Long-Term maintenance of anomia treatment effects in primary progressive aphasia.

This study examined the maintenance of anomia treatment effects in primary progressive aphasia (PPA). Following baseline testing, a phonological treatment and an orthographic treatment were administered over the course of six months. The treatment stimuli consisted of nouns that were consistently named correctly at baseline (Prophylaxis items) and/or nouns that were consistently named incorrectly at baseline (Remediation items). Naming accuracy was measured at baseline, and it was measured at 1 month, 8 months, and 15 months post-treatment. The change in naming accuracy from baseline to each post-treatment evaluation was calculated within each treatment condition, and within a matched untrained condition. The change in naming accuracy was then compared between the three conditions. The results of these analyses indicate that phonological and orthographic treatments are both effective in the Prophylaxis and Remediation of anomia in all three variants of PPA. For Prophylaxis items, some of the effects of each treatment can persist for as long as 15 months post-treatment. These long-term treatment effects were more robust in the orthographic treatment condition and for participants with the semantic variant of PPA.

Prophylaxis and remediation of anomia in the semantic and logopenic variants of primary progressive aphasia.

This study evaluated the efficacy of phonological and orthographic treatments for anomia in the semantic and logopenic variants of primary progressive aphasia (svPPA and lvPPA, respectively). Both treatments were administered for 6 months. The treatment stimuli consisted of nouns that were consistently named correctly at baseline (prophylaxis items) and/or nouns that were consistently named incorrectly at baseline (remediation items). Oral naming accuracy was measured for trained and untrained picture exemplars, as well as matched items from an untrained condition (UC). Written naming and scene description tasks were also conducted. For all tasks, the change in naming accuracy from baseline to 1 month post-treatment was compared between the UC and each treatment condition. These comparisons indicated that both treatments were effective in the remediation and prophylaxis of anomia in both variants. Furthermore, generalisation to untrained exemplars occurred in both subtypes, whereas item generalisation occurred in lvPPA, and task generalisation was present in svPPA.

Baseline Conceptual-Semantic Impairment Predicts Longitudinal Treatment Effects for Anomia in Primary Progressive Aphasia and Alzheimer's Disease.

Background: An individual's diagnostic subtype may fail to predict the efficacy of a given type of treatment for anomia. Classification by conceptual-semantic impairment may be more informative. Aims: This study examined the effects of conceptual-semantic impairment and diagnostic subtype on anomia treatment effects in primary progressive aphasia (PPA) and Alzheimer's disease (AD). Methods & Procedures: At baseline, the picture and word versions of the Pyramids and Palm Trees and Kissing and Dancing tests were used to measure conceptual-semantic processing. Based on norming that was conducted with unimpaired older adults, participants were classified as being impaired on both the picture and word versions (i.e., modality-general conceptual-semantic impairment), the picture version (Objects or Actions) only (i.e., visual-conceptual impairment), the word version (Nouns or Verbs) only (i.e., lexical-semantic impairment), or neither the picture nor the word version (i.e., no impairment). Following baseline testing, a lexical treatment and a semantic treatment were administered to all participants. The treatment stimuli consisted of nouns and verbs that were consistently named correctly at baseline (Prophylaxis items) and/or nouns and verbs that were consistently named incorrectly at baseline (Remediation items). Naming accuracy was measured at baseline, and it was measured at three, seven, eleven, fourteen, eighteen, and twenty-one months. Outcomes & Results: Compared to baseline naming performance, lexical and semantic treatments both improved naming accuracy for treated Remediation nouns and verbs. For Prophylaxis items, lexical treatment was effective for both nouns and verbs, and semantic treatment was effective for verbs, but the pattern of results was different for nouns -- the effect of semantic treatment was initially nonsignificant or marginally significant, but it was significant beginning at 11 Months, suggesting that the effects of prophylactic semantic treatment may become more apparent as the disorder progresses. Furthermore, the interaction between baseline Conceptual-Semantic Impairment and the Treatment Condition (Lexical vs. Semantic) was significant for verb Prophylaxis items at 3 and 18 Months, and it was significant for noun Prophylaxis items at 14 and 18 Months. Conclusions: The pattern of results suggested that individuals who have modality-general conceptual-semantic impairment at baseline are more likely to benefit from lexical treatment, while individuals who have unimpaired conceptual-semantic processing at baseline are more likely to benefit from semantic treatment as the disorder progresses. In contrast to conceptual-semantic impairment, diagnostic subtype did not typically predict the treatment effects.

