Discontinuation and non-adherence to endocrine therapy in breast cancer patients: is lack of communication the decisive factor?

INTRODUCTION: Non-adherence to anti-hormonal therapy is a major problem in gynecologic oncology. Reasons reported are side effects and lack of support. The aim of our study was an analysis of influence of experiences of patients with endocrine therapy and communication and information on this topic and their influence on adherence. METHODS: We developed a structured questionnaire which was tested in a pilot version and then programmed as online questionnaire and presented to patient members of self-help and breast cancer organizations. RESULTS: Patients only had received scarce information on endocrine therapy. Only 12.8% stated that their questions were answered in detail, 43.2% got no answers or only non-detailed answers. 76% had side effects limiting functions of daily life. 60% of physicians did not react on these side effects. There is a significant correlation between number and intensity of side effects and non-adherence or disruption of therapy (p = 0.029 and p < 0.01, respectively). Women who reported having received detailed answers to their questions also reported better adherence (p = 0.014). CONCLUSION: In order to improve adherence, detailed information on side effects and answers in case of symptoms are most important. Physicians should not rely on presenting written information but should mainly engage in direct communication.

Auditory language comprehension in children with developmental dyslexia: evidence from event-related brain potentials.

In the present study, event-related brain potentials (ERPs) were used to compare auditory sentence comprehension in 16 children with developmental dyslexia (age 9-12 years) and unimpaired controls matched on age, sex, and nonverbal intelligence. Passive sentences were presented, which were either correct or contained a syntactic violation (phrase structure) or a semantic violation (selectional restriction). In an overall sentence correctness judgment task, both control and dyslexic children performed well. In the ERPs, control children and dyslexic children demonstrated a similar N400 component for the semantic violation. For the syntactic violation, control children demonstrated a combined pattern, consisting of an early starting bilaterally distributed anterior negativity and a late centro-parietal positivity (P600). Dyslexic children showed a different pattern that is characterized by a delayed left lateralized anterior negativity, followed by a P600. These data indicate that dyslexic children do not differ from unimpaired controls with respect to semantic integration processes (N400) or controlled processes of syntactic reanalyses (P600) during auditory sentence comprehension. However, early and presumably highly automatic processes of phrase structure building reflected in the anterior negativity are delayed in dyslexic children. Moreover, the differences in hemispheric distribution of the syntactic negativity indicate different underlying processes in dyslexic children and controls. The bilateral distribution in controls suggests an involvement of right hemispherically established prosodic processes in addition to the left hemispherically localized syntactic processes, supporting the view that prosodic information may be used to facilitate syntactic processing during normal comprehension. The left hemispheric distribution observed for dyslexic children, in contrast, suggests that these children do not rely on information about the prosodic contour during auditory sentence comprehension as much as controls do. This finding points toward a phonological impairment in dyslexic children that might hamper the development of syntactic processes.

The relative timing of syntactic and semantic processes in sentence comprehension.

The functional primacy of syntactic over semantic processes was put to test in an auditory event-related brain potentials study using sentences in which the final words were semantically and/or syntactically incongruent with the prior context. Crucially, these words encoded the syntactically relevant word category information in the suffix, available only after the word stem which carried the semantic information. Semantic violations elicited an N400 and syntactic violations a biphasic LAN-P600 pattern. Words that were semantically and syntactically incongruent with the context evoked a biphasic LAN-P600 ERP pattern, but no N400. The similarity of the ERP pattern for the pure syntactic and the double violation condition provides strong evidence for a functional primacy of initial syntactic over lexical-semantic processes.

What's different in second-language processing? Evidence from event-related brain potentials.

German sentences which were either correct, contained a selectional restriction violation, or a word category violation were presented auditorily to 16 native speakers of German (L1 group) and to 16 native speakers of Russian, who had learned German after the age of 10 (L2 group). Semantic violations elicited an N400 effect for both groups, but with a reduced amplitude and a longer peak latency in the L2 group. Compared to correct sentences, sentences with a phrase structure violation elicited an early anterior negativity followed by a broad centro-parietal positivity in native speakers. By contrast, there was no differential modulation of the early anterior negativity in the L2 group. A late positivity was also elicited in the second language learners, but it was slightly delayed compared to that shown by native speakers. This pattern is discussed in terms of different degrees of automaticity with respect to the subprocesses involved in sentence comprehension.

What's left if the Jabberwock gets the semantics? An ERP investigation into semantic and syntactic processes during auditory sentence comprehension.

This study examined auditory ERP responses to syntactic phrase structure violations occurring either in sentences containing regular words or in sentences in which content words had been replaced by pseudowords while retaining morphological markers (so-called jabberwocky sentences). Syntactic violations were found to elicit an early anterior negativity followed by a P600 for both types of sentences, suggesting that the syntactic processes in question are independent of the presence of lexical-semantic information. In syntactically correct sentences, content words in regular sentences elicited an N400 component while their pseudoword place-holders in jabberwocky sentences did not. By contrast, in syntactically incorrect sentences neither sentence type showed an N400 for the word creating the syntactic violation, indicating that the detection of a syntactic error at an early stage blocks semantic integration processes in regular sentences. We discuss these results and findings from related studies in the light of a timing hypothesis of syntactic and semantic information processing and propose that syntactic information extracted particularly early can affect semantic processes while syntactic information extracted relatively late cannot.

Brain responses during sentence reading: visual input affects central processes.

