Prophylaxis and remediation of anomia in the semantic and logopenic variants of primary progressive aphasia.

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.

Tipos de trastornos anómicos en las afasias / Types of anomic disorders in aphasia

Los trastornos anómicos están presentes en todos los síndromes afásicos, pero son muy heterogéneos ya que las causas que los producen son muy variadas al ser muchos los procesos cognitivos que intervienen en la producción oral. En este estudio se analizó una muestra de 28 pacientes afásicos pertenecientes a diferentes síndromes (afasias de Broca, de Wernicke, etc.), pero todos con trastornos anómicos. El objetivo era comprobar las variedades de anomias existentes y si esas variedades están ligadas a los síndromes clásicos. A esos pacientes se le aplicaron ocho tareas lexicosemánticas, fundamentalmente de denominación de dibujos (objetos y acciones), semánticas (emparejamiento palabra-dibujo, asociación semántica, etc.) y fonológicas (repetición de palabras y seudopalabras). En base a los resultados en esas tareas se clasificó a los pacientes mediante análisis discriminante en cuatro grupos (anomia pura, semántica, fonológica y mixta) y se analizaron las principales disociaciones (p. ej. denominación de objetos frente a denominación de acciones) existentes entre ellos. También se hicieron correlaciones entre los resultados de las tareas para comprobar la capacidad de las pruebas de predecir los distintos tipos de anomias. Los resultados muestran la existencia de una gran variedad de trastornos anómicos, que además son independientes de los síndromes a los que pertenezcan los pacientes (AU)

The anomic disorders are present in all the aphasic syndromes, but they are very heterogeneous because of their multiple causes, as there are many cognitive processes involved in the oral production. A sample of 28 aphasic patients belonging to different syndromes (Broca’s aphasia, Wernicke’s, etc.) but all with anomic disorders was analyzed in this study. The goal was to check the variety of anomias and their connection with the classical syndromes. Eight lexical-semantic tasks were applied to those patients, especially picture naming (objects and actions) and semantic (word-picture matching, semantic association, etc.) and phonological tasks (words and pseudowords repetition). On the basis of their results on those tasks the patients were classified in four groups through a discriminant analysis (pure, semantic, phonological and mixed anomia) and the main dissociations between the groups were analyzed (e.g, objects vs. actions naming). Other analysis were also carried out, specifically the correlations between the results in the tasks to check the capacity of the tasks to predict the different types of anomia. The results show the existence of a great variety of anomic disorders, which are besides independent of the syndromes to which the patients belong (AU)

Intraoperative speech mapping in 17 bilingual patients undergoing resection of a mass lesion.

OBJECTIVE: Language mapping has been reported previously for bilingual patients undergoing cortical resection of an epileptic focus that may have developed early in life. In this setting, the cortical organization of language may have been affected by the effects of having a seizure focus established early in life. Adults presenting with a primary brain tumor offer a different opportunity to study bilingual cortical representation of language sites, because presumably the brain has been unaffected by epilepsy during the first decade of life or beyond. In this analysis, we present the results for 17 bilingual patients who underwent speech mapping as part of the surgical procedure to remove a mass lesion. METHODS: The localization of cortical sites essential for language was assessed in 17 patients undergoing resection of a mass lesion. Stimulation mapping was performed in each language by use of an object-naming task. A site thought to be essential for naming was any site, in either language, in which interruption of naming (anomia) occurred in at least two-thirds of the stimulations at that site. RESULTS: A site essential for naming was identified in the exposed cortex for 5 of 17 patients, whereas no essential site was found for 12 patients, presumably because of a limited surgical exposure. For the patients in whom a site essential for naming was identified, two patients displayed anomia in both languages, two others had anomia in only one language, and one showed anomia in one language but only hesitation of naming in the other language. CONCLUSION: Although no site was identified in the majority of the patients, those individuals in whom a site was identified demonstrate that bilingual patients undergoing tumor resection should be mapped for all languages regardless of patient age before it is decided which cortical and subcortical areas are safe to remove.

Language function following subdural grid-directed temporal lobectomy.

The purpose of the study was to determine the extent to which a temporal resection may be undertaken without producing risk to temporal language areas. Patients undergoing craniotomy and placement of a subdural electrode array (SEA) for evaluation of intractable epilepsy were studied to determine the variability of distance of temporal language cortex from the temporal pole. Hemisphere dominance was determined by intracarotid sodium amytal injection. Temporal lobe speech arrest (SA) was mapped with a 64 contact point SEA. Thirty-one patients had left dominant hemisphere SEAs. Thirty had SA 5 cm to 9 cm from the temporal pole (median 7 cm). One had SA at 3 cm. Twenty-one patients subsequently had temporal lobectomy (TL). Mean extent of resection was 5.7 cm (range 3 to 9 cm). In 18 TL patients who had neuropsychometric evaluation of language function pre- and post-surgery, there was no significant deterioration. Thirty-nine patients had right non-dominant SEAs placed. Eighteen had TL. Thirteen of these had pre- and post-surgery language evaluation and there was no significant change. Comparison of preoperative scores showed significant superiority of the right non-dominant group over the left dominant group for naming. TL up to 5 cm without stimulation mapping of language areas would be safe in the majority of cases, but one subject (3%) had SA mapped anterior to this and a small number of cases may therefore be at risk to language function following a 5 cm TL. Extensive lateral resections up to 9 cm are possible with preservation of language function with stimulation cortical mapping.