Rehabilitating and Decelerating Language Loss in Primary Progressive Aphasia With tDCS Plus Language Therapy
| Status: | Recruiting |
|---|---|
| Conditions: | Neurology, Neurology |
| Therapuetic Areas: | Neurology |
| Healthy: | No |
| Age Range: | 18 - 100 |
| Updated: | 1/17/2019 |
| Start Date: | October 10, 2018 |
| End Date: | September 2023 |
| Contact: | Shannon M Sheppard, PhD |
| Email: | sheppard@jhmi.edu |
| Phone: | 410-502-6045 |
Rehabilitating and Decelerating Language Loss in Primary Progressive Aphasia With Transcranial Direct Current Stimulation (tDCS) Plus Language Therapy
People with Primary Progressive Aphasia (PPA) are is a debilitating disorder characterized by
the gradual loss of language functioning, even though cognitive functioning is relatively
well preserved until the advanced stages of the disease. There are very few evidence-based
treatment options available. This study investigates the behavioral and neural effects of
multiple consecutive tDCS sessions paired with language therapy targeting verbs in sentences
with individuals with PPA.
the gradual loss of language functioning, even though cognitive functioning is relatively
well preserved until the advanced stages of the disease. There are very few evidence-based
treatment options available. This study investigates the behavioral and neural effects of
multiple consecutive tDCS sessions paired with language therapy targeting verbs in sentences
with individuals with PPA.
Primary Progressive Aphasia (PPA) is a debilitating disorder characterized by the gradual
loss of language functioning, even though cognitive functioning is relatively well preserved
until the advanced stages of the disease. There are three main PPA variants classified based
on the pattern of language impairments and areas of atrophy, but anomia is present across all
variants in the earliest stages. While there is a significant amount of research
investigating multiple treatment approaches for individuals with aphasia resulting from
stroke, individuals with PPA have far fewer treatment options to choose from. Recently, a
growing body of literature of treatment in stroke-based aphasia have found promising results
for pairing traditional language therapy with non-invasive neurostimulation via transcranial
direct current stimulation (tDCS). The small amount of studies of the effects of tDCS applied
to left inferior frontal gyrus (IFG) in PPA also yield promising results that show tDCS can
enhance generalization to untreated structures. Research in stroke-based aphasia has also
shown that language outcomes significantly improve when participants are treated with more
complex language stimuli, because this treatment approach results in enhanced generalization.
For example, therapy that has participants build sentences around verbs has been found to
improve word-level verb and noun naming. The current proposal aims to investigate whether
combining the benefits of tDCS while providing verb retrieval therapy that uses sentence
building to improve word-level retrieval deficits, will enhance word retrieval deficits in
PPA and slow the loss of language functioning. It is hypothesized that Furthermore, the
proposed study will investigate the atrophy patterns at baseline, to determine which atrophy
patterns are predictive of improved word retrieval. Specifically, this proposal aims: 1) to
determine whether tDCS to left IFG coupled with therapy promoting verb retrieval within
sentences improve noun and verb retrieval in treated and untreated items in individuals with
PPA, and 2) To investigate which patterns of atrophy are predictive of maintenance and
generalization of word-retrieval in individuals with PPA following tDCS+therapy vs.
sham+therapy. This proposed research will allow the investigators to evaluate the potential
benefits and sustainability of tDCS in PPA, the generalization of trained items to untrained
items, as well as the deceleration of language loss.
loss of language functioning, even though cognitive functioning is relatively well preserved
until the advanced stages of the disease. There are three main PPA variants classified based
on the pattern of language impairments and areas of atrophy, but anomia is present across all
variants in the earliest stages. While there is a significant amount of research
investigating multiple treatment approaches for individuals with aphasia resulting from
stroke, individuals with PPA have far fewer treatment options to choose from. Recently, a
growing body of literature of treatment in stroke-based aphasia have found promising results
for pairing traditional language therapy with non-invasive neurostimulation via transcranial
direct current stimulation (tDCS). The small amount of studies of the effects of tDCS applied
to left inferior frontal gyrus (IFG) in PPA also yield promising results that show tDCS can
enhance generalization to untreated structures. Research in stroke-based aphasia has also
shown that language outcomes significantly improve when participants are treated with more
complex language stimuli, because this treatment approach results in enhanced generalization.
For example, therapy that has participants build sentences around verbs has been found to
improve word-level verb and noun naming. The current proposal aims to investigate whether
combining the benefits of tDCS while providing verb retrieval therapy that uses sentence
building to improve word-level retrieval deficits, will enhance word retrieval deficits in
PPA and slow the loss of language functioning. It is hypothesized that Furthermore, the
proposed study will investigate the atrophy patterns at baseline, to determine which atrophy
patterns are predictive of improved word retrieval. Specifically, this proposal aims: 1) to
determine whether tDCS to left IFG coupled with therapy promoting verb retrieval within
sentences improve noun and verb retrieval in treated and untreated items in individuals with
PPA, and 2) To investigate which patterns of atrophy are predictive of maintenance and
generalization of word-retrieval in individuals with PPA following tDCS+therapy vs.
sham+therapy. This proposed research will allow the investigators to evaluate the potential
benefits and sustainability of tDCS in PPA, the generalization of trained items to untrained
items, as well as the deceleration of language loss.
Inclusion Criteria:
- Diagnosis of PPA, based on the PPA criteria and presence of naming deficits
- Capable of giving informed consent or indicating another to provide informed consent
- 18 years of age to 100 years of age..
Exclusion Criteria:
- Did not speak English before the age of five
- Less than 10 years of education
- Severe naming deficits
- Significant history of drug or alcohol abuse
- History of psychiatric or neurological problems affecting the brain (besides PPA)
- Has experienced seizures during the previous 12 months
- History of brain surgery or any metal in the head
- Uncorrected visual loss or hearing loss by self-report
- Use of medications that lower the seizure threshold (e.g., methylphenidate) or use of
N-Methyl-D-aspartate (NMDA) receptor antagonists (e.g., memantine)
- Scalp sensitivity (per participant report)
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