The use and function of gestures in word-finding difficulties in aphasia

Background: Gestures are spontaneous hand and arm movements that are part of everyday communication. The roles of gestures in communication are disputed. Most agree that they augment the information conveyed in speech. More contentiously, some argue that they facilitate speech, particularly when word-finding difficulties (WFD) occur. Exploring gestures in aphasia may further illuminate their role. Aims: This study explored the spontaneous use of gestures in the conversation of participants with aphasia (PWA) and neurologically healthy participants (NHP). It aimed to examine the facilitative role of gesture by determining whether gestures particularly accompanied WFD and whether those difficulties were resolved. Methods & Procedures: Spontaneous conversation data were collected from 20 PWA and 21 NHP. Video samples were analysed for gesture production, speech production, and WFD. Analysis 1 examined whether the production of semantically rich gestures in these conversations was affected by whether the person had aphasia, and/or whether there were difficulties in the accompanying speech. Analysis 2 identified all WFD in the data and examined whether these were more likely to be resolved if accompanied by a gesture, again for both groups of participants. Outcomes & Results: Semantically rich gestures were frequently employed by both groups of participants, but with no effect of group. There was an effect of the accompanying speech, with gestures occurring most commonly alongside resolved WFD. An interaction showed that this was particularly the case for PWA. NHP, on the other hand, employed semantically rich gestures most frequently alongside fluent speech. Analysis 2 showed that WFD were common in both groups of participants. Unsurprisingly, these were more likely to be resolved for NHP than PWA. For both groups, resolution was more likely if a WFD was accompanied by a gesture. Conclusions: These findings shed light on the different functions of gesture within conversation. They highlight the importance of gesture during WFD, both in aphasic and neurologically healthy language, and suggest that gesture may facilitate word retrieval

Pragmatic disorders and their social impact

Pragmatic disorders in children and adults have been the focus of clinical investigations for approximately 40 years. In that time, clinicians and researchers have established a diverse range of pragmatic phenomena that are disrupted in these disorders. Pragmatic deficits include problems with the use and understanding of speech acts, the processing of non-literal language, failure to adhere to Gricean maxims in conversation and discourse deficits. These deficits are found in several clinical populations including individuals with autistic spectrum disorders, schizophrenia, traumatic brain injury and right-hemisphere damage. However, what is less often investigated is the social impact of pragmatic disorders on the children and adults who are affected by them. In this paper, I examine what is known about pragmatic disorders in these clinical groups. I then consider the wider social consequences of these disorders, where consequences are broadly construed to include factors that act as indicators of social adjustment

Ageing makes us dyslexic

Background: The effects of typical ageing on spoken language are well known: word production is disproportionately affected while syntactic processing is relatively well preserved. Little is known, however, about how ageing affects reading.Aims: What effect does ageing have on written language processing? In particular, how does it affect our ability to read words? How does it affect phonological awareness (our ability to manipulate the sounds of our language)?Methods & Procedures: We tested 14 people with Parkinson's disease (PD), 14 typically ageing adults (TAA), and 14 healthy younger adults on a range of background neuropsychological tests and tests of phonological awareness. We then carried out an oral naming experiment where we manipulated consistency, and a nonword repetition task where we manipulated the word-likeness of the nonwords.Outcomes & Results: We find that normal ageing causes individuals to become mildly phonologically dyslexic in that people have difficulty pronouncing nonwords. People with Parkinson's disease perform particularly poorly on language tasks involving oral naming and metalinguistic processing. We also find that ageing causes difficulty in repeating nonwords. We show that these problems are associated with a more general difficulty in processing phonological information, supporting the idea that language difficulties, including poorer reading in older age, can result from a general phonological deficit.Conclusions: We suggest that neurally this age-induced dyslexia is associated with frontal deterioration (and perhaps deterioration in other regions) and cognitively to the loss of executive processes that enable us to manipulate spoken and written language. We discuss implications for therapy and treatment

Macro-Level Cognitive and Linguistic Function in Early Stage Alzheimer’s Disease and Mild Cognitive Impairment

