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Behavioural and neurofunctional improvements in Primary Progressive Aphasia after a cue-based naming training combined with rTMS over Broca’s region
Poster Session C, Thursday, October 1, 10:45 am - 12:45 pm, Wangari Maathai
Stefan Heim1,2, Judith Baltes1,2,3,4, Nele Wiemers1,3, Julijana Buschmann3, Michael Wagner3,4, Klaus Fließbach3,4, Bettina Bewernick3; 1RWTH Aachen University, 2Research Centre Jülich, 3University of Bonn, 4German Center for Neurodegenerative Disease (DZNE)
Background and Objectives: Primary Progressive Aphasia (PPA) is a group of neurodegenerative language disorders. In early stages, word-finding difficulties are common across all PPA variants with relatively preserved non-linguistic cognition. Pilot studies suggest that combining speech-language therapy (SLT) with non-invasive brain stimulation often combined with naming interventions may lead to improvement in language function. We investigated the effectiveness and feasibility of combining high-frequency transcranial magnetic stimulation (rTMS) to Broca’s area with a structured cue-based naming training in patients with PPA, and the neurofunctional basis of potential training-related improvements with fMRI. Methods: Six participants with PPA underwent a 4-week intervention phase (5x/week) including daily excitatory rTMS to Broca’s area followed by 45-minute naming training incorporating a structured cueing hierarchy comprising semantic, phonological and orthographic cues presented as retrieval strategies to facilitate word finding during naming tasks, with a preceding 4-week baseline and a follow-up after 8 weeks. Naming accuracy for trained and untrained items was assessed, as well as use of retrieval strategies, connected speech, and cognitive functions (executive function, processing speed, verbal working memory). Regional cerebral blood flow was measured with task-related fMRI before and after training: (1) a passive language comprehension task with semantic and syntactic aspects, and (2) a verbal fluency task with semantic and phonological blocks testing top-down linguistic processing, with the highly automatised generation of months or days as a baseline (Heim et al., 2009). Results: Each participant had significant improvement in naming trained items post-intervention and at follow-up. A generalization to untrained items was also observed for the group. Participants used strategies more frequently and effectively after treatment. Improvements in connected speech were found. These behavioural improvements were accompanied by increased rCBF after training in Broca’s region in all participants in semantic language comprehension. Additionally, some participants also showed rCBF increases in the inferior frontal junction area directly superior to Broca’s region. Conclusion: The results suggest that a significant language improvement for several months is possible despite the progressive nature of PPA, presumably due to intensified recruitment of Broca’s region after brain stimulation, adding to natural compensation (cf. Heim et al. 2014). References: Heim, S., Eickhoff, S.B., & Amunts, K. (2009). Different roles of cytoarchitectonic BA 44 and BA 45 in phonological and semantic verbal fluency as revealed by dynamic causal modelling. NeuroImage, 48, 616-624. Heim, S., Grande, M., Kuijsten, W., Seidel, B., Etcheverry Sáez, L., Schulte, S., Pieperhoff, P., Südmeyer, M., Caspers, S., Minnerop, M., Binkofski, F., Huber, W. & Amunts, K. (2014). Neurofunctional Plasticity in Fluent Primary Progressive Aphasia: A Longitudinal fMRI Study. Brain and Language, 131, 11-19.
Topic Areas: Disorders: Acquired, Language Production