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To characterize and compare the neuropsychological profiles of patients with primary progressive apraxia of speech (PPAOS) and apraxia of speech with progressive agrammatic aphasia (AOS-PAA).
Thirty-nine patients with PPAOS and 49 patients with AOS-PAA underwent formal neurological, speech, language, and neuropsychological evaluations. Cognitive domains assessed included immediate and delayed episodic memory (Wechsler Memory Scale-Third edition; Logical Memory; Visual Reproduction; Rey Auditory Verbal Learning Test), processing speed (Trail Making Test A), executive functioning (Trail Making Test B; Delis-Kaplan Executive Functioning Scale – Sorting), and visuospatial ability (Rey-Osterrieth Complex Figure copy).
The PPAOS patients were cognitively average or higher in the domains of immediate and delayed episodic memory, processing speed, executive functioning, and visuospatial ability. Patients with AOS-PAA performed more poorly on tests of immediate and delayed episodic memory and executive functioning compared to those with PPAOS. For every 1 unit increase in aphasia severity (e.g. mild to moderate), performance declined by 1/3 to 1/2 a standard deviation depending on cognitive domain. The degree of decline was stronger within the more verbally mediated domains, but was also notable in less verbally mediated domains.
The study provides neuropsychological evidence further supporting the distinction of PPAOS from primary progressive aphasia and should be used to inform future diagnostic criteria. More immediately, it informs prognostication and treatment planning.
In his extraordinary essay ‘The Metaphysical Studio’, Phillip Zarrilli advocated for the actor's psychophysical exploration of risky uncertainties and unknown possibilities in the ‘spatio-temporal realm between presence and absence, between “what is” and “what is not” – this liminal realm between’. It was typical of Zarrilli that when he received confirmation that his cancer had returned for the third and final time, he both responded pragmatically and perceived the experience as a philosophically interesting inhabitation of ‘that liminal place between’. Just as ‘The Metaphysical Studio’ emphasizes the actor's investigation of ‘the relationship between that “self” and “others” – the other “selves” that inhabit me; those I might wish to inhabit; the other as “Character”; the interpersonal you-as-other;’ it was also typical that Zarrilli sought to take care of many of the ‘others’ connected with him. These others included a sprawling global training community of students, practitioners and scholars. In a final video call alongside his life and work collaborator Kaite O'Reilly and with more than thirty-five students from around the world who had studied his intercultural performer training at the University of Exeter, Zarrilli stressed, ‘it's never about me, it's always about you’. This stress on ‘you’ was rooted in his emphasis on participants gaining ownership of the training and assimilating it into their own practice, along with a core focus on the other and the collective. During the call, Zarrilli signalled the importance of consistently working within the studio and performance space on strong interpersonal relationships, which ‘can arise when people are learning how to be generous with their energy, with what they can give, with how they can be present to each other. And again, we need more of that in the world’. It is unsurprising that those who participated in Zarrilli's training experienced how that focus on intersubjectivity developed a joyful international and intergenerational community, underpinned by politicized intentions around accessibility, generous group awareness, an ethics of care, and an ability to share the space, which could also be carried into the wider world.
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