Brief intervention for agrammatism in Primary Progressive Nonfluent Aphasia: A case report

Machado, Thais Helena; Campanha, Aline Carvalho; Caramelli, Paulo; Carthery-Goulart, Maria Teresa

doi:10.1590/S1980-57642014DN83000014

Abstracts

The non-fluent and agrammatic variant of Primary Progressive Aphasia (NFPPA) is characterized by reduced verbal production with deficits in building grammatically correct sentences, involving dysfunctions in syntactic and morphological levels of language. There are a growing number of studies about non-pharmacological alternatives focusing on the rehabilitation of functional aspects or specific cognitive impairments of each variant of PPA. This study reports a short-term treatment administered to a patient with NFPPA focusing on the production of sentences. The patient had significant reduction in verbal fluency, use of keywords, phrasal and grammatical simplifying as well as anomia. Using the method of errorless learning, six sessions were structured to stimulate the formation of sentences in the present and past with the cloze technique. The patient had improvement restricted to the strategy, with 100% accuracy on the trained phrases and generalization to untrained similar syntactic structure after training. These results persisted one month after the treatment.

primary progressive aphasia; treatment; speech and language therapy; intervention; cognitive rehabilitation

A variante não fluente e agramática da Afasia Progressiva Primária (APPNF) caracteriza-se por redução da produção verbal com falhas para construir sentenças gramaticalmente corretas, envolvendo disfunções nos níveis sintático e morfológico da linguagem. É crescente o número de pesquisas sobre alternativas não farmacológicas enfocando a reabilitação de aspectos funcionais ou comprometimentos cognitivos específicos de cada variante das APP. Relatar um tratamento de curta-duração administrado a um paciente com APPNF enfocando a produção de sentenças. O paciente apresentava redução importante da fluência verbal, uso de palavras-chave, simplificação frasal e gramatical, além de anomia. Utilizando o método de aprendizado sem erros, foram estruturadas seis sessões para estimular a formação de frases no presente e no passado com a técnica de cloze. O paciente apresentou melhora restrita à estratégia, com 100% de acerto nas frases treinadas e generalização para as não-treinadas de estrutura sintática semelhante após o treinamento. Os resultados foram mantidos um mês após o tratamento.

afasia progressiva primária; terapia fonoaudiológica; tratamento; intervenção; reabilitação cognitiva

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REFERENCES

¹
Mesulam MM. Slowely progressive aphasia without generalized demen-tia. Ann Neurol 1982;11:592-598.
²
Gorno-Tempini ML, Hillis AE, Weintraub S, et al. Classification of primary pro-gressive aphasia and its variants. Neurology 2011; 76:1006-1014.
³
Mesulam M. Primary progressive aphasia - A dementia of the language network. Dement Neuropsychol 2013;7:2-9.
⁴
Weintraub S, Mesulam M, Wieneke C, Rademaker A, Rogalski EJ, Thompson CK. The Northwestern Anagram Test: Measuring Sentence Production in Primary Progressive Aphasia. Am J Alzheimer's Dis Other Dement 2009;24:408-416.
⁵
Reed DA, Johnson NA, Thompson C, Weintraub S, Mesulam MM. A clinical trial of bromocriptine for treatment of primary progressive aphasia. Ann Neurol 2004;56:750.
⁶
Kertesz A, Morlog D, Light M, Blair M, Davidson W, Jesso S, et al. Galantamine in frontotemporal dementia and primary progressive aphasia. Dement Geriatr Cogn Disord 2008;25:178-185.
⁷
Decker DA, Heilman KM. Steroid treatment of primary progressive aphasia. Arch Neurol 2008;65:1533-1535.
⁸
Johnson NA, Rademaker A, Weintraub S, Gitelman D, Wienecke C, Mesulam M. Pilot trial of memantine in primary progressive aphasia. Alzheimer Dis Assoc Disord 2010;24:308.
⁹
Olazarán J, Reisberg B, Clare L, Cruz I, et al. Non pharmacological therapies in Alzheimer's disease: a systematic review of efficacy. Dement Geriatr Cogn Disord 2010;30:161-178.
¹⁰
Carthery-Goulart MT, Silveira AC, Machado TH, et al. Nonpharmacological interventions for cognitive impairments following primary progressive aphasia - A systematic review of the literature. Dement Neuropsychol 2013;7:122-131.
¹¹
Schneider SL, Thompson CK, Luring B. Effects of verbal plus gestural matrix training on sentence production in a patient with primary pro-gressive afasia. Aphasiology 1996; 10:297-317.
¹²
Bock K, Levelt W. Language production: Grammatical encoding. In: M.A. Gernsbacher (Ed.), Handbook of psycholinguistics, San Diego, CA: Academic Press; 1994:945-984.
¹³
De Renzi E, Vignolo, LA. The Token Test: a sensitive test to detect receptive disturbances in aphasics. Brain. 1962;85:665-78.
¹⁴
Bishop DVM. Test for the Reception of Grammar. Age and Cognitive Performance. Research Centre, University of Manchester. Manchester; 1983.
¹⁵
Bishop DVM. The Test for Reception of Grammar, version 2 (TROG-2). London: Psychological Corporation; 2003.
¹⁶
Goodglas H, Kaplan E. The assessment of aphasia and related dosorders. Philadelphia: Lea & Febiger; 1983.
¹⁷
Fichman HC, Fernandes CS, Nitrini R, et al. Age and educational level effects on the performance of normal elderly on category verbal fluency tasks. Dement Neuropsychol 2009;3:49-54.
¹⁸
Machado TH, Fichman HC, Santos EL, et al. Normative data for healthy elderly on the phonemic verbal fluency task - FAS. Dement Neuropsychol 2009;3:55-60.
¹⁹
Kolk H. Disorders of syntax in aphasia: Linguistic-descriptive and processing approaches. In: B. Stemmer & H.A. Whitaker (Eds.), Handbook of neurolinguistics (pp. 250 - 260). San Diego Academic Press; 1998.
²⁰
Marshall J, Pring T, Chiat S. Verb retrieval and sentence production in aphasia. Brain Lang 1998;63:159-183.

