The effects of adding attention training to naming treatment for individuals with aphasia.

AIM: Given the ever-increasing evidence for the co-occurrence of attention impairments and language disorders in chronic aphasia, this study aimed to compare the effects of two naming treatment programs, one with and one without attention training components, on the naming performance of participants with aphasia. MATERIALS AND METHODS: This was a single-subject crossover study in which six people with chronic aphasia and different degrees of naming and attention impairments participated. Two treatment programs were implemented for each participant, with the sequence of the treatments with crossover design. Each program consisted of 12 treatment sessions plus pre- and post-treatment assessment sessions (15 weeks for each participant). The visual analysis and WEighted STatistics methods were employed for data analysis. RESULTS: Based on visual analysis, both treatments improved in comparison to the baseline phase. Statistical analysis revealed that the number of participants with significant naming improvement following combined program (5 participants) was larger than the number of participants showing improvement following completion of the single, program. CONCLUSION: Although integrating attention training into a conventional treatment for anomia can increase the effect of treatment on naming ability, more studies are required to clarify the role of attention in remediating naming impairments in aphasia.

Generalization in Aphasia Treatment: A Tutorial for Speech-Language Pathologists.

PURPOSE: Generalization has been defined and instantiated in a variety of ways over the last half-century, and this lack of consistency has created challenges for speech-language pathologists to plan for, implement, and measure generalization in aphasia treatment protocols. This tutorial provides an overview of generalization with a focus on how it relates to aphasia intervention, including a synthesis of existing principles of generalization and examples of how these can be embedded in approaches to aphasia treatment in clinical and research settings. METHOD: Three articles collectively listing 20 principles of generalization formed the foundation for this tutorial. The seminal work of Stokes and Baer (1977) focused attention on generalization in behavioral change following treatment. Two aphasia-specific resources identified principles of generalization in relation to aphasia treatment (Coppens & Patterson, 2018; Thompson, 1989). A selective literature review was conducted to identify evidence-based examples of each of these 20 principles from the extant literature. RESULTS: Five principles of generalization were synthesized from the original list of 20. Each principle was supported by studies drawn from the aphasia treatment literature to exemplify its application. CONCLUSIONS: Generalization is an essential aspect of meaningful aphasia intervention. Successful generalization requires the same dedication to strategic planning and outcome measurement as the direct training aspect of intervention. Although not all people with aphasia are likely to benefit equally from each of the principles reviewed herein, our synthesis provides information to consider for maximizing generalization of aphasia treatment outcomes. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.24714399.

Behavioral Treatment for Speech and Language in Primary Progressive Aphasia and Primary Progressive Apraxia of Speech: A Systematic Review.

Primary progressive aphasia (PPA) and primary progressive apraxia of speech (PPAOS) are neurodegenerative syndromes characterized by progressive decline in language or speech. There is a growing number of studies investigating speech-language interventions for PPA/PPAOS. An updated systematic evaluation of the treatment evidence is warranted to inform best clinical practice and guide future treatment research. We systematically reviewed the evidence for behavioral treatment for speech and language in this population. Reviewed articles were published in peer-reviewed journals through 31 May 2021. We evaluated level of evidence, reporting quality, and risk of bias using a modified version of the American Speech-Language Hearing Association (ASHA) Levels of Evidence, an appraisal point system, additional reporting quality and internal/external validity items, and, as appropriate, the Single Case Experimental Design Scale or the Physiotherapy Evidence Database - PsycBITE Rating Scale for Randomized and Non-Randomized Controlled Trials. Results were synthesized using quantitative summaries and narrative review. A total of 103 studies reported treatment outcomes for 626 individuals with PPA; no studies used the diagnostic label PPAOS. Most studies evaluated interventions for word retrieval. The highest-quality evidence was provided by 45 experimental and quasi-experimental studies (16 controlled group studies, 29 single-subject designs). All (k = 45/45) reported improvement on a primary outcome measure; most reported generalization (k = 34/43), maintenance (k = 34/39), or social validity (k = 17/19) of treatment for at least one participant. The available evidence supports speech-language intervention for persons with PPA; however, treatment for PPAOS awaits systematic investigation. Implications and limitations of the evidence and the review are discussed.

A Survey of Canadian Physiotherapists' and Physiotherapy Students' Knowledge and Use of Executive Functioning Assessments in Clinical Practice.

