Josephy-Hernandez Sylvia, Rezaii Neguine, Jones Amelia, Loyer Emmaleigh, Hochberg Daisy, Quimby Megan, Wong Bonnie, Dickerson Bradford C
Frontotemporal Disorders Unit, Department of Neurology, Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA.
Speech and Language Pathology Department, Spaulding Rehabilitation Hospital, Charlestown, MA 02129, USA.
Brain Commun. 2023 Jul 20;5(4):fcad202. doi: 10.1093/braincomms/fcad202. eCollection 2023.
Despite the important role of written language in everyday life, abnormalities in functional written communication have been sparsely investigated in primary progressive aphasia. Prior studies have analysed written language separately in each of the three variants of primary progressive aphasia-but have rarely compared them to each other or to spoken language. Manual analysis of written language can be a time-consuming process. We therefore developed a program that quantifies content units and total units in written or transcribed language samples. We analysed written and spoken descriptions of the Western Aphasia Battery picnic scene, based on a predefined content unit corpus. We calculated the ratio of content units to units as a measure of content density. Our cohort included 115 participants (20 controls for written, 20 controls for spoken, 28 participants with nonfluent variant primary progressive aphasia, 30 for logopenic variant and 17 for semantic variant). Our program identified content units with a validity of 99.7% (95%CI 99.5-99.8). All patients wrote fewer units than controls ( < 0.001). Patients with the logopenic variant ( = 0.013) and the semantic variant (0.004) wrote fewer content units than controls. The content unit-to-unit ratio was higher in the nonfluent and semantic variants than controls ( = 0.019), but no difference in the logopenic variant ( = 0.962). Participants with the logopenic ( < 0.001) and semantic ( = 0.04) variants produced fewer content units in written compared to spoken descriptions. All variants produced fewer units in written samples compared to spoken ( < 0.001). However, due to a relatively smaller decrease in written content units, we observed a larger content unit-to-unit ratio in writing over speech ( < 0.001). Written and spoken content units ( = 0.5, = 0.009) and total units ( = 0.64, < 0.001) were significantly correlated in patients with nonfluent variant, but this was not the case for logopenic or semantic. Considering all patients with primary progressive aphasia, fewer content units were produced in those with greater aphasia severity (Progressive Aphasia Severity Scale Sum of Boxes, = -0.24, = 0.04) and dementia severity (Clinical Dementia Rating scale Sum of Boxes, = -0.34, = 0.004). In conclusion, we observed reduced written content in patients with primary progressive aphasia compared to controls, with a preference for content over non-content units in patients with the nonfluent and semantic variants. We observed a similar 'telegraphic' style in both language modalities in patients with the nonfluent variant. Lastly, we show how our program provides a time-efficient tool, which could enable feedback and tracking of writing as an important feature of language and cognition.
尽管书面语言在日常生活中起着重要作用，但在原发性进行性失语症中，功能性书面交流异常却鲜有研究。先前的研究分别分析了原发性进行性失语症三种变体中的书面语言，但很少将它们相互比较，也很少与口语进行比较。书面语言的人工分析可能是一个耗时的过程。因此，我们开发了一个程序，用于量化书面或转录语言样本中的内容单元和总单元。我们基于预定义的内容单元语料库，分析了西方失语症成套测验野餐场景的书面和口语描述。我们计算了内容单元与总单元的比率，作为内容密度的一种度量。我们的队列包括115名参与者（20名书面语言对照组、20名口语对照组、28名非流利型原发性进行性失语症患者、30名音韵性失语型患者和17名语义性失语型患者）。我们的程序识别内容单元的有效性为99.7%（95%置信区间99.5 - 99.8）。所有患者写出的单元数量均少于对照组（<0.001）。音韵性失语型患者（=0.013）和语义性失语型患者（0.004）写出的内容单元少于对照组。非流利型和语义性失语型患者的内容单元与总单元的比率高于对照组（=0.019），但音韵性失语型患者无差异（=0.962）。与口语描述相比，音韵性失语型（<0.001）和语义性失语型（=0.04）患者写出的内容单元较少。与口语相比，所有变体在书面样本中产生的单元数量均较少（<0.001）。然而，由于书面内容单元的减少相对较小，我们观察到写作中内容单元与总单元的比率高于口语（<0.001）。非流利型患者的书面和口语内容单元（=0.5，=0.009）以及总单元（=0.64，<0.001）显著相关，但音韵性失语型或语义性失语型患者并非如此。考虑所有原发性进行性失语症患者，失语症严重程度较高（进行性失语症严重程度量表方块总和，= -0.24，=0.04）和痴呆严重程度较高（临床痴呆评定量表方块总和，= -0.34，=0.004）的患者产生的内容单元较少。总之，我们观察到原发性进行性失语症患者的书面内容相较于对照组有所减少，非流利型和语义性失语型患者更倾向于使用内容单元而非非内容单元。我们在非流利型患者的两种语言形式中都观察到了类似的“电报式”风格。最后，我们展示了我们的程序如何提供一种高效的工具，这可以实现对写作这一语言和认知重要特征的反馈和跟踪。
