Associations among depression, demographic variables, and language impairments in chronic post-stroke aphasia.

INTRODUCTION: Depression may influence treatment participation and outcomes of people with post-stroke aphasia, yet its prevalence and associated characteristics in aphasia are poorly understood. Using retrospective data from an overarching experimental study, we examined depressive symptoms and their relationship to demographic and language characteristics in people with chronic aphasia. As a secondary objective, we compared prevalence of depressive symptoms among the overarching study's included and excluded participants. METHODS: We examined retrospective data from 121 individuals with chronic aphasia including depression scale scores, demographic information (sex, age, time post onset of stroke, education, race/ethnicity, and Veteran status), and scores on assessments of general and modality-specific language impairments. RESULTS: Approximately 50% of participants reported symptoms indicative of depressive disorders: 23% indicative of major depression and 27% indicative of mild depression. Sex (males) and comparatively younger age emerged as statistically significant variables associated with depressive symptoms; naming ability was minimally associated with depressive symptoms. Time post onset of stroke, education level, race/ethnicity, Veteran status, and aphasia severity were not significantly associated with depressive symptoms. Depression-scale scores were significantly higher for individuals excluded from the overarching study compared to those who were included. CONCLUSIONS: The rate of depressive disorders in this sample was higher than rates of depression reported in the general stroke literature. Participant sex, age, and naming ability emerged as factors associated with depressive symptoms, though these links appear complex, especially given variable reports from prior research. Importantly, depressive symptoms do not appear to diminish over time for individuals with chronic aphasia. Given these results and the relatively limited documentation of depression in aphasia literature, depression remains a pressing concern for aphasia research and routine clinical care.

Effects of online augmented kinematic and perceptual feedback on treatment of speech movements in apraxia of speech.

Apraxia of speech (AOS) is a motor speech disorder characterized by disturbed spatial and temporal parameters of movement. Research on motor learning suggests that augmented feedback may provide a beneficial effect for training movement. This study examined the effects of the presence and frequency of online augmented visual kinematic feedback (AVKF) and clinician-provided perceptual feedback on speech accuracy in 2 adults with acquired AOS. Within a single-subject multiple-baseline design, AVKF was provided using electromagnetic midsagittal articulography (EMA) in 2 feedback conditions (50 or 100%). Articulator placement was specified for speech motor targets (SMTs). Treated and baselined SMTs were in the initial or final position of single-syllable words, in varying consonant-vowel or vowel-consonant contexts. SMTs were selected based on each participant's pre-assessed erred productions. Productions were digitally recorded and online perceptual judgments of accuracy (including segment and intersegment distortions) were made. Inter- and intra-judge reliability for perceptual accuracy was high. Results measured by visual inspection and effect size revealed positive acquisition and generalization effects for both participants. Generalization occurred across vowel contexts and to untreated probes. Results of the frequency manipulation were confounded by presentation order. Maintenance of learned and generalized effects were demonstrated for 1 participant. These data provide support for the role of augmented feedback in treating speech movements that result in perceptually accurate speech production. Future investigations will explore the independent contributions of each feedback type (i.e. kinematic and perceptual) in producing efficient and effective training of SMTs in persons with AOS.

The presence of an endogenous endo-D-arabinase in Mycobacterium smegmatis and characterization of its oligoarabinoside product.

Endogenous mycobacterial endo-D-arabinase activity, which degrades cell wall polysaccharide arabinogalactan, was found in Mycobacterium smegmatis. The arabinan product contains 20-30 arabinosyl residues but no galactofuranosyl residues. Recognition of this endogenous activity results in the possibility of developing antituberculosis drugs that do not require bacterial growth for activity.

Isolation and characterization of a novel glucuronosyl diacylglycerol from Mycobacterium smegmatis.

