Hungarian adaptation of the cerebellar cognitive affective/Schmahmann Syndrome Scale.

Recent studies have reported that cerebellar lesions can cause cognitive, behavioral, and affective symptoms. This constellation is called the cerebellar cognitive affective syndrome (CCAS). A bedside instrument, the CCAS-Scale, has been developed to screen for this clinical presentation. The aim of this study is to adapt the CCAS-Scale to Hungarian according to international cross-cultural guidelines. In cooperation with the senior author of the original CCAS-Scale, we defined a five-step adaptation protocol (license number 6758-1/2021). Step 1: translation of the scale from English to Hungarian by two separate teams. Step 2: comparison of the two translated versions, synthesis (preliminary version). Step 3: back translation by an independent professional translator. Step 4: authorization, revision, and correction. Step 5: pre-testing the scale, measuring the test times. Following our protocol, we produced the CCAS-H and the instructions booklet. We pre-tested healthy (n = 10) and cerebellar stroke patients (n = 10) and finalized the scale. Although not significantly, but cerebellar patients reached lower raw scores compared with healthy subjects. Testing times differed significantly between the two groups. A meticulous validation protocol was outlined to assess the validity and reliability of the newly adapted test. CCAS-H is a quick and adequate scale to examine the cerebellar-cognitive affective syndrome, which will be available for Hungarian professionals. Our main challenge was to define the stimuli and cues with adequate psycholinguistic and psychometric properties. As a next step, we are gathering data for the validation with the help of six other Hungarian Neurology departments.

A Speech Recognition-based Solution for the Automatic Detection of Mild Cognitive Impairment from Spontaneous Speech.

BACKGROUND: Even today the reliable diagnosis of the prodromal stages of Alzheimer's disease (AD) remains a great challenge. Our research focuses on the earliest detectable indicators of cognitive decline in mild cognitive impairment (MCI). Since the presence of language impairment has been reported even in the mild stage of AD, the aim of this study is to develop a sensitive neuropsychological screening method which is based on the analysis of spontaneous speech production during performing a memory task. In the future, this can form the basis of an Internet-based interactive screening software for the recognition of MCI. METHODS: Participants were 38 healthy controls and 48 clinically diagnosed MCI patients. The provoked spontaneous speech by asking the patients to recall the content of 2 short black and white films (one direct, one delayed), and by answering one question. Acoustic parameters (hesitation ratio, speech tempo, length and number of silent and filled pauses, length of utterance) were extracted from the recorded speech signals, first manually (using the Praat software), and then automatically, with an automatic speech recognition (ASR) based tool. First, the extracted parameters were statistically analyzed. Then we applied machine learning algorithms to see whether the MCI and the control group can be discriminated automatically based on the acoustic features. RESULTS: The statistical analysis showed significant differences for most of the acoustic parameters (speech tempo, articulation rate, silent pause, hesitation ratio, length of utterance, pause-per-utterance ratio). The most significant differences between the two groups were found in the speech tempo in the delayed recall task, and in the number of pauses for the question-answering task. The fully automated version of the analysis process - that is, using the ASR-based features in combination with machine learning - was able to separate the two classes with an F1-score of 78.8%. CONCLUSION: The temporal analysis of spontaneous speech can be exploited in implementing a new, automatic detection-based tool for screening MCI for the community.

Recursive Subsystems in Aphasia and Alzheimer's Disease: Case Studies in Syntax and Theory of Mind.

The relationship between recursive sentence embedding and theory-of-mind (ToM) inference is investigated in three persons with Broca's aphasia, two persons with Wernicke's aphasia, and six persons with mild and moderate Alzheimer's disease (AD). We asked questions of four types about photographs of various real-life situations. Type 4 questions asked participants about intentions, thoughts, or utterances of the characters in the pictures ("What may X be thinking/asking Y to do?"). The expected answers typically involved subordinate clauses introduced by conjunctions or direct quotations of the characters' utterances. Broca's aphasics did not produce answers with recursive sentence embedding. Rather, they projected themselves into the characters' mental states and gave direct answers in the first person singular, with relevant ToM content. We call such replies "situative statements." Where the question concerned the mental state of the character but did not require an answer with sentence embedding ("What does X hate?"), aphasics gave descriptive answers rather than situative statements. Most replies given by persons with AD to Type 4 questions were grammatical instances of recursive sentence embedding. They also gave a few situative statements but the ToM content of these was irrelevant. In more than one third of their well-formed sentence embeddings, too, they conveyed irrelevant ToM contents. Persons with moderate AD were unable to pass secondary false belief tests. The results reveal double dissociation: Broca's aphasics are unable to access recursive sentence embedding but they can make appropriate ToM inferences; moderate AD persons make the wrong ToM inferences but they are able to access recursive sentence embedding. The double dissociation may be relevant for the nature of the relationship between the two recursive capacities. Broca's aphasics compensated for the lack of recursive sentence embedding by recursive ToM reasoning represented in very simple syntactic forms: they used one recursive subsystem to stand in for another recursive subsystem.

Recursion in aphasia.

This study investigates how aphasic impairment impinges on syntactic and/or semantic recursivity of human language. A series of tests has been conducted with the participation of five Hungarian speaking aphasic subjects and 10 control subjects. Photographs representing simple situations were presented to subjects and questions were asked about them. The responses are supposed to involve formal structural recursion, but they contain semantic-pragmatic operations instead, with 'theory of mind' type embeddings. Aphasic individuals tend to exploit the parallel between 'theory of mind' embeddings and syntactic-structural embeddings in order to avoid formal structural recursion. Formal structural recursion may be more impaired in Broca's aphasia and semantic recursivity may remain selectively unimpaired in this type of aphasia.