Maintenance Versus Transmission Deficits: The Effect of Delay on Naming Performance in Aphasia

A shared serial order system for verbal working memory and language production: evidence from aphasia

Many aspects of human performance require producing sequences of items in serial order. The current study takes a multiple-case approach to investigate whether the system responsible for serial order is shared across cognitive domains, focusing on working memory (WM) and word production. Serial order performance in three individuals with post-stroke language and verbal WM disorders (hereafter persons with aphasia, PWAs) were assessed using recognition and recall tasks for verbal and visuospatial WM, as well as error analyses in spoken and written production tasks to assess whether there was a tendency to produce the correct phonemes/letters in the wrong order. One PWA exhibited domain-specific serial order deficits in verbal and visuospatial WM. The PWA with verbal serial order WM deficit made more serial order errors than expected by chance in both repetition and writing-to-dictation tasks, whereas the other two PWAs showed no serial order deficits in verbal WM and production tasks. These findings suggest separable serial order systems for verbal and visuospatial WM and a shared system for serial order processing in verbal WM and word production. Implications for the domain-generality of WM, its connection to language production, and serial order processing across cognitive functionssc are discussed.

Revealing Linguistic and Verbal Short-Term and Working Memory Abilities in People with Severe Aphasia

Background

The assessment of aphasia in people with severe deficits is hampered by a paucity of tests that are appropriate for this population and that are sensitive to their underlying linguistic and short-term and working memory (STM/WM) strengths and weaknesses. The Temple Assessment of Language and Short-Term Memory in Aphasia (TALSA) provides a means of assessing people with severe aphasia (PWSA).

Aims

The aim of this paper is to demonstrate the sensitivity of the TALSA to the underlying linguistic and STM/WM strengths and weaknesses in PWSA. We assessed eight PWSA on selected subtests of the TALSA and found that 1) the TALSA is sensitive to the underlying linguistic and verbal STM/WM abilities of PWSA, 2) the TALSA reveals a wide variety of linguistic and verbal STM/WM profiles in PWSA and, 3) the TALSA can potentially demonstrate common patterns of performance in PWSA.

Main contributions

The TALSA allows researchers to include more PWSA in the study of aphasia and enables clinicians to establish more accurate prognoses, create precisely targeted treatment plans and document incremental progress in therapy.

Conclusions

The TALSA is an important addition to the assessment of severe aphasia. It provides an in-depth evaluation of underlying linguistic and verbal STM/WM strengths and weaknesses of PWSA.

The effect of time on lexical and syntactic processing in aphasia

Processing deficits at the lexical level, such as delayed and reduced lexical activation, have been theorized as the source of breakdowns in syntactic operations and thus contribute to sentence comprehension deficits in individuals with aphasia (IWA). In the current study, we investigate the relationship between lexical and syntactic processing in object-relative sentences using eye-tracking while listening in IWA. We explore whether manipulating the time available to process a critical lexical item (the direct-object noun) when it is initially heard in a sentence has an immediate effect on lexical access as well as a downstream effect on syntactic processing. To achieve this aim, we use novel temporal manipulations to provide additional time for lexical processing to occur. In addition to exploring these temporal effects in IWA, we also seek to understand the effect that additional time has on sentence processing in neurotypical age-matched adults (AMC). We predict that the temporal manipulations designed to provide increased processing time for critical lexical items will 1) enhance lexical processing of the target noun, 2) facilitate syntactic integration, and 3) improve sentence comprehension for both IWA and AMC. We demonstrate that strengthening lexical processing via the addition of time can affect lexical processing and facilitate syntactic retrieval of the target noun and lead to enhanced interference resolution in both unimpaired and impaired systems. In aphasia, additional time can mitigate impairments in spreading activation thereby improving lexical access and reducing interference during downstream dependency linking. However, individuals with aphasia may require longer additions of time to fully realize these benefits.

Word production and comprehension in frontotemporal degeneration: A neurocognitive computational Pickian account

Over a century ago, Arnold Pick reported deterioration of word production and comprehension in frontotemporal degeneration, now a common finding. Individuals with semantic dementia (SD) and behavioral variant frontotemporal dementia (bvFTD) present with word retrieval difficulty, while their comprehension is less affected. Computational models have illuminated naming and comprehension in poststroke and progressive aphasias, including SD, but there are no simulations for bvFTD. Here, the WEAVER++/ARC model, previously applied to poststroke and progressive aphasias, is extended to bvFTD. Simulations tested the hypothesis of a loss of activation capacity in semantic memory in SD and bvFTD, caused by network atrophy (Pick, 1908a). The outcomes revealed that capacity loss explains 97% of the variance in naming and comprehension of 100 individual patients. Moreover, capacity loss correlates with individual ratings of atrophy in the left anterior temporal lobe. These results support a unified account of word production and comprehension in SD and bvFTD.