Purpose: This study examined what physiotherapists and physiotherapy students understand and know about executive functioning (EF), what EF outcome measures they use clinically, and whether their primary area of practice influences their assessment practices. Method: An open online survey was distributed to registered members of the Canadian Physiotherapy Association, its various divisions, and colleges of physiotherapy within Canada that took approximately 15 minutes to complete and was available for 13 months. Pearson correlation was used to assess the relationship between subjective and objective understanding and knowledge of EF (UKEF) and a one-way multivariate analysis of variance was used to analyze differences in survey responses based on respondents' primary area of practice. Results: A total of 335 respondents consented to participate (completion rate = 78.4%). There was a significant moderate positive correlation between subjective and objective UKEF (r = 0.43; 95% CI: 0.32, 0.54; n = 260; p < 0.001). Significant differences in survey responses were related to physiotherapists' primary areas of practice (i.e., musculoskeletal, neurological, cardiorespiratory, or multi-systems; F12,555.89 = 2.29, p = 0.008; Wilks Λ = 0.880; partial η2 = 0.042). Conclusions: Respondents reported that they had good subjective UKEF, but this was only moderately correlated with objective UKEF.

Objectif : examiner ce que les physiothérapeutes et les étudiants en physiothérapie comprennent et savent sur le fonctionnement exécutif (FE), les mesures de résultats du FE qu'ils utilisent en clinique et si leur secteur primaire de pratique influe sur leurs pratiques d'évaluation. Méthodologie : les membres de l'Association canadienne de physiothérapie, ses diverses divisions et les ordres de physiothérapie du Canada ont reçu un sondage en ligne ouvert qui exigeait une quinzaine de minutes de leur temps et qui était disponible sur une période de 13 mois. Les chercheurs ont utilisé la corrélation de Pearson pour évaluer la relation entre la compréhension et les connaissances subjectives et objectives du FE (CCEF) et une analyse de variance multivariée unidirectionnelle pour analyser les différences entre les réponses au sondage d'après les secteurs primaires de pratique des répondants. Résultats : Au total, 335 répondants ont consenti à participer (taux d'achèvement = 78,4 %). Ils ont constaté une corrélation positive modérée significative entre les CCEF subjectives et objectives (r = 0,43; IC à 95 % : 0,32, 0,54; n = 260; p < 0,001). Des différences significatives dans les réponses au sondage étaient liées aux secteurs primaires de pratique des physiothérapeutes (musculosquelettique, neurologique, cardiorespiratoire ou multisystémique; F12,555,89 = 2,29; p = 0,008; Λ de Wilks = 0,880; η2 partiel = 0,042). Conclusions : les répondants ont déclaré qu'ils avaient de bonnes CCEF, mais leur réponse était seulement corrélée modérément avec les CCEF objectives.

Language-Specific Dual-Task Effects After Stroke: A Systematic Review.

PURPOSE: The dual-task paradigm has been frequently used to examine stroke-related deficits because it samples behavioral performance under conditions of distraction similar to functioning in real-life environments. This original systematic review synthesizes studies that examined dual-task effects involving spoken language production in adults affected by stroke, including transient ischemic attack (TIA) and poststroke aphasia. METHOD: Five databases were searched (inception to March 2022) for eligible peer-reviewed articles. The 21 included studies reported a total of 561 stroke participants. Thirteen studies focused on single word production, for example, word fluency, and eight on discourse production, for example, storytelling. Most studies included participants who had suffered a major stroke. Six studies focused on aphasia, whereas no study focused on TIA. A meta-analysis was not appropriate because of the heterogeneity of outcome measures. RESULTS: Some single word production studies found dual-task language effects whereas others did not. This finding was compounded by the lack of appropriate control participants. Most single word and discourse studies utilized motoric tasks in the dual-task condition. Our certainty (or confidence) assessment was based on a methodological appraisal of each study and information about reliability/fidelity. As 10 of the 21 studies included appropriate control groups and limited reliability/fidelity information, the certainty of the findings may be described as weak. CONCLUSIONS: Language-specific dual-task costs were identified in single word studies, especially those that focused on aphasia as well as half of the nonaphasia studies. Unlike single word studies, nearly all studies of discourse showed dual-task decrements on at least some variables. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.23605311.

Telehealth Assessments and Interventions for Individuals With Poststroke Aphasia: A Scoping Review.

