The Mini Linguistic State Examination (MLSE): a brief but accurate assessment tool for classifying Primary Progressive Aphasias

Abstract

Background: This paper introduces a new clinical test, the Mini Linguistic State Examination (MLSE), as a short assessment for screening and classification of the different manifestations of primary progressive aphasia (PPA). Differentiation and monitoring of PPA variants are vital for management, planning and development of new treatments. The MLSE is designed to improve the uniformity of testing, screening for recruitment to clinical trials, and consistency of research results. It is a brief but effective test which can be adapted to the worlds major languages. Methods: Fifty-four patients and 30 age-, sex- and education-matched controls completed testing with the MLSE and components of the Boston Diagnostic Aphasia Examination in addition to their standard clinical diagnostic assessment. The MLSE includes five domains (motor speech, phonology, semantics, syntax and working memory) that were compared across groups. A random forest classification was used to learn the relationship between these five domains and assess the power of the diagnostic accuracy for predicting PPA subtypes. The final machine learning model was used to create a decision tree to guide the optimal manual classification of patients. Results: On average, the test took less than 20 minutes to administer. Significant group differences were found across all five domains, in terms of the distributions of error-types. These differences mirror the well-known language profiles for the three main PPA variants, which typically require an extended neuropsychology and speech pathology assessment. The random forest prediction model had an overall classification accuracy of 96% (92% for logopenic variant PPA, 93% for semantic variant PPA and 98% for non-fluent variant PPA). The derived decision tree for manual classification produced correct classification of 91% of participants whose data were not included in the training set. Conclusions: The MLSE is a new short cognitive test, with a scoring system that is easy to learn and apply. It is accurate for classifying PPA syndromes, and has potential to screen and monitor language deficits that occur in other focal and neurodegenerative brain disorders associated with language impairment. With increasing importance of language assessment in clinical research, the MLSEs linguistic assessment tool enables the essential profiling of language deficits in a wide clinical community.

Language disorder in progressive supranuclear palsy and corticobasal syndrome: neural correlates and detection by the MLSE screening tool

“…Error-based scoring provides domain scores corresponding to key linguistic domains (motor speech, knowledge of phonological structure, semantic knowledge, syntactic knowledge, and auditory-verbal working memory) as well as an overall total score out of 100, with lower scores indicating poorer performance. The MLSE has shown high inter-rater agreement and diagnostic accuracy for the classification of primary progressive aphasic syndromes (>90% accuracy using random forest classification) (Patel et al, 2020).…”

“…Speech and language deficits are common in both disorders, but their recognition has been hampered by the lack of a brief but sensitive clinical assessment tool. In this paper, we use the Mini Linguistic State Examination (MLSE (Patel et al, 2020)) to investigate the range of speech and language deficits in PSP and the corticobasal syndrome (CBS), and their neural correlates in structural magnetic resonance imaging (MRI).…”

“…The speech and language symptoms of PSP and CBS have been difficult to assess and characterise in non-specialist settings because of the lack of a validated brief language screening test. The MLSE is accurate for the assessment of primary progressive aphasias (Patel et al, 2020) but its performance in other neurological disorders is yet to be assessed. We included patients with a range of PSP and CBS phenotypic presentations to reflect the range of cases presenting to cognitive and movement disorders clinics, noting that speech and language impairment occurs in PSP/CBS patients even in those who do not meet criteria for PSP-SL or CBS-NAV (Dodich et al, 2019).…”

Language Disorder in Progressive Supranuclear Palsy and Corticobasal Syndrome: Neural Correlates and Detection by the MLSE Screening Tool

“…Speech and language deficits are common in both disorders, but their recognition has been hampered by the lack of a brief but sensitive clinical assessment tool (Peterson et al, 2019 ). In this article, we use the Mini Linguistic State Examination (MLSE; Patel et al, 2020 ) to investigate the range of speech and language deficits in PSP and the corticobasal syndrome (CBS), and their neural correlates in structural magnetic resonance imaging (MRI).…”

“…The MLSE was recently developed as a screening tool to identify and categorise speech and language deficits in neurological disorders (Patel et al, 2020 ). We, therefore, used the MLSE to compare PSP, CBS, and nfvPPA.…”