Why are patients with progressive nonfluent aphasia nonfluent?
Why are patients with progressive nonfluent aphasia nonfluent?
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DOI：
10.1212/wnl.0b013e3181ed9c7d
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发表时间：
2010-08-17
期刊：
影响因子：
9.9
通讯作者：
Grossman, M.
中科院分区：
文献类型：
--
作者：
Gunawardena, D.;Ash, S.;Grossman, M.
目的：探讨进行性非流利失语症 (PNFA) 患者言语不流利的认知和神经基础。背景：言语不流利是 PNFA 的标志性特征，这归因于这些患者也出现句法处理、运动言语计划和执行功能的损伤。 PNFA 患者左下额叶萎缩。方法：对 16 名 PNFA 患者、12 名行为变异型额颞叶痴呆 (bvFTD) 患者和 13 名年龄匹配的对照者进行了大型半结构化语音样本以及语言和执行功能的神经心理学测量。半结构化语音样本中的语音流畅度被量化为每分钟单词数 (WPM)。逐步线性回归分析用于将 WPM 与患者功能的语法、运动言语计划和执行方面联系起来。然后使用结构 MRI 将这些测量值与 8 名 PNFA 患者和 7 名 bvFTD 患者的皮质厚度相关联。结果：相对于对照组和 bvFTD 患者，PNFA 患者的 WPM 显着降低。回归分析显示，在 PNFA 中，只有语法测量可以预测 WPM，而在 bvFTD 中，执行测量是 WPM 的唯一显着预测因子。相对于对照组，PNFA 的左下额叶和前上颞区皮质变薄显着，回归分析将该区域与 PNFA 中 WPM 的减少相关联。 PNFA 患者的左额下颞叶区也出现了与有限的语法处理相关的显着皮层变薄，并且这与与 WPM 减少相关的额颞叶变薄区域重叠。 结论：PNFA 患者言语不流利的部分原因可能是与左下额叶和前上颞叶疾病相关的语法处理困难。神经病学(R)2010; 75：588-594
Objective: To investigate the cognitive and neural basis for nonfluent speech in progressive nonfluent aphasia (PNFA).Background: Nonfluent speech is the hallmark feature of PNFA, and this has been attributed to impairments in syntactic processing, motor-speech planning, and executive functioning that also occur in these patients. Patients with PNFA have left inferior frontal atrophy.Methods: A large semi-structured speech sample and neuropsychological measures of language and executive functioning were examined in 16 patients with PNFA, 12 patients with behavioral-variant frontotemporal dementia (bvFTD), and 13 age-matched controls. Speech fluency was quantified as words per minute (WPM) in the semi-structured speech sample. Stepwise linear regression analyses were used to relate WPM to grammatic, motor-speech planning, and executive aspects of patient functioning. These measures were then related to cortical thickness in 8 patients with PNFA and 7 patients with bvFTD using structural MRI.Results: WPM was significantly reduced in patients with PNFA relative to controls and patients with bvFTD. Regression analyses revealed that only grammatic measures predicted WPM in PNFA, whereas executive measures were the only significant predictor of WPM in bvFTD. Cortical thinning was significant in PNFA relative to controls in left inferior frontal and anterior-superior temporal regions, and a regression analysis related this area to reduced WPM in PNFA. Significant cortical thinning associated with limited grammatic processing also was seen in the left inferior frontal-superior temporal region in PNFA, and this overlapped with the area of frontal-temporal thinning related to reduced WPM.Conclusion: Nonfluent speech in PNFA may be due in part to difficulty with grammatic processing associated with left inferior frontal and anterior-superior temporal disease. Neurology (R) 2010; 75: 588-594