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Neuropsychologia. 2015 Oct;77:211-22. doi: 10.1016/j.neuropsychologia.2015.08.019. Epub 2015 Aug 20.

What do pauses in narrative production reveal about the nature of word retrieval deficits in PPA?

Author information

1
Department of Communication Sciences and Disorders, Northwestern University, United States. Electronic address: Jennifer-mack-0@northwestern.edu.
2
Department of Communication Sciences and Disorders, Northwestern University, United States.
3
Linguistics Department, Tel Aviv University, Israel; Sagol School of Neuroscience, Tel Aviv University, Israel.
4
Cognitive Neurology and Alzheimer's Disease Center, Northwestern University, United States.
5
Cognitive Neurology and Alzheimer's Disease Center, Northwestern University, United States; Department of Psychiatry and Behavioral Sciences, Northwestern University, United States; Department of Neurology, Northwestern University, United States.
6
Cognitive Neurology and Alzheimer's Disease Center, Northwestern University, United States; Department of Neurology, Northwestern University, United States.
7
Department of Communication Sciences and Disorders, Northwestern University, United States; Cognitive Neurology and Alzheimer's Disease Center, Northwestern University, United States; Department of Neurology, Northwestern University, United States.

Abstract

Naming and word-retrieval deficits, which are common characteristics of primary progressive aphasia (PPA), differentially affect production across word classes (e.g., nouns, verbs) in some patients. Individuals with the agrammatic variant (PPA-G) often show greater difficulty producing verbs whereas those with the semantic variant (PPA-S) show greater noun deficits and those with logopenic PPA (PPA-L) evince no clear-cut differences in production of the two word classes. To determine the source of these production patterns, the present study examined word-finding pauses as conditioned by lexical variables (i.e., word class, frequency, length) in narrative speech samples of individuals with PPA-S (n=12), PPA-G (n=12), PPA-L (n=11), and cognitively healthy controls (n=12). We also examined the relation between pause distribution and cortical atrophy (i.e., cortical thickness) in nine left hemisphere regions of interest (ROIs) linked to word production. Results showed higher overall pause rates for PPA compared to unimpaired controls; however, greater naming severity was not associated with increased pause rate. Across all groups, more pauses were produced before lower vs. higher frequency words, with no independent effects of word length after controlling for frequency. With regard to word class, the PPA-L group showed a higher rate of pauses prior to production of nouns compared to verbs, consistent with noun-retrieval deficits arising at the lemma level of word production. Those with PPA-G and PPA-S, like controls, produced similar pause rates across word classes; however, lexical simplification (i.e., production of higher-frequency and/or shorter words) was evident in the more-impaired word class: nouns for PPA-S and verbs for PPA-G. These patterns are consistent with conceptual and/or lemma-level impairments for PPA-S, predominantly affecting objects/nouns, and a lemma-level verb-retrieval deficit for PPA-G, with a concomitant impairment in phonological encoding and articulation affecting overall pause rates. The greater tendency to pause before nouns was correlated with atrophy in the left precentral gyrus, inferior frontal gyrus and inferior parietal lobule, whereas the greater tendency to pause before less frequent and longer words was associated with atrophy in left precentral and inferior parietal regions.

KEYWORDS:

Brain–behavior relationship; Narrative analysis; Primary progressive aphasia; Word class effects; Word retrieval deficits

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