Speech and Language Interventions for Italian People With PPA

Official title

Speech and Language-Tailored Interventions for People With Primary Progressive Aphasia

Overview

Primary progressive aphasia (PPA) is an umbrella term used to refer to several clinical variants that manifest as an insidious deterioration of speech/language skills, usually due to frontotemporal lobar degeneration and/or Alzheimer's disease. Consensus criteria have been proposed by an international community regarding the sub-classification of PPA into three variants: (1) semantic variant PPA, characterized by impaired confrontation naming and single-word comprehension; (2) logopenic variant PPA), characterised by word-finding difficulties and sentence repetition deficits; and (3) non-fluent variant, characterised by agrammatism with or without apraxia of speech. Speech and language therapists (SLTs) play a crucial role in the diagnostic process and in setting a therapeutic path along with monitoring the evolution of the clinical picture. Despite growing evidence supporting the benefits of speech-language intervention, the frequency with which individuals with PPA are referred for speech and language services, is suboptimal likely due to skepticism regarding the value of speech and language therapy in the context of neurodegeneration, the scarcity of SLTs with expertise in the treatment of PPA, the lack of awareness regarding the role of the SLT amongst referrers, and the geographical barriers that impede access to in-person speech and language services. In Italy, patients with PPA are rarely offered treatment options due to a lack of understanding of the disorder on the part of health professionals and erroneous assumptions regarding the utility of treatment in patients facing a worsening prognosis. The primary aim of this pilot study is to develop tailored speech and language interventions for patients with different variants of PPA by addressing their linguistic and cognitive difficulties. Secondly, to explore the intervention's effect also on untreated tasks and assess the long-term maintenance of the proposed interventions by monitoring patients for up to six months. Finally, in each PPA variant, the investigators aim to investigate which variables among the sociodemographic, clinical, linguistic/cognitive, and brain MRI features at baseline predict successful clinical results, as well as which structural and functional brain changes are associated with speech and language improvements.

Detailed description

A total of 30 PPA patients will be recruited, with a clinical and imaging-supported diagnosis of PPA according to the current diagnostic criteria, and MMSE\>15. At the study entry (T0), all patients will undergo a clinical interview, a neurological and neuropsychological evaluation, and a speech and language assessment. All these visits will be repeated soon after the intervention (at week 5, W5), at 3 months (M3), and at 6 months (M6) post-intervention. Specifically, measures of patient's and caregivers' satisfaction and patients' functional communication abilities will be collected as primary outcomes. At baseline (T0) and after intervention (W5), all patients recruited at IRCCS San Raffaele and 40% of patients recruited at IRCCS Maugeri Clinical and Scientific Institute will also perform a brain structural and functional MRI. Thirty healthy controls, matched with PPA cases for age and sex, will be also recruited. Only at baseline (T0), all controls will undergo the same visits as the PPA patients, as well as the brain MRI scan. IRCCS Maugeri Clinical and Scientific Institute will be specifically in charge of the development of the SLT protocols, for the online administration of tailored speech and language interventions and for data analysis. IRCCS Ospedale San Raffaele Milano will be specifically in charge of brain structural and functional MRI acquisition, the definition of task-based functional MRI paradigms, and MRI analysis. This unit will also recruit and collect data on the entire sample of healthy controls. Brain structural and functional changes associated with SLT interventions using the most advanced MRI techniques will be investigated. The sociodemographic, clinical, language, speech, and MRI features obtained in patients will be processed through machine learning to develop a computation paradigm that better defines their prediction value for the intervention's efficacy.

Interventions

• Behavioral Behavioral Treatment
  The SLT intervention will be entirely administered online through a web-based platform. While each of the treatments will engage semantics, phonology, and orthography, the protocols will be tailored relative to the characteristics of each PPA variant. Patients with svPPA and lvPPA will undergo a lexical retrieval training (LRT) intervention implemented using a training cascade. Patients with nfvPPA will undergo Video-implemented Script Training (VISTA), a choral reading approach training accura

Primary outcome measures

• Change in measure of naming after Lexical Retrieval Training (LRT) [Time frame: From enrollment to the end of treatment at 5 weeks, 3 Months and 6 Months]
• Change in number of articulatory and grammatical errors [Time frame: From enrollment to the end of treatment at 5 weeks, 3 Months and 6 Months]
• Change in measures of patients and caregivers satisfaction and patients functional communication abilities [Time frame: From enrollment to the end of treatment at 5 weeks, 3 Months and 6 Months]
• Change on untrained probes within each clinical variant [Time frame: From enrollment to the end of treatment at 5 weeks, 3 Months and 6 Months]

Secondary outcome measures (12)

