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Disfluencies in spontaneous speech in persons with low-grade glioma before and after surgery
Abstract
Impaired lexical retrieval is common in persons with low-grade glioma (LGG). Several studies have reported a discrepancy between subjective word-finding difficulties and results on formal tests. Analysis of spontaneous speech might be more sensitive to signs of word-finding difficulties, hence we aimed to explore disfluencies in a spontaneous-speech task performed by participants with presumed LGG before and after surgery. Further, we wanted to explore how the presence of disfluencies in spontaneous speech differed in the participants with and without objectively established lexical-retrieval impairment and with and without self-reported subjective experience of impaired language, speech and communication. Speech samples of 26 persons with presumed low-grade glioma were analysed with regard to disfluency features. The post-operative speech samples had a higher occurrence of fillers, implying more disfluent language production. The participants performed worse on two of the word fluency tests, and after surgery the number of participants who were assessed as having an impaired lexical retrieval had increased from 6 to 12. The number of participants who experienced a change in their language, speech or communication had increased from 9 to 12. Additional comparisons showed that those with impaired lexical retrieval had a higher proportion of false starts after surgery than those with normal lexical retrieval, and differences in articulation rate and speech rate, favouring those not having experienced any change in language, speech or communication. Taken together, the findings from this study strengthen the existing claim that temporal aspects of language and speech are important when assessing persons with gliomas.
Purpose:
To investigate the course of fatigue, subjective and objective language functions in patients with lower-grade gliomas during the first year of disease. Further, to examine if subjective and objective language variables predicted ratings of fatigue.
Methods:
Fatigue was assessed with the Fatigue Severity Scale, subjective language with self-reported word-finding, expression of thoughts, reading and writing from the Functional Assessment of Cancer Therapy - Brain, and objective language with standardized tests. Mixed models were used to investigate changes in variables over time and predictors of fatigue.
Results:
Twenty-three patients with gliomas (WHO 1-3) were included. Average ratings of fatigue did not change significantly, but altering patterns were observed. Subjective concerns about word-finding and expression of thoughts increased significantly during follow-up. The regression analyses showed that concerns about abilities to read and write significantly predicted fatigue. The results indicated that less concerns about reading and writing were associated with lower levels of fatigue.
Conclusions:
Patients with lower-grade gliomas report fatigue and language concerns throughout the first year. Concerns about reading and writing call for careful consideration as they seem to provoke fatigue. The findings underline the importance of the patients' perspective in treatment and follow-up.
Purpose of review
To provide up-to-date evidence on patient-reported outcomes (PROs) in neuro-oncology, with a focus on the core constructs of health-related quality of life (HRQoL) and the use of PROs in clinical trials and clinical practice.
[Supplemental Digital Content: Video Abstract PROs in Neuro-Oncology.mov]
Recent findings
PROs are gaining importance in brain tumor research and medical care. For patients with a brain tumor, core PRO constructs are pain, difficulty communicating, perceived cognition, seizures, symptomatic adverse events, physical functioning and role and social functioning, which are assessed through patient-reported outcome measures (PROMs). Initiatives have been taken to improve the reliability and robustness of PRO data, including standardization of items included in clinical trial protocols (the SPIRIT-PRO extension) and formulation of PRO priority objectives for use in clinical trials (the SISAQOL-Innovative Medicines Initiative). In brain tumor patients with cognitive impairment, caregiver-reported outcomes may complement or replace PROs to increase accuracy. The next key challenge will be to widely implement PROs and apply PRO data in clinical practice to benefit patients with brain tumors.
Summary
PROs are clinically relevant endpoints providing information only known by the patient. Standardization of the use of PROs in clinical trials and wide implementation in clinical practice is needed to improve HRQoL of brain tumor patients.
The purpose of this study was to explore how persons having received various treatments for glioma, a type of brain tumour, experience their language, speech, and communication in everyday life. Twelve persons with low-grade glioma and one with high-grade glioma who had undergone tumour resection in 2014-2016 in different tumour locations were interviewed using a semi-structured protocol. The video-recorded interviews were transcribed and analysed using qualitative content analysis, which revealed three manifest categories, nine sub-categories and one latent theme. Participants experienced changed communication that affected word finding, motor speech and comprehension. They also expressed how communication required a greater effort; time and context were important factors and participants felt frustrated with their communication. Further, they were dealing with changes and used multiple strategies to manage communication. For most participants it did not affect their everyday life, but it was not like before. In addition, participants adapted their way of living to manage illness-related problems. Uncertainty was a latent theme which emanated from the participants' illness experience, reflecting how living with a slow-growing brain tumour affects life-decisions and views of perceived symptoms. Discussion of how results can be interpreted in relation to previous research and health care are included.
Majority of lower grade glioma (LGG) are located eloquently rendering surgical resection challenging. Aim of our study was to assess rate of permanent deficits and its predisposing risk factors. We retrieved 83 patients harboring an eloquently located LGGs from the prospective LoG-Glio Database. Patients without surgery or incomplete postoperative data were excluded. Sign rank test, explorative correlations by Spearman ρ and multivariable regression for new postoperative deficits were calculated. Eloquent region involved predominantly motor (45%) and language (40%). At first follow up after 3 months permanent neuro-logical deficits (NDs) were noted in 39%. Mild deficits remained in 29% and severe deficits in 10%. Complete tumor removal (CTR) was successfully in 62% of intended cases. Postoperative and 3-month follow up National Institute of Health Stroke Score (NIHSS) showed significantly lower values than preoperatively (p<0.001). 38% cases showed a decreased NIHSS at 3-month, while occurrence was only 14% at 9-12-month follow up. 6/7 patients with mild aphasia recovered after 9-12 months, while motor deficits present at 3-month follow up were persistent in majority of patients. Eastern oncology group functional status (ECOG) significantly decreased by surgery (p < 0.001) in 31% of cases. Between 3-month and 9-12-months follow up no significant improvement was seen. In the multivariable model CTR (p=0.019, OR 31.9), and ECOG>0 (p=0.021, OR 8.5) were independent predictors for permanent postoperative deficit according to NIHSS at 3-month according to multivariable regression model. Patients harboring eloquently located LGG are highly vulnerable for permanent deficits. Almost one third of patients have a permanent reduction of their functional status based on ECOG. Risk of an extended resection has to be balanced with the respective oncological benefit. Especially, patients with impaired pre-operative status are at risk for new permanent deficits. There is a relevant improvement of neurological symptoms in the first year after surgery, especially for patients with slight aphasia.
Background
Glioma (brain tumour) patients can suffer from mild linguistic and non-linguistic cognitive problems when the glioma is localised in an eloquent brain area. Word-finding problems are among the most frequently reported complaints. However, mild problems are difficult to measure with standard language tests because they are generally designed for more severe aphasic patients.
