Connected language performance in neurotypical and persons with aphasia: Use of the Brazilian-Portuguese Story Retell Procedure (SRP-BP).

INTRODUCTION: It is important to analyze the micro- and macrostructure of connected language production across languages in neurotypical and impaired speakers such as people with aphasia (PWA). However, the validity, reliability, sensitivity, or specificity of the available Brazilian-Portuguese connected language production batteries remains untested. OBJECTIVE: The purpose of this study was to provide a preliminary assessment of the translated Brazilian-Portuguese Story Retell Procedure (SRP-BP) in PWA and neurotypical control participants (NCP) and investigate whether the SRP can serve as a measure of overall communication impairment in PWA. METHODS: This cross-sectional study was developed at the Federal University of São Paulo. Seven right-handed PWA and 14 NCP were recruited. PWA had a single left-hemisphere post-stroke lesion and were without severe aphasia or non-fluent aphasia that might interfere with performing the SRP. The connected language measures calculated from the SRP-BP were the numbers of words, information units, and propositions produced. The data were analyzed with the non-parametric Mann-Whitney test. RESULTS: The NCP produced significantly more information units and propositions in each of the 12 SRP-BP stories than the PWA group. The same group results were found for the number of words for 11 of the 12 stories, with no statistically significant difference between groups for the Água (Water) story. CONCLUSION: The SRP-BP distinguished the connected language production of PWA from that of NCP. These results motivate additional psychometric assessment and test development of the SRP-BP in neurotypical, PWA, and other language and cognitively impaired populations.

Speech Intelligibility in Dysarthrias: Influence of Utterance Length.

AIM: To analyze the effect of utterance length on the intelligibility of words produced by dysarthric speakers. METHODS: A total of 10 adult speakers with dysarthria (5 men and 5 women; mean age 58.8 years, SD 14.1) took part in the study. Six speakers exhibited mild-to-moderate impairment, while 4 had severe-to-extreme impairment, according to scores on the single-words subtest of the Protocol for the Evaluation of Speech Intelligibility in Dysarthrias (PESI). The speakers were recorded producing, by repetition, a list of 25 sentences from the sentence subtest of the PESI plus a list of 25 separate words taken from the same sentence list. The speech samples were sound recorded and subsequently transcribed by 40 listeners. Intelligibility scores were calculated according to the percentage of target words correctly transcribed in each list of stimuli. RESULTS: The intelligibility scores for the target words produced in sentences were lower than the scores obtained by utterance of single words (z = -2.82; p < 0.01). This difference was not consistently due to dysarthria severity. CONCLUSION: The results of the present study support the hypothesis that utterance length can negatively influence speech intelligibility in people with dysarthria.

Evaluation of macrolinguistic aspects of the oral discourse in patients with Alzheimer's disease.

INTRODUCTION: Alzheimer's disease (AD) is a degenerative syndrome that impairs cognitive functioning, including speech and language. Discourse can be used to analyze language processing, which is organized into microlinguistic and macrolinguistic dimensions. OBJECTIVES: To identify the occurrence of changes in the macrolinguistic dimension of oral discourse in AD patients. Design: This was developed as a cross-sectional study. Setting: Outpatient clinic of the Behavioural Neurology Division of São Paulo Federal University. PARTICIPANTS: 121 elderly patients, with ≥ 4 years of education, divided into AD and comparison groups. MEASUREMENTS: The subjects were asked to create a narrative based on seven figures that made up a story. The macrolinguistic aspects of the narratives were analyzed. RESULTS: The performance of the AD group was inferior to that of the comparison group on content-related, no-content-related complete and incomplete propositions as well as macropropositions, main information units, appropriated local and global coherence, cohesive devices and all subtypes, cohesive errors and some of their subtypes. Global coherence, macropropositions and ellipsis subtype of cohesive devices were the variables that best differentiated the groups. CONCLUSIONS: Changes were observed in most aspects of the macrolinguistic dimension of oral discourse in patients with AD.

Language impairments in Alzheimer´s disease: What changes can be found between mild and moderate stages of the disease?

