Language Impairment in Vascular Dementia: A Clinical Review.

Vascular cognitive impairment (VCI) encompasses a wide range of conditions, including cognitive impairment associated with stroke or vascular brain injury, mild vascular cognitive impairment, and vascular dementia (VD). Knowledge of language impairment associated with VD is far less extensive than that of Alzheimer's disease. Although not prevalent in VD, impairment in language skills has been reported. A better understanding of the neurolinguistic features associated with the different presentations of VD could facilitate medical diagnosis. In this article, we report data on language impairment in VD, with particular attention to their primary or secondary functional origin. To better appreciate this functional origin, we also outline the main characteristics of impairment in other cognitive functions. Key elements that should be considered in the speech-language assessment of individuals with possible or proven VD are also highlighted.

The symptoms of surface dyslexia in Arabic: the impact of orthographic ambiguity on reading abilities of a patient with Alzheimer's disease.

Like other Semitic languages, Arabic is known for its rich morphology and consonantal writing system. In this article, we report the first case of acquired surface dyslexia in an Arabic-speaking patient (HBS). Surface dyslexia is characterised by difficulty reading irregularly spelled words, while performance is better with regular words and nonwords. The purpose of this study was to describe the symptoms of surface dyslexia in Arabic and to investigate how orthographic depth may affect reading in the context of semantic impairment. In HBS, who had Alzheimer's disease, reading was impaired for both words and nonwords. Her reading performance was affected by orthographic ambiguity and by the presence of diacritics depicting short vowels. In particular, she produced mainly vowel errors, suggesting an overreliance on the sublexical route of reading. On the other hand, HBS was able to distinguish long vowels from consonants represented by the same letters, provided there was a real root. This finding can be taken as evidence that HBS could access the word's root to decide whether the vowel letter represents a long vowel or a consonant. The results of this study suggest that the characteristics of surface dyslexia appear to be universal: reading regular words is spared compared to irregular words and non-words. However, the error patterns that HBS showed in reading support a language-specific conceptualisation of the processing components of the lexical and sublexical routes of reading.

Preliminary Validation Study of the French-Quebec Version of the Mild Behavioral Impairment Checklist.

BACKGROUND: Alzheimer disease dementia may be preceded by cognitive stages during which behavioral and psychological changes can occur. More precisely, behavioral symptoms may be observed during the subjective cognitive decline (SCD) or the mild cognitive impairment (MCI) stages; these symptoms can be measured using the Mild Behavioral Impairment Checklist (MBI-C). OBJECTIVE: To validate the French-Quebec version of the MBI-C in individuals ages 60-85 years. METHOD: The sample included 60 participants (20 MCI, 20 SCD, 20 cognitively healthy) and their informants. To assess the discriminant validity of the MBI-C, a Kruskal-Wallis analysis with a multiple comparisons test was performed on the MBI-C Total score. To determine convergent validity, Spearman correlations were calculated between the MBI-C subscales and a set of validation tools. Finally, test-retest reliability was assessed with Spearman correlations of MBI-C scores between two test sessions. RESULTS: All of the analyses indicated satisfactory psychometric properties for the French-Quebec version of the MBI-C. CONCLUSION: This validation study reveals that the MBI-C can be used successfully in dementia risk assessments. From now on, the use of a validated MBI-C will be possible in the French-Quebec population.

Intensive and non-intensive treatment of lexical anomia are equally efficient in post-stroke aphasia.

Although the treatment for lexical anomia in individuals with aphasia (IWA) was shown effective, little is known about the optimal treatment intensity required. The aim of this study was to verify whether intensive and non-intensive treatments led to different outcomes when parameters of intensity are rigorously controlled. Six IWA with post-stroke lexical anomia received phonological treatment at two distinct frequencies: intensive (four times a week) and non-intensive (once a week). Results showed that both treatments were equally effective. This finding is especially relevant in contexts in which speech-language therapy delivery services are limited.

Cognitive Profile of the Logopenic Variant of Primary Progressive Aphasia Using the Dépistage Cognitif de Québec.

BACKGROUND/AIMS: The logopenic variant of primary progressive aphasia (lvPPA) is characterized by impaired word-finding and sentence repetition with phonologic errors but spared motor speech and grammar and semantic knowledge. Although its language deficits have been well studied, the full spectrum of cognitive changes in the lvPPA remains to be defined. We aimed to explore the neurocognitive profile of the lvPPA using a newly developed cognitive screening tool for atypical dementias, the Dépistage Cognitif de Québec (DCQ). METHODS: We compared 29 patients with lvPPA to 72 amnestic variant Alzheimer disease (aAD) to 438 healthy control (HC) participants. Performance on the 5 indexes of the DCQ (Memory, Visuospatial, Executive, Language and Behavioral) was compared between the 3 groups. RESULTS: Results showed a significantly lower performance for lvPPA participants in all neurocognitive domains, when compared to HC. When compared to aAD, lvPPA participants had significantly lower scores for language, executive, and visuospatial abilities, but not for memory and behavior. CONCLUSION: Altogether, these findings better define the neurocognitive changes of lvPPA.

