What do pauses in narrative production reveal about the nature of word retrieval deficits in PPA?

Jennifer E. Mack, Sarah D. Chandler, Aya Meltzer-Asscher, Emily Rogalski, Sandra Weintraub, M. Marsel Mesulam, Cynthia K. Thompson

Research output: Contribution to journalArticlepeer-review


Naming and word-retrieval deficits, which are common characteristics of primary progressive aphasia (PPA), differentially affect production across word classes (e.g., nouns, verbs) in some patients. Individuals with the agrammatic variant (PPA-G) often show greater difficulty producing verbs whereas those with the semantic variant (PPA-S) show greater noun deficits and those with logopenic PPA (PPA-L) evince no clear-cut differences in production of the two word classes. To determine the source of these production patterns, the present study examined word-finding pauses as conditioned by lexical variables (i.e., word class, frequency, length) in narrative speech samples of individuals with PPA-S (n=12), PPA-G (n=12), PPA-L (n=11), and cognitively healthy controls (n=12). We also examined the relation between pause distribution and cortical atrophy (i.e., cortical thickness) in nine left hemisphere regions of interest (ROIs) linked to word production. Results showed higher overall pause rates for PPA compared to unimpaired controls; however, greater naming severity was not associated with increased pause rate. Across all groups, more pauses were produced before lower vs. higher frequency words, with no independent effects of word length after controlling for frequency. With regard to word class, the PPA-L group showed a higher rate of pauses prior to production of nouns compared to verbs, consistent with noun-retrieval deficits arising at the lemma level of word production. Those with PPA-G and PPA-S, like controls, produced similar pause rates across word classes; however, lexical simplification (i.e., production of higher-frequency and/or shorter words) was evident in the more-impaired word class: nouns for PPA-S and verbs for PPA-G. These patterns are consistent with conceptual and/or lemma-level impairments for PPA-S, predominantly affecting objects/nouns, and a lemma-level verb-retrieval deficit for PPA-G, with a concomitant impairment in phonological encoding and articulation affecting overall pause rates. The greater tendency to pause before nouns was correlated with atrophy in the left precentral gyrus, inferior frontal gyrus and inferior parietal lobule, whereas the greater tendency to pause before less frequent and longer words was associated with atrophy in left precentral and inferior parietal regions.

Original languageEnglish
Pages (from-to)211-222
Number of pages12
StatePublished - 1 Oct 2015


  • Brain-behavior relationship
  • Narrative analysis
  • Primary progressive aphasia
  • Word class effects
  • Word retrieval deficits

All Science Journal Classification (ASJC) codes

  • Experimental and Cognitive Psychology
  • Cognitive Neuroscience
  • Behavioral Neuroscience


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