Rationale and protocol of the ENGAGE study: a double-blind randomized controlled preference trial using a comprehensive cohort design to measure the effect of a cognitive and leisure-based intervention in older adults with a memory complaint.

BACKGROUND: Leisure activities can be both enjoyable and cognitively stimulating, and participation in such activities has been associated with reduced age-related cognitive decline. Thus, integrating stimulating leisure activities in cognitive training programs may represent a powerful and innovative approach to promote cognition in older adults at risk of dementia. The ENGAGE study is a randomized controlled, double-blind preference trial with a comprehensive cohort design that will test the efficacy and long-term impact of an intervention that combines cognitive training and cognitively stimulating leisure activities. METHODS: One hundred and forty-four older adults with a memory complaint will be recruited in Montreal and Toronto. A particular effort will be made to reach persons with low cognitive reserve. Participants will be randomly assigned to one of two conditions: cognitive + leisure training (ENGAGE-MUSIC/SPANISH) or active control (ENGAGE-DISCOVERY). The ENGAGE-MUSIC/SPANISH training will include teaching of mnemonic and attentional control strategies, casual videogames selected to train attention, and classes in music or Spanish as a second language. The ENGAGE-DISCOVERY condition will comprise psychoeducation on cognition and the brain, low-stimulating casual videogames and documentary viewing with discussions. To retain the leisure aspect of the activities, participants will be allowed to exclude either music or Spanish at study entry if they strongly dislike one of these activities. Participants randomized to ENGAGE-MUSIC/SPANISH who did not exclude any activity will be assigned to music or Spanish based on a second random assignment. Training will be provided in 24 2-h sessions over 4 months. Outcomes will be measured at baseline, at 4-month follow-up, and at 24-month follow-up. The primary outcome will be cognitive performance on a composite measure of episodic memory (delayed recall scores for words and face-name associations) measured at baseline and at the 4-month follow-up. Secondary outcomes will include a composite measure of attention (speed of processing, inhibition, dual tasking, and shifting), psychological health, activities of daily living, and brain structure and function and long-term maintenance measured at the 24-month follow-up. Information on cognitive reserve proxies (education and lifestyle questionnaires), sex and genotype (apolipoprotein (Apo)E4, brain-derived neurotrophic factor (BDNF), and catechol-O-methyltransferase (COMT)) will be collected and considered as moderators of training efficacy. DISCUSSION: This study will test whether a program combining cognitive training with stimulating leisure activities can increase cognition and reduce cognitive decline in persons at risk of dementia. TRIAL REGISTRATION: NCT03271190 . Registered on 5 September 2017.

Generalization of the effects of phonological training for anomia using structural equation modelling: a multiple single-case study.

Structural Equation Modelling analysis of three longitudinal er-fMRI sessions was used to test the impact of phonological training and of the generalization process on the pattern of brain connectivity during overt picture naming in two chronic anomic patients. Phonological training yielded a positive effect on the trained material. Six months after the training, a generalization of the positive impact on the untrained items was also observed. Connectivity analysis showed that training and generalization effects shared paralleled cortical patterns of functional integration. These findings may represent the neurophysiological correlate of the training-induced cognitive strategies for the compensation of anomia.

Brain activation and lexical learning: the impact of learning phase and word type.

This study investigated the neural correlates of second-language lexical acquisition in terms of learning phase and word type. Ten French-speaking participants learned 80 Spanish words-40 cognates, 40 non-cognates-by means of a computer program. The learning process included the early learning phase, which comprised 5 days, and the consolidation phase, which lasted 2 weeks. After each phase, participants performed an overt naming task during an er-fMRI scan. Naming accuracy was better for cognates during the early learning phase only. However, cognates were named faster than non-cognates during both phases. The early learning phase was characterized by activations in the left iFG and Broca's area, which were associated with effortful lexical retrieval and phonological processing, respectively. Further, the activation in the left ACC and DLPFC suggested that monitoring may be involved during the early phases of lexical learning. During the consolidation phase, the activation in the left premotor cortex, the right supramarginal gyrus and the cerebellum indicated that articulatory planning may contribute to the consolidation of second-language phonetic representations. No dissociation between word type and learning phase could be supported. However, a Fisher r-to-z test showed that successful cognate retrieval was associated with activations in Broca's area, which could reflect the adaptation of known L1 phonological sequences. Moreover, successful retrieval of non-cognates was associated with activity in the anterior-medial left fusiform and right posterior cingulate cortices, suggesting that their successful retrieval may rely upon the access to semantic and lexical information, and even on the greater likelihood of errors.

[Recovery from vascular aphasia: prognostic factors and evidence from functional brain imaging]. / Récupération de l'aphasie d'origine vasculaire: facteurs de pronostic et apport de la neuro-imagerie fonctionnelle.

INTRODUCTION: Aphasia is a devastating language impairment resulting from acquired brain damage and resulting in severe communication handicap. Aphasia onset is generally followed by some degree of recovery. STATE OF ART: Prognosis of recovery is considered to depend upon a series of interacting neurobiological and individual factors. Prognosis is better determined based on neurobiological factors, whereas individual factors have a less predictable clinical outcome value. In addition, the results of recent functional neuro-imaging studies allow us to better understand the functional anatomy of the recovery from vascular aphasia. The neuro-imaging literature suggests that recovery from aphasia could depend upon right homologous to language areas, as well as on preserved perilesional left hemisphere regions. The role of either hemisphere seems to be modulated by time elapsed after brain damage, and language processing domain. Further, increasing evidence suggests that intensive and specific language therapy may interact with brain plasticity to promote recovery in chronic and severe aphasia. PERSPECTIVE AND CONCLUSION: A better understanding of the factors determining recovery from aphasia will contribute to optimizing intervention and, consequently improve the quality of life of people with aphasia.