Aims
The aim of the present study was to investigate whether word-finding problems reported by patients with a glioma can be objectified with a standard object naming test, and a linguistic processing speed test. In addition, we examined whether word-finding problems and linguistic processing speed are related to non-verbal cognitive abilities.
Methods & Procedures
We tested glioma patients (N=36) as part of their standard pre-treatment clinical work-up. Word-finding problems were identified by a clinical linguist during the anamnesis. Linguistic processing speed was assessed with a newly designed sentence judgment test (SJT) as part of the Diagnostic Instrument for Mild Aphasia (DIMA), lexical retrieval with the Boston Naming Test (BNT), presence of aphasia with a Token Test (TT), and non-verbal processing with the Trail Making Test A and B (TMT). Test performances of glioma patients were compared to those of healthy control participants (N=35).
Outcomes & Results
The results show that many glioma patients (58%) report word-finding problems; these complaints were in only half of the cases supported by deviant scores on the BNT. Moreover, the presence of reported word-finding problems did not correlate with the BNT scores. However, word-finding problems were significantly correlated with reaction times on the SJT and the TMT. Although there were no significant differences between the patient and control group on the SJT, a subgroup of patients with a glioma in the frontal lobe of the language-dominant hemisphere was slower on the SJT. Finally, performance on the SJT and TMT were significantly correlated in the patient group but not in the control group.
Conclusions
Linguistic processing speed appears to be an important factor in explaining reported word-finding problems. Moreover, the overlap between speed of language processing and non-verbal processing indicates that patients may rely on more domain-general cognitive abilities as compared to healthy participants. The variability observed between patients emphasises the need for tailored neuro-linguistic assessments including an extensive anamnesis regarding language problems in clinical work-up.
Purpose
Anomia, or difficulty with naming and word finding, is a pervasive deficit among individuals with aphasia. There is an extensive literature on the mechanisms underlying anomia and on approaches to treatment, but very little is known about the subjective experience of anomia during day-to-day life.
Method
As part of a larger testing battery, 53 adults with poststroke aphasia took part in a novel, structured interview that included an open-ended question about the general experience of anomia: “Do you ever know what you want to say, but you can't say it out loud? Please describe that feeling.” Video-recorded interview responses were transcribed and analyzed using thematic analysis, an iterative, data-driven process that categorizes interview data into common themes.
Results
Five main themes emerged among the data from 37 participants who produced adequate responses for use in thematic analysis: strategies to cope with or compensate for anomia, comments on awareness of the level of breakdown (e.g., “I have an idea, but can't get the right words”), negative emotions, impact on relationships, and changes in frequency over time.
Conclusions
Participants showed strong awareness of anomia and its implications, demonstrating an ability to describe their language breakdown, identify relevant strategies to compensate and/or cope, and acknowledge the impact of anomia on their emotions and social interactions. This patient perspective may serve as a valuable supplement to information typically gained via objective language assessments. Clinicians and researchers may wish to consider incorporating similar subjective measures during assessment and treatment planning.
Supplemental Material
https://doi.org/10.23641/asha.15032643
The present corpus study aims to contribute to the debate regarding the lexical or non-lexical status of filled pauses. While they are commonly associated with hesitation, disfluency and production difficulty, it has also been argued that they can serve more fluent communicative functions in discourse (e.g. turn-taking, stance-marking). Our work is grounded in a usage-based and discourse-functional approach to filled pauses, and we address this debate by examining the multiple characteristics of euh and eum in spoken French, as well as their co-occurrence with discourse markers. Combining quantitative and qualitative analyses, we analyze their distribution across different communication settings (prepared monologues vs. spontaneous conversations) and levels of language proficiency (native vs. non-native). Quantitative findings indicate differences in frequency, duration, position and patterns of co-occurrence across corpora, and our qualitative analyses identify fine-grained differences, mainly two distinct patterns of distribution (initial position clustered with a discourse marker vs. medial position clustered with other hesitation markers), reflecting the different "fluent" and "disfluent" uses of filled pauses. We thus argue for a dual status of euh and eum based on formal, functional and contextual features.
Objective
Knowledge about the long-term outcome of high-level language ability in awake surgery patients with low-grade gliomas or cavernomas in language eloquent regions is limited, particularly regarding subtle changes in high-level language abilities.
Patients and methods
The study group consisted of 27 patients with LGG or cavernoma which involved language eloquent regions in the left hemisphere. A comprehensive assessment battery was used to target subtle changes in overall high-level language ability as well as in language sub skills. Assessments were made preoperatively and at 3 and 12 months postoperatively.
Results
The results showed that overall high-level language ability had not decreased significantly at group level at 3 or 12 months postoperatively. The proportion of patients with a decline of 5 percent or more at follow up 3 and 12 months were 13% and 9% respectively. There was a marked decline in semantic fluency (animals and verbs) at 3 and 12 months postoperatively. Phonemic fluency, while not significantly reduced at three months, improved markedly in the interval between 3 and 12 months. At 12 months, the only significant decline relative to preoperative scores were seen in semantic fluency for animals and verbs. Verbal cognitive speed did not decline significantly postoperatively but approximately 40% of the patients had a decline of 5% or more at 12 months.
Conclusions
Overall high-level language ability was not significantly affected postoperatively at 3 and 12 months in LGG and cavernoma awake surgery patients. Semantic word fluency had deteriorated postoperatively at 3 and 12 months follow-up. Taken together our results indicate a decline in processing speed of verbal material postoperatively in the patient group.
Although subtle discourse declines in people with mild cognitive impairment (MCI) have been reported, heterogeneous measures and tasks among the MCI discourse studies have yielded widely varying outcomes. The present study aimed to first, identify discourse measures that aid the differentiation among people with amnestic MCI (aMCI), people with non-amnestic MCI (naMCI), and cognitively healthy control (HC) participants, and second, delineate the cognitive functions related to such discourse measures. Three discourse tasks (an episodic narrative, a planning task, and a picture description) were performed by 30 aMCI, 22 naMCI, and 21 HC participants. Samples were analyzed using six categories of 15 measures, namely coherence, cohesion, proposition, grammaticality, lexicality, and fluency. The statistical analyses included (1) a multivariate analysis of variance for group comparison; (2) binary simple logistic regression and receiver operating characteristic curve analysis for differentiation between two groups; (3) binary multiple logistic regression for being diagnosed with naMCI or aMCI with the minimum number of predictors; and (4) Pearson correlation analysis for identifying the cognitive functions associated with the discourse measures. The proportion of cohesive words and propositional density in aMCI participants were worse than those in naMCI participants. Global coherence, the proportion of cohesive words, and the proportion of dysfluencies and pauses in naMCI participants were lower than those in the HC participants. Global and local coherence and the proportion of cohesive words, cohesive ties per utterances, propositional density, and dysfluencies and pauses in aMCI participants were worse than those in the HC participants. The aforementioned measures were demonstrated to be effective predictors for classifying groups by receiver operating characteristic curve analysis. In addition, the proportions of cohesive words and pauses were common discourse measures for differentiation between naMCI and HC participants or between aMCI and HC participants using binary multiple logistic regression. According to the correlation analysis, memory and executive functions are needed for coherent, cohesive, and efficient discourse productions in MCI. The detailed description of discourse performances in this study will aid the characterization of the declined language abilities of MCI participants and also the understanding of the cognitive functions involved in discourse performance in MCI.
