Making the Right Connections: Maximizing Lexical Generalization in Lexical Impairments in Primary Progressive Aphasia and Alzheimer's Disease.

Purpose Positive intervention effects following lexical retrieval interventions are increasingly reported with people with progressive language impairments; however, generalization of therapy gains are less frequently evident and less well understood. This study sought to explore the impact of specific therapy ingredients on generalization outcomes. Method Twelve participants with progressive lexical retrieval deficits (four each with semantic variant primary progressive aphasia, logopenic variant primary progressive aphasia, and Alzheimer's disease, amnestic presentation) and their family members participated in a 6-week intervention that aimed to increase access to different word classes (nouns, verbs, and adjectives) through a strategic self-cueing approach. Generalization was actively facilitated through strategy practice in connected speech. Repeated baselines of picture naming and connected speech were conducted prior to intervention and repeated immediately post and at 6 weeks following intervention. Results All three diagnostic groups showed significant improvements in naming performance post-intervention for all word classes and for both treated and untreated items, demonstrating consistent treatment effectiveness and generalization at the word level. No changes in the informativeness or efficiency of connected speech were found. Conclusions Despite heterogeneity across participants, widespread evidence of both treatment effects and generalization to untreated items was found for all diagnostic groups and word classes. The consistent within-level generalization across all groups is explored here in relation to optimization of strategy use through incorporation of cognitive scaffolds, strategic practice at the connected speech level, and the inclusion of family members. The absence of across-level generalization to connected speech is also explored. Supplemental Material https://doi.org/10.23641/asha.14219771.

Lost for words: Perspectives and experiences of people with primary progressive aphasia and Alzheimer's disease and their families of participation in a lexical retrieval intervention.

Purpose: Previous qualitative research involving family members' experiences of living with a person with dementia has consistently revealed themes of reduced connectedness and reciprocity of communication, highlighting the importance of education, support and practical strategies to facilitate communication within families. This study aimed to evaluate the perspectives and experiences of both family members and people with dementia following participation in a targeted speech-language pathology intervention involving people with primary progressive aphasia (PPA) and Alzheimer's disease (AD) and their family members. Method: Semi-structured interviews of eight people with dementia (six PPA, two AD) and 10 family members were conducted following an intervention to increase lexical retrieval within functional contexts. Thematic analysis was used to analyse the interview transcripts. Result: Two themes common to participants with dementia and family members emerged: (1) perceived benefits of the intervention and (2) lack of previous information on communication difficulties. Two separate themes emerged for people with dementia, predominantly people with PPA, involving: (1) improved communication and (2) increased participation. Three separate themes emerged for family members: (1) increased awareness and knowledge, (2) increased value of interaction and engagement and (3) uncertainty of the future. Conclusion: The findings of this qualitative study revealed a range of perspectives on the experiences of client and family participants following a communication focussed intervention, examining both the nature of perceived direct gains and gaining insight into the issues faced by these client populations and their families. The provision of individualised information and education should be a fundamental human right for all people with communication impairment with greater attention given to people with progressive conditions where such needs are not currently met.

Profiling sentence repetition deficits in primary progressive aphasia and Alzheimer's disease: Error patterns and association with digit span.

The use of sentence repetition tasks to distinguish dementia syndromes, particularly variants of primary progressive aphasia (PPA), is receiving growing attention. Impaired sentence repetition is a core feature of logopenic variant PPA, although the underlying cognitive mechanisms of this impairment and its significance as a diagnostic criterion remain poorly understood. Sentence repetition abilities of 12 people with dementia, using an adapted error classification schema, were analyzed, along with digit span abilities, a measure frequently used to assess working memory capacity, to explore error patterns and correlations. Participants with semantic variant PPA showed the greatest performance on sentence repetition and digit span in comparison to the logopenic variant PPA and Alzheimer's disease participants. Sentence repetition errors were characterized by middle omissions for semantic variant PPA, ending omissions and phonological errors for logopenic variant PPA, and ending omissions and unrelated word substitutions for Alzheimer's disease. Significant correlations were found between sentence repetition and digit span abilities. Findings are discussed in relation to working memory capacity theories, specifically, the dual-component model.

Determining stability in connected speech in primary progressive aphasia and Alzheimer's disease.

PURPOSE: Using connected speech to assess progressive language disorders is confounded by uncertainty around whether connected speech is stable over successive sampling, and therefore representative of an individual's performance, and whether some contexts and/or language behaviours show greater stability than others. METHOD: A repeated measure, within groups, research design was used to investigate stability of a range of behaviours in the connected speech of six individuals with primary progressive aphasia and three individuals with Alzheimer's disease. Stability was evaluated, at a group and individual level, across three samples, collected over 3 weeks, involving everyday monologue, narrative and picture description, and analysed for lexical content, fluency and communicative informativeness and efficiency. RESULT: Excellent and significant stability was found on the majority of measures, at a group and individual level, across all genres, with isolated measures (e.g. nouns use, communicative efficiency) showing good, but greater variability, within one of the three genres. CONCLUSION: Findings provide evidence of stability on measures of lexical content, fluency and communicative informativeness and efficiency. While preliminary evidence suggests that task selection is influential when considering stability of particular connected speech measures, replication over a larger sample is necessary to reproduce findings.

Exploring generalisation processes following lexical retrieval intervention in primary progressive aphasia.

PURPOSE: Within the current literature, positive intervention effects demonstrate the significant potential for people with Primary Progressive Aphasia (PPA) to learn/relearn words. Generalisation of intervention effects to other words and/or other contexts, however, remains unclear. METHOD: This multiple baseline, case-series design investigated the effects of a self-cueing lexical retrieval intervention across word classes (nouns, verbs and adjectives) on four individuals with PPA, three suggestive of the semantic variant and one of the logopenic variant. The intervention integrated semantic, phonological and orthographic levels of language production and drew on autobiographical memory. Changes in accuracy in retrieving treated and untreated items (pre-intervention, post-intervention and 4-weeks maintenance) were determined using the Cochran's Q test, with follow-up McNemar pairwise comparisons. RESULT: All participants showed significant improvements in naming treated items, across all word classes. Different patterns of generalised improvement to untreated words were found for each participant. In discourse, the semantic variant participants demonstrated a significant increase in correct information units, in contrast to the participant with the logopenic variant who remained stable. CONCLUSION: This study provides evidence that people with PPA can show improved lexical retrieval following intervention. The findings suggest possible differences in generalisation across word classes and according to underlying deficit.