The Impairment of Number Transcoding Abilities in Individuals with Amnestic Mild Cognitive Impairment and Alzheimer Disease: Associations With Attentional and Executive Functions.

BACKGROUND: Studies have shown that number transcoding abilities (ie, translating numbers from one numerical code to another) are affected early in the development of Alzheimer disease (AD). However, no study has extensively explored how these abilities are affected in individuals with mild cognitive impairment (MCI). OBJECTIVE: To determine the contribution that number transcoding tasks make to the identification of MCI, and to pinpoint the cognitive correlates of performance in these tasks. METHODS: We compared the performance of 20 individuals with the amnestic subtype of MCI, eight individuals with AD, and 20 healthy controls on three number transcoding tasks. RESULTS: The results confirmed the presence of number transcoding impairment in the individuals with AD. The individuals with MCI were found to be impaired in two of the transcoding tasks; these individuals produced perseverations of the input code-the most noteworthy error type in individuals with AD. In addition, the relationship between impairment in attentional and executive functions and impairment in number transcoding was supported by the correlational analyses. CONCLUSIONS: This study confirmed that number transcoding abilities are impaired in individuals with MCI, although less severely than in individuals with AD. Our results provide evidence for the clinical value of including number transcoding tasks in the assessment of cognitive deficits associated with pathological aging.

Improvement in functional vocabulary and generalization to conversation following a self-administered treatment using a smart tablet in primary progressive aphasia.

Currently, public services in speech-language pathology for primary progressive aphasia (PPA) are very limited, although several interventions have been shown to be effective. In this context, new technologies have the potential to enable people with PPA to improve their communication skills. The main aim of this study was to investigate the efficacy of a self-administered therapy using a smart tablet to improve naming of functional words and to assess generalization to an ecological conversation task. Five adults with PPA completed the protocol. Using an ABA design with multiple baselines, naming performance was compared across four equivalent lists: (1) trained with functional words; (2) trained with words from a picture database; (3) exposed but not trained; and (4) not exposed (control). Treatment was self-administered four times a week for a period of four consecutive weeks. A significant improvement for trained words was found in all five participants, and gains were maintained two months post-treatment in four of them. Moreover, in three participants, evidence of generalization was found in conversation. This study supports the efficacy of using a smart tablet to improve naming in PPA and suggests the possibility of generalization to an ecological context.

MorphoLex-FR: A derivational morphological database for 38,840 French words.

Studies on morphological processing in French, as in other languages, have shown disparate results. We argue that a critical and long-overlooked factor that could underlie these diverging results is the methodological differences in the calculation of morphological variables across studies. To address the need for a common morphological database, we present MorphoLex-FR, a sizeable and freely available database with 12 variables for prefixes, roots, and suffixes for the 38,840 words of the French Lexicon Project. MorphoLex-FR constitutes a first step to render future studies addressing morphological processing in French comparable. The procedure we used for morphological segmentation and variable computation is effectively the same as that in MorphoLex, an English morphological database. This will allow for cross-linguistic comparisons of future studies in French and English that will contribute to our understanding of how morphologically complex words are processed. To validate these variables, we explored their influence on lexical decision latencies for morphologically complex nouns in a series of hierarchical regression models. The results indicated that only morphological variables related to the suffix explained lexical decision latencies. The frequency and family size of the suffix exerted facilitatory effects, whereas the percentage of more frequent words in the morphological family of the suffix was inhibitory. Our results are in line with previous studies conducted in French and in English. In conclusion, this database represents a valuable resource for studies on the effect of morphology in visual word processing in French.

Efficacy of a self-administered treatment using a smart tablet to improve functional vocabulary in post-stroke aphasia: a case-series study.

