Investigating the Benefits of Remotely-supervised Neuromodulation in Primary Progressive Aphasia

/Abstract The logopenic variant of primary progressive aphasia (lvPPA) is a disorder characterized by gradual decline in language abilities that is typically caused by underlying Alzheimer’s Disease (AD) pathology. The impact of lvPPA on people’s communication lives is profoundly devastating. It can emerge in adults as young as their 50s, stripping them of their ability to communicate and function and affecting their careers, their family roles, and their potential to enjoy the rewards of mid-to-late life. Although lvPPA and other disorders on the AD and other AD Related Dementias (AD/ADRD) continuum are now identified earlier and with greater precision, research investigating interventions to ameliorate lvPPA’s debilitating effects on communication, prolong language skills, and maximize quality of life lags significantly behind. There is a critical need for rigorous investigations of behavioral and neuromodulatory treatments capable of leveraging spared brain areas for functional improvement, specifically for people with lvPPA, who are underrepresented in treatment research. Failure to meet this need means that people with lvPPA and their families are more likely to face an increased disability burden earlier and for a longer period than is necessary. To date, the field has relied on laboratory-based neuromodulation protocols developed for healthy aging and stroke-induced aphasia populations. This approach has prevented development of intervention models aligned with lvPPA functional needs and neurobiological factors, delaying vertical progress in much-needed nonpharmacological interventions. The overall objective of this project is to enhance the potency of proven language treatment for lvPPA by pairing it with tailored and accessible (home-based) neuromodulatory intervention that targets critical brain networks supporting effective intervention in this population. The central hypothesis is that such an approach will be feasible, acceptable, and show evidence of clinical benefit. Guided by strong preliminary data, two specific aims will be pursued: 1) Evaluate the feasibility, acceptability, and preliminary benefit of remotely-supervised transcranial direct current stimulation (RS-tDCS) and virtual speech-language treatment (vSLT) in persons with lvPPA and 2) Identify neural and electrical field factors that predict responsiveness to RS-tDCS in persons with lvPPA. To accomplish these aims, 80 individuals with lvPPA will undergo comprehensive cognitive-linguistic and neuroimaging assessment and RS-tDCS (active or sham) in conjunction with language telerehabilitation. This project’s contribution will be significant because of its broad application to individuals with other disorders on the AD/ADRD continuum who have historically been underserved by rehabilitation specialists and who would benefit from innovative treatments to prolong independence and quality of life. Project Number: 1RF1AG085565-01A1 | Fiscal Year: 2025 | NIH Institute/Center: National Institute on Aging (NIA) | Principal Investigator: Maya Henry (+1 co-PI) | Institution: UNIVERSITY OF TEXAS AT AUSTIN, AUSTIN, TX | Award Amount: $5,343,452 | Activity Code: RF1 | Study Section: Special Emphasis Panel[ZRG1 BP-D (02)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11159307