Tracking Passive Sentence Comprehension in Agrammatic Aphasia.

People with agrammatic aphasia often experience greater difficulty comprehending passive compared to active sentences. The Trace Deletion Hypothesis (TDH; Grodzinsky, 2000) proposes that aphasic individuals cannot generate accurate syntactic representations of passive sentences and, hence, use an agent-first processing strategy which leads to at-chance performance. We tested this claim using the eyetracking-while-listening paradigm in order to reveal online processing routines. Ten agrammatic aphasic participants and 10 age-matched controls listened to passive and active sentences and performed a sentence-picture matching task (i.e., selecting between two pictures with reversed thematic roles), while their eye movements were monitored. Control participants' performance was at ceiling, whereas accuracy for the aphasic participants was above chance for active sentences and at chance for passive sentences. Further, for the control participants, the eye movement data showed an initial agent-first processing bias, followed by fixation on the correct picture in the vicinity of the verb in both active and passive sentences. However, the aphasic participants showed no evidence of agent-first processing, counter the predictions of the TDH. In addition, in active sentences, they reliably fixated the correct picture only at sentence offset, reflecting slowed processing. During passive sentence processing, fixations were at chance throughout the sentence, but different patterns were noted for correct and incorrect trials. These results are consistent with the proposal that agrammatic sentence comprehension failure involves lexical processing and/or lexical integration deficits.

Grammatical Ability Predicts Relative Action Naming Impairment in Primary Progressive Aphasia.

BACKGROUND: Findings from several studies have indicated that participants with nfvPPA and participants with svPPA exhibit different patterns on action and object naming tasks, while other recent studies have found that neither participants with nfvPPA nor participants with svPPA show a significant difference in accuracy between object naming and action naming. AIMS: The goal of this study was to test the hypothesis that relative action naming impairment is associated with grammatical ability in PPA, rather than a specific subtype of PPA. METHODS & PROCEDURES: Thirty-four participants with PPA completed the Boston Naming Test, the Action Naming subtest of the Boston Diagnostic Aphasia Examination, and the Northwestern Anagram Test, which was used to measure grammatical ability. Z-scores for the two naming tasks were calculated based on normative data from unimpaired controls. For each participant with PPA, the relative action naming impairment was calculated by subtracting the object naming z-score from the action naming z-score. Linear regression analysis was then used to evaluate the role of grammatical ability as a predictor of relative action naming impairment, while controlling for age, education, cognitive ability (as measured by the Montreal Cognitive Assessment), and semantic ability (as measured by the Pyramids and Palm Trees test). The interaction between grammatical ability and each control variable was also examined. OUTCOMES & RESULTS: The main effect of grammatical ability was a significant predictor of relative action naming impairment, while none of the control variables was a significant predictor. However, the interaction between grammatical ability and semantic ability was also significant. CONCLUSIONS: Individuals who have both grammatical impairment and semantic impairment have the largest relative action naming impairment. These individuals may benefit from a treatment that focuses on the retrieval of verbs and their arguments.

The divided visual world paradigm: eye tracking reveals hemispheric asymmetries in lexical ambiguity resolution.

