Background:Generalization of speech-language pathology treatment is an important goal in clinical practice and research. Functional communication rating scales are often used to investigate potential treatment effects in daily life. Connected speech samples more closely reflect meaningful changes in communication as a result of treatment than test/re-test outcomes. Little attention has been directed to this relationship in aphasia due to neurodegenerative etiologies. Aims:We investigated whether correlations between ratings on the Georgetown University Center for Aphasia Research and Rehabilitation Functional Communication Scale (CARR-FCS) and total content units (CUs) from spoken descriptions of the Cookie Theft Picture from the Boston Diagnostic Aphasia Examination (CTP-BDAE), versus correlations with scores on the Boston Naming Test (BNT), differed among variants of primary progressive aphasia (PPA) at baseline testing and 6-12 month follow-up (ClinicalTrials.gov Identifier: NCT02675270). At baseline and follow-up, for semantic variant PPA (svPPA), we hypothesized that performance on picture description will correlate more strongly with the CARR-FCS, compared to confrontation naming, as those with svPPA tend to have especially poor performance on confrontation naming [compared to logopenic variant PPA (lvPPA) and nonfluent agrammatic PPA (nfaPPA)], a task that may not be reflective of functional communication ability because communication via other means (e.g., circumlocutions) is not captured. We did not expect to find this effect in lvPPA or nfaPPA because, although anomia is present in all PPA variants, it is less severely compromised in these variants. At follow-up, for nfaPPA, we hypothesized that performance on picture description will correlate more strongly with the CARR-FCS, compared to confrontation naming, because those with nfaPPA can have a marked decline in confrontation naming due to worsening apraxia of speech. Methods and Procedures:At two time points, we calculated correlation coefficients between care partners' ratings on the CARR-FCS and total CUs from spoken descriptions of the CPT-BDAE and BNT scores of individuals with PPA. We compared the size of the correlations. Outcomes and Results:Correlations were significantly stronger between total CUs and ratings on the CARR-FCS, compared to BNT scores and CARR-FCS ratings, for svPPA at both time points, but were not significantly different for lvPPA and nfaPPA. Conclusions:These findings suggest that, while confrontation naming performance may be a proxy for functional communication in lvPPA and nfaPPA, a measure of connected speech is more representative of functional communication in svPPA because confrontation naming is typically more impaired in svPPA than in either of the other two variants.

The underlying causes of reading impairment in neurodegenerative disease are not well understood. The current study seeks to determine the causes of surface alexia and phonological alexia in primary progressive aphasia (PPA) and typical (amnestic) Alzheimer’s disease (AD). Participants included 24 with the logopenic variant (lvPPA), 17 with the nonfluent/agrammatic variant (nfvPPA), 12 with the semantic variant (svPPA), 19 with unclassifiable PPA (uPPA), and 16 with AD. Measures of Surface Alexia and Phonological Alexia were computed by subtracting control-condition word reading accuracy from irregular word reading and pseudoword reading accuracy, respectively. Cases of Surface Alexia were common in svPPA, lvPPA, uPPA, and AD, but not in nfvPPA. At the subgroup level, average Surface Alexia was significantly higher in svPPA, lvPPA, and uPPA, compared to unimpaired age-matched controls. Cases of Phonological Alexia were common in nfvPPA, lvPPA, and uPPA, and average Phonological Alexia was significantly higher in these subgroups, compared to unimpaired age-matched controls. Behavioral regression results indicated that Surface Alexia can be predicted by impairment in the lexical-semantic processing of nouns, suggesting that a lexical-semantic deficit is required for the development of surface alexia, while cortical volume regression results indicated that Surface Alexia can be predicted by reduced volume in the left Superior Temporal Pole, which has been associated with conceptual-semantic processing. Behavioral regression results indicated that Phonological Alexia can be predicted by impairment on Pseudoword Repetition, suggesting that this type of reading difficulty may be due to impaired phonological processing. The cortical volume regression results suggested that Phonological Alexia can be predicted by reduced volume within the left Inferior Temporal Gyrus and the left Angular Gyrus, areas that are associated with lexical-semantic processing and phonological processing, respectively.

INTRODUCTIONInterventions to treat speech-language difficulties in primary progressive aphasia (PPA) often use word accuracy as a highly comparable outcome. However, there are more constructs of importance to people with PPA that have received less attention.METHODSFollowing Core Outcome Set Standards for Development Recommendations (COSSTAD), this study comprised: Stage 1 - systematic review to identify measures; Stage 2 - consensus groups to identify important outcome constructs for people with PPA (n = 82) and care partners (n = 91); Stage 3 - e-Delphi consensus with 57 researchers.RESULTSThe systematic review identified 84 Outcome Measurement Instruments. Core outcome constructs identified included: (1) Participate in conversations with family and friends, (2) get words out, (3) be more fluent, (4) convey a message by any means, and (5) understand what others are saying. Researchers were unable to reach a consensus on measurement instruments.DISCUSSIONFurther work is required to develop appropriate measurement instruments that address all core outcome constructs important to key stakeholders.Highlights We introduce new symptom-led perspectives on primary progressive aphasia (PPA). The focus is on non-fluent/agrammatic (nfvPPA) and semantic (svPPA) variants. Foregrounding of early and non-verbal features of PPA and clinical trajectories is featured. We introduce a symptom-led staging scheme for PPA. We propose a prototype for a functional impairment scale, the PPA Progression Planning Aid.

