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Aging Clinical and Experimental Research Apr 2021Frontotemporal dementia (FTD) is the second most frequent dementia, after Alzheimer's, in patients under the age of 65. It encompasses clinical entities characterized by... (Meta-Analysis)
Meta-Analysis Review
Frontotemporal dementia (FTD) is the second most frequent dementia, after Alzheimer's, in patients under the age of 65. It encompasses clinical entities characterized by behavioral, language, and executive control dysfunction. Neurofilament light chain (NfL) is a new, non-disease specific, widely studied biomarker indicative of axonal injury and degeneration. Various studies have previously explored the role of NfL in the diagnostic process, monitoring, and prognosis of dementia. The current systematic review and meta-analysis include all the available data concerning the role of NfL in frontotemporal dementia and its use as a potential biomarker in differentiating patients with FTD from (a) healthy individuals, (b) Alzheimer's dementia, (c) Dementia with Lewy bodies, (d) Motor Neuron disease, (e) Parkinsonian syndromes, and (f) psychiatric disorders. We also analyze the utility of NfL in distinguishing specific FTD subgroups. Neurofilament light chain has a potential role in differentiating patients with frontotemporal dementia from healthy controls, patients with Alzheimer's dementia, and psychiatric disorders. Higher NfL levels were also noted in patients with semantic primary progressive aphasia (PPA) when compared with behavioral FTD and non-fluent PPA patients. Further studies exploring the use of NfL in frontotemporal dementia are needed.
Topics: Alzheimer Disease; Aphasia, Primary Progressive; Biomarkers; Frontotemporal Dementia; Humans; Intermediate Filaments; Neurofilament Proteins
PubMed: 32306372
DOI: 10.1007/s40520-020-01554-8 -
Brain and Language Nov 2023Studies on the efficacy of language treatment for multilingual people with post-stroke aphasia and its generalization to untreated languages have produced mixed results.... (Meta-Analysis)
Meta-Analysis Review
Studies on the efficacy of language treatment for multilingual people with post-stroke aphasia and its generalization to untreated languages have produced mixed results. We conducted a systematic review and a meta-analysis to examine within- and cross-language treatment effects and the variables that affect them. We searched PubMed, PsycINFO, CINAHL, and Google Scholar (February 2020; January 2023), identifying 40 studies reporting on 1573 effect sizes from 85 individuals. We synthesized effect sizes for treatment outcomes using a multi-level model to correct for multiple observations from the same individuals. The results showed significant treatment effects, with robust within-language treatment effects and weaker cross-language treatment effects. Age of language acquisition of the treatment language predicted within-language and cross-language effects. Our results suggest that treating multilingual people with aphasia in one language may generalize to their other languages, especially following treatment in an early-acquired language and a later-learned language that became the language of immersion.
Topics: Humans; Language; Aphasia; Multilingualism; Language Development; Treatment Outcome
PubMed: 37994828
DOI: 10.1016/j.bandl.2023.105326 -
Journal of Alzheimer's Disease : JAD 2023Semantic and Phonological fluency (SF and PF) are routinely evaluated in patients with Alzheimer's disease (AD). There are disagreements in the literature regarding... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Semantic and Phonological fluency (SF and PF) are routinely evaluated in patients with Alzheimer's disease (AD). There are disagreements in the literature regarding which fluency task is more affected while developing AD. Most studies focus on SF assessment, given its connection with the temporoparietal amnesic system. PF is less reported, it is related to working memory, which is also impaired in probable and diagnosed AD. Differentiating between performance on these tasks might be informative in early AD diagnosis, providing an accurate linguistic profile.
OBJECTIVE
Compare SF and PF performance in healthy volunteers, volunteers with probable AD, and patients with AD diagnosis, considering the heterogeneity of age, gender, and educational level variables.
METHODS
A total of 8 studies were included for meta-analysis, reaching a sample size of 1,270 individuals (568 patients diagnosed with AD, 340 with probable AD diagnosis, and 362 healthy volunteers).
RESULTS
The three groups consistently performed better on SF than PF. When progressing to a diagnosis of AD, we observed a significant difference in SF and PF performance across our 3 groups of interest (p = 0.04). The age variable explained a proportion of this difference in task performance across the groups, and as age increases, both tasks equally worsen.