A neurocognitive computational account of word production, comprehension, and repetition in primary progressive aphasia

Computational models have elucidated word production, comprehension, and repetition in poststroke aphasia syndromes, but simulations are lacking for primary progressive aphasia (PPA) resulting from neurodegenerative disease. Here, the WEAVER++/ARC model, which has previously been applied to poststroke aphasia, is extended to the three major PPA variants: nonfluent/agrammatic, semantic, and logopenic. Following a seminal suggestion by Pick (1892/1977) and modern empirical insights, the model assumes that PPA arises from a progressive loss of activation capacity in portions of the language network with neurocognitive epicenters specific to each PPA variant. Computer simulations revealed that the model succeeds reasonably well in capturing the patterns of impaired and spared naming, comprehension, and repetition performance, at both group and individual patient levels. Moreover, it captures the worsening of performance with progression of the disease. The model explains about 90% of the variance, lending computational support to Pick's suggestion and modern insights.

Integrity of input verbal short-term memory ability predicts naming accuracy in aphasia

Background

Contemporary models of aphasia predominantly attribute lexical retrieval deficits to impaired access and/or maintenance of semantic, lexical, and phonological representations of words. A central hypothesis of language-emergent models of verbal short-term memory (STM) is that temporary storage and maintenance of verbal information arises from activation of linguistic representations in long-term memory. This close relationship between short-term retention and linguistic representations has prompted accounts of aphasia that include impairments to both these components.

Aims

We investigated associations between measures of input semantic and phonological verbal STM and corresponding output processing measures. We hypothesised that both input and output functions of verbal STM rely on a common substrate (i.e., temporary activation and maintenance of long-term linguistic representations).

Methods & Procedure

Twenty adults with aphasia completed a series of semantic and phonological probe spans. Results were compared with naming performance in immediate and delayed conditions. The data were analysed using correlations, principal components analysis and linear regressions.

Results & Discussion

Input semantic and phonological verbal STM abilities were predictive of naming accuracy. Greater input semantic and phonological STM spans were associated with fewer semantic and phonological naming errors. Latent factors identified by principal components analysis of probe span data were consistent with a two-step interactive model of word retrieval. Probe spans measuring access to semantic and initial consonant-vowel representations aligned with lexical-semantic abilities (lexical-semantic factor). Probe spans assessing access to the rhyme component of a word measured lexical-phonological abilities (lexical-phonological factor). The principal components analysis indicated that stronger lexical-semantic abilities were associated with fewer semantic and nonword errors, and stronger lexical phonological abilities were associated with fewer formal and unrelated errors. In addition, our results were consistent with models that postulate serial access to phonology, proceeding from initial to final phonemes. The span measuring access to initial consonant-vowel was associated with lexical selection, while the span measuring access to rhyme information was associated with phonological selection.

Conclusion

Performance on input semantic and phonological tasks predicts accuracy of picture naming performance and types of errors made by people with aphasia. These results indicate overlap in input and output semantic and phonological processing, which must be accounted for in models of lexical processing. These findings also have implications for approaches to diagnosis and treatments for lexical comprehension and production that capitalise on the overlap of input and output processing.

Treatment of the Linguistic and Temporal Components of Lexical Activation to Improve Word Retrieval in Aphasia

Current approaches to treatments for word processing impairments in aphasia emphasize two components to target, the linguistic content, semantic or phonological representations of words, and the processing component, access to and retrieval of those representations. In this study, we explore these two components of a treatment to improve lexical activation that supports access and retrieval of word representations. Five people with aphasia participated. The treatment task was repetition of concrete word pairs after a 5-s response delay which was intended to provide practice in maintaining activation of the words for that 5-s period before reproducing them. Two of the five participants demonstrated a difficulty in maintaining activation of single words in repetition, with accuracy decreasing significantly after the 5-s interval. The treatment was applied to all participants, however, to determine if its benefit was specific to those with the activation maintenance impairment. Results confirmed that the activation maintenance treatment in the context of this repetition task led to more treatment gains for the two participants who demonstrated this specific impairment. They made gains on four of the nine measures compared to improvements on one to two measures for the other participants. A second question addressed in this study was the relative importance of the item component (linguistic content) of the treatment and the processing component, maintenance of activation. To that end, there were two conditions of treatment probes, (1) repeated content for all treatment, immediate post-treatment and 3-month maintenance probes and (2) novel content for probes in these three phases of treatment. Only one participant showed significant improvement in treatment when items were novel for all probes. We discuss the possibility that this outcome reflects a more specific deficit in the temporal processing component of lexical activation compared to the two other participants who showed better performance on probes with repeated items in treatment and post-treatment phases. Clinical implications of this study and directions of future research are discussed.

