Patterns of poststroke brain damage that predict speech production errors in apraxia of speech and aphasia dissociate.
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ABSTRACT:
SUBMITTER: Basilakos A
PROVIDER: S-EPMC4442076 | biostudies-literature | 2015 Jun
REPOSITORIES: biostudies-literature
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Project description:ObjectiveThe goal of this study was to explore the prevalence of nonverbal oral apraxia (NVOA), its association with other forms of apraxia, and associated imaging findings in patients with primary progressive aphasia (PPA) and progressive apraxia of speech (PAOS).MethodsPatients with a degenerative speech or language disorder were prospectively recruited and diagnosed with a subtype of PPA or with PAOS. All patients had comprehensive speech and language examinations. Voxel-based morphometry was performed to determine whether atrophy of a specific region correlated with the presence of NVOA.ResultsEighty-nine patients were identified, of which 34 had PAOS, 9 had agrammatic PPA, 41 had logopenic aphasia, and 5 had semantic dementia. NVOA was very common among patients with PAOS but was found in patients with PPA as well. Several patients exhibited only one of NVOA or apraxia of speech. Among patients with apraxia of speech, the severity of the apraxia of speech was predictive of NVOA, whereas ideomotor apraxia severity was predictive of the presence of NVOA in those without apraxia of speech. Bilateral atrophy of the prefrontal cortex anterior to the premotor area and supplementary motor area was associated with NVOA.ConclusionsApraxia of speech, NVOA, and ideomotor apraxia are at least partially separable disorders. The association of NVOA and apraxia of speech likely results from the proximity of the area reported here and the premotor area, which has been implicated in apraxia of speech. The association of ideomotor apraxia and NVOA among patients without apraxia of speech could represent disruption of modules shared by nonverbal oral movements and limb movements.
| S-EPMC4032207 | biostudies-literature
Project description:BackgroundApraxia of speech (AOS) is a core feature of nonfluent/agrammatic primary progressive aphasia (naPPA), but its precise characteristics and the prevalence of AOS features in spontaneous speech are debated.ObjectiveTo assess the frequency of features of AOS in the spontaneous, connected speech of individuals with naPPA and to evaluate whether these features are associated with an underlying motor disorder such as corticobasal syndrome or progressive supranuclear palsy.MethodsWe examined features of AOS in 30 patients with naPPA using a picture description task. We compared these patients to 22 individuals with behavioral variant frontotemporal dementia and 30 healthy controls. Each speech sample was evaluated perceptually for lengthened speech segments and quantitatively for speech sound distortions, pauses between and within words, and articulatory groping. We compared subgroups of naPPA with and without at least two features of AOS to assess the possible contribution of a motor impairment to speech production deficits.ResultsnaPPA patients produced both speech sound distortions and other speech sound errors. Speech segmentation was found in 27/30 (90%) of individuals. Distortions were identified in 8/30 (27%) of individuals, and other speech sound errors occurred in 18/30 (60%) of individuals. Frequent articulatory groping was observed in 6/30 (20%) of individuals. Lengthened segments were observed rarely. There were no differences in the frequencies of AOS features among naPPA subgroups as a function of extrapyramidal disease.ConclusionFeatures of AOS occur with varying frequency in the spontaneous speech of individuals with naPPA, independently of an underlying motor disorder.
| S-EPMC10259074 | biostudies-literature
Project description:The nature and frequency of speech production errors in neurodegenerative disease have not previously been precisely quantified. In the present study, 16 patients with a progressive form of non-fluent aphasia (PNFA) were asked to tell a story from a wordless children's picture book. Errors in production were classified as either phonemic, involving language-based deformations that nevertheless result in possible sequences of English speech segments; or phonetic, involving a motor planning deficit and resulting in non-English speech segments. The distribution of cortical atrophy as revealed by structural MRI scans was examined quantitatively in a subset of PNFA patients (N=7). The few errors made by healthy seniors were only phonemic in type. PNFA patients made more than four times as many errors as controls. This included both phonemic and phonetic errors, with a preponderance of errors (82%) classified as phonemic. The majority of phonemic errors were substitutions that shared most distinctive features with the target phoneme. The systematic nature of these substitutions is not consistent with a motor planning deficit. Cortical atrophy was found in prefrontal regions bilaterally and peri-Sylvian regions of the left hemisphere. We conclude that the speech errors produced by PNFA patients are mainly errors at the phonemic level of language processing and are not caused by a motor planning impairment.
