Jean Neils-Strunjas

Cognition, language, and clinical pathological features of non-Alzheimer's dementias: An overview

UNLABELLED There are many distinct forms of dementia whose pharmacological and behavioral management differ. Differential diagnosis among the dementia variants currently relies upon a weighted combination of genetic and protein biomarkers, neuroanatomical integrity, and behavior. Diagnostic specificity is complicated by a high degree of overlap in the initial presenting symptoms across dementia subtypes. For this reason, reliable markers are of considerable diagnostic value. Communication disorders have proven to be among the strongest predictors for discriminating among dementia subtypes. As such, speech-language pathologists may be poised to make an increasingly visible contribution to dementia diagnosis and its ongoing management. The value and durability of this potential contribution, however, demands an improved discipline-wide knowledge base about the unique features associated with different dementia variants. To this end we provide an overview of cognition, language, and clinical pathological features of four of the most common non-Alzheimers dementias: frontotemporal dementia, vascular dementia, Lewy body disease dementia, and Parkinsons disease dementia. LEARNING OUTCOMES Readers will learn characteristics and distinguishing features of several non-Alzheimers dementias, including Parkinsons disease dementia, frontotemporal dementia, vascular dementia, and Lewy body dementia. Readers will also learn to distinguish between several variants of frontotemporal dementia. Finally, readers will gain knowledge of the term primary progressive aphasia as it relates to the aforementioned dementia etiologies.

A Comparison of Rating Scales Used in the Diagnosis of Extraesophageal Reflux

OBJECTIVE To evaluate the level of agreement between reflux area index scores, the reflux symptom index (RSI), and the reflux finding score (RFS). Inter- and intrarater reliability of the RFS was assessed. A criterion of pH 5 was used to evaluate its effects on agreement. STUDY DESIGN Adult participants were enrolled in this prospective study. METHODS Eighty-two participants (72 patients and 10 controls) completed the RSI, videoendoscopy, and 24-hour pH probe monitoring. The reflux area index for extraesophageal reflux (EER) events was calculated at pH 4 and 5. Two speech-language pathologists and one otolaryngologist independently rated 36 endoscopic examinations using the RFS through a web-based system. A repeated rating of six examinations was completed. RESULTS Chi-square revealed poor agreement between the diagnostic tools, regardless of which pH criterion was used. Intraclass correlation coefficients revealed fair interrater reliability of the RFS and moderate intrarater reliability. Independent-sample t tests for the RFS and reflux area index (RAI) scores failed to identify patients from normal controls. CONCLUSIONS The results of this study highlight the lack of agreement among the current available diagnostic tools for EER. Raters were not in agreement regarding the presence and severity of physical findings of EER. Results support the need for greater consensus among the clinical tools used in the diagnosis of EER. Physical rating scales may overidentify patients and would benefit from uniform scales and training. Assessing EER occurring at pH 5 may also yield important diagnostic information. Further research is needed to verify normative RAI cutpoints.

Use of fMRI in the study of chronic aphasia recovery after therapy: a case study.

Abstract Purpose: The role of intensity of aphasia therapy was investigated using functional magnetic resonance imaging (fMRI) to document changes in neural activation patterns associated with massed versus distributed therapy in an individual with chronic conduction aphasia. Method: Language therapy targeted word-finding deficits and phonological processing. fMRI scans were acquired at baseline, after massed therapy, and after distributed therapy. Results: Treatment was effective, as demonstrated by increases in performance on standardized measures, narrative analysis, and task performance in the fMRI scanner. Task improvement across fMRI testing sessions corresponded with increases in fMRI blood oxygenation level dependent (BOLD) signal. Greatest behavioral gains and BOLD signal increases occurred after massed therapy, with slight gains accompanying distributed therapy. Increases in fMRI BOLD signal occurred after therapy in left basal ganglia and right hemisphere frontotemporal cortex. Conclusions: Intensity of aphasia therapy impacts the recovery process and warrants additional research. Basal ganglia and right hemisphere structures may be important neural substrates for aphasia recovery.

Perseverative Writing Errors in a Patient with Alzheimer's Disease ☆ ☆☆

This study reports the writing performance of a dysgraphic patient with Alzheimers disease and moderate dementia who frequently perseverated on strokes and letters. Letter formation errors were also frequently produced. Oral spelling was superior to written spelling. The habitual style of writing (cursive writing) was significantly more prone to perseverations than writing in uppercase letters, a form of writing less frequently used by the patient. Central (linguistic) spelling processes were relatively preserved. The pattern of preserved and impaired functions is consistent with impairment of the peripheral mechanism that generates the graphic motor patterns code. We suggest that damage to the peripheral orthographic mechanism may cause deficits in some patients with Alzheimers disease.

'What's his name?' A comparison of elderly participants' and undergraduate students' misnamings

This study examined the effects of age on the types of errors produced when recalling names of faces. The types of errors included confusions (errors within the target set), intrusions (errors outside the target set), errors phonologically similar to the target, errors not phonologically similar to the target, and errors containing the same number of syllables as the target name. Participants included 49 elderly adults (57-85 years) and 48 undergraduate students (18-44 years). Age group had a significant effect on the number of name errors produced (n=681 for elderly and n=422 for undergraduates). Elderly participants produced more confusions than their younger counterparts; however, younger participants produced significantly more intrusions. The age groups also differed in their production of error names that were phonologically similar to the target name. The elderly participants produced more errors that were not phonologically similar to the target than the young adults. The results are discussed with regard to theories of name-face association and tip-of-the-tongue phenomena.

