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Why are patients with progressive nonfluent aphasia nonfluent?
Gunawardena D, Ash S, McMillan C, Avants B, Gee J, Grossman M.. Neurology, 2010-08-01
Topic: Risk, prevention and care in population studies
Objective To investigate the cognitive and neural basis for nonfluent speech in progressive nonfluent aphasia (PNFA). Background Nonfluent speech is the hallmark feature of PNFA, and this has been attributed to impairments in syntactic processing, motor-speech planning, and executive functioning that also occur in these patients. Patients with PNFA have left inferior frontal atrophy. Methods A large semi-structured speech sample and neuropsychological measures of language and executive functioning were examined in 16 patients with PNFA, 12 patients with behavioral-variant frontotemporal dementia (bvFTD), and 13 age-matched controls. Speech fluency was quantified as words per minute (WPM) in the semi-structured speech sample. Stepwise linear regression analyses were used to relate WPM to grammatic, motor-speech planning, and executive aspects of patient functioning. These measures were then related to cortical thickness in 8 patients with PNFA and 7 patients with bvFTD using structural MRI. Results WPM was significantly reduced in patients with PNFA relative to controls and patients with bvFTD. Regression analyses revealed that only grammatic measures predicted WPM in PNFA, whereas executive measures were the only significant predictor of WPM in bvFTD. Cortical thinning was significant in PNFA relative to controls in left inferior frontal and anterior-superior temporal regions, and a regression analysis related this area to reduced WPM in PNFA. Significant cortical thinning associated with limited grammatic processing also was seen in the left inferior frontal-superior temporal region in PNFA, and this overlapped with the area of frontal-temporal thinning related to reduced WPM. Conclusion Nonfluent speech in PNFA may be due in part to difficulty with grammatic processing associated with left inferior frontal and anterior-superior temporal disease.
Key findings
- Results WPM was significantly reduced in patients with PNFA relative to controls and patients with bvFTD.
- Regression analyses revealed that only grammatic measures predicted WPM in PNFA, whereas executive measures were the only significant predictor of WPM in bvFTD.
- Cortical thinning was significant in PNFA relative to controls in left inferior frontal and anterior-superior temporal regions, and a regression analysis related this area to reduced WPM in PNFA.
- Significant cortical thinning associated with limited grammatic processing also was seen in the left inferior frontal-superior temporal region in PNFA, and this overlapped with the area of frontal-temporal thinning related to reduced WPM.
- Conclusion Nonfluent speech in PNFA may be due in part to difficulty with grammatic processing associated with left inferior frontal and anterior-superior temporal disease.
Why it matters
This study found that reduced speech fluency in progressive nonfluent aphasia was predicted by grammatic measures, while in behavioral-variant frontotemporal dementia it was predicted by executive measures. It is about the basis of nonfluent speech and does not test any treatment, cure or prevention.
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Study details
- Participants16
- Evidence strengthLow
How this study scored 49/100
Published in a leading specialty journal. Scored zero for study design, effect reported and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (Neurology) |
| Journal's citation record | 4 / 4 | Neurology: journal h-index 525 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2010 — within 20 year(s) of the newest study here |
| Sample size | 1 / 4 | 16 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 4 / 7 | Cited 96 times (OpenAlex, 2026-10-10) |
| Citations per year | 2 / 5 | 5.3 citations a year over 18 year(s) since 2010 |
| Impact for its field and year | 3 / 6 | Cited 4.6× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 2 / 6 | Cited by 7 other studies in this library |
| Still being cited | 1 / 4 | Cited 7 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 4 / 4 | Last-listed author Murray Grossman: h-index 119 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University of Pennsylvania: institution h-index 1,859 (OpenAlex) |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 1 institution(s) in 1 country — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 20713947) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 49 / 100 | — |
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
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APA 7th
Gunawardena, D., Ash, S., McMillan, C., Avants, B., Gee, J., & Grossman, M. (2010). Why are patients with progressive nonfluent aphasia nonfluent? Neurology. https://doi.org/10.1212/wnl.0b013e3181ed9c7d
Vancouver
Gunawardena D, Ash S, McMillan C, Avants B, Gee J, Grossman M. Why are patients with progressive nonfluent aphasia nonfluent? Neurology. 2010. doi:10.1212/wnl.0b013e3181ed9c7d. PMID: 20713947.
BibTeX
@article{gunawardena2010-20713947,
author = {Gunawardena, D. and Ash, S. and McMillan, C. and Avants, B. and Gee, J. and Grossman, M.},
title = {{Why are patients with progressive nonfluent aphasia nonfluent?}},
journal = {Neurology},
year = {2010},
doi = {10.1212/wnl.0b013e3181ed9c7d},
pmid = {20713947},
url = {https://doi.org/10.1212/wnl.0b013e3181ed9c7d}
}
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