Written language preservation in glioma patients undergoing awake surgery: The value of tailored intra-operative assessment.

Written language is increasingly important, as contemporary society strongly relies on text-based communication. Nonetheless, in neurosurgical practice, language preservation has classically focused on spoken language. The current study aimed to evaluate the potential role of intra-operative assessments in the preservation of written language skills in glioma patients undergoing awake surgery. It is the first feasibility study to use a standardized and detailed Written language battery in glioma patients undergoing awakening surgery. Reading and spelling were assessed pre- and post-operatively in eleven patients. Intra-operatively, 7 cases underwent written language assessment in addition to spoken object naming. Results show that reading and spelling deficits may arise before and after glioma surgery and that written language may be differently affected than spoken language. In our case series, task-specific preservation of function was obtained in all cases when a specific written language skill was monitored intra-operatively. However, the benefits of intra-operative testing did not always generalize, and non-monitored written language tasks may not be preserved. Hence, when a specific written language skill needs to be preserved, to facilitate return to work and maintain quality of life, results indicate that intra-operative assessment of that skill is advised. An illustrative case report demonstrates how profile analyses can be used pre-operatively to identify cognitive components at risk and intra-operatively to preserve written language abilities in clinical practice.

The language profile of progressive supranuclear palsy.

A progressive speech/language disorder, such as the non fluent/agrammatic variant of primary progressive aphasia and progressive apraxia of speech, can be due to neuropathologically verified Progressive Supranuclear Palsy (PSP). The prevalence of linguistic deficits and the linguistic profile in PSP patients who present primarily with a movement disorder is unknown. In the present study, we investigated speech and language performance in a sample of clinically diagnosed PSP patients using a comprehensive language battery, including, besides traditional language tests, a detailed analysis of connected speech (picture description task assessing 26 linguistic features). The aim was to identify the most affected linguistic levels in seventeen PSP with a movement disorder presentation, compared to 21 patients with Parkinson's disease and 27 healthy controls. Machine learning methods were used to detect the most relevant language tests and linguistic features characterizing the language profile of PSP patients. Our results indicate that even non-clinically aphasic PSP patients have subtle language deficits, in particular involving the lexical-semantic and discourse levels. Patients with the Richardson's syndrome showed a lower performance in the word comprehension task with respect to the other PSP phenotypes with predominant frontal presentation, parkinsonism and progressive gait freezing. The present findings support the usefulness of a detailed language assessment in all patients in the PSP spectrum.

Screening for Aphasia in NeuroDegeneration for the Diagnosis of Patients with Primary Progressive Aphasia: Clinical Validity and Psychometric Properties.

BACKGROUND: We evaluated the psychometric proprieties of the Screening for Aphasia in NeuroDegeneration (SAND) battery in Italian primary progressive aphasia (PPA) and movement disorder (MD) patients. METHODS: The sample included 30 consecutive PPA and 45 MD patients who completed the SAND battery together with a clinical interview and a neurological/neuropsychological examination and 130 healthy controls (HC). RESULTS: The SAND battery showed good internal consistency and good convergent and divergent validity. receiver operating characteristic analysis revealed an area under the curve of 0.978 for PPA versus HC and of 0.786 for PPA versus MD. A cutoff ≥3 gave a sensitivity of 0.933% and a specificity of 0.946% for discriminating PPA versus HC, whereas a cutoff ≥5 gave a sensitivity of 0.767% and a specificity of 0.667% for discriminating PPA versus MD. CONCLUSION: These results indicate that the SAND battery is an adequate, reliable, and valid diagnostic tool for PPA.

SAND: a Screening for Aphasia in NeuroDegeneration. Development and normative data.

Language assessment has a critical role in the clinical diagnosis of neurodegenerative diseases, in particular, in the case of Primary Progressive Aphasia (PPA). The current diagnostic criteria (Gorno-Tempini et al., 2011) identify three main variants on the basis of clinical features and patterns of brain atrophy. Widely accepted tools to diagnose, clinically classify, and follow up the heterogeneous language profiles of PPA are still lacking. In this study, we develop a screening battery, composed of nine tests (picture naming, word and sentence comprehension, word and sentence repetition, reading, semantic association, writing and picture description), following the recommendations of current diagnostic guidelines and taking into account recent research on the topic. All tasks were developed with consideration of the psycholinguistic factors that can affect performance, with the aim of achieving sensitivity to the language deficit to which each task was relevant, and to allow identification of the selective characteristic impairments of each PPA variant. Normative data on 134 Italian subjects pooled across homogeneous subgroups for age, sex, and education are reported. Although further work is still needed, this battery represents a first step towards a concise multilingual standard language examination, a fast and simple tool to help clinicians and researchers in the diagnosis of PPA.

Mapping nouns and finite verbs in left hemisphere tumors: a direct electrical stimulation study.

Neurosurgical mapping studies with nouns and finite verbs are scarce and subcortical data are nonexistent. We used a new task that uses finite verbs in six Italian-speaking patients with gliomas in the left language-dominant hemisphere. Language-relevant positive areas were detected only with nouns in four patients, with both tasks yet in distinct cortical areas in one patient, and only with finite verbs in another patient. Positive areas and types of errors varied across participants. Finite verbs provide complementary information to nouns, and permit more accurate mapping of language production when nouns are unaffected by electrical stimulation.

Efficacy of semantic-phonological treatment combined with tDCS for verb retrieval in a patient with aphasia.

