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Trying to tell a tale - Discourse impairments in progressive aphasia and frontotemporal dementia

Department of Neurology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Neurology (Impact Factor: 8.3). 06/2006; 66(9):1405-13. DOI: 10.1212/01.wnl.0000210435.72614.38
Source: PubMed

ABSTRACT To assess discourse in patients with frontotemporal dementia (FTD).
The authors asked patients with progressive nonfluent aphasia (PNFA), patients with semantic dementia (SemD), and nonaphasic patients with a disorder of social comportment and executive functioning (SOC/EXEC) to narrate the story of a wordless children's picture book.
The authors found significant discourse impairments in all three groups of patients. Moreover, there were qualitatively important differences between the groups. Patients with PNFA had the sparsest output, producing narratives with the fewest words per minute. Patients with SemD had difficulty retrieving words needed to tell their narratives. Though not aphasic, patients with SOC/EXEC had profound difficulty organizing their narratives, and they could not effectively express the point of the story. This deficit correlated with poor performance on a measure of executive resources requiring an organized mental search. In addition, a correlation of narrative organization with cortical atrophy in patients with SOC/EXEC was significant in right frontal and anterior temporal brain regions.
Impaired day-to-day communication in nonaphasic frontotemporal dementia patients with a disorder of social comportment and executive functioning is due in part to a striking deficit in discourse organization associated with right frontotemporal disease. Difficulty with discourse in progressive aphasia is due largely to the language impairments of these patients.

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    • "Glosser and Deser hypothesized that their reduced cognitive abilities contributed to their impaired global coherence abilities; however, they did not empirically test the hypothesis . Ash et al. (2006) investigated global coherence ability in individuals with frontotemporal dementia (FTD) who presented with executive function impairments. The FTD group demonstrated impaired maintenance of global coherence ability. "
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    • "Additional evidence consistent with the hypothesis that rPFC is involved in decision-making during the processing of ambiguous sentences, even though it is not part of the core left peri-Sylvian language network, comes from the study of patients with bvFTD. These patients are not aphasic: their speech is generally well-structured grammatically, and they have minimal difficulty interpreting word meaning, although they do have some difficulty appreciating the hierarchical structure of lengthier narratives (Ash et al., 2006; Farag et al., 2010) and they are impaired at lexical selection when trying to establish common ground with a conversational partner (McMillan et al., 2012b). Despite the absence of aphasia, these patients appear to have difficulty appreciating the ambiguity present in a doubly-quantified sentence. "
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    ABSTRACT: Traditional neuroanatomic models of language comprehension have emphasized a core language network situated in peri-Sylvian cortex. More recent evidence appears to extend the neuroanatomic network beyond peri-Sylvian cortex to encompass other aspects of sentence processing. In this study, we evaluate the neuroanatomic basis for processing the ambiguity in doubly-quantified sentences. For example, a sentence like "All the dogs jumped in a lake" can be interpreted with a collective interpretation (e.g., several dogs jumping into a single lake) or a distributive interpretation (e.g., several dogs each jumping into a different lake). In Experiment 1, we used BOLD fMRI to investigate neuroanatomic recruitment by young adults during the interpretation of ambiguous doubly-quantified sentences in a sentence-picture verification task. We observed that young adults exhibited a processing cost associated with interpreting ambiguous sentences and this was related to frontal and parietal cortex recruitment. In Experiment 2, we investigate ambiguous sentence processing with the identical materials in non-aphasic patients with behavioral variant frontotemporal dementia (bvFTD) who have frontal cortex disease and executive and decision-making limitations. bvFTD patients are insensitive to ambiguity associated with doubly-quantified sentences, and this is related to the magnitude of their frontal cortex disease. These studies provide converging evidence that cortical regions that extend beyond peri-Sylvian cortex help support the processing costs associated with the interpretation of ambiguous doubly-quantified sentences.
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    • "While previous studies have observed that changes in discourse abilities are related to or mediated by complex cognitive functions, this relationship has not been systematically explored in healthy-aging populations. Clinically-based research in patients with neurogenic discourse impairments suggest a strong relationship between deficits in EF abilities and competence in discourse (Alexander 2006; Ash et al. 2006, 2009; Blair et al. 2007; Coelho 2002; Murray and Stout 1999; Peelle and Grossman 2008; Tucker and Hanlon 1998; Ylvisaker et al. 2008). Understanding how these communication abilities vary in healthy populations is an important benchmark for determining severity of deficit and potential treatment candidacy options for neurological populations that exhibit discourse deficits (Cannizzaro and Coelho 2002; Cannizzaro et al. "
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    ABSTRACT: This study examined the narrative discourse production and executive function (EF) abilities of 46 neuro-typical adults (18-98 years old). Two questions were addressed: Is the analysis of narrative structure sensitive to changes associated with aging? & What is the relationship between measures of narrative structure and EF? Narratives were elicited under two conditions and narrative structure was analyzed for the presence of organizing story grammar elements. Narrative structure was significantly correlated with age as well as linguistic and non-linguistic measures of EF. Factor analysis of story structure and EF variables yielded two factors reflecting constructs of output-fluidity and organizational-efficiency. These data suggest that narrative structure and EF represent aspects of goal-directed knowledge that are not bound by a traditional linguistic and non-linguistic division. Thus, narrative structure may represent a global and ecologically valid measure of goal-directed executive function knowledge that is also sensitive to changes associated with typical aging.
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