title: Mild Developmental Foreign Accent Syndrome and Psychiatric Comorbidity: Altered White Matter Integrity in Speech and Emotion Regulation Networks.
abstract: Foreign accent syndrome (FAS) is a speech disorder that is defined by the emergence of a peculiar manner of articulation and intonation which is perceived as foreign. In most cases of acquired FAS (AFAS) the new accent is secondary to small focal lesions involving components of the bilaterally distributed neural network for speech production. In the past few years FAS has also been described in different psychiatric conditions (conversion disorder, bipolar disorder, and schizophrenia) as well as in developmental disorders (specific language impairment, apraxia of speech). In the present study, two adult males, one with atypical phonetic production and the other one with cluttering, reported having developmental FAS (DFAS) since their adolescence. Perceptual analysis by naïve judges could not confirm the presence of foreign accent, possibly due to the mildness of the speech disorder. However, detailed linguistic analysis provided evidence of prosodic and segmental errors previously reported in AFAS cases. Cognitive testing showed reduced communication in activities of daily living and mild deficits related to psychiatric disorders. Psychiatric evaluation revealed long-lasting internalizing disorders (neuroticism, anxiety, obsessive-compulsive disorder, social phobia, depression, alexithymia, hopelessness, and apathy) in both subjects. Diffusion tensor imaging (DTI) data from each subject with DFAS were compared with data from a group of 21 age- and gender-matched healthy control subjects. Diffusion parameters (MD, AD, and RD) in predefined regions of interest showed changes of white matter microstructure in regions previously related with AFAS and psychiatric disorders. In conclusion, the present findings militate against the possibility that these two subjects have FAS of psychogenic origin. Rather, our findings provide evidence that mild DFAS occurring in the context of subtle, yet persistent, developmental speech disorders may be associated with structural brain anomalies. We suggest that the simultaneous involvement of speech and emotion regulation networks might result from disrupted neural organization during development, or compensatory or maladaptive plasticity. Future studies are required to examine whether the interplay between biological trait-like diathesis (shyness, neuroticism) and the stressful experience of living with mild DFAS lead to the development of internalizing psychiatric disorders.
authors.affiliation: Cognitive Neurology and Aphasia Unit and Cathedra ARPA of Aphasia, Centro de Investigaciones Médico-Sanitarias, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Malaga Malaga, Spain.
authors.forename: Marcelo L
authors.initials: ML
authors.lastname: Berthier
authors.affiliation: Molecular Imaging Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga Malaga, Spain.
authors.forename: Núria
authors.initials: N
authors.lastname: Roé-Vellvé
authors.affiliation: Department of Spanish Language, University of Malaga Malaga, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Moreno-Torres
authors.affiliation: Barcelonabeta Brain Research Center, Pasqual Maragall Foundation Barcelona, Spain.
authors.forename: Carles
authors.initials: C
authors.lastname: Falcon
authors.affiliation: Molecular Imaging Unit, Centro de Investigaciones Médico-Sanitarias, University of MalagaMalaga, Spain; Department of Applied Mathematics, Superior Technical School of Engineering in Informatics, University of MalagaMalaga, Spain.
authors.forename: Karl
authors.initials: K
authors.lastname: Thurnhofer-Hemsi
authors.affiliation: Molecular Imaging Unit, Centro de Investigaciones Médico-Sanitarias, University of MalagaMalaga, Spain; Department of Applied Mathematics, Superior Technical School of Engineering in Informatics, University of MalagaMalaga, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Paredes-Pacheco
authors.affiliation: Cognitive Neurology and Aphasia Unit and Cathedra ARPA of Aphasia, Centro de Investigaciones Médico-Sanitarias, Instituto de Investigación Biomédica de Málaga (IBIMA), University of MalagaMalaga, Spain; Department of Psychobiology and Methodology of Behavioural Sciences, Faculty of Psychology, University of MalagaMalaga, Spain.
authors.forename: María J
authors.initials: MJ
authors.lastname: Torres-Prioris
authors.affiliation: Cognitive Neurology and Aphasia Unit and Cathedra ARPA of Aphasia, Centro de Investigaciones Médico-Sanitarias, Instituto de Investigación Biomédica de Málaga (IBIMA), University of MalagaMalaga, Spain; Unit of Physical Medicine and Rehabilitation, Regional University Hospital, MalagaMalaga, Spain.
authors.forename: Irene
authors.initials: I
authors.lastname: De-Torres
authors.affiliation: Molecular Imaging Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga Malaga, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Alfaro
authors.affiliation: Molecular Imaging Unit, Centro de Investigaciones Médico-Sanitarias, University of Malaga Malaga, Spain.
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Gutiérrez-Cardo
authors.affiliation: Service of Neurology, Hospital Universitari i Politècnic La Fe Valencia, Spain.
authors.forename: Miquel
authors.initials: M
authors.lastname: Baquero
authors.affiliation: Cognitive Neurology and Aphasia Unit and Cathedra ARPA of Aphasia, Centro de Investigaciones Médico-Sanitarias, Instituto de Investigación Biomédica de Málaga (IBIMA), University of Malaga Malaga, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Ruiz-Cruces
authors.affiliation: Cognitive Neurology and Aphasia Unit and Cathedra ARPA of Aphasia, Centro de Investigaciones Médico-Sanitarias, Instituto de Investigación Biomédica de Málaga (IBIMA), University of MalagaMalaga, Spain; Department of Psychobiology and Methodology of Behavioural Sciences, Faculty of Psychology, University of MalagaMalaga, Spain.
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Dávila
keywords: developmental speech disorders; diffusion tensor imaging; foreign accent; personality; psychiatric disorders