title: Narrative discourse deficits in amyotrophic lateral sclerosis.
abstract: OBJECTIVE
  We examined narrative discourse in amyotrophic lateral sclerosis (ALS) to assess the role of executive functioning in support of language and the neuroanatomical basis for such support.
  
  
  METHODS
  We analyzed a semistructured speech sample in 26 patients with ALS and 19 healthy seniors for narrative discourse features of coherence. Regression analyses related a measure of discourse coherence ("local connectedness") to gray matter atrophy and reduced white matter fractional anisotropy.
  
  
  RESULTS
  Patients with ALS were impaired relative to controls on measures of discourse adequacy, including local connectedness and maintenance of the theme. These discourse measures were related to measures of executive functioning but not to motor functioning. Regressions related local connectedness to gray matter atrophy in ventral and dorsal prefrontal regions and to reduced fractional anisotropy in white matter tracts mediating projections between prefrontal regions.
  
  
  CONCLUSIONS
  Patients with ALS exhibit deficits in their ability to organize narrative discourse. These deficits appear to be related in part to executive limitations. Consistent with the hypothesis that ALS is a multisystem disorder, this deficit is related to disease in prefrontal regions.
authors.affiliation: From the Department of Neurology and the Penn Frontotemporal Degeneration Center (S.A., A.M., C.O., C.T.M., A.B., D.J.I., L.M., L.E., M.G.), and Center for Neurodegenerative Disease Research (D.J.I.), Perelman School of Medicine, University of Pennsylvania, Philadelphia. ash@mail.med.upenn.edu.
authors.forename: Sharon
authors.initials: S
authors.lastname: Ash
authors.affiliation: From the Department of Neurology and the Penn Frontotemporal Degeneration Center (S.A., A.M., C.O., C.T.M., A.B., D.J.I., L.M., L.E., M.G.), and Center for Neurodegenerative Disease Research (D.J.I.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Anna
authors.initials: A
authors.lastname: Menaged
authors.affiliation: From the Department of Neurology and the Penn Frontotemporal Degeneration Center (S.A., A.M., C.O., C.T.M., A.B., D.J.I., L.M., L.E., M.G.), and Center for Neurodegenerative Disease Research (D.J.I.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Olm
authors.affiliation: From the Department of Neurology and the Penn Frontotemporal Degeneration Center (S.A., A.M., C.O., C.T.M., A.B., D.J.I., L.M., L.E., M.G.), and Center for Neurodegenerative Disease Research (D.J.I.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Corey T
authors.initials: CT
authors.lastname: McMillan
authors.affiliation: From the Department of Neurology and the Penn Frontotemporal Degeneration Center (S.A., A.M., C.O., C.T.M., A.B., D.J.I., L.M., L.E., M.G.), and Center for Neurodegenerative Disease Research (D.J.I.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Ashley
authors.initials: A
authors.lastname: Boller
authors.affiliation: From the Department of Neurology and the Penn Frontotemporal Degeneration Center (S.A., A.M., C.O., C.T.M., A.B., D.J.I., L.M., L.E., M.G.), and Center for Neurodegenerative Disease Research (D.J.I.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: David J
authors.initials: DJ
authors.lastname: Irwin
authors.affiliation: From the Department of Neurology and the Penn Frontotemporal Degeneration Center (S.A., A.M., C.O., C.T.M., A.B., D.J.I., L.M., L.E., M.G.), and Center for Neurodegenerative Disease Research (D.J.I.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Leo
authors.initials: L
authors.lastname: McCluskey
authors.affiliation: From the Department of Neurology and the Penn Frontotemporal Degeneration Center (S.A., A.M., C.O., C.T.M., A.B., D.J.I., L.M., L.E., M.G.), and Center for Neurodegenerative Disease Research (D.J.I.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Lauren
authors.initials: L
authors.lastname: Elman
authors.affiliation: From the Department of Neurology and the Penn Frontotemporal Degeneration Center (S.A., A.M., C.O., C.T.M., A.B., D.J.I., L.M., L.E., M.G.), and Center for Neurodegenerative Disease Research (D.J.I.), Perelman School of Medicine, University of Pennsylvania, Philadelphia.
authors.forename: Murray
authors.initials: M
authors.lastname: Grossman
mesh_terms: D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000175:diagnosis* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D033262:Narration; D009483:Neuropsychological Tests; D013060:Speech / Q000502:physiology; D013064:Speech Disorders / Q000175:diagnosis* / Q000523:psychology*