South American Research Journal, 3(2), 69-73

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—

donde la cognición está ligada a la acción— algunos

Action language deficit: Preclinic sign of

Parkinson's? Literature review

investigadores han observado específicamente un déficit en el

lenguaje de acción en desórdenes del movimiento como la EP

y plantean que este podría ser un signo preclínico de la EP.

Esta revisión se planteó el objetivo de presentar una visión de

un conjunto de publicaciones sobre el DLA en español e

inglés entre 2013 y 2023, y analizar si hay una postura

dominante sobre el tema. A través del modelo PRISMA, se

exploraron 3 bases de datos: Scopus, PubMed y Web of

Science. Tras aplicar los criterios de inclusión— se

obtuvieron 25 publicaciones. La mayoría sustentó el DLA,

pero otros experimentos —también incluidos—no pudieron

replicar el éxito. Los principales desafíos parecen ser la

estandarización y adaptación de tests a distintos idiomas. Se

concluyó que existe una mayoría de publicaciones que

sustentan este déficit en la EP pero todavía no se recomienda

considerarlo un signo preclínico en el diagnóstico.

Déficit en el lenguaje de acción ¿Un signo

preclínico

Parkinson?

Revisión

bibliográfica

Maria Mercedes Moreno-Loor¹

Universidad del Azuay. Av. 24 de mayo 7-77 & Hernán Malo.

Cuenca, Ecuador.

Correspondence: mmorenonpm3@es.uazuay.edu.ec

Reception: April 18, 2024 - Acceptance: May 18, 2024 -

Publication: May 20, 2024.

Palabras clave: Parkinson, lenguaje de acción,

revisión, cognición corporizada, embodiment.

ABSTRACT

INTRODUCTION

Parkinson's disease (PD) is

late-diagnosed

neurodegenerative condition, sometimes present almost a

decade before its confirmation. It is characterized by

involuntary movements such as tremor, slowness, rigidity and

loss of postural control related to dopamine depletion in the

substantia nigra. In addition to motor symptoms, there are

complications with the autonomic system, and

neuropsychological symptoms such as depression or

cognitive alterations, including deficiency in verbal fluency.

Aligned with the embodiment theory and the concept of

motor cognition -where cognition is linked to action- some

researchers have specifically observed a deficit in action

language (ALD) in movement disorders such as PD and

suggest that this could be a preclinical sign of PD. This review

aimed to present an overview of a set of publications on DLA

in Spanish and English between 2013 and 2023, and to

analyze whether there is a dominant position on the topic.

Through the PRISMA model, 3 databases were explored:

Scopus, PubMed and Web of Science. After applying the

inclusion criteria, 25 publications were obtained. Most of

them supported the DLA, but other experiments -also

included- could not replicate the success. The main

challenges seem to be the standardization and adaptation of

tests to different languages. It was concluded that there is a

majority of publications supporting this deficit in PD but it is

not yet recommended to consider it as a preclinical sign in the

diagnosis.

According to the World Health Organization

WHO, 2022), disability and death from Parkinson's

(

disease (PD) are increasing faster than any other

neurological disorder. This condition stands out in a

worrying and growing way among the most common

chronic neurological problems, which has led to talk of

the “Parkinson's pandemic” (Dorsey et al., 2018). Its

diagnosis is usually late, since when confirmed, it has

generally been latent for up to a decade without being

detected.

The most visible motor symptoms include tremor

at rest, bradykinesia (slowing of movements), stiffness

in the limbs, freezing of gait, problems initiating

walking, imbalance and dyskinetic movements

(

abnormal and involuntary).

In addition to motor symptoms, there are

complications with the autonomic system such as

intestinal problems and sleep disturbances, and

neuropsychological symptoms such as depression,

anxiety and cognitive alterations such as loss of verbal

fluency also appear (Gianelli et al., 2021). Some

researchers postulate that, in PD, verbal fluency is

markedly presented through an action language deficit

(

ALD), a cognitive domain that critically involves

motor brain networks (Suárez-García et al., 2021).

The DLA approach is aligned with embodiment

theory and its derivative concept of motor cognition

Keywords: Parkinson, action language, review,

embodied cognition, embodiment.

(

MC), which encompasses the notion that cognition is

embedded in action and that the motor system is

involved in mental processing (Sommerville and

Decety, 2006). Thus, the recruitment of the motor

system would be necessary to process linguistic material

that expresses motor content, to which is added the

hypothesis that the expression and recognition

mechanisms would be caused by the same underlying

mechanism, and that emotional deficiencies are linked

to motor deficiencies (Gallezot et al., 2022).