The effect of visual contrast on sentence reading was investigated using event-related brain potentials (ERPs). Under the low contrast condition semantic integration as reflected in the N400 ERP component was delayed to some degree. The left anterior negativity (LAN) reflecting initial syntactic processes, in contrast, seemed to change its characteristics as a function of visual input. In the high contrast condition the LAN preceded the P200 component whereas in the low contrast condition it was present after this component. These ERP-data from word-by-word sentence reading together with prior results from sentence listening suggest that the physical characteristics of the input must fall within a certain optimal range to guarantee ERP-effects of fast initial syntactic processes.

Electrophysiological evidence for two steps in syntactic analysis. Early automatic and late controlled processes.

In this study we examined the properties of the processes involved in the structural analysis of sentences using event-related brain potential measures (ERP). Previous research had shown two ERP components to correlate with phrase structure violations: an early left anterior negativity (ELAN), which is assumed to reflect first-pass parsing processes, and a late parietally distributed positivity (P600), assumed to reflect second-pass parsing processes. We hypothesized that the first-pass parsing processes are highly automatic, whereas second-pass parsing processes are more controlled. To test this hypothesis we varied the proportion of correct sentences and sentences containing phrase structure violations with incorrect sentences being either of a low (20% violation) or a high (80% violation) proportion. Results showed that the early left anterior negativity was elicited and equally pronounced under both proportion conditions. By contrast, the late positivity was elicited for a low proportion of incorrect sentences only. This data pattern suggests that first-pass parsing processes are automatic, whereas second-pass parsing processes are under participants' strategic control.

First-pass versus second-pass parsing processes in a Wernicke's and a Broca's aphasic: electrophysiological evidence for a double dissociation.

The present paper is a first attempt to integrate the classical brain lesion behavioral impairment approach of functional neuroanatomy and the electrophysiological brain mapping approach in the domain of syntactic processing. In a group of normal age-matched controls we identified three electrophysiological components previously observed in correlation with language comprehension processes: an early left anterior negativity normally seen in correlation with syntactic first-pass parsing processes (ELAN), a centroparietal negativity seen in correlation with processes of lexical-semantic integration (N400), and a late centroparietal positivity observed in correlation with secondary syntactic processes of reanalysis and repair (P600). The early left anterior negativity was absent in a patient with an extended lesion in the anterior part of the left hemisphere sparing the temporal lobe, although the late centroparietal positivity and the centroparietal N400 were present. In a patient with a left temporal-parietal lesion the early left anterior negativity was found to be present, whereas the N400 component was absent. These findings suggest that first-pass parsing and secondary processes are subserved by distinct brain systems.

Temporal structure of syntactic parsing: early and late event-related brain potential effects.

Event-related brain potentials (ERPs) were recorded from participants listening to or reading sentences that were correct, contained a violation of the required syntactic category, or contained a syntactic-category ambiguity. When sentences were presented auditorily (Experiment 1), there was an early left anterior negativity for syntactic-category violations, but not for syntactic-category ambiguities. Both anomaly types elicited a late centroparietally distributed positivity. When sentences were presented visually word by word (Experiment 2), again an early left anterior negativity was found only for syntactic-category violations, and both types of anomalies elicited a late positivity. The combined data are taken to be consistent with a 2-stage model of parsing, including a 1st stage, during which an initial phrase structure is built and a 2nd stage, during which thematic role assignment and, if necessary, reanalysis takes place. Disruptions to the 1st stage of syntactic parsing appear to be correlated with an early left anterior negativity, whereas disruptions to the 2nd stage might be correlated with a late posterior distributed positivity.

Event-related brain potentials during natural speech processing: effects of semantic, morphological and syntactic violations.

The present study investigated different aspects of auditory language comprehension. The sentences which were presented as connected speech were either correct or incorrect including a semantic error (selectional restriction), a morphological error (verb inflection), or a syntactic error (phrase structure). After each sentence, a probe word was presented auditorily, and subjects had to decide whether this word was part of the preceding sentence or not. Event-related brain potentials (ERPs) were recorded from 7 scalp electrodes. The ERPs evoked by incorrect sentences differed significantly from the correct ones as a function of error type. Semantic anomalies evoked a 'classical' N400 pattern. Morphological errors elicited a pronounced negativity between 300 and 600 ms followed by a late positivity. Syntactic errors, in contrast, evoked an early negativity peaking around 180 ms followed by a negativity around 400 ms. The early negativity was only significant over the left anterior electrode. The present data demonstrate that linguistic errors of different categories evoke different ERP patterns. They indicate that with using connected speech as input, different aspects of language comprehension processes cannot only be described with respect to their temporal structure, but eventually also with respect to possible brain systems subserving these processes.

Event-related brain potentials while encountering semantic and syntactic constraint violations.

Abstract The objective of the present study was to delineate brain-electrical correlates of semantic and syntactic integration processes during language comprehension. Twenty-eight subjects were engaged in a lexical decision task. The target item (a legal word or a pseudo word) was always preceded by a prime consisting of a sentence fragment that provided a particular context. With respect to the prime a word target could be either a correct completion, a violation of a semantic selection restriction, or a violation of a syntactic subcategorization rule. An N400-like wave was elicited by both types of deviations. Syntactic anomalies evoked a negative shift predominantly over the anterior scalp with a preponderance over the left hemisphere, while semantic anomalies were accompanied by a much more widespread negativity with the maximum over posterior temporal areas. The amplitude of the semantic vie lation effect was found to be related to the strength of the priming constraints. The topographic difference is consistent with the idea that syntactic and semantic aspects of comprehension are handled by different neural subsystems.