Recent studies reported enhanced performance on language tasks induced by transcranial direct current stimulation (tDCS) in patients with aphasia. One chronic patient with non-fluent aphasia received 20 sessions of a verb anomia training combined with off-line bihemispheric tDCS applied to the dorsolateral prefrontal cortex (DLPFC) - anodal tDCS over left DLPFC plus cathodal tDCS over right DLPFC. A significant improvement in verb naming was observed at all testing times (4, 12, 24, and 48 weeks from post-entry/baseline testing) for treated and untreated verbs. Our findings show beneficial effects of verb anomia training in combination with tDCS in chronic aphasic patient, suggesting a long-lasting effect of this treatment.

Anomia training and brain stimulation in chronic aphasia.

Recent studies have reported enhanced performance on language tasks induced by non-invasive brain stimulation, i.e., repetitive transcranial magnetic stimulation (rTMS), or transcranial direct current stimulation (tDCS), in patients with aphasia due to stroke or Alzheimer's disease (AD). The first part of this article reviews brain stimulation studies related to language recovery in aphasic patients. The second part reports results from a pilot study with three chronic stroke patients who had non-fluent aphasia, where real or placebo rTMS was immediately followed by 25 minutes of individualised speech therapy. Real rTMS consisted of high-frequency rTMS over the left dorsolateral prefrontal cortex (BA 8/9) for 25 minutes. Each patient underwent a total of four weeks of intervention. P1 underwent four weeks of real rTMS (5 days/week) where individualised speech therapy was provided for 25 minutes immediately following each rTMS session. P2 and P3 each underwent two weeks of placebo rTMS, followed immediately by individualised speech therapy; then two weeks of real rTMS, followed immediately by individualised speech therapy. Assessments took place at 2, 4, 12, 24 and 48 weeks post-entry/baseline testing. Relative to entry/baseline testing, a significant improvement in object naming was observed at all testing times, from two weeks post-intervention in real rTMS plus speech therapy, or placebo rTMS plus speech therapy. Our findings suggest beneficial effects of targeted behavioural training in combination with brain stimulation in chronic aphasic patients. However, further work is required in order to verify whether optimal combination parameters (rTMS alone or speech therapy alone) and length of rTMS treatment may be found.

Time perception in spatial neglect: a distorted representation?

OBJECTIVE: It has been proposed that time, space, and numbers share the same metrics and cortical network, the right parietal cortex. Several recent investigations have demonstrated that the mental number line representation is distorted in neglect patients. The aim of this study is to investigate the relationship between time and spatial configuration in neglect patients. METHOD: Fourteen right-brain damaged patients (six with neglect and eight without neglect), as well as eight age-matched healthy controls, performed a time discrimination task. A standard tone (short: 700 ms and long: 1,700 ms) had to be confronted in duration to a test tone. Test tone differed of 100, 200, and 300 ms respect to the standard tone duration. RESULTS: Neglect patients performed significantly worse than patients without neglect and healthy controls, irrespective of the duration of the standard tone. CONCLUSION: These results support the hypothesis that mental representations of space and time both share, to some extent, a common cortical network. Besides, spatial neglect seems to distort the time representation, inducing an overestimation of time durations.

The residual calculation abilities of a patient with severe aphasia: evidence for a selective deficit of subtraction procedures.

We report the case study of a severe fluent aphasic patient, who showed relatively preserved numerical abilities. A detailed investigation of number processing indicated good numerical comprehension and a relative sparing of addition and subtraction abilities; on the other hand, multiplication and division were severely impaired. A further study of multi-digit operations showed that the patient's performance was characterized by a selective impairment of the borrowing procedure, in which she applied the so-called Smaller-from-Larger bug, typically observed in children learning to calculate. The present case provides further evidence for the dissociation between operations based on verbal sequences and on quantity manipulation, respectively impaired and preserved in patients with severe aphasia. Moreover, it provides evidence indicating that procedures may be dissociated from conceptual knowledge within a single arithmetical operation.

Frequency and patterns of subclinical cognitive impairment in patients with ANCA-associated small vessel vasculitides.

We investigated the prevalence of disease-related cognitive impairment in patients with anti-neutrophil cytoplasmic antibodies (ANCA)-associated small vessel vasculitides (SVV). We studied 43 patients with ANCA-associated SVV (Wegener's granulomatosis (WG), Churg-Strauss syndrome (CSS) and microscopic polyangiitis (MP)), with no evidence of focal neurological deficits and dementia and in whom other potential causes of cognitive decline were carefully excluded. All patients underwent a detailed neuropsychological evaluation and their performances were compared with those of matched healthy controls. Patients were considered to be affected by subclinical cognitive impairment when they had abnormal results in at least two neuropsychological tests. Magnetic resonance imaging (MRI) scans of the brain were also obtained in 11 patients.The average neuropsychological test scores were not significantly different between the SVV patients and the control subjects. Thirteen patients had abnormal results in two tests (seven patients) or three or more tests (six patients). Most frequently, abnormal tests were the Rey Figure Recall (six cases), the Wisconsin Card Sorting Test (six cases), and the reaction times (eight cases). The frequency and extent of brain MRI abnormalities were higher in impaired than in unimpaired patients. This study demonstrates that 30% of clinically nondemented SVV patients can have a subclinical neuropsychological impairment, characterized by mild abstract reasoning loss, mental speed reduction and nonverbal memory impairment. MRI findings in impaired patients are consistent with the presence of an SVV-mediated subcortical damage of the brain.