Publication Dates

Publication in this collection
Sept 2014

History

Received
25 Feb 2014
Accepted
27 Apr 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

[1] ¹
Mesulam MM. Slowely progressive aphasia without generalized demen-tia. Ann Neurol 1982;11:592-598.

[2] ²
Gorno-Tempini ML, Hillis AE, Weintraub S, et al. Classification of primary pro-gressive aphasia and its variants. Neurology 2011; 76:1006-1014.

[3] ³
Mesulam M. Primary progressive aphasia - A dementia of the language network. Dement Neuropsychol 2013;7:2-9.

[4] ⁴
Weintraub S, Mesulam M, Wieneke C, Rademaker A, Rogalski EJ, Thompson CK. The Northwestern Anagram Test: Measuring Sentence Production in Primary Progressive Aphasia. Am J Alzheimer's Dis Other Dement 2009;24:408-416.

[5] ⁵
Reed DA, Johnson NA, Thompson C, Weintraub S, Mesulam MM. A clinical trial of bromocriptine for treatment of primary progressive aphasia. Ann Neurol 2004;56:750.

[6] ⁶
Kertesz A, Morlog D, Light M, Blair M, Davidson W, Jesso S, et al. Galantamine in frontotemporal dementia and primary progressive aphasia. Dement Geriatr Cogn Disord 2008;25:178-185.

[7] ⁷
Decker DA, Heilman KM. Steroid treatment of primary progressive aphasia. Arch Neurol 2008;65:1533-1535.

[8] ⁸
Johnson NA, Rademaker A, Weintraub S, Gitelman D, Wienecke C, Mesulam M. Pilot trial of memantine in primary progressive aphasia. Alzheimer Dis Assoc Disord 2010;24:308.

[9] ⁹
Olazarán J, Reisberg B, Clare L, Cruz I, et al. Non pharmacological therapies in Alzheimer's disease: a systematic review of efficacy. Dement Geriatr Cogn Disord 2010;30:161-178.

[10] ¹⁰
Carthery-Goulart MT, Silveira AC, Machado TH, et al. Nonpharmacological interventions for cognitive impairments following primary progressive aphasia - A systematic review of the literature. Dement Neuropsychol 2013;7:122-131.

[11] ¹¹
Schneider SL, Thompson CK, Luring B. Effects of verbal plus gestural matrix training on sentence production in a patient with primary pro-gressive afasia. Aphasiology 1996; 10:297-317.

[12] ¹²
Bock K, Levelt W. Language production: Grammatical encoding. In: M.A. Gernsbacher (Ed.), Handbook of psycholinguistics, San Diego, CA: Academic Press; 1994:945-984.

[13] ¹³
De Renzi E, Vignolo, LA. The Token Test: a sensitive test to detect receptive disturbances in aphasics. Brain. 1962;85:665-78.

[14] ¹⁴
Bishop DVM. Test for the Reception of Grammar. Age and Cognitive Performance. Research Centre, University of Manchester. Manchester; 1983.

[15] ¹⁵
Bishop DVM. The Test for Reception of Grammar, version 2 (TROG-2). London: Psychological Corporation; 2003.

[16] ¹⁶
Goodglas H, Kaplan E. The assessment of aphasia and related dosorders. Philadelphia: Lea & Febiger; 1983.

[17] ¹⁷
Fichman HC, Fernandes CS, Nitrini R, et al. Age and educational level effects on the performance of normal elderly on category verbal fluency tasks. Dement Neuropsychol 2009;3:49-54.

[18] ¹⁸
Machado TH, Fichman HC, Santos EL, et al. Normative data for healthy elderly on the phonemic verbal fluency task - FAS. Dement Neuropsychol 2009;3:55-60.

[19] ¹⁹
Kolk H. Disorders of syntax in aphasia: Linguistic-descriptive and processing approaches. In: B. Stemmer & H.A. Whitaker (Eds.), Handbook of neurolinguistics (pp. 250 - 260). San Diego Academic Press; 1998.

[20] ²⁰
Marshall J, Pring T, Chiat S. Verb retrieval and sentence production in aphasia. Brain Lang 1998;63:159-183.

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