Consequently, an alteration of the motor system—not

only in people with PD as is the central theme of this

work—should affect the ability to process linguistic

elements with motor content (Buccino et al., 2018).

RESUMEN

La enfermedad de Parkinson es una afección

neurodegenerativa de tardío diagnóstico, a veces presente casi

una década antes de su confirmación. Se caracteriza por

movimientos involuntarios como temblor, lentitud, rigidez y

pérdida del control postural relacionada con la depleción de

dopamina en la sustancia nigra. A los síntomas motores se

suman complicaciones con el sistema autónomo, y síntomas

neuropsicológicos como depresión o alteraciones cognitivas,

entre ellas la deficiencia en la fluidez verbal. Alineados con

la teoría del embodiment y el concepto de la cognición motora

https://doi.org/10.5281/zenodo.12797682

South American Research Journal, 3(2), 69-73

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ISSN 2806-5638

Figure 1. Action Language Deficit DLA



Among the selected sample of articles, is there a

majority of studies that support the paradigm that

DLA is marked within the alterations of verbal

fluency in PD?

Can DLA be considered a preclinical sign in the

diagnosis of PD?

Search for publications

Note. This figure represents responses to two visual stimuli: A) The person

being evaluated is asked to name the activity he or she is observing; if he or

she has DLA, he or she responds more slowly when the image represents a

higher action activity, such as “jumping” compared to B) when the image

shows a lower action activity, such as “sleeping”. This example is not the

only way to evaluate a person with DLA. Source of the slides: Object and

Action Naming Battery by Judit Druks. Figure created by the autors.

Articles published in English and Spanish between

September 2013 and September 2023 were searched in the

Scopus, PubMed and Web of Science (WOS) databases that

included the search criteria (Table 1).

Table 1. Search criteria

Among the hypotheses to explain the underlying

mechanisms of CM is neuronal exploitation and reuse.

Gallese and Cuccio (2018) postulate that the evolution of the

nervous system could have experienced an efficient reuse of

networks when it was differentiating itself from other

mammals. If, in an evolutionary leap of homo sapiens, the tail

was discarded, for example, the corresponding neuronal

network could have been reused to share it with language,

redesigning itself to fulfill motor and cognitive functions.

Because action and language are linked, these authors explain

that the meaning given to a word or phrase depends on the

context and the experience of the body. For example, the verb

to cut is different depending on the context: to cut bread vs.

to cut grass. Thus, the abstraction of mental concepts is

influenced by experience with the world. Thus, the Italian

expression “to cut the rope” (an action with the hands)

depending on the idiomatic context can metaphorically mean

to run away (an action with the feet). The metaphor of

movement and action permeates everyday life, say Lakoff

and Johnson (1980), who defend the embodiment not only of

language but also of thought.

The search of databases and registries yielded a total of

76 results: 41 articles in Scopus, 14 in PubMed, and 21 in

Web of Science (WOS). Twenty-seven duplicates were

removed, leaving 49 articles. After reading the abstract of

each publication, 19 articles that did not independently assess

DLA in PD were excluded, leaving a subtotal of 30. Using

direct citation identification, 2 more records were added,

reaching a final total of 32 articles. Of these, 7 literature

review articles were excluded, resulting in 25 research

articles. The flow followed in the final selection process is

illustrated in Figure 2.

Figure 2. PRISMA flowchart

Among the theories that oppose embodiment are

cognitivism, intellectualism, computational functionalism,

realism and Cartesian dualism. In the face of this debate,

comes the concept of enaction (Varela et al., 1997) that rejects

both realism and idealism: it is not that the world is one for

everyone (external approach) nor that everything comes from

the mind of the person who perceives it (internal approach):

enaction proposes a middle point where the world and the

person who perceives it define each other reciprocally, a

position that is advocated in this work.

We can see embodiment and CM as philosophical

debates that, when transferred to the neuropsychological

field, invite us in this work to try to answer the question of

whether there is a marked DLA in people with Parkinson's

that supports the embodiment theory.

Data collection process

The data were collected in a matrix organized by

columns of: record identification, DOI, year, author(s), title

of the publication, type of publication, country, abstract,

evaluation instrument, language of the evaluation, result and

conclusion. Each article was subsequently read, analyzed,

synthesized and the columns of: Supports the DLA (pro,

neutral or con) were added to the matrix.

METHODOLOGY

The methodological format for this research is a

bibliographic review whose questions have been guided by

the paradigm that in the human nervous system there are

neural networks that share motor and linguistic domains, and

that when the networks deteriorate, performance in both

domains is affected, as explained by some research on DLA

in people with PD.

