Aphasia, Primary Progressive

Language-processing difficulties are more of an indicator than memory loss of amnestic mild cognitive impairment (aMCI), a risk factor for dementia due to Alzheimer's disease, according to a new study. Individuals with mild cognitive impairment, especially of the "amnestic subtype" (aMCI), are at increased risk for dementia due to Alzheimer's disease relative to cognitively healthy older adults. Now, a study co-authored by researchers from MIT, Cornell University, and Massachusetts General Hospital has identified a key deficit in people with aMCI, which relates to producing complex language. This deficit is independent of the memory deficit that characterizes this group and may provide an additional "cognitive biomarker" to aid in early detection -- the time when treatments, as they continue to be developed, are likely to be most effective. The researchers found that while individuals with aMCI could appreciate the basic structure of sentences (syntax) and their meaning (semantics), they struggled with processing certain ambiguous sentences in which pronouns alluded to people not referenced in the sentences themselves. "These results are among the first to deal with complex syntax and really get at the abstract computation that's involved in processing these linguistic structures," says MIT linguistics scholar Suzanne Flynn, co-author of a paper detailing the results. The focus on subtleties in language processing, in relation to aMCI and its potential transition to dementia such as Alzheimer's disease is novel, the researchers say. "Previous research has looked most often at single words and vocabulary," says co-author Barbara Lust, a professor emerita at Cornell University. "We looked at a more complex level of language knowledge. When we process a sentence, we have to both grasp its syntax and construct a meaning. We found a breakdown at that higher level where you're integrating form and meaning." The paper, "Disintegration at the syntax-semantics interface in prodromal Alzheimer's disease: New evidence from complex sentence anaphora in amnestic Mild Cognitive Impairment (aMCI)," appears in the Journal of Neurolinguistics. The paper's authors are Flynn, a professor in MIT's Department of Linguistics and Philosophy; Lust, a professor emerita in the Department of Psychology at Cornell and a visiting scholar and research affiliate in the MIT Department of Linguistics and Philosophy; Janet Cohen Sherman, an associate professor of psychology in the Department of Psychiatry at Massachusetts General Hospital and director of the MGH Psychology Assessment Center; and, posthumously, the scholars James Gair and Charles Henderson of Cornell University. Anaphora and ambiguity To conduct the study, the scholars ran experiments comparing the cognitive performance of aMCI patients to cognitively healthy individuals in separate younger and older control groups. The research involved 61 aMCI patients of Massachusetts General Hospital, with control group research conducted at Cornell and MIT. The study pinpointed how well people process and reproduce sentences involving "anaphora." In linguistics terms, this generally refers to the relation between a word and another form in the sentence, such the use of "his" in the sentence, "The electrician repaired his equipment." (The term "anaphora" has another related use in the field of rhetoric, involving the repetition of terms.) In the study, the researchers ran a variety of sentence constructions past aMCI patients and the control groups. For instance, in the sentence, "The electrician fixed the light switch when he visited the tenant," it is not actually clear if "he" refers to the electrician, or somebody else entirely. The "he" could be a family member, friend, or landlord, among other possibilities. On the other hand, in the sentence, "He visited the tenant when the electrician repaired the light switch," "he" and the electrician cannot be the same person. Alternately, in the sentence, "The babysitter emptied the bottle and prepared the formula," there is no reference at all to a person beyond the sentence. Ultimately, aMCI patients performed significantly worse than the control groups when producing sentences with "anaphoric coreference," the ones with ambiguity about the identity of the person referred to via a pronoun. "It's not that aMCI patients have lost the ability to process syntax or put complex sentences together, or lost words; it's that they're showing a deficit when the mind has to figure out whether to stay in the sentence or go outside it, to figure out who we're talking about," Lust explains. "When they didn't have to go outside the sentence for context, sentence production was preserved in the individuals with aMCI whom we studied." Flynn notes: "This adds to our understanding of the deterioration that occurs in early stages of the dementia process. Deficits extend beyond memory loss. While the participants we studied have memory deficits, their memory difficulties do not explain our language findings, as evidenced by a lack of correlation in their performance on the language task and their performances on measures of memory. This suggests that in addition to the memory difficulties that individuals with aMCI experience, they are also struggling with this central aspect of language." Looking for a path to treatment The current paper is part of an ongoing series of studies that Flynn, Lust, Sherman, and their colleagues have performed. The findings have implications for potentially steering neuroscience studies toward regions of the brain that process language, when investigating MCI and other forms of dementia, such as primary progressive aphasia. The study may also help inform linguistics theory concerning various forms of anaphora. Looking ahead, the scholars say they would like to increase the size of the studies as part of an effort to continue to define how it is that diseases progress and how language may be a predictor of that. "Our data is a small population but very richly theoretically guided," Lust says. "You need hypotheses that are linguistically informed to make advances in neurolinguistics. There's so much interest in the years before Alzheimer's disease is diagnosed, to see if it can be caught and its progression stopped." As Flynn adds, "The more precise we can become about the neuronal locus of deterioration, that's going to make a big difference in terms of developing treatment." Support for the research was provided by the Cornell University Podell Award, Shamitha Somashekar and Apple Corporation, Federal Formula Funds, Brad Hyman at Massachusetts General Hospital, the Cornell Bronfenbrenner Center for Life Course Development, the Cornell Institute for Translational Research on Aging, the Cornell Institute for Social Science Research, and the Cornell Cognitive Science Program.

