Marta Balagué, clinical neuropsychologist with more than 15 years of experience in neuropsychological diagnosis in the field of neurodegenerative processes, answers the questions about her presentation on the update on the diagnosis of primary progressive aphasias last March in #YoMeQuedoEnCasa learning with #NeuronUPAcademy.
If you would like to see the presentation, it is available exclusively at NeuronUP
Questions regarding the presentation on the update in the diagnosis of primary progressive aphasias
1. Nuria Anastasi Vilanova: First of all, I would like to say that I loved your presentation. I want to ask you what conclusions can be drawn from the SPEECH RATE, I am very interested because I work as a psychologist in an senior’s residence and I give them the semantic fluency test (say all the animals you can in 1 minute) and also a formal or phonological fluency test (say all the possible words that start with P (to give an example) in 1 minute.
My question is, what number of words said per minute would correspond to each of the APPs, or, in other words, within what interval could it be considered indicative of serious pathology for their advanced age? Within what interval (of answers per minute) would it be considered indicative of mild pathology or disfluency, and within what interval would it be indicative of health or unaffected?
Thank you very much for your interest, Nuria.
First of all I apologize because I did not clarify it in the presentation. When we talk about speech rate, or also about articulation rate, we do not refer to verbal fluencies (semantic or phonetic), we refer to spoken language, spontaneous language (when we assess aphasia it is important to have a conversation of about 5 minutes with the patient) or language induced from the description of a picture (in the Boston Aphasia Test you have a sample: cookie stealing, for example). The speech rate consists of counting the number of words during the conversation or the poster, and calculating the words per minute (you can count one minute or do the average). Articulation rate is the same but instead of words we count syllables (this is usually done with specific language analysis software). In a normal person the average is between 100 and 175 words per minute. But I insist that it is not calculated from verbal fluencies (Animals or ‘P’).
Regarding verbal fluencies (semantics and phonetics) it depends on the age and educational level of the patient (the scales of Neuronorm, for example, will indicate the normal intervals and allow you to graduate the deficits, the reference is this: Peña-Casanova, J., Quinones-Ubeda, S., Gramunt-Fombuena, N., Quintana-Aparicio, M., Aguilar, M., Badenes, D., … & Barquero, M. S. (2009). Spanish Multicenter Normative Studies (NEURONORMA Project): norms for verbal fluency tests. Archives of Clinical Neuropsychology, 24(4), 395-411.)
On the other hand, verbal fluencies are not very specific to diagnose APPs. In general APP-semantics can show alteration in semantic fluency while maintaining preserved phonetics. APP-non-fluent, if the problem is Apraxia of Speech, will show alteration in both, if it is predominantly agrammatical, it may even do both correctly. APP-logopenic may do both correctly, or may also show alteration in both. As I said, there is no clear profile in the affectation of verbal fluencies for each of the PPPs.
I hope I have helped you, if you still have doubts, or I have not explained myself well, write to me again without any problem!
2. Eva María Cubero: Good afternoon, a doubt that has remained with me, what are phonological insertions? Thank you!
Phonological insertion errors occur when we add sounds or syllables to words and these sounds or syllables are identifiable, i.e. they are not distortions (we can clearly identify which letter or sound the patient is making)
For example: instead of “martillo” they say “martatillo” (hammer), instead of “raqueta” they say “racaqueta” (racket)
I hope I’ve cleared up your doubts.
If you want to see the paper in deferred is available exclusively at NeuronUP
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