The Discourse Profile in Corticobasal Syndrome: A Comprehensive Clinical and Biomarker Approach
Abstract
:1. Introduction
1.1. Assessment of Oral Discourse Production in CBS
1.2. Connected Speech Analysis in Primary Progressive Aphasia
1.3. Connected Speech Analysis in Alzheimer’s Disease
1.4. The Present Study
2. Methods
2.1. Participants
2.2. Clinical and Neuropsychological Assessment
2.3. Discourse Assessment
2.4. Neuroimaging Examination
2.5. Statistical Analysis
3. Results
3.1. Demographic and Clinical Characteristics
3.2. Neuroimaging
3.3. Neuropsychological Assessment
3.4. The Discourse Profile
4. Discussion
4.1. Cognitive-Linguistic Performance of CBS Patients
4.2. Discursive Performance of CBS Patients
4.3. Discourse Performance in CBS-Non-AD and CBS-AD Patients
4.4. Limitations and Future Directions
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviation
ACE-R | Addenbrooke’s Cognitive Examination revised |
AD | Alzheimer’s disease |
AQ | Aphasia Quotient |
CBD | corticobasal degeneration |
CBS | corticobasal syndrome |
CBS-AD | corticobasal syndrome with probable Alzheimer’s disease as underlying pathology |
CBS-non-AD | corticobasal syndrome not related to Alzheimer’s disease as underlying pathology |
CDR | Clinical Dementia Rating scale |
CG | control group |
CIU | correct information unit |
FAQ | Functional Activities Questionnaire |
FDG | [18F]fluorodeoxyglucose |
H&Y | Hoehn and Yahr scale |
lvPPA | logopenic variant of primary progressive aphasia |
MRI | magnetic resonance image |
nfvPPA | non-fluent variant of primary progressive aphasia |
NPI | Neuropsychiatric Inventory |
PET | positron emission tomography |
PiB-PET | [11C]Pittsburgh Compound-B positron emission tomography (PIB-PET) |
PPA | primary progressive aphasia |
PSP | progressive supranuclear palsy |
SD | standard deviation |
svPPA | semantic variant of primary progressive aphasia |
WAB-R | Western Aphasia Battery revised |
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Discursive Variable | Definition |
---|---|
Speech rate and speech sound errors | |
Number of words | Total number of words produced. Contractions were considered as one word. False starts, repaired sequences, and filled pauses (see “other disruptions of fluency”) were not included in word counting |
Speech production rate | Total number of words/duration of the sample without pauses |
Phonological paraphasias phw | (Total number of phonological paraphasias/number of words) × 100 |
Distortions phw | (Number of distortions/number of words) × 100 |
Other disruptions to fluency | |
False starts phw | Single words that are abandoned after some phonemes are produced. (Total number of false starts/number of words) × 100 |
Repaired sequences phw | Complete words (or a single complete word) that are reworked. (Total number of repaired sequences/number of words) × 100 |
Filled pauses phw | Examples of filled pauses are “hmmm” and “aah” (in Portuguese: “hum” and “é”). (Total number of filled pauses/number of words) × 100 |
Incomplete sentences phw | Sentences abandoned (and not repaired) and sentences missing obligatory elements (a verb and its obligatory arguments). (Total number of sentences abandoned/number of words) × 100 |
Lexical-semantic level | |
