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Sentence repetition impairment in all variants of primary progressive aphasia

Naida L. Graham1, 2*, David Tang-Wai3, 4, Sandra E. Black4, 5, Carol Leonard6, Mario Masellis5, Sara Mitchell5, Maria Carmela Tartaglia3, 7, So-Yeun Jennifer Kim8 and Elizabeth Rochon1, 2
  • 1 University of Toronto, Department of Speech-Language Pathology, Canada
  • 2 Toronto Rehabilitation Institute, Canada
  • 3 Toronto Western Hospital, University Health Network Memory Clinic, Canada
  • 4 University of Toronto, Department of Medicine (Neurology), Canada
  • 5 Sunnybrook Health Sciences Centre, L.C. Campbell Cognitive Neurology Research Unit, Canada
  • 6 University of Ottawa, Department of Audiology and Speech-Language Pathology, Canada
  • 7 University of Toronto, Tanz Centre for Research in Neurodegenerative Diseases, Canada
  • 8 University of Toronto, Canada

Introduction Impairment in sentence repetition is a core diagnostic criterion for diagnosis of logopenic variant (lvPPA) primary progressive aphasia (PPA). Although the diagnostic criteria (Gorno-Tempini et al., 2011) do not specify the pattern of performance on sentence repetition for the nonfluent variant (nfvPPA), the implication is that it should differ from lvPPA. Nevertheless, studies have shown that it may be impaired in both variants (Leyton et al., 2014), although the underlying cause may differ: it may arise from verbal working memory impairment in lvPPA (Gorno-Tempini et al., 2008), and from grammatical processing impairment in nfvPPA (Leyton et al., 2012). In the semantic variant (svPPA), spared repetition is a subsidiary diagnostic feature. We investigated the assumption that individuals with different variants of PPA can be distinguished from each other and from controls, by their performance on sentence repetition. Method We evaluated performance on digit span, and two repetition tasks in 52 participants with PPA (9 lvPPA, 23 nfvPPA, 20 svPPA) matched on aphasia severity (Kertesz, 2007), and 20 controls. The first repetition task was sentence repetition from the Boston Diagnostic Aphasia Examination, comprising 16 sentences/phrases divided equally between high and low probability. The conditions are matched on length and are of similar syntactic complexity. The second task involved repetition of each of 10 multisyllabic words or phrases three times in a row (Duffy, 2013); this task reduced the load on verbal working memory and grammatical processing, but nevertheless required output that was comparable in length to a sentence. We expected that patients would find this less difficult than sentence repetition. Results Analyses of variance showed similar patterns of performance for each group on digit span, repetition of high probability sentences, and repetition of multisyllabic words three times in a row: the lvPPA and nfvPPA groups were significantly impaired relative to controls, while the svPPA group performed normally. On repetition of low probability sentences all of the patient groups were impaired. Discussion For the lvPPA and nfvPPA groups, the overall pattern of performance suggests that the sentence repetition impairment was associated with a problem in verbal working memory since these groups were impaired on both tasks. In svPPA, scores on these tasks were normal, but the impaired performance on low probability sentences may be due to poor comprehension of the stimuli; this is consistent with previous work (Patterson, Graham, & Hodges, 1994) demonstrating that svPPA patients were better at repeating word strings when they comprehended the words, and suggests stage dependent decline in sentence repetition, reflecting comprehension loss. The lvPPA and nfvPPA groups were impaired on repetition of multisyllabic words three times in a row. Thus, our attempt to reduce the load on working memory and grammatical processing did not facilitate repetition performance. Error analyses would help to further clarify the locus of impairment for each group on these repetition tasks. Conclusion Impairment in repetition of sentences is an essential diagnostic feature for lvPPA. Our results indicate that this is not unique to lvPPA, since impairment was demonstrated in all variants.

Acknowledgements

This work was supported by the Canadian Institutes of Health Research (grant numbers.
82744 and 130462).

References

Duffy, J. R. (2013). Motor Speech Disorders: Substrates, Differential Diagnosis and Management (Third ed.). St. Louis, Missouri: Elsevier, Mosby.
Gorno-Tempini, M. L., Brambati, S. M., Ginex, V., Ogar, J. M., Dronkers, N. F., Marcone, A., Perani, D., Garibotto, V., Cappa, S. F., & Miller, B. L. (2008). The logopenic/phonological variant of primary progressive aphasia. Neurology, 71, 1227-1234.
Gorno-Tempini, M. L., Hillis, A. E., Weintraub, S., Kertesz, A., Mendez, M., Cappa, S. F., Ogar, J. M., Rohrer, J. D., Black, S., Boeve, B. F., Manes, F., Dronkers, N. F., Vandenberghe, R., Rascovsky, K., Patterson, K., Miller, B. L., Knopman, D. S., Hodges, J. R., Mesulam, M. M., & Grossman, M. (2011). Classification of primary progressive aphasia and its variants. Neurology, 76, 1006-1014.
Kertesz, A. Western Aphasia Battery Revised. San Antonio, Harcourt Assessment, 2007.
Leyton, C. E., Piguet, O., Savage, S., Burrell, J., & Hodges, J. R. (2012). The neural basis of logopenic progressive aphasia. Journal of Alzheimer's Disease, 32, 1051-1059.
Leyton, C. E., Savage, S., Irish, M., Schubert, S., Piguet, O., Ballard, K. J., & Hodges, J. R. (2014). Verbal repetition in primary progressive aphasia and Alzheimer's disease. Journal of Alzheimer's Disease, 41, 575-585.
Patterson, K., Graham, N., & Hodges, J. R. (1994). The impact of semantic memory loss on phonological representations. Journal of Cognitive Neuroscience, 6, 57-69.

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Keywords: Progressive aphasia, working memory, Sentence repetition, word repetition, differential diagnosis

Conference: Academy of Aphasia 55th Annual Meeting , Baltimore, United States, 5 Nov - 7 Nov, 2017.

Presentation Type: poster presentation

Topic: General Submission

Citation: Graham NL, Tang-Wai D, Black SE, Leonard C, Masellis M, Mitchell S, Tartaglia M, Kim S and Rochon E (2019). Sentence repetition impairment in all variants of primary progressive aphasia. Conference Abstract: Academy of Aphasia 55th Annual Meeting . doi: 10.3389/conf.fnhum.2017.223.00019

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Received: 01 May 2017; Published Online: 25 Jan 2019.

* Correspondence: Dr. Naida L Graham, University of Toronto, Department of Speech-Language Pathology, Toronto, Ontario, Canada, naida.graham@cantab.net