| S-EPMC2839014 | biostudies-literature
Project description:BACKGROUND: Previous work indicates that single word intelligibility tests developed for dysarthria are sensitive to segmental production errors in aphasic individuals with and without apraxia of speech. However, potential listener learning effects and difficulties adapting elicitation procedures to coexisting language impairments limit their applicability to left hemisphere stroke survivors. AIMS: The main purpose of this study was to examine basic psychometric properties for a new monosyllabic intelligibility test developed for individuals with aphasia and/or AOS. A related purpose was to examine clinical feasibility and potential to standardize a computer-mediated administration approach. METHODS #ENTITYSTARTX00026; PROCEDURES: A 600-item monosyllabic single word intelligibility test was constructed by assembling sets of phonetically similar words. Custom software was used to select 50 target words from this test in a pseudo-random fashion and to elicit and record production of these words by 23 speakers with aphasia and 20 neurologically healthy participants. To evaluate test-retest reliability, two identical sets of 50-word lists were elicited by requesting repetition after a live speaker model. To examine the effect of a different word set and auditory model, an additional set of 50 different words was elicited with a pre-recorded model. The recorded words were presented to normal-hearing listeners for identification via orthographic and multiple-choice response formats. To examine construct validity, production accuracy for each speaker was estimated via phonetic transcription and rating of overall articulation. OUTCOMES #ENTITYSTARTX00026; RESULTS: Recording and listening tasks were completed in less than six minutes for all speakers and listeners. Aphasic speakers were significantly less intelligible than neurologically healthy speakers and displayed a wide range of intelligibility scores. Test-retest and inter-listener reliability estimates were strong. No significant difference was found in scores based on recordings from a live model versus a pre-recorded model, but some individual speakers favored the live model. Intelligibility test scores correlated highly with segmental accuracy derived from broad phonetic transcription of the same speech sample and a motor speech evaluation. Scores correlated moderately with rated articulation difficulty. CONCLUSIONS: We describe a computerized, single-word intelligibility test that yields clinically feasible, reliable, and valid measures of segmental speech production in adults with aphasia. This tool can be used in clinical research to facilitate appropriate participant selection and to establish matching across comparison groups. For a majority of speakers, elicitation procedures can be standardized by using a pre-recorded auditory model for repetition. This assessment tool has potential utility for both clinical assessment and outcomes research.
| S-EPMC3246841 | biostudies-literature
Project description:Purpose Individuals with primary progressive apraxia of speech (AOS) have AOS in which disruptions in articulation and prosody predominate the speech pattern. Many develop aphasia and/or dysarthria later in the disease course. The aim of this study was to describe the communication limitations in these patients, as measured by (a) the patient via the Communicative Participation Item Bank (CPIB) and (b) the speech-language pathologist via the American Speech-Language-Hearing Association's (ASHA) Functional Communication Measures (FCMs) and an adapted motor speech disorder (MSD) severity rating. Method Speech and language evaluations were completed for 24 patients with progressive AOS (n = 7 with isolated AOS; n = 17 with a combination of AOS and aphasia). Descriptive comparisons were utilized to evaluate differences in communication measures among patients with various combinations of MSDs and aphasia. Differences associated with phonetic predominant or prosodic predominant AOS were also examined. Across the entire cohort, correlations were calculated between the participation ratings and other clinical assessment measures. Results The CPIB reflected greater limitations for those with aphasia and AOS compared to isolated AOS, but was not notably different when dysarthria occurred with AOS (n = 9/24). Across the cohort, there were statistically significant correlations between the CPIB and ASHA FCM-Motor Speech and Language Expression ratings and the MSD severity rating. The CPIB did not correlate with the ASHA FCM-Language Comprehension or other speech-language measures. Conclusions Patients with neurodegenerative AOS experience reduced participation in communication that is further exacerbated by co-occurring language deficits. The study suggests measures of severity cannot be assumed to correlate with measures of participation restrictions and offers a foundation for further research examining the day-to-day sequela of progressive speech and language disorders. Supplemental Material https://doi.org/10.23641/asha.12743252.