Alzheimer’s disease (AD) is a global health concern, particularly as there is currently no cure for the disease. Interventions to slow progression of disease, pharmacological or non-pharmacological, need to be targeted early on before any significant neurodegeneration has occurred, as these changes are irreversible, and lost cognitive function cannot be recovered. This makes it imperative to detect pathological cognitive decline as early as possible. Although biomarkers have received a lot of attention in this regard, they have several limitations, particularly outside of research settings, such as cost and availability. Cognitive markers, other than traditional neuropsychological test measures, on the other hand, have received comparatively less attention with regards to early detection; and, particularly cognitive markers that are rooted in real-world, everyday cognition, have been lacking. Due to the disease being incurable, interventions are aimed at maintaining independent living and good quality of life for as long as possible. This necessitates outcomes that can measure meaningful change in cognition and everyday functioning. The goal of the present dissertation was to identify gaps in the current literature on cognitive and linguistic assessments that are embedded in aspects of everyday cognition in AD, and work towards developing paradigms to address the gaps. Due to the emphasis on early detection, the work focused on patients in the very early stage of AD and on its preceding stage of Mild Cognitive Impairment (MCI). In light of evidence reporting the inability of AD patients to follow narratives, be it verbal or non-verbal, a systematic review of text comprehension studies was conducted to characterize and evaluate macro-level measures of discourse comprehension in their sensitivity to early stage AD, and their ability to distinguish pathological ageing due to AD or MCI from cognitive ageing. Results showed that, not only AD patients, but also MCI patients were significantly more impaired on macro-level measures of comprehension compared to cognitively healthy older adults. These findings were consistent across all eight studies included in the review, indicating a robust effect, though there were minor differences in the sensitivity of different measures. Next, moving towards non-verbal narratives, a novel picture-based paradigm assessing event cognition, with a focus on event integration and macro-event recognition, was introduced. This study aimed to examine the macro-level processing of events by using a format requiring integration of micro-events, depicted in pictures, into a larger macro-event. AD and MCI patients’ ability to connect the micro-events temporally and causally to identify the depicted macro-event was assessed. As hypothesized, the findings showed that patient groups had significant difficulties in determining temporal order of micro-events, even when provided with a verbal cue, as well as in conceptualizing the macro-event from the presented micro-events, when compared to healthy older adults. Finally, using traditional neuropsychological tests, the cognitive processes involved in performing the macro-event recognition task were determined by examining correlations. Primarily, semantic memory and executive functioning appear to play a role. However, the strength of correlations was fairly moderate, indicating added value of event recognition task in cognitive assessment. Taken together, these findings show the sensitivity of macro-level cognitive and linguistic markers based in everyday cognition in the early stages of AD, and highlight the positive role of such cognitive assessment methods in bringing together objective assessment methods and everyday cognition

Language Profile and Performances on Math Assessments for Children with Mild Intellectual Disabilities

It has been assumed that mathematics testing indicates the development of mathematics concepts, but the linguistic demands of assessment have not been evaluated, especially for children with mild intellectual disabilities. 244 children (grades 2 – 5) were recruited from a larger reading intervention study. Using a multilevel longitudinal SEM model, baseline and post-intervention time points were examined for the contribution of item linguistic complexity, child language skills, and their potential interaction in predicting item level mathematics assessment performance. Item linguistic complexity was an important, stable, and negative predictor of mathematics achievement with children’s language skills significantly and positively predicting mathematics achievement. The interaction between item linguistic complexity and language skills was significant though not stable across time. Following intervention, children with higher language skills performed better on linguistically complex mathematics items. Mathematics achievement may be related to an interaction between children’s language skills and the linguistic demands of the tests themselves

Health-related quality of life in people with aphasia: Implications for fluency disorders quality of life research

