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BMJ Case Reports Jan 2016Transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL syndrome) consists of recurrent headaches with focal neurological signs, which... (Review)
Review
Transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL syndrome) consists of recurrent headaches with focal neurological signs, which can include motor, sensory and aphasic symptoms. Although considered rare, it is becoming increasingly recognised in clinical practice due to the accumulation of case reports. The pathophysiology remains unclear although changes in the neurovascular resemble those found in migraine, which are thought to be triggered by an infectious process. HaNDL can mimic various serious, including life-threatening, diseases, such as stroke and meningoencephalitis, which is why vigorous tests should be sought before this diagnosis of exclusion can be reached. Treatment is symptomatic and the prognosis is excellent. A literature review of the topic is discussed. We report an adolescent girl who presented with recurrent expressive dysphasia and right-sided hypoaesthesia and moderate occipital headaches who was diagnosed with HaNDL syndrome.
Topics: Acetazolamide; Adolescent; Aphasia, Broca; Carbonic Anhydrase Inhibitors; Diagnosis, Differential; Female; Headache; Humans; Hypesthesia; Lymphocytosis; Nervous System Diseases; Syndrome
PubMed: 26768705
DOI: 10.1136/bcr-2015-213018 -
Psychonomic Bulletin & Review Apr 2016Speech production is studied from both psycholinguistic and motor-control perspectives, with little interaction between the approaches. We assessed the explanatory value... (Review)
Review
Speech production is studied from both psycholinguistic and motor-control perspectives, with little interaction between the approaches. We assessed the explanatory value of integrating psycholinguistic and motor-control concepts for theories of speech production. By augmenting a popular psycholinguistic model of lexical retrieval with a motor-control-inspired architecture, we created a new computational model to explain speech errors in the context of aphasia. Comparing the model fits to picture-naming data from 255 aphasic patients, we found that our new model improves fits for a theoretically predictable subtype of aphasia: conduction. We discovered that the improved fits for this group were a result of strong auditory-lexical feedback activation, combined with weaker auditory-motor feedforward activation, leading to increased competition from phonologically related neighbors during lexical selection. We discuss the implications of our findings with respect to other extant models of lexical retrieval.
Topics: Aphasia; Auditory Perception; Humans; Models, Psychological; Motor Activity; Psycholinguistics; Semantics; Speech
PubMed: 26223468
DOI: 10.3758/s13423-015-0903-7 -
Brain and Behavior Nov 2023Language deficits are cardinal manifestations of some frontotemporal dementia (FTD) phenotypes and also increasingly recognized in sporadic and familial amyotrophic...
The involvement of language-associated networks, tracts, and cortical regions in frontotemporal dementia and amyotrophic lateral sclerosis: Structural and functional alterations.
BACKGROUND
Language deficits are cardinal manifestations of some frontotemporal dementia (FTD) phenotypes and also increasingly recognized in sporadic and familial amyotrophic lateral sclerosis (ALS). They have considerable social and quality-of-life implications, and adaptive strategies are challenging to implement. While the neuropsychological profiles of ALS-FTD phenotypes are well characterized, the neuronal underpinnings of language deficits are less well studied.
METHODS
A multiparametric, quantitative neuroimaging study was conducted to characterize the involvement of language-associated networks, tracts, and cortical regions with a panel of structural, diffusivity, and functional magnetic resonance imaging (MRI) metrics. Seven study groups were evaluated along the ALS-FTD spectrum: healthy controls (HC), individuals with ALS without cognitive impairment (ALSnci), C9orf72-negative ALS-FTD, C9orf72-positive ALS-FTD, behavioral-variant FTD (bvFTD), nonfluent variant primary progressive aphasia (nfvPPA), and semantic variant PPA (svPPA). The integrity of the Broca's area, Wernicke's area, frontal aslant tract (FAT), arcuate fascicle (AF), inferior occipitofrontal fascicle (IFO), inferior longitudinal fascicle (ILF), superior longitudinal fascicle (SLF), and uncinate fascicle (UF) was quantitatively evaluated. The functional connectivity (FC) between Broca's and Wernicke' areas and FC along the FAT was also specifically assessed.
