Department of Speech, Language, and Hearing Sciences, The University of Arizona, 1131 E. Second Street, Tucson, AZ 85721-0071, USA.
J Mol Neurosci. 2011 Nov;45(3):724-36. doi: 10.1007/s12031-011-9579-2. Epub 2011 Jun 28.
Despite considerable recent progress in understanding the underlying neurobiology of primary progressive aphasia (PPA) syndromes, relatively little attention has been directed toward the examination of behavioral interventions that may lessen the pervasive communication problems associated with PPA. In this study, we report on an individual with a behavioral profile and cortical atrophy pattern consistent with the logopenic variant of PPA. At roughly two-and-a-half years post onset, his marked lexical retrieval impairment prompted administration of a semantically based intervention to improve word retrieval. The treatment was designed to improve self-directed efforts to engage the participant's relatively preserved semantic system in order to facilitate word retrieval. His positive response to an intensive (2-week) dose of behavioral treatment was associated with improved lexical retrieval of items within trained categories, and generalized improvement for naming of untrained items that lasted over a 6-month follow-up interval. These findings support the potential value of intensive training to achieve self-directed strategic compensation for lexical retrieval difficulties in logopenic PPA. Additional insight was gained regarding the neural regions that supported improved performance by the administration of a functional magnetic resonance imaging protocol before and after treatment. In the context of a picture-naming task, post-treatment fMRI showed increased activation of left dorsolateral prefrontal regions that have been implicated in functional imaging studies of generative naming in healthy individuals. The increased activation in these frontal regions that were not significantly atrophic in our patient (as determined by voxel-based morphometry) is consistent with the notion that neural plasticity can support compensation for specific language loss, even in the context of progressive neuronal degeneration.
尽管人们在理解原发性进行性失语症（PPA）综合征的神经生物学基础方面取得了相当大的进展，但相对较少关注可能减轻与 PPA 相关的普遍交流问题的行为干预措施。在这项研究中，我们报告了一位具有行为特征和皮质萎缩模式与失语法变异型 PPA 一致的个体。在发病后大约两年半的时间里，他明显的词汇检索障碍促使我们进行了一项基于语义的干预，以改善词汇检索。该治疗旨在改善患者相对保留的语义系统的自我指导努力，以促进词汇检索。他对密集（2 周）剂量的行为治疗的积极反应与训练类别中项目的词汇检索改善有关，并在 6 个月的随访期间持续改善未训练项目的命名。这些发现支持密集训练对改善失语法性 PPA 患者词汇检索困难的自我指导策略补偿的潜在价值。通过在治疗前后进行功能磁共振成像（fMRI）协议，我们获得了更多关于支持治疗后表现改善的神经区域的见解。在图片命名任务中，治疗后的 fMRI 显示左侧背外侧前额叶区域的激活增加，这些区域在健康个体的生成性命名功能成像研究中被涉及。在我们的患者中，这些额叶区域没有明显萎缩（根据体素形态测量学确定），它们的激活增加与神经可塑性可以支持特定语言丧失的补偿的观点一致，即使在进行性神经元变性的背景下也是如此。
