Supporting communication in bvFTD patients (Meade et al., 2024)

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 S1. Supplemental tasks from the Western Aphasia Battery–Revised.Meade, G., Machulda, M. M., Clark, H. M., Duffy, J. R., Botha, H., Whitwell, J. L., Josephs, K. A., & Utianski, R. L. (2024). Identifying and addressing functional communication challenges in patients with behavioral variant frontotemporal dementia. American Journal of Speech-Language Pathology, 33(4), 1573–1589. https://doi.org/10.1044/2024_AJSLP-24-00013

目的：本研究旨在阐述四位符合行为变异性额颞叶痴呆（bvFTD）的神经退行性疾病患者的沟通障碍。该疾病以早期行为和人格改变为特征。通过对患者临床特征的描述，本研究识别了该人群中功能沟通的常见障碍，并提出了语言病理学家（SLPs）如何通过提供针对性的策略训练，以减轻这些障碍的建议。方法：从一组患有进行性沟通障碍的患者中选取了四位bvFTD患者。其中三位患者在至少一次随访时返回。本研究呈现了病例史以及全面的言语语言、神经心理学和神经学测试结果。结果：在初次评估时，患者年龄在54至66岁之间，病程为1.5至6年。与bvFTD的诊断一致，所有患者均表现出显著的行为和人格改变，影响了沟通。患者1和2在入组时也伴有轻微的失语症，主要表现为遗忘词义。患者3和4在入组时均患有构音障碍和中等至严重的失语症，伴有显著的遗忘词义和语法错误。四位患者均存在执行功能受损，而视觉空间技能相对保留；患者2和4的情景记忆也受损。尽管所有患者的功能性沟通能力逐渐受限，但无人接受过SLP的常规支持。结论：本病例系列研究进一步丰富了关于bvFTD患者存在沟通障碍的有限但日益增长的文献。SLPs处于独特的位置，能够识别功能性沟通的障碍，并在疾病进展过程中为患者及其护理伙伴提供定制化的策略训练。对该人群中治疗方案有效性的系统性评估将极具价值。补充材料S1：来自西方失语症电池修订版的补充任务。Meade, G.，Machulda, M. M.，Clark, H. M.，Duffy, J. R.，Botha, H.，Whitwell, J. L.，Josephs, K. A.，& Utianski, R. L. (2024). 识别并解决行为变异性额颞叶痴呆患者功能性沟通的挑战。美国言语语言病理学杂志，33(4)，1573–1589. https://doi.org/10.1044/2024_AJSLP-24-00013