Rehabilitation and Prophylaxis of Anomia in Primary Progressive Aphasia

这个项目的长期目标是为临床医生提供一种基于科学的方法来确定 神经退行性疾病患者异常的最佳治疗(S)，包括原发进行性 失语症(PPA)和阿尔茨海默病(AD)。期望的结果是更长的保存期 对可以成功检索的词进行功能(预防)，对词进行改进(补救 在基线时无法成功检索到的信息。基于语义的治疗将与 基于词汇的治疗和维持治疗收益将在一个月、八个月、 治疗后15个月。参与者将是具有所有三种类型的PPA的人-语义(SVPPA)， 非流利/无语法(NfvPPA)和对数(LvPPA)--以及AD患者，他们有重要的单词- 发现问题(失范)。通过使用受试者内部设计，每个参与者都将获得 治疗，两个治疗组中有不同的项目。无法前往实验室的参与者 所需数量的治疗和评估会议将通过视频会议远程参加。 在基线上，将获得结构性MRI扫描，并将实施两个语义组：一个 包括基于概念的测试(无单词)和由基于词汇的测试组成的测试。结果是 这些测试组合将用于计算相对的词汇-语义/概念-语义损伤 对每个参与者进行测量。 根据提案中讨论的理论考虑，预测那些词汇量较大的人 功能障碍大于概念功能障碍对词汇的治疗效果更好。 基于语义的治疗优于基于语义的治疗，而那些概念障碍更大的人将 基于语义的治疗比基于词汇的治疗显示出更好的治疗效果。此外，它还 据预测，相对词汇-语义/概念-语义损害措施将提供 关于治疗效果的其他信息，以及可从 诊断亚组和人口统计变量。基线萎缩在预测治疗效果中的应用 也将进行测试；具体地说，据预测，在左侧颞极有基线萎缩的参与者 和/或左下颞回将更有可能表现出对未训练项目的泛化 与词汇处理条件相比，使用了语义处理。对技术的验证 改善PPA和AD患者的单词查找能力，从而提高交流能力，对 这些病人以及他们的家人和照顾者。并且能够根据科学数据确定， 对于特定的患者，哪种治疗方法最有可能取得成功，是每个临床医生的愿望。

The long-range goal of this project is to provide the clinician with a scientifically-based means of determining optimal treatment(s) for anomia in patients with neurodegenerative disorders, including primary progressive aphasia (PPA) and Alzheimer's disease (AD). The desired outcomes are a longer period of preservation of function (Prophylaxis) for words that can be retrieved successfully, and improvement (Remediation) for words that cannot be retrieved successfully at baseline. Semantically-based treatment will be compared with lexically-based treatment, and maintenance of treatment gains will be measured at one-month, eight months, and 15 months post-treatment. Participants will be persons with all three types of PPA -- semantic (svPPA), nonfluent/agrammatic (nfvPPA), and logopenic (lvPPA) -- and persons with AD who have significant word- finding problems (anomia). Through the use of a within-subjects design, each participant will receive both treatments, with different items in the two treatment sets. Participants who are unable to travel to the laboratory for the required number of treatment and evaluation sessions will participate remotely via videoconferencing. At baseline, structural MRI scans will be obtained, and two semantic batteries will be administered: one consisting of conceptually-based tests (without words), and one consisting of lexically-based tests. The results of these test batteries will be used to compute a Relative Lexical-Semantic/Conceptual-Semantic impairment measure for each participant. Based on theoretical considerations discussed in the proposal, it is predicted that persons whose lexical impairments are greater than their conceptual impairments will show greater treatment effects for lexically- based treatment than for semantically-based treatment, while those with a greater conceptual impairment will show greater treatment effects with a semantically-based treatment than a lexically-based treatment. Further, it is predicted that the Relative Lexical-Semantic/Conceptual-Semantic impairment measure will provide additional information about the treatment effects, above and beyond what can be obtained from the Diagnostic Subgroups and demographic variables. The use of baseline atrophy in predicting treatment effects will also be tested; Specifically, it is predicted that participants with baseline atrophy in the left temporal pole and/or the left inferior temporal gyrus will be more likely to demonstrate generalization to untrained items when semantic treatment is utilized, compared to the lexical treatment condition. The validation of techniques for improving word-finding, and hence communication, in persons with PPA and AD is of great significance for these patients and their families and caregivers. And being able to determine, on the basis of scientific data, which treatment is most likely to succeed for a given patient, is the aspiration of every clinician.