| S-EPMC8758323 | biostudies-literature
Project description:ObjectiveWe sought to determine via a cross-sectional study the contribution of (1) the right hemisphere's speech-relevant white matter regions and (2) interhemispheric connectivity to speech fluency in the chronic phase of left hemisphere stroke with aphasia.MethodsFractional anisotropy (FA) of white matter regions underlying the right middle temporal gyrus (MTG), precentral gyrus (PreCG), pars opercularis (IFGop) and triangularis (IFGtri) of the inferior frontal gyrus, and the corpus callosum (CC) was correlated with speech fluency measures. A region within the superior parietal lobule (SPL) was examined as a control. FA values of regions that significantly predicted speech measures were compared with FA values from healthy age- and sex-matched controls.ResultsFA values for the right MTG, PreCG, and IFGop significantly predicted speech fluency, but FA values of the IFGtri and SPL did not. A multiple regression showed that combining FA of the significant right hemisphere regions with the lesion load of the left arcuate fasciculus-a previously identified biomarker of poststroke speech fluency-provided the best model for predicting speech fluency. FA of CC fibers connecting left and right supplementary motor areas (SMA) was also correlated with speech fluency. FA of the right IFGop and PreCG was significantly higher in patients than controls, while FA of a whole CC region of interest (ROI) and the CC-SMA ROI was significantly lower in patients.ConclusionsRight hemisphere white matter integrity is related to speech fluency measures in patients with chronic aphasia. This may indicate premorbid anatomical variability beneficial for recovery or be the result of poststroke remodeling.
| S-EPMC4844242 | biostudies-literature
Project description:Non-fluent aphasia implies a relatively straightforward neurological condition characterized by limited speech output. However, it is an umbrella term for different underlying impairments affecting speech production. Several studies have sought the critical lesion location that gives rise to non-fluent aphasia. The results have been mixed but typically implicate anterior cortical regions such as Broca's area, the left anterior insula, and deep white matter regions. To provide a clearer picture of cortical damage in non-fluent aphasia, the current study examined brain damage that negatively influences speech fluency in patients with aphasia. It controlled for some basic speech and language comprehension factors in order to better isolate the contribution of different mechanisms to fluency, or its lack. Cortical damage was related to overall speech fluency, as estimated by clinical judgements using the Western Aphasia Battery speech fluency scale, diadochokinetic rate, rudimentary auditory language comprehension, and executive functioning (scores on a matrix reasoning test) in 64 patients with chronic left hemisphere stroke. A region of interest analysis that included brain regions typically implicated in speech and language processing revealed that non-fluency in aphasia is primarily predicted by damage to the anterior segment of the left arcuate fasciculus. An improved prediction model also included the left uncinate fasciculus, a white matter tract connecting the middle and anterior temporal lobe with frontal lobe regions, including the pars triangularis. Models that controlled for diadochokinetic rate, picture-word recognition, or executive functioning also revealed a strong relationship between anterior segment involvement and speech fluency. Whole brain analyses corroborated the findings from the region of interest analyses. An additional exploratory analysis revealed that involvement of the uncinate fasciculus adjudicated between Broca's and global aphasia, the two most common kinds of non-fluent aphasia. In summary, the current results suggest that the anterior segment of the left arcuate fasciculus, a white matter tract that lies deep to posterior portions of Broca's area and the sensory-motor cortex, is a robust predictor of impaired speech fluency in aphasic patients, even when motor speech, lexical processing, and executive functioning are included as co-factors. Simply put, damage to those regions results in non-fluent aphasic speech; when they are undamaged, fluent aphasias result.