OBJECTIVE: To investigate how language deteriorates over the Alzheimer's Disease course. METHODS: A cross-sectional, observational study was carried out. 35 patients diagnosed with dementia due to AD using the NINCDS-ARDRA criteria and undergoing treatment for AD with a therapeutic dose of acetylcholinesterase inhibitors were assessed by the Boston Diagnostic Aphasia Examination (BDAE). The sample comprised 15 patients with mild AD (MMSE > 23, CDR = 0 or 0.5‒1.0) and 20 patients with moderate AD (MMSE = 13‒23, CDR = 2). The results for the 2 groups on all language tasks were compared. RESULTS: A statistically significant difference was found between the mild and moderate AD groups for total score on the BDAE (95% CI 47.10‒114.08, t = 5.0, DF = 21, p = 0.000*), as well as on several tasks involving oral and writing comprehension, language oral expression and writing. CONCLUSION: The study results showed major changes in the moderate stage. Also, the decline in language performance correlated with the worsening of dementia syndrome, independently of sociodemographic variables.

Speech and orofacial apraxias in Alzheimer's disease.

BACKGROUND: Alzheimer's disease (AD) affects not only memory but also other cognitive functions, such as orientation, language, praxis, attention, visual perception, or executive function. Most studies on oral communication in AD focus on aphasia; however, speech and orofacial apraxias are also present in these patients. The aim of this study was to investigate the presence of speech and orofacial apraxias in patients with AD with the hypothesis that apraxia severity is strongly correlated with disease severity. METHODS: Ninety participants in different stages of AD (mild, moderate, and severe) underwent the following assessments: Clinical Dementia Rating, Mini-Mental State Examination, Lawton Instrumental Activities of Daily Living, a specific speech and orofacial praxis assessment, and the oral agility subtest of the Boston diagnostic aphasia examination. RESULTS: The mean age was 80.2 ± 7.2 years and 73% were women. Patients with AD had significantly lower scores than normal controls for speech praxis (mean difference=-2.9, 95% confidence interval (CI)=-3.3 to -2.4) and orofacial praxis (mean difference=-4.9, 95% CI=-5.4 to -4.3). Dementia severity was significantly associated with orofacial apraxia severity (moderate AD: ß =-19.63, p= 0.011; and severe AD: ß =-51.68, p < 0.001) and speech apraxia severity (moderate AD: ß = 7.07, p = 0.001; and severe AD: ß =8.16, p < 0.001). CONCLUSION: Speech and orofacial apraxias were evident in patients with AD and became more pronounced with disease progression.

Assessment protocol for acquired apraxia of speech. / Protocolo de avaliação para apraxia de fala adquirida.

PURPOSE: To develop an assessment protocol for speech motor planning with phonologically balanced stimuli for Brazilian Portuguese, including all necessary variables for this diagnosis. METHODS: Three stages were carried out: In the first, word lists were built with the main criterion being syllabic and accentual patterns. From the survey conducted in Stage 1, the words that composed the first version of the protocol lists in Stage 2 were selected, and grouped into two fundamental tasks for diagnosing acquired apraxia of speech (AOS): repetition and Reading Aloud (RA). In Stage 3, the occurrence of words was investigated using the Brazilian Corpus (PUC-SP) - Linguateca database, and a statistical analysis was performed to verify if the repetition and RA lists were balanced in terms of the occurrences. Thus, the lists were distributed in quartiles and submitted to both descriptive and bivariate analyses. A significance level of 5% (p<0.05) was adopted. RESULTS: After completion of all stages, the words that composed the lists of the repetition and RA tasks were obtained. Finally, other tasks considered essential for the assessment of AOS, such as diadochokinetic rates and the board for spontaneous oral emission, were then added to the protocol. CONCLUSION: The developed protocol contains the tasks considered standard for the assessment of AOS according to the international literature, which makes this instrument important for diagnosing this disorder in speakers of Brazilian Portuguese.

