Early Detection and Treatment of Emerging Cognitive-Linguistic Impairment in Minority Cognitive Aging and Primary Progressive Aphasia

项目总结/摘要 痴呆症是工业化国家面临的最严峻的公共卫生危机之一。许多国家， 包括美国在内的10个国家最近通过了全面的国家痴呆症战略。 国家痴呆症战略（第2B节）确定了早期诊断和与社区治疗的联系 服务作为其管理计划的支柱。循证门诊治疗的可用性 进行性语言障碍仍然非常罕见。2014年，我们开始通过一个 纵向干预，目标是在两年时间内维持100个单词的核心词汇。 这种对学生友好的处理方法在促进学生对关键词汇的记忆方面显示出很大的希望， 额颞叶退化症和阿尔茨海默病第二个目的是评估对未来的预测。 语言遗忘我们在项目初期学到了很多东西，它的更新有可能 来告诉我们更多我们目前的建议包括三个目标，所有这些目标都与美国直接一致， 国家痴呆症战略和我们资助机构的使命（即，国家耳聋研究所 3在具体目标1（SA 1）中，我们将评估 一种非侵入性脑刺激（经颅直流电刺激）方案， 颞叶作为我们正在进行的语义行为治疗的辅助手段。我们将使用交叉 两组语义变异型原发性进行性失语症患者完成假手术， 主动刺激条件与行为治疗配对（顺序平衡）。我们随后将 随访该患者队列两年以上，以评估治疗收益的持久性。在SA 2中，我们将评估 在服务严重不足的人群中出现认知语言障碍的预测因子（即，非洲老人 美国成年人）。我们将确定老年人谁是在转换为轻度认知风险增加 通过整体认知和语言测量指数的损害。然后我们将跟踪并描述这一点 使用敏感行为（视觉对抗命名期间的凝视模式）和 神经心理学指标最后，在SA 3中，我们将评估抽象的表示，处理和转换 词义作为年龄、病理和个体差异的函数（例如，词汇量，年数 教育）使用机器学习。这一更新反映了一个富有成效的和严格的生产线的延续， 研究，将产生有关人类语义记忆的补充数据，促进 语言的保持，以及与年龄相关的语言变化的可变性。

PROJECT SUMMARY/ABSTRACT Dementia is among the most daunting public health crises facing industrialized nations. Many countries, including the United States,1 have recently adopted comprehensive national dementia strategies.2 The US National Dementia Strategy (section 2B) has identified early diagnosis and links to community treatment services as pillars of its management plan. The availability of evidence-based outpatient treatment for progressive language impairments remains exceedingly sparse. In 2014, we began to address this void via a longitudinal intervention targeting maintenance of a core vocabulary consisting of 100 words over two years. This caregiver-friendly treatment is showing great promise for promoting the retention of key vocabulary in frontotemporal degeneration and Alzheimer's Disease. A secondary aim involved evaluating prediction of later language forgetting. We have learned much during this initial project period, and its renewal has the potential to tell us much more. Our current proposal consists of three aims, all of which directly align both with the US National Dementia Strategy and the mission of our funding institute (i.e., the National Institute on Deafness and Other Communication Disorders).3 In Specific Aim 1 (SA1), we will evaluate the long-term effectiveness of a regimen of noninvasive brain stimulation (transcranial direct current stimulation) delivered over the anterior temporal lobes as an adjuvant to our ongoing semantic behavioral treatment. We will do so using a crossover design where two groups of patients with semantic variant Primary Progressive Aphasia complete sham and active stimulation conditions paired with behavioral treatment (order counterbalanced). We will subsequently follow this patient cohort over two years to evaluate the durability of treatment gains. In SA2, we will evaluate predictors of emerging cognitive-linguistic impairment in a vastly underserved population (i.e., older African American adults). We will identify older adults who are at increased risk for conversion to mild cognitive impairment as indexed by global cognitive and language measures. We will then follow and characterize this prospective cohort using sensitive behavioral (gaze patterns during visual confrontation naming) and neuropsychological markers. Finally, in SA3 we will evaluate representation, processing, and shifts in abstract word meaning as functions of age, pathology, and individual differences (e.g., vocabulary size, years of education) using machine learning. This renewal reflects the continuation of a productive and rigorous line of research that will yield complementary data about human semantic memory, best practices in promoting language maintenance, and variability of age-associated language change.