CONCLUSION
The performance of SF and PF might play a differential role in early AD diagnosis. These tasks rely on partially different neural bases of language processing. They are thus worth exploring independently in diagnosing normal aging and its transition to pathological stages, including probable and diagnosed AD.
Topics: Humans; Semantics; Alzheimer Disease; Verbal Behavior; Neuropsychological Tests; Linguistics
PubMed: 37482994
DOI: 10.3233/JAD-221272 -
Journal of Neurosurgery. Pediatrics Oct 2023Awake craniotomy (AC) is employed to maximize tumor resection while preserving neurological function in eloquent brain tissue. This technique is used frequently in...
OBJECTIVE
Awake craniotomy (AC) is employed to maximize tumor resection while preserving neurological function in eloquent brain tissue. This technique is used frequently in adults but remains poorly established in children. Its use has been limited due to concern for children's neuropsychological differences compared with adults and how these differences may interfere with the safety and feasibility of the procedure. Among studies that have reported pediatric ACs, complication rates and anesthetic management vary. This systematic review was performed to comprehensively analyze outcomes and synthesize anesthetic protocols of pediatric ACs.
METHODS
The authors followed PRISMA guidelines to extract studies that reported AC in children with intracranial pathologies. The Medline/PubMed, Ovid, and Embase databases were searched from database inception to 2021, using the terms ("awake") AND ("Pediatric*" OR "child*") AND (("brain" AND "surgery") OR "craniotomy"). Data extracted included patient age, pathology, and anesthetic protocol. Primary outcomes assessed were premature conversion to general anesthesia, intraoperative seizures, completion of monitoring tasks, and postoperative complications.
RESULTS
Thirty eligible studies published from 1997 to 2020 were included that described a total of 130 children ranging in age from 7 to 17 years who had undergone AC. Of all patients reported, 59% were male and 70% had left-sided lesions. Procedure indications included the following etiologies: tumors (77.6%), epilepsy (20%), and vascular disorders (2.4%). Four (4.1%) of 98 patients required conversion to general anesthesia due to complications or discomfort during AC. In addition, 8 (7.8%) of 103 patients experienced intraoperative seizures. Furthermore, 19 (20.6%) of 92 patients had difficulty completing monitoring tasks. Postoperative complications occurred in 19 (19.4%) of 98 patients and included aphasia (n = 4), hemiparesis (n = 2), sensory deficit (n = 3), motor deficit (n = 4), or others (n = 6). The most commonly reported anesthetic techniques were asleep-awake-asleep protocols using propofol, remifentanil or fentanyl, a local scalp nerve block, and with or without dexmedetomidine.
CONCLUSIONS
The findings of this systematic review suggest the tolerability and safety of ACs in the pediatric population. Although pediatric intracranial pathologies pose etiologies that certainly may benefit from AC, there is a need for surgeons and anesthesiologists to perform individualized risk-benefit analyses due to the risks associated with awake procedures in children. Age-specific, standardized guidelines for preoperative planning, intraoperative mapping, monitoring tasks, and anesthesia protocols will help to continue minimizing complications, while improving tolerability, and streamlining workflow in the treatment of this patient population.
Topics: Adult; Humans; Male; Child; Adolescent; Female; Brain Neoplasms; Wakefulness; Retrospective Studies; Craniotomy; Postoperative Complications; Anesthetics; Seizures
PubMed: 37410631
DOI: 10.3171/2023.4.PEDS22296 -
Journal of Communication Disorders 2023Prosody serves central functions in language processing including linguistic functions (linguistic prosody), like structuring the speech signal. Impairments in... (Review)
Review
A systematic review on production and comprehension of linguistic prosody in people with acquired language and communication disorders resulting from unilateral brain lesions.
BACKGROUND
Prosody serves central functions in language processing including linguistic functions (linguistic prosody), like structuring the speech signal. Impairments in production and comprehension of linguistic prosody have been described for persons with unilateral right (RHDP) or left hemisphere damage (LHDP). However, reported results differ with respect to the characteristics and severities of these impairments AIMS: We conducted a systematic literature review focusing on production and comprehension of linguistic prosody at the prosody-syntax interface (i.e., phrase or sentence level) in LHDP and RHDP.