OBJETIVO: Elaborar um protocolo de avaliação do planejamento motor da fala com estímulos fonologicamente balanceados para o português brasileiro e que contemple todas as variáveis necessárias para este diagnóstico. MÉTODO: Foram realizadas três etapas: Na primeira, construíram-se listas de palavras cujo critério principal foram os padrões silábicos e acentuais. Do levantamento realizado na Etapa 1, procedeu-se à seleção dos vocábulos que compuseram a primeira versão do protocolo na Etapa 2, reunidas em duas tarefas: de repetição e de Leitura em Voz Alta (LVA). Em seguida, investigou-se a ocorrência das palavras usando a base de dados do Corpus Brasileiro (PUC-SP) - Linguateca. Na etapa 3 realizou-se a análise estatística para verificar se as listas de repetição e de LVA estavam equilibradas quanto à ocorrência das palavras. Assim, as listas foram distribuídas em quartis e foram analisadas de forma descritiva e bivariada. O nível de significância utilizado foi de 5%. RESULTADOS: Após a realização de todas as etapas, foi possível obter as palavras que compuseram as listas das tarefas de repetição e de LVA. Finalmente, foram então acrescidas ao protocolo as demais tarefas consideradas essenciais para a avaliação da apraxia como as taxas diadococinéticas e a prancha para a emissão oral espontânea. CONCLUSÃO: O protocolo desenvolvido contém as tarefas consideradas padrão para a avaliação da apraxia de fala pela literatura internacional, o que torna esse instrumento importante para o diagnóstico desse distúrbio em falantes do português brasileiro.

Speech and phonological impairment across Alzheimer's disease severity.

INTRODUCTION: Phonetic-phonological impairments have been described in dementia due to Alzheimer's disease (AD). However, whether the likely phonological-linguistic changes progress with the evolution of the disease or whether phonetic-motor manifestations occur in all three stages of AD (mild, moderate, and severe) has not yet been clarified. Thus, the aim of this study was to verify whether phonological-linguistic and phonetic-motor speech manifestations occur in the mild, moderate, and severe stages of AD. METHODS: Thirty participants in each stage of probable AD (mild, moderate, and severe) and 30 healthy older adults underwent cognitive, instrumental activities of daily living and phonetic-phonological assessments. Phonetic-phonological manifestations were classified into three types: likely phonetic-motor, likely phonological-linguistic, and manifestations that may occur in disorders of both phonetic and phonological origin. RESULTS: The manifestations analyzed in this study occurred rarely. The manifestations that may occur in disorders of both phonetic and phonological origin were the most common in all stages of the disease. The likely phonetic-motor manifestations emerged during the mild stage of the disease (distortions, prolonged intersegment duration, and vowel prolongations), while the likely phonological-linguistic manifestations were present mainly in the moderate (substitutions and attempts at the word level) and severe stages (substitutions, attempts at the word level, self-corrections, and anticipations). The occurrence of phonetic-phonological manifestations increased with disease progression. CONCLUSIONS: The type of phonological and phonetic manifestations in the individuals with AD differed according to the dementia stage and were statistically more frequent as dementia worsened.

Language skills differences between adults without formal education and low formal education.

BACKGROUND: The influence of education on cognition has been extensively researched, particularly in countries with high levels of illiteracy. However, the impact of low education in all cognitive functions appears to differ. Regarding to language, the effects of education on many linguistic tasks-supported by different processing-remain unclear. The primary objective of this study was to determine whether oral language task performance differs among individuals with no formal and low-educated subjects, as measured by the Brazilian Montreal-Toulouse Language Assessment Battery (MTL-BR). This is the only language battery available for use in Brazil, but lacks normative data for illiterate individuals. The secondary objective was to gather data for use as clinical parameters in assessing persons with aphasia (PWA) not exposed to a formal education. METHODS: A total of 30 healthy illiterate individuals aged 34-60 years were assessed. All participants underwent the MTL-BR Battery, excluding its written communication tasks. The data obtained in the present study were compared against results of a previous investigation of individuals with 1-4 years of education evaluated using the same MTL-BR instrument. RESULTS: Statistically significant differences in performance were found between non-formal education and the low-educated (2-4 years) groups on the tasks Auditory Comprehension, Repetition, Orthographic/Phonological Fluency, Number dictation, Reading of numbers and also on simple numerical calculations. CONCLUSION: The study results showed that individuals with no formal education/illiterate had worse performance than low-education individuals on some of the language tasks of the MTL-Br Battery, suggesting that each year of education impacts cognitive-language performance. Also, data were obtained which can serve as a guide for PWA not exposed to a formal education.