Eye tracking was combined with the visual half-field procedure to examine hemispheric asymmetries in meaning selection and revision. In two experiments, gaze was monitored as participants searched a four-word array for a target that was semantically related to a lateralized ambiguous or unambiguous prime. Primes were preceded by a related or unrelated centrally-presented context word. In Experiment 1, unambiguous primes were paired with concordant weakly-related context words and strongly-related targets that were similar in associative strength to discordant subordinate-related context words and dominant-related targets in the ambiguous condition. Context words and targets were reversed in Experiment 2. A parallel study involved the measurement of event-related potentials (ERPs; Meyer, A. M., and Federmeier, K. D., 2007. The effects of context, meaning frequency, and associative strength on semantic selection: distinct contributions from each cerebral hemisphere. Brain Res. 1183, 91-108). Similar to the ERP findings, gaze revealed context effects for both visual fields/hemispheres when subordinate-related targets were presented: initial gaze revealed meaning activation when an unrelated context was utilized, whereas later gaze also revealed activation in the discordant context, indicating that meaning revision had occurred. However, eye tracking and ERP measures diverged when dominant-related targets were presented: for both visual fields/hemispheres, initial gaze indicated the presence of meaning activation in the discordant context, and, for the right hemisphere, discordant context information actually facilitated gaze relative to unrelated context information. These findings are discussed with respect to the activeness of the task and hemispheric asymmetries in the flexible use of context information.

The effects of context, meaning frequency, and associative strength on semantic selection: distinct contributions from each cerebral hemisphere.

The visual half-field procedure was used to examine hemispheric asymmetries in meaning selection. Event-related potentials were recorded as participants decided if a lateralized ambiguous or unambiguous prime was related in meaning to a centrally presented target. Prime-target pairs were preceded by a related or unrelated centrally presented context word. To separate the effects of meaning frequency and associative strength, unambiguous words were paired with concordant weakly related context words and strongly related targets (e.g., taste-sweet-candy) that were similar in associative strength to discordant subordinate-related context words and dominant-related targets (e.g., river-bank-deposit) in the ambiguous condition. Context words and targets were reversed in a second experiment. In an unrelated (neutral) context, N400 responses were more positive than baseline (facilitated) in all ambiguous conditions except when subordinate targets were presented on left visual field-right hemisphere (LVF-RH) trials. Thus, in the absence of biasing context information, the hemispheres seem to be differentially affected by meaning frequency, with the left maintaining multiple meanings and the right selecting the dominant meaning. In the presence of discordant context information, N400 facilitation was absent in both visual fields, indicating that the contextually consistent meaning of the ambiguous word had been selected. In contrast, N400 facilitation occurred in all of the unambiguous conditions; however, the left hemisphere (LH) showed less facilitation for the weakly related target when a strongly related context was presented. These findings indicate that both hemispheres use context to guide meaning selection, but the LH is more likely to focus activation on a single, contextually relevant sense.

The Relationship Between Baseline Volume in Temporal Areas and Post-Treatment Naming Accuracy in Primary Progressive Aphasia.

BACKGROUND: Structural imaging has not been used previously to predict the effect of treatment in primary progressive aphasia (PPA). AIMS: This study examined relationships between baseline brain volume and the effects of phonological and orthographic treatments for anomia in PPA. It was predicted that lower baseline volume would be associated with lower post-treatment naming accuracy for treated items and smaller generalization effects. METHODS & PROCEDURES: Twenty-one individuals with PPA participated. The treatment stimuli consisted of nouns that were consistently named correctly at baseline (Prophylaxis items) and/or nouns that were consistently named incorrectly at baseline (Remediation items). All 21 participants had Prophylaxis items, while 10 participants had Remediation items. Naming accuracy for untrained and trained items (Exemplar set 1) was measured. In addition, stimulus generalization was examined by having participants name an alternative exemplar of each untrained and trained item (Exemplar set 2). Correlational analyses focused on the relationships between naming accuracy and volume of regions previously identified as having a role in naming and semantic processing. OUTCOMES & RESULTS: Unexpectedly, there were no significant correlations between baseline volume and post-treatment accuracy for treated items. However, baseline volume within the left temporal pole was positively correlated with post-treatment accuracy for Untrained Exemplar set 2 Prophylaxis items, while baseline volume in the left inferior temporal gyrus was positively correlated with post-treatment accuracy for Untrained Exemplar set 1 Remediation items. CONCLUSIONS: These findings suggest that lower volume in the left temporal pole is associated with decline for Untrained items, while lower volume in the left inferior temporal gyrus is associated with a lack of improvement for Untrained items. Possible explanations for the different patterns observed across Exemplar sets are discussed.

