Non-fluent speech in frontotemporal lobar degeneration

We investigated the cognitive and neural bases of impaired speech fluency, a central feature of primary progressive aphasia. Speech fluency was assessed in 35 patients with frontotemporal lobar degeneration (FTLD) who presented with progressive non-fluent aphasia (PNFA, n=11), semantic dementia (SemD, n=12), or a social and executive disorder without aphasia (SOC/EXEC, n=12). Fluency was quantified as the number of words per minute in an extended, semi-structured speech sample. This was related to language characteristics of the speech sample and to neuropsychological measures. PNFA patients were significantly less fluent than controls and other FTLD patients. Fluency correlated with grammatical expression but not with speech errors or executive difficulty. SemD and SOC/EXEC patients were also less fluent than controls. In SemD, fluency was associated with semantically limited content. In SOC/EXEC, fluency was associated with executive limitations. Voxel-based morphometry analyses of high-resolution MRI related fluency to gray matter volume in left inferior frontal, insula, and superior temporal regions for the entire cohort of FTLD patients. This region overlapped partially distinct atrophic areas in each FTLD subgroup. It thus appears to play a crucial role in speech fluency, which can be interrupted in different ways in different FTLD subgroups.

[1]  Bruce L. Miller,et al.  Progressive Nonfluent Aphasia and Its Characteristic Motor Speech Deficits , 2007, Alzheimer disease and associated disorders.

[2]  Harry A. Whitaker,et al.  Studies in neurolinguistics , 1976 .

[3]  O. Selnes.  A Compendium of Neuropsychological Tests , 1991, Neurology.

[4]  M. Alexander,et al.  Broca's area aphasias , 1990, Neurology.

[5]  Howard J. Rosen,et al.  Distinctive Neuropsychological Patterns in Frontotemporal Dementia, Semantic Dementia, And Alzheimer Disease , 2003, Cognitive and behavioral neurology : official journal of the Society for Behavioral and Cognitive Neurology.

[6]  M. Freedman,et al.  Frontotemporal lobar degeneration , 1998, Neurology.

[7]  W. Levelt,et al.  The spatial and temporal signatures of word production components , 2004, Cognition.

[8]  Murray Grossman,et al.  Sentence Processing in Frontotemporal Dementia , 2005, Cortex.

[9]  B. Miller,et al.  Performance in Specific Language Tasks Correlates With Regional Volume Changes in Progressive Aphasia , 2007, Cognitive and behavioral neurology : official journal of the Society for Behavioral and Cognitive Neurology.

[10]  Mercer Mayer,et al.  Frog, Where Are You? , 1969 .

[11]  Stephen M Smith,et al.  Fast robust automated brain extraction , 2002, Human brain mapping.

[12]  M. Weiner,et al.  Cognition and anatomy in three variants of primary progressive aphasia , 2004, Annals of neurology.

[13]  A. Hillis,et al.  Deterioration of naming nouns versus verbs in primary progressive aphasia , 2004, Annals of neurology.

[14]  Robert A. Bornstein,et al.  The Wechsler Memory Scale—Revised , 1990 .

[15]  Sophie K. Scott,et al.  The functional neuroanatomy of prelexical processing in speech perception , 2004, Cognition.

[16]  J. Hodges,et al.  When More Yields Less: Speaking and Writing Deficits in Nonfluent Progressive Aphasia , 2004, Neurocase.

[17]  A. Kertesz,et al.  Pragmatics in frontal lobe dementia and primary progressive aphasia , 1998, Journal of Neurolinguistics.

[18]  B Miller,et al.  Clinical and pathological diagnosis of frontotemporal dementia: report of the Work Group on Frontotemporal Dementia and Pick's Disease. , 2001, Archives of neurology.

[19]  Mark D'Esposito,et al.  Progressive Nonfluent Aphasia: Language, Cognitive, and PET Measures Contrasted with Probable Alzheimer's Disease , 1996, Journal of Cognitive Neuroscience.

[20]  Clinical and neuropathological criteria for frontotemporal dementia. The Lund and Manchester Groups. , 1994, Journal of neurology, neurosurgery, and psychiatry.

[21]  J. Mohr,et al.  Broca’s Area and Broca’s Aphasia (1976) , 2006 .

[22]  M. Lezak.  Neuropsychological assessment, 3rd ed. , 1995 .

[23]  J. Trojanowski,et al.  Cognitive and motor assessment in autopsy-proven corticobasal degeneration , 2007, Neurology.

[24]  Philip Lieberman,et al.  Speech production, syntax comprehension, and cognitive deficits in Parkinson's disease , 1992, Brain and Language.

[25]  Kirrie J. Ballard,et al.  Patterns of language decline in non-fluent primary progressive aphasia , 1997 .

[26]  D. Stuss,et al.  Neuropsychological studies of the frontal lobes. , 1984, Psychological bulletin.

[27]  K. W. Hunt.  Grammatical structures written at three grade levels , 1965 .

[28]  A. Friederici,et al.  Auditory Language Comprehension: An Event-Related fMRI Study on the Processing of Syntactic and Lexical Information , 2000, Brain and Language.

[29]  D. Poeppel,et al.  The cortical organization of speech processing , 2007, Nature Reviews Neuroscience.