Formal language assessment in low-educated persons with aphasia: can the lesion effect be distinguished from the education effect?

BACKGROUND: Language tests are important in the assessment and follow up of people with aphasia (PWA). However, language assessment in the low literacy population is still a challenge. OBJECTIVE: To investigate whether a formal evaluation of aphasia is able to distinguish the neurological effect from the effect of low educational level in people with post-stroke aphasia. METHODS: The sample consisted of a group of 30 aphasic subjects (AG) and a control group (CG) of 36 individuals, both with an educational level of 1-4 years. The Brazilian Montreal-Toulouse Language Assessment battery was applied to all subjects. RESULTS: There were statistically significant differences between the groups in 19 out of the 20 tasks analyzed. CONCLUSIONS: These results suggest that formal evaluation procedures are able to detect language disorders resulting from stroke, even in subjects with low educational level.

Brazilian practice guidelines for stroke rehabilitation: Part II.

The Brazilian Practice Guidelines for Stroke Rehabilitation - Part II, developed by the Scientific Department of Neurological Rehabilitation of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, in Portuguese), focuses on specific rehabilitation techniques to aid recovery from impairment and disability after stroke. As in Part I, Part II is also based on recently available evidence from randomized controlled trials, systematic reviews, meta-analyses, and other guidelines. Part II covers disorders of communication, dysphagia, postural control and balance, ataxias, spasticity, upper limb rehabilitation, gait, cognition, unilateral spatial neglect, sensory impairments, home rehabilitation, medication adherence, palliative care, cerebrovascular events related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the future of stroke rehabilitation, and stroke websites to support patients and caregivers. Our goal is to provide health professionals with more recent knowledge and recommendations for better rehabilitation care after stroke.

As Diretrizes Brasileiras de Reabilitação do Acidente Vascular Cerebral (AVC) - Parte II, desenvolvida pelo Departamento Científico de Reabilitação Neurológica da Academia Brasileira de Neurologia é voltada para intervenções específicas de técnicas de reabilitação de déficits neurológicos e incapacidades. Seguindo o mesmo modelo da Parte I, a Parte II também se baseia em estudos randomizados, revisões sistemáticas, metanálises e outras diretrizes sobre o mesmo tema. A segunda parte aborda os distúrbios da comunicação, disfagia, controle postural e equilíbrio, ataxias, espasticidade, reabilitação do membro superior, marcha, cognição, negligência espacial unilateral, déficits sensoriais, reabilitação domiciliar, aderência ao uso de medicamentos, cuidados paliativos, o futuro da reabilitação no AVC, e websites de orientação sobre AVC para pacientes e cuidadores. Nosso objetivo é fornecer aos profissionais envolvidos na reabilitação conhecimento atualizado e recomendações para um melhor cuidado no pós-AVC.

Microlinguistic aspects of the oral narrative in patients with Alzheimer's disease.

BACKGROUND: Alzheimer's disease (AD) is characterized by memory loss and cognitive impairment. Phonological, syntactic, semantic and discursive aspects of language may also be affected. Analysis of micro- and macrolinguistic abilities of discourse may assist in diagnosing AD. The aim of this study was to identify changes in the discourse (lexical errors and syntactic index) of AD patients. METHODS: 121 elderly subjects narrated a story based on a seven-figure picture description. RESULTS: Patients with AD presented more word-finding difficulties, revisions and repetitions, and the syntactic index was lower than controls. CONCLUSION: Performance in microlinguistics at the lexical and syntactic levels was lower than expected in participants with AD.