PURPOSE: There are increasing demands for aphasia assessment and intervention services to be delivered remotely. The purpose of this scoping review was to address what is known about the delivery of assessments and interventions using telehealth for people with poststroke aphasia. Specifically, the review sought to (a) identify which telehealth assessment protocols have been used, (b) identify which telehealth intervention protocols have been used, and (c) describe evidence on the effectiveness and feasibility of telehealth for people with poststroke aphasia. METHOD: A scoping review of the literature published in English since 2013 was conducted by searching MEDLINE, Embase, PsycINFO, CINAHL, and Scopus databases to identify relevant studies. A total of 869 articles were identified. Two reviewers screened records independently, finding 25 articles eligible for inclusion. Data extraction was conducted once and validated by the second reviewer. RESULTS: Two of the included studies examined telehealth assessment protocols, whereas the remaining studies focused on the delivery of telehealth interventions. The results of the included studies illustrated both effectiveness and feasibility regarding telehealth for people with poststroke aphasia. However, a lack of procedural variation among the studies was found. CONCLUSIONS: Overall, this scoping review yielded continued support for the use of telehealth practices as an alternate mode of delivering both assessment and intervention services to people with poststroke aphasia. However, further research is needed to investigate the range of aphasia assessment and intervention protocols that can be offered via telehealth, such as assessments or interventions that use patient-reported measures or address extralinguistic cognitive abilities.

Measuring communication as a core outcome in aphasia trials: Results of the ROMA-2 international core outcome set development meeting.

BACKGROUND: Evidence-based recommendations for a core outcome set (COS; minimum set of outcomes) for aphasia treatment research have been developed (the Research Outcome Measurement in Aphasia-ROMA, COS). Five recommended core outcome constructs: communication, language, quality of life, emotional well-being and patient-reported satisfaction/impact of treatment, were identified through three international consensus studies. Constructs were paired with outcome measurement instruments (OMIs) during an international consensus meeting (ROMA-1). Before the current study (ROMA-2), agreement had not been reached on OMIs for the constructs of communication or patient-reported satisfaction/impact of treatment. AIM: To establish consensus on a communication OMI for inclusion in the ROMA COS. METHODS & PROCEDURES: Research methods were based on recommendations from the Core Outcome Measures in Effectiveness Trials (COMET) Initiative. Participants with expertise in design and conduct of aphasia trials, measurement instrument development/testing and/or communication outcome measurement were recruited through an open call. Before the consensus meeting, participants agreed on a definition of communication, identified appropriate OMIs, extracted their measurement properties and established criteria for their quality assessment. During the consensus meeting they short-listed OMIs and participants without conflicts of interest voted on the two most highly ranked instruments. Consensus was defined a priori as agreement by ≥ 70% of participants. OUTCOMES & RESULTS: In total, 40 researchers from nine countries participated in ROMA-2 (including four facilitators and three-panel members who participated in pre-meeting activities only). A total of 20 OMIs were identified and evaluated. Eight short-listed communication measures were further evaluated for their measurement properties and ranked. Participants in the consensus meeting (n = 33) who did not have conflicts of interest (n = 29) voted on the top two ranked OMIs: The Scenario Test (TST) and the Communication Activities of Daily Living-3 (CADL-3). TST received 72% (n = 21) of 'yes' votes and the CADL-3 received 28% (n = 8) of 'yes' votes. CONCLUSIONS & IMPLICATIONS: Consensus was achieved that TST was the preferred communication OMI for inclusion in the ROMA COS. It is currently available in the original Dutch version and has been adapted into English, German and Greek. Further consideration must be given to the best way to measure communication in people with mild aphasia. Development of a patient-reported measure for satisfaction with/impact of treatment and multilingual versions of all OMIs of the COS is still required. Implementation of the ROMA COS would improve research outcome measurement and the quality, relevance, transparency, replicability and efficiency of aphasia treatment research. WHAT THIS PAPER ADDS: What is already known on this subject International consensus has been reached on five core constructs to be routinely measured in aphasia treatment studies. International consensus has also been established for OMIs for the three constructs of language, quality of life and emotional well-being. Before this study, OMIs for the constructs of communication and patient-reported satisfaction/impact of treatment were not established. What this paper adds to existing knowledge We gained international consensus on an OMI for the construct of communication. TST is recommended for inclusion in the ROMA COS for routine use in aphasia treatment research. What are the potential or actual clinical implications of this work? The ROMA COS recommends OMIs for a minimum set of outcomes for adults with post-stroke aphasia within phases I-IV aphasia treatment research. Although not intended for clinical use, clinicians may employ the instruments of the ROMA COS, considering the quality of their measurement properties. The systematic inclusion of a measure of communication, such as TST, in clinical practice could ultimately support the implementation of research evidence and best practices.

