machulda
- Department of Psychiatry & Psychology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Arenn F Carlos
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | | | - Matthew L Senjem
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Clifford R Jack
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Jennifer L Whitwell
- Department of Radiology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
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Jebahi F, Nickels KV, Kielar A. Patterns of performance on the animal fluency task in logopenic variant of primary progressive aphasia: A reflection of phonological and semantic skills. JOURNAL OF COMMUNICATION DISORDERS 2024; 108:106405. [PMID: 38324949 DOI: 10.1016/j.jcomdis.2024.106405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/03/2024] [Accepted: 01/19/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE This study aimed to characterize the quantitative (total number of correct words generated) and qualitative (psycholinguistic properties of correct words generated) performance patterns on the animal fluency task in individuals with the logopenic variant of primary progressive aphasia and to investigate the influence of phonological and semantic abilities to these patterns. METHODS Fifteen participants with lvPPA and twenty neurotypical adults completed the animal fluency task and an assessment battery to characterize their phonological and semantic abilities. We recorded the total number of correct words produced and their psycholinguistic properties. Group differences were analyzed using independent samples t-tests and analysis of covariance. Stepwise and multiple linear regression analyses were implemented to investigate the contribution of psycholinguistic properties on word generation as well as the role of phonological and semantic abilities on performance. We also investigated the mediating role of phonological and semantic abilities on the relationship between relevant psycholinguistic properties and word generation output. RESULTS Compared to neurotypical controls, participants with lvPPA produced fewer correct responses and more words with lower age of acquisition. The total number of correct words generated was predicted by the age of word acquisition, such that individuals who generated more responses, produced words acquired later in life. Phonology and semantics influenced the number of correct words generated and their frequency, age of acquisition, and semantic neighborhood density. Familiarity and arousal were driven by semantic abilities. Phonological abilities partially mediated the relationship between age of acquisition and word generation output. CONCLUSIONS This study provides valuable insights into the performance patterns of the animal fluency task in lvPPA. Individuals with lvPPA with more intact phonological and semantic abilities generated greater number of words with more complex psycholinguistic properties. Our findings contribute to the understanding of language processes underlying word retrieval in lvPPA.
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Affiliation(s)
- Fatima Jebahi
- Department of Speech, Language and Hearing Sciences, University of Arizona, Tucson, AZ, USA; Cognitive Science Graduate Interdisciplinary Program, University of Arizona, Tucson, AZ, USA.
| | - Katlyn V Nickels
- Department of Speech, Language and Hearing Sciences, University of Arizona, Tucson, AZ, USA; Cognitive Science Graduate Interdisciplinary Program, University of Arizona, Tucson, AZ, USA
| | - Aneta Kielar
- Department of Speech, Language and Hearing Sciences, University of Arizona, Tucson, AZ, USA; Cognitive Science Graduate Interdisciplinary Program, University of Arizona, Tucson, AZ, USA; BIO5 Institute, University of Arizona, Tucson, AZ, USA
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Utianski RL, Josephs KA. An Update on Apraxia of Speech. Curr Neurol Neurosci Rep 2023; 23:353-359. [PMID: 37269450 PMCID: PMC10629164 DOI: 10.1007/s11910-023-01275-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE OF REVIEW Apraxia of speech (AOS) is a motor speech disorder that has long been recognized to occur secondary to acute neurologic insults and, more recently, to neurodegenerative diseases as a harbinger for progressive supranuclear palsy and corticobasal syndrome. This article reviews recent findings regarding the clinic phenotypes of AOS, neuroimaging correlates, and the underlying disease processes. RECENT FINDINGS Two clinical subtypes of AOS map onto two underlying 4-repeat tauopathies. New imaging techniques have recently been applied to the study of progressive AOS. There is no data on the impact of behavioral intervention, although studies of nonfluent/agrammatic primary progressive aphasia that include patients with AOS suggest some benefit in speech intelligibility and maintenance. While recent findings suggest subtypes of AOS exist that are linked to molecular pathology and have important implications for disease progression, further research is needed to assess outcome of behavioral and other types of intervention.
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Affiliation(s)
- Rene L Utianski
- Department of Neurology, Mayo Clinic College of Medicine and Science, 200 1St Street S.W., Rochester, MN, 55905, USA
| | - Keith A Josephs
- Department of Neurology, Mayo Clinic College of Medicine and Science, 200 1St Street S.W., Rochester, MN, 55905, USA.
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Riello M, Frangakis CE, Ficek B, Webster KT, Desmond JE, Faria AV, Hillis AE, Tsapkini K. Neural Correlates of Letter and Semantic Fluency in Primary Progressive Aphasia. Brain Sci 2021; 12:1. [PMID: 35053745 PMCID: PMC8773895 DOI: 10.3390/brainsci12010001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/21/2022] Open
Abstract
Verbal fluency (VF) is an informative cognitive task. Lesion and functional imaging studies implicate distinct cerebral areas that support letter versus semantic fluency and the understanding of neural and cognitive mechanisms underlying task performance. Most lesion studies include chronic stroke patients. People with primary progressive aphasia (PPA) provide complementary evidence for lesion-deficit associations, as different brain areas are affected in stroke versus PPA. In the present study we sought to determine imaging, clinical and demographic correlates of VF in PPA. Thirty-five patients with PPA underwent an assessment with letter and category VF tasks, evaluation of clinical features and an MRI scan for volumetric analysis. We used stepwise regression models to determine which brain areas are associated with VF performance while acknowledging the independent contribution of clinical and demographic factors. Letter fluency was predominantly associated with language severity (R2 = 38%), and correlated with the volume of the left superior temporal regions (R2 = 12%) and the right dorsolateral prefrontal area (R2 = 5%). Semantic fluency was predominantly associated with dementia severity (R2 = 47%) and correlated with the volume of the left inferior temporal gyrus (R2 = 7%). No other variables were significantly associated with performance in the two VF tasks. We concluded that, independently of disease severity, letter fluency is significantly associated with the volume of frontal and temporal areas whereas semantic fluency is associated mainly with the volume of temporal areas. Furthermore, our findings indicated that clinical severity plays a critical role in explaining VF performance in PPA, compared to the other clinical and demographic factors.
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Affiliation(s)
- Marianna Riello
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (M.R.); (B.F.); (K.T.W.); (J.E.D.); (A.E.H.)
| | - Constantine E. Frangakis
- Department of Biostatistics, Johns Hopkins School of Public Health, Baltimore, MD 21227, USA;
- Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD 21227, USA;
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21227, USA
| | - Bronte Ficek
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (M.R.); (B.F.); (K.T.W.); (J.E.D.); (A.E.H.)
| | - Kimberly T. Webster
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (M.R.); (B.F.); (K.T.W.); (J.E.D.); (A.E.H.)
- Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21227, USA
| | - John E. Desmond
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (M.R.); (B.F.); (K.T.W.); (J.E.D.); (A.E.H.)
| | - Andreia V. Faria
- Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD 21227, USA;
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (M.R.); (B.F.); (K.T.W.); (J.E.D.); (A.E.H.)
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
| | - Kyrana Tsapkini
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA; (M.R.); (B.F.); (K.T.W.); (J.E.D.); (A.E.H.)
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD 21218, USA
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