Open-class proportion | Verbs, nouns, adjectives, and adverbs ending in -ly (in Portuguese: -mente) were considered open-class words. Light verbs (verbs with little semantic content), conjunctions, prepositions, articles and pronouns were counted as closed-class words. Open-class words/closed-class words |
Verb proportion | Verbs/verbs + nouns |
Lexical-semantic errors phw | (Semantic paraphasias, paraphrases, and word-finding difficulties/number of words) × 100 |
% CIU | Correct information units (CIU) are words that are relevant to the context (the picture) and informative. Total number of correct information units/total number of words produced |
Syntactic structure and complexity | |
Number of utterances | Total number of utterances |
Number of sentences | Total number of complete sentences, i.e., a sentence with at least a verb and its obligatory arguments |
Morphosyntactic errors phw | (Total number of ungrammatical sentences, inflectional errors, and absence of determiners/number of words) × 100 |
Embeddings phw | (Total number of sentences embedded within another sentence/number of words) × 100 |
Mean length of sentences | Total number of words in sentences/total number of sentences |
Proportion of sentences | Total number of complete sentences/total number of utterances |
Syntax production rate | Total number of words in sentences/total number of words |
CBS (n = 14) | CBS-Non-AD (n = 10) | CBS-AD (n = 4) | CG (n = 15) | CBS vs. CG p-Value | CBS-Non-AD vs. CBS-AD vs. CG p-Value | |
---|---|---|---|---|---|---|
Age (y) | 67.9 (8.4) | 66.4 (8.3) | 71.5 (8.7) | 67.3 (8.1) | 0.813 | 0.746 |
Education (y) | 8.8 (5.8) | 9.3 (5.9) | 7.5 (6.0) | 9.3 (5.4) | 0.914 | 0.875 |
Sex (F/M) | 9/5 | 5/5 | 4/0 | 10/5 | 0.892 | 0.203 |
Hand dominance (R/L) | 12/2 | 8/2 | 4/0 | 14/1 | 0.500 | 0.430 |
Symptom duration (y) | 4.6 (2.1) | 4.7 (2.4) | 4.5 (1.2) | -- | -- | 0.770 * |
CDR | 1.9 (0.7) | 1.9 (0.7) | 2.0 (0.8) | -- | -- | 0.941 * |
FAQ | 19.9 (7.8) | 18.6 (7.6) | 23.0 (8.4) | -- | -- | 0.337 * |
NPI | 17.2 (16.7) | 12.9 (8.7) | 26.7 (27.1) | -- | -- | 0.394 * |
H&Y | 2.9 (1.3) | 3.0 (1.3) | 2.7 (1.7) | -- | -- | 0.774 * |
CBS (n = 14) | CBS-Non-AD (n = 10) | CBS-AD (n = 4) | CG (n = 15) | CBS vs. CG p-Value | CBS-Non-AD vs. CBS-AD vs. CG p-Value | |
---|---|---|---|---|---|---|
ACE-R | ||||||
Total score | 44.0 (19.4) | 48.5 (18.4) | 32.8 (19.5) | 86.1 (9.0) | <0.001 | <0.001 ab |
Attention | 10.8 (3.9) | 12.3 (3.0) | 7.0 (3.7) | 16.9 (1.3) | <0.001 | <0.001 ab |
Memory | 9.7 (6.8) | 11.6 (6.7) | 5.0 (5.3) | 20.3 (5.3) | <0.001 | 0.001 ab |
Fluency | 2.6 (2.6) | 2.7 (2.7) | 2.3 (2.6) | 10.3 (2.2) | <0.001 | <0.001 ab |
Language | 15.3 (6.6) | 15.4 (6.4) | 15.0 (8.0) | 24.4 (2.4) | <0.001 | 0.003 a |
Visuospatial | 5.6 (3.7) | 6.5 (4.0) | 3.5 (0.6) | 14.3 (1.7) | <0.001 | <0.001 ab |
WAB-R | ||||||
Aphasia Quotient | 83.0 (11.6) | 83.8 (11.5) | 81.0 (13.6) | 98.2 (1.6) | <0.001 | <0.001 ab |
Spont speech | 16.8 (2.3) | 16.9 (2.3) | 16.5 (2.9) | 19.9 (0.3) | <0.001 | <0.001 ab |
Aud comp | 8.6 (1.4) | 8.6 (1.6) | 8.7 (1.2) | 9.9 (0.1) | 0.003 | 0.011 b |
Repetition | 8.7 (1.0) | 8.8 (0.9) | 8.5 (1.3) | 9.7 (0.3) | <0.001 | 0.002 ab |
Naming | 7.1 (2.3) | 7.3 (2.5) | 6.9 (1.8) | 9.6 (0.6) | <0.001 | 0.001 ab |
