Phonological disruption and subsequent self-correcting behaviour in Cantonese aphasic speakers

Jargonaphasia in logopenic variant primary progressive aphasia

BACKGROUND

Logopenic variant primary progressive aphasia (lvPPA), which is most commonly an early onset variant of Alzheimer's disease (AD), is a progressive impairment in word retrieval and language expression. Clinicians often misdiagnose these patients when they present with severely unintelligible speech consistent with jargonaphasia.

METHODS

We reviewed all patients presenting to a behavioral neurology program over a 23-year period who met criteria for lvPPA after completion of an evaluation extending to positron emission tomography (PET) of the brain. Among these lvPPA patients, we additionally identified and characterized those whose presentation involved incomprehensible yet fluent verbal output.

RESULTS

Out of 95 patients with lvPPA, 9 (9.47%) had jargonaphasia on presentation. These patients differed from the remaining 86 patients in lacking awareness or concern for their impaired communication, having worse mental status scale scores, greater auditory comprehension difficulty, and more bilateral temporo-parietal hypometabolism. In addition, 44.4% of those with jargonaphasia, compared to 14% of those without, were bi/multilingual.

CONCLUSION

Nearly 1 in 10 patients with lvPPA present with severely unintelligible speech. These patients have disease extending to bilateral temporoparietal areas affecting language comprehension and disease awareness. Jargonaphasia can be a confusing presentation of AD and must be differentiated from other progressive aphasias, Wernicke's aphasia, and the word salad of "schizoaphasia".

Do People With Apraxia of Speech and Aphasia Improve or Worsen Across Repeated Sequential Word Trials?

PURPOSE

During motor speech examinations for suspected apraxia of speech (AOS), clients are routinely asked to repeat words several times sequentially. The purpose of this study was to understand the task in terms of the relationship among consecutive attempts. We asked to what extent phonemic accuracy changes across trials and whether the change is predicted by AOS diagnosis and sound production severity.

METHOD

One hundred thirty-three participants were assigned to four diagnostic groups based on quantitative metrics (aphasia plus AOS, aphasia-only, and aphasia with two borderline speech profiles). Each participant produced four multisyllabic words 5 times consecutively. These productions were audio-recorded and transcribed phonetically and then summarized as the proportion of target phonemes that was produced accurately. Nonparametric statistics were used to analyze percent change in accuracy from the first to the last production based on diagnostic group and a broad measure of speech sound accuracy.

RESULTS

Accuracy on the repeated words deteriorated across trials for all groups, showing reduced accuracy from the first to the last repetition for 62% of participants. Although diagnostic groups differed on the broad measure of speech sound accuracy, severity classification based on this measure did not determine degree of deterioration on the repeated words task.

DISCUSSION

Responding to a request to say multisyllabic words 5 times sequentially is challenging for people with aphasia with and without AOS, and as such, performance is prone to errors even with mild impairment. For most, the task does not encourage self-correction. Instead, it promotes errors, regardless of diagnosis, and is, therefore, useful for screening purposes.