Background:An individual's diagnostic subtype may fail to predict the efficacy of a given type of treatment for anomia. Classification by conceptual-semantic impairment may be more informative. Aims:This study examined the effects of conceptual-semantic impairment and diagnostic subtype on anomia treatment effects in primary progressive aphasia (PPA) and Alzheimer's disease (AD). Methods & Procedures:At baseline, the picture and word versions of the Pyramids and Palm Trees and Kissing and Dancing tests were used to measure conceptual-semantic processing. Based on norming that was conducted with unimpaired older adults, participants were classified as being impaired on both the picture and word versions (i.e., modality-general conceptual-semantic impairment), the picture version (Objects or Actions) only (i.e., visual-conceptual impairment), the word version (Nouns or Verbs) only (i.e., lexical-semantic impairment), or neither the picture nor the word version (i.e., no impairment). Following baseline testing, a lexical treatment and a semantic treatment were administered to all participants. The treatment stimuli consisted of nouns and verbs that were consistently named correctly at baseline (Prophylaxis items) and/or nouns and verbs that were consistently named incorrectly at baseline (Remediation items). Naming accuracy was measured at baseline, and it was measured at three, seven, eleven, fourteen, eighteen, and twenty-one months. Outcomes & Results:Compared to baseline naming performance, lexical and semantic treatments both improved naming accuracy for treated Remediation nouns and verbs. For Prophylaxis items, lexical treatment was effective for both nouns and verbs, and semantic treatment was effective for verbs, but the pattern of results was different for nouns -- the effect of semantic treatment was initially nonsignificant or marginally significant, but it was significant beginning at 11 Months, suggesting that the effects of prophylactic semantic treatment may become more apparent as the disorder progresses. Furthermore, the interaction between baseline Conceptual-Semantic Impairment and the Treatment Condition (Lexical vs. Semantic) was significant for verb Prophylaxis items at 3 and 18 Months, and it was significant for noun Prophylaxis items at 14 and 18 Months. Conclusions:The pattern of results suggested that individuals who have modality-general conceptual-semantic impairment at baseline are more likely to benefit from lexical treatment, while individuals who have unimpaired conceptual-semantic processing at baseline are more likely to benefit from semantic treatment as the disorder progresses. In contrast to conceptual-semantic impairment, diagnostic subtype did not typically predict the treatment effects.

BackgroundIn the diagnostic criteria for lvPPA (Gorno-Tempini et al. 2011), "speech (phonologic) errors in spontaneous speech and naming" is a secondary criterion, but studies of naming error patterns in PPA have not found evidence to support this criterion. Furthermore, only a few studies have examined naming error patterns in PPA.AimsIn the current study, we examined the pattern of naming errors for nouns and verbs in all three subtypes of PPA, as well as unclassifiable PPA and typical (amnestic) Alzheimer's disease (AD). Statistical analyses focused on three common error types: phonological, semantic, and circumlocution errors.Methods & ProceduresThe final sample included 35 participants with PPA and four participants with typical AD. Participants were asked to name 284 noun pictures and 116 verb pictures. Separately for nouns and verbs, repeated-measures ANCOVA was used to examine the interaction between Error Type and Diagnostic Subtype.Twenty of the participants also completed a structural MRI scan. For these participants, we examined the relationships between naming errors and brain volume within ten left hemisphere regions of interest (ROIs).Methods & ProceduresThe final sample included 35 participants with PPA and four participants with typical AD. Participants were asked to name 284 noun pictures and 116 verb pictures. Separately for nouns and verbs, repeated-measures ANCOVA was used to examine the interaction between Error Type and Diagnostic Subtype.Twenty of the participants also completed a structural MRI scan. For these participants, we examined the relationships between naming errors and brain volume within ten left hemisphere regions of interest (ROIs).Outcomes & ResultsIn lvPPA, the proportion of phonological errors was significantly lower than the proportion of semantic errors for verbs. In svPPA, uPPA, and typical AD, semantic errors were significantly greater than phonological errors for both nouns and verbs. In between-subtype analyses, the proportion of semantic errors for nouns was significantly greater for participants with svPPA and uPPA, compared to those with nfvPPA.For nouns, the MRI analyses revealed significant negative correlations between the proportion of circumlocution errors and volume in the left inferior temporal gyrus and the left fusiform gyrus. For verbs, there were significant negative correlations between circumlocution errors and volume in the left insula, and between semantic errors and volume in the left superior temporal pole.Outcomes & ResultsIn lvPPA, the proportion of phonological errors was significantly lower than the proportion of semantic errors for verbs. In svPPA, uPPA, and typical AD, semantic errors were significantly greater than phonological errors for both nouns and verbs. In between-subtype analyses, the proportion of semantic errors for nouns was significantly greater for participants with svPPA and uPPA, compared to those with nfvPPA.For nouns, the MRI analyses revealed significant negative correlations between the proportion of circumlocution errors and volume in the left inferior temporal gyrus and the left fusiform gyrus. For verbs, there were significant negative correlations between circumlocution errors and volume in the left insula, and between semantic errors and volume in the left superior temporal pole.ConclusionsThe findings of this study indicate that semantic naming errors may be common for both nouns and verbs in typical AD and all subtypes of PPA, with the possible exception of nouns in nfvPPA. In contrast, phonological naming errors were not significantly more common than semantic errors in any diagnostic subtype. Furthermore, phonological naming errors were not significantly more common in lvPPA, compared to any other diagnostic subtype.