The Company Prosodic Deficits Keep Following Right Hemisphere Stroke: A Systematic Review.

OBJECTIVES: The aim of this systematic review was to identify the presence and nature of relationships between specific forms of aprosodia (i.e., expressive and receptive emotional and linguistic prosodic deficits) and other cognitive-communication deficits and disorders in individuals with right hemisphere damage (RHD) due to stroke. METHODS: One hundred and ninety articles from 1970 to February 2020 investigating receptive and expressive prosody in patients with relatively focal right hemisphere brain damage were identified via database searches. RESULTS: Fourteen articles were identified that met inclusion criteria, passed quality reviews, and included sufficient information about prosody and potential co-occurring deficits. Twelve articles investigated receptive emotional aprosodia, and two articles investigated receptive linguistic aprosodia. Across the included studies, receptive emotional prosody was not systematically associated with hemispatial neglect, but did co-occur with deficits in emotional facial recognition, interpersonal interactions, or emotional semantics. Receptive linguistic processing was reported to co-occur with amusia and hemispatial neglect. No studies were found that investigated the co-occurrence of expressive emotional or linguistic prosodic deficits with other cognitive-communication impairments. CONCLUSIONS: This systematic review revealed significant gaps in the research literature regarding the co-occurrence of common right hemisphere disorders with prosodic deficits. More rigorous empirical inquiry is required to identify specific patient profiles based on clusters of deficits associated with right hemisphere stroke. Future research may determine whether the co-occurrences identified are due to shared cognitive-linguistic processes, and may inform the development of evidence-based assessment and treatment recommendations for individuals with cognitive-communication deficits subsequent to RHD.

Aprosodia Subsequent to Right Hemisphere Brain Damage: A Systematic Review and Meta-Analysis.

OBJECTIVE: To identify which aspects of prosody are negatively affected subsequent to right hemisphere brain damage (RHD) and to evaluate the methodological quality of the constituent studies. METHOD: Twenty-one electronic databases were searched to identify articles from 1970 to February 2020 by entering keywords. Eligibility criteria for articles included a focus on adults with acquired RHD, prosody as the primary research topic, and publication in a peer-reviewed journal. A quality appraisal was conducted using a rubric adapted from Downs and Black (1998). RESULTS: Of the 113 articles appraised as eligible and appropriate for inclusion, 71 articles were selected to undergo data extraction for both meta-analyses of population effect size estimates and qualitative synthesis. Across all domains of prosody, the effect estimate was g = 2.51 [95% CI (1.94, 3.09), t = 8.66, p < 0.0001], based on 129 contrasts between RHD and non-brain-damaged healthy controls (NBD), indicating a significant random effects model. This effect size was driven by findings in emotional prosody, g = 2.48 [95% CI (1.76, 3.20), t = 6.88, p < 0.0001]. Overall, studies of higher quality (rpb = 0.18, p < 0.001) and higher sample size/contrast ratio (rpb = 0.25, p < 0.001) were more likely to report significant differences between RHD and NBD participants. CONCLUSIONS: The results confirm consistent evidence for emotional prosody deficits in the RHD population. Inconsistent evidence was observed across linguistic prosody domains and pervasive methodological issues were identified across studies, regardless of their prosody focus. These findings highlight the need for more rigorous and sufficiently high-powered designs to examine prosody subsequent to RHD, particularly within the linguistic prosody domain.

Demystifying the Complexity of Aphasia Treatment: Application of the Rehabilitation Treatment Specification Systemx.