CBS (n = 14) | CBS-Non-AD (n = 10) | CBS-AD (n = 4) | CG (n = 15) | CBS vs. CG p-Value | CBS-Non-AD vs. CBS-AD vs. CG p-Value | |
---|---|---|---|---|---|---|
Speech rate and speech sound errors | ||||||
Number of words | 53.4 (22.5) | 48.5 (25.1) | 65.5 (6.2) | 72.9 (27.3) | 0.051 | 0.065 |
Speech prod rate | 0.8 (0.2) | 0.8 (0.2) | 0.9 (0.3) | 1.4 (0.3) | <0.001 | <0.001 a |
Phon paraphasias phw | 0.0 (0.0) | 0.0 (0.0) | 0.0 (0.0) | 0.0 (0.0) | -- | --- |
Distortions phw | 4.2 (9.0) | 5.4 (10.5) | 1.2 (1.4) | 0.0 (0.3) | 0.077 | 0.058 |
Other disruptions to fluency | ||||||
False starts phw | 2.1 (3.0) | 1.73 (3.5) | 3.0 (1.1) | 1.8 (2.6) | 0.847 | 0.109 |
Repaired sequences phw | 8.1 (6.5) | 7.5 (6.6) | 9.6 (7.2) | 5.5 (3.3) | 0.505 | 0.652 |
Filled pauses phw | 1.8 (2.0) | 1.3 (2.0) | 3.0 (1.7) | 0.7 (1.4) | 0.146 | 0.024 b |
Incomplete sentences phw | 4.0 (6.1) | 3.4 (6.7) | 4.1 (4.3) | 0.6 (1.2) | 0.089 | 0.120 |
CBS (n = 15) | CBS-Non-AD (n = 11) | CBS-AD (n = 4) | CG (n = 15) | CBS vs. CG p-Value | CBS-Non-AD vs. CBS-AD vs. CG p-Value | |
---|---|---|---|---|---|---|
Open-class proportion | 0.7 (0.1) | 0.7 (0.1) | 0.6 (0.1) | 1.0 (0.2) | <0.001 | 0.002 ab |
Verb proportion | 0.4 (0.1) | 0.4 (0.1) | 0.4 (0.0) | 0.4 (0.0) | 0.813 | 0.378 |
Lexical-semantic errors phw | 4.4 (5.9) | 3.7 (5.4) | 6.3 (7.6) | 0.7 (1.5) | 0.012 | 0.013 b |
% CIU | 72.4 (17.3) | 73.8 (16.9) | 68.9 (20.2) | 84 (6.9) | 0.037 | 0.101 |
CBS (n = 15) | CBS-Non-AD (n = 11) | CBS-AD (n = 4) | CG (n = 15) | CBS vs. CG p-Value | CBS-Non-AD vs. CBS-AD vs. CG p-Value | |
---|---|---|---|---|---|---|
Number of utterances | 11.1 (4.2) | 10.4 (4.6) | 12.8 (3.0) | 12.7 (4.2) | 0.331 | 0.284 |
Number of sentences | 8.6 (5.0) | 7.9 (5.6) | 10.2 (3.2) | 8.8 (4.4) | 0.652 | 0.464 |
Embeddings phw | 0.7 (1.2) | 0.1 (0.5) | 2.2 (1.3) | 2.4 (1.8) | 0.020 | 0.003 a |
Mean length of sentences | 5.6 (1.4) | 5.5 (1.3) | 5.7 (1.7) | 6.4 (2.8) | 0.172 | 0.376 |
Proportion of sentences | 0.7 (0.2) | 0.7 (0.2) | 0.8 (0.2) | 0.6 (0.2) | 0.270 | 0.457 |
Syntax production rate | 0.8 (0.2) | 0.8 (0.1) | 0.8 (0.2) | 0.7 (0.2) | 0.747 | 0.815 |
Morphosyntactic errors phw | 0.0 (0.0) | 0.0 (0.0) | 0.0 (0.0) | 0.0 (0.0) | 0.652 | 0.699 |
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de Almeida, I.J.; Silagi, M.L.; Carthery-Goulart, M.T.; Parmera, J.B.; Cecchini, M.A.; Coutinho, A.M.; Dozzi Brucki, S.M.; Nitrini, R.; Schochat, E. The Discourse Profile in Corticobasal Syndrome: A Comprehensive Clinical and Biomarker Approach. Brain Sci. 2022, 12, 1705. https://doi.org/10.3390/brainsci12121705
de Almeida IJ, Silagi ML, Carthery-Goulart MT, Parmera JB, Cecchini MA, Coutinho AM, Dozzi Brucki SM, Nitrini R, Schochat E. The Discourse Profile in Corticobasal Syndrome: A Comprehensive Clinical and Biomarker Approach. Brain Sciences. 2022; 12(12):1705. https://doi.org/10.3390/brainsci12121705
Chicago/Turabian Stylede Almeida, Isabel Junqueira, Marcela Lima Silagi, Maria Teresa Carthery-Goulart, Jacy Bezerra Parmera, Mario Amore Cecchini, Artur Martins Coutinho, Sonia Maria Dozzi Brucki, Ricardo Nitrini, and Eliane Schochat. 2022. "The Discourse Profile in Corticobasal Syndrome: A Comprehensive Clinical and Biomarker Approach" Brain Sciences 12, no. 12: 1705. https://doi.org/10.3390/brainsci12121705