A glucuronic acid-containing diacylglycerol was isolated from exponentially growing Mycobacterium smegmatis. Structural analysis of the purified glycolipid, performed by gas chromatography-mass spectrometry, fast atom bombardment-mass spectrometry, and high resolution proton NMR, indicated the structure 3-(O-alpha-D-glucuronopyranosyl)-1,2-diacyl-sn-glycerol. Two forms of the glycolipid were observed differing in fatty acid composition. Both molecular species contained a hexadecanoic acid residue, whereas the second acyl group was either tuberculostearic acid (10-methylstearic acid) or octadecenoic acid. The inherent antigenicity of the glycolipid was shown by its ability to bind to anti-Mycobacterium avium (serovar 26) and anti-Mycobacterium tuberculosis sera by Western blot-type thin-layer chromatography. This is the second instance of the isolation of a glycosyl diacylglycerol from members of the Mycobacterium genus, further confirming its close relationship to Gram-positive bacteria.

Construction and use of low-copy number T7 expression vectors for purification of problem proteins: purification of mycobacterium tuberculosis RmlD and pseudomonas aeruginosa LasI and RhlI proteins, and functional analysis of purified RhlI.

Purification of proteins from Escherichia coli under native conditions is often hampered by inclusion-body formation after overexpression from T7 promoter-based expression vectors. This is probably due to the relatively high copy number of the ColE1-based expression vectors. To circumvent these problems, the low-copy-number pViet and pNam expression vectors were constructed. These vectors contain the pSC101 origin of replication and allow the expression of oligohistidine and intein chitin-binding domain fusion proteins, respectively. Since pViet and pNam do not replicate in E. coli B strains, an E. coli K-12 host strain [SA1503(DE3)] was constructed. This strain is defective in the Lon and OmpT proteases and allows IPTG-inducible expression of recombinant proteins from the T7 promoter. The new vectors were successfully tested by purification of three very insoluble proteins (RmlD, LasI and RhlI) under non-denaturing conditions, and all three proteins retained enzymatic activity. The purified hexahistidine (His6)-tagged Pseudomonas aeruginosa RhlI protein was subjected to more detailed analyses, which indicated that (1) only butyryl-acyl carrier protein (ACP) and S-adenosylmethionine (SAM) were required for synthesis of N-butyryl-L-homoserine lactone; (2) when present at physiological concentrations, butyryl-coenzyme A and NADPH were not substrates for RhlI; (3) RhlI was able to synthesize N-hexanoyl-L-homoserine lactone from hexanoyl-ACP and SAM; (4) RhlI was able to direct synthesis of N-butyryl-L-homoserine lactone from crotonyl-ACP in a reaction coupled to purified P. aeruginosa FabI (enoyl-ACP reductase).

The complete structure of the capsular polysaccharide from Streptococcus sanguis 34.

A complete structure for the capsular polysaccharide of Streptococcus sanguis 34, which is responsible for coaggregation of this bacterium with Actinomyces viscosus T14V, an important step in the formation of dental plaque, is proposed, based partly on the 1H-n.m.r. spectrum, which was assigned by 2-dimensional COSY, homonuclear Hartmann-Hahn spectroscopy, and nuclear Overhauser effects. A phosphoric diester linkage was identified from the 31P-n.m.r. spectrum, and the linkage was determined from long range 1H-31P correlation spectroscopy. The proposed structure is supported both by methylation analysis before and after dephosphorylation and by g.l.c.-m.s. of the phosphorylated monosaccharides as their trimethylsilyl derivatives, isolated by partial hydrolysis of the polysaccharide. The structure is composed of repeating linear hexasaccharide units joined by a phosphoric diester linkage, i.e., [----PO4(-)----6)-alpha-D-GalpNAc-(1----3)-beta-L-Rhap-(1----4)-be ta -D-Glcp- (1----6)-beta-D-Galf-(1----6)-beta-D-GalpNAc-(1----3)-alpha-D-Galp -(1----]n.

New pyruvylated, glycosylated acyltrehaloses from Mycobacterium smegmatis strains, and their implications for phage resistance in mycobacteria.