METHODS & PROCEDURES
In a systematic literature search we included: (i) empirical studies with (ii) adult RHDP and/or LHDP (iii) investigating production and/or comprehension of linguistic prosody at the (iv) phrase or sentence level (v) reporting quantitative data on prosodic measures. We excluded overview papers; studies involving participants with dysarthria, apraxia of speech, foreign accent syndrome, psychiatric diseases, and/or neurodegenerative diseases; studies focusing primarily on emotional prosody; and on lexical stress / word level; studies of which no full text was available and/or that were published in a language other than English. We searched the databases BIOSIS, MEDLINE, EMBASE, PubMed, Web of Science, CINAHL, Cochrane Library, PSYNDEX, PsycINFO and speechBITE, last searched on January 13 2022.We found 2,631 studies without duplicates. We identified 43 studies which were included into our systematic review. For data extraction and synthesis of results, we grouped studies by (i) modality (production vs. comprehension), (ii) function (syntactic structure vs. information structure), and (iii) by experiment task. For production studies, outcome measures were defined as the productive use of the different prosodic cues (lengthening, pause, f0, amplitude). For comprehension studies, performance measures (accuracy and reaction times) were defined as outcome measures. In accordance with the PRISMA 2020 statement (Page et al., 2021), we conducted a quality check to assess study risk of bias. Our review was pre-registered with PROSPERO (CRD42019120308).
OUTCOMES & RESULTS
Of the 43 studies reviewed, 30 studies involved RHDP (n = 309), assessing production in 15 studies and focusing on comprehension of prosody in 16 studies (one study investigated production and comprehension). LHDP (n = 438) were included in 35 studies of which 15 studied production and 21 evaluated comprehension of prosody (one study investigated production and comprehension). Despite the heterogeneity of results in the studies reviewed, our synthesis of results suggests that both LHDP and RHDP show limitations, but no complete impairment, in their production and/or comprehension of linguistic prosody. Prosodic limitations are evident in different areas of processing linguistic prosody, like syntactic disambiguation or the distinction between sentence types. There is a tendency towards more severe limitations in LHDP as compared to RHDP.
CONCLUSIONS
We only included published studies into our review and did not perform an assessment of risk of reporting bias as well as systematic certainty assessments of the outcomes. Despite these limitations, we conclude that both groups show deficits in production and comprehension of linguistic prosody, but neither LHDP nor RHDP are completely impaired in their prosodic processing. This suggests that prosody is a relevant communicative resource for LHDP and RHDP worth being addressed in speech-language-therapy.
Topics: Adult; Humans; Comprehension; Language; Linguistics; Communication Disorders; Brain; Speech Perception
PubMed: 36623377
DOI: 10.1016/j.jcomdis.2022.106298 -
The Journal of Craniofacial Surgery Sep 2022Syndrome of the trephined (SoT) is a severe complication following decompressive craniectomy resulting in neurological decline which can progress to aphasia, catatonia,... (Review)
Review
Syndrome of the trephined (SoT) is a severe complication following decompressive craniectomy resulting in neurological decline which can progress to aphasia, catatonia, and even death. While cranioplasty can reverse neurological symptoms of SoT, awareness of SoT is poor outside of the neurosurgery community. The authors performed a systematic review of the literature on SoT with a focus on reconstructive implications. Search terms "syndrome of the trephined" and "sunken flap syndrome" were applied to PubMed to identify primary studies through October 2021. Full-text review yielded 11 articles discussing SoT and reconstructive techniques or implications with 56 patients undergoing cranial reconstruction. Average age of the patients was 41.8±9.5 years. Sixty-three percent of the patients were male. The most common indication for craniectomy was traumatic brain injury (43%), followed by tumor resection (23%), intracerebral hemorrhage (11%), and aneurysmal subarachnoid hemorrhage (2%). Patients most commonly suffered from motor deficits (52%), decreased wakefulness (30%), depression or anxiety (21%), speech deficits (16%), headache (16%), and cognitive difficulties (2%). Time until presentation of symptoms following decompression was 4.4±8.9 months. Patients typically underwent cranioplasty with polyetheretherketone (48%), titanium mesh (21%), split thickness calvarial bone (16%), full thickness calvarial bone (14%), or split thickness rib graft (4%). Eight percent of patients required free tissue transfer for soft tissue coverage. Traumatic Brain Injury (TBI) was a risk factor for development of SoT when adjusting for age and sex (odds ratio: 8.2, 95% confidence interval: 1.2-8.9). No difference significant difference was observed between length until initial improvement of neurological symptoms following autologous versus allograft reconstruction (P=0.47). SoT can be a neurologically devastating complication of decompressive craniectomy which can resolve following urgent cranioplasty. Familiarity with this syndrome and its reconstructive implications is critical for the plastic surgery provider, who may be called upon to assist with these urgent cases.