RESULTS
Patients with nfvPPA and svPPA exhibit distinctive patterns of gray and white matter degeneration in language-associated brain regions. Individuals with bvFTD exhibit Broca's area, right FAT, right IFO, and UF degeneration. The ALSnci group exhibits Broca's area atrophy and decreased FC along the FAT. Both ALS-FTD cohorts, irrespective of C9orf72 status, show bilateral FAT, AF, and IFO pathology. Interestingly, only C9orf72-negative ALS-FTD patients exhibit bilateral uncinate and right ILF involvement, while C9orf72-positive ALS-FTD patients do not.
CONCLUSIONS
Language-associated tracts and networks are not only affected in language-variant FTD phenotypes but also in ALS and bvFTD. Language domains should be routinely assessed in ALS irrespective of the genotype.
Topics: Humans; Frontotemporal Dementia; Amyotrophic Lateral Sclerosis; C9orf72 Protein; Brain; Language
PubMed: 37694825
DOI: 10.1002/brb3.3250 -
Arquivos de Neuro-psiquiatria Oct 2015The assessment of aphasics' cognitive performance is challenging and such patients are generally excluded from studies that describe cognitive deficits after stroke. We...
The assessment of aphasics' cognitive performance is challenging and such patients are generally excluded from studies that describe cognitive deficits after stroke. We evaluated aphasics' performance in cognitive tasks compared to non-aphasic subjects. A sample of 47 patients (21 aphasics, 17 non-aphasics with left hemisphere lesions and 9 non-aphasics with right hemisphere lesions) performed cognitive tasks (attention, verbal and visual memory, executive functions, visuospatial skills and praxis). Aphasic patients performed poorer than all non-aphasics in Digit Span (p < 0.001), Clock-Drawing Test (p = 0.006), Verbal memory (p = 0.002), Visual Memory (p < 0.01), Verbal Fluency (p < 0.001), and Gesture Praxis (p < 0.001). Aphasia severity correlated with performance in Trail Making test part B (p = 0.004), Digit Span forward (p < 0.001) and backwards (p = 0.011), and Gesture Praxis (p = 0.002). Aphasia is accompanied by deficits not always easy to be evaluated by cognitive tests due to speech production and motor impairments. Assessment of cognitive functions in aphasics might contribute to optimize therapeutic intervention.
Topics: Adult; Aged; Aged, 80 and over; Aphasia; Cognition Disorders; Executive Function; Female; Humans; Male; Memory; Middle Aged; Neuropsychological Tests; Severity of Illness Index; Speech Disorders; Statistics, Nonparametric; Stroke; Task Performance and Analysis; Vision Disorders
PubMed: 26465401
DOI: 10.1590/0004-282X20150133 -
Journal of Speech, Language, and... Nov 2022The aim of this study was to use acoustic and kinematic speech measures to characterize type of motor speech impairment-apraxia of speech (AOS) versus dysarthria-in...
PURPOSE
The aim of this study was to use acoustic and kinematic speech measures to characterize type of motor speech impairment-apraxia of speech (AOS) versus dysarthria-in individuals with four-repeat tauopathy (4RT)-associated syndromes, including nonfluent variant primary progressive aphasia (nfvPPA), primary progressive AOS (PPAOS), corticobasal syndrome (CBS), and progressive supranuclear palsy syndrome (PSPs).
METHOD
Twenty patient participants were recruited and stratified into two groups: (a) a motor-speech-impaired group of individuals with nfvPPA, PPAOS, CBS, or PSPs and suspected 4RT pathology ("MSI+") and (b) a non-motor-speech-impaired group of individuals with logopenic variant primary progressive aphasia ("MSI-"). Ten healthy, age-matched controls also participated in the study. Participants completed a battery of speech tasks, and 15 acoustic and kinematic speech measures were derived. Quantitative speech measures were grouped into feature categories ("AOS features," "dysarthria features," "shared features"). In addition to quantitative speech measures, two certified speech-language pathologists made independent, blinded auditory-perceptual ratings of motor speech impairment. A principal component analysis (PCA) was conducted to investigate the relative contributions of quantitative features.