Background and Objectives Primary progressive aphasia (PPA) is a neurodegenerative condition that predominantly impairs language. Most investigations of how focal atrophy affects language consider 1 time point compared with healthy controls. However, true atrophy quantification requires comparing individual brains over time. In this observational cohort study, we identified areas where focal atrophy was associated with contemporaneous decline in naming in the same individuals. Methods Cross-sectional analyses–related Boston Naming Test (BNT) performance and volume in 22 regions of interests (ROIs) at each time point using Least Absolute Shrinkage and Selection Operator (LASSO) regression. Longitudinal analysis evaluated changes in BNT performance and change in volume in the same ROIs. Results Participants (N = 62; 50% female; mean age = 66.8 ± 7.4 years) with PPA completed the BNT and MRI twice (mean = 343.9 ± 209.0 days apart). In cross-sectional left inferior frontal gyrus pars opercularis, superior temporal pole, middle temporal gyrus, and inferior temporal gyrus were identified as critical for naming at all time points. Longitudinal analysis revealed that increasing atrophy in the left supramarginal gyrus and middle temporal pole predicted greater naming decline, as did female sex and longer intervals between time points. Discussion Although cross-sectional analyses identified classic language areas that were consistently related to poor performance at multiple time points, it was not increasing atrophy in these areas that lead to further decline: longitudinal analysis of each person's atrophy over time instead identified nearby but distinct regions where increased atrophy was related to decreasing performance. The results demonstrate that directly examining atrophy (in each individual) over time furthers understanding of decline in PPA and reveal the importance of left supramarginal gyrus and middle temporal pole in maintaining naming when areas normally critical for language degenerate. The novel results provide insight into how the underlying disease progresses to result in the clinical decline in naming, the deficit most common among all 3 PPA variants.

BACKGROUND:Findings from several studies have indicated that participants with nfvPPA and participants with svPPA exhibit different patterns on action and object naming tasks, while other recent studies have found that neither participants with nfvPPA nor participants with svPPA show a significant difference in accuracy between object naming and action naming.AIMS:The goal of this study was to test the hypothesis that relative action naming impairment is associated with grammatical ability in PPA, rather than a specific subtype of PPA.METHODS & PROCEDURES:Thirty-four participants with PPA completed the Boston Naming Test, the Action Naming subtest of the Boston Diagnostic Aphasia Examination, and the Northwestern Anagram Test, which was used to measure grammatical ability. Z-scores for the two naming tasks were calculated based on normative data from unimpaired controls. For each participant with PPA, the relative action naming impairment was calculated by subtracting the object naming z-score from the action naming z-score. Linear regression analysis was then used to evaluate the role of grammatical ability as a predictor of relative action naming impairment, while controlling for age, education, cognitive ability (as measured by the Montreal Cognitive Assessment), and semantic ability (as measured by the Pyramids and Palm Trees test). The interaction between grammatical ability and each control variable was also examined.OUTCOMES & RESULTS:The main effect of grammatical ability was a significant predictor of relative action naming impairment, while none of the control variables was a significant predictor. However, the interaction between grammatical ability and semantic ability was also significant.CONCLUSIONS:Individuals who have both grammatical impairment and semantic impairment have the largest relative action naming impairment. These individuals may benefit from a treatment that focuses on the retrieval of verbs and their arguments.

Advanced imaging studies in neurodegenerative disease have yielded new insights into subtypes of disease, progression of disease in various brain regions, and changes in structural and functional connectivity between brain regions related to symptom progression. However, few studies have revealed imaging markers at baseline that correlate with rate or degree of decline in function. Here we tested the hypothesis that imaging features at baseline correlate with outcome of naming in primary progressive aphasia. We obtained longitudinal multimodal imaging in 15 individuals with primary progressive aphasia at the same time points as assessment of naming. We found that functional connectivity between particular brain regions (measured with resting state functional connectivity magnetic resonance imaging) is strongly associated with accuracy of naming 21 months later, independently of baseline severity of naming impairment. These data indicate that functional connectivity may carry information about later performance in naming, and is potentially useful for refining prognosis.