Telerehabilitation of Anomia in Primary Progressive Aphasia.

BACKGROUND: The efficacy of telerehabilitation-based treatment for anomia has been demonstrated in post-stroke aphasia, but the efficacy of this method of anomia treatment delivery has not been established within the context of degenerative illness. AIMS: The current study evaluated the feasibility and efficacy of a telerehabilitation-based approach to anomia treatment within the three subtypes of primary progressive aphasia (PPA). METHODS & PROCEDURES: Each of the three telerehabilitation participants represented a distinct subtype of PPA. Following a baseline evaluation of language and cognition, a phonological treatment and an orthographic treatment were administered to all participants over the course of six months. One month after the end of treatment, a post-treatment evaluation began. All treatment sessions and the majority of the evaluation sessions were administered via telerehabilitation. Treatment effects were examined within each subject, and treatment effects were also compared between each telerehabilitation participant and a group of in-person participants who had the same subtype of PPA. OUTCOMES & RESULTS: All three telerehabilitation participants exhibited positive treatment effects. CGR (nonfluent/agrammatic variant PPA) and WCH (logopenic variant PPA) showed maintenance of naming for prophylaxis items in both treatment conditions, while ACR (semantic variant PPA) demonstrated increased naming of remediation items in the phonological treatment condition. Compared to in-person participants with the same subtype of PPA, each of the telerehabilitation participants typically showed effects that were either within the expected range or larger than expected. CONCLUSIONS: Telerehabilitation-based anomia treatment is feasible and effective in all three subtypes of PPA.

Prophylactic Treatments for Anomia in the Logopenic Variant of Primary Progressive Aphasia: Cross-Language Transfer.

BACKGROUND: Treatment studies for anomia in PPA have rarely compared multiple treatments in the same individual, and few anomia treatment studies have included participants with the logopenic variant of PPA (lvPPA). AIMS: The goals of this study were to evaluate two types of treatment for anomia in a bilingual participant (ND) with lvPPA, and to examine possible cross-language transfer of treatment effects. METHODS & PROCEDURES: ND is a Norwegian-English bilingual woman with lvPPA who began this study at the age of 69. In the phonological treatment, ND listened to a word while viewing a corresponding picture, and she repeated the word. In the orthographic treatment, ND read a word out loud while viewing the corresponding picture, and she then copied the word. Both treatments were conducted in English, and accuracy for three tasks (oral naming, written naming, and naming to definition) was assessed in English and Norwegian. The treatment occurred over a one-year period, with eight sessions at the laboratory during the first month, followed by monthly laboratory sessions and thrice-weekly home practice sessions during the subsequent 11 months. Post-treatment assessments were conducted at 1 week, 8 months, 1 year, 20 months, and 3 years. OUTCOMES & RESULTS: Compared to untrained items, the orthographic treatment resulted in greater English written naming accuracy. This treatment also resulted in cross-language transfer: greater Norwegian oral naming and naming to definition accuracy. The phonological treatment resulted in marginally greater English oral naming accuracy, but it did not have a significant effect on naming accuracy in Norwegian. CONCLUSIONS: These findings suggest that the orthographic treatment was effective in strengthening the orthographic representations of the treated items, which facilitated ND's written naming performance. The pattern of cross-language transfer suggests that the orthographic treatment also strengthened the language-independent semantic representations of the treated items, thereby facilitating access to their Norwegian phonological representations.

Phonological short-term memory in logopenic variant primary progressive aphasia and mild Alzheimer's disease.

