Person-centered intervention response in primary progressive aphasia: A secondary analysis of the Communication...

Person-centered outcomes that capture clinically meaningful change are essential to non-pharmacological intervention research for Alzheimer's disease and related dementias. Primary progressive aphasia (PPA) is a neurodegenerative syndrome characterized by progressive language impairment. The Communication Bridge-2 (CB2) randomized controlled trial previously demonstrated the efficacy of a personalized, participation-focused speech-language intervention on Goal Attainment Scaling (GAS), a person-centered communication participation outcome. This secondary responder analysis characterized meaningful participant- and goal-level response following intervention and at 12 months after enrollment to inform clinical translation and future appropriate use criteria.

Fifty participants with mild to moderate PPA in the CB2 experimental arm, each with three individualized communication participation goals (N = 150 goals), were included. Prespecified responder thresholds were defined as GAS ≥1 following each intervention block and GAS ≥0 at 12 months, reflecting improvement or maintenance relative to baseline in a progressive condition. Descriptive analyses examined responder patterns across time points, participants, baseline severity, PPA subtypes, and goal characteristics.

All participants met responder criteria at one or more evaluation time points. At 12 months, 79% of goals met responder criteria, and 60% of participants met responder criteria across all three goals. More than half of the goals (51.3%) met responder criteria at all three evaluation time points. Meaningful response was observed across PPA subtypes, baseline severity levels, and diverse goal characteristics. Exploratory patterns suggested higher 12-month responder rates for goals targeting speech, familiar communication partners, and familiar communication contexts.

This secondary responder analysis demonstrates that a person-centered, participation-focused speech-language intervention was associated with meaningful goal-level improvement or maintenance across a heterogeneous PPA population, with many responses sustained over 12 months. These findings support the value of GAS as a pragmatic, person-centered outcome for capturing meaningful response in progressive neurodegenerative disease and provide translational evidence to inform future appropriate use criteria and individualized dementia care.