Department of Communication Sciences and Disorders, The University of Texas at Austin.
Memory and Aging Center, Department of Neurology, University of California, San Francisco.
J Speech Lang Hear Res. 2019 Aug 15;62(8):2723-2749. doi: 10.1044/2018_JSLHR-L-18-0144. Epub 2019 Aug 7.
Purpose Recent studies confirm the utility of speech-language intervention in primary progressive aphasia (PPA); however, long-term outcomes, ideal dosage parameters, and relative benefits of intervention across clinical variants warrant additional investigation. The purpose of this study was to determine whether naming treatment affords significant, lasting, and generalized improvement for individuals with semantic and logopenic PPA and whether dosage manipulations significantly affect treatment outcomes. Method Eighteen individuals with PPA (9 semantic and 9 logopenic variant) underwent lexical retrieval treatment designed to leverage spared cognitive-linguistic domains and develop self-cueing strategies to promote naming. One group (n = 10) underwent once-weekly treatment sessions, and the other group (n = 8) received the same treatment with 2 sessions per week and an additional "booster" treatment phase at 3 months post-treatment. Performance on trained and untrained targets/tasks was measured immediately after treatment and at 3, 6, and 12 months post-treatment. Results Outcomes from the full cohort of individuals with PPA showed significantly improved naming of trained items immediately post-treatment and at all follow-up assessments through 1 year. Generalized improvement on untrained items was significant up to 6 months post-treatment. The positive response to treatment was comparable regardless of session frequency or inclusion of a booster phase. Outcomes were comparable across PPA subtypes, as was maintenance of gains over the post-treatment period. Conclusion This study documents positive naming treatment outcomes for a group of individuals with PPA, demonstrating strong direct treatment effects, maintenance of gains up to 1 year post-treatment, and generalization to untrained items. Lexical retrieval treatment, in conjunction with daily home practice, had a strong positive effect that did not require more than 1 clinician-directed treatment session per week. Findings confirm that strategic training designed to capitalize on spared cognitive-linguistic abilities results in significant and lasting improvement, despite ongoing disease progression, in PPA.
目的
最近的研究证实了言语语言干预在原发性进行性失语症(PPA)中的效用;然而,长期结果、理想的剂量参数以及干预在临床变异体中的相对益处仍需要进一步研究。本研究的目的是确定命名治疗是否为语义和流畅性失语症患者提供显著、持久和广泛的改善,以及剂量调整是否显著影响治疗结果。
方法
18 名 PPA 患者(9 名语义性和 9 名流畅性变异型)接受了词汇检索治疗,旨在利用保留的认知语言领域并开发自我提示策略以促进命名。一组(n=10)接受每周一次的治疗,另一组(n=8)接受相同的治疗,每周两次,并在治疗后 3 个月增加一个“强化”治疗阶段。治疗后立即以及治疗后 3、6 和 12 个月测量接受和未接受训练的目标/任务的表现。
结果
PPA 患者的全部队列的结果显示,训练项目的命名在治疗后立即以及所有随访评估中均显著改善,直至 1 年。未接受训练的项目的泛化改善在治疗后 6 个月时显著。无论治疗频率或强化阶段的纳入与否,治疗的积极反应都是可比的。治疗效果在 PPA 亚型之间是可比的,治疗后期间的收益保持也是可比的。
结论
本研究记录了一组 PPA 患者的积极命名治疗结果,表明直接治疗效果显著,治疗后 1 年仍保持收益,并泛化至未接受训练的项目。词汇检索治疗结合日常家庭练习具有积极的影响,每周不需要超过 1 次临床指导的治疗。研究结果证实,旨在利用保留的认知语言能力的策略性训练会导致 PPA 患者显著且持久的改善,尽管疾病仍在进展。