Emotional Sentence Processing in Parkinson's Disease.

PURPOSE: Emotional processing allows us to predict our own and others' behavior, communicate our wants and needs, and understand those of others. Thus, deficits in emotional processing can negatively impact one's quality of life. While changes in emotional processing across several domains (e.g., prosody, faces) in Parkinson's disease (PD) are widely accepted, there is a dearth of literature, with equivocal results, regarding how emotional language processing is affected by PD. This study investigated emotional sentence processing in this population. METHOD: Eighteen persons with PD and 22 healthy adults (HAs) completed a language task in which they rated sentences on their pleasantness (valence), and a battery of cognitive tasks and mood measures that were examined as factors influencing performance. As an interaction between emotionality and concreteness during processing has been indicated in prior research, concreteness of sentence stimuli was also manipulated. RESULTS: Individuals with PD rated negatively valenced sentences as less negative and positively-valenced sentences as less positive than HAs. The PD group also demonstrated a reduced overall range of valence rating scores. Sentence concreteness did not influence ratings. Results for positive sentences could be explained by individual differences in working memory (WM), whereas individual differences in WM, depression, and group explained differences in ratings to negative sentences. CONCLUSIONS: Our study provides one of few accounts of emotional language processing deficits in PD, particularly beyond the word level. Individuals with PD may experience difficulty perceiving and assessing the intensity of the emotional content of language, and deficits may disproportionately impact processing of sentences about negative situations. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21313713.

Global Coherence and Cognition in Parkinson's Disease.

PURPOSE: This study compared global coherence (GC) in individuals with Parkinson's disease (PD) to a healthy older adult (HOA) group during single (sitting) and dual (stationary cycling) tasks. Additionally, it explored the relationship between GC and cognition in PD. METHOD: Thirty-seven individuals with PD and 19 HOAs participated in the prospective, cross-sectional study. Participants completed discourse monologues elicited using published prompts while seated and while pedaling a stationary bicycle. Four rating levels of GC were analyzed (GC1 = no relationship to the topic, GC2 = remote relationship, GC3 = conditional relationship, and GC4 = complete relationship) using a published protocol with good interrater reliability and test-retest stability. Participants completed a battery of cognitive tasks, from which four latent factors were extracted: processing speed, working memory, inhibition, and updating. RESULTS: Linear mixed modeling identified significant effects of GC level and GC level interactions with group, processing speed, and inhibition. The Group × GC Level interaction reflected that the PD group had a higher proportion of GC2 and GC1 utterances and fewer GC4 utterances than the HOA group. No differences between single and dual task conditions were found. Faster speed of processing predicted more GC4 utterances, whereas slower speed of processing predicted more G1 utterances. Better inhibition predicted fewer GC2 utterances. Group also predicted GC4 and GC2 proportions. CONCLUSIONS: Individuals with PD experienced greater difficulties with GC than HOAs. Processing speed and inhibition contributed significantly to GC across groups. Analysis of GC should be considered an informative addition to assessment of communicative effectiveness in PD. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.20416056.

Evaluating informative content and global coherence in fluent and non-fluent aphasia.

BACKGROUND: Discourse analysis is an important component of aphasia assessment because it can provide an insight into functional communication abilities. However, there are many unknowns regarding the levels of discourse breakdowns that occur across aphasia types. The purpose of the current study is to explore the possible differences in discourse-level communication in persons with fluent and non-fluent aphasia during picture description. AIMS: To examine if persons with fluent and non-fluent aphasia differ on utterance-level discourse measures when evaluating informative content and global coherence. Additionally, to evaluate and compare the types of global coherence violations made by each group. METHODS & PROCEDURES: Data from 31 people with aphasia was collected from AphasiaBank, which included 13 people with fluent aphasia and 18 people with non-fluent aphasia. Discourse samples from three picture descriptions were analysed. Discourse outcomes included utterances with new information (UNIs-relevant utterances containing new information) and global coherence (the extent to which each utterance maintained the overall discourse theme). Additionally, seven types of errors were identified to explore the nature of breakdowns in global coherence. OUTCOMES & RESULTS: People with fluent aphasia produced significantly higher proportions of UNIs and had significantly higher average global coherence ratings than those with non-fluent aphasia. Differences in global coherence violations were identified with people with fluent aphasia producing more non-specific, incorrect and off-topic utterances and people with non-fluent aphasia producing more incomplete utterances. One of the most common global coherence error types in both groups was commentary. CONCLUSIONS & IMPLICATIONS: Although people with fluent aphasia produced more types of global coherence errors, including incorrect, non-specific and off-topic utterances, the group was still rated significantly higher on utterance relevance and topic maintenance, indicating that the ability to produce a complete utterance plays an important role in some aspects of discourse production. Additionally, these findings provide an insight into potential targets for intervention.

