Tosto et al. (2011)

NATURE OF PROSODIC DISORDERS

ANALYSIS FORM

 

Key:

 

AD = Altzheimer’s disease

NA = not applicable

NT = neurotypical

P = participant

pmh = Patricia Hargrove, blog developer

WNL = within normal limits

 

 

SOURCE: Tosto, G., Gasparini, M., G.L. Lenzi, G. L., & Bruno, G. (2011). Prosodic impairment in Altzheimer’s disease: Assessment and clinical relevance. Journal of Neuropsychiatry and Clinical Neuroscience, 23 (2), E21-E23.

Journal Address: http://neuro.psychiatryonline.org

REVIEWER(S): pmh

 

DATE: June 13, 2015

ASSIGNED GRADE FOR OVERALL QUALITY: D (Based on the case study design, the highest possible grade was D+.)

 

POPULATION: Altzheimer’s disease (AD); Adult

 

PURPOSE: To describe comprehension and production of emotional prosody in an Italian male with mild, early onset AD.

 

INSIGHTS ABOUT PROSODY:

  • This case study diverges from the clinical literature on prosody in dementia in which the expectation is that

– problems with the comprehension of emotional prosody appear in the early stages of AD and then remain stable throughout the mild and moderate stages and

– problems with the production and imitation of emotional prosody are minimal during the early stages of AD but during the moderate stage of AD, significant problems with the production and imitation of emotional prosody begin to emerge.

  • In this case study of an adult Italian speaking male diagnosed being in the early stages of early onset AD, the participant (P) displayed significant impairment in the production and comprehension of emotional prosody.
  • The investigators recommend that clinicians (C) should carefully monitor the emotional prosody skills of Ps with AD and consider emotional prosody skills when working with AD individuals and their families.

 

 

  1. What type of evidence was identified? Case Study
  1. Group membership determination:
  • If there were groups of participants were members of groups matched? Not Applicable (NA), there was only one P.
  1. Was participant’s communication status concealed?
  • from participant? No
  • from assessment administrators? No
  • from data analyzers? No

                                                                    

 

  1. Was the participant adequately described? Yes. I would have liked more information but to be fair to the investigators I rated this question as “yes” because this was a letter to the Editor and was only 3 pages long.

 

How many participants were involved in the study? 1

The following variables were described:

  • age: 55 years
  • gender: male
  • cognitive skills: 29/30 on the Mini-Mental State Exam; within normal limits (WNL)
  • neurological exam: WNL
  • diagnosis: early onset AD
  • MRI results: cortical/subcortical atrophy of fronto-parietal areas
  • PET scan results: hypometabolism in the right frontal-temporal-parietal areas, left posterior parietal areas, and basal ganglia
  • results of neuropsychological testing:

– widespread, mild cognitive impairment,

     – more impaired on tasks sensitive for both right-hemisphere and executive function

  • educational level of P: may be 14 years

 

– Were the communication problems adequately described? No

  • disorder type: AD

 

 

  1. What were the different conditions for this research?

                                                                                                             

– Subject (Classification) Groups? No. There was only 1 P. ____

If yes, list:

Experimental Conditions? No

 

– Criterion/Descriptive Conditions? Yes

  • Experimental Protocol –Melodic Alternation [previously administered to a group of neurotypical (NT) adults: 10 Ps; same gender; mean age = 54.5; mean education: 14 years]

– Task 1: Auditory Verbal Task: P listened and identified the same neutral sentence produced with sad, happy, angry, surprised, and neutral prosody

– Task 2: Visual Task: P viewed facial expressions depicting sad, happy, angry, surprised, and neutral emotions and identified each

– Task 3: Repetition Task: using the sentences from Task 1, P imitated the same sentence using the emotional prosody modeled in the sentence. Independent judges listened to the models and the imitation to judge accuracy.

– Task 4: Production Task: The investigators presented P with a sentence and directed him/her to produce the sentence with sad, happy, angry, surprised, and neutral intonations.

 

  1. Were the groups controlled acceptably? NA

 

 

  1. Were dependent measures appropriate and meaningful? Yes

 

–   The dependent measures were

  • Dependent Measure #1: Performance on Task 1: Auditory Verbal Task
  • Dependent Measure #2: Performance on Task 1: Visual Task
  • Dependent Measure #3: Performance on Task 1: Repetition Task
  • Dependent Measure #4: Performance on Task 1: Production Task

 

All the dependent measures were subjective.

 

None of the dependent/ outcome measures were objective.

                                         

 

  1. Were reliability measures provided?

                                                                                                            

– Interobserver for analyzers? Yes

  • Dependent Measure #3: Performance on Task 1: Repetition Task—K index = 0.86
  • Dependent Measure #4: Performance on Task 1: Production Task—-K index = 0.93

 

Intraobserver for analyzers? No

 

– Treatment/Procedural fidelity for investigators? No

 

  1. Description of design:
  • In this case study, a 55-year-old Italian male, who had been diagnosed as being in the early stages of early-onset AD, was administered 4 tasks to assess his emotional prosody skills.
  • The 4 tasks were

– Task 1: Auditory Verbal Task: P listened to and identified the same neutral sentence produced with sad, happy, angry, surprised, and neutral prosody

– Task 2: Visual Task: P viewed facial expressions depicting sad, happy, angry, surprised, and neutral emotions and identified each

– Task 3: Repetition Task: using the sentences from Task 1, P imitated the same sentence using the emotional prosody modeled in the sentence. Independent judges listened to the models and the imitation to judge accuracy.

– Task 4: Production Task: The investigators presented P with a sentence and directed him to produce the sentence with sad, happy, angry, surprised, and neutral intonations. Independent judges listened to the production to judge accuracy.

  • The 4 tasks, Melodic Alternation, had previously been administered to a group of neurotypical (NT) adults: 10 Ps; same gender; mean age = 54.5; mean education: 14 years. This provided comparison data.

 

 

  1. What were the results of the inferential statistical testing? NA

 

  1. What were the results of the correlational statistical testing? Correlational statistics were presented only of the reliability data for measures #3 and #4. (See item #8.)

 

  1. What were the results of the descriptive analysis?
  • Dependent Measure #1: Performance on Task 1: Auditory Verbal Task—P correctly identified 31 of 60 trials (NT control group identified 58/60.) The emotional states that exhibited most errors were neutral, happy, and sad. The P also frequently confused these 3 states.

 

  • Dependent Measure #2: Performance on Task 1: Visual Task—P correctly identified 73% of the trials (NT control group identified correctly 92%. The emotional states that exhibited most problems were neutral and sad.

 

  • Dependent Measure #3: Performance on Task 1: Repetition Task—Overall, P incorrectly imitated prosody 33% of the time. The poorest imitation rate was for happiness (83% errors); the best imitation rates were for surprise (no errors) and neutral.

 

  • Dependent Measure #4: Performance on Task 1: Production Task—All the production trails were associated with some failure. Happy (100% error rate) and angry (83% error rate) were the most challenging emotions to produce acceptably.

 

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