A considerable body of research supports the use of behavioral communication treatment as the standard of care for aphasia. In spite of robust progress in clinical aphasiology, many questions regarding optimal care remain unanswered. One of the major challenges to progress in the field is the lack of a common framework to adequately describe individual treatments, which, if available, would allow comparisons across studies as well as improved communication among researchers, clinicians, and other stakeholders. Here, we describe how aphasia treatment approaches can be systematically characterized using the Rehabilitation Treatment Specification System (RTSS). At the core of the RTSS is a tripartite structure that focuses on targets (the behavior that is expected to change as a result of treatment), ingredients (what a clinician does to affect change in the target), and mechanism(s) of action (why a given treatment works by linking the ingredients to the target). Three separate articles in the current issue specifically describe how the RTSS can be used to describe different kinds of aphasia treatment approaches: functional approaches, cognitive-linguistic approaches, and biological approaches. It is our hope that the application of the RTSS in clinical aphasiology will improve communication in published studies, grant proposals, and in the clinical care of persons with aphasia.

Spoken Discourse Assessment and Analysis in Aphasia: An International Survey of Current Practices.

Purpose Spoken discourse analysis is commonly employed in the assessment and treatment of people living with aphasia, yet there is no standardization in assessment, analysis, or reporting procedures, thereby precluding comparison/meta-analyses of data and hindering replication of findings. An important first step is to identify current practices in collecting and analyzing spoken discourse in aphasia. Thus, this study surveyed current practices, with the goal of working toward standardizing spoken discourse assessment first in research settings with subsequent implementation into clinical settings. Method A mixed-methods (quantitative and qualitative) survey was publicized to researchers and clinicians around the globe who have collected and/or analyzed spoken discourse data in aphasia. The survey data were collected between September and November 2019. Results Of the 201 individuals who consented to participate, 189 completed all mandatory questions in the survey (with fewer completing nonmandatory response questions). The majority of respondents reported barriers to utilizing discourse including transcription, coding, and analysis. The most common barrier was time (e.g., lack of time). Respondents also indicated that there was a lack of, and a need for, psychometric properties and normative data for spoken discourse use in the assessment and treatment of persons with aphasia. Quantitative and qualitative results are described in detail. Conclusions The current survey study evaluated spoken discourse methods in aphasia across research and clinical settings. Findings from this study will be used to guide development of process standardization in spoken discourse and for the creation of a psychometric and normative property database. Supplemental Material https://doi.org/10.23641/asha.166395100.

Effects of concurrent action and object naming treatment on naming skills and functional brain activation patterns in primary progressive aphasia: An fMRI study with a case-series design.

Individuals with primary progressive aphasia (PPA) exhibit differential impairment patterns in noun and verb naming, but it remains unclear whether anomia treatment results in similar improvements in noun and verb naming. Therefore, we examined the immediate and long-term (3-months post-treatment) behavioral and neural effects of an anomia treatment on object and action naming skills in PPA. A case-series design was utilized involving two individuals with PPA. Object and action words were trained concurrently and probed regularly using word lists matched on a number of lexical characteristics. One participant showed improvements in all word categories with different effect sizes whereas the other participant demonstrated improved naming only on trained object words. Treatment-induced fMRI changes were found in both hemispheres, with distinct patterns observed across participants. Further research is needed to better understand the effects of residual language and cognitive skills on behavioral and neurophysiological outcomes following anomia treatment for PPA.

Cognitive and Linguistic Benefits of Aerobic Exercise: A State-of-the-Art Systematic Review of the Stroke Literature.

This systematic review aimed to determine how aerobic exercise affects cognition after stroke, with particular focus on aphasia and language improvement. Methodological quality was assessed with the PEDro+ scale with half of the 27 included studies rated as high quality. Data extraction focused on cognitive effects of aerobic exercise post-stroke, intervention characteristics, outcome measures, and participant characteristics. Whereas attention, memory, and executive functioning measures were common across the included studies, no study included a language-specific, performance-based measure. Seventeen studies reported positive cognitive effects, most frequently in the domains of attention, memory and executive functioning. Variability in outcome measures, intervention characteristics, and participant characteristics made it difficult to identify similarities among studies reporting positive cognitive effects of exercise or among those studies reporting null outcomes. Only three studies provided specific information about the number of individuals with aphasia included or excluded, who comprise approximately one-third of the stroke population. The review identified patent gaps in our understanding of how aerobic exercise may affect not only the cognitive domain of language post-stroke but also the broader cognitive functioning of individuals with post-stroke aphasia. Methodological limitations of the reviewed studies also warrant further examination of the direct impact of aerobic exercise on cognition post-stroke with careful attention to the selection and reporting of population, intervention, and outcomes.