Cognitive intervention results in web-based videophone treatment adherence and improved cognitive scores.

Background We report findings from an intervention study using telehealth modalities to determine whether provision of telehealth services can improve access to care and increase adherence to cognitive therapy in veterans with mild traumatic brain injury (TBI) while matching traditional care in terms of outcomes. Material/Methods Veterans who were initially non-adherent to clinic-based cognitive therapy were offered a newly developed treatment. The control participants were selected from patient records of veterans who had completed cognitive treatment and matched to MOPS-VI participants on the basis of age, marital or relationship status, and composite memory index score. Baseline and post-treatment cognitive functioning as assessed by the Test of Memory and Learning 2nd Edition (TOMAL-2) was obtained for all participants. The MOPS-VI modules were designed to increase understanding of TBI and elicit problem-solving skills for attention and memory impairment. Results Sixty-seven percent of veterans (who were assigned to the MOPS-VI treatment group because they were initially non-adherent with the clinic-based treatment) completed the MOPS-VI telemedicine treatment. Results of a two-way analysis of Variance (ANOVA) comparing baseline and follow-up scores on the TOMAL-2 in the MOPS-VI and control groups revealed there was a significant pre-post assessment effect, indicating that participant’s memory and learning improved after treatment for both MOPS-VI and standard treatment groups. There was no significant difference between clinic-based treatment and MOPS-VI therapy. Conclusions Preliminary evidence supports the efficacy of the treatment, defined as increased compliance in completing the treatment program, and improvements in standardized memory and learning test results comparable to those following clinic-based treatment.

A case for genetics education: Collaborating with speech-language pathologists and audiologists†

Because speech‐language pathologists (SLPs) and audiologists (AUDs) are among the first referrals for parents of children exhibiting feeding, speech, language, hearing, and balance difficulties, it is important for SLP and AUD professionals to recognize genetic causes of and contributions to complex and Mendelian communication disorders. We review genetics in the curricula of speech‐language pathology and audiology programs and obstacles to its integration throughout curricula. We present suggestions about how SLPs and AUDs can aid in diagnosis and contribute their clinical expertise in characterizing phenotypes, followed with a review of a new genetics‐education website developed by the National Coalition for Health Professional Education in Genetics (NCHPEG), the University of Cincinnati, and the National Society of Genetic Counselors. The need to integrate genetics content into curricula and continuing education across disciplines is clear, as is the need for and benefit of multidisciplinary collaboration in patient care. The NCHPEG site for speech‐language pathology and audiology begins to address those needs and may serve as a practical model for future multidisciplinary collaborations between genetics professionals and other health professions.

Visual Discrimination Predicts Naming and Semantic Association Accuracy in Alzheimer Disease

ObjectiveLanguage impairment is a common symptom of Alzheimer disease (AD), and is thought to be related to semantic processing. This study examines the contribution of another process, namely visual perception, on measures of confrontation naming and semantic association abilities in persons with probable AD. MethodsTwenty individuals with probable mild-moderate Alzheimer disease and 20 age-matched controls completed a battery of neuropsychologic measures assessing visual perception, naming, and semantic association ability. Visual discrimination tasks that varied in the degree to which they likely accessed stored structural representations were used to gauge whether structural processing deficits could account for deficits in naming and in semantic association in AD. ResultsVisual discrimination abilities of nameable objects in AD strongly predicted performance on both picture naming and semantic association ability, but lacked the same predictive value for controls. Although impaired, performance on visual discrimination tests of abstract shapes and novel faces showed no significant relationship with picture naming and semantic association. These results provide additional evidence to support that structural processing deficits exist in AD, and may contribute to object recognition and naming deficits. ConclusionsOur findings suggest that there is a common deficit in discrimination of pictures using nameable objects, picture naming, and semantic association of pictures in AD. Disturbances in structural processing of pictured items may be associated with lexical-semantic impairment in AD, owing to degraded internal storage of structural knowledge.

Clinical Assessment Strategies: Evaluation of Language Comprehension and Production by Formal Test Batteries

Assessment of language may be conducted to further knowledge about a language disorder and underlying processes, but more commonly, testing is conducted for the patient’s benefit. In a patient-centered approach, the goals for testing include determining the normalcy of the patient’s language, and, if a language impairment exists, determining the cause of the language impairment. A patient- centered approach will also define the patient’s language deficits and ability to communicate in everyday situations. Age, sex, culture, languages spoken, and education have all been shown to affect test performance, and such factors need to be considered in the development of new tests and the collection of normative data.

Effectiveness of Systematic Articulation Training Program Accessing Computers (SATPAC) Approach to Remediate Dentalized and Interdental/S,Z/: A Preliminary Study:

Traditional methods for treating speech distortion errors in older school-age children have tended to yield mixed success. The current study was a preliminary evaluation of an alternative approach called the Systematic Articulation Training Program Accessing Computers (SATPAC), which was tested for the remediation of /s/ and /z/. Procedures involved a sequence of phonetic placement and/or oral-motor placement cues as needed to establish the targets, followed by concentrated drill structured around a facilitating context nonsense word and then advanced to more natural contexts. Participants were 18 children aged 6 years, 9 months to 11 years, 10 months. Treatment involved once per week, individual, 10-min. sessions with an experienced speech-language pathologist. Group A (n = 9) received 15 weeks of treatment, while treatment was delayed for Group B (n = 9). Then the groups were reversed. During period one, Group A (treated) significantly improved their accuracy of /s, z/ in spontaneous speech, while Group B (untreated) showed no significant change. During period two, Group B improved significantly when treatment was applied. The majority of the participants retained proficiency two years later.