Effects of a Cycling Dual Task on Emotional Word Choice in Parkinson's Disease.

Purpose Individuals with Parkinson's disease (PD) demonstrate language- and emotion-related impairments; however, emotional language production has received little attention within the literature despite the fact that deficits could significantly impact one's daily interactions with loved ones and others. Multitasking (i.e., dual tasking), specifically while completing language tasks, is a common everyday occurrence and typically impacts performance on 1 or both tasks. This study compared emotional word use during discourse production in individuals with PD and healthy older adults (HOAs) under single- and dual-task conditions. Method Participants completed a discourse task while sitting in a quiet room and while stationary cycling. Discourse output was analyzed along several emotional and intellectual language dimensions obtained from the Linguistic Inquiry and Word Count program (Pennebaker, Booth, & Francis, 2007 ). Results Groups did not differ on any outcome measure in the single-task condition. However, HOAs produced a higher percentage of words associated with affective processes and positive emotion while completing the dual-task condition, whereas the PD group exhibited a decrease in production of these words. Compared to the single-task condition, during cycling, individuals with PD also produced a lower percentage of inhibition-related words. Conclusions These results suggest that cycling, like other types of exercise, improves mood as manifested in discourse word choice in HOAs; however, it may lead to reduced use of emotional words in individuals with PD. Expressing emotion may also be more difficult in those with PD than in HOAs and, therefore, easily disrupted in distracting circumstances.

Improved cognition while cycling in Parkinson's disease patients and healthy adults.

Persons with Parkinson's disease (PD) are typically more susceptible than healthy adults to impaired performance when two tasks (dual task interference) are performed simultaneously. This limitation has by many experts been attributed to limitations in cognitive resources. Nearly all studies of dual task performance in PD employ walking or balance-based motor tasks, which are commonly impaired in PD. These tasks can be performed using a combination of one or two executive function tasks. The current study examined whether persons with PD would demonstrate greater dual task effects (DTEs) on cognition compared to healthy older adults (HOAs) during a concurrent cycling task. Participants with and without PD completed a battery of 12 cognitive tasks assessing visual and verbal processing in the following cognitive domains: speed of processing, controlled processing, working memory and executive function. Persons with PD exhibited impairments compared to healthy participants in select tasks (i.e., 0-back, 2-back and operation span). Further, both groups unexpectedly exhibited dual task facilitation of response times in visual tasks across cognitive domains, and improved verbal recall during an executive function task. Only one measure, 2-back, showed a speed-accuracy trade-off in the dual task. These results demonstrate that, when paired with a motor task in which they are not impaired, people with PD exhibit similar DTEs on cognitive tasks as HOAs, even when these task effects are facilitative. More generally, these findings demonstrate that pairing cognitive tasks with cycling may actually improve cognitive performance which may have therapeutic relevance to cognitive decline associated with aging and PD pathology.

Aerobic Exercise Improves Mood, Cognition, and Language Function in Parkinson's Disease: Results of a Controlled Study.

OBJECTIVES: Parkinson's disease (PD) results in a range of non-motor deficits that can affect mood, cognition, and language, and many of these issues are unresponsive to pharmacological intervention. Aerobic exercise can improve mood and cognition in healthy older adults, although only a few studies have examined exercise effects on these domains in PD. The current study assesses the effects of aerobic exercise on aspects of cognition, mood, and language production in people with PD. METHODS: This study compares the effects of aerobic exercise to stretch-balance training and a no-contact control group in participants with idiopathic PD. The aerobic and stretch-balance groups trained three times a week for 16 weeks, while controls continued normal activities. Outcome measures included disease severity, mood, cognition (speed of processing, memory, and executive function), and language production (picture descriptions). Cognition and language were assessed in single and dual task conditions. RESULTS: Depressive symptoms increased only in the control group (p<.02). Executive function improved in the aerobic exercise group only in the single task (p=.007) and declined in controls in the dual task. Completeness of picture descriptions improved significantly more in the aerobic group than in the stretch-balance group (p<.02). CONCLUSIONS: Aerobic exercise is a viable intervention for PD that can be protective against increased depressive symptoms, and can improve several non-motor domains, including executive dysfunction and related aspects of language production. (JINS, 2016, 22, 878-889).