Standardizing Assessment of Spoken Discourse in Aphasia: A Working Group With Deliverables.

Purpose The heterogeneous nature of measures, methods, and analyses reported in the aphasia spoken discourse literature precludes comparison of outcomes across studies (e.g., meta-analyses) and inhibits replication. Furthermore, funding and time constraints significantly hinder collecting test-retest data on spoken discourse outcomes. This research note describes the development and structure of a working group, designed to address major gaps in the spoken discourse aphasia literature, including a lack of standardization in methodology, analysis, and reporting, as well as nominal data regarding the psychometric properties of spoken discourse outcomes. Method The initial initiatives for this working group are to (a) propose recommendations regarding standardization of spoken discourse collection, analysis, and reporting in aphasia, based on the results of an international survey and a systematic literature review and (b) create a database of test-retest spoken discourse data from individuals with and without aphasia. The survey of spoken discourse collection, analysis, and interpretation procedures was distributed to clinicians and researchers involved in aphasia assessment and rehabilitation from September to November 2019. We will publish survey results and recommend standards for collecting, analyzing, and reporting spoken discourse in aphasia. A multisite endeavor to collect test-retest spoken discourse data from individuals with and without aphasia will be initiated. This test-retest information will be contributed to a central site for transcription and analysis, and data will be subsequently openly curated. Conclusion The goal of the working group is to create recommendations for field-wide standards in methods, analysis, and reporting of spoken discourse outcomes, as has been done across other related disciplines (e.g., Consolidated Standards of Reporting Trials, Enhancing the Quality and Transparency of Health Research, Committee on Best Practice in Data Analysis and Sharing). Additionally, the creation of a database through our multisite collaboration will allow the identification of psychometrically sound outcome measures and norms that can be used by clinicians and researchers to assess spoken discourse abilities in aphasia.

Quantitative and Qualitative Analysis of Verb Fluency Performance in Individuals With Probable Alzheimer's Disease and Healthy Older Adults.

Purpose To date, verb fluency tasks have been mainly analyzed quantitatively for individuals with dementia. Qualitative analysis, however, such as examining the semantic and psycholinguistic content of the responses might further inform researchers and clinicians about patients' cognitive and linguistic status. Therefore, the current study examined psycholinguistic and lexical characteristics of verb fluency responses in individuals with probable Alzheimer's disease (pAD) and healthy older adults to delineate qualitative and quantitative differences between the two groups. Method The verb fluency responses from participants with pAD (amnestic type) were compared to those from age- and education-matched healthy older adults. The responses were analyzed with respect to the number and proportion of correct responses, word frequency, age of acquisition, phoneme and syllable length, and neighborhood density. The verb responses were also categorized into mental state verbs and action verbs. Additionally, a battery of cognitive-linguistic tests was administered, and for each group, relationships between correct verb fluency responses and other cognitive-linguistic skills were investigated using correlation and regression analyses. Results Similar to previous findings regarding noun retrieval in dementia, the results revealed that individuals with pAD not only produced fewer correct verb fluency responses but also generated little to no mental state verbs compared to the control group. The group with pAD also produced verbs with shorter phoneme and syllable lengths, higher word frequency, and earlier age of acquisition ratings relative to the healthy older adults. The number of correct verb fluency responses was mainly predicted by a reading comprehension score in the pAD group and a nonverbal fluency test score in the healthy group. Conclusion The current quantitative and qualitative findings add support to the contention that lexical-semantic impairments underlie word retrieval problems in pAD and such difficulties present in generative naming paradigms and also across grammatical categories.

Cognitive-Linguistic Functions in Adults With Epilepsy: Preliminary Electrophysiological and Behavioral Findings.

Purpose Cognition and language difficulties are frequently reported in both children and adults with epilepsy. The majority of the existing research has focused on pediatric epilepsy, documenting impairments in learning, academics, and social-emotional functioning. In comparison, language deficits in younger and older adults with epilepsy have received less empirical attention. Given recently identified limitations in the extant literature regarding assessing epilepsy-related language problems in adults (Dutta et al., 2018), the current exploratory study described in this research note investigated the cognitive-linguistic abilities of adults with focal or generalized types of epilepsy. Method Twelve participants with epilepsy and 11 age- and education-matched healthy controls completed a cognitive-linguistic test battery. Event-related potential (ERP) procedures were also employed to assess the integrity of neural activity supporting psycholinguistic processing in both groups using a lexical decision task. Results No significant performance differences between epilepsy and healthy control groups were noted on basic language tasks; however, group differences were evident on the more complex language measures, including spoken discourse. Even though both groups performed the lexical decision task similarly in terms of accuracy, individuals with epilepsy demonstrated longer reaction times and some atypical ERP characteristics compared to controls. Conclusion The cognitive-linguistic assessment and ERP findings suggested that, compared to neurotypical adults, individuals with epilepsy demonstrate slower processing times and greater difficulty with high-level language and spoken discourse production, despite performing within typical limits on basic language tests. Preliminary results from this research are significant in providing new knowledge about language functioning in adults with epilepsy.