BACKGROUND: Aphasia is an acquired language disorder that occurs secondary to brain injury, such as stroke. It causes communication difficulties that have a significant impact on quality of life and social relationships. Although the efficacy of speech-language therapy has been clearly demonstrated in this population, long-term services are currently limited due to logistical and financial constraints. In this context, the potential contribution of technology, such as smart tablets, is worth exploring, especially to improve vocabulary that is relevant in daily life. AIMS: The main aim was to investigate the efficacy of a self-administered treatment using a smart tablet to improve naming of functional words in post-stroke anomia. METHODS & PROCEDURES: Four adults with post-stroke aphasia took part in the study. An ABA design with multiple baselines was used to compare naming performances for four equivalent lists: (1) trained with functional words chosen with the participant; (2) trained with words randomly chosen from a picture database; (3) exposed but not trained; and (4) not exposed (control). OUTCOMES & RESULTS: For all participants, the treatment self-administered at home (four times/week for 4 weeks) resulted in a significant improvement for both sets of trained words that was maintained 2 months after the end of treatment. Moreover, in two participants, evidence of generalization to conversation was found. CONCLUSIONS & IMPLICATIONS: This study confirms the efficacy of using smart tablets to improve naming in post-stroke aphasia. Although more studies are needed, the use of new technologies is unquestionably a promising approach to improve communication skills in people with aphasia, especially by targeting vocabulary that is relevant to them in their daily lives.

Key Factors for the Success of Self-Administered Treatments of Poststroke Aphasia Using Technologies.

Background: Use of technology in language rehabilitation has grown significantly in recent years, and there is increasing evidence of its effectiveness in the treatment of poststroke aphasia. Technology has the potential to foster intensity and repetition by enabling people with aphasia to improve their skills without the constant presence of the clinician. The main objective of this article is to review and illustrate key factors for the success of self-administered treatments of poststroke aphasia using technologies. Methods: We briefly reviewed technology-based treatments of aphasia and described three determining factors for the success of self-administered treatments delivered by technology, namely, treatment-related, technology-related, and patient-related factors. Two clinical cases were also presented to illustrate issues and challenges related to the various factors to be considered before proposing such treatments. Conclusions: Self-administered treatments of poststroke aphasia using new technologies enable patients to be more independent in their rehabilitation and to benefit from more intensive and extended treatment. These benefits are important in the current economic context, where human and financial resources for clinical practice are limited. Speech-language therapists should consider these opportunities and propose new methods to deliver attractive and intensive treatments of poststroke aphasia.

The Dépistage Cognitif de Québec: A New Clinician's Tool for Early Recognition of Atypical Dementia.

INTRODUCTION: Early recognition of atypical dementia remains challenging partly because of lack of cognitive screening instruments precisely tailored for this purpose. METHODS: We assessed the validity and reliability of the Dépistage Cognitif de Québec (DCQ; www.dcqtest.org), a newly developed cognitive screening test, to detect atypical dementia using a multicenter cohort of 628 participants. Sensitivity and specificity were compared to the Montreal Cognitive Assessment (MoCA). A predictive diagnostic algorithm for atypical dementia was determined using classification tree analysis. RESULTS: The DCQ showed excellent psychometric properties. It was significantly more accurate than the MoCA to detect atypical dementia. All correlations between DCQ indexes and standard neuropsychological measures were significant. A statistical model distinguished typical from atypical dementia with a predictive power of 79%. DISCUSSION: The DCQ is a better tool to detect atypical dementia than standard cognitive screening tests. Expanding the clinician's tool kit with the DCQ could reduce missed/delayed identification of atypical dementia and accelerate therapeutic intervention.

Orthographic connectivity in Arabic reading: a case study of an individual with deep dyslexia and letter-by-letter reading.

Arabic orthography is complex, partly as a consequence of variations in orthographic connectivity. In this article, we present the case study of CHS, an Arabic individual with deep dyslexia associated with letter-by-letter reading. In the experimental study, we specifically explored the influence of orthographic connectivity on CHS's word recognition and reading abilities. Our results show that CHS's performance was better preserved for words and non-words made up of connected letters than made up of non-connected letters. CHS demonstrated impairment of visuoperceptual mechanisms, which affected the processing of complex orthographic material. These results provide insight into the cognitive processes associated with reading Arabic.

Language Disorders in Huntington Disease: A Systematic Literature Review.