Purpose
In Parkinson's disease (PD), there are significant changes in the basal ganglia, a structure known to be important for controlling automatic responses to cues. Changes to the basal ganglia in PD impair an individual's ability to trigger a behavior in response to cues, but more so in response to internal cues more than external ones. Filled pauses are considered a subconscious or automatic speech response to an internal cue that there are difficulties with ongoing communication. Typical speakers use filled pauses (such as uh or um) to mark silent pauses. The purpose of this study was to examine how automatic speech responses are impacted in PD by looking at filled and silent pausing behaviors, extending our understanding of the role of the basal ganglia in automatic behaviors. We hypothesized that individuals with PD would use fewer filled pauses and longer silent pauses. We also hypothesized that longer pauses would be more likely to be marked with filled pauses and that this relationship would be weaker in speakers with PD.
Method
Speech samples were collected via a story-retelling task from 15 individuals with PD and 18 age-matched controls. Duration and frequency of filled and silent pauses were measured using spectrographic analysis. Number and duration of marked silent pauses (those consecutive with 1 or more filled pauses) were measured. The t tests and analyses of variance were used to test our hypotheses.
Results
There was no significant difference in the number of silent pauses between groups, but the duration of silent pauses was significantly greater for individuals with PD. Despite this, individuals with PD produced significantly fewer filled pauses and fewer marked silent pauses. For both groups, longer silent pauses were more likely to be marked by filled pauses, but individuals with PD marked a smaller percentage of silent pauses at longer durations than controls.
Conclusions
Producing fewer marked silent pauses, coupled with longer silent pauses, reduces natural cues to discourse and puts people with PD at greater risk of sounding unnatural and losing their communicative turn. These results suggest that automatic responses regarding speech production difficulties are impaired by PD. This interpretation fits with nonspeech literature where automatic responses have been demonstrated to be impaired in PD.
Background:
Low-grade glioma (LGG) is a type of brain tumour often situated in or near areas involved in language, sensory or motor functions. Depending on localization and tumour characteristics, language or cognitive impairments due to tumour growth and/or surgical resection are obvious risks. One task that may be at risk is writing, both because it requires intact language and memory function and because it is a very complex and cognitively demanding task. The most commonly reported language deficit in LGG patients is oral lexical-retrieval difficulties, and poor lexical retrieval would be expected to affect writing fluency.
Aims:
To explore whether writing fluency is affected in LGG patients before and after surgery and whether it is related to performance on tasks of oral lexical retrieval.
Methods & procedures:
Twenty consecutive patients with presumed LGG wrote a narrative and performed a copy task before undergoing surgery and at 3-month follow-up using keystroke-logging software. The same tasks were performed by a reference group (N = 31). The patients were also tested using the Boston Naming Test (BNT) and word-fluency tests before and after surgery. Writing fluency was compared between the patients and the reference group, and between the patients before and after surgery. Relationships between performance on tests of oral lexical retrieval and writing fluency were investigated both before and after surgery.
Outcome & results:
Different aspects of writing fluency were affected in the LGG patients both before and after surgery. However, when controlling for the effect of typing speed, the LGG group differed significantly from the reference group only in the proportion of pauses within words. After surgery, a significant decline was seen in production rate and typing speed in the narrative task, and a significant increase was seen in pauses before words. Strong positive relationships were found between oral lexical retrieval and writing fluency both before and after surgery.
Conclusions & implications:
Although aspects of writing fluency were affected both before and after surgery, the results indicate that typing speed is an important factor behind the pre-surgery differences. However, the decline in overall productivity and the increase in pauses before words after surgery could be related to a lexical deficit. This is supported by the finding that oral lexical-retrieval scores were strongly correlated with writing fluency. However, further exploration is needed to identify the language and cognitive abilities affecting writing processes in LGG patients.
In patients with low-grade glioma (LGG), language deficits are usually only found and investigated after surgery. Deficits may be present before surgery but to date, studies have yielded varying results regarding the extent of this problem and in what language domains deficits may occur. This study therefore aims to explore the language ability of patients who have recently received a presumptive diagnosis of low-grade glioma, and also to see whether they reported any changes in their language ability before receiving treatment. Twenty-three patients were tested using a comprehensive test battery that consisted of standard aphasia tests and tests of lexical retrieval and high-level language functions. The patients were also asked whether they had noticed any change in their use of language or ability to communicate. The test scores were compared to a matched reference group and to clinical norms. The presumed LGG group performed significantly worse than the reference group on two tests of lexical retrieval. Since five patients after surgery were discovered to have a high-grade glioma, a separate analysis excluding them were performed. These analyses revealed comparable results; however one test of word fluency was no longer significant. Individually, the majority exhibited normal or nearly normal language ability and only a few reported subjective changes in language or ability to communicate. This study shows that patients who have been diagnosed with LGG generally show mild or no language deficits on either objective or subjective assessment.
Electronic supplementary material
The online version of this article (10.1007/s11060-017-2699-y) contains supplementary material, which is available to authorized users.
Background The European Low-Grade Glioma network indicated a need to better understand common practices regarding the managing of diffuse low-grade gliomas. This area has experienced great advances in recent years.
Method A general survey on the managing of diffuse low grade gliomas was answered by 21 centres in 11 European countries. Here we focused on specific questions regarding perioperative and intraoperative cognitive assessments.
Results More centres referred to the same speech and language therapist and/or neuropsychologist across all assessments; a core of assessment tools was routinely used across centres; fluency tasks were commonly used in the perioperative stages, and object naming during surgery; tasks that tapped on attention, executive functions, visuospatial awareness, calculation and emotions were sparsely administered; preoperative assessments were performed 1 month or 1 week before surgery; timing for postoperative assessments varied; finally, more centres recommended early rehabilitation, whenever needed.
Conclusions There is an emerging trend towards following similar practices for the management of low-grade gliomas in Europe. Our results are descriptive and formalise current discussions in our group. Also, they contribute towards the development of a European assessment protocol.