| S-EPMC3808690 | biostudies-literature
Project description:The consensus criteria for the diagnosis and classification of primary progressive aphasia (PPA) have served as an important tool in studying this group of disorders. However, a large proportion of patients remain unclassifiable whilst others simultaneously meet criteria for multiple subtypes. We prospectively evaluated a large cohort of patients with degenerative aphasia and/or apraxia of speech using multidisciplinary clinical assessments and multimodal imaging. Blinded diagnoses were made using operational definitions with important differences compared to the consensus criteria. Of the 130 included patients, 40 were diagnosed with progressive apraxia of speech (PAOS), 12 with progressive agrammatic aphasia, 9 with semantic dementia, 52 with logopenic progressive aphasia, and 4 with progressive fluent aphasia, while 13 were unclassified. The PAOS and progressive fluent aphasia groups were least impaired. Performance on repetition and sentence comprehension was especially poor in the logopenic group. The semantic and progressive fluent aphasia groups had prominent anomia, but only semantic subjects had loss of word meaning and object knowledge. Distinct patterns of grey matter loss and white matter changes were found in all groups compared to controls. PAOS subjects had bilateral frontal grey matter loss, including the premotor and supplementary motor areas, and bilateral frontal white matter involvement. The agrammatic group had more widespread, predominantly left sided grey matter loss and white matter abnormalities. Semantic subjects had bitemporal grey matter loss and white matter changes, including the uncinate and inferior occipitofrontal fasciculi, whereas progressive fluent subjects only had left sided temporal involvement. Logopenic subjects had diffuse and bilateral grey matter loss and diffusion tensor abnormalities, maximal in the posterior temporal region. A diagnosis of logopenic aphasia was strongly associated with being amyloid positive (46/52 positive). Our findings support consideration of an alternative way of identifying and categorizing subtypes of degenerative speech and language disorders.
| S-EPMC4522343 | biostudies-literature
Project description:PurposeTo study the effects of masked auditory feedback (MAF) on speech fluency in adults with aphasia and/or apraxia of speech (APH/AOS). We hypothesized that adults with AOS would increase speech fluency when speaking with noise. Altered auditory feedback (AAF; i.e., delayed/frequency-shifted feedback) was included as a control condition not expected to improve speech fluency.MethodTen participants with APH/AOS and 10 neurologically healthy (NH) participants were studied under both feedback conditions. To allow examination of individual responses, we used an ABACA design. Effects were examined on syllable rate, disfluency duration, and vocal intensity.ResultsSeven of 10 APH/AOS participants increased fluency with masking by increasing rate, decreasing disfluency duration, or both. In contrast, none of the NH participants increased speaking rate with MAF. In the AAF condition, only 1 APH/AOS participant increased fluency. Four APH/AOS participants and 8 NH participants slowed their rate with AAF.ConclusionsSpeaking with MAF appears to increase fluency in a subset of individuals with APH/AOS, indicating that overreliance on auditory feedback monitoring may contribute to their disorder presentation. The distinction between responders and nonresponders was not linked to AOS diagnosis, so additional work is needed to develop hypotheses for candidacy and underlying control mechanisms.
| S-EPMC4987030 | biostudies-literature
Project description:Beta-amyloid (A?) deposition can be observed in primary progressive aphasia (PPA) and progressive apraxia of speech (PAOS). While it is typically associated with logopenic PPA, there are exceptions that make predicting A? status challenging based on clinical diagnosis alone. We aimed to determine whether MRI regional volumes or clinical data could help predict A? deposition. One hundred and thirty-nine PPA (n = 97; 15 agrammatic, 53 logopenic, 13 semantic and 16 unclassified) and PAOS (n = 42) subjects were prospectively recruited into a cross-sectional study and underwent speech/language assessments, 3.0 T MRI and C11-Pittsburgh Compound B PET. The presence of A? was determined using a 1.5 SUVR cut-point. Atlas-based parcellation was used to calculate gray matter volumes of 42 regions-of-interest across the brain. Penalized binary logistic regression was utilized to determine what combination of MRI regions, and what combination of speech and language tests, best predicts A? (+) status. The optimal MRI model and optimal clinical model both performed comparably in their ability to accurately classify subjects according to A? status. MRI accurately classified 81% of subjects using 14 regions. Small left superior temporal and inferior parietal volumes and large left Broca's area volumes were particularly predictive of A? (+) status. Clinical scores accurately classified 83% of subjects using 12 tests. Phonological errors and repetition deficits, and absence of agrammatism and motor speech deficits were particularly predictive of A? (+) status. In comparison, clinical diagnosis was able to accurately classify 89% of subjects. However, the MRI model performed well in predicting A? deposition in unclassified PPA. Clinical diagnosis provides optimum prediction of A? status at the group level, although regional MRI measurements and speech and language testing also performed well and could have advantages in predicting A? status in unclassified PPA subjects.
| S-EPMC4752814 | biostudies-other