Identifying and Addressing Functional Communication Challenges in Patients With Behavioral Variant Frontotemporal Dementia.

IF 2.3 3区医学 Q1 AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY American Journal of Speech-Language Pathology Pub Date : 2024-07-03 Epub Date: 2024-06-06 DOI:10.1044/2024_AJSLP-24-00013

Gabriela Meade, Mary M Machulda, Heather M Clark, Joseph R Duffy, Hugo Botha, Jennifer L Whitwell, Keith A Josephs, Rene L Utianski

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Abstract

Purpose: We describe the communication challenges of four patients with a neurodegenerative disorder consistent with behavioral variant frontotemporal dementia (bvFTD), characterized by early behavioral and personality changes. By describing their clinical profiles, we identify common barriers to functional communication in this population and provide recommendations for how speech-language pathologists (SLPs) might contribute to minimizing them.

Method: Four patients with bvFTD were selected from a cohort of patients with progressive communication impairments. Three of them returned for at least one follow-up visit. Case histories are presented along with the results of comprehensive speech and language, neuropsychological, and neurological testing.

Results: At the time of initial evaluation, patients were between the ages of 54 and 66 years and had been experiencing symptoms for 1.5-6 years. Consistent with their bvFTD diagnoses, all patients had prominent behavioral and personality changes that impacted communication. Patients 1 and 2 also had mild aphasia at enrollment, primarily characterized by anomia and loss of word meaning. Patients 3 and 4 both had apraxia of speech and moderate-to-severe aphasia at enrollment with prominent anomia and agrammatism. All four patients had impaired executive functioning and relative sparing of visuospatial skills; episodic memory was also impaired for Patients 2 and 4. Even though functional communication was progressively limited for all patients, none of them received regular support from an SLP.

Conclusions: This case series adds to a scant, but growing, literature demonstrating that patients with bvFTD have communication impairments. SLPs are uniquely positioned to identify barriers to functional communication and to provide tailored strategy training to the patients and their care partners over the course of their disease. Systematic evaluation of the efficacy of treatment in this population would be valuable.

Supplemental material: https://doi.org/10.23641/asha.25933762.

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识别并解决行为变异性额颞叶痴呆症患者的功能性交流障碍。

目的：我们描述了四名神经退行性疾病患者的交流障碍，这些患者与行为变异性额颞叶痴呆症（bvFTD）一致，具有早期行为和人格改变的特征。通过描述他们的临床特征，我们发现了这一人群中常见的功能性交流障碍，并就语言病理学家（SLP）如何最大限度地减少这些障碍提出了建议：从一组渐进性交流障碍患者中挑选了四名 bvFTD 患者。其中三人至少接受了一次随访。病例病史以及全面的言语和语言、神经心理学和神经学测试结果均在报告中列出：初次评估时，患者年龄在 54 岁至 66 岁之间，出现症状已有 1.5-6 年。与 bvFTD 诊断一致的是，所有患者都有明显的行为和性格改变，影响了交流。1 号和 2 号患者在入院时也有轻度失语，主要表现为失认和词义缺失。3 号和 4 号患者入院时均患有语言障碍和中重度失语症，并伴有明显的失认症和语无伦次。所有四名患者的执行功能均受损，视觉空间技能相对较少；2 号和 4 号患者的外显记忆也受损。尽管所有患者的功能性交流都逐渐受到限制，但他们都没有定期得到语言康复师的支持：本系列病例补充了证明 bvFTD 患者存在交流障碍的少量文献，但这些文献仍在不断增加。SLP在识别功能性交流障碍方面具有独特的优势，可以在患者患病期间为患者及其护理伙伴提供量身定制的策略培训。对这一人群的治疗效果进行系统评估将非常有价值。补充材料：https://doi.org/10.23641/asha.25933762。

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来源期刊

American Journal of Speech-Language Pathology AUDIOLOGY & SPEECH-LANGUAGE PATHOLOGY-REHABILITATION

CiteScore

4.30

自引率

11.50%

发文量

353

审稿时长

>12 weeks

期刊介绍： Mission: AJSLP publishes peer-reviewed research and other scholarly articles on all aspects of clinical practice in speech-language pathology. The journal is an international outlet for clinical research pertaining to screening, detection, diagnosis, management, and outcomes of communication and swallowing disorders across the lifespan as well as the etiologies and characteristics of these disorders. Because of its clinical orientation, the journal disseminates research findings applicable to diverse aspects of clinical practice in speech-language pathology. AJSLP seeks to advance evidence-based practice by disseminating the results of new studies as well as providing a forum for critical reviews and meta-analyses of previously published work. Scope: The broad field of speech-language pathology, including aphasia; apraxia of speech and childhood apraxia of speech; aural rehabilitation; augmentative and alternative communication; cognitive impairment; craniofacial disorders; dysarthria; fluency disorders; language disorders in children; speech sound disorders; swallowing, dysphagia, and feeding disorders; and voice disorders.