Petronilla Battista

Introduction: Globally, there is a lack of awareness of rare dementias such as those led by language decline (the primary progressive aphasias, PPA). The main treatment for PPA is speech and language therapy, yet many people are unaware of the benefits and are often not referred on by other health care professionals. Delays in diagnosis can exacerbate a delay in accessing resources such as speech and language therapy which can assist in maintenance of communication and independence. Some people affected by PPA are able to seek out information independently and navigate their own way to these services, but others experience substantial challenges in accessing support. This study was born out of discussions with people affected by PPA who identified an urgent need to raise awareness of PPA and the benefits of speech and language therapy. The aim of the project was to co‐develop a PPA awareness campaign and, through feedback, understand the impact of a co‐produced and delivered awareness campaign on awareness and knowledge of PPA and the role of the speech and language therapy. Methods: This study was informed by the People with Aphasia and Other Layperson Involvement (PAOLI) framework for guiding patient and public involvement (PPI) in aphasia research. Key components of the PPA awareness campaign were co‐developed at a World Café event with 30 people affected by PPA. Consequently, engagement data were collected from social media posts during the 10‐week campaign, and registration and attendance at the co‐planned webinars. A feedback survey was collected from attendees after the event, and a micro‐costing analysis conducted to understand the costs. Results: The 10‐week PPA awareness campaign focused on raising awareness of the role of speech and language therapy for PPA and a bespoke logo was developed that was shared across seven participating countries internationally. Attendees reported increased knowledge of the role of speech and language therapists and valued hearing the voices of people affected by PPA throughout the campaign. Webinar events were well attended across the participating countries with an average of 300 attendees, ranging from 233 in Greece to 369 in the UK. The cost of developing the awareness campaign was calculated at £26.20 per webinar attendee in the UK. Discussion: The PPA awareness campaign was conceived by people affected by PPA and aimed to increase awareness that speech and language therapy can support people affected by the condition. The awareness campaign developed iteratively and concluded with an awareness day event spanning seven‐countries internationally which are all now permanently accessible as resources on the International Speech and Language Therapist / Pathologist PPA network (International SLT/P PPA network) website. Future campaigns will take a more focused approach by targeting more specific audiences such as trainee doctors. The co‐development blueprint for the PPA awareness campaigns provides actionable, field‐tested recommendations for planning future health awareness initiatives. WHAT THIS PAPER ADDS: What is already known on the subject Primary Progressive Aphasia (PPA) is a rare language led dementia for which speech and language therapy is the main treatment. At present, people affected by PPA report a lack of information available about speech and language therapy. This can perpetuate feelings of loneliness and social isolation. What this paper adds to the existing knowledge This paper provides the key components of a co‐developed PPA awareness campaign and describes a collaboration across organisations and countries to deliver the first year of the PPA awareness campaign. Future PPA awareness campaigns will build on this, by targeting specific audiences and aiming to increase knowledge and awareness of the role of the speech and language therapist. What are the clinical implications of this study? Increasing awareness of PPA and the role of the speech and language therapist has been identified by people with lived experience in the UK, as the core care pathway for people with PPA and their families. The PPA awareness campaign has made this information available to people affected by PPA and health care professionals. This includes a set of recommendations for the development of future similar awareness campaigns beyond PPA.

Background/Objectives: Brain tumors are highly lethal cancers, with gliomas representing the most complex subtype. Magnetic resonance imaging (MRI) is the main non-invasive imaging modality. This review evaluates deep learning (DL) and artificial intelligence methods for brain tumor segmentation and classification. Methods: In this systematic review, PubMed and Scopus were searched for articles published from 2022 to March 2025. Authors independently identified eligible studies based on predefined inclusion criteria and extracted data. The study quality and risk of bias were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) checklist. Results: Thirty-one studies met the inclusion criteria from 310 records, with eight addressing both segmentation and classification. Most segmentation studies used publicly available multiparametric MRI datasets. Performance varied by architecture and tumor region, with whole-tumor segmentation achieving the highest Dice Similarity Coefficient (DSC). Classical U-Nets reported DSC values ranging 80–87%, while models with residual or attention mechanisms exceeded 90%. Classification focused on tumor type and glioma grading, using features learned from multiparametric MRI. Reported accuracy ranged from 91.3% to 99.4%, with sensitivity and specificity often above 95%. However, variability across tumor subregions, limited external validation, reliance on public datasets, and heterogeneous preprocessing raise concerns about robustness and real-world generalizability. Evidence on the use of explainability methods for both tasks remains limited. Conclusions: DL models for glioma segmentation and classification demonstrate promising performance. However, standardized validation protocols, multi-center datasets, and the integration of explainable artificial intelligence techniques are needed to improve transparency, robustness, and clinical applicability.

INTRODUCTION: The impact of bilingualism on speech‐language assessment and therapy in primary progressive aphasia (PPA) remains underexplored, despite its suggested influence on disease presentation. METHODS: A bilingual Italian (L1)—English (L2) individual with logopenic‐variant PPA completed a bilingual assessment as well as dual‐language lexical retrieval therapy (LRT). His bilingual experience was characterized in detail, and therapy outcomes were evaluated within and across languages. RESULTS: Pre‐morbidly, the patient was a relatively balanced bilingual individual with stronger L1 literacy. Following disease onset, L2 showed faster decline, whereas L1 remained stable. Age at acquisition, dominance, and language use were among the main factors contributing to his language maintenance and decline. Therapy yielded relatively equivalent item‐specific gains in both languages (L1 d ₂  = 5.0; L2 d ₂  = 5.6), asymmetric crosslinguistic transfer to L2 > L1, and modest functional improvements. DISCUSSION: Findings support the relevance of in‐depth bilingual assessment and therapy to guarantee successful treatment in PPA, unveiling the relevance of bilingual experience in shaping treatment outcomes.