Topics: Adult; Brain Injuries, Traumatic; Decompressive Craniectomy; Dental Implants; Female; Humans; Male; Middle Aged; Postoperative Complications; Plastic Surgery Procedures; Retrospective Studies; Skull; Syndrome
PubMed: 36054899
DOI: 10.1097/SCS.0000000000008724 -
International Journal of Stroke :... Oct 2023Aphasia is a common consequence of stroke, and people who live with this condition experience poor outcomes. Adherence to clinical practice guidelines can promote... (Review)
Review
BACKGROUND
Aphasia is a common consequence of stroke, and people who live with this condition experience poor outcomes. Adherence to clinical practice guidelines can promote high-quality service delivery and optimize patient outcomes. However, there are currently no high-quality guidelines specific to post-stroke aphasia management.
AIMS
To identify and evaluate recommendations from high-quality stroke guidelines that can inform aphasia management.
SUMMARY OF REVIEW
We conducted an updated systematic review in accordance with PRISMA guidelines to identify high-quality clinical guidelines published between January 2015 and October 2022. Primary searches were performed using electronic databases: PubMed, EMBASE, CINAHL, and Web of Science. Gray literature searches were conducted using Google Scholar, guideline databases, and stroke websites. Clinical practice guidelines were evaluated using the Appraisal of Guidelines and Research and Evaluation (AGREE II) tool. Recommendations were extracted from high-quality guidelines (scored > 66.7% on Domain 3: "Rigor of Development"), classified as aphasia-specific or aphasia-related, and categorized into clinical practice areas. Evidence ratings and source citations were assessed, and similar recommendations were grouped. Twenty-three stroke clinical practice guidelines were identified and 9 (39%) met our criteria for rigor of development. From these guidelines, 82 recommendations for aphasia management were extracted: 31 were aphasia-specific, 51 aphasia-related, 67 evidence-based, and 15 consensus-based.
CONCLUSION
More than half of stroke clinical practice guidelines identified did not meet our criteria for rigorous development. We identified 9 high-quality guidelines and 82 recommendations to inform aphasia management. Most recommendations were aphasia-related; aphasia-specific recommendation gaps were identified in three clinical practice areas: "accessing community supports," "return to work, leisure, driving," and "interprofessional practice."
Topics: Humans; Stroke; Aphasia; Databases, Factual; PubMed; Consensus
PubMed: 36803248
DOI: 10.1177/17474930231161454 -
American Journal of Speech-language... Oct 2022A systematic review (SR) represents a rigorous process of identifying and summarizing current research to answer specific clinical questions. Not all SRs present...
PURPOSE
A systematic review (SR) represents a rigorous process of identifying and summarizing current research to answer specific clinical questions. Not all SRs present high-quality information, because they do not adhere to established standards of conduct or reporting. This tutorial aims to (a) describe two tools developed in epidemiology for reporting (PRISMA 2020; Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and appraising (AMSTAR 2; A MeaSurement Tool to Assess Systematic Reviews) SRs and (b) exemplify the use of AMSTAR 2. First, we describe the intents of PRISMA 2020 and AMSTAR 2 and compare the items on each checklist. Next, we apply the AMSTAR 2 list of domains to critically appraise methodological quality in two randomly selected SRs, which describe aphasia treatment. Appraisal results are reported, including the AMSTAR 2 ratings for overall confidence in the results of each review. For each SR, the overall rating was , indicating that within the seven critical domains of AMSTAR 2, the SR had more than one critical weakness.
