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Neuromodulation as a Therapeutic Approach: Addressing Phonological Errors in Naming and Word Finding in Logopenic Variant of Primary Progressive Aphasia

Poster B84 in Poster Session B, Tuesday, October 24, 3:30 - 5:15 pm CEST, Espace Vieux-Port

Tifani Biro1, Gonzalo Ortega1, Mark Liberman1, Roy Hamilton1; 1University of Pennsylvania

The logopenic variant of primary progressive aphasia (lvPPA) is characterized by impaired single-word retrieval, diminished phrasal repetition, compromised comprehension of complex sentences, and phonological speech errors (e.g., saying "cap" instead of "tap"). These phonological errors are thought to stem from deficits in phonological working memory, which can be attributed to atrophy in the temporo-parietal regions. However, the exact characteristics and underlying pathology of these phonological errors in lvPPA patients remain unclear, with the impact of temporal lobe degeneration often being overlooked. Temporal regions store subphonemic representations for consonant place and manner of articulation, which are activated during speech production. Consequently, temporal degeneration may lead to a systematic impairment in the retrieval of subphonemic characteristics in lvPPA speech, a hypothesis yet to be thoroughly investigated. Targeting these subphonemic characteristics could be critical in mitigating the progression of speech impairment associated with lvPPA. Neuromodulation, using transcranial direct-current stimulation (tDCS), may enhance the weakened connections to these subphonemic representations by stimulating intact brain regions involved in phonological processes. This makes neuromodulation a potentially promising treatment approach for lvPPA. This study primarily aimed to specify the subphonemic characteristics of lvPPA speech errors and to evaluate the effectiveness of neuromodulation as a therapeutic approach. A double-blind, sham-controlled, crossover design was employed, involving ten treatment sessions of either active or sham high-definition tDCS (HD-tDCS) paired with modified constraint-induced language therapy (mCILT). Participants' speech was recorded during an object-naming task from the Western Aphasia Battery (WAB) before treatment (baseline), after 12 weeks of sham HD-tDCS combined with mCILT, and after 12 weeks of active HD-tDCS combined with mCILT. Preliminary findings from a small sample size (n = 8) indicated that patients' phonological accuracy for consonant place and manner of articulation was lower at baseline compared to their accuracy for consonant voicing and vowel characteristics. However, patients’ phonological accuracy improved after active HD-tDCS combined with mCILT, extending to place and manner of articulation, consonant voicing, and vowel characteristics such as height, frontness, and tenseness. Additionally, there was a marked decrease in the number of revisions made by patients in their speech following active HD-tDCS combined with mCILT. These results suggest that neuromodulation may effectively preserve and restore specific language domains in lvPPA patients, thereby enhancing their quality of life and potentially presenting new directions in the treatment of this condition.

Topic Areas: Speech-Language Treatment, Disorders: Acquired

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