Language impairment in the moderate stage of dementia due to Alzheimer's disease.

BACKGROUND: During the moderate stage of dementia due to Alzheimer's disease (AD), language disorder is more evident and it impacts on communication. An overview of language impairment could be helpful to find compensatory communication strategies for these patients. OBJECTIVE: To identify all language impairments among patients with moderate-stage of AD. METHODS: 20 patients diagnosed with probable AD based on the criteria of the NINCDS-ARDRA, with a MMSE score of 13-23 points and CDR=2, who were undergoing treatment for AD with therapeutic doses of acetyl cholinesterase inhibitors, were assessed using the Boston Diagnostic Aphasia Examination (BDAE), a test that provides a broad assessment of language. The results were compared with the performance of a normal population. RESULTS: The patients assessed in this study presented normal scores for oral and written word recognition, repetition, mechanics of writing, primer-level dictation and spelling to dictation but also had impairment at most levels of linguistic processing, in oral and written comprehension and production. In general, as expected, the tasks relying on access to the mental lexicon were most significantly affected. However, they performed well in the naming task, in which semantic cues were presented. Moreover, the patients assessed in this study had better performance in written comprehension tasks than in oral ones. CONCLUSION: The severity of the language impairments was not homogenous, with some linguistic abilities more impaired than others. The abilities that were found to be preserved can help to guide strategies for aiding in communication at this stage of AD.

Influence of age and schooling in written discourse of healthy adults.

BACKGROUND: Discourse production is a very complex cognitive task that requires the integration of several linguistic cognitive skills. Socio-demographic factors such as schooling can impact on cognitive tasks. This study investigated the impact of age and schooling in some macrolinguistic and microlinguistic aspects in the written discourse of healthy adults. METHODS: Individuals with no previous history of language, hearing, neurological, or psychiatric disorders were asked to write a story based on a figure that showed a "bank robbery." A total of 463 graphic narrative were analyzed. The schooling was stratified into the following three bands: 5 to 8 years, 9 to 11 years and 12 or more, and the age ranged from 19 to 75 years. RESULTS: Individuals with high schooling (12 years or more) produced discourses with more information units, more coherent, and cohesive. The oldest group (60 to 75 years) needed more time to finish the written production. CONCLUSION: The schooling influences some micro and macrolinguistic aspects in the written discourse production. A higher educational level provided a greater number of words as well as a higher number of information units, and the discourses produced are more coherent and cohesive. The age influenced only the time of discourse production.

Speech in the foreign accent syndrome: differential diagnosis between organic and functional cases.

Foreign accent syndrome (FAS) is an extremely rare disorder, with 112 cases described until 2019. We compare two cases of the foreign accent syndrome in native speakers of Brazilian Portuguese in its classic form (FAS) and psychiatric variant (FALS). Two cases were analyzed: (1) a right-handed, 69-year-old man, with a prior history of stroke, and (2) a right-handed, 43-year-old woman, diagnosed with schizophrenia. They were evaluate for language and speech, including the speech intelligibility. Both patients had speech impairments complaints, similar to a new accent, without previous exposure to a foreign language. However, the onset of the speech disorder was sudden in case 1 and insidious and with transient events in case 2, with speech intelligibility scores of 95.5 and 55.3% respectively. Besides neurologic impairment, the clinical presentation of FALS was extremely severe and differed to that expected in FAS cases, in which speech intelligibility is preserved.

A síndrome do sotaque estrangeiro (SSE) é um distúrbio extremamente raro, com 112 casos descritos até 2019. Foram comparados dois casos de SSE em falantes nativos do português brasileiro em sua forma clássica e em sua variante psiquiátrica. Os seguintes casos foram analisados: (1) homem de 69 anos, destro, com história prévia de acidente vascular cerebral, e (2) mulher de 43 anos, destra, com diagnóstico de esquizofrenia. Eles foram avaliados quanto à linguagem e à fala, incluindo a inteligibilidade. Ambos apresentaram alterações de fala, como um sotaque novo adquirido, sem exposição prévia à língua estrangeira. Entretanto, o início do distúrbio foi súbito no caso 1 e insidioso e com eventos transitórios no caso 2, com escores de inteligibilidade da fala de 95,5 e 55,3%, respectivamente. Além do comprometimento neurológico, a apresentação clínica da variante psiquiátrica foi mais grave e diferiu dos casos de SSE, cuja inteligibilidade da fala é preservada.