This study examined the maintenance of anomia treatment effects in primary progressive aphasia (PPA). Following baseline testing, a phonological treatment and an orthographic treatment were administered over the course of six months. The treatment stimuli consisted of nouns that were consistently named correctly at baseline (Prophylaxis items) and/or nouns that were consistently named incorrectly at baseline (Remediation items). Naming accuracy was measured at baseline, and it was measured at 1 month, 8 months, and 15 months post-treatment. The change in naming accuracy from baseline to each post-treatment evaluation was calculated within each treatment condition, and within a matched untrained condition. The change in naming accuracy was then compared between the three conditions. The results of these analyses indicate that phonological and orthographic treatments are both effective in the Prophylaxis and Remediation of anomia in all three variants of PPA. For Prophylaxis items, some of the effects of each treatment can persist for as long as 15 months post-treatment. These long-term treatment effects were more robust in the orthographic treatment condition and for participants with the semantic variant of PPA.

Event Abstract Back to Event Prophylaxis of Anomia for Nouns and Verbs in Primary Progressive Aphasia: Lexical and Semantic Treatments Aaron M. Meyer1*, Sarah F. Snider1, Shelby McGowan1, Donna C. Tippett2, Argye Hillis2 and Rhonda B. Friedman1 1 Georgetown University Medical Center, United States 2 Johns Hopkins University, United States In a longitudinal treatment study (Meyer et al., 2018), phonological and orthographic treatments were both effective in the prophylaxis of anomia for nouns in all three variants of primary progressive aphasia (PPA). In the current study, we combined these treatments into a single “lexical” treatment and compared the efficacy of this treatment with that of semantic treatment. Both noun and verb stimuli were included. Participants included three individuals with lvPPA, two with svPPA, and two with nfvPPA. For each participant, up to 120 pictures of nouns were selected. The selected items were named correctly by the participant during three baseline oral naming tests. Each participant had two sets of treated nouns: the Lexical Treatment Condition (LTC) and the Semantic Treatment Condition (STC). Untrained sets (ULC and USC) were matched with the treated sets on frequency, semantic category, and number of syllables, phonemes, and letters. For each participant, up to 60 pictures of verbs were also selected. Separately from nouns, verbs were divided into two treated sets and one untreated set [Untrained Condition (UC)] and matched on transitivity and the variables described above. For each selected noun or verb, there were two different picture exemplars. Exemplar 1 was tested twice during the baseline evaluation and was utilized during treatment. Exemplar 2 was tested once at baseline, was not trained, and was used to assess treatment efficacy. In both treatment conditions, the pictured item was presented first. In LTC, the word’s orthographic and phonological features were then presented in written and auditory form. For example, for the item elephant, the following features were presented: “This word starts with the letter ‘e.’” “This word has three syllables.” “Copy elephant.” The participant then copied the word on a sheet of paper. In STC, the word’s semantic features were presented in written and auditory form. For example, for the item elephant, the following features were presented: “This has a trunk.” “It is gray.” “An elephant is large.” In both conditions, the word (in written and auditory form) was then presented with the picture, and the participant was asked to read/repeat the word. In the first month of treatment, there were two sessions per week. Each session included both types of treatment. During the subsequent two months, one treatment session occurred per month; shorter home practice sessions occurred three times per week. Our first assessment of naming accuracy for Exemplar 2 was conducted for nouns and verbs after three months of treatment. For nouns, there was a significant treatment effect in LTC, but not in STC, and the treatment effect was significantly larger in LTC, compared to STC [t(6) = 3.06, p = .022]. In contrast, for verbs there was a marginally significant treatment effect in LTC and a significant treatment effect in STC, while the two treatment effects were not significantly different [t(6) = - 0.49, p = .642]. These findings suggest that semantic treatment for prophylaxis items may be more beneficial for verbs than for nouns. Possible explanations for these results will be discussed. Figure 1 References Meyer, A. M., Tippett, D. C., Turner, R. S., & Friedman, R. B. (2018). Long-term maintenance of anomia treatment effects in primary progressive aphasia. Neuropsychological Rehabilitation. DOI: 10.1080/09602011.2018.1425146 Keywords: primary progressive aphasia, PPA, Anomia, Treatment, Semantic feature, Lexical feature Conference: Academy of Aphasia 57th Annual Meeting, Macau, Macao, SAR