Speech-Language Pathologists Can Help by Providing Strategies to Patients and Care Partners That Improve Quality of Life ROCKVILLE, Md., Feb. 22, 2024 /PRNewswire/ -- With primary progressive aphasia (PPA) once again in the spotlight following news of Wendy Williams' recent diagnosis, the American Speech-Language-Hearing Association (ASHA) is sharing information about the signs of PPA, how it differs from other conditions, and how speech-language pathologists (SLPs) can help families improve communication with—and overall quality of life for—loved ones who are diagnosed. Continue Reading What Is PPA? PPA is a rare and lesser-known neurological condition. It is caused by changes in the frontal and temporal lobes of the brain, which are largely responsible for language and executive functioning. These areas also act as the body's center for making decisions and navigating daily life and activities. PPA is a rare and lesser-known neurological condition. Post this PPA is more likely to occur in people in their 40s to 60s. There is no cure or direct treatment, but SLPs can help people manage the changes that occur in communication and thinking—and put supports and care plans in place for addressing the progression of the disease (see "How SLPs Can Help," below). How Is PPA Different From Other Conditions? PPA is not the same as the following diseases or conditions: Aphasia caused by stroke or other brain injuries. PPA is progressive, so the communication challenges may start slowly—not suddenly—and will get worse over time. Alzheimer's disease and other forms of dementia, where memory changes are the earliest and most recognizable differences. PPA primarily impacts language and communication skills as the earliest signs. Depression or anxiety, although some of the communication or behavioral changes may be similar. Someone with PPA who has trouble interacting with others may socially withdraw or show changes in personality, which can lead to an early but inaccurate diagnosis of mental health disorders. Communication Changes With PPA Some common communication changes that people with PPA may experience early in the disease include: talking or signing slower than usual; having difficulty thinking of words, even the names of familiar objects and people; leaving words out or mixing up the order of words in sentences; using a different word than the one they mean (e.g., "table" instead of "chair"); having difficulty understanding what words mean; struggling to follow a conversation; and/or making mistakes in spelling that they wouldn't typically make. How SLPs Can Help SLPs help by learning an individual's communication priorities early—and then putting systems in place that are supportive as the disease progresses. PPA affects the whole family. Consequently, SLP services extend beyond the person with PPA. They include any or all of the following: Explaining the communication changes that a person is experiencing—and finding strategies that support their participation in the things they want, need, and love to do. Introducing communication strategies and tools that may not be needed today but will be in the future—so that they are well established before the person needs them. Pairing different communication situations with different strategies, like using quick gestures or other signals for medical needs and recording the person's speech for later use for personal messages like their favorite dad jokes and bedtime stories. Working with the person's family and friends to be supportive communication partners—and adapting to changes as they occur. Empowering the person to advocate for their communication needs everywhere they go—and helping connect the person with resources and new communities. Helping a person maintain effective communication, which may look different as their condition progresses. How Families Can Support Communication People with PPA may be unable to fully realize their communication challenges. It's important for loved ones to continue to include the person in conversations and decision making. Tips for how to do that include the following: Validate frustrations, and use supports like writing or drawing to make the interaction more successful. Communication breakdowns are particularly hard for people in the earlier stages of the disease. Slow down when you are speaking with someone who has PPA. Use direct language, and keep sentences short. Give the person time to communicate (rather than finishing the sentence for them). Add nonverbal cues to your speech (e.g., pointing to an object while asking a question about it) if a person's understanding is affected. Avoid open-ended questions, and provide choices to pick from. Break down directions into small steps. Find an SLP at . Media Contact: Francine Pierson, 301-296-8715 SOURCE American Speech-Language-Hearing Association (ASHA)

NEW YORK, Feb. 22, 2024 /PRNewswire/ -- On behalf of Wendy Williams Hunter, her care team is sharing this very personal update with her cherished fans, friends, and supporters to correct inaccurate and hurtful rumors about her health. As Wendy's fans are aware, in the past she has been open with the public about her medical struggles with Graves' Disease and Lymphedema as well as other significant challenges related to her health. Over the past few years, questions have been raised at times about Wendy's ability to process information and many have speculated about Wendy's condition, particularly when she began to lose words, act erratically at times, and have difficulty understanding financial transactions. In 2023, after undergoing a battery of medical tests, Wendy was officially diagnosed with primary progressive aphasia and frontotemporal dementia (FTD). Aphasia, a condition affecting language and communication abilities, and frontotemporal dementia, a progressive disorder impacting behavior and cognitive functions, have already presented significant hurdles in Wendy's life. Wendy would not have received confirmation of these diagnoses were it not for the diligence of her current care team, who she chose, and the extraordinary work of the specialists at Weill Cornell Medicine. Receiving a diagnosis has enabled Wendy to receive the medical care she requires. The decision to share this news was difficult and made after careful consideration, not only to advocate for understanding and compassion for Wendy, but to raise awareness about aphasia and frontotemporal dementia and support the thousands of others facing similar circumstances. Unfortunately, many individuals diagnosed with aphasia and frontotemporal dementia face stigma and misunderstanding, particularly when they begin to exhibit behavioral changes but have not yet received a diagnosis. There is hope that with early detection and far more empathy, the stigma associated with dementia will be eliminated, and those affected will receive the understanding, support, and care they deserve and need. Wendy is still able to do many things for herself. Most importantly she maintains her trademark sense of humor and is receiving the care she requires to make sure she is protected and that her needs are addressed. She is appreciative of the many kind thoughts and good wishes being sent her way. Contact: Jennifer Hanley Ridge Hill Group [email protected] SOURCE Wendy Williams