Disentangling the Psycholinguistic Loci of Anomia with Cognitive Psychometric Models

This article reviews advanced statistical techniques for measuring impairments in object naming, particularly in the context of stroke-induced aphasia. Traditional testing strategies can be challenged by the multifaceted nature of impairments that arise due to the complex relationships between localized brain damage and disruption to the cognitive processes required for successful object naming. Cognitive psychometric models can combine response-type analysis with item-response theory to yield accurate estimates of multiple abilities using data collected from a single task. The models also provide insights about how the test items can be challenging in different ways. Although more work is needed to fully optimize their clinical utility in practice, these formal concepts can guide thoughtful selection of stimuli used in treatment or assessment, as well as providing a framework to interpret response-type data.

Similarities between Cognitive Models of Language Production and Everyday Functioning: Implications for Development of Interventions for Functional Difficulties

The loss of the ability to independently complete activities of daily living, such as meal preparation and household chores, is a defining characteristic of clinical dementia; however, minor difficulties in completing everyday activities emerge in the mild cognitive impairment stage, and even healthy older adults exhibit subtle functional difficulties compared to younger adults. These functional difficulties are associated with an array of negative outcomes, including decreased quality of life, higher costs of care, and increased frustration, depression, caregiver burden, and institutionalization. While cognitive models have been proposed to explain the functional deficits seen in dementia and subtler forms of cognitive decline, in contrast to other cognitive disorders such as aphasia, there are essentially no theoretically motivated interventions to address difficulties in everyday functioning. Proposed models of functional impairment share features with cognitive processing models of language, including hierarchical organization of representations and interactive, spreading activation; thus, an examination of aphasia interventions has the potential to inform the development of theoretically motivated interventions for everyday activities. This review first addresses the shared characteristics of cognitive models of everyday function and language, with a focus on linguistic production. Next, we will present aphasia interventions that target single-word production, sentence production, short-term memory, and semantics, and discuss their implications for everyday functioning interventions. We conclude with a discussion of limitations of the language-everyday functioning comparison as well as areas of future research.

Treatment of verbal short-term memory abilities to improve language function in aphasia: A case series treatment study

Recent approaches to interventions for aphasia have incorporated verbal short-term memory (STM) and working memory (WM) components. We investigated whether a treatment involving repetition of word sequences after a response delay would improve tolerance of increased verbal STM load in repetition and, consequently, improve performance on repetition and other language tasks. Eight individuals with aphasia participated. We used a single subject design with outcome measures on near-transfer tasks closely related to the treatment task and far-transfer tasks more distantly related to the treatment task. We minimized repeated presentation of stimuli in all phases of treatment to control for confounding effects of repeated exposure of treated items. Four participants demonstrated modest acquisition effects. On outcome measures, we observed improvements by some participants on near-transfer tasks, (repetition of concrete and abstract word strings and verbal spans) and far-transfer tasks (naming and discourse). Some participants demonstrated a significant decline in word repetition accuracy after a response delay before treatment, indicating difficulty in maintaining activation of linguistic representations. It was these participants who showed the most improvement on outcome measures. More studies are needed to determine who will respond to this treatment and what factors might influence the effectiveness of this treatment approach.

