Speech Motor Profiles in Primary Progressive Aphasia.

PURPOSE: Previous research on motor speech disorders (MSDs) in primary progressive aphasia (PPA) has largely focused on patients with the nonfluent/agrammatic variant of PPA (nfvPPA), with few systematic descriptions of MSDs in variants other than nfvPPA. There has also been an emphasis on studying apraxia of speech, whereas less is known about dysarthria or other forms of MSDs. This study aimed to examine the qualitative and quantitative characteristics of MSDs in a prospective sample of individuals with PPA independent of subtype. METHOD: We included 38 participants with a root diagnosis of PPA according to current consensus criteria, including one case with primary progressive apraxia of speech. Speech tasks comprised various speech modalities and levels of complexity. Expert raters used a novel protocol for auditory speech analyses covering all major dimensions of speech. RESULTS: Of the participants, 47.4% presented with some form of MSD. Individual speech motor profiles varied widely with respect to the different speech dimensions. Besides apraxia of speech, we observed different dysarthria syndromes, special forms of MSDs (e.g., neurogenic stuttering), and mixed forms. Degrees of severity ranged from mild to severe. We also observed MSDs in patients whose speech and language profiles were incompatible with nfvPPA. CONCLUSIONS: The results confirm that MSDs are common in PPA and can manifest in different syndromes. The findings emphasize that future studies of MSDs in PPA should be extended to all clinical variants and should take into account the qualitative characteristics of motor speech dysfunction across speech dimensions. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.22555534.

The role of left temporo-parietal and inferior frontal cortex in comprehending syntactically complex sentences: A brain stimulation study.

BACKGROUND AND OBJECTIVES: Syntactic competence relies on a left-lateralized network converging on hubs in inferior-frontal and posterior-temporal cortices. We address the question whether anodal transcranial direct current stimulation (a-tDCS) over these hubs can modulate comprehension of sentences, whose syntactic complexity systematically varied along the factors embedding depths and canonicity. Semantic content and length of the sentences were kept identical and forced choice picture matching was required after the full sentence had been presented. METHODS: We used a single-blind, within-subject, sham-controlled design, applying a-tDCS targeting left posterior tempo-parietal (TP) and left inferior frontal cortex (FC). Stimulation sites were determined by individual neuro-navigation. 20 participants were included of whom 19 entered the analysis. Results were analysed using (generalized) mixed models. In a pilot-experiment in another group of 20 participants we validated the manipulation of syntactic complexity by the two factors embedding depth and argument-order. RESULTS: Reaction times increased and accuracy decreased with higher embedding depth and non-canonical argument order in both experiments. Notably a-tDCS over TP enhanced sentence-to-picture matching, while FC-stimulation showed no consistent effect. Moreover, the analysis disclosed a session effect, indicating improvements of task performance especially regarding speed. CONCLUSIONS: We conclude that the posterior 'hub' of the neuronal network affording syntactic analysis represents a 'bottleneck', likely due to working-memory capacity and the challenges of mapping semantic to syntactic information allowing for role assignment. While this does not challenge the role of left inferior-frontal cortex for syntax processing and novel-grammar learning, the application of highly established syntactic rules during sentence comprehension may be considered optimized, thus not augmentable by a-tDCS in the uncompromised network. SIGNIFICANCE STATEMENT: Anodal transcranial direct current stimulation (a-tDCS) over left temporo-parietal cortex enhances comprehension of complex sentences in uncompromised young speakers. Since a-tDCS over left frontal cortex did not elicit any change, the 'bottleneck' for the understanding of complex sentences seems to be the posterior, temporo-parietal rather than the anterior inferior-frontal 'hub' of language processing. Regarding the attested role of inferior-frontal cortex in syntax processing, we suggest that its function is optimized in competent young speakers, preventing further enhancement by (facilitatory) tDCS. Results shed light on the functional anatomy of syntax processing during sentence comprehension; moreover, they open perspectives for research in the lesioned language network of people with syntactic deficits due to aphasia.

BONEs not CATs attract DOGs: Semantic context effects for picture naming in the lesioned language network.

