Automated detection of speech timing alterations in autopsy-confirmed nonfluent/agrammatic variant primary progressive aphasia
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Abstract
Background and Objectives Motor speech function, including speech timing, is a key domain for diagnosing nonfluent/agrammatic variant primary progressive aphasia (nfvPPA). Yet, standard assessments use subjective, specialist-dependent evaluations, undermining reliability and scalability. Moreover, few studies have examined relevant anatomo-clinical alterations in patients with pathologically confirmed diagnoses. This study overcomes such caveats using automated speech timing analyses in a unique cohort of autopsy-proven cases. Methods In a cross-sectional study, we administered an overt reading task and quantified articulation rate, mean syllable and pause duration, and syllable and pause duration variability. Neuroanatomical disruptions were assessed using cortical thickness and white matter (WM) atrophy analysis. Results We evaluated 22 persons with nfvPPA (mean age: 67.3 years; 13 female patients) and confirmed underlying 4-repeat tauopathy, 15 persons with semantic variant primary progressive aphasia (svPPA; mean age: 66.5 years; 8 female patients), and 10 healthy controls (HCs; 70 years; 5 female patients). All 5 speech timing measures revealed alterations in persons with nfvPPA relative to both the HC and svPPA groups, controlling for dementia severity. The articulation rate robustly discriminated individuals with nfvPPA from HCs (area under the ROC curve [AUC] = 0.95), outperforming specialist-dependent perceptual measures of dysarthria and apraxia of speech severity. Patients with nfvPPA exhibited structural abnormalities in left precentral and middle frontal as well as bilateral superior frontal regions, including their underlying WM. The articulation rate correlated with atrophy of the left pars opercularis and supplementary/presupplementary motor areas. Secondary analyses showed that, controlling for dementia severity, all measures yielded greater deficits in patients with nfvPPA and corticobasal degeneration (nfvPPA-CBD, n = 12) than in those with progressive supranuclear palsy pathology (nfvPPA-PSP, n = 10). The articulation rate robustly discriminated between individuals in each subgroup (AUC = 0.82). More widespread cortical thinning was observed for the nfvPPA-CBD than the nfvPPA-PSP group across frontal regions. Discussion Automated speech timing analyses can capture specific markers of nfvPPA while potentially discriminating between patients with different tauopathies. Thanks to its objectivity and scalability; this approach could support standard speech assessments. Classification of Evidence This study provides Class III evidence that automated speech analysis can accurately differentiate patients with nonfluent PPA from normal controls and patients with semantic variant PPA.
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The moderate sample size allows for detecting moderate-to-large effects but limits small-effect detection.
“Because sbvFTD and bvFTD are rare diseases, our moderate sample sizes, while comparable with other studies,9,33,49 allow for detecting moderate-to-large effects but limit small-effect detection.”
From Automated Speech Analysis to Differentiate Frontal and Right Anterior Temporal Lobe Atrophy in Frontotemporal Dementia (2025) · cites this paper as [33]
Substantial work has developed AI models to aid neurological diagnoses from multi-sequence brain MRI or PET, and more recent efforts involve multimodal AI models incorporating clinical, laboratory, and imaging data to differentiate dementia etiologies.
“Substantial work has been done to develop AI models that can aid in neurological diagnoses based on multi-sequence brain MRI or PET, and more recent efforts involve the development of multimodal AI models that incorporate clinical, laboratory, and imaging data for differentiating etiologies of dementia.77–79”
From Review of Artificial Intelligence for Clinical Use in Alzheimer's Disease and Related Dementias (2026) · cites this paper as [77]
Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredAcross primary progressive aphasia variants, ASLA markers capture syndrome-specific patterns that predict underlying neuropathology years before death and correlate with variant-specific atrophy, even longitudinally.