Language assessment has a crucial role in the clinical diagnosis of several neurodegenerative diseases. The analysis of extended speech production is a precious source of information encompassing the phonetic, phonological, lexico-semantic, morpho-syntactic, and pragmatic levels of language organization. The knowledge about the distinctive linguistic variables identifying language deficits associated to different neurodegenerative diseases has progressively improved in the last years. However, the heterogeneity of such variables and of the way they are measured and classified limits any generalization and makes the comparison among studies difficult. Here we present an exhaustive review of the studies focusing on the linguistic variables derived from the analysis of connected speech samples, with the aim of characterizing the language disorders of the most prevalent neurodegenerative diseases, including primary progressive aphasia, Alzheimer's disease, movement disorders, and amyotrophic lateral sclerosis. A total of 61 studies have been included, considering only those reporting group analysis and comparisons with a group of healthy persons. This review first analyzes the differences in the tasks used to elicit connected speech, namely picture description, story narration, and interview, considering the possible different contributions to the assessment of different linguistic domains. This is followed by an analysis of the terminologies and of the methods of measurements of the variables, indicating the need for harmonization and standardization. The final section reviews the linguistic domains affected by each different neurodegenerative disease, indicating the variables most consistently impaired at each level and suggesting the key variables helping in the differential diagnosis among diseases. While a large amount of valuable information is already available, the review highlights the need of further work, including the development of automated methods, to take advantage of the richness of connected speech analysis for both research and clinical purposes.
Background: Developing effective interventions for people with aphasia, which both ameliorate impaired language and directly impact on real-life communication, is a key focus of aphasia research. While single-word and sentence-level models of language processing have informed effective interventions, there is limited evidence of intervention approaches that extend the principles from these models to discourse. Aims: This pilot randomised controlled trial (RCT) aimed to compare a novel multilevel intervention, a Novel Approach to Real-life communication: Narrative Intervention in Aphasia (NARNIA), with usual care (UC), with a view to assess the feasibility and acceptability of the approach and estimate effect sizes to design and power a definitive trial. Methods & Procedures: In a prospective, single-blind, RCT, 14 people with mild to moderate aphasia, between 2 and 165 months following stroke, were randomised to the two interventions. Both therapy conditions were delivered four times weekly over 5 weeks. The NARNIA intervention specifically combined word retrieval, sentence production, and discourse macrostructure across a range of everyday discourse (ED) genres. UC comprised any speech-language therapy routinely used in clinical practice, individually tailored to meet the assessed needs of the participant. The Curtin University Discourse Protocol (CUDP) was used to measure verb access, sentence production, and discourse structure. Outcomes & Results: Eight participants were assigned to the NARNIA intervention and six participants to UC. No significant differences were present in baseline prognostic factors between the two groups prior to intervention. Following intervention, orientation aspects of macrostructure were significantly greater in the NARNIA group on ED measures than in the UC group, with no other between-group differences found. Significant changes were, however, seen within groups across ED genres. The NARNIA group made significant gains across all language levels, while the UC made isolated gains in sentence production. Few changes were seen in narrative discourse for either group. While single-word processing was not significantly different between groups, significant within-group differences were seen. While both groups significantly improved in retrieving nouns in isolation, only the NARNIA group made significant improvement in verb processing. No change was seen in constrained sentence production for either group. Conclusions: These findings are highly promising in demonstrating the use of macrostructure to scaffold production of words and sentences and improve discourse organisation. The significantly greater within-group gains for the NARNIA participants will provide a platform to power a larger trial to evaluate the effectiveness of this integrated multilevel intervention for aphasia.
It is known that Alzheimer’s disease (AD) influences the temporal characteristics of spontaneous speech. These phonetical changes are present even in mild AD. Based on this, the question arises whether an examination based on language analysis could help the early diagnosis of AD and if so, which language and speech characteristics can identify AD in its early stage. The purpose of this article is to summarize the relation between prodromal and manifest AD and language functions and language domains. Based on our research we are inclined to claim that AD can be more sensitively detected with the help of a linguistic analysis than with other cognitive examinations. The temporal characteristics of spontaneous speech such as speech tempo, number of pauses in speech and their length are sensitive detectors of the early stage of the disease, which enables an early simple linguistic screening for AD. However, knowledge about the unique features of the language problems associated with different dementia variants still has to be improved and refined.
Subjective cognitive complaints (SCCs) are frequent in the elderly population. The majority of individuals with subjective complaints never progress to significant cognitive decline, but some of them have a higher risk of progression to objective cognitive impairment than persons with no cognitive concerns. We performed a systematic review of community-based studies that focused on the progression risk associated with SCC and on the complainers' characteristics associated with progression. Seventeen studies were included. As a group, SCCs are associated with a significantly higher risk of progression to dementia. Worried complainers, persons who refer an impact of their complaints on activities of daily living, and those whose complaints are also noticed by an informant have the highest risk of progression. Taking into account the fluctuating course of SCC and their frequent reversion, care should be taken to not overvaluate them. Further studies are necessary to better define risk features.
© The Author(s) 2015.
This study addresses whether there is a threshold, some particular length of silent gap between two speakers' turns, at which negative social attributions emerge. The effect of such inter-turn silence was tested by constructing dialogues where responses to requests were identical and affirmative so that study participants' (n = 380) ratings about "willingness" would be colored by lag time, not semantics. 100 ms intervals between 200 and 1200 ms were tested in a between groups design. There was a notable drop-off in ratings at 600 ms and a statistically significant difference in ratings between 700 and 800 ms.
Background
Glioma patients often complain about problems in daily conversation. A detailed spontaneous speech analysis could provide more insight in these communicative problems; no previous studies are reported.
Objective
To select sensitive parameters in spontaneous speech pre- and post-operatively in patients with gliomas in eloquent areas.
Methods
We included 27 patients and 21 healthy controls. In addition to a naming and category fluency test, spontaneous speech was collected 1 month pre-operatively and 3 months post-operatively, and analysed with the variables: Self-corrections, Repetitions, Lexical Diversity, Incomplete Sentences and Mean Length of Utterance (MLUw). A correlation analysis was performed between the linguistic variables and tumour characteristics (grade, localisation and volume), treatment related factors, and between the linguistic variables and the language tasks.
Results
Pre-operatively, patients produced more Incomplete Sentences than the controls (p < 0.001). Post-operatively, patients’ utterance length (MLUw) (p < 0.05) was also deviant. The quality of the spontaneous speech was influenced by tumour grade and localisation. There was no influence of tumour volume or treatment-related factors. Pre- and post-operatively, patients’ performance on the naming and the fluency task deviated from normal (p < 0.001). The majority of the linguistic variables did not correlate with the language tasks, pointing to a measurement of distinct linguistic aspects.
Conclusion
Pre- and post-operatively there was a disorder in naming, category fluency and spontaneous speech, partly influenced by tumour characteristics. A spontaneous speech analysis appeared to be a valuable addition to standardised language tasks. Both measurements are important tools to obtain a complete linguistic profile.
Object:
Patients with gliomas frequently have cognitive deficits, and surgery can exacerbate these deficits. Preoperative assessment is therefore crucial in patients undergoing surgery for glioma in eloquent areas, because the proximity of functional areas increases the risk of permanent postoperative cognitive disturbances. Although pre- and postoperative language and motor function in patients with glioma have been investigated frequently, data on good cognition studies are scarce. Most studies have focused on clinical neurological functioning or have only used brief neurological instruments. The authors investigated whether surgery for glioma in eloquent areas influences cognition early after surgery, by using an elaborate test protocol.
