Early Recovery of Aphasia through Thrombolysis: The Significance of Spontaneous Speech

Aphasia in one of the most devastating stroke-related consequences for social interaction and daily activities. Aphasia recovery in acute stroke depends on the degree of reperfusion after thrombolysis or thrombectomy. As aphasia assessment tests are often time-consuming for patients with acute troke, physicians have been developing rapid and simple tests. The aim of our study is to evaluate the improvement of language functions in the earliest stage in patients treated with thrombolysis and in nontreated patients using our rapid screening tes

Jargon in reading aloud sparing Arabic digits but not number words

A person with aphasia, DRG, showed a severe phonological/neologistic jargon when reading aloud but in a lesser degree in naming and spontaneous speech. Reading digits was free of phonological errors. Case report: DRG, 58 y.o.; education = 8 years. Vascular lesion: left occipito-temporal and right temporo-parietal (CT). No auditory cortical ERP were found. Neuropsychological examination: DRG showed the typical pattern of cortical deafness. He could not perceive any verbal and non-verbal sound. He did not blink to very loud sounds. His spontaneous speech was relatively understandable, fluent and loud, with phonemic paraphasias and a few neologisms. He had no problems in visual recognition and written calculation showed only occasional errors in complex operations. His reading comprehension was preserved while reading aloud was severely neologistic (Table 1). Experimental investigation: DRG's naming and reading aloud of words were compared at an interval of nine months. The amount of correct items and of non target-recognizable neologisms is reported in Table 1. A worse performance in reading aloud was consistent over time and tasks. Reading aloud of numbers, up to six digits long, presented in the Arabic code (e.g., "9", "267") and in the alphabetic code (e.g., "nine", "two hundred sixty seven"), resulted in a different performance. Reading aloud of alphabetically presented words was successful in only 28/110 items (25%), with neologisms being the most frequent error type. Reading Arabic numbers was successful in 25/55 items (45%); no phonological/neologistic error was produced, errors being of the "lexical" type, thus numbers were substituted by other phonologically correct numbers. Discussion: DRG showed a previously unreported dissociation in speech output: naming and connected spontaneous speech were less affected by phonological disturbances than reading aloud. The opposite dissociation, reading aloud superior to naming, was described by Semenza et al. (1992), also in a case of cortical deafness. These authors explained their case suggesting a difficulty in activating the speech output lexicon from the semantic system and by a disturbed print to sound conversion (sublexical route). Reading aloud could be performed either via the direct, lexical, non semantic, route or by summation of residual capacities of disturbed access to speech output lexicon from the semantic system and disturbed print to sound conversion. In contrast, DRG would be disturbed in the direct lexical route and in print to sound conversion: lexical activation of the speech output lexicon from the semantic system would not be sufficient to read correctly aloud without the help of the other two routes. Lack of phonological errors in reading Arabic numbers would be explained by the fact that Arabic numbers, consistently with recent literature (Bencini et al., 2011; Semenza et al., 2014; Dotan and Friedmann, 2015), would directly activate the whole phonological form rather than needing grapheme to phoneme conversion. This case provides insights about the processing dynamics among the three reading routes

Using the ATN system as a guide for the neuropsychological assessment of Alzheimer’s disease

Many studies have attempted to determine whether Alzheimer’s disease (AD) in-vivo biomarkers can predict neuropsychological performance since pathophysiological changes precede cognitive changes by several years. Nonetheless, neuropsychological measures can also detect cognitive deterioration in cognitively normal individuals with AD-positive biomarkers. Recent studies have investigated whether cognitive measures can be used as a proxy for biomarkers. This is a crucial issue since biomarker analysis is expensive, invasive, and not yet widespread in clinical practice. However, these studies have so far considered only one or two classes of AD biomarkers. Here, we aim at preliminarily evaluating whether and which neuropsychological measures can discriminate individuals that have been classified according to the full scheme of biomarkers known as ATN system. This scheme groups biomarkers as a function of the three main AD-related pathologic processes they measure (i.e., β-amyloidosis, tauopathy, and neurodegeneration) to provide an unbiased and descriptive definition of the Alzheimer’s continuum

