Six individuals with probable Alzheimer’s disease (AD) participated in a phase 1 study employing a repeated measures, parallel baseline design testing the hypothesis that error-free experience during word production practice combined with an acetyl cholinesterase inhibitor would improve confrontation naming ability. While acetyl cholinesterase inhibitors are safe and delay cognition decline associated with AD, improvement over baseline cognition is less evident; clinically significant cognitive deficits persist and progress. Both animal and clinical research strongly implicate acetylcholine in learning, a form of neuroplasticity. In clinical practice, however, people with AD are given cholinergic medications without concomitant systematic/targeted retraining. In this study six participants with probable AD and taking donepezil participated in targeted word production practice using an errorless learning strategy. Results showed that combining behavioral enrichment training and an acetyl cholinesterase inhibitor resulted in significant improvements in verbal confrontation naming of trained items for three of six participants. Differences in baseline dementia severity, living conditions, and medications may have influenced the training response. Detection of substantial treatment effects in 50% of subjects suggests further language treatment studies in AD in combination with an acetyl cholinesterase inhibitor are warranted and provide useful information on inclusion/exclusion criteria for use in subsequent studies. (JINS, 2009, 15, 311–322.)

Intense language training has been found to be more efficient in the rehabilitation of chronic aphasia than treatment spread across time. Intense treatment, however, challenges personnel and financial resources of the health care system. The present study examined, whether laypersons can be trained to apply standardized language training for chronic aphasia with effects comparable to training by experts. Twenty individuals with chronic aphasia participated in the training, Constraint-Induced Aphasia Therapy (CIAT), which comprises communicative language games with increasing level of difficulty in a motivating context for 3 hr/day on 10 consecutive days. Following a random-control design, training was applied either by experienced therapists (n = 10) or trained laypersons (n = 10). Standardized language assessments revealed significant within-group improvements, however, between-group differences were not present. We conclude that a standardized training program, such as CIAT, can be efficiently accomplished by trained laypersons with results comparable to that of experienced therapists. (JINS, 2007, 13, 846–853.)

Twenty-three chronic nonfluent aphasia patients with moderate or severe word-finding impairments and 11 with profound word-finding impairments received two novel picture-naming treatments. The intention treatment initiated picture-naming trials with a complex left-hand movement and was designed to enhance right frontal participation during word retrieval. The attention treatment required patients to view visual stimuli for picture-naming trials in their left hemispace and was designed to enhance right posterior perisylvian participation during word retrieval. Because the intention treatment addressed action mechanisms and nonfluent aphasia reflects difficulty initiating or maintaining action (i.e., language output), it was hypothesized that intention component of the treatment would enhance re-acquisition of picture naming more than the attention component. Patients with moderate and severe word-finding impairment showed gains with both treatments but greater incremental improvement from one treatment phase to the next with the intention than the attention treatment. Thus, the hypothesis that intention component would be a more active constituent than the attention component was confirmed for these patients. Patients with profound word-finding impairment showed some improvement with both treatments but no differential effects for the intention treatment. Almost all patients who showed treatment gains on either treatment also demonstrated generalization from trained to untrained items. (JINS, 2007, 13, 582–594.)

The complex process of cortical reorganization of language-related brain regions during recovery from aphasia and the effects of therapeutic interventions on brain systems are poorly understood. We studied two patients with chronic aphasia and compared their functional neuroanatomical responses to a younger control group on two tasks, an oral-reading task involving overt speech and a “passive” audiovisual story-comprehension task. Following identical therapy, we re-examined behavioral (language) and functional neuroanatomical changes using the same functional magnetic resonance imaging (fMRI) tasks. We hypothesized that better recovery would be associated with brain activation patterns more closely resembling healthy controls, whereas positive responses to language treatment would be associated with increased activity in undamaged left perisylvian areas and/or right-hemisphere areas homologous to the damaged regions. For the participant with a frontal lesion who was most responsive to therapy, brain activation increased in the right hemisphere during oral-reading, but decreased bilaterally in most regions on story-comprehension. The other participant with a temporal–parietal lesion showed decreased activation, particularly in the right hemisphere, during oral-reading but increased activation bilaterally on story-comprehension. Results highlight individual variability following language therapy, with brain activation changes depending on lesion site and size, language skill, type of intervention, and the nature of the fMRI task. (JINS, 2006, 12, 828–842.)

Naming of two semantically impaired aphasic patients was treated with the contextual repetition priming technique, which involves repeated repetition of names of pictures that are related semantically, phonologically, or are unrelated. Our previous studies using this technique have suggested that patients with impaired access to lexical-semantic representations benefit in the short-term from this treatment technique, but show no long-term improvement in naming. In contrast, patients with good access to semantics show short- and long-term benefits from this treatment. Here we report two studies of treatment for two individuals with aphasia affecting access to lexical semantics and anomia but spared access to input and output phonology and spared conceptual semantics. We predicted that they would show short-term facilitation from the contextual priming, but no long-term improvements in naming. The results confirmed the prediction. An account of this pattern is offered within the framework of an interactive activation model of word retrieval. Additionally, we discuss alternative techniques for addressing naming deficits when access to semantics is impaired. (JINS, 2006, 12, 853–866.)