ABSTRACT Background The relative scarcity of studies of bilingual speakers with primary progressive aphasia (PPA) leads to knowledge gaps regarding their symptoms and patterns of language impairment. It is unknown if PPA symptoms in bilingual speakers differ from those of monolingual speakers. In addition, it remains unclear if one of a bilingual speaker’s languages is more vulnerable to the onset of symptoms and/or is better preserved. Furthermore, bilingualism factors (e.g. order/age of language acquisition (L1/L2) and language dominance) may explain patterns of impairment both within and across the variants of PPA. Aims To characterize the bilingualism factors, speech and language symptoms, and patterns of language impairment in a retrospective cohort of bilingual speakers with PPA. Methods In a large cohort (N = 69) of bilingual speakers, we performed a chart review to extract information regarding self/caregiver-reported PPA symptoms, first language impacted by PPA at symptom onset, less preserved language at time of evaluation, and bilingual history factors (age/order of acquisition (L1/L2) and language dominance). We explored how emergence and presentation of symptoms associated with bilingualism factors. Results The presenting symptoms were mostly consistent with current PPA diagnostic criteria, although symptoms unique to bilingual speakers were reported. The language reported to first be impacted by PPA, as well as the less preserved language at the time of evaluation, was generally reported to be the less dominant language, regardless of PPA variant. These measures did not associate as closely with age/order of acquisition (L1 versus L2). Conclusion Bilingual speakers with PPA may report additional symptoms that reflect their ability to speak more than one language. The less dominant language was most susceptible to the initial impact of PPA and also tended to the less preserved language at the time of evaluation. Future studies of bilingual speakers with neurodegenerative diseases should systematically consider bilingualism factors, which are likely to contribute to clinical presentation and disease progression.

ABSTRACT Background Many studies have aimed to uncover the neural mechanisms underlying language recovery in people with post-stroke aphasia (PWA), advancing our understanding of neural plasticity and guiding effective interventions. However, most research has been conducted on English-speaking individuals, and focused on either phonology or semantics. This study investigates neural changes associated with a novel Hebrew morphology-based naming therapy. Methods Four Hebrew-speaking PWA received a twenty-session naming therapy focused on the Hebrew root morpheme. Participants were scanned using functional magnetic resonance imaging (fMRI) before and after treatment, while performing an overt picture naming task of morphologically complex treated and untreated words. Data analysis focused on changes in brain activation and connectivity within the language network following treatment. Results Three participants, whose naming significantly improved following treatment, showed bilateral activation for picture naming before and after therapy, with a dominant left-hemisphere pattern. Nevertheless, these participants exhibited an increase in activation in varied bilateral areas but predominantly in the right-hemisphere for both treated and untreated words. Changes in connectivity were also varied mostly including enhanced inter-hemispheric and left intra-hemispheric connectivity. In contrast, the participant who did not benefit from treatment showed no significant activation changes for treated words and decreased activation and connectivity for untreated words. Conclusions Neural changes observed in treatment responders suggest that our novel therapy induces neural plasticity. The changes found in both right and left hemispheres suggest that multiple mechanisms may be involved in the recovery process. The distribution of neural changes across different brain regions suggests that the effects of the treatment are not specific to morphological processing.

ABSTRACT Background Phonological anomia is one of the most persistent consequences of stroke-induced aphasia. Understanding how phonological treatment outcomes generalize within and across languages is essential for designing effective bilingual interventions. In bilingual aphasia, cross-linguistic transfer and cognate facilitation are often expected but inconsistently observed. Aims This single-case study tested, in a balanced Basque – Spanish bilingual with post-stroke phonological anomia, whether intensive phonological therapy (i) generalized to untreated items within the treated language, (ii) produced cross-linguistic transfer, (iii) was influenced by cognate status, and (iv) was maintained approximately 4.5 months later. Methods & Procedures A two-phase multiple-baseline design was implemented. Therapy was delivered monolingually in two consecutive 4-week blocks (Phase 1 = Basque, Phase 2 = Spanish) using an item-specific phonological programme aligned with Phonological Component Analysis principles. A list of 200 translation-equivalent items was created; within each language, items were assigned to treated and untreated sets, which differed