Phage resistance and apparent lysogenization of Mycobacterium smegmatis due to infection with mycobacteriophage D29 results in the emergence of new variations of the pyruvylated, acylated trehaloses described by Saadat and Ballou, J. Biol. Chem. 258 (1983) 1813-1818. Thin-layer chromatography of the glycolipids from two strains of phage-resistant M. smegmatis (mc(2)22 and mc(2)11) and comparison with those from phage-sensitive strains revealed a new, more mobile glycolipid in each case. The structures of these acyltrehalose-containing lipooligosaccharides were elucidated by a combination of gas-liquid chromatography-mass spectrometry, methylation analysis, 1H and 13C NMR spectroscopy, and fast-atom bombardment mass spectrometry. The glycolipid from M. smegmatis mc(2)22 is beta-D-Glcp-(1-->3)-4,6-O-(1-methoxycarbonylethylidene)-beta-D-Glc p-(1-->4)- beta-D-Glcp-(1-->6)-2-O-acyl-alpha-D-Glcp-(<==>1)-3,4-O-acyl-alpha-D-Glc p and that from M. smegmatis mc(2)11 is 4,6-O-(1-methoxycarbonylethylidene)-3-O-Me-beta-D-Glcp-(1-->3)-4,6 -O- (1-methoxycarbonylethylidene)-beta-D-Glcp-(1-->4)-beta-D-Glcp-(1-- >6)-2-O-acyl- alpha-D-Glcp-(1<==>1)-3,4-di-O-acyl-alpha-D-Glcp. These differ from the original pyruvylated glycolipids of Saadat and Ballou in the extent of their O-acylation and O-methylation. The findings are the first example of the definition of a chemical basis for phage resistance and presumed lysogeny in mycobacteria, and show parallels to related changes in gram-negative enteric bacteria.

An investigation of attention allocation deficits in aphasia.

Nine aphasic and 18 normal adults participated in a dual task with components of phoneme monitoring and semantic judgment. Subjects listened to lists of recorded spoken words and were required to detect semantic and phonetic targets. Two within-subject variables were manipulated: the probability of target occurrence for each dual-task component (.2, .5, and .8) and the explicitness of instruction (explicit vs. implicit). Only in the explicit condition were subjects told about the probability structure and given the attention allocation strategy congruent with that structure. Reaction times were recorded on-line for analysis by an IBM-AT. The results showed that normal subjects' overall latencies in detecting phonetic targets decreased as the target occurrence probability increased in both implicit and explicit instruction conditions. The detection latencies for semantic targets showed a similar probability effect but only in the explicit condition. By contrast, the aphasic subjects did not show the probability effect in any condition, although they performed above the chance level on both semantic and phonetic tasks. The presence of the probability effects for the normal subjects indicated that an efficient attention allocation mechanism was operating so as to optimize the performance level. On the other hand, the absence of probability effects for the aphasic subjects suggests that their attention control system might be inefficient so that task-demand cues (probability and attention allocation instruction) were not utilized properly.

Effects of speech rate on the absolute and relative timing of apraxic and conduction aphasic sentence production.

The purpose of this investigation was to provide a constructive replication of the Kent and McNeil (1987, In Phonetic approaches to speech production in aphasia and related disorders. San Diego: College-Hill Press) study of the speech timing characteristics of apraxic and conduction aphasic speakers. Acoustic analysis was used to obtain absolute utterance durations, segment durations, and vowel formant trajectories from utterances produced under control, fast, and slow rate conditions. Segment-to-whole ratios and slope values were calculated. Results support the hypothesis presented by Kent and McNeil (1987) that there is a phonetic-motoric component contributing to the speech patterns of both the apraxic and conduction aphasic speakers sampled. Theories of rate control in normal and disordered speakers are discussed.

Current concepts in adult aphasia.