[Communication, language and the brain: from past anterior to near future]. / Communication, langage et cerveau : du passé antérieur au futur proche.

The goal of this article is to share some reflection on the astonishing evolution of the ideas in communication neuroscience and neurolinguistics over the last 30 years, since the founding of the société de neuropsychologie de langue française. in particular, a number of conceptual and methodological advancements have characterized this period, many of which have been lead or heavily contributed by french-speaking research groups in that field. among the advances discussed, are (a) the widening to discourse and pragmatic components of the concept of language, as well as the theoretical and clinical implication of this conceptual extension, (b) the unique contribution of anatomical and functional neuroimaging, (c) the massive impact of the cognitive revolution on theoretical frameworks of language components, and its influence on therapy, (d) the disappearance and the re-appearance of the brain in the main stream research on language over this period, (e) the new perspectives offered though attention put on social aspects of language and the social participation of the individual with language disorders, (f) the emergence of a genuine science of aphasia rehabilitation, and (g) the rediscovery of inter-individual characteristics both genetically- and environmentally- determined. The authors then risk themselves in trying to envision what could characterize the evolution in the field for the next 30 years. Though perilous, this speculative exercise allowed to pinpoint to a number of anticipated advancements including (a) a probable reconciliation between cognitive and connectionist models to the benefit of both visions, (b) an increased contribution of social and emotional neurosciences, (c) some inescapable technological advancements, including light portable neuroimaging devices which will allow to study the neurobiological bases of communication in natural contexts, (d) the integration between communication and aging in cognitive neuroscience and (e) the development of new research fields at some unexpected cross-roads (e.g., physical activity and communication ?) as well as the description of new types of aphasia (e.g., towards a chat aphasia !). Taken together, the advancements made over the 30 last years, and the perspective of future development, confirms the premier role of cognitive neuroscience of language and neurolinguistics in setting the pace through innovative approaches that allow unveiling the mysteries of the mutual relationships between brain and cognition.

[The impact of lesions in the right hemisphere on linguistic skills: theoretical and clinical perspectives]. / Impacto de las lesiones del hemisferio derecho sobre las habilidades lingüísticas: perspectivas teórica y clínica.

INTRODUCTION: A lesion of the right hemisphere of right-handers can result in verbal communication impairments. The recent development of theoretical frameworks with regard to discourse and pragmatic abilities, among others, now allows us to recognize and describe these impairments. AIM: To offer an overview of the verbal communication deficits that can be found in right-hemisphere-damaged individuals. These deficits can interfere, at different levels, with prosody, the semantic processing of words and discourse and pragmatic abilities. DEVELOPMENT: Such impairments appear to be present in about half of right-hemisphere-damaged patients and, when present, can result in different clinical profiles. These deficits raise the question of their labeling and their relationship with aphasia. CONCLUSIONS: Given the evolution of the concept of language and the universal definition of aphasia, it is proposed that these deficits correspond to another manifestation of aphasia, thus challenging the idea that they are of a 'non-aphasic' nature.

Clinical note: acquired pragmatic impairments and aphasia.

Recent advances in the field of communication sciences have led to the description of acquired communication disorders affecting pragmatic skills in patients with brain damage. The present article discusses the impact of such findings on the clinical concept of aphasia. Through reference to a number of articles contained in this Special Issue, it must be reiterated that pragmatic and other linguistic components of communication abilites are two sides of a same coin-that of language-and intimately interrelated. It is also argued that the difference between traditional (e.g., syntax) and pragmatic components of language cannot be explained in simple terms such as the former being subserved only by linguistic processes and the latter by other cognitive processes. Pragmatic components are thus to be considered as part of language. The evolution of the concept of language has a direct impact on the clinical concept of aphasia. Indeed, if aphasia corresponds to an acquired impairment of language, then pragmatic impairments must be considered part of aphasia. The inclusion of pragmatic impairments in the concept of aphasia does not hold only when they occur within the frame of classic types of aphasia, but also when they occur in isolation. Consequently, a new type of aphasia-pragmatic aphasia-should be considered and defined in order to describe the clinical condition of those individuals suffering from acquired pragmatic disorders as those reported among right-hemisphere-damaged right-handers. It is concluded that the recent evolution around the concept of language should be followed by an evolution of the concept of aphasia per se.

Two cases of deep dyslexia in unilingual hispanophone aphasics.

This paper addresses the interaction between a particular cognitive property inherent to the human brain, i.e., the capacity to learn how to process written information in a manner such that reading words aloud can become a standard aspect of overt behavior, and some of the culture-linked characteristics of the written codes invented by the species. First, the paper reiterates that the Spanish written code is transparent to the point of entailing full graphophonemic conversion, i.e., reading behavior is possible without access to one's memory of written words (to one's "logographic lexicon"). The Ardila claim (Ardila, 1991; Ardila, Rosselli, & Pinzon, 1989) that certain clinical forms of acquired reading disorders which have been reported to occur among various cultural subgroups do not occur among unilingual readers of Spanish is then summarized. This is followed by two brief case reports of acquired aphasia in native speakers and fluent readers of Spanish; prototypical "deep dyslexia" was documented to exist in both cases (Ruiz & Ansaldo, 1990). The Ardila claim is thereafter assessed by reference to the notions of surface, phonological, and deep dyslexia; parameters such as educational background are taken into account in this discussion.