China, 27 Oct - 29 Oct, 2019. Presentation Type: Poster presentation Topic: Not eligible for student award Citation: Meyer AM, Snider SF, McGowan S, Tippett DC, Hillis A and Friedman RB (2019). Prophylaxis of Anomia for Nouns and Verbs in Primary Progressive Aphasia: Lexical and Semantic Treatments. Front. Hum. Neurosci. Conference Abstract: Academy of Aphasia 57th Annual Meeting. doi: 10.3389/conf.fnhum.2019.01.00087 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 04 May 2019; Published Online: 09 Oct 2019. * Correspondence: Dr. Aaron M Meyer, Georgetown University Medical Center, Washington D.C., District of Columbia, 20057, United States, am2292@georgetown.edu Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Aaron M Meyer Sarah F Snider Shelby McGowan Donna C Tippett Argye Hillis Rhonda B Friedman Google Aaron M Meyer Sarah F Snider Shelby McGowan Donna C Tippett Argye Hillis Rhonda B Friedman Google Scholar Aaron M Meyer Sarah F Snider Shelby McGowan Donna C Tippett Argye Hillis Rhonda B Friedman PubMed Aaron M Meyer Sarah F Snider Shelby McGowan Donna C Tippett Argye Hillis Rhonda B Friedman Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Background: Individuals with primary progressive aphasia (PPA) and their caregivers want to know what to expect so that they can plan support appropriately. The ability to predict decline in naming and semantic knowledge, and advise individuals with PPA and their caregivers regarding future planning, would be invaluable clinically.Aims: The aims of this study were to investigate patterns of decline in naming and semantic knowledge in each of the clinical variants of PPA (logopenic variant PPA, lvPPA; nonfluent agrammatic PPA, nfaPPA; and semantic variant PPA, svPPA) and to examine the effects of other variables on rate of decline. We hypothesized that speech-language rehabilitation, higher education, and higher baseline test scores would be associated with slower decline, and older age with faster decline.Methods and Procedures: A total of 94 participants with PPA underwent language testing, including 36 participants with lvPPA, 31 participants with nfaPPA, and 27 participants with svPPA. All participant groups were similar in age and education. We focused on decline on three tests: the short form of the Boston Naming Test (BNT), the Hopkins Assessment of Naming Actions (HANA), and the short form of the Pyramids and Palm Trees Test (PPTT).Outcome and Results: Across language tests, the most precipitous rates of decline (loss of points per month) occurred in nfaPPA, followed by svPPA, then lvPPA. Female sex, longer symptom duration, higher baseline test score, and speech-language rehabilitation were associated with slower decline.Conclusions: PPA variants were distinguishable by rapidity of decline, with nfaPPA having the most precipitous decline. As hypothesized, higher baseline test scores and speech-language rehabilitation were associated with slower decline. Surprisingly, age and education were not important prognostically for individuals in this study. Further study of prognostically-relevant variables in PPA is indicated in this population.

Background: Structural imaging has not been used previously to predict the effect of treatment in primary progressive aphasia (PPA).Aims: This study examined relationships between baseline brain volume and the effects of phonological and orthographic treatments for anomia in PPA. It was predicted that lower baseline volume would be associated with lower post-treatment naming accuracy for treated items and smaller generalisation effects.Methods & Procedures: Twenty-one individuals with PPA participated. The treatment stimuli consisted of nouns that were consistently named correctly at baseline (Prophylaxis items) and/or nouns that were consistently named incorrectly at baseline (Remediation items). All 21 participants had Prophylaxis items, while 10 participants had Remediation items. Naming accuracy for Untrained and Trained items (Exemplar set 1) was measured. In addition, stimulus generalisation was examined by having participants name an alternative exemplar of each Untrained and Trained item (Exemplar set 2). Correlational analyses focused on the relationships between naming accuracy and volume of regions previously identified as having a role in naming and semantic processing.Outcomes & Results: Unexpectedly, there were no significant correlations between baseline volume and post-treatment accuracy for treated items. However, baseline volume within the left temporal pole was positively correlated with post-treatment accuracy for Untrained Exemplar set 2 Prophylaxis items, while baseline volume in the left inferior temporal gyrus (ITG) was positively correlated with post-treatment accuracy for Untrained Exemplar set 1 Remediation items.Conclusions: These findings suggest that lower volume in the left temporal pole is associated with decline for Untrained items, while lower volume in the left ITG is associated with a lack of improvement for Untrained items. Possible explanations for the different patterns observed across exemplar sets are discussed.