Abstract It is increasingly important that clinicians address the health-related quality of life (HRQOL) of adults with communication disorders in clinical practice. The overall aim of this paper is to draw conclusion about the suitability of the Short Form 36 Health Survey for the communication disorders of aphasia and stuttering. This study reports on the impact of post-stroke aphasia on 30 Australian older adults’ HRQOL. It also comments on the capacity of the SF-36 to measure HRQOL in this population, specifically whether it is sensitive to the three known determinants of post-stroke HRQOL – emotional, physical and social functioning. Comparisons with other data are made to assist interpretation of the SF-36 subscale scores: with 75 older adults with no history of neurological conditions; and with data from the 1995 National Health Survey data. The main findings are: (1) adults with post-stroke aphasia have similar HRQOL to their peers on six subscales, but significantly lower Role emotional and Mental health HRQOL; (2) a substantial number of aphasic adults reported depressive mood; and (3) aphasic adults with depressive mood have significantly worse HRQOL on six subscales than aphasic adults without depressive mood, but similar Role emotional and Body pain HRQOL. In conclusion, stroke and aphasia have minimal impact on older adults’ HRQOL as measured by the SF-36, which conflicts with an established evidence base of the negative consequences of aphasia on life. Thus, the SF-36 is not advisable for use with aphasic adults. Implications of these findings for aphasia and stuttering are discussed. Educational objectives: The reader will be able to: (a) describe the impact of aphasia and depressive mood on quality of life; (b) compare the impact of aphasia on the quality of life of adults to adults who do not have aphasia; (c) describe the similarities and differences between quality of life of adults with aphasia and adults who stutter; and (d) describe the strengths and limitations of the SF-36 as a measure of quality of life in adults who stutter versus adults with aphasia

A Machine Learning-Based Linguistic Battery for Diagnosing Mild Cognitive Impairment Due to Alzheimer\u27s Disease

This is an open access article distributedunder the terms of the Creative CommonsAttribution License, which permits unrestricted use, distribution, and reproductionin any medium,provided the original author and source are credited. There is a limited evaluation of an independent linguistic battery for early diagnosis of Mild Cognitive Impairment due to Alzheimer\u27s disease (MCI-AD). We hypothesized that an independent linguistic battery comprising of only the language components or subtests of popular test batteries could give a better clinical diagnosis for MCI-AD compared to using an exhaustive battery of tests. As such, we combined multiple clinical datasets and performed Exploratory Factor Analysis (EFA) to extract the underlying linguistic constructs from a combination of the Consortium to Establish a Registry for Alzheimer\u27s disease (CERAD), Wechsler Memory Scale (WMS) Logical Memory (LM) I and II, and the Boston Naming Test. Furthermore, we trained a machine-learning algorithm that validates the clinical relevance of the independent linguistic battery for differentiating between patients with MCI-AD and cognitive healthy control individuals. Our EFA identified ten linguistic variables with distinct underlying linguistic constructs that show Cronbach\u27s alpha of 0.74 on the MCI-AD group and 0.87 on the healthy control group. Our machine learning evaluation showed a robust AUC of 0.97 when controlled for age, sex, race, and education, and a clinically reliable AUC of 0.88 without controlling for age, sex, race, and education. Overall, the linguistic battery showed a better diagnostic result compared to the Mini-Mental State Examination (MMSE), Clinical Dementia Rating Scale (CDR), and a combination of MMSE and CDR

Linguistic biomarkers for the detection of Mild Cognitive Impairment

A timely diagnosis of the prodromal stages of dementia remains a big challenge for healthcare systems: many assessment tools have been proposed over recent years, but the commonest screening instruments are largely unreliable for detecting subtle changes in cognition. The scientific literature contains a rising number of reports about language disturbances at the earliest stages of dementia, a clinical syndrome known as “Mild Cognitive Impairment" (MCI). Here we take advantage of these findings to develop a novel NLP method capable of identifying cognitive frailty at a very early stage by processing Italian spoken productions. This study constitutes a first step in the creation of an automatic tool for non-intrusive, low-cost dementia screening exploiting linguistic biomarkers. Our findings show that acoustic features (i.e., fluency indexes and spectral properties of the voice) are the most reliable parameters for MCI early identification. Moreover, lexical and syntactic features, grabbing the erosion of verbal abilities caused by the pathology, emerge as statistically significant and can support speech traits in the classification process