Differentiating primary progressive aphasias in a brief sample of connected speech
Differentiating primary progressive aphasias in a brief sample of connected speech
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DOI：
10.1212/wnl.0b013e31829c5d0e
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发表时间：
2013-07-23
期刊：
影响因子：
9.9
通讯作者：
Grossman, Murray
中科院分区：
文献类型：
--
作者：
Ash, Sharon;Evans, Emily;Grossman, Murray
目的：一种无需特殊培训即可实施和评分的简短言语表达方案，将有助于原发性进行性失语症（PPA）三种主要形式的鉴别诊断：非流利型/语法缺失型PPA、命名障碍变异型PPA和语义变异型PPA。
方法：我们采用图片描述任务来获取简短的言语样本，并评估语音产生、语速、词汇检索和语法性方面的损伤。我们将结果与通过一个更长的、先前已验证的方案所获得的结果进行比较，并通过多模态成像进一步验证表现，以评估缺陷的神经解剖学基础。
结果：我们发现每种PPA变异型都有不同的语法受损模式，并且每种变异型在其他语言产生特征方面也存在损伤：非流利型/语法缺失型PPA的特点是语音错误；命名障碍变异型PPA表现为不流利（错误起始和犹豫）；语义变异型PPA表现为名词检索不佳。在这个简短的言语样本和一个更长的叙述性言语样本之间发现了很强的相关性。语法性的综合测量以及其他言语产生的测量与每种PPA变异型中不同的灰质萎缩区域以及白质分数各向异性降低相关。
结论：这些发现提供了证据，表明流畅、符合语法的表达需要大规模网络；这些网络在PPA综合征中可能会被选择性地破坏；对简短言语样本的定量分析可以揭示相应的独特言语特征。
Objective: A brief speech expression protocol that can be administered and scored without special training would aid in the differential diagnosis of the 3 principal forms of primary progressive aphasia (PPA): nonfluent/agrammatic PPA, logopenic variant PPA, and semantic variant PPA.Methods: We used a picture-description task to elicit a short speech sample, and we evaluated impairments in speech-sound production, speech rate, lexical retrieval, and grammaticality. We compared the results with those obtained by a longer, previously validated protocol and further validated performance with multimodal imaging to assess the neuroanatomical basis of the deficits.Results: We found different patterns of impaired grammar in each PPA variant, and additional language production features were impaired in each: nonfluent/agrammatic PPA was characterized by speech-sound errors; logopenic variant PPA by dysfluencies (false starts and hesitations); and semantic variant PPA by poor retrieval of nouns. Strong correlations were found between this brief speech sample and a lengthier narrative speech sample. A composite measure of grammaticality and other measures of speech production were correlated with distinct regions of gray matter atrophy and reduced white matter fractional anisotropy in each PPA variant.Conclusions: These findings provide evidence that large-scale networks are required for fluent, grammatical expression; that these networks can be selectively disrupted in PPA syndromes; and that quantitative analysis of a brief speech sample can reveal the corresponding distinct speech characteristics.