Event Abstract Back to Event Language Decline in Primary Progressive Aphasia: Patterns and Prognostic Variables Rajani Sebastian1, Amy Wright1, Aaron Meyer2, Rhonda Friedman2, Argye E. Hillis1, 3, 4 and Donna C. Tippett1, 3, 5* 1 Johns Hopkins Medicine, Department of Neurology, United States 2 Georgetown University Medical Center, United States 3 Johns Hopkins University, Department of Physical Medicine and Rehabilitation, United States 4 Johns Hopkins University, Department of Cognitive Science, United States 5 Johns Hopkins Medicine, Department of Otolaryngology--Head and Neck Surgery, United States Problem The aim of this study was to investigate patterns of decline on language testing in each of the clinical subtypes of PPA (logopenic variant PPA, lvPPA; nonfluent agrammatic PPA, nfaPPA; and semantic variant PPA, svPPA) and to examine the effects of other variables on rate of decline. We hypothesized that speech-language rehabilitation, higher education, and higher baseline test scores would be associated with slower decline, and older age with faster decline. Method Thirty-six patients with lvPPA (mean age = 69.3 years; SD = 8.01; mean education = 16.6 years; SD = 2.90), 31 patients with nfaPPA (mean age = 67.7 years; SD = 9.61; mean education = 15.8 years; SD = 2.58), and 27 patients with svPPA (mean age = 64.1 years; SD = 7.39; mean education = 15.8 years; SD = 2.01) were included. Participants (n = 94; mean age = 67.3 years; SD = 8.59; 58 female; mean education = 16.1 years; SD = 2.57) completed language testing on at least two occasions. Follow up testing ranged from 11 to 44 months post baseline (mean interval 19.1 months; SD = 6.62). We focused on decline on three tests: Boston Naming Test, short form (BNT; Kaplan, Goodglass, & Weintraub, 2001; Mack, Freed, Williams, & Henderson, 1992); Hopkins Assessment of Naming Actions (HANA; Lala, Race, Tsapkini, & Hillis, 2012), and the picture short form of the Pyramids and Palm Trees Test (PPTT) (Breining et al., 2015). A multivariate regression model was used to study language decline over time. Results PPA subtypes were distinguishable by rapidity of decline. Across language tests, the most precipitous rates of decline (loss of points per month) occurred in nfaPPA (BNT: 0.91 points per month, p<0.0001; HANA: 0.76 points per month, p <0.0001; PPTT: 0.35 points per month, p <0.0001), followed by svPPA (BNT: 0.35 points per month, p <0.0001; HANA: 0.23 points per month, p <0.0001; PPTT: 0.05 points per month, p =0.001), and then lvPPA (BNT: 0.24, points per month, p=0.002; HANA: 0.10 points per month, p = 0.060; PPTT: 0.02 points per month, p = 0.138). All scores had a 95% confidence interval. This steep downward trajectory for nfaPPA may be explained, in part, because, individuals present with apraxia of speech and may become mute early in their disease progression (Croot, Ballard, Leyton, & Hodges, 2012; Gorno-Tempini et al., 2006), thereby compromising performance on confrontation naming. Female gender, longer symptom duration, higher baseline test score, and speech-language rehabilitation were associated with slower decline. Conclusions PPA variants were distinguishable by rapidity of decline, with nfaPPA having the most precipitous decline. As hypothesized, higher baseline test scores and speech-language rehabilitation were associated with slower decline. Surprisingly, age and education were not important prognostically for individuals in this study. These variables, however, influence recovery from stroke (Hillis & Tippett, 2014). Further study of prognostically relevant variables in PPA is indicated in this population. The ability to predict decline in function, and advise individuals with PPA and their caregivers regarding future planning, would be invaluable clinically. Acknowledgements This work was made possible by NIH grants ROI DC 011317, R01 DC 03681, and K99 DC015554 from NIDCD. We gratefully acknowledge this support. References Breining, B. L., Lala, T., Martínez Cuitiño, M., Manes, F., Peristeri, E., Tsapkini, K., . . . Hillis, A. E. (2015). A brief assessment of object semantics in primary progressive aphasia. Aphasiology, 29(4), 488-505. Croot, K., Ballard, K., Leyton, C.E., & Hodges, J.R. (2012). Apraxia of speech and phonological errors in the diagnosis of nonfluent/agrammatic and logopenic variants of primary progressive aphasia. Journal of Speech, Language, and Hearing Research, 55, S1562-72. doi: 10.1044/1092-4388(2012/11-0323. Gorno-Tempini, M.L., Ogar, J.M., Brambati, S.M., Wang, P., Jeong, J.H., Rankin, K.P., . . . & Miller, B.L. (2006). Anatomical correlates of early mutism in progressive nonfluent aphasia. Neurology, 67, 1849-1851. doi: 10.1212/01.wnl.0000237038.55627.5b. Hillis, A. E., & Tippett, D. C. (2014). Stroke recovery: Surprising influences and residual consequences. Advances in Medicine, 2014 Kaplan, E., Goodglass, H., & Weintraub, S. (2001). Boston naming test-2 (BNT- 2). Austin TX: Pro-Ed. Mack, W.J., Freed, D.M., Williams, B.W., & Henderson, V.W. (1992). Boston naming test: Shortened versions for use in Alzheimer’s disease. Journal of Gerontology, 47, 154-158. doi: 10.1093/geronj/47.3.P154. Keywords: primary progressive aphasia, Language decline, semantic variant primary progressive aphasia, nonfluent agrammatic primary progressive aphasia, logopenic variant primary progressive aphasia Conference: Academy of Aphasia 55th Annual Meeting , Baltimore, United States, 5 Nov - 7 Nov, 2017. Presentation Type: poster or oral Topic: Consider for student award Citation: Sebastian R, Wright A, Meyer A, Friedman R, Hillis AE and Tippett DC (2019). Language Decline in Primary Progressive Aphasia: Patterns and Prognostic Variables. Conference Abstract: Academy of Aphasia 55th Annual Meeting . doi: 10.3389/conf.fnhum.2017.223.00074 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 20 Apr 2017; Published Online: 25 Jan 2019. * Correspondence: Ms. Donna C Tippett, Johns Hopkins