OBJECTIVE: A systematic review examining the presence and nature of language disorders associated with Huntington disease (HD). BACKGROUND: HD is characterized by gradual motor dysfunction, psychiatric problems, and cognitive decline. Communication abilities in HD may be affected not only by dysarthria but also by language impairment. However, the nature and type of this impairment is not well defined. METHODS: We searched the PubMed and PsycINFO databases and selected studies on the basis of the original language of the article, peer-review status, and specificity of the results regarding language and communication disorders. RESULTS: Thirty-one articles meeting the selection criteria were selected for this review. According to most of the studies, individuals with HD present with primary deficits of language. However, a few authors suggested that language deficits in HD result from nonlinguistic impairments, or that language abilities are largely preserved. More specifically, studies showed that HD is associated with difficulties in producing and understanding sentences and discourse, processing semantic representations of object and action concepts, retrieving lexical forms of nouns, and applying morphological and syntactic rules. There is some disagreement regarding whether HD affects reading abilities, sentence production, semantic processing, and application of morphological rules in verb conjugation. CONCLUSIONS: Although people with HD present with language impairment, further studies are needed to identify their functional origin. Clinical studies are also needed to determine the impact of such impairments on an individual's functional communication in daily living and to chart the progression of the impairments over the course of the disease.

Dysexecutive Symptoms in Primary Progressive Aphasia: Beyond Diagnostic Criteria.

Primary progressive aphasia (PPA) is a heterogeneous neurodegenerative condition in which the most prominent clinical feature is language difficulties. Other cognitive domains have been described to remain unaffected at the early stages of the disease and, therefore, excluded from diagnostic criteria. However, we show in this article that executive function (EF) disorders may be present in the 3 variants (nonfluent/agrammatic, logopenic, and semantic) of PPA. We also illustrate changes in language and EF by means of a 3-year behavioral and neuroimaging longitudinal study of a patient suffering from the semantic variant of PPA. This review provides an update on current knowledge of PPA, suggesting that dysexecutive symptoms may be encountered in the 3 PPA variants, in their early phases and/or in more advanced stages, when atrophy extends to adjacent brain areas.

In-Home Synchronous Telespeech Therapy to Improve Functional Communication in Chronic Poststroke Aphasia: Results from a Quasi-Experimental Study.

BACKGROUND: Although the use of telepractice in speech-language therapy for assessment purposes is well documented, its effectiveness and potential for rehabilitation in poststroke aphasia remain largely unknown. The purpose of this study was to investigate the effectiveness of a remotely delivered synchronous pragmatic telespeech language therapy for improving functional communication in aphasia. METHODS: A pre-/post-test design was chosen in which each participant was his or her own control. Using a telerehabilitation platform and software (Oralys TeleTherapy) based on the Promoting Aphasics' Communicative Effectiveness (PACE) approach, 20 participants with chronic poststroke aphasia received 9 speech therapy sessions over a 3-week period. RESULTS: Teletreatment with the PACE pragmatic rehabilitation approach led to improvements in functional communication, marked by (a) an increase in communication effectiveness, reflecting significantly improved autonomy in functional communication; (b) a decrease in communication exchange duration, meaning that the treatment made communication faster and more efficient; (c) a decrease in the number of communication acts, meaning that, after treatment, less information was needed to be efficiently understood by the communication partner; and (d) an increase in the number of different communication strategies used, meaning that the treatment fostered the use of a variety of alternative communication modes. CONCLUSIONS: This study provides additional arguments about the benefits of telerehabilitation for poststroke patients with aphasia. It showed that multimodal language therapy delivered through synchronous telerehabilitation had positive effects on functional communication in chronic aphasia.

Treatment of verb anomia in aphasia: efficacy of self-administered therapy using a smart tablet.

Aphasia is a chronic condition that usually requires long-term rehabilitation. However, even if many effective treatments can be offered to patients and families, speech therapy services for individuals with aphasia often remain limited because of logistical and financial considerations, especially more than 6 months after stroke. Therefore, the need to develop tools to maximize rehabilitation potential is unquestionable. The aim of this study was to test the efficacy of a self-administered treatment delivered with a smart tablet to improve written verb naming skills in CP, a 63-year-old woman with chronic aphasia. An ABA multiple baseline design was used to compare CP's performance in verb naming on three equivalent lists of stimuli trained with a hierarchy of cues, trained with no cues, and not trained. Results suggest that graphemic cueing therapy, done four times a week for 3 weeks, led to better written verb naming compared to baseline and to the untrained list. Moreover, generalization of the effects of treatment was observed in verb production, assessed with a noun-to-verb production task. Results of this study suggest that self-administered training with a smart tablet is effective in improving naming skills in chronic aphasia. Future studies are needed to confirm the effectiveness of new technologies in self-administered treatment of acquired language deficits.

When the Wedding March becomes sad: Semantic memory impairment for music in the semantic variant of primary progressive aphasia.