This paper provides a review of recent research from the areas of speech and language pathology, cognitive psychology, psycholinguistics, neurology, and rehabilitation medicine which is used to refine and extend current definitions of aphasia. Evidence is presented from these diverse disciplines, which supports a multimodality, performance-based, verbal and non-verbal, cortical and subcortical, and cognitively multidimensional view of aphasia. A summary of current practice in the assessment and treatment of adult aphasia is summarized.

The case of the lawyer's lugubrious language: dysarthria plus primary progressive aphasia or dysarthria plus dementia?

A productive, intelligent, 60-year-old practicing attorney slowly begins to notice that the language that he has commanded throughout his life is beginning to become more difficult to produce, exacting its toll on his mental energy and emotional stability. His search for answers to his diminished "memory for words" leads him through the fetid ranks of traditional medicine and into the search for a differential diagnosis involving clinical neurology, neuropsychology, and speech-language pathology. Consistencies and conflicts in the signs and symptoms between the competing diagnoses raise theoretical and clinical classification issues. A course of treatment for aphasia provides evidence to support the diagnosis of primary progressive aphasia, but the development of concommitant spastic dysarthria and dysphagia challenge current wisdom about the underlying neuropathology of aphasia and support a diagnosis of early dementia. A selective but steady and rapid decline of abilities over the course of 2 years leads to the patient's death and autopsy, from which a neuropathologic analysis was to provide the "final" and "ultimate" diagnosis. But it doesn't!

An investigation of emphatic stress comprehension in adult aphasia: a replication.

The differential effects of normal and emphatic stress on the auditory comprehension performance of 9 aphasic and 5 normal adults were assessed. As a partial replication of Pashek and Brookshire (1982), four paragraph-length stimuli were used from the original study. Each paragraph was presented twice. One version was recorded with one fact per sentence receiving normal stress, the second version with emphatic stress. Following each paragraph, subjects answered 16 "yes/no" questions about the eight target facts in each paragraph. This procedure allowed for direct comparison of performance across conditions on the same paragraph rather than on different paragraphs as in the original study. Analysis of the results revealed that the aphasic subjects demonstrated significantly better performance for stimuli presented with emphatic stress. In addition, no significant learning effect was observed over two repetitions of each paragraph. These data are interpreted as successfully replicating the findings of Pashek and Brookshire. The results suggest that emphatic stress plays an important role in auditory comprehension. However, the observed effect of emphatic stress should not be attributed solely to changes incumbent upon the stress bearing word. Alternative explanations are discussed.

Effects of presentation rate and divided attention on auditory comprehension in children with an acquired language disorder.

We examined why auditory comprehension in language-disordered children improves when the rate of presentation of speech is slowed. Seven children with an acquired language disorder associated with a convulsive disorder participated in two divided-attention tasks in which pairs of sentences were presented simultaneously. Subjects were instructed to respond first to the sentence produced by a male speaker (primary sentence) and then to the sentence produced by a female speaker (secondary sentence). In the first condition, both sentences were presented at a normal rate of speech. In the second condition, primary sentences were time expanded 75%, and secondary sentences were presented at a normal rate. We hypothesized that when the primary sentences were presented slowly, spare attention would be available for processing the secondary sentences. Results showed that slowing the presentation rate of the primary sentences significantly improved performance on the secondary sentences, even though secondary sentences were presented at a normal rate of speech. Hypotheses of generally slowed processing of auditory information in language-disordered individuals cannot account for these results. They are consistent, however, with a model of defective attention allocation.

Effects of length and linguistic complexity on temporal acoustic measures in apraxia of speech.