Medicine, Department of Neurology, Baltimore, Maryland, 21287, United States, dtippet1@jhmi.edu Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Rajani Sebastian Amy Wright Aaron Meyer Rhonda Friedman Argye E Hillis Donna C Tippett Google Rajani Sebastian Amy Wright Aaron Meyer Rhonda Friedman Argye E Hillis Donna C Tippett Google Scholar Rajani Sebastian Amy Wright Aaron Meyer Rhonda Friedman Argye E Hillis Donna C Tippett PubMed Rajani Sebastian Amy Wright Aaron Meyer Rhonda Friedman Argye E Hillis Donna C Tippett Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Event Abstract Back to Event When is the test effect most effective in aphasia rehabilitation? Rhonda B. Friedman1*, Shelby A. McGowan1, Aaron M. Meyer1 and Sarah F. Snider1 1 Georgetown University, Neurology, United States The role of testing in the maintenance of learned material has been well studied in healthy populations, and its role in the rehabilitation of language in aphasia is beginning to receive attention1,2. The current analysis builds upon a study that examines the effectiveness of incorporating testing into a rehabilitation paradigm emphasizing overlearning of material learned during language therapy. In the original study we hypothesized that both additional studying and additional testing following learning would result in better long-term retention. We further predicted that testing would be better than studying (the “test effect”), and that testing plus studying would achieve the best results. Results confirmed all hypotheses save the last; there was a trend towards testing alone resulting in greater benefit than testing plus studying. In the current investigation, we sought to determine what factors predict the test effect both at the level of participants and items. Procedure Participants were seven persons with naming impairment subsequent to left hemisphere stroke. Stimuli for each participant were 120 pictured items consistently named incorrectly on three baseline tests. Treatment occurred twice weekly. Sessions consisted of four blocks: test, study, test, study. On study blocks a picture was presented simultaneously with its spoken and written word; the participant produced the word and studied it for five seconds. On test blocks the picture was presented alone; the participant named the picture. Five seconds later the word was played over headphones, providing feedback. Learned words were assigned to an overtraining condition, the variable of importance in our paradigm. During this phase, items continued to be 1) studied only, 2) tested only, 3) studied and tested, or 4) neither studied nor tested ("dropout"). Participants returned for testing at one month and four months post-treatment. Analyses To determine whether the relative difficulty of the item predicted the presence of the test effect we grouped items into those that were learned early and those learned late. We also examined the participants’ language profiles to identify factors that might predict the presence of the test effect. Results All participants demonstrated a test effect at one month post; five of the seven also showed the effect at four months post. The two participants who failed to demonstrate the effect were those whose lexical deficit went beyond word retrieval; they showed abnormal performance on written word to picture matching, indicating a bidirectional difficulty connecting word and concept. All five participants who demonstrated the test effect at four months post showed a greater test effect for the later learned items. Testing appears to be more important for the items that the participants have greater difficulty relearning, which is consonant with the fact that the test effect in neurologically-intact persons is demonstrated for the learning of new material. Additionally, for the later learned items there was a statistically significant advantage for the Test vs. the Test plus Study items at four months post-treatment. We suggest that this indicates that studying, when added to testing, can have a detrimental effect upon the long-term consolidation of learning. Figure 1 References 1 Friedman, R. B., Sullivan, K. L., Snider, S. F., Luta, G., & Jones, K. T. (2017). Leveraging the test effect to improve maintenance of the gains achieved through cognitive rehabilitation. Neuropsychology, 31, 220–228. 2 Middleton, E. L., Schwartz, M. F., Rawson, K. A., & Garvey, K. (2015). Test-enhanced learning versus errorless learning in aphasia rehabilitation: Testing competing psychological principles. Journal of Experimental Psychology: Learning, Memory, and Cognition, 41, 1253–1261. Keywords: aphasia rehabilitation, test effect, anomia treatment, maintenance of learning, Overlearning, Overtraining Conference: Academy of Aphasia 55th Annual Meeting , Baltimore, United States, 5 Nov - 7 Nov, 2017. Presentation Type: poster presentation Topic: General Submission Citation: Friedman RB, McGowan SA, Meyer AM and Snider SF (2019). When is the test effect most effective in aphasia rehabilitation?. Conference Abstract: Academy of Aphasia 55th Annual Meeting . doi: 10.3389/conf.fnhum.2017.223.00015 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 28 Apr 2017; Published Online: 25 Jan 2019. * Correspondence: Dr. Rhonda B Friedman, Georgetown University, Neurology, Washington, DC, 20057, United States, friedmar@georgetown.edu Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Rhonda B Friedman Shelby A McGowan Aaron M Meyer Sarah F Snider Google Rhonda B Friedman Shelby A McGowan Aaron M Meyer Sarah F Snider Google Scholar Rhonda B Friedman Shelby A McGowan Aaron M Meyer Sarah F Snider PubMed Rhonda B Friedman Shelby A McGowan Aaron M Meyer Sarah F Snider Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

To characterize, cross-sectionally and longitudinally, patients with Primary Progressive Aphasia (PPA), by multi-modality brain MRI, and to look for potential prognostic markers of later decline in naming.

