Establishing Evidence-based Treatment for Speech and Language in Primary Progressive Aphasia

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Project Summary/Abstract Primary progressive aphasia (PPA) is a disorder characterized by gradual decline in communication ability caused by neurodegeneration of brain regions that support speech and language. PPA is a devastating condition that can affect adults as young as their 50’s, depriving them of the ability to communicate and function in society. The cognitive and neural bases of PPA have been well characterized and a growing evidence base supports the utility of speech-language treatment for this population. Based on this body of work, we are now poised to broaden and optimize treatment options for persons with PPA, adding cutting-edge neuromodulatory and behavioral techniques that leverage current technological and conceptual advances. The long-term objective of this project is to establish a more comprehensive continuum of care for persons with PPA by evaluating novel neuromodulatory and speech-language treatment methods addressing the communication deficits in PPA. The study has three main goals: 1) to evaluate the acceptability and benefit of remotely-supervised transcranial direct current stimulation (RS-tDCS) in conjunction with proven restitutive treatments for naming and speech production/fluency for persons with PPA 2) to identify baseline neural factors that relate to responsiveness to tDCS in PPA and 3) to evaluate the benefit of a novel, multifaceted, person-centered intervention designed to improve functional communication for individuals with PPA. In order to accomplish these aims, we will enroll 126 individuals with PPA who will undergo comprehensive assessment and virtual treatment, with a subset of participants receiving RS-tDCS in conjunction with speech-language intervention. The necessary recruitment and expertise to support the aims of this study will be facilitated by a longstanding collaboration with the University of California, San Francisco’s Memory and Aging Center and through a new collaboration with the University of New Mexico. This work will provide fundamental evidence regarding the efficacy of rehabilitation strategies across the severity continuum and phenotypic spectrum in PPA, with the potential to improve clinical care for individuals with this debilitating condition.