CONCLUSIONS
While PRISMA 2020 is a tool to guide preparation of SRs, to examine SR quality, the AMSTAR 2 is the tool of choice. Applied to two current aphasia treatment SRs, the AMSTAR 2 demonstrates that although both SRs were thorough, thoughtful summaries of a body of aphasia treatment literature, they did not achieve high ratings for methodological quality. Clinicians reading SRs are advised to familiarize themselves with quality assessment tools to assure that an SR meets expected criteria to document internal and external validity of the SR process, so resulting findings can be confidently applied for patients with aphasia.
Topics: Humans; Research Report; Checklist; Aphasia
PubMed: 35580235
DOI: 10.1044/2022_AJSLP-21-00288 -
Cureus Jul 2021Locked-in syndrome (LIS) is a neurological disorder in which there is damage to the ventral pons and caudal midbrain. An ischemic cause, such as basilar artery... (Review)
Review
Locked-in syndrome (LIS) is a neurological disorder in which there is damage to the ventral pons and caudal midbrain. An ischemic cause, such as basilar artery occlusion, can often lead to LIS. LIS has three subtypes: classical, partial, and total. There is loss of motion in the four extremities in classical LIS, loss of horizontal gaze, and aphasia. In partial LIS, the patient still has some motor function. Complete LIS has the worst outcome because patients cannot blink or have vertical gaze, thus rendering them incapable of communicating. Most cases of LIS occur due to ischemic infarcts. These patients require a great deal of physical rehabilitation to regain partial motor ability and a means to communicate. While the clinical features and pathophysiology are known, the prognosis and long-term treatment remain unknown. We conducted a systematic review using the Meta-Analysis Of Observational Studies in Epidemiology (MOOSE) protocol. We use an advanced PubMed strategy using the inclusion criteria of observational studies or clinical trials conducted in the last 20 years, written in English, and conducted on humans. We excluded systematic reviews, literature reviews, metanalysis, and studies that did not meet the outcomes of our objectives. The prognosis of LIS is not good, and most patients remain locked in, with poor quality of life, especially motor functions. Respiratory failure and depression are big comorbidities. In the acute setting, patients benefit from rapid intervention. The subacute treatment needs to manage aggressively to improve functional scores best. The long-term treatment focus is on the quality of life and managing comorbidities.
PubMed: 34471579
DOI: 10.7759/cureus.16727 -
Clinical Rehabilitation Mar 2022In clinical practice and research, standardised sets of data and outcomes are routinely collected to facilitate data comparison, benchmarking and quality improvement.... (Review)
Review
OBJECTIVE
In clinical practice and research, standardised sets of data and outcomes are routinely collected to facilitate data comparison, benchmarking and quality improvement. Most existing data sets are condition-specific and cannot be applied to all patients in a given clinical setting. This review aimed to determine whether the development of a minimum data set for subacute rehabilitation is feasible by collating and comparing existing rehabilitation minimum data sets and core outcome sets.
DATA SOURCES
Published literature was identified through database searches (Scopus, PubMed, EMBASE, CINAHL and the COMET Initiative) in September 2021. Additional data sets were identified through a grey literature search.
REVIEW METHODS
This review was conducted in alignment with the PRISMA-ScR recommendations. Datasets were included if they were published in English, designed for adults, and intended for use in subacute rehabilitation. Data were extracted and taxonomically organised to identify commonalities. Items present in ≥50% of data sets were considered common.
RESULTS
Twenty minimum data sets and seven core outcome sets were included. There were 29 common minimum data set domains, with 19 relating to , seven relating to , two relating to and one relating to . Four common domains were identified within the Core Outcome Set analysis, which all related to , specifically (86%) (57%) (86%) and (100%).
CONCLUSION
Common item domains in conditions requiring subacute rehabilitation have been identified, suggesting that development of a dataset for subacute rehabilitation may be feasible.
Topics: Adult; Humans; Medicine; Outcome Assessment, Health Care; Quality of Life
PubMed: 34873966
DOI: 10.1177/02692155211060468