Introduction Primary progressive aphasia (PPA) is a neurodegenerative syndrome characterized by progressive speech and language impairments that impact communication, independence, and psychosocial well-being. People with PPA (PwPPA) and their carers face communication difficulties that lead to social withdrawal. Speech and language therapy (SLT) offers non-pharmacological strategies to support communication, yet evidence regarding its perceived impact on daily life remains limited. This study explored the experiences of PwPPA and their carers following SLT, focusing on perceived changes in communication abilities, confidence, and psychosocial well-being. Methods PwPPA participated in a 5-week, tailored telerehabilitation program (Lexical Retrieval Cascade Treatment for logopenic PPA/semantic PPA; Video-Implemented Script Training for nonfluent/agrammatic PPA). Post-treatment questionnaires were developed to collect the opinions of PwPPA and their carers regarding the SLT. The questionnaires included 22 closed-ended Likert-scale items and two open-ended questions for each group. Quantitative data were analyzed for frequency and consistency between PwPPA and carers, while qualitative responses underwent reflexive thematic analysis. Twenty-five PwPPA and 24 carers completed the questionnaires. Results Quantitative findings showed consistent perceptions between PwPPA and carers, with approximately 30% reporting improvements in communication confidence, speaking ability, and stress. Thematic analysis revealed four shared themes: reduction in negative emotions/increased self-efficacy, proactivity, acquisition of compensatory strategies, and the importance of the treatment setting and patient–clinician relationship. Additional themes included enhanced communicative effectiveness for PwPPA and increased awareness and improved interpersonal relationships for carers. Participants emphasized the benefits of individualized, supportive therapy delivered in a comfortable environment, including via telerehabilitation. Conclusion Our study highlights the positive influence of SLT on both communication and psychosocial outcomes in PwPPA and their carers. Integrating subjective experiences with quantitative measures underscores the importance of person-centered, holistic interventions that address linguistic, emotional, and social dimensions, supporting everyday communication and quality of life.

Background/Objectives: Post-traumatic epileptogenesis is a frequent and clinically relevant consequence of traumatic brain injury (TBI), often contributing to worsened neurological and functional outcomes. In patients experiencing early post-injury seizures, rehabilitative strategies that support recovery while considering increased epileptogenic risk are needed. This case study explores the potential benefits of combining neurofeedback (NFB) with motor therapy on cognitive and motor recovery. Methods: A patient hospitalized for severe TBI who experienced an acute symptomatic seizure in the early post-injury phase underwent baseline quantitative EEG (qEEG), neuromotor, functional, and neuropsychological assessments. The patient then completed a three-week rehabilitation program (five days/week) including 30 sensorimotor rhythm (SMR) NFB sessions (35 min each) combined with daily one-hour motor therapy. qEEG and clinical assessments were repeated post-intervention and at 6-month follow-up. Results: Post-intervention qEEG showed significant reductions in Delta and Theta power, reflecting decreased cortical slowing and enhanced neural activation. Relative power analysis indicated reduced Theta activity and Alpha normalization, suggesting improved cortical stability. Increases were observed in Beta and High-beta activity, alongside significant reductions in the Theta/Beta ratio, consistent with improved attentional regulation. Neuropsychological outcomes revealed reliable improvements in global cognition, memory, and visuospatial abilities, mostly maintained or enhanced at follow-up. Depressive and anxiety symptoms decreased markedly. Motor and functional assessments demonstrated meaningful improvements in motor performance, coordination, and functional independence. Conclusions: Findings suggest that integrating NFB with motor therapy may support recovery processes and be associated with sustained neuroplastic changes in the early post-injury phase after TBI, a condition associated with elevated risk for post-traumatic epilepsy.

Background: Differentiating between logopenic (lvPPA) and nonfluent/agrammatic (nfvPPA) variants of Primary Progressive Aphasia relies on expert evaluations of speech and language production. The dichotomy fluency/non‐fluency is not enough to support the clinical diagnosis as an effortful production of sentences (including morphosyntactic and phonological errors) can be present in both variants for different reasons. Connected speech analysis greatly supports the phenotypical classification of PPA, targeting abnormal language production. Method: In this cross‐sectional study, 19 Italian patients with PPA (nfvPPA=9; lvPPA=10) underwent an audio‐recorded picture description task from the SAND battery. The speech data were analyzed using computational methods with the Computerized Language ANalysis (CLAN) software, allowing the extraction of linguistic features. Using a Mann‐Whitney non‐parametric test corrected for false discovery rate (FDR), we analyzed 45 linguistic features belonging to four linguistic levels. A machine‐learning (ML) model was trained to classify nfvPPA vs lvPPA. Result: We identified ten features belonging to 4 linguistic levels differentiating nfvPPA from lvPPA. These included, at the phonetic and phonological level: silent pause ratio; at the lexico‐semantic level: noun, adverb, article, and determiner ratios; at the morphosyntactic level: total number of utterances and utterance error ratio; and at the pragmatic/discourse level: total words, total morphemes, and idea density. The ML model reached a sensitivity and specificity> 90%. Conclusion: We implemented natural language processing to perform a machine‐learning classification based on connected speech samples of Italian‐speaking subjects. This approach has been applied for the first time to Italian PPA and demonstrated that key linguistic markers can be identified and compared across the two variants.