Qualitative and quantitative aspects of the F-A-S fluency test in people with aphasia.

Verbal fluency tests are widely used in neuropsychological assessment. The quantitative and qualitative analysis of the performance of aphasic individuals on the phonemic verbal fluency (PVF) test can contribute to a better understanding of cognitive changes in this group of patients. OBJECTIVE: This study aimed to analyze clustering and switching measures of PVF in people with aphasia and investigate the relationship between the use of these strategies, the quantitative performance on the test, and the performance on executive functions. METHODS: This is a cross-sectional study of 15 people with aphasia, right-handed, native speakers of Brazilian Portuguese, aged 19 to 92 years. They were submitted to the F-A-S test and the Clock Drawing Test (CDT). The following measures were obtained in the F-A-S test: total score, number of clusters, mean cluster size, and number of switches. Spearman's test was used to analyze correlation. RESULTS: We found a positive correlation among all F-A-S test scores, ranging from p=0.61 (p<0.001) to p=0.91 (p<0.001). No correlation was identified between these measures and CDT performance (p≤0.31; p≥0.260). CONCLUSIONS: The quantitative and qualitative analysis of F-A-S in people with aphasia, even those with different linguistic manifestations, showed that these individuals presented lower scores and that the number of total words and the number of switches were strongly correlated. We found no correlation between executive function, assessed by the CDT, and switching performance on the F-A-S test.

Testes de fluência verbal são procedimentos amplamente utilizados na avaliação neuropsicológica. A análise da performance de pessoas com afasia no teste de fluência verbal fonêmica (FVF), do ponto de vista quantitativo e qualitativo, pode contribuir para uma melhor compreensão das mudanças cognitivas que ocorrem nesse grupo de pacientes. OBJETIVO: Os objetivos deste estudo foram analisar as medidas de estratégias de agrupamento e de mudança de agrupamento na FVF de pessoas com afasia e investigar a correlação entre o uso dessas estratégias, o desempenho quantitativo no teste e o desempenho em funções executivas. Métodos: Foi realizado um estudo transversal com 15 pessoas com afasia, destros, falantes nativos do português brasileiro, com idade entre 19 e 92 anos. Eles foram submetidos ao teste F-A-S e ao Teste do Relógio (TDR). Foram obtidas as seguintes medidas no F-A-S: escore total, número e tamanho médio de agrupamento e número de mudança de agrupamento. Para análise de correlação foi utilizado o teste de Spearman. RESULTADOS: Foi verificada correlação positiva entre todos os escores do teste F-A-S, variando entre p=0,61 (p<0,001) e p=0,91 (p<0,001). Não foram encontradas correlações entre tais medidas e o escore no TDR (p≤0,31; p≥0,260). CONCLUSÕES: A análise quantitativa e qualitativa do F-A-S de pessoas com afasia, mesmo com diferentes manifestações linguísticas, mostrou que elas apresentam escores inferiores e o número total de palavras e o número de mudanças de agrupamento possuem forte correlação. Não foi observada correlação entre funções executivas, avaliada pelo TDR, e o desempenho na medida de mudança de agrupamento.

Correction to: Brief Montreal-Toulouse Language Assessment Battery: adaptation and content validity.

An amendment to this paper has been published and can be accessed via the original article.

Brief Montreal-Toulouse Language Assessment Battery: adaptation and content validity.