RESULTS
Quantitative speech measures were generally concordant with independent clinician ratings of motor speech impairment severity. Hypothesis-driven groupings of quantitative measures differentiated predominantly apraxic from predominantly dysarthric presentations within the MSI+ group. PCA results provided additional evidence for differential profiles of motor speech impairment in the MSI+ group; heterogeneity across individuals is explained in large part by varying levels of overall severity-captured by the shared feature variable group-and degree of apraxia severity, as measured by the AOS feature variable group.
CONCLUSIONS
Quantitative features reveal heterogeneity of MSI in the 4RT group in terms of both overall severity and subtype of MSI. Results suggest the potential for acoustic and kinematic speech assessment methods to inform characterization of motor speech impairment in 4RT-associated syndromes.
SUPPLEMENTAL MATERIAL
https://doi.org/10.23641/asha.21401778.
Topics: Humans; Speech; Aphasia, Primary Progressive; Dysarthria; Biomechanical Phenomena; Primary Progressive Nonfluent Aphasia; Apraxias; Aphasia; Tauopathies; Acoustics
PubMed: 36306508
DOI: 10.1044/2022_JSLHR-22-00177 -
Journal of Speech, Language, and... Mar 2021Purpose Of the three currently recognized variants of primary progressive aphasia, behavioral differentiation between the nonfluent/agrammatic (nfvPPA) and logopenic...
Purpose Of the three currently recognized variants of primary progressive aphasia, behavioral differentiation between the nonfluent/agrammatic (nfvPPA) and logopenic (lvPPA) variants is particularly difficult. The challenge includes uncertainty regarding diagnosis of apraxia of speech, which is subsumed within criteria for variant classification. The purpose of this study was to determine the extent to which a variety of speech articulation and prosody metrics for apraxia of speech differentiate between nfvPPA and lvPPA across diverse speech samples. Method The study involved 25 participants with progressive aphasia (10 with nfvPPA, 10 with lvPPA, and five with the semantic variant). Speech samples included a word repetition task, a picture description task, and a story narrative task. We completed acoustic analyses of temporal prosody and quantitative perceptual analyses based on narrow phonetic transcription and then evaluated the degree of differentiation between nfvPPA and lvPPA participants (with the semantic variant serving as a reference point for minimal speech production impairment). Results Most, but not all, articulatory and prosodic metrics differentiated statistically between the nfvPPA and lvPPA groups. Measures of distortion frequency, syllable duration, syllable scanning, and-to a limited extent-syllable stress and phonemic accuracy showed greater impairment in the nfvPPA group. Contrary to expectations, classification was most accurate in connected speech samples. A customized connected speech metric-the narrative syllable duration-yielded excellent to perfect classification accuracy. Discussion Measures of average syllable duration in multisyllabic utterances are useful diagnostic tools for differentiating between nfvPPA and lvPPA, particularly when based on connected speech samples. As such, they are suitable candidates for automatization, large-scale study, and application to clinical practice. The observation that both speech rate and distortion frequency differentiated more effectively in connected speech than on a motor speech examination suggests that it will be important to evaluate interactions between speech and discourse production in future research.
