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Dement Geriatr Cogn Dis Extra. 2017 Mar 2;7(1):52-73. doi: 10.1159/000456710. eCollection 2017 Jan-Apr.

White Matter Disruption and Connected Speech in Non-Fluent and Semantic Variants of Primary Progressive Aphasia.

Marcotte K1,2,3, Graham NL1,4, Fraser KC5, Meltzer JA4,6,7,8, Tang-Wai DF9,10, Chow TW6,9,11, Freedman M6,12,13, Leonard C4,8,14, Black SE1,6,8,9,15,16,17, Rochon E1,4,8,18.

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aToronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada.
bÉcole d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, Montréal, Québec, Canada.
cCentre de recherche de l'Hôpital du Sacré-Cœur de Montréal, Montreal, Québec, Canada.
dDepartment of Speech-Language Pathology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
eDepartment of Computer Science, University of Toronto, Toronto, Ontario, Canada.
fRotman Research Institute, Baycrest Health Sciences, Toronto, Ontario, Canada.
gDepartment of Psychology, University of Toronto, Toronto, Ontario, Canada.
hHeart and Stroke Foundation, Center for Stroke Recovery, Ottawa, Ontario, Canada.
iDepartment of Medicine (Neurology), University of Toronto, Toronto, Ontario, Canada.
jUniversity Health Network Memory Clinic, Toronto Western Hospital, Toronto, Ontario, Canada.
kDepartment of Clinical Neurology, University of Southern California, Los Angeles, California, USA.
lDepartment of Medicine, Division of Neurology, Baycrest Health Sciences, University of Toronto, and Mt. Sinai Hospital, Toronto, Ontario, Canada.
mSam and Ida Ross Memory Clinic, Baycrest Health Sciences, Toronto, Ontario, Canada.
nSchool of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
oInstitute of Medical Science, University of Toronto, Toronto, Ontario, Canada.
pL.C. Campbell Cognitive Neurology Research Unit, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
qBrain Sciences Research Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.
rRehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.


Differential patterns of white matter disruption have recently been reported in the non-fluent (nfvPPA) and semantic (svPPA) variants of primary progressive aphasia (PPA). No single measure is sufficient to distinguish between the PPA variants, but connected speech allows for the quantification of multiple measures. The aim of the present study was to further investigate the white matter correlates associated with connected speech features in PPA. We examined the relationship between white matter metrics and connected speech deficits using an automated analysis of transcriptions of connected speech and diffusion tensor imaging in language-related tracts. Syntactic, lexical, and semantic features were automatically extracted from transcriptions of topic-directed interviews conducted with groups of individuals with nfvPPA or svPPA as well as with a group of healthy controls. A principal component analysis was performed in order to reduce the number of language measures and yielded a five-factor solution. The results indicated that nfvPPA patients differed from healthy controls on a syntactic factor, and svPPA patients differed from controls on two semantic factors. However, the patient groups did not differ on any factor. Moreover, a correlational analysis revealed that the lexical richness factor was significantly correlated with radial diffusivity in the left inferior longitudinal fasciculus, which suggests that semantic deficits in connected speech reflect a disruption of this ventral pathway, and which is largely consistent with the results of previous studies. Using an automated approach for the analysis of connected speech combined with probabilistic tractography, the present findings demonstrate that nfvPPA patients are impaired relative to healthy controls on syntactic measures and have increased radial diffusivity in the left superior longitudinal fasciculus, whereas the svPPA group was impaired on lexico-semantic measures relative to controls and showed increased radial diffusivity in the uncinate and inferior longitudinal fasciculus bilaterally.


Connected speech; Diffusion tensor imaging; Non-fluent variant; Primary progressive aphasia; Semantic variant

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