BACKGROUND: Evaluating patients in the acute phase of brain damage allows for the early detection of cognitive and linguistic impairments and the implementation of more effective interventions. However, few cross-cultural instruments are available for the bedside assessment of language abilities. The aim of this study was to develop a brief assessment instrument and evaluate its content validity. METHODS: Stimuli for the new assessment instrument were selected from the M1-Alpha and MTL-BR batteries (Stage 1). Sixty-five images were redesigned and analyzed by non-expert judges (Stage 2). This was followed by the analysis of expert judges (Stage 3), where nine speech pathologists with doctoral training and experience in aphasiology and/or linguistics evaluated the images, words, nonwords, and phrases for inclusion in the instrument. Two pilot studies (Stage 4) were then conducted in order to identify any remaining errors in the instrument and scoring instructions. RESULTS: Sixty of the 65 figures examined by the judges achieved inter-rater agreement rates of at least 80%. Modifications were suggested to 22 images, which were therefore reanalyzed by the judges, who reached high levels of inter-rater agreement (AC1 = 0.98 [CI = 0.96-1]). New types of stimuli such as nonwords and irregular words were also inserted in the Brief Battery and favorably evaluated by the expert judges. Optional tasks were also developed for specific diagnostic situations. After the correction of errors detected in Stage 4, the final version of the instrument was obtained. CONCLUSION: This study confirmed the content validity of the Brief MTL-BR Battery. The method used in this investigation was effective and can be used in future studies to develop brief instruments based on preexisting assessment batteries.

Protocolo de avaliação para apraxia de fala adquirida / Assessment protocol for acquired apraxia of speech

RESUMO Objetivo Elaborar um protocolo de avaliação do planejamento motor da fala com estímulos fonologicamente balanceados para o português brasileiro e que contemple todas as variáveis necessárias para este diagnóstico. Método Foram realizadas três etapas: Na primeira, construíram-se listas de palavras cujo critério principal foram os padrões silábicos e acentuais. Do levantamento realizado na Etapa 1, procedeu-se à seleção dos vocábulos que compuseram a primeira versão do protocolo na Etapa 2, reunidas em duas tarefas: de repetição e de Leitura em Voz Alta (LVA). Em seguida, investigou-se a ocorrência das palavras usando a base de dados do Corpus Brasileiro (PUC-SP) - Linguateca. Na etapa 3 realizou-se a análise estatística para verificar se as listas de repetição e de LVA estavam equilibradas quanto à ocorrência das palavras. Assim, as listas foram distribuídas em quartis e foram analisadas de forma descritiva e bivariada. O nível de significância utilizado foi de 5%. Resultados Após a realização de todas as etapas, foi possível obter as palavras que compuseram as listas das tarefas de repetição e de LVA. Finalmente, foram então acrescidas ao protocolo as demais tarefas consideradas essenciais para a avaliação da apraxia como as taxas diadococinéticas e a prancha para a emissão oral espontânea. Conclusão O protocolo desenvolvido contém as tarefas consideradas padrão para a avaliação da apraxia de fala pela literatura internacional, o que torna esse instrumento importante para o diagnóstico desse distúrbio em falantes do português brasileiro.

ABSTRACT Purpose To develop an assessment protocol for speech motor planning with phonologically balanced stimuli for Brazilian Portuguese, including all necessary variables for this diagnosis. Methods Three stages were carried out: In the first, word lists were built with the main criterion being syllabic and accentual patterns. From the survey conducted in Stage 1, the words that composed the first version of the protocol lists in Stage 2 were selected, and grouped into two fundamental tasks for diagnosing acquired apraxia of speech (AOS): repetition and Reading Aloud (RA). In Stage 3, the occurrence of words was investigated using the Brazilian Corpus (PUC-SP) - Linguateca database, and a statistical analysis was performed to verify if the repetition and RA lists were balanced in terms of the occurrences. Thus, the lists were distributed in quartiles and submitted to both descriptive and bivariate analyses. A significance level of 5% (p<0.05) was adopted. Results After completion of all stages, the words that composed the lists of the repetition and RA tasks were obtained. Finally, other tasks considered essential for the assessment of AOS, such as diadochokinetic rates and the board for spontaneous oral emission, were then added to the protocol. Conclusion The developed protocol contains the tasks considered standard for the assessment of AOS according to the international literature, which makes this instrument important for diagnosing this disorder in speakers of Brazilian Portuguese.