Topics: Aphasia, Primary Progressive; Apraxias; Benchmarking; Humans; Semantics; Speech
PubMed: 33630653
DOI: 10.1044/2020_JSLHR-20-00445 -
Brain Connectivity May 2021Current neurocognitive models of language function have been primarily built from evidence regarding object naming, and their hypothesized white-matter circuit... (Observational Study)
Observational Study
Current neurocognitive models of language function have been primarily built from evidence regarding object naming, and their hypothesized white-matter circuit mechanisms tend to be coarse grained. In this cross-sectional, observational study, we used novel correlational tractography to assess the white-matter circuit mechanism behind , measured through action picture-naming performance in adults with chronic aphasia. The analysis identified tracts implicated in current neurocognitive dual-stream models of language function, including the left inferior fronto-occipital fasciculus, inferior longitudinal fasciculus, and arcuate fasciculus. However, the majority of tracts associated with verb retrieval were not ones included in dual-stream models of language function. Instead, they were projection pathways that connect frontal and parietal cortices to subcortical regions associated with motor functions, including the left corticothalamic pathway, frontopontine tract, parietopontine tract, corticostriatal pathway, and corticospinal tract. These results highlight that corticosubcortical projection pathways implicated in motor functions may be importantly related to language function. This finding is consistent with grounded accounts of cognition and may furthermore inform neurocognitive models. Impact statement This study suggests that in addition to traditional dual-stream language fiber tracts, the integrity of projection pathways that connect frontal and parietal cortices to subcortical motor regions may be critically associated with verb-retrieval impairments in adults with aphasia. This finding challenges neurological models of language function.
Topics: Adult; Aphasia; Brain; Cross-Sectional Studies; Diffusion Tensor Imaging; Humans; Magnetic Resonance Imaging; White Matter
PubMed: 33470167
DOI: 10.1089/brain.2020.0921 -
Journal of Stroke Sep 2019Digital therapeutics is an evidence-based intervention using high-quality software, with the sole purpose of treatment. As many healthcare systems are encountering high... (Review)
Review
Digital therapeutics is an evidence-based intervention using high-quality software, with the sole purpose of treatment. As many healthcare systems are encountering high demands of quality outcomes, the need for digital therapeutics is gradually increasing in the clinical field. We conducted review of the implications of digital therapeutics in the treatment of neurological deficits for stroke patients. The implications of digital therapeutics have been discussed in four domains: cognition, speech and aphasia, motor, and vision. It was evident that different forms of digital therapeutics such as online platforms, virtual reality trainings, and iPad applications have been investigated in many trials to test its feasibility in clinical use. Although digital therapeutics may deliver high-quality solutions to healthcare services, the medicalization of digital therapeutics is accompanied with many limitations. Clinically validated digital therapeutics should be developed to prove its efficacy in stroke rehabilitation.
PubMed: 31587534
DOI: 10.5853/jos.2019.01963 -
Biomedicines Jun 2024The cerebellum is emerging as a promising target for noninvasive brain stimulation (NIBS). A systematic review was conducted to evaluate the effects of cerebellar NIBS... (Review)
Review
The cerebellum is emerging as a promising target for noninvasive brain stimulation (NIBS). A systematic review was conducted to evaluate the effects of cerebellar NIBS on both motor and other symptoms in stroke rehabilitation, its impact on functional ability, and potential side effects (PROSPERO number: CRD42022365697). A systematic electronic database search was performed by using PubMed Central (PMC), EMBASE, and Web of Science, with a cutoff date of November 2023. Data extracted included study details, NIBS methodology, outcome measures, and results. The risk of bias in eligible studies was also assessed. Twenty-two clinical studies involving 1016 participants were finally included, with a focus on outcomes related to post-stroke motor recovery (gait and balance, muscle spasticity, and upper limb dexterity) and other functions (dysphagia and aphasia). Positive effects were observed, especially on motor functions like gait and balance. Some efficiency was also observed in dysphagia rehabilitation. However, findings on language recovery were preliminary and inconsistent. A slight improvement in functional ability was noted, with no serious adverse effects reported. Further studies are needed to explore the effects of cerebellar NIBS on post-stroke non-motor deficits and to understand how cerebellar engagement can facilitate more precise treatment strategies for stroke rehabilitation.
PubMed: 38927555
DOI: 10.3390/biomedicines12061348 -
Internal Medicine (Tokyo, Japan) Jun 2021
Topics: Aphasia; Humans; Motor Cortex; Syndrome
PubMed: 33431730
DOI: 10.2169/internalmedicine.6212-20