[30]  J. Gee,et al.  What's in a name: voxel-based morphometric analyses of MRI and naming difficulty in Alzheimer's disease, frontotemporal dementia and corticobasal degeneration. , 2003, Brain : a journal of neurology.

[31]  Katy A. Cross,et al.  Patterns of neuropsychological impairment in frontotemporal dementia , 2007, Neurology.

[32]  O. Spreen,et al.  Comprar A Compendium of Neuropsychological Tests - Administration, Norms, and Commentary | Esther Strauss | 9780195159578 | Oxford University Press , 2009 .

[33]  Harold Goodglass,et al.  Contrasting cases of Italian agrammatic aphasia without comprehension disorder , 1983, Brain and Language.

[34]  Alfonso Caramazza,et al.  Modality-Specific Deterioration in Naming Verbs in Nonfluent Primary Progressive Aphasia , 2002, Journal of Cognitive Neuroscience.

[35]  Murray Grossman,et al.  Syntactic and thematic components of sentence processing in progressive nonfluent aphasia and nonaphasic frontotemporal dementia , 2007, Journal of Neurolinguistics.

[36]  Sandra Weintraub,et al.  Primary progressive aphasia: longitudinal course, neuropsychological profile, and language features , 1995 .

[37]  Guy B. Williams,et al.  Progressive non-fluent aphasia is associated with hypometabolism centred on the left anterior insula. , 2003, Brain : a journal of neurology.

[38]  N. Dronkers.  A new brain region for coordinating speech articulation , 1996, Nature.

[39]  M. Grossman,et al.  Trying to tell a tale , 2006, Neurology.

[40]  Matthew A. Lambon Ralph,et al.  Naming in semantic dementia—what matters? , 1998, Neuropsychologia.

[41]  Jennifer Farmer,et al.  Distinct antemortem profiles in patients with pathologically defined frontotemporal dementia. , 2007, Archives of neurology.

[42]  Guido F. Schauer,et al.  Neuroanatomical correlates of behavioural disorders in dementia. , 2005, Brain : a journal of neurology.

[43]  C. Reynolds,et al.  Wechsler memory scale-revised , 1988 .

[44]  Stephen M. Smith,et al.  Hidden Markov random field model and segmentation of brain MR images , 2001 .

[45]  R. Poldrack,et al.  Recovering Meaning Left Prefrontal Cortex Guides Controlled Semantic Retrieval , 2001, Neuron.

[46]  J. Hodges,et al.  Semantic dementia: a unique clinicopathological syndrome , 2007, The Lancet Neurology.

[47]  J. Gee,et al.  Large-scale neural network for sentence processing , 2006, Brain and Language.

[48]  M. Rogers,et al.  Dissolution of spoken language in primary progressive aphasia , 1998 .

[49]  Bruce L. Miller,et al.  Anatomical Correlates of Sentence Comprehension and Verbal Working Memory in Neurodegenerative Disease , 2007, The Journal of Neuroscience.

[50]  C. Jack,et al.  Progressive aphasia secondary to Alzheimer disease vs FTLD pathology , 2008, Neurology.

[51]  Murray Grossman,et al.  Sentence comprehension and voxel-based morphometry in progressive nonfluent aphasia, semantic dementia, and nonaphasic frontotemporal dementia , 2008, Journal of Neurolinguistics.

[52]  C. Fiebach,et al.  The role of left inferior frontal and superior temporal cortex in sentence comprehension: localizing syntactic and semantic processes. , 2003, Cerebral cortex.

[53]  Raymond Scott Turner,et al.  Clinical, neuroimaging, and pathologic features of progressive nonfluent aphasia , 1996, Annals of neurology.

[54]  K. Rankin,et al.  Anatomical correlates of early mutism in progressive nonfluent aphasia , 2006, Neurology.

[55]  G. Canter,et al.  Contrasting speech patterns in apraxia of speech and phonemic paraphasia , 1985, Brain and Language.

[56]  Donald T. Stuss,et al.  Frontal lobes and language , 1989, Brain and Language.

[57]  J. Gee,et al.  Geodesic estimation for large deformation anatomical shape averaging and interpolation , 2004, NeuroImage.

[58]  M. Grossman,et al.  Primary Progressive Aphasia: A Review , 2004, Neurocase.

[59]  Jennifer L. Whitwell,et al.  Clinicopathological and imaging correlates of progressive aphasia and apraxia of speech. , 2006, Brain : a journal of neurology.

[60]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[61]  Julie S. Snowden,et al.  Fronto-Temporal Lobar Degeneration: Fronto-Temporal Dementia, Progressive Aphasia, Semantic Dementia , 1996 .

[62]  M. Farah,et al.  Role of left inferior prefrontal cortex in retrieval of semantic knowledge: a reevaluation. , 1997, Proceedings of the National Academy of Sciences of the United States of America.

[63]  M. Grossman,et al.  Verb Comprehension in Frontotemporal Degeneration: The Role of Grammatical, Semantic and Executive Components. , 2001, Neurocase.

[64]  D. Swinney,et al.  Response of anterior temporal cortex to syntactic and prosodic manipulations during sentence processing , 2005, Human brain mapping.

[65]  D. Neary,et al.  Semantic dementia: a form of circumscribed cerebral atrophy , 1995 .