Neural Correlates of Verb Fluency Performance in Cognitively Healthy Older Adults and Individuals With Dementia: A Pilot fMRI Study.

Currently there are ~6 million Americans who are affected by dementia. Verbal fluency tasks have been commonly and frequently utilized to document the disease progression in many forms of dementia. Verb fluency has been found to display substantial potential to detect and monitor the cognitive declines of individuals with dementia who have fronto-striatal involvement. The neural substrates underlying verb fluency task performance, however, have remained unclear so far, especially in individuals with dementia. Therefore, in the current study, brain activation patterns of seven individuals with dementia and nine healthy older adults were investigated using functional MRI. The participants performed in the scanner an overt, subject-paced verb fluency task, representative of fluency tasks used in clinical settings. The brain activation patterns during the verb fluency task were compared between the two groups, and a correlational analysis was conducted to determine the neural correlates of verb fluency performance. The results suggest that compared to healthy older adults, individuals with dementia demonstrated poorer verb fluency performance and showed higher activation in specific neural regions, such as the bilateral frontal lobe. In addition, the correlational analysis revealed that poorer verb fluency performance lead to increased activation in certain cortical and subcortical areas, including left hippocampus and right supramarginal gyrus. The current findings are consistent with previous neurophysiological findings related to semantic (noun) fluency performance in older adults and individuals with dementia and add to the empirical evidence that supports the role of the frontal lobe and hippocampus in verb retrieval and search. Declines in verb fluency performance cannot only be used as a cognitive marker, but also represent neuropathological changes due to the neurodegenerative disease.

Test-retest reliability in an fMRI study of naming in dementia.

fMRI has been used as an outcome measure in dementia treatment studies, with many previous studies comparing only single pre- and post-treatment fMRI scans to determine treatment-induced neural changes, while utilizing single subject experimental designs. The purpose of the current study was to evaluate fMRI test-retest reliability in dementia patients and typical older adults using noun and verb confrontation naming to evaluate the validity of using a single pre/post-treatment scan comparison. Seven individuals with dementia and 9 control participants were tested three times over two months using the same fMRI procedures. Differences in individual and group level activation patterns were observed that varied across time. Additionally, the extent of variability fluctuated across individuals, groups, and the grammatical category of target words. Our findings suggested that one time fMRI scanning may inadequately represent an individual's typical brain activation pattern, particularly an individual with dementia. Thus, multiple imaging baselines are recommended.

Sentence Processing in Aphasia: An Examination of Material-Specific and General Cognitive Factors.

The purpose of this study was to characterize further the nature of sentence processing deficits in acquired aphasia. Adults with aphasia and age-and education-matched adults with no brain damage completed a battery of formal cognitive-linguistic tests and an experimental sentence judgment task, which was performed alone and during focused attention and divided attention or dual-task conditions. The specific aims were to determine whether (a) increased extra-linguistic cognitive demands (i.e., focused and divided conditions) differentially affected the sentence judgement performances of the aphasic and control groups, (b) increased extra- linguistic cognitive demands interact with stimulus parameters (i.e., syntactic complexity, number of propositions) known to influence sentence processing, and (c) syntactic- or material specific resource limitations (e.g., sentence judgment in isolation), general cognitive abilities (e.g., short-term and working memory test scores), or both share a significant relationship with dual-task outcomes. Accuracy, grammatical sensitivity, and reaction time findings were consistent with resource models of aphasia and processing accounts of aphasic syntactic limitations, underscoring the theoretical and clinical importance of acknowledging and specifying the strength and nature of interactions between linguistic and extra-linguistic cognitive processes in not only individuals with aphasia, but also other patient and typical aging populations.