Treatment of Primary Progressive Aphasia

Tippett, Donna C.; Hillis, Argye E.; Tsapkini, Kyrana

doi:10.1007/s11940-015-0362-5

Cited by 89 publications

(65 citation statements)

References 105 publications

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“…To date, however, few studies employing neuromodulation techniques like TMS or transcranial direct current stimulation have assessed whether these treatment approaches generalize. A few studies have shown that rTMS combined with behavioral interventions leads to generalization in naming tasks (Cotelli et al, 2011; see Tippett et al, 2015, for evidence of generalization in patients with primary progressive aphasia following transcranial direct current stimulation). Here, we extend findings from previous research, demonstrating that rTMS therapy can also improve naming performance for novel items in the absence of concurrent speech-language therapy when administered across several days.…”

Section: Discussionmentioning

confidence: 99%

“…Research using behavioral interventions has found that generalization to novel (untrained) stimuli is a short-lived effect, with larger and long-lasting treatment effects for those items that were trained in the treatment protocol (for reviews, see Kiran and Bassetto, 2008; Nickels, 2002). Future studies will need to establish whether NBS treatment approaches, whether administered concurrently with behavioral treatments (eg, Tippett et al, 2015) or alone, confer more robust and persistent generalization effects. Determining this has the potential to inform the development of optimal treatment protocols that best utilize resources and time.…”

Section: Discussionmentioning

confidence: 99%

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Functional Reorganization of Right Prefrontal Cortex Underlies Sustained Naming Improvements in Chronic Aphasia via Repetitive Transcranial Magnetic Stimulation

Harvey

Podell

Turkeltaub

et al. 2017

Cognitive and Behavioral Neurology

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Background and Objective While noninvasive brain stimulation techniques show promise for language recovery after stroke, the underlying mechanisms remain unclear. We applied inhibitory repetitive transcranial magnetic stimulation (rTMS) to regions of interest in the right inferior frontal gyrus of patients with chronic poststroke aphasia and examined changes in picture naming performance and cortical activation. Methods Nine patients received 10 days of 1-Hz rTMS (Monday through Friday for 2 weeks). We assessed naming performance before and immediately after stimulation on the first and last days of rTMS therapy, and then again at 2 and 6 months post-rTMS. A subset of six of these patients underwent functional magnetic resonance imaging pre-rTMS (baseline) and at 2 and 6 months post-rTMS. Results Naming accuracy increased from pre- to post-rTMS on both the first and last days of treatment. We also found naming improvements long after rTMS, with the greatest improvements at 6 months post-rTMS. Long-lasting effects were associated with a posterior shift in the recruitment of the right inferior frontal gyrus: from the more anterior Brodmann area 45 to the more posterior Brodmann areas 6, 44, and 46. The number of left hemispheric regions recruited for naming also increased. Conclusions This study found that rTMS to the right hemisphere Broca area homologue confers long-lasting improvements in picture naming performance. The mechanism involves dynamic bilateral neural network changes in language processing, which take place within the right prefrontal cortex and the left hemisphere more generally. Clinical Trial Registration ClinicalTrials.gov (Identifier NCT00608582).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Functional Reorganization of Right Prefrontal Cortex Underlies Sustained Naming Improvements in Chronic Aphasia via Repetitive Transcranial Magnetic Stimulation

Harvey

Podell

Turkeltaub

et al. 2017

Cognitive and Behavioral Neurology

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“…There is evidence that beneficial effects may be achieved with cumulative sessions [167], including when paired with a behavioral program to enhance outcome (e.g. cognitive or physical exercises for recovery of function, e.g., [168], [169], [170]). Therefore, repeated tDCS administration over time will likely be essential to the effectiveness of many treatments.…”

Section: Tdcs Special Considerations For Safety In Home Usementioning

confidence: 99%

Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016

et al. 2016

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This review updates and consolidates evidence on the safety of transcranial Direct Current Stimulation (tDCS). Safety is here operationally defined by, and limited to, the absence of evidence for a Serious Adverse Effect, the criteria for which are rigorously defined. This review adopts an evidence-based approach, based on an aggregation of experience from human trials, taking care not to confuse speculation on potential hazards or lack of data to refute such speculation with evidence for risk. Safety data from animal tests for tissue damage are reviewed with systematic consideration of translation to humans. Arbitrary safety considerations are avoided. Computational models are used to relate dose to brain exposure in humans and animals. We review relevant dose-response curves and dose metrics (e.g. current, duration, current density, charge, charge density) for meaningful safety standards. Special consideration is given to theoretically vulnerable populations including children and the elderly, subjects with mood disorders, epilepsy, stroke, implants, and home users. Evidence from relevant animal models indicates that brain injury by Direct Current Stimulation (DCS) occurs at predicted brain current densities (6.3–13 A/m2) that are over an order of magnitude above those produced by conventional tDCS. To date, the use of conventional tDCS protocols in human trials (≤40 min, ≤4 mA, ≤7.2 Coulombs) has not produced any reports of a Serious Adverse Effect or irreversible injury across over 33,200 sessions and 1,000 subjects with repeated sessions. This includes a wide variety of subjects, including persons from potentially vulnerable populations.

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“…That is, tDCS paired with a behavioral treatment offers the promise of synergistic effects that would not otherwise be apparent through stimulation or behavioral treatment alone (Monti et al, 2013; Price et al, 2015; Tippett et al, 2015). …”

Section: Introductionmentioning

confidence: 99%

Semantic Feature Training in Combination with Transcranial Direct Current Stimulation (tDCS) for Progressive Anomia

Hung

Bauer

Grossman

et al. 2017

Front. Hum. Neurosci.

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We examined the effectiveness of a 2-week regimen of a semantic feature training in combination with transcranial direct current stimulation (tDCS) for progressive naming impairment associated with primary progressive aphasia (N = 4) or early onset Alzheimer’s Disease (N = 1). Patients received a 2-week regimen (10 sessions) of anodal tDCS delivered over the left temporoparietal cortex while completing a language therapy that consisted of repeated naming and semantic feature generation. Therapy targets consisted of familiar people, household items, clothes, foods, places, hygiene implements, and activities. Untrained items from each semantic category provided item level controls. We analyzed naming accuracies at multiple timepoints (i.e., pre-, post-, 6-month follow-up) via a mixed effects logistic regression and individual differences in treatment responsiveness using a series of non-parametric McNemar tests. Patients showed advantages for naming trained over untrained items. These gains were evident immediately post tDCS. Trained items also showed a shallower rate of decline over 6-months relative to untrained items that showed continued progressive decline. Patients tolerated stimulation well, and sustained improvements in naming accuracy suggest that the current intervention approach is viable. Future implementation of a sham control condition will be crucial toward ascertaining whether neurostimulation and behavioral treatment act synergistically or alternatively whether treatment gains are exclusively attributable to either tDCS or the behavioral intervention.

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Treatment of Primary Progressive Aphasia

Cited by 89 publications

References 105 publications

Functional Reorganization of Right Prefrontal Cortex Underlies Sustained Naming Improvements in Chronic Aphasia via Repetitive Transcranial Magnetic Stimulation

Functional Reorganization of Right Prefrontal Cortex Underlies Sustained Naming Improvements in Chronic Aphasia via Repetitive Transcranial Magnetic Stimulation

Safety of Transcranial Direct Current Stimulation: Evidence Based Update 2016

Semantic Feature Training in Combination with Transcranial Direct Current Stimulation (tDCS) for Progressive Anomia

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