Abstract
Linguistic anxiety (LA) is an abnormal stress response induced by situations that require the use of verbal behavior, and it is accentuated during language testing in persons with aphasia (PWA). The presence of LA in PWA may jeopardize the interpretation of cognitive evaluations, leading to biased conclusions about the severity of the language alteration and the effectiveness of the treatments. In the present study, we report the case of a woman (Mrs. A) with severe chronic mixed transcortical aphasia due to left frontal and parietal hemorrhages that partially spared the perisylvian area. Mrs. A was treated with the dopamine agonist Rotigotine alone and combined with Intensive Language-Action Therapy (ILAT). Complementary evaluations included autonomic reactivity during the performance of different language tasks, resting state functional magnetic resonance imaging (rs-fMRI) and [18F]-fluorodeoxyglucose positron emission tomography (18F-FDG-PET). We found that formal language testing in a clinical setting triggered a dramatic increase of automatic echolalia, perseverations and frustration, making the task completion difficult. The treatment improved aphasia, but gains were more robust when evaluation was performed by Mrs. A’s husband at home than by clinicians. Autonomic evaluation under Rotigotine revealed higher reactivity during tasks tapping an impaired function in comparison with a task evaluating a preserved function (verbal repetition). Baseline 18F-FDG-PET analysis showed decreased metabolic activity in left limbic-paralimbic areas, whereas rs-fMRI revealed compensatory activity in the right hemisphere. We also analyzed the different factors (e.g., premorbid personality traits, task difficulty) that may have contributed to LA in Mrs. A during language testing. Our findings emphasize the usefulness of implicating adequately trained laypersons in the evaluation and treatment of PWA showing LA. Further studies using multidimensional evaluations are needed to disentangle the interplay between anxiety and abnormal language as well as the neural mechanisms underpinning LA in PWA.
Highlights
Aphasia is a neuropsychological syndrome characterized by an impairment of language, affecting speech production and auditory comprehension as well as the ability to read and write
The right orbitofrontal cortex (OFC) showed a stronger coupling with the bilateral Amygdala and the right posterior MTG (pMTG), the Amygdala and HC showed stronger functional synchronization with regions within the anxiety network in the right hemisphere and posterior temporo-parietal perisylvian areas (PSA)
In the present study we reported the case of Mrs A, a woman who had a severe chronic MTCA and overwhelming Linguistic anxiety (LA) after suffering two simultaneous left hemisphere hemorrhages
Summary
Aphasia is a neuropsychological syndrome characterized by an impairment of language, affecting speech production (spontaneous speech, naming and repetition) and auditory comprehension as well as the ability to read and write. Emotional changes may be linked to adjustment problems related to the imposed life changes resulting from cognitive and motor deficits (Chemerinski and Robinson, 2000) Factors such as personality traits (Aben et al, 2002; Greenop et al, 2009), coping strategies (Vuger-Kovacicet al., 2007), family support (Morris et al, 1991) and premorbid mood disorders (Burvill et al, 1995; Sembi et al, 1998; Leppävuori et al, 2003) may influence outcomes. All this suggests the need to adopt a multidimensional approach to identify the multiple factors that contribute to the emotional and psychological consequences of post-stroke aphasia
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