RESULTS

The review questions were:

This review aimed to identify whether there was a

majority of publications supporting DLA and whether this

https://doi.org/10.5281/zenodo.12797682

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https://www.sa-rj.net/index.php/sarj/article/view/49

ISSN 2806-5638

alteration could become a preclinical marker for the diagnosis

of PD. Before answering the research questions, a general

summary of the records is presented.

Table 5. Publications according to the dominant position regarding

the DLA

Position

Quantity

Identification

Table 2. Publications per year

E01, E03, E04, E05, E06, E07, E08, E09,

E10, E12, E15, E17, E18, E19, E20,

E21, E22, E24

In favor

Year

Quantity

Identificatión

Against

Neutral

E02, E11, E23, E25

E13, E14, E16

013

E01, E02

E03, E04

E05, E06, E07, E08

E09, E10, E11

E12, E13, E14

E15, E16

E17, E18, E19

E20, E21, E22, E23

E24, E25

Note. This table shows a larger number of studies N=18 with a dominant

position in favor of DLA.}

016

017

018

019

020

021

022

023

Figure 3. Publications supporting the DLA

Note. This table shows that most of the studies were published in 2017 and

022, N=4 under the same conditions.

Table 3. Publications per country

Country

Quantity

Identification

Note. This figure shows a 72% majority of articles that support the DLA;

6% do not report support for the DLA; and 12% remain neutral. To the right

USA

Colombia

Argentina

Italy

Australia

Belgium

Brazil

E01, E02, E07, E10, E13, E18, E24

E04, E05, E09, E16, E17, E21

E08, E22

E12, E23

E14

E15

E06

E25

E19

of the graph, the breakdown of languages used in the evaluations that came

out in favor can be seen, with Spanish and English obtaining majorities of

36% and 24% respectively.

Among all the reviewed articles, it was found that a

majority, 72%, reported results in favor of the DLA. It is

interesting to note that half of these articles (36% of 72%)

used Spanish for the assessments, as illustrated in Figure 3.

On the other hand, the studies opposing the DLA

administered the tests in several languages, including English

(E02), Turkish (E11), Danish (E25) and Italian (E23).

Denmark

Spain

United Kingdom

Türkiye

E03

E11

E20

Uruguay

Note. This table shows that most of the studies were published in the USA

N=7, followed by Colombia N=6, and Argentina and Italy in the same

conditions N=2. Publications from other countries do not have a relevant

weight.

DISCUSSION

The methodologies used in these studies to assess the

semantics of actions are varied, and include: the picture

matching task [Semantic Association Task, SAT] (Aiello et

al., 2022); the phonemic version of the standard German

verbal fluency task, Regensburger Wortflüssigkeitstest

Table 4. Publications by assessment language

Language of

Amount

Identification

assessment

(

Klostermann et al., 2022; Wolff et al., 2021); the picture-

word association task (PWA) with action-verb and object-

substance conditions (Suárez-García et al., 2021); storytelling

tasks and automatic recognition of language components

E04, E05, E08, E09, E16, E17, E19,

E20, E21, E22

Spanish

English

E01, E02, E03, E07, E10, E12, E13,

E14, E24

(

Eyigoz et al., 2020); the metaphor comprehension task, with

button-grab responses (Humphries et al., 2019); the Pyramids

and Palms Test (PPT) and the Kissing and Dancing Test

German

Danish

E18

E25

E15

E23

E06

E11

(

KDT); Verbal fluency for verbs (action fluency), verb

Dutch

naming task, subtest of the Cambridge Semantic Memory

Battery; (Salmazo-Silva et al., 2017) ; fMRI scans of PD

versus controls (Abrevaya et al., 2017); Experimental

protocol with a baseline session and a reading session

(Nisticò et al., 2019); Computer naming task: reading +

picture with timing and voice recording (Muñoz-Salgado and

Del Río, 2021). Two investigations use the phonemic version

of the standard German verbal fluency task, Regensburger

Italian

Portuguesw

Turkish

Note. This table shows that most of the studies used Spanish for their

evaluations N=12, followed by English N=11 and the mixed ones that, being

reviews, could also include studies in Spanish and English.

https://doi.org/10.5281/zenodo.12797682

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ISSN 2806-5638

Wortflüssigkeitstest, and others refer to the Object and Action

Naming Battery used by Bocanegra (2017) .

verb processing deficits in Parkinson’s disease. Journal of

Neurolinguistics ,

61.

https://doi.org/10.1016/j.jneuroling.2021.101040

The structure of the questions in the evaluative tasks is

varied. For example, Wolff et al. (2021) categorized the

questions according to (i) general movement, (ii) movement

of one's own body, (iii) movement of objects, and (iv)

movement of other beings. Thus, in response to questions

about the ecological validity of the tasks, there are narrative

modalities such as that of the team of Eyigoz et al. (2020).

