A Preliminary Examination of a Novel Telepractice Screening Protocol for Poststroke Aphasia.

BACKGROUND: The delivery of telepractice interventions for people with poststroke aphasia has been found effective and feasible compared to traditional, in-person interventions; however, telepractice assessments, particularly screening protocols, which may foster convenient access to aphasia diagnostic services, have received limited examination within the aphasia literature. Therefore, the purpose of this study was to examine a novel telepractice screening protocol for people with poststroke aphasia that assesses both language and extralinguistic cognitive abilities via both performance-based and patient-reported measures. METHOD: Twenty-one participants with previously diagnosed poststroke aphasia completed the telepractice administration of the Frenchay Aphasia Screening Test (FAST), the Aphasia Impact Questionnaire-21 (AIQ-21), the Oxford Cognitive Screen (OCS), and the Cognitive-Communication Checklist for Acquired Brain Injury (CCCABI). Care partners of the participants completed the Communicative Effectiveness Index (CETI). After the telepractice session, each participant completed a feasibility questionnaire to rate their overall experience. RESULTS: All participants screened as having aphasia. Pearson correlation analyses yielded a strong positive relationship between OCS and FAST scores (r = .74), a strong relationship between OCS and CCCABI scores (r = -.71), and a moderate relationship between FAST and AIQ-21 scores (r = -.35). Moderate relationships were noted between the performance-based measures and the CETI (r = .30). The overall feasibility of telepractice administration was rated positively by each participant. No significant relationships were found between the feasibility responses and participant characteristics. CONCLUSIONS: Overall, the telepractice screening protocol yielded an effective and feasible way to identify poststroke aphasia. Similar to in-person administration of screening measures, it was more difficult to identify milder levels of aphasia severity. Future research should examine whether this telescreening protocol can identify poststroke aphasia within the broader stroke population.

Telepractice Assessments for Individuals with Aphasia: A Systematic Review.

Purpose: Current literature broadly demonstrates the effectiveness and feasibility of telepractice services for people with aphasia. However, the examination of telepractice assessments for people with aphasia is limited. The purpose of this systematic review was to examine the current use of telepractice assessment protocols for people with aphasia. Specifically, the review sought to: (a) identify the assessments utilized in the aphasia telepractice literature; (b) appraise critically the quality of such investigations; and (c) evaluate critically the psychometric properties of the standardized tests used. Methods: A review of the literature published in English since 2000 was conducted in January 2023 by searching MEDLINE, EMBASE, PsychInfo, CINAHL, and Scopus databases. A total of 2,429 articles were screened. Two reviewers assessed records independently finding 11 articles eligible for inclusion. Data extraction was conducted once and validated by a second reviewer. Quality appraisal was carried out for the included studies as well as for the standardized testing measures used in these studies. Results: There was a lack of variation among the telepractice assessment protocols and aphasia tests used across all the included studies. That is, there was limited investigation of screening tests, discourse analysis, extralinguistic cognitive measures, and the use of patient-reported measures. Study characteristics lacked high-quality and free-of-bias examinations. Most standardized tests that were utilized exhibited poor validity and reliability properties. Conclusions: Overall, the current systematic review pointed to the need to investigate a wider range of aphasia assessment protocols that can be offered via telepractice. Moreover, more robust research designs are necessary to examine the variety of assessment tests and/or procedures that are available for in-person aphasia assessment services. Finally, given that many tests used in the included studies had psychometric property issues, the current review raised concerns regarding the use of these tests in research and clinical practices.

Multiple faces of anxiety: a frontal lobe perspective.

Marked dysregulation of the human prefrontal cortex (PFC) and anterior cingulate cortex (ACC) characterises a variety of anxiety disorders, and its amelioration is a key feature of treatment success. Overall treatment response, however, is highly variable, and about a third of patients are resistant to treatment. In this review we hypothesise that a major contributor to this variation in treatment response are the multiple faces of anxiety induced by distinct forms of frontal cortex dysregulation. Comparison of findings from humans and non-human primates reveals marked similarity in the functional organisation of threat regulation across the frontal lobes. This organisation is discussed in relation to the 'predatory imminence continuum' model of threat and the differential engagement of executive functions at the core of both emotion generation and regulation strategies.

Stemming the Tide: The Proactive Role of Allied Health Therapy in Parkinson's Disease.

Motor and nonmotor symptoms occur in early Parkinson's disease (PD), or even in the prodromal stage. Many of these symptoms can be addressed by allied health therapies, including physical therapy, occupational therapy, speech therapy, and psychological therapies. However, referrals to these services early in the disease are low. We provide a review summarizing the efficacy of proactive allied health interventions on motor and nonmotor symptoms and daily function in prodromal and early disease. We also highlight areas for additional research and provide recommendations to improve care for individuals with early PD within each discipline. We recognize the overlapping roles of the allied health disciplines and support integrated or transdisciplinary care beginning soon after diagnosis to help stem the tide in the progression of PD symptoms and disability.