The breakdown of rapid and accurate retrieval of words is a hallmark of aphasic speech and a prime target of therapeutic intervention. Complementary, psycho- and neurolinguistic research have developed a spectrum of models, how and by which neuronal network uncompromised speakers can rely on remarkable lexical retrieval capacities. Motivated by both lines of research we invited 32 participants with a chronic left hemispheric brain lesion to name pictures in the presence of distractor words. This picture-word-interference (PWI) paradigm is widely used in psycho- and neurolinguistic research. We find that also after brain lesion categorically related words (CAT â†’ [dog]picture) impede naming, while associatively related words (BONE â†’ [dog]picture) ease access, when compared to unrelated distractor words. The effects largely affecting latencies in neurotypical populations, are reproduced for error rate in our participants with lesions in the language network. Unsurprisingly, overall naming abilities varied greatly across patients. Notably, however, the two effects (categorical interference / associative facilitation) differ between participants. Correlating performance with lesion patterns we find support for the notion of a divergence of brain areas affording different aspects of the task: (i) lesions in the left middle temporal gyurs (MTG) deteriorate overall naming, confirming previous work; more notably, (ii) lesions comprising the inferior frontal hub (inferior frontal gyrus, IFG) of the language-network increase the interference effect for the categorical condition; on the contrary, (iii) lesions to the mid-to-posterior temporal hub (posterior middle and superior temporal gyri, pMTG/ pSTG) increase the facilitatory effect for the associative condition on error rates. The findings can be accommodated in a neuro-linguistic framework, which localizes lexical activation but also lexical interference in posterior parts of the language network (pMTG/pITG); conversely, selection between co-activated categorically related entries is afforded by frontal language areas (IFG). While purely experimental in nature our study highlights that lesion site differentially influences specific aspects of word retrieval. Since confrontational naming is a cornerstone of aphasia rehabilitation, this may be of note when designing and evaluating novel therapeutic regimes.

On the lexical representation of compound nouns: Evidence from a picture-naming task with compound targets and gender-marked determiner primes in aphasia.

Our study examines the lexical representation and processing of compounds in participants with aphasia (PWA) and language-unimpaired control speakers. Participants were engaged in primed picture-naming in German, a language that marks for grammatical gender. Gender-marked determiners served as primes (dermasc, diefem, dasneut [the]) and noun-noun compounds as targets (e.g., Goldneutfischmasc [goldfish]). Experiment 1 tested whether the compound's constituents are activated at a lexical-syntactic level during production. Primes were gender-congruent either with the morphological head of the target compound (e.g., dermasc for the target Goldneutfischmasc), or its modifier (dasneut for Goldneutfischmasc), or incongruent with both (diefem). Head congruency of prime and target produced strong facilitatory effects across groups. Modifier congruent primes produced contrasting effects. Modifier congruency speeded up picture naming in the controls and PWA with isolated deficits of lexical access (PWA-lex) but they delayed picture naming in PWA with additional deficits of phonological encoding (PWA-pho). Both patterns suggest that the lemmas of both constituents of compound targets and their grammatical gender are activated during compound retrieval, in line with a multiple-lemma representation of compounds. Experiment 2 explored the nature of the observed effects compared to a gender-neutral control condition. While facilitatory effects were shown by PWA-lex and the controls, PWA-pho did not profit from congruent primes but showed inhibitory effects by incongruent primes, exclusively. Inhibitory effects were also attested for the controls but not for PWA-lex. The functional origin of determiner priming effects and their theoretical and clinical implications are discussed in the framework of current accounts.

Recursive hierarchical embedding in vision is impaired by posterior middle temporal gyrus lesions.

The generation of hierarchical structures is central to language, music and complex action. Understanding this capacity and its potential impairments requires mapping its underlying cognitive processes to the respective neuronal underpinnings. In language, left inferior frontal gyrus and left posterior temporal cortex (superior temporal sulcus/middle temporal gyrus) are considered hubs for syntactic processing. However, it is unclear whether these regions support computations specific to language or more generally support analyses of hierarchical structure. Here, we address this issue by investigating hierarchical processing in a non-linguistic task. We test the ability to represent recursive hierarchical embedding in the visual domain by contrasting a recursion task with an iteration task. The recursion task requires participants to correctly identify continuations of a hierarchy generating procedure, while the iteration task applies a serial procedure that does not generate new hierarchical levels. In a lesion-based approach, we asked 44 patients with left hemispheric chronic brain lesion to perform recursion and iteration tasks. We modelled accuracies and response times with a drift diffusion model and for each participant obtained parametric estimates for the velocity of information accumulation (drift rates) and for the amount of information accumulated before a decision (boundary separation). We then used these estimates in lesion-behaviour analyses to investigate how brain lesions affect specific aspects of recursive hierarchical embedding. We found that lesions in the posterior temporal cortex decreased drift rate in recursive hierarchical embedding, suggesting an impaired process of rule extraction from recursive structures. Moreover, lesions in inferior temporal gyrus decreased boundary separation. The latter finding does not survive conservative correction but suggests a shift in the decision criterion. As patients also participated in a grammar comprehension experiment, we performed explorative correlation-analyses and found that visual and linguistic recursive hierarchical embedding accuracies are correlated when the latter is instantiated as sentences with two nested embedding levels. While the roles of the inferior temporal gyrus and posterior temporal cortex in linguistic processes are well established, here we show that posterior temporal cortex lesions slow information accumulation (drift rate) in the visual domain. This suggests that posterior temporal cortex is essential to acquire the (knowledge) representations necessary to parse recursive hierarchical embedding in visual structures, a finding mimicking language acquisition in young children. On the contrary, inferior frontal gyrus lesions seem to affect recursive hierarchical embedding processing by interfering with more general cognitive control (boundary separation). This interesting separation of roles, rooted on a domain-general taxonomy, raises the question of whether such cognitive framing is also applicable to other domains.