Suh Samuel, Friedman Rhonda B, Meyer Aaron M, Snider Sarah F, Sebastian Rajani, Tippett Donna C
Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287.
Center for Aphasia Research and Rehabilitation, Department of Neurology, Georgetown University, Washington, DC 20057.
Aphasiology. 2025 May 28. doi: 10.1080/02687038.2025.2510327.
Generalization of speech-language pathology treatment is an important goal in clinical practice and research. Functional communication rating scales are often used to investigate potential treatment effects in daily life. Connected speech samples more closely reflect meaningful changes in communication as a result of treatment than test/re-test outcomes. Little attention has been directed to this relationship in aphasia due to neurodegenerative etiologies.
We investigated whether correlations between ratings on the Georgetown University Center for Aphasia Research and Rehabilitation Functional Communication Scale (CARR-FCS) and total content units (CUs) from spoken descriptions of the Cookie Theft Picture from the Boston Diagnostic Aphasia Examination (CTP-BDAE), versus correlations with scores on the Boston Naming Test (BNT), differed among variants of primary progressive aphasia (PPA) at baseline testing and 6-12 month follow-up (ClinicalTrials.gov Identifier: NCT02675270). At baseline and follow-up, for semantic variant PPA (svPPA), we hypothesized that performance on picture description will correlate more strongly with the CARR-FCS, compared to confrontation naming, as those with svPPA tend to have especially poor performance on confrontation naming [compared to logopenic variant PPA (lvPPA) and nonfluent agrammatic PPA (nfaPPA)], a task that may not be reflective of functional communication ability because communication via other means (e.g., circumlocutions) is not captured. We did not expect to find this effect in lvPPA or nfaPPA because, although anomia is present in all PPA variants, it is less severely compromised in these variants. At follow-up, for nfaPPA, we hypothesized that performance on picture description will correlate more strongly with the CARR-FCS, compared to confrontation naming, because those with nfaPPA can have a marked decline in confrontation naming due to worsening apraxia of speech.
At two time points, we calculated correlation coefficients between care partners' ratings on the CARR-FCS and total CUs from spoken descriptions of the CPT-BDAE and BNT scores of individuals with PPA. We compared the size of the correlations.
Correlations were significantly stronger between total CUs and ratings on the CARR-FCS, compared to BNT scores and CARR-FCS ratings, for svPPA at both time points, but were not significantly different for lvPPA and nfaPPA.
These findings suggest that, while confrontation naming performance may be a proxy for functional communication in lvPPA and nfaPPA, a measure of connected speech is more representative of functional communication in svPPA because confrontation naming is typically more impaired in svPPA than in either of the other two variants.
言语病理学治疗的泛化是临床实践和研究中的一个重要目标。功能沟通评定量表常用于调查日常生活中的潜在治疗效果。与复测结果相比，连贯言语样本更能密切反映治疗后沟通方面有意义的变化。由于神经退行性病因导致的失语症，很少有人关注这种关系。
我们调查了在基线测试和6 - 12个月随访时，乔治敦大学失语症研究与康复中心功能沟通量表（CARR - FCS）评分与波士顿诊断失语症检查（CTP - BDAE）中曲奇盗窃图片口头描述的总内容单位（CUs）之间的相关性，与波士顿命名测试（BNT）分数之间的相关性，在原发性进行性失语症（PPA）的不同变体之间是否存在差异（ClinicalTrials.gov标识符：NCT02675270）。在基线和随访时，对于语义变异型PPA（svPPA），我们假设与对图片描述的表现相比，对图片描述的表现与CARR - FCS的相关性更强，因为svPPA患者在对图片描述方面的表现往往特别差[与语音变异型PPA（lvPPA）和非流利性语法缺失型PPA（nfaPPA）相比]，对图片描述这项任务可能无法反映功能沟通能力，因为通过其他方式（如迂回表达）进行的沟通未被涵盖。我们预计在lvPPA或nfaPPA中不会发现这种效应，因为尽管所有PPA变体都存在命名障碍，但在这些变体中其受损程度较轻。在随访时，对于nfaPPA，我们假设与对图片描述的表现相比，对图片描述的表现与CARR - FCS的相关性更强，因为nfaPPA患者由于言语失用症加重，对图片描述的表现可能会有明显下降。
在两个时间点，我们计算了护理伙伴对CARR - FCS的评分与PPA患者CPT - BDAE口头描述的总CUs以及BNT分数之间的相关系数。我们比较了相关性的大小。
在两个时间点，对于svPPA，总CUs与CARR - FCS评分之间的相关性显著强于BNT分数与CARR - FCS评分之间的相关性，但对于lvPPA和nfaPPA则无显著差异。
这些发现表明，虽然对图片描述的表现可能是lvPPA和nfaPPA中功能沟通的一个指标，但连贯言语的测量更能代表svPPA中的功能沟通，因为svPPA中对图片描述的表现通常比其他两种变体中的任何一种受损更严重。