Methods:
Twenty-eight patients with gliomas of the left hemisphere in language and nonlanguage areas were assessed before and 3 months after surgery with a comprehensive neuropsychological test protocol. The authors performed a correlation analysis between change in cognitive performance and tumor characteristics (that is, location, volume, pathological features, and histological grade) and between cognitive change and treatment-related factors (the extent of the resection and postoperative treatment with chemo- and radiotherapy).
Results:
Both pre- and postoperatively, the mean performance of the patients was worse than the performance of the normal population in the language domain, the memory domain, and the executive functions (p < 0.05). Postoperatively, a decline was found in the language domain (t = 2.34, p = 0.027) and in the executive functions (t = 2.45, p = 0.022). However, cognitive change postsurgery was influenced by the location of the tumor; the decrease of cognitive score in the language domain was only observed in patients with tumors in or close to language areas (t = 2.33, p = 0.029). No effect on cognitive change was found for the other tumor characteristics and treatment-related factors.
Conclusions:
This study underlines the importance of the use of a neuropsychological test protocol before and after surgery in patients with glioma, because several tasks in the domains of language, memory, and executive functions appeared to deteriorate after surgery. Tumor resection in language areas increases the risk of cognitive deficits in the language domain postoperatively.
We describe how a neuropsychological evaluation in patients with brain tumors should be performed, specifically in the case of low-grade gliomas. Neuropsychological examination is crucial before starting any treatment as well as during the follow-up, since it can improve neurosurgery techniques and reveal potential cognitive effects of chemotherapy and radiotherapy, besides planning rehabilitation. We underline that sensitive and wide-ranging tests are required; specific tasks based on the lesion site should be added. Moreover, some tests can provide additional information about the evolution of the tumor. A careful, thorough examination improves quality of life.
In surgery for tumors of the dominant hemisphere, the attention devoted to quality of resection and preservation of language function has not been accompanied by comparable interest in preservation of cognitive abilities which may affect quality of life. We studied 22 patients undergoing awake surgery for glioma removal in the language areas of the brain. Besides monitoring tumor variables (size, location, histology, edema), we used a multifaceted battery of tests to investigate mood, cognition, and language in an attempt to assess the burden of disease and treatment, and the relationships between these three dimensions. Baseline assessment showed that 45% of the patients were depressed and 23% anxious; some cognitive and language impairment was noted for 59 and 50%, respectively. A general decline in postoperative cognitive performance (significant for memory and attention only) and language function (significant for picture naming) was observed, whereas depression was unchanged and anxiety decreased. Tumor histology, but not demographic variables or extent of resection, correlated with postoperative cognitive changes: patients undergoing surgery for high-grade tumors were more likely to improve. No correlation was observed between scores for mood, cognition, and language function. A subset of patients with low-grade glioma was followed up for 3-6 months; although some improvement was observed they did not always regain their preoperative performance. In conclusion, we believe that cognitive assessment performed in conjunction with language testing is a necessary step in the global evaluation of brain tumor patients both before and after surgery.
Awake surgery with intraoperative brain mapping is highly recommended for patients with diffuse low-grade gliomas in language areas, to maximise the extent of resection while preserving the integrity of functional networks and thus quality of life. The picture-naming test "DO.80" is the gold standard for language assessment before, during, and after surgery. Cognitive functioning is correlated with quality of life, itself linked with return to work. Our objective was to evaluate the significance of measuring naming speed, and its correlation with the return to professional activities. Two complementary studies are reported. In the first retrospective study, eleven patients were examined post-operatively. Five patients were selected because they were not able to resume their professional activities ("no return group 1"). They were compared with a control group of six patients who are working normally after surgery ("return group 1"). The eleven patients performed a global language and neuropsychological assessment, with a post-operative median follow-up of 35 months. In a subsequent prospective study, twelve patients were examined pre-operatively and post-operatively. Six patients who were not able to return to work ("no return group 2") were compared with a control group of six patients who were working normally after the surgery ("return group 2"). The twelve patients performed a pre and post-operative language assessment, with a median follow-up of 9 months. Our results show, for the first time, that naming speed is significantly correlated with a major criterion of quality of life: the return to professional activities. There were no differences between the two groups regarding other measures of cognition. Assessing naming times, and not only naming accuracy, is essential in the management of low-grade glioma patients, before, during, and after surgery, to preserve their quality of life by resuming their previous professional activity. Our results have fundamental implications concerning the comprehension of language processing and its relationship with cognitive functioning.
Detection thresholds for gaps and overlaps, that is acoustic and perceived silences and stretches of overlapping speech in speaker changes, were determined. Subliminal gaps and overlaps were categorized as no-gap-no-overlaps. The established gap and overlap detection thresholds both corresponded to the duration of a long vowel, or about 120 ms. These detection thresholds are valuable for mapping the perceptual speaker change categories gaps, overlaps, and no-gap-no-overlaps into the acoustic domain. Furthermore, the detection thresholds allow generation and understanding of gaps, overlaps, and no-gap-no-overlaps in human-like spoken dialogue systems.
Hemispheric low-grade gliomas (LGGs) have an unpredictable progression and overall survival (OS) profile. As a result, the objective in the present study was to design a preoperative scoring system to prognosticate long-term outcomes in patients with LGGs.
The authors conducted a retrospective review with long-term follow-up of 281 adults harboring hemispheric LGGs (World Health Organization Grade II lesions). Clinical and radiographic data were collected and analyzed to identify preoperative predictors of OS, progression-free survival (PFS), and extent of resection (EOR). These variables were used to devise a prognostic scoring system.
The 5-year estimated survival probability was 0.86. Multivariate Cox proportional hazards modeling demonstrated that 4 factors were associated with lower OS: presumed eloquent location (hazard ratio [HR] 4.12, 95% confidence interval [CI] 1.71-10.42), Karnofsky Performance Scale score < or = 80 (HR 3.53, 95% CI 1.56-8.00), patient age > 50 years (HR 1.96, 95% CI 1.47-3.77), and tumor diameter > 4 cm (HR 3.43, 95% CI 1.43-8.06). A scoring system calculated from the sum of these factors (range 0-4) demonstrated risk stratification across study groups, with the following 5-year cumulative survival estimates: Scores 0-1, OS = 0.97, PFS = 0.76; Score 2, OS = 0.81, PFS = 0.49; and Scores 3-4, OS = 0.56, PFS = 0.18 (p < 0.001 for both OS and PFS, log-rank test). This proposed scoring system demonstrated a high degree of interscorer reliability (kappa = 0.86). Four illustrative cases are described.