The purpose of this study was to examine the effects of varying length and linguistic utterance types on temporal acoustic characteristics of the imitative speech of apraxic speakers. Vowel duration and two between-word segment durations were examined during the production of three response types: words, word-strings, and sentences. Three length conditions were studied in words, two length conditions for word-strings, and three length conditions for sentences, yielding eight experimental conditions. Apraxic speakers exhibited significantly longer vowel and between-word segment durations than control speakers in all conditions. Apraxic speakers consistently produced longer vowel and between-word segment durations in sentence contexts than in word contexts. Further, intrasubject and intersubject variability for between-word segment durations were substantially greater for the apraxic speakers in sentences compared to word conditions, whereas control speakers exhibited greater homogeneity in sentence production. The differences in duration and variability in sentence production versus word or word-string production imply different mechanisms for executing motor programs for varying linguistic stimuli.

Characterization of the specific antigenicity of Mycobacterium fortuitum.

Mycobacterium fortuitum, biovar, fortuitum, the cause of serious skin and soft-tissue infections, can be differentiated from M. fortuitum, biovar. peregrinum, and other rapidly growing opportunistic mycobacteria by the presence of a unique antigenic glycolipid. The glycolipid is among the simplest of the acyl-trehalose-containing lipooligosaccharide class. The application of 1H and 13C NMR, methylation analysis, FAB/MS, and other procedures demonstrated the structure, beta-D-Glcp-(1----6)-2-O-acyl-alpha-D-Glcp-(1 in equilibrium with 1)-3,4,6-tri-O-acyl-alpha-D-Glcp. Thus, practically all environmental mycobacteria, many of them opportunistic pathogens, can be differentiated serologically and chemically on the basis of unique sugar arrangements within a few classes of glycolipids. The simplicity of the structure in M. fortuitum fortuitum combined with the distinct roughness of the parent strain raises the intriguing possibility that it is a spontaneous rough variant of the other mycobacteria with more elaborate glycolipids.

Ipsilateral auditory pathway suppression in dichotic CV speech perception: evidence from error analysis.

The exact nature of ipsilateral auditory pathway suppression under dichotic stimulation remains controversial. To help resolve this controversy, the distinctive feature confusions (blend vs nonblend errors) made on a dichotic listening CV test by two hemispherectomees were analyzed. Results support ipsilateral auditory pathway suppression under dichotic CV stimulation. Ipsilateral auditory pathway suppression is discussed in terms of stimulus specificity, subject, and task difference.

Hemispheric specialization for the processing of linguistic and non-linguistic stimuli in congenitally deaf and hearing adults: a review and contribution.

Congenitally deaf individuals, interpreters for the deaf and hearing controls viewed words, dots, American sign language signs and drawings of objects presented tachistoscopically. The stimuli were presented both bilaterally and unilaterally to the subjects. The deaf subjects showed a significant left visual field (LVF) superiority for the processing of the drawings while the nondeaf groups showed significant right visual field (RVF) advantages. Laterality differences between groups on the other tasks were nonsignificant. The deaf group also showed a significant LVF advantage in the bilateral condition across all tasks as opposed to a RVF advantage yielded by nondeaf groups. A significant LVF advantage for words and dots was found compared to the RVF advantage for signs across all subjects. The differences between deaf and nondeaf groups are discussed in terms of processing strategies and the critical period for language acquisition theory.

Oral structure nonspeech motor control in normal, dysarthric, aphasic and apraxic speakers: isometric force and static position control.

This study investigated the isometric force and static position control of the upper lip, lower lip, tongue, jaw, and finger in four subject groups (normal control, apraxia of speech, conduction aphasia, and ataxic dysarthria) at two force and displacement levels. Results from both the force and position tasks suggested that the apraxic and dysarthric groups tended to produce significantly greater instability than the normal group, although the pattern of instability across articulators was not systematic within or across the force and position experiments for subjects within or between groups. The conduction aphasic group produced force and position stability that typically was not significantly different from any of the remaining three groups, suggesting that their force and position stability as indexed in the present study fell somewhere between that of the normal group and the apraxic and dysarthric groups. It is suggested that other analyses of force and position control, such as descriptive accounts of the trial-by-trial time histories, might shed additional light on the speech and orofacial sensorimotor control deficits in persons with apraxia, dysarthria, and conduction aphasia.