Understanding Speed-Accuracy Processing Dynamics in Aphasia Using Response Time Modeling

People with aphasia demonstrate language impairments evident in both performance accuracy and processing speed, but the direct relationship between accuracy and speed requires further consideration. This article describes two recent attempts to make quantitative progress in this domain using response time modeling: the diffusion model (Ratcliff, 1978) applied to two-choice tasks and a multinomial ex-Gaussian model applied to picture naming. The diffusion model may be used to characterize core linguistic processing efficiency and speed-accuracy tradeoffs independently, and research suggests that maladaptive speed-accuracy tradeoffs lead to performance impairments in at least some people with aphasia. The multinomial ex-Gaussian response time model of picture naming provides a simple and straightforward way to estimate the optimal response time cutoffs for individual people with aphasia (i.e., the cutoff where additional time is unlikely to lead to a correct response). While response time modeling applied to aphasia research is at an early stage of development, both the diffusion model and multinomial ex-Gaussian response time model of picture naming show promise and should be further developed in future work. This article also provides preliminary recommendations for clinicians regarding how to conceptualize, identify, and potentially address maladaptive speed-accuracy tradeoffs for people with aphasia.

Methodological Considerations for Incorporating Clinical Data Into a Network Model of Retrieval Failures

Difficulty retrieving information (e.g., words) from memory is prevalent in neurogenic communication disorders (e.g., aphasia and dementia). Theoretical modeling of retrieval failures often relies on clinical data, despite methodological limitations (e.g., locus of retrieval failure, heterogeneity of individuals, and progression of disorder/disease). Techniques from network science are naturally capable of handling these limitations. This paper reviews recent work using a multiplex lexical network to account for word retrieval failures and highlights how network science can address the limitations of clinical data. Critically, any model we employ could impact clinical practice and patient lives, harkening the need for theoretically well-informed network models.

Identifying Verbal Short-Term Memory and Working Memory Impairments in Individuals With Latent Aphasia

Purpose This study was undertaken to explore whether measures of verbal short-term memory and working memory are sensitive to impairments in people with latent aphasia, who score within normal limits on typical aphasia test batteries. Method Seven individuals with latent aphasia and 24 neurotypical control participants completed 40 tasks from the Temple Assessment of Language and Short-term Memory in Aphasia (TALSA) that assess various aspects of verbal short-term memory, working memory, and language processing. Subtests were identified that differentiated between the two groups of participants. Results Twenty-one TALSA tasks were identified on which the participants with latent aphasia had significantly different performance than the typical control participants. All of these subtests engaged verbal short-term memory, and some involved working memory as well. Furthermore, the TALSA detected individual differences in linguistic profiles among participants with latent aphasia. Conclusions People with latent aphasia may be identified by tests that tap verbal short-term memory and working memory. In addition, the TALSA was found to be sensitive to the heterogeneity of this population. Further development of these measures will improve identification and treatment of this challenging population.

Connections and selections: Comparing multivariate predictions and parameter associations from latent variable models of picture naming

Connectionist simulation models and processing tree mathematical models of picture naming have complementary advantages and disadvantages. These model types were compared in terms of their predictions of independent language measures and their associations between model components and measures that should be related according to their theoretical interpretations. The models were tasked with predicting independent picture naming data, neuropsychological test scores of semantic association and speech production, grammatical categories of formal errors, and lexical properties of target items. In all cases, the processing tree model parameters provided better predictions and stronger associations between parameters and independent language measures than the connectionist simulation model. Given the enhanced generalizability of latent variable measurements afforded by the processing tree model, evidence regarding mechanistic and representational features of the speech production system are re-evaluated. Several areas are indicated as being potentially viable targets for elaboration of the mechanistic descriptions of picture naming errors.

Quantifying the Interplay of Semantics and Phonology During Failures of Word Retrieval by People With Aphasia Using a Multiplex Lexical Network

Investigating instances where lexical selection fails can lead to deeper insights into the cognitive machinery and architecture supporting successful word retrieval and speech production. In this paper, we used a multiplex lexical network approach that combines semantic and phonological similarities among words to model the structure of the mental lexicon. Network measures at different levels of analysis (degree, network distance, and closeness centrality) were used to investigate the influence of network structure on picture naming accuracy and errors by people with Anomic, Broca's, Conduction, and Wernicke's aphasia. Our results reveal that word retrieval is influenced by the multiplex lexical network structure in at least two ways-(a) the accuracy of production and error type on incorrect productions were influenced by the degree and closeness centrality of the target word, and (b) error type also varied in terms of network distance between the target word and produced error word. Taken together, the analyses demonstrate that network science techniques, particularly the use of the multiplex lexical network to simultaneously represent semantic and phonological relationships among words, reveal how the structure of the mental lexicon influences language processes beyond traditionally examined psycholinguistic variables. We propose a framework for how the multiplex lexical network approach allows for understanding the influence of mental lexicon structure on word retrieval processes, with an eye toward a better understanding of the nature of clinical impairments, like aphasia.