The authors propose a simple and reliable scoring system that can be used to preoperatively prognosticate the degree of lesion resectability, PFS, and OS in patients with LGGs. The application of a standardized scoring system for LGGs should improve clinical decision-making and allow physicians to reliably predict patient outcome at the time of the original imaging-based diagnosis.
After reviewing situational and demographic factors that have been argued to affect speakers' disfluency rates, we examined disfluency rates in a corpus of task-oriented conversations (Schober & Carstensen, 2001 ) with variables that might affect fluency rates. These factors included: speakers' ages (young, middle-aged, and older), task roles (director vs. matcher in a referential communication task), difficulty of topic domain (abstract geometric figures vs. photographs of children), relationships between speakers (married vs. strangers), and gender (each pair consisted of a man and a woman). Older speakers produced only slightly higher disfluency rates than young and middle-aged speakers. Overall, disfluency rates were higher both when speakers acted as directors and when they discussed abstract figures, confirming that disfluencies are associated with an increase in planning difficulty. However, fillers (such as uh) were distributed somewhat differently than repeats or restarts, supporting the idea that fillers may be a resource for or a consequence of interpersonal coordination.
Background: In assessing post-operative language impairment, clinical teams typically rely on “aphasia subtype” classifications, based on post-stroke patterns of impairment. However, this approach may significantly underestimate the prevalence of post-surgical language impairments due to the different pathophysiological mechanisms involved. There is a paucity of research in chronic post-surgical patients.
Aims: We investigated post-surgical language performance in the chronic phase.
Methods & Procedures: Using both the Western Aphasia battery Revised (WAB-R) and the Comprehensive Aphasia test (CAT), we assessed a range of language skills in 26 right-handed patients approximately 6–12 months after they underwent surgery to remove a primary tumour in their left cerebral hemisphere. Participants’ self-reports of their speech and language skills post-surgery were also collected.
Outcomes and Results: Following surgery, 77% of patients scored below normal cut-off on one or more language subtests of the CAT battery. This contrasted with only 27% on the WAB AQ. The CAT findings were supported by subjective data, with 58% of patients self-reporting post-surgical communication difficulty.
Conclusions: Our results show that current “aphasia subtype” testing is inadequate, and is likely to significantly underestimate chronic language deficits in this population. Alternative approaches to formal language assessment need to be used in this group of patients whose pattern of impairments is very different from that observed in post-stroke aphasia.
Background
Diagnosis of prodromal Alzheimer's disease (AD) still represents a burning issue and there is growing interest for detection of early and non-invasive biomarkers. Although progressive episodic memory impairment is the typical predominant feature of AD, communicative difficulties can be already present at the early stages of the disease.
Objective
This study investigated narrative discourse production deficit as a hallmark of CSF- defined prodromal AD and its correlation with cerebral hypoperfusion pattern.
Method
Narrative assessment with a multilevel procedure for discourse analysis was conducted on 28 subjects with Mild Cognitive impairment (15 MCI due to AD; 13 MCI non-AD) and 28 healthy controls. The diagnostic workup included CSF AD biomarkers. Cerebral hypoperfusion pattern was identified by SPECT image processing.
Results
The results showed that the discourse analysis of global coherence and lexical informativeness indexes allowed to identify MCI due to AD from MCI non-AD and healthy subjects. These findings allow to hypothesize that loss of narrative efficacy could be a possible early clinical hallmark of the Alzheimer’s disease. Furthermore, a significant correlation of global coherence and lexical informativeness reduction with the SPECT hypoperfusion was found in the dorsal aspect of the anterior part of the left inferior frontal gyrus, supporting the hypothesis that this area has a significant role in communicative efficacy and in particular in semantic selection executive control.
Conclusion
This study therefore contributes to understanding of neural networks for language processing and their involvement in prodromal Alzheimer's disease. It also suggests an easy and sensitive tool for clinical practice that can help identifying individuals with prodromal Alzheimer’s disease.
Pauses may be studied as an aspect of the temporal organization of speech, as well as an index of internal cognitive processes, such as word access, selection and retrieval, monitoring, articulatory planning, and memory. Several studies have demonstrated specific distributional patterns of pauses in typical speech. However, evidence from patients with language impairment is sparse and restricted to small-scale studies. The aim of the present study is to investigate empty pause distribution and associations between pause variables and linguistic elements in aphasia. Eighteen patients with chronic aphasia following a left hemisphere stroke were recruited. The control group consisted of 19 healthy adults matched for age, gender, and years of formal schooling. Speech samples from both groups were transcribed, and silent pauses were annotated using ELAN. Our results indicate that in both groups, pause duration distribution follows a log-normal bimodal model with significantly different thresholds between the two populations, yet specific enough for each distribution to justify classification into two distinct groups of pauses for each population: short and long. Moreover, we found differences between the patient and control group, prominently with regard to long pause duration and rate. Long pause indices were also associated with fundamental linguistics elements, such as mean length of utterance. Overall, we argue that post-stroke aphasia may induce quantitative but not qualitative alterations of pause patterns during speech, and further suggest that long pauses may serve as an index of internal cognitive processes supporting sentence planning. Our findings are discussed within the context of pause pattern quantification strategies as potential markers of cognitive changes in aphasia, further stressing the importance of such measures as an integral part of language assessment in clinical populations.
Objective: Glioma patients often complain about problems in daily conversation with a negative impact on quality of life. Disorders in standardized language tests (e.g. naming and fluency), are frequently observed. Most studies claim recovery of language functions within 3 months. However, long-term effects of surgery on spontaneous speech remain unknown.
Patients and Methods: Eighteen glioma patients were compared to healthy controls in spontaneous speech variables: Type Token Ratio (TTR), Mean Length of Utterance words (MLUw), Incomplete Sentences, Self-corrections and Repetitions. Boston Naming Test (BNT) and Category Fluency (CF) were also assessed. We compared: pre- and 3 months postoperatively (T1-T2), 3 months and 1 year postoperatively (T2-T3), pre- and 1 year postoperatively (T1-T3). Correlations were computed between deviating variables and BNT/CF, tumor localization, and tumor grade.
Results: Patients had deficits in Incomplete sentences (T1, T2, T3), TTR (T2,T3), MLUw (T3) and Self-corrections (T2). Between T1-T2 no decline was present. Between T2-T3 and T1-T3, there was a decrease of MLUw, Self-corrections and Repetitions and an increase of Incomplete Sentences, BNT and CF were impaired (T1, T2, T3) without differences between test-moments. Most spontaneous speech variables did not correlate with standardized tests. Tumor localization and grade had no influence on spontaneous speech .
Conclusion: Glioma patients showed impaired spontaneous speech combined with naming and fluency deficits. Surgery appeared to have deteriorated the quality of spontaneous speech until long-term but not the performance at test-level. Hence, spontaneous speech has an added value to standardized tests for diagnosis of language impairments.