This study evaluated the efficacy of phonological and orthographic treatments for anomia in the semantic and logopenic variants of primary progressive aphasia (svPPA and lvPPA, respectively). Both treatments were administered for 6 months. The treatment stimuli consisted of nouns that were consistently named correctly at baseline (prophylaxis items) and/or nouns that were consistently named incorrectly at baseline (remediation items). Oral naming accuracy was measured for trained and untrained picture exemplars, as well as matched items from an untrained condition (UC). Written naming and scene description tasks were also conducted. For all tasks, the change in naming accuracy from baseline to 1 month post-treatment was compared between the UC and each treatment condition. These comparisons indicated that both treatments were effective in the remediation and prophylaxis of anomia in both variants. Furthermore, generalisation to untrained exemplars occurred in both subtypes, whereas item generalisation occurred in lvPPA, and task generalisation was present in svPPA.

Event Abstract Back to Event Maintenance of Anomia Treatment Effects in Primary Progressive Aphasia Aaron Meyer1*, Donna Tippett2, R. Scott Turner1 and Rhonda Friedman1 1 Georgetown University, United States 2 Johns Hopkins University, United States Orthographic and phonological treatments for anomia were tested in PPA. Twenty-two individuals participated: 10 with lvPPA, 5 with svPPA, and 7 with nfvPPA. At baseline, participants attempted to name two sets of pictured nouns: Exemplar 1, which was utilized during treatment; and Exemplar 2, which was never trained. Based on the oral naming accuracy of each participant, individualized treatment words were selected. All participants had Prophylaxis items, which were consistently named correctly at baseline. Ten participants had Remediation items, which were consistently named incorrectly at baseline. Accuracy for the selected items was tested in two other ways: Written Naming and naming during Scene Description. Each scene contained one of the selected items. The orthographic treatment condition (OTC) involved the pairing of a pictured noun and the corresponding written word, which was read orally and then copied by the participant. In the phonological treatment condition (PTC), a pictured noun was paired with the corresponding auditory word, which was repeated by the participant. The untrained condition (UC) included items that were matched with items from OTC and PTC on semantic category, frequency, and length. The first month of treatment included two sessions per week. Home practice sessions occurred during the subsequent five months. During this period, each participant used training cards to perform the treatment tasks with a caregiver three times per week. Post-treatment evaluations occurred at 1 month and 8 months after the end of home practice. The change in accuracy from baseline to post-treatment was calculated for each type of item (Prophylaxis or Remediation) within each treatment condition (UC, PTC, or OTC). For each task, a one-way repeated-measures ANOVA was used to examine the effect of treatment condition. The paired-samples t-test was utilized to compare OTC and PTC to UC. For Prophylaxis and Remediation items, the effect of treatment condition was significant for all tasks at 1 month post-treatment. For Prophylaxis items, the decline in accuracy for Exemplars 1 and 2 was significantly smaller in OTC and PTC, and the decline in accuracy for Written Naming and Scene Description was significantly smaller in OTC. For Remediation items, the increase in accuracy for all tasks was significantly larger in both PTC and OTC. These results indicate that both treatments are effective in the prophylaxis and remediation of anomia in PPA. Furthermore, the significant effects for Exemplar 2 and Scene Description indicate that both treatments result in stimulus and task generalization. The one exception is PTC did not result in task generalization for Prophylaxis items. Sixteen participants completed testing at 8 months post-treatment, including 7 with lvPPA, 4 with svPPA, and 5 with nfvPPA. For Prophylaxis items, the pattern of significant effects was identical to the pattern at 1 month post-treatment. For Remediation items, the effect of treatment condition was significant only for Exemplar 1; the increase in accuracy was significantly greater in OTC and marginally greater in PTC. These findings suggest that the effects of Prophylaxis treatment are maintained over time, while the effects of Remediation treatment may dissipate over time. Figure 1 Acknowledgements This study was supported by the NIDCD under grant numbers R01DC011317 and R01DC011317-01AS1. Keywords: Treatment, Anomia, primary progressive aphasia, Maintenance, generalization Conference: 54th Annual Academy of Aphasia Meeting, Llandudno, United Kingdom, 16 Oct - 18 Oct, 2016. Presentation Type: Poster Sessions Topic: Academy of Aphasia Citation: Meyer A, Tippett D, Turner R and Friedman R (2016). Maintenance of Anomia Treatment Effects in Primary Progressive Aphasia. Front. Psychol. Conference Abstract: 54th Annual Academy of Aphasia Meeting. doi: 10.3389/conf.fpsyg.2016.68.00021 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 15 Apr 2016; Published Online: 15 Aug 2016. * Correspondence: Dr. Aaron Meyer, Georgetown University, Washington, DC, United States, am2292@georgetown.edu Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Aaron Meyer Donna Tippett R. Scott Turner Rhonda Friedman Google Aaron Meyer Donna Tippett R. Scott Turner Rhonda Friedman Google Scholar Aaron Meyer Donna Tippett R. Scott Turner Rhonda Friedman PubMed Aaron Meyer Donna Tippett R. Scott Turner Rhonda Friedman Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.