A limitation observed in this sample of studies was the

impossibility of applying unified tests. The contradictory

findings in this work could be explained by the concentration

of research carried out by the same authors in a Spanish-

speaking population (Colombia and Argentina), which could

unbalance the objectivity of the postulate, suggesting that the

tests that work are only suitable for the semantics of Spanish.

However, a more feasible explanation would be that the

morphological pattern (including linguistic and tonal

differences) may be distinctively affected in PD depending on

the patient's mother tongue, as well as under ecological

testing conditions (E16). Therefore, this preclinical marker

could be useful only in the populations studied. Cultural

relativity does not rule out embodiment theory, but rather

reinforces enaction, where the world and the person who

perceives it define each other reciprocally (Varela et al.,

Bocanegra, Y., García, A., Lopera, F., Pineda, D., Baena, A.,

Ospina, P., Alzate, D., Buriticá, O., Moreno, L., Ibáñez, A.,

Cuetos, F. (2017). Unspeakable motion: Selective action-

verb impairments in Parkinson’s disease patients without

mild cognitive impairment. Brain and Language, 168, 37–

46. https://doi.org/10.1016/j.bandl.2017.01.005

Buccino, G., Dalla Volta, R., Arabia, G., Morelli, M., Chiriaco, C.,

Lupo, A., Silipo, F., & Quattrone, A. (2018). Processing

graspable object images and their nouns is impaired in

Parkinson’s disease patients. Cortex , 100, 32–39.

https://doi.org/10.1016/j.cortex.2017.03.009

Cervetto, S., Birba, A., Pérez, G., Amoruso, L., & García, A. M.

(2022). Body into Narrative: Behavioral and

Neurophysiological Signatures of Action Text Processing

After Ecological Motor Training. Neuroscience, 507, 52–

63.

https://doi.org/10.1016/J.NEUROSCIENCE.2022.10.024

Dorsey, E., Sherer, T., Okun, M., & Bloemd, B. (2018). The

Emerging Evidence of the Parkinson Pandemic. Journal of

Parkinson’s

Disease ,

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1),

S3.

https://doi.org/10.3233/JPD-181474

Eyigoz, E., Courson, M., Sedeño, L., Rogg, K., Orozco-Arroyave, J.

R., Nöth, E., Skodda, S., Trujillo, N., Rodríguez, M., Rusz,

J., Muñoz, E., Cardona, J. F., Herrera, E., Hesse, E., Ibáñez,

A., Cecchi, G., & García, A. M. (2020). From discourse to

pathology: Automatic identification of Parkinson’s disease

patients via morphological measures across three

997).

The opposition to embodiment, such as Cartesian

dualism, has ignored and underestimated the involvement of

the body in mental processes, arguing that mental phenomena

are not physical and therefore not influenced by the body.

However, research continues, such as that of Cervetto et al.

languages.

Cortex ,

132 ,

191–205.

https://doi.org/10.1016/j.cortex.2020.08.020

Gallese, V. y Cuccio, V. (2018). The neural exploitation hypothesis

and its implications for an embodied approach to language

and cognition: Insights from the study of action verbs

processing and motor disorders in Parkinson’s disease.

(

2022), who reported improvements in DLA after an

intervention with physical exercise and video games.

Although this intervention was not carried out on people with

PD, it offers an interesting example of alternative therapies

that could be applied to this population.

Cortex ,

100 ,

215–225.

https://doi.org/10.1016/j.cortex.2018.01.010

Gallezot, C., Riad, R., Titeux, H., Lemoine, L., Montillot, J.,

Sliwinski, A., Hamet Bagnou, J., Cao, X., Youssov, K.,

Dupoux, E., & Levi, A. (2022). Emotion expression

through spoken language in Huntington disease.

https://doi.org/10.1016/j.cortex.2022.05.024

CONCLUSIONS

Gianelli, C., Maiocchi, C., & Canessa, N. (2021). Action Fluency in

Parkinson’s Disease: A Mini-Review and Viewpoint.

The selected sample shows that most studies support the

paradigm that DLA is prominent among verbal fluency

disorders in PD. However, the heterogeneity in the types of

tests used and the results obtained make it difficult to identify

consistent relationships.

Motor cognition and the alteration of the semantics of

actions in PD constitute a theoretical model that is still

controversial. It would be necessary to standardize the tasks,

adjust the ecological validity and successfully replicate new

studies to incorporate the alteration of DLA in the diagnosis

of parkinsonian syndromes, so that the use of DLA as a

preclinical sign in the diagnosis of PD is accurate.

Frontiers 806.

Aging

Neuroscience ,

13 ,

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