It has been argued that individuals with logopenic variant primary progressive aphasia (lvPPA) have an impairment of the phonological loop, which is a component of the short-term memory (STM) system. In contrast, this type of impairment is not thought to be present in mild typical Alzheimer's disease (AD). Thus, one would predict that people with lvPPA would score significantly lower than a matched AD group on tasks that require phonological STM. In the current study, an lvPPA group was compared with a mild AD group that was matched on age, education, and general cognitive functioning. For a subset of the tasks that involved pseudowords, the AD and lvPPA groups were compared to a healthy control group that was matched on age and education. The lvPPA group was more impaired than the AD group on all of the tasks that required phonological STM, including the pseudoword tasks, but there were no significant differences between these groups on tasks that required visuospatial STM. Compared to the healthy controls, the lvPPA group performed significantly worse on the repetition and reading of pseudowords, while the AD group did not differ significantly from the controls on these tasks. These findings are consistent with the hypothesis that phonological STM is impaired in lvPPA.

A "concrete view" of aging: event related potentials reveal age-related changes in basic integrative processes in language.

Normal aging is accompanied by changes in both structural and functional cerebral organization. Although verbal knowledge seems to be relatively stable across the lifespan, there are age-related changes in the rapid use of that knowledge during on-line language processing. In particular, aging has been linked to reduce effectiveness in preparing for upcoming words and building an integrated sentence-level representation. The current study assessed whether such age-related changes extend even to much simpler language units, such as modification relations between a centrally presented adjective and a lateralized noun. Adjectives were used to elicit concrete and abstract meanings of the same, polysemous lexical items (e.g., "green book" vs. "interesting book"). Consistent with findings that lexical information is preserved with age, older adults, like younger adults, exhibited concreteness effects at the adjectives, with more negative responses to concrete adjectives over posterior (300-500 ms; N400) and frontal (300-900 ms) channels. However, at the noun, younger adults exhibited concreteness-based predictability effects linked to left hemisphere processing and imagery effects linked to right hemisphere processing, contingent on whether the adjectives and nouns formed a cohesive conceptual unit. In contrast, older adults showed neither effect, suggesting that they were less able to rapidly link the adjective-noun meaning to form an integrated conceptual representation. Age-related changes in language processing may thus be more pervasive than previously realized.

Event-related potentials reveal the effects of aging on meaning selection and revision.

ERPs were recorded as older adults decided if a target word was related to a lateralized ambiguous or unambiguous prime; prime-target pairs were preceded by a related or unrelated context word. In an unrelated context, N400 facilitation effects differed from those seen in young adults, with older adults showing priming for the dominant meaning (e.g., BOOM-BANK-DEPOSIT) on right visual field/left hemisphere (RVF/LH) trials and priming for the subordinate meaning (e.g., BOOM-BANK-RIVER) on LVF/RH trials. Higher-functioning older adults, especially those with better inhibition, were more likely to show bilateral activation of the dominant meaning and unilateral activation of the subordinate meaning, suggesting a retention of young-like activation. In a biasing context (e.g., RIVER-BANK-DEPOSIT), older adults selected the contextually-consistent meaning, but were less likely than young adults to revise their selection.

What's "right" in language comprehension: ERPs reveal right hemisphere language capabilities.

Although the term "nonverbal" is often applied to the right cerebral hemisphere (RH), a growing body of work indicates that the RH can comprehend language and, indeed, that it makes critical contributions to normal language functions. Reviewed here are studies that have examined RH language capabilities by combining visual half-field presentation methods with event-related potential (ERP) measures. Because they afford temporal and functional specificity and can be obtained as participants simply process language for meaning, ERPs provide especially valuable insights into RH language functions. Such studies suggest that the RH appreciates word and message-level meaning information, and that it may play a particularly important role in the processing of relatively unpredictable semantic relationships. In addition, this work suggests that patterns observed for everyday language processing may often be an emergent property of multiple, distinct mechanisms operating in parallel as the left and right hemispheres jointly comprehend language.