Connected speech deficit as an early hallmark of CSF-defined Alzheimer\u2019s disease and correlation with cerebral hypoperfusion pattern

Background: Diagnosis of prodromal Alzheimer's disease (AD) still represents a hot topic and there is a growing interest for the 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 the narrative discourse production deficit as a hallmark of CSFdefined 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 the loss of narrative efficacy could be a possible early clinical hallmark of the Alzheimer\u2019s 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 the 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\u2019s disease

Facial Emotion Recognition in Patients with Amnesic Mild Cognitive Impairment and Mild-Moderate Alzheimer's Disease

Background: Although several studies have found evidence of impairment in facial emotion recognition in Alzheimer's disease, current understanding regarding which specific emotions are preserved and disrupted is inconsistent. Moreover, facial emotion recognition has been little explored in subjects with amnesic mild cognitive impairment. Objective: To investigate processing of human faces identity and emotional expressions in patients with probable mild-moderate Alzheimer disease (AD), amnesic mild cognitive impairment (a-MCI) and healthy control subjects (CS). Methods: Thirty subjects were included in the study: 10 AD (mean MMSE corrected score=20.94; DS=1.96), 10 a-MCI (mean MMSE corrected score=25.98; DS=0.69), and 10 CS (mean MMSE corrected score=29.85; DS=0.4). The three groups did not differ for age and education. All patients underwent an extensive neuropsychological test battery. Geriatric Depression Scale was employed to exclude depressed patients. A new battery for assessing face emotion processing was developed. It included 48 faces pictures of 6 models balanced for sex and age (young, adult and old). For each model there were poses corresponding to seven emotions (anger, disgust, fear, happiness, sadness, surprise, boredom) as well as neutral expressions. Subjects had to perform four different tasks: 1) deciding the emotion label that best described the facial expression shown; 2) choosing the picture that matched the target emotion verbal label; 3) sorting the faces displaying the same facial expression; 4) sorting the faces displaying the same identity. Results: Recognition accuracy in all three groups was better for positive emotions and neutral expressions than negative emotions, consistent with previous studies. AD patients were more impaired in the recognition of overall emotions and neutral faces than a-MCI and CS subjects. Compared with CS, a-MCI did not differ significantly in their emotion recognition abilities. When segregated by emotions, we found significant differences in emotion recognition between the diagnostic groups for fearful and sad faces. In particular, AD patients and a-MCI subjects differed significantly from CS in fearful face recognition; AD patients also had impairment in recognizing facial expressions of sadness. Only patients with AD were impaired on the facial identity task. The predominant pattern across all groups and emotions was of a better recognition of emotions when displayed by young faces instead of either adult or old faces. Conclusions: A selective impairment in recognition of facial expressions of fear is already present in patients with a-MCI. An additional deficit in processing of sad faces emerge with AD progression and may be related to the degeneration progression towards structures implicated in emotional processing systems. An early detection of emotional impairment in MCI phases of dementia may have clinical impact and prognostic value

Cognitive deficit in post-acute COVID-19: an opportunity for EEG evaluation?

Background and purpose: Among the most common post-COVID symptoms, many patients experienced subjective cognitive deficit, commonly named "brain fog," that might be present also in those individuals without severe acute COVID-19 respiratory involvement. Some studies have investigated some of the mechanisms that might be associated with the brain fog with objective techniques including transcranial magnetic stimulation and neuroimaging. Methods: The aim of this study was to investigate the presence of electroencephalographic (EEG) alterations in people with post-COVID self-reported cognitive deficit. Results: Out of the 90 patients attending the post-COVID neurology ambulatory service, twenty patients presenting brain fog at least 4 weeks after acute non-severe COVID-19 infection, and without previous history of epilepsy, were investigated with 19-channel EEG, Montreal Cognitive Assessment (MoCA), and magnetic resonance imaging (MRI). EEG was found altered in 65% of the sample, among which 69% presented a slowing activity and 31% were characterized by epileptic discharges principally in the frontal areas. None of the patients showed DWI MRI lesions. Conclusions: These findings highlight the usefulness of EEG analysis to objectively describe possible neurophysiological abnormalities in post-COVID patients presenting subjective cognitive deficit