Objectives:
Low-grade glioma (LGG) is a slow-growing brain tumour often situated in or near areas involved in language and/or cognitive functions. Thus, language impairments due to tumour growth or surgical resection are obvious risks. We aimed to investigate language outcome following surgery in patients with presumed LGG, using a comprehensive and sensitive language assessment.
Materials and methods:
Thirty-two consecutive patients with presumed LGG were assessed preoperative, early post-operative, and 3 months post-operative using sensitive tests including lexical retrieval, language comprehension and high-level language. The patients' preoperative language ability was compared with a reference group, but also with performance at post-operative controls. Further, the association between tumour location and language performance pre- and post-operatively was explored.
Results:
Before surgery, the patients with presumed LGG performed worse on tests of lexical retrieval when compared to a reference group (BNT: LGG-group median 52, Reference-group median 54, P = .002; Animals: LGG-group mean 21.0, Reference-group mean 25, P = 001; Verbs: LGG-group mean 17.3, Reference-group mean 21.4, P = .001). At early post-operative assessment, we observed a decline in all language tests, whereas at 3 months there was only a decline on a single test of lexical retrieval (Animals: preoperative. median 20, post-op median 14, P = .001). The highest proportion of language impairment was found in the group with a tumour in language-eloquent areas at all time-points.
Conclusions:
Although many patients with a tumour in the left hemisphere deteriorated in their language function directly after surgery, their prognosis for recovery was good.
A new software paradigm `Software as a Service' based on web services is proposed for multilingual linguistic tools and exemplified with the BAS CLARIN web services. Instead of traditional tool development and distribution the tool functionality is implemented on a highly available server that users or applications access via HTTP requests. As examples we describe in detail five multilingual web services for speech science operational since 2012 and discuss the benefits and drawbacks of the new paradigm as well as our experiences with user acceptance and implementation problems. The services include automatic segmentation of speech, grapheme-to-phoneme conversion, syllabification, speech synthesis, and optimal symbol sequence alignment.
Studies in cancer and noncancer populations demonstrate lower than expected correlations between subjective cognitive symptoms and cognitive functioning as determined by standardized neuropsychological tests. This paper systematically examines the association between subjective and objective cognitive functioning in patients with low-grade glioma and the associations of these indicators of cognitive function with clusters of sociodemographic, clinical, and self-reported physical and mental health factors.
Multiple regression analyses with the subjective and 2 objective indicators of cognitive functioning as dependent variables and 4 clusters of predictor variables were conducted in 169 patients with predominantly low-grade glioma.
Correlations between the subjective and the 2 objective cognitive indicators were negligible (0.04) to low (0.24). Objective cognitive deficits were predominantly associated with sociodemographic (older age, lower education, male sex) and clinical (left hemisphere tumor) variables, while lower ratings of subjective cognitive function were more closely related to self-reported mental health symptoms (fatigue, lower mental well-being), physical (motor) dysfunction and female sex. Self-reported communication deficits were associated significantly with both subjective and objective dysfunction.
We recommend that both subjective and objective measures of cognitive functioning, together with a measure of psychological distress, be used for comprehensive neuropsychological assessments of patients with glioma to determine which areas are most affected and which specific intervention strategies are most appropriate.
BACKGROUND
Low-grade glioma (LGG) patients have increased life expectancy, so interest is high in the treatments that maximize cognition and quality of life.
OBJECTIVE
To examine presurgical baseline cognitive deficits in a case series of LGG patients and determine cognitive effects of surgical resection with awake mapping.
METHODS
We retrospectively assessed neurological deficits, subjective concerns from patient or caregiver, and cognitive deficits at baseline and postsurgery for 22 patients with newly diagnosed LGG who underwent baseline neuropsychological evaluation and magnetic resonance imaging before awake surgical resection with mapping. Twelve of the 22 patients returned for postoperative evaluation approximately 7 months after surgery.
RESULTS
At baseline, 92% of patients/caregivers reported changes in cognition or mood. Neurological examinations and Montreal Cognitive Assessment Scale scores were largely normal; however, on many tests of memory and language, nearly half of individuals showed deficits. After surgery, 45% had no deficits on neurological examination, whereas 55% had only transient or mild difficulties. Follow-up neuropsychological testing found most performances stable to improved, particularly in language, although some patients showed declines on memory tasks.
CONCLUSION
Most LGG patients in this series presented with normal neurological examinations and cognitive screening, but showed subjective cognitive and mood concerns and cognitive decline on neuropsychological testing, suggesting the importance of comprehensive evaluation. After awake mapping, language tended to be preserved, but memory demonstrated decline in some patients. These results highlight the importance of establishing a cognitive baseline before surgical resection and further suggest that awake mapping techniques provide reasonable language outcomes in individuals with LGG in eloquent regions.
Speech disfluencies have different effects on comprehension depending on the type and placement of disfluency. Words following false starts (such as windmill after in the in the eleventh example is um in the a windmill) have longer word monitoring latencies than the same tokens with the false starts excised. The decremental effect seems to be limited to false starts that occur in the middle of sentences or after discourse markers. I suggest it is at these points that the repair process is most burdened by the false start. In contrast, words following repetitions (heart in of a of a heart) do not have longer word monitoring latencies than the same tokens with the repetitions excised. In two experiments, words following spontaneously produced repetitions have faster word monitoring latencies. Two other experiments suggest that this seeming repetition advantage is more likely the result of slowed monitoring after a phonological phrase disruption. Inserting repetitions where they did not occur in a manner that preserved the original phonological phrases resulted in neither an advantage nor a disadvantage or repeating. These studies provide a first glimpse at how speech disfluencies affect understanding, and also provide information about the types of comprehension models that can accommodate the effects of speech disfluencies.
Silent pauses are a common form of disfluency in speech yet little attention has been paid to them in the psycholinguistic literature. The present paper investigates the consequences of such silences for listeners, using an Event-Related Potential (ERP) paradigm. Participants heard utterances ending in predictable or unpredictable words, some of which included a disfluent silence before the target. In common with previous findings using er disfluencies, the N400 difference between predictable and unpredictable words was attenuated for the utterances that included silent pauses, suggesting a reduction in the relative processing benefit for predictable words. An earlier relative negativity, topographically distinct from the N400 effect and identifiable as a Phonological Mismatch Negativity (PMN), was found for fluent utterances only. This suggests that only in the fluent condition did participants perceive the phonology of unpredictable words to mismatch with their expectations. By contrast, for disfluent utterances only, unpredictable words gave rise to a late left frontal positivity, an effect previously observed following ers and disfluent repetitions. We suggest that this effect reflects the engagement of working memory processes that occurs when fluent speech is resumed. Using a surprise recognition memory test, we also show that listeners were more likely to recognise words which had been encountered after silent pauses, demonstrating that silence affects not only the process of language comprehension but also its eventual outcome. We argue that, from a listener's perspective, one critical feature of disfluency is the temporal delay which it adds to the speech signal.