Unexpected dual task benefits on cycling in Parkinson disease and healthy adults: a neuro-behavioral model.

BACKGROUND: When performing two tasks at once, a dual task, performance on one or both tasks typically suffers. People with Parkinson's disease (PD) usually experience larger dual task decrements on motor tasks than healthy older adults (HOA). Our objective was to investigate the decrements in cycling caused by performing cognitive tasks with a range of difficulty in people with PD and HOAs. METHODS: Twenty-eight participants with Parkinson's disease and 20 healthy older adults completed a baseline cycling task with no secondary tasks and then completed dual task cycling while performing 12 tasks from six cognitive domains representing a wide range of difficulty. RESULTS: Cycling was faster during dual task conditions than at baseline, and was significantly faster for six tasks (all p<.02) across both groups. Cycling speed improved the most during the easiest cognitive tasks, and cognitive performance was largely unaffected. Cycling improvement was predicted by task difficulty (p<.001). People with Parkinson's disease cycled slower (p<.03) and showed reduced dual task benefits (p<.01) than healthy older adults. CONCLUSIONS: Unexpectedly, participants' motor performance improved during cognitive dual tasks, which cannot be explained in current models of dual task performance. To account for these findings, we propose a model integrating dual task and acute exercise approaches which posits that cognitive arousal during dual tasks increases resources to facilitate motor and cognitive performance, which is subsequently modulated by motor and cognitive task difficulty. This model can explain both the improvement observed on dual tasks in the current study and more typical dual task findings in other studies.

Associations between cognitive and gait performance during single- and dual-task walking in people with Parkinson disease.

BACKGROUND: Cognitive impairments in Parkinson disease (PD) manifest as deficits in speed of processing, working memory, and executive function and attention abilities. The gait impairment in PD is well documented to include reduced speed, shortened step lengths, and increased step-to-step variability. However, there is a paucity of research examining the relationship between overground walking and cognitive performance in people with PD. OBJECTIVE: This study sought to examine the relationship between both the mean and variability of gait spatiotemporal parameters and cognitive performance across a broad range of cognitive domains. DESIGN: A cross-sectional design was used. METHODS: Thirty-five participants with no dementia and diagnosed with idiopathic PD completed a battery of 12 cognitive tests that yielded 3 orthogonal factors: processing speed, working memory, and executive function and attention. Participants completed 10 trials of overground walking (single-task walking) and 5 trials of overground walking while counting backward by 3's (dual-task walking). RESULTS: All gait measures were impaired by the dual task. Cognitive processing speed correlated with stride length and walking speed. Executive function correlated with step width variability. There were no significant associations with working memory. Regression models relating speed of processing to gait spatiotemporal variables revealed that including dual-task costs in the model significantly improved the fit of the model. LIMITATIONS: Participants with PD were tested only in the on-medication state. CONCLUSIONS: Different characteristics of gait are related to distinct types of cognitive processing, which may be differentially affected by dual-task walking due to the pathology of PD.

Delayed Stimulus-Specific Improvements in Discourse Following Anomia Treatment Using an Intentional Gesture.

Purpose: In this study, the authors assessed how the addition of intentional left-hand gestures to an intensive treatment for anomia affects 2 types of discourse: picture description and responses to open-ended questions.Method: Fourteen people with aphasia completed treatment for anomia comprising 30 treatment sessions over 3 weeks.Seven subjects also incorporated intentional left-hand gestures into each treatment trial.Results: Both groups demonstrated significant changes in trained items and improved naming of untrained items but no change in Western Aphasia Battery­Aphasia Quotient(WAB­AQ; Kertesz, 1982) scores. Changes in discourse were limited to the 3-month follow-up assessment. Several discourse measures showed significant improvements in the picture description task and declines during question responses. Additionally, the gesture group produced more words at each assessment, whereas the no gesture group produced fewer words at each assessment. These patterns led to improvements in picture descriptions and minimal declines in question responses in the gesture group. In contrast, the no gesture group showed minimal improvements in picture descriptions and production declines in question responses relative to pretreatment levels.Conclusion: The intensive treatment protocol is a successful method for improving picture naming even of untrained items.Further, the authors conclude that the intentional left-hand gesture contributed significantly to the generalization of treatment to discourse.