“Across primary progressive aphasia variants, ASLA markers capture syndromespecific patterns 49-53 that predict underlying neuropathology years before death 7 and correlate with variant-specific atrophy, 53-56 even longitudinally. 57”
From Speech and language markers of neurodegeneration: a call for global equity (2023) · cites this paper as [7]
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- A.P. Vogel is Chief Science Officer of Redenlab Inc. The remaining authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures. Publication History Previously published on medRxiv, https://doi.org/10.1101/ 2022.02.21.22271228. Received by Neurology October 24, 2021. Ac- cepted in final form April 4, 2022. Submitted and externally peer reviewed. The handling editor was Linda Hershey, MD, PhD, FAAN. Cognitive Neurology and Aphasia Unit, Centro de Investigaciones Médico- Sanitarias, University of Malaga, Malaga, Spain; Instituto de Investigación Biomédica de Málaga - IBIMA, Malaga, Spain; Area of Psychobiology, Faculty of Psychology and Speech Therapy, University of Malaga, Malaga, Spain Drafting/revision of the manuscript for content, including medical writing for content; Analysis or interpretation of data · DOI
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- Authors
- García, A. M., Welch, A. E., Mandelli, M. L., Henry, M. L., Lukic, S., Torres Prioris, M. J., Deleon, J., Ratnasiri, B. M., Lorca-Puls, D. L., Miller, B. L., Seeley, W., Vogel, A. P., & Gorno-Tempini, M. L.
- Affiliations
- Universidad de Santiago de Chile (CL)
- From the Global Brain Health Institute (A.M.G.), University of California, San Francisco; Cognitive Neuroscience Center (A.M.G.), Universidad de San Andrés, Buenos Aires; National Scientific and Technical Research Council (CONICET) (A.M.G.), Buenos Aires, Argentina; Departamento de Lingüística y Literatura, Facultad de Humanidades (A.M.G.), Universidad de Santiago de Chile; Memory and Aging Center (A.E.W., M.L.M., S.L., J.D., B.M.R., D.L.L.P., B.L.M., W.S., M.L.G.-T.), Department of Neurology,...
- ORCID
- Venue
- Neurology
- Published
- 2022-08-02
- Volume
- 99
- Issue
- 5
- Pages
- e500-e511
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- PMC
- PMC9421598
- OpenAlex
- W4281834255
- Cited by
- 47
- References
- 50
- Citations by year
- 2026: 15 · 2025: 8 · 2024: 9 · 2023: 12 · 2022: 3
- FWCI
- 5.21
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Neurology (publishedVersion)
- medRxiv (acceptedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- RISalud Institutional Health Repository of Andalucía (submittedVersion, other-oa)
- Repositorio Institucional de la Universidad de Málaga (University of Málaga) (submittedVersion, cc-by-nc-nd)
- Funders
- Alzheimer's Association (UK-22-865742, GBHI ALZ UK-22-865742, ALZ UK-22-865742)
- Larry L. Hillblom Foundation (R01 NS050915)
- Universidad de Santiago de Chile
- Global Brain Health Institute (UK-22-865742)
- Alzheimer's Society
- Agenția Națională pentru Cercetare și Dezvoltare
- Consejo Nacional de Investigaciones Científicas y Técnicas (1210176)
- Agencia Nacional de Investigación y Desarrollo (ANID BECAS‐CHILE 74200073, 74200073, 1210176)
- National Institutes of Health (NIDCD R01DC016291, NS050915, NINDS R01 NS050915)
- Atlantic Fellows Program
- National Institute on Aging (1210176, AG052943, NIA U01 AG052943, U01AG052943, P01AG019724)
- National Institute on Deafness and Other Communication Disorders (K23DC018021, NIDCD R01DC016291, NIA U01 AG052943, R01DC016291, K24DC015544)
- National Institute of Neurological Disorders and Stroke (RF1NS050915, NIA U01 AG052943, R01NS050915)
- CHIST-ERA
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neurobiology of Language and Bilingualism
- Health Sciences › Medicine › Physiology › Voice and Speech Disorders
- Keywords
- speech timing, articulation rate, pause duration, semantic dementia, corticobasal degeneration, progressive supranuclear palsy, white matter atrophy, cortical thinning, supplementary motor area, pars opercularis, frontal lobe atrophy
- MeSH terms
- Aged, Atrophy, Autopsy, Cross-Sectional Studies, Female, Humans, Speech, Reproducibility of Results, Aphasia, Primary Progressive, Primary Progressive Nonfluent Aphasia
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