There are few data available on the cognitive deficits of patients with primary or secondary intracranial mass lesions before treatment. The aim of the present study was to document the incidence of cognitive impairments among patients with brain tumors of the frontal or temporal lobes, immediately after diagnosis but before the commencement of treatment.
One hundred thirty-nine patients were neuropsychologically examined using standardized psychometric testing procedures that measured various aspects of memory, attention, language, and executive functions. Furthermore, reports by the patients of their own cognitive functioning in the weeks before treatment were recorded.
With the classification of test performances below the 10th percentile as impaired, more than 90% of patients displayed impairments in at least one area of cognition. Impairments of executive functions were observed for 78% of patients, and impairments of memory and attention were observed for more than 60% of patients. Analysis of the correlation between the patients' own reports and the neuropsychological assessment results revealed only a weak relationship. No effects of anticonvulsant drugs on cognition were observed.
The present findings suggest that most patients with brain tumors of the frontal or temporal lobes demonstrate impairments of cognitive functioning at the time of diagnosis. Therefore, for quality assessments of neurosurgical procedures, baseline evaluations of cognitive measures should be performed.
The objectives of this study were to register the brain locations in a consecutive series of low-grade gliomas (LGGs) and compare these localizations with the locations of de novo glioblastomas (GBMs) that were collected during the same period in an effort to analyze whether LGGs are situated in preferential areas and to review the pathophysiologic hypothesis of such a phenomenon.
One hundred thirty-two patients with LGG and 102 patients with GBM who were followed consecutively between 1996 and 2003 by the authors were reviewed, whatever their treatment. Using anatomic, three-dimensional magnetic resonance imaging, the location of each tumor was analyzed accurately according to a classification system based on the proximity of eloquent areas previously reported by the authors.
One hundred nine LGGs (82.6%), compared with 55 GBMs (53.9%), were situated within functional regions (P < 0.001). More specifically, 36 LGGs (27.3%), compared with 11 GBMs (10.8%), were localized in the region of the supplementary motor area (SMA) (P < 0.001); and 33 LGGs (25%), compared with 11 GBMs (10.8%), were located within the insula (P < 0.001).
The current findings suggest that LGGs are located preferentially in "secondary" functional areas (immediately near the so-called primary eloquent regions), especially within the SMA and the insular lobe. This preferential localization may be explained by developmental, cytomyeloarchitectonic, neurochemical, metabolic, and functional reasons. A better knowledge of the pathophysiologic mechanisms underlying preferential LGGs locations may improve understanding of the genesis and natural history of these tumors and, subsequently, their management.
Pauses during continuous speech, particularly those that occur within clauses, are thought to reflect the planning of forthcoming verbal output. We used functional Magnetic Resonance Imaging (fMRI) to examine their neural correlates. Six volunteers were scanned while describing seven Rorschach inkblots, producing 3 min of speech per inkblot. In an event-related design, the level of blood oxygenation level dependent (BOLD) contrast during brief speech pauses (mean duration 1.3 s, SD 0.3 s) during overt speech was contrasted with that during intervening periods of articulation. We then examined activity associated with pauses that occurred within clauses and pauses that occurred between grammatical junctions. Relative to articulation during speech, pauses were associated with activation in the banks of the left superior temporal sulcus (BA 39/22), at the temporoparietal junction. Continuous speech was associated with greater activation bilaterally in the inferior frontal (BA 44/45), middle frontal (BA 8) and anterior cingulate (BA 24) gyri, the middle temporal sulcus (BA 21/22), the occipital cortex and the cerebellum. Left temporal activation was evident during pauses that occurred within clauses but not during pauses at grammatical junctions. In summary, articulation during continuous speech involved frontal, temporal and cerebellar areas, while pausing was associated with activity in the left temporal cortex, especially when this occurred within a clause. The latter finding is consistent with evidence that within-clause pauses are a correlate of speech planning and in particular lexical retrieval.
The purpose of the present study was to introduce a Swedish version of the Boston Naming Test and to offer normative data based on a sample of native Swedish-speaking healthy adults stratified concerning age, gender, and length of education. The subjects were assessed with other lexical tests and half of the group also performed tests of global cognitive function. A semantic analysis of the responses was performed and the typical Swedish naming of the pictures of BNT was investigated. The results showed that long education, high performance on tests of global cognitive ability (FSIQ), verbal fluency, and other lexical tests had a significant positive association to a good performance on BNT whereas age and gender had a minor influence. The response analysis showed that the more difficult an item was, the more variations in the response pattern. To conclude, the Boston Naming Test is appropriate for use in a Swedish-speaking context and an effective test for assessment of naming ability.
Subcortical stimulation can be used to identify functional language tracts during resection of gliomas located close to or within language areas or pathways. The objective of the present study was to investigate the feasibility of the routine use of subcortical stimulation for identification of language tracts in a large series of patients with gliomas and to determine the influence that subcortical language tract identification exerted on the extent of surgery and on the appearance of immediate and definitive postoperative deficits.
Subcortical stimulation for language tract identification was systematically used during surgical removal of 88 gliomas (44 high-grade and 44 low-grade gliomas) involving language pathways. Procedures were performed during asleep/awake craniotomy. Subcortical stimulation was continuously alternated with surgical resection in a back-and-forth fashion. Language performances were tested by neuropsychological language evaluation preoperatively and at 3, 30, and 90 days after surgery.
Language tracts were identified in 59% of patients, with differences according to tumor location but not according to histological grade. Language tract identification influenced the ability to reach a complete tumor removal in low-grade gliomas, in which tracts were documented inside the peripheral mass of the tumor. Identification of language tracts was associated with a higher occurrence of transient postoperative deficits (67.3% of cases), but a low occurrence of definitive morbidity (2.3% of cases). A pattern of typical language disturbances related to the phonological and semantic system can be identified according to tumor location, with preservation being important for the maintenance of language integrity.
Our study supports the routine use of subcortical stimulation for language tract identification as a reliable tool for guiding surgical removal of gliomas in or in close proximity to language areas or pathways.
Verbal fluency tests are useful measures of acquired language impairment and cognitive decline of various etiologies. The aim of this study was to provide normative data for the Swedish population on the three verbal fluency tests, FAS, Animals and Verbs. A group of 165 healthy participants ranging from 16 to 89 years of age were assessed with the verbal fluency tests and tests of level of intellectual functioning. The sample was stratified by education, age and gender. Level of education had a substantial influence on the performance on verbal fluency, most clearly so in FAS and Verbs. Intellectual level had a positive and significant correlation with all measures of word fluency. Moreover, there was an interaction between age and gender such that women aged between 30 and 64 years outperformed elderly men on FAS and Verbs. Guidelines for instructions and scoring in Swedish are given in the article.
Boston diagnostic examination for aphasia
- H Goodglass
- E Kaplan
- Goodglass H.