Many people with Parkinson's disease start having symptoms years before their diagnosis. These symptoms can affect movement, communication, mood, work, and other aspects of daily life. Allied health therapies can be used soon after diagnosis, or even when diagnosis is suspected, to address these challenges proactively. This article reviews the roles of physical, occupational, speech, and psychological therapies. We highlight interventions for early Parkinson's disease that are strongly supported by research, such as exercise and self-management.

Adherence to Non-Pharmacological Interventions in Parkinson's Disease: A Rapid Evidence Assessment of the Literature.

Background: Low adherence to non-pharmacological interventions can impact treatment effectiveness. Yet, there is limited information on adherence barriers and facilitators to non-pharmacological interventions in Parkinson's disease (PD). Objective: 1) To examine the quality of adherence reporting and 2) to identify key determinants of adherence to PD non-pharmacological interventions. Methods: A rapid evidence assessment was conducted, following PRISMA guidelines, that included controlled studies of exercise, physiotherapy, occupational therapy, speech-language therapy with explicit reporting of 'adherence' OR 'compliance', published in the last 15 years. Data extracted included: adherence rates, adherence outcomes, and factors associated with adherence. A collaborative thematic analysis was conducted to identify determinants of adherence. Results: The search yielded 2,445 articles of which 114 met criteria for full screening with 45 studies meeting all inclusion criteria. High quality adherence data that aligned with the intervention goals were reported by 22.22%(N = 10) of studies, with the majority reporting attendance/attrition rates only 51.11%(N = 23). Four major themes (34 subthemes) emerged: disease and health, personal, program design, and system and environmental. Conclusions: There has been limited progress in the quality of adherence reporting in PD non-pharmacological interventions over the last decade. Acknowledging this limitation, key determinants of adherence included: alignment with personal beliefs, attitudes, and expectations; the demands of the intervention and worsening disease symptoms and personal/time obligations; and accessibility and safety concerns. Program design elements found to facilitate adherence included: opportunities for social engagement and in-person offerings linked to higher levels of interventionist support, performative feedback, and social reinforcement.

Comparative Roles of the Caudate and Putamen in the Serial Order of Behavior: Effects of Striatal Glutamate Receptor Blockade on Variable versus Fixed Spatial Self-Ordered Sequencing in Marmosets.

Self-ordered sequencing is an important executive function involving planning and executing a series of steps to achieve goal-directed outcomes. The lateral frontal cortex is implicated in this behavior, but downstream striatal outputs remain relatively unexplored. We trained marmosets on a three-stimulus self-ordered spatial sequencing task using a touch-sensitive screen to explore the role of the caudate nucleus and putamen in random and fixed response arrays. By transiently blocking glutamatergic inputs to these regions, using intrastriatal CNQX microinfusions, we demonstrate that the caudate and putamen are both required for, but contribute differently to, flexible and fixed sequencing. CNQX into either the caudate or putamen impaired variable array accuracy, and infusions into both simultaneously elicited greater impairment. We demonstrated that continuous perseverative errors in variable array were caused by putamen infusions, likely due to interference with the putamen's established role in monitoring motor feedback. Caudate infusions, however, did not affect continuous errors, but did cause an upward trend in recurrent perseveration, possibly reflecting interference with the caudate's established role in spatial working memory and goal-directed planning. In contrast to variable array performance, while both caudate and putamen infusions impaired fixed array responding, the combined effects were not additive, suggesting possible competing roles. Infusions into either region individually, but not simultaneously, led to continuous perseveration. Recurrent perseveration in fixed arrays was caused by putamen, but not caudate, infusions. These results are consistent overall with a role of caudate in planning and flexible responding and the putamen in more rigid habitual or automatic responding.

Improving preclinical to clinical translation of cognitive function for aging-related disorders: the utility of comprehensive touchscreen testing batteries in common marmosets.

Concerns about poor animal to human translation have come increasingly to the fore, in particular with regards to cognitive improvements in rodent models, which have failed to translate to meaningful clinical benefit in humans. This problem has been widely acknowledged, most recently in the field of Alzheimer's disease, although this issue pervades the spectrum of central nervous system (CNS) disorders, including neurodevelopmental, neuropsychiatric, and neurodegenerative diseases. Consequently, recent efforts have focused on improving preclinical to clinical translation by incorporating more clinically analogous outcome measures of cognition, such as touchscreen-based assays, which can be employed across species, and have great potential to minimize the translational gap. For aging-related research, it also is important to incorporate model systems that facilitate the study of the long prodromal phase in which cognitive decline begins to emerge and which is a major limitation of short-lived species, such as laboratory rodents. We posit that to improve translation of cognitive function and dysfunction, nonhuman primate models, which have conserved anatomical and functional organization of the primate brain, are necessary to move the field of translational research forward and to bridge the translational gaps. The present studies describe the establishment of a comprehensive battery of touchscreen-based tasks that capture a spectrum of domains sensitive to detecting aging-related cognitive decline, which will provide the greatest benefit through longitudinal evaluation throughout the prolonged lifespan of the marmoset.

