A unique approach to language treatment in progressive aphasia

We are currently conducting a treatment study targeting the maintenance of language in two progressive neurological disorders, Alzheimer's Disease (AD) and Frontotemporal Degeneration (FTD).  As these conditions worsen, people experience profound language impairments. These disorders have devastating consequences on a patient's functional independence and on caregiver well-being.

In 2007 we began to explore a treatment for Primary Progressive Aphasia (PPA) at the University of Florida. We visited patients in their homes and crafted a communication picture board specific to each person. We then trained those words over time as language and cognition worsened.  We learned a great deal from the early stages of this work.  Simple repeated picture naming was not enough. We modified the original approach and were recently awarded a 5-year grant from the National Institutes of Health to investigate a novel approach to preventing language loss in dementia and progressive aphasia. 

Figure 1. Venn Diagram representing distinct treatment philosophies in brain injury rehabilitation

Figure 1. Venn Diagram representing distinct treatment philosophies in brain injury rehabilitation

Cognitive-language treatment approaches for dementia

Most language treatments work with the implicit goal of restoring lost function. This philosophy is often justified when someone suffers a stroke. However, the nature of a neurodegenerative condition makes restoration difficult.  Learning effects are often rigid and short-lived in the context of a memory disorder. An alternative aim is to pursue compensatory techniques such as structuring a patient's environment to optimize their cognitive and linguistic functioning. Memory books and video "banks" fall under this intervention approach. 

We have proposed a technique centered upon maintenance of a set of critical words over a two year span. Our treatment works by cementing a set of 100 words during early stage dementia (within 1-2 years of onset) and continually training that same set of words over a span of two years. Thus, we work directly with the patient and caregiver to tailor a small, specialized vocabulary (a micro-lexicon). We then train those words using a technique we term, modified semantic feature analysis (mSFA).

How does the treatment work?