Music can induce particular emotions and activate semantic knowledge. In the semantic variant of primary progressive aphasia (svPPA), semantic memory is impaired as a result of anterior temporal lobe (ATL) atrophy. Semantics is responsible for the encoding and retrieval of factual knowledge about music, including associative and emotional attributes. In the present study, we report the performance of two individuals with svPPA in three experiments. NG with bilateral ATL atrophy and ND with atrophy largely restricted to the left ATL. Experiment 1 assessed the recognition of musical excerpts and both patients were unimpaired. Experiment 2 studied the emotions conveyed by music and only NG showed impaired performance. Experiment 3 tested the association of semantic concepts to musical excerpts and both patients were impaired. These results suggest that the right ATL seems essential for the recognition of emotions conveyed by music and that the left ATL is involved in binding music to semantics. They are in line with the notion that the ATLs are devoted to the binding of different modality-specific properties and suggest that they are also differentially involved in the processing of factual and emotional knowledge associated with music.

Semantic memory impairment for biological and man-made objects in individuals with amnestic mild cognitive impairment or late-life depression.

OBJECTIVE: Amnestic mild cognitive impairment (aMCI) and late-life depression (LLD) both increase the risk of developing Alzheimer disease (AD). Very little is known about the similarities and differences between these syndromes. The present study addresses this issue by examining the nature of semantic memory impairment (more precisely, object-based knowledge) in patients at risk of developing AD. METHODS: Participants were 17 elderly patients with aMCI, 18 patients with aMCI plus depressive symptoms (aMCI/D+), 15 patients with LLD, and 29 healthy controls. All participants were aged 55 years or older and were administered a semantic battery designed to assess semantic knowledge for 16 biological and 16 man-made items. RESULTS: Overall performance of aMCI/D+ participants was significantly worse than the 3 other groups, and performance for questions assessing knowledge for biological items was poorer than for questions relating to man-made items. CONCLUSION: This study is the first to show that aMCI/D+ is associated with object-based semantic memory impairment. These results support the view that semantic deficits in aMCI are associated with concomitant depressive symptoms. However, depressive symptoms alone do not account exclusively for semantic impairment, since patients with LLD showed no semantic memory deficit.

Impact of the LSVT on vowel articulation and coarticulation in Parkinson's disease.

The purpose of this study was to investigate the impact of the Lee Silverman Voice Treatment (LSVT®) on vowel articulation and consonant-vowel (C-V) coarticulation in dysarthric speakers with Parkinson's disease (PD). Nine Quebec French speakers diagnosed with idiopathic PD underwent the LSVT®. Speech characteristics were compared before and after treatment. Vowel articulation was measured using acoustic vowel space and calculated with the first (F1) and second formant (F2) of the vowels /i/, /u/ and /a/. C-V coarticulation was measured using locus equations, an acoustic metric based on the F2 transitions within vowels in relation to the preceding consonant. The relationship between these variables, speech loudness and vowel duration was also analysed. Results showed that vowel contrast increased in F1/F2 acoustic space after administration of the LSVT®. This improvement was associated with the gain in speech loudness and longer vowel duration. C-V coarticulation patterns between consonant contexts showed greater distinctiveness after the treatment. This improvement was associated with the gain in speech loudness only. These results support the conclusions of previous studies investigating the relationship between the LSVT®, speech loudness and articulation in PD. These results expand clinical understanding of the treatment and indicate that loud speech changes C-V coarticulation patterns. Clinical applications and theoretical considerations are discussed.

Normative Data for the Famous People Fluency Test in the Adult French-Quebec Population and Validation Study in Mild Cognitive Impairment and Alzheimer's Disease.

OBJECTIVE: The production of words in verbal fluency tests relies heavily on executive functions and linguistic abilities. New tests such as the famous people fluency test can also be useful in clinical practice and research. This test, in which participants are asked to name so many famous people, has the potential to distinguish healthy individuals from participants with neurological disorders such as mild cognitive impairment or Alzheimer's disease. METHOD: The aim of this study was to determine the psychometric validity of the test (Study 1) and to provide normative data in the adult population of French Quebec for the famous people fluency test (Study 2). RESULTS: The results of the normative study, derived from a sample of 378 healthy individuals between the ages of 50 and 92, showed that age and educational level significantly influence performance on the test. Therefore, percentile ranks were calculated for performance on the famous people fluency test, stratified for these two variables. The results of Study 2 showed that the test differentiated the performance of healthy participants from the performance of participants with mild cognitive impairment or Alzheimer's disease. The results also showed that the famous people fluency test has adequate convergent validity, established with a semantic fluency test, and that the results showed good stability over time (test-retest validity). CONCLUSION: Norms and psychometric data for the famous people fluency test will improve the ability of clinicians and researchers to better recognize executive and language impairments associated with pathological conditions.