Association of plasma biomarkers with cognition, cognitive decline, and daily function across and within neurodegenerative diseases: Results from the Ontario Neurodegenerative Disease Research Initiative.

INTRODUCTION: We investigated whether novel plasma biomarkers are associated with cognition, cognitive decline, and functional independence in activities of daily living across and within neurodegenerative diseases. METHODS: Glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), phosphorylated tau (p-tau)181 and amyloid beta (Aß)42/40 were measured using ultra-sensitive Simoa immunoassays in 44 healthy controls and 480 participants diagnosed with Alzheimer's disease/mild cognitive impairment (AD/MCI), Parkinson's disease (PD), frontotemporal dementia (FTD) spectrum disorders, or cerebrovascular disease (CVD). RESULTS: GFAP, NfL, and/or p-tau181 were elevated among all diseases compared to controls, and were broadly associated with worse baseline cognitive performance, greater cognitive decline, and/or lower functional independence. While GFAP, NfL, and p-tau181 were highly predictive across diseases, p-tau181 was more specific to the AD/MCI cohort. Sparse associations were found in the FTD and CVD cohorts and for Aß42/40 . DISCUSSION: GFAP, NfL, and p-tau181 are valuable predictors of cognition and function across common neurodegenerative diseases, and may be useful in specialized clinics and clinical trials.

Premotor cortex is hypoactive during sustained vowel production in individuals with Parkinson's disease and hypophonia.

Introduction: Hypophonia is a common feature of Parkinson's disease (PD); however, the contribution of motor cortical activity to reduced phonatory scaling in PD is still not clear. Methods: In this study, we employed a sustained vowel production task during functional magnetic resonance imaging to compare brain activity between individuals with PD and hypophonia and an older healthy control (OHC) group. Results: When comparing vowel production versus rest, the PD group showed fewer regions with significant BOLD activity compared to OHCs. Within the motor cortices, both OHC and PD groups showed bilateral activation of the laryngeal/phonatory area (LPA) of the primary motor cortex as well as activation of the supplementary motor area. The OHC group also recruited additional activity in the bilateral trunk motor area and right dorsal premotor cortex (PMd). A voxel-wise comparison of PD and HC groups showed that activity in right PMd was significantly lower in the PD group compared to OHC (p < 0.001, uncorrected). Right PMd activity was positively correlated with maximum phonation time in the PD group and negatively correlated with perceptual severity ratings of loudness and pitch. Discussion: Our findings suggest that hypoactivation of PMd may be associated with abnormal phonatory control in PD.

User-centered design of feedback regarding health-related behaviors derived from wearables: An approach targeting older adults and persons living with neurodegenerative disease.

Objective: There has been tremendous growth in wearable technologies for health monitoring but limited efforts to optimize methods for sharing wearables-derived information with older adults and clinical cohorts. This study aimed to co-develop, design and evaluate a personalized approach for information-sharing regarding daily health-related behaviors captured with wearables. Methods: A participatory research approach was adopted with: (a) iterative stakeholder, and evidence-led development of feedback reporting; and (b) evaluation in a sample of older adults (n = 15) and persons living with neurodegenerative disease (NDD) (n = 25). Stakeholders included persons with lived experience, healthcare providers, health charity representatives and individuals involved in aging/NDD research. Feedback report information was custom-derived from two limb-mounted inertial measurement units and a mobile electrocardiography device worn by participants for 7-10 days. Mixed methods were used to evaluate reporting 2 weeks following delivery. Data were summarized using descriptive statistics for the group and stratified by cohort and cognitive status. Results: Participants (n = 40) were 60% female (median 72 (60-87) years). A total of 82.5% found the report easy to read or understand, 80% reported the right amount of information was shared, 90% found the information helpful, 92% shared the information with a family member or friend and 57.5% made a behavior change. Differences emerged in sub-group comparisons. A range of participant profiles existed in terms of interest, uptake and utility. Conclusions: The reporting approach was generally well-received with perceived value that translated into enhanced self-awareness and self-management of daily health-related behaviors. Future work should examine potential for scale, and the capacity for wearables-derived feedback to influence longer-term behavior change.