Analysis of population recognition of pictures from the sentence production program for aphasia. / Análise do reconhecimento populacional das figuras do sentence production program for aphasia.

PURPOSE: To analyze the recognition of the pictures and contexts familiarity from the Sentence Production Program for Aphasia (SPPA) to acquire data determining its potential use in Portuguese and/or need for adaption. METHODS: The stimuli for English speakers were first translated, back-translated and adjusted without changing the syntactic structures of the phrases. The material was then tested in 39 highly literate individuals. In the first stage of the study, the adults had to produce a phrase corresponding to each picture. In the second stage, participants were exposed to the original phrases associated with their respective contexts. Participants were given an answer sheet containing numbered responses for each picture and rated the familiarity of the contexts on an analogic scale ranging from 0 to 10. RESULTS: Based on the sentences produced by the participants, the overall mean agreement of stimuli with responses for the pictures from the SPPA was 35.5%. Familiarity of the contexts with pictures was greater in scenes involving sentences with a syntactic structure similar to that of Portuguese. CONCLUSION: Given most stimuli had a low level of recognition, adaptations are required for use of the program in the Brazilian population. The study allowed identification of those pictures which need adapting before use in the rehabilitation of agrammatic patients in Brazil.

OBJETIVO: Analisar o reconhecimento das figuras e a familiaridade dos contextos do Sentence Production Program for Aphasia (SPPA), para obter dados sobre a possibilidade de uso para a língua portuguesa e/ou da necessidade de sua adaptação. MÉTODO: Inicialmente, foi realizada a tradução dos estímulos por falantes do inglês e, em seguida, a retrotradução para ajustes sem a alteração das estruturas sintáticas das frases. O material foi então submetido para a análise de 39 indivíduos adultos de alta escolaridade. Na primeira fase do estudo, os adultos deveriam criar uma frase de acordo com cada figura apresentada. Na fase seguinte do estudo, os participantes foram expostos às frases originais associadas aos seus respectivos contextos. Os participantes receberam uma folha de registro das respostas com numeração segundo as figuras e julgaram a familiaridade dos contextos a partir de uma escala analógica de 0 a 10. RESULTADOS: Observou-se que a média geral de concordância dos estímulos com as respostas para as figuras do SPPA foi de 35,5%. Em relação à familiaridade dos contextos com as figuras, essa foi maior para as cenas relativas às frases com estrutura sintática mais usadas em português. CONCLUSÃO: Pelo fato de os estímulos terem apresentado baixo grau de reconhecimento, adaptações serão necessárias para que o programa possa vir a ser utilizado na população brasileira. O estudo também permitiu identificar quais as figuras que necessitam de adaptação antes de serem usadas para a reabilitação de pacientes agramáticos no Brasil.

Language impairments in Alzheimer's disease: What changes can be found between mild and moderate stages of the disease?

Abstract Objective: To investigate how language deteriorates over the Alzheimer's Disease course. Methods: A cross-sectional, observational study was carried out. 35 patients diagnosed with dementia due to AD using the NINCDS-ARDRA criteria and undergoing treatment for AD with a therapeutic dose of acetylcholinesterase inhibitors were assessed by the Boston Diagnostic Aphasia Examination (BDAE). The sample comprised 15 patients with mild AD (MMSE > 23, CDR = 0 or 0.5‒1.0) and 20 patients with moderate AD (MMSE = 13‒23, CDR = 2). The results for the 2 groups on all language tasks were compared. Results: A statistically significant difference was found between the mild and moderate AD groups for total score on the BDAE (95% CI 47.10‒114.08, t = 5.0, DF = 21, p = 0.000*), as well as on several tasks involving oral and writing comprehension, language oral expression and writing. Conclusion: The study results showed major changes in the moderate stage. Also, the decline in language performance correlated with the worsening of dementia syndrome, independently of sociodemographic variables.