Connected Language in Primary Progressive Aphasia: Testing the Utility of Linguistic Measures in Differentially Diagnosing PPA and its Variants
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1
University of Maryland, College Park, Department of Hearing & Speech Sciences, United States
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2
Johns Hopkins University, Department of Neurology, United States
INTRODUCTION
Difficulty in using language is the primary impairment in Primary Progressive Aphasia (PPA). It is marked by a gradual decline in language production, object naming, syntax, or word comprehension abilities (Gorno-Tempini et al., 2011). However, some language decline is also characteristic of healthy aging, Mild Cognitive Impairment (MCI), and Alzheimer’s Dementia (AD). Hence, it is difficult to differentiate early PPA from healthy aging and related neurodegenerative diseases.
Currently, there is little uniformity in measures used to quantify language impairments in PPA. Individuals with different PPA variants have been shown to have unequal deficits in various domains of language. However, research has not focused on finding narrative tasks with simple administration procedures to aid in differentially diagnosing PPA. The present study had two goals 1) to identify characteristics of narrative language unique to PPA; and 2) to determine which measures of fluency, word retrieval, and syntax best differentiate PPA subtypes based on narrative language samples.
METHODS
This study was a retrospective analysis of data from the Transcranial Direct Current Stimulation (tDCS) for Primary Progressive Aphasia study at Johns Hopkins University (PI: Tsapkini) and the DementiaBank database (https://talkbank.org/DementiaBank/; Becker et al., 1994). Participants were 25 neurologically healthy English speakers, 20 individuals with MCI, 20 with AD, and 26 with PPA (non-fluent/agrammatic N=10, logopenic N=9, semantic N=7). Groups were matched for age and education (mean age=69 years, mean education=15 years). Language samples consisted of Cookie Theft picture descriptions (Goodglass & Kaplan, 1983) transcribed in the CHAT format. CLAN software programs (MacWhinney, 2000) were used to extract measures of fluency, word retrieval, and syntax.
RESULTS & DISCUSSION
With a significance threshold of p < .01 to correct for multiple comparisons, participants with PPA produced lower speech rates (F(1,3) = 12.615, p < .01), proportion of Correct Information Units (F(1,3) = 8.748, p < .01), and proportion of grammatical utterances (F(1,3) = 6.923, p < .01) than controls and participants with MCI. Additionally, participants with PPA produced higher numbers of disfluencies (F(1,3) = 9.713, p < .01), word retrieval errors (F(1,3) =7.437, p < .01), and total number of errors (F(1,3) = 10.828, p < .01) than control and MCI groups. PPA and AD groups did not differ on language measures (all ps > .01) (See Table 1). In the within-groups comparison, participants with agrammatic PPA were shown to have lower speech rates (K-W 2 = 15.016, df = 2, p < .01), idea density (K-W 2 = 11.043, df = 2, p < .01), MLU based on morphemes (K-W 2 = 13.987, df = 2, p < .01), and verbs/utterance (K-W 2 = 16.487, df = 2, p < .01) than participants with logopenic and semantic PPA. None of the measures tested significant between logopenic and semantic PPA.
These findings suggest that 1) although different impairments are characteristic of each PPA variant, there are some aspects of language that are impaired across PPA subtypes; and 2) brief elicitation tasks can provide a clinical basis for classifications of PPA and PPA variant discrimination.
References
REFERENCES
Becker, J.T., Boiler, F., Lopez, O.L., Saxton, J., & McGonigle, K.L. (1994). The natural history of Alzheimer’s disease: description of study cohort and accuracy of diagnosis. Archives of Neurology, 51(6), 585-594.
Goodglass, H. & Kaplan, E. (1983). Boston diagnostic aphasia examination. Media, PA: Williams & Wilkins.
Gorno-Tempini, M.L., Hillis, A.E., Weintraub, S., Kertesz, A., Mendez, M., Cappa, S.F…Grossman, M. (2011). Recommendations for the classification of primary progressive aphasia and its variants. Neurology, 76(11), 1006-1014.
MacWhinney B. (2000). The CHILDES project: Tools for analyzing talk, Vol 1: Transcription format and programs. 3. Mahwah, NJ: Erlbaum.
Keywords:
primary progressive aphasia,
Progressive non-fluent aphasia,
Semantic Dementia,
Logopenic progressive aphasia,
Narrative speech
Conference:
Academy of Aphasia 55th Annual Meeting , Baltimore, United States, 5 Nov - 7 Nov, 2017.
Presentation Type:
poster presentation
Topic:
Consider for student award
Citation:
Vander Woude
AD,
Faroqi-Shah
Y,
Ficek
B,
Webster
K and
Tsapkini
K
(2019). Connected Language in Primary Progressive Aphasia: Testing the Utility of Linguistic Measures in Differentially Diagnosing PPA and its Variants.
Conference Abstract:
Academy of Aphasia 55th Annual Meeting .
doi: 10.3389/conf.fnhum.2017.223.00112
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Received:
21 Apr 2017;
Published Online:
25 Jan 2019.
*
Correspondence:
Ms. Ashlyn D Vander Woude, University of Maryland, College Park, Department of Hearing & Speech Sciences, College Park, United States, vwoude@umd.edu