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.

Rehabilitating and Decelerating Language Loss in Primary Progressive Aphasia With tDCS Plus Language Therapy

Primary Progressive Aphasia

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.

Active tDCS plus Speech-Language Therapy

Sham tDCS plus Speech-Language Therapy

Rehabilitating and Decelerating Language Loss in Primary Progressive Aphasia With Transcranial Direct Current Stimulation (tDCS) Plus Language Therapy

To determine whether tDCS + language therapy will improve naming performance of
participants with Primary Progressive Aphasia more effectively than language therapy
alone (the sham condition). The primary outcome variable will be trained verbs on the
Object and Action Naming battery (OANBtrained). The OANB has 262 items, scored from 0 to
262, with higher scores on the OANB reflecting better naming abilities. The OANB includes
100 verbs (15 trained, 85 untrained) and 162 nouns.

To determine whether tDCS + language therapy will improve naming performance of
participants with Primary Progressive Aphasia more effectively than language therapy
alone (the sham condition). The OANB has 262 items, scored from 0 to 262, with higher
scores on the OANB reflecting better naming abilities. There are 100 verbs (15 trained,
85 untrained) on the OANB, and 162 nouns.

To determine whether tDCS + language therapy will improve naming performance of
participants with Primary Progressive Aphasia more effectively than language therapy
alone (the sham condition). The OANB has 262 items, scored from 0 to 262, with higher
scores on the OANB reflecting better naming abilities. There are 100 verbs (15 trained,
85 untrained) and 162 nouns on the OANB.

The ASHA FACS will be administered pre-treatment and post-treatment to evaluate changes
in functional communication skills. The ASHA FACS is used for measuring the functional
communication of adults with speech, language, and cognitive communication disorders. The
Communicative Independence Scale will be used, which is rated on a 7-point scale ranging
from 1 "does not perform the behavior" to 7 "does perform the behavior". The scores on
the Communicative Independence Scale range from a low score of 1 to a high score of 7. A
higher score on this subscale indicates better ability to communicate independently.

The ASHA FACS will be administered pre- treatment and post treatment to evaluate changes
in functional communication skills. The ASHA FACS is used for measuring the functional
communication of adults with speech, language, and cognitive communication disorders. The
Communicative Independence Scale will be used, which is rated on a 7-point scale ranging
from 1 "does not perform the behavior" to 7 "does perform the behavior". The scores on
the Communicative Independence Scale range from a low score of 1 to a high score of 7. A
higher score on this subscale indicates better ability to communicate independently.

Active tDCS will be applied at the beginning of 45min speech-language therapy session and
will last for 20 min. Language therapy will be verb naming therapy in a sentence context.
This will be followed by sham tDCS plus speech-language therapy after a 2 month washout
period.

Sham tDCS will be applied at the beginning of 45min speech-language therapy session.
Language therapy will be oral and written naming. Language therapy will be verb naming
therapy in a sentence context. This will be followed by active tDCS plus speech-language
therapy after a 2 month washout period.

Rehabilitating and Decelerating Language Loss in Primary Progressive Aphasia With tDCS Plus Language Therapy

About this trial

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