• Change in measure of oral production as assessed by Picture description subtests [Time frame: From enrollment to the end of treatment at 5 weeks, 3 Months and 6 Months]
• Change in measure of quality of life as assessed by Communication Outcome After Stroke (COAST) [Time frame: From enrollment to the end of treatment at 5 weeks, 3 Months and 6 Months]
• Change in measure of naming as assessed by Picture Naming subtest from Screening for Aphasia in NeuroDegeneration (SAND) [Time frame: From enrollment to the end of treatment at 5 weeks, 3 Months and 6 Months]
• Change in measure of comprehension as assessed by Auditory sentence comprehension subtest from Screening for Aphasia in NeuroDegeneration (SAND) [Time frame: From enrollment to the end of treatment at 5 weeks, 3 Months and 6 Months]
• Change in measure of comprehension as assessed by Single-word comprehension subtest from Screening for Aphasia in NeuroDegeneration (SAND) [Time frame: From enrollment to the end of treatment at 5 weeks, 3 Months and 6 Months]
• Change in measure of repetition as assessed by Repetition subtest from Screening for Aphasia in NeuroDegeneration (SAND) [Time frame: From enrollment to the end of treatment at 5 weeks, 3 Months and 6 Months]
• Change in measure of repetition as assessed by Sentence repetition subtest from Screening for Aphasia in NeuroDegeneration (SAND) [Time frame: From enrollment to the end of treatment at 5 weeks, 3 Months and 6 Months]
• Change in measure of reading as assessed by Reading subtest from Screening for Aphasia in NeuroDegeneration (SAND) [Time frame: From enrollment to the end of treatment at 5 weeks, 3 Months and 6 Months]
• Change in measure of writing as assessed by Writing subtest from Screening for Aphasia in NeuroDegeneration (SAND) [Time frame: From enrollment to the end of treatment at 5 weeks, 3 Months and 6 Months]
• Change in measure of semantics as assessed by Semantic association subtest from Screening for Aphasia in NeuroDegeneration (SAND) [Time frame: From enrollment to the end of treatment at 5 weeks, 3 Months and 6 Months]
• Change in measure of naming as assessed by Subtest from CAGI battery [Time frame: From enrollment to the end of treatment at 5 weeks, 3 Months and 6 Months]
• Change in measure of comprehension as assessed by Single-word comprehension subtest from CAGI [Time frame: From enrollment to the end of treatment at 5 weeks, 3 Months and 6 Months]

Eligibility criteria

Inclusion criteria

• Diagnosis of PPA according to the current clinical criteria (Gorno-Tempini et al., 2011)
• Mild PPA defined using the Progressive Aphasia Severity Scale (PASS)
• Age between 40 and 85 years
• Patients with Italian mother tongue
• Patients with the ability to sign the informed consent
• Patients with the ability to comply with the study procedures
• Patients with stable pharmacological treatment for at least 4 weeks.

Exclusion criteria

• Mini-Mental State Exam (MMSE) Score <15
• Presence of other neurological or psychiatric diseases, including cerebrovascular disease
• Severe and uncorrected hearing loss or visual disturbances
• Inability to repeat multi-syllable words (4 syllables)
• Concurrent participation in other pharmacological and non-pharmacological experimental studies

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Observational model

Cohort

Study locations

Italy · 2 centers

• Istituti Clinici Scientifici Maugeri IRCCS — Bari
• IRCCS Ospedale San Raffaele — Milan

Publications

• Tippett DC, Hillis AE, Tsapkini K. Treatment of Primary Progressive Aphasia. Curr Treat Options Neurol. 2015 Aug;17(8):362. doi: 10.1007/s11940-015-0362-5. PMID 26062526
• Grossman M. Primary progressive aphasia: clinicopathological correlations. Nat Rev Neurol. 2010 Feb;6(2):88-97. doi: 10.1038/nrneurol.2009.216. PMID 20139998
• Henry ML, Hubbard HI, Grasso SM, Mandelli ML, Wilson SM, Sathishkumar MT, Fridriksson J, Daigle W, Boxer AL, Miller BL, Gorno-Tempini ML. Retraining speech production and fluency in non-fluent/agrammatic primary progressive aphasia. Brain. 2018 Jun 1;141(6):1799-1814. doi: 10.1093/brain/awy101. PMID 29718131
• Mesulam MM. Primary progressive aphasia--differentiation from Alzheimer's disease. Ann Neurol. 1987 Oct;22(4):533-4. doi: 10.1002/ana.410220414. No abstract available. PMID 3324947
• Volkmer A, Rogalski E, Henry M, Taylor-Rubin C, Ruggero L, Khayum R, Kindell J, Gorno-Tempini ML, Warren JD, Rohrer JD. Speech and language therapy approaches to managing primary progressive aphasia. Pract Neurol. 2020 Apr;20(2):154-161. doi: 10.1136/practneurol-2018-001921. Epub 2019 Jul 29. PMID 31358572
• Battista P, Piccininni M, Montembeault M, Messina A, Minafra B, Miller BL, Henry ML, Gorno Tempini ML, Grasso SM. Access, referral, service provision and management of individuals with primary progressive aphasia: A survey of speech-language therapists in Italy. Int J Lang Commun Disord. 2023 Jul-Aug;58(4):1046-1060. doi: 10.1111/1460-6984.12843. Epub 2023 Jan 13. PMID 36636857
• Gorno-Tempini ML, Hillis AE, Weintraub S, Kertesz A, Mendez M, Cappa SF, Ogar JM, Rohrer JD, Black S, Boeve BF, Manes F, Dronkers NF, Vandenberghe R, Rascovsky K, Patterson K, Miller BL, Knopman DS, Hodges JR, Mesulam MM, Grossman M. Classification of primary progressive aphasia and its variants. Neurology. 2011 Mar 15;76(11):1006-14. doi: 10.1212/WNL.0b013e31821103e6. Epub 2011 Feb 16. PMID 21325651

Identifiers

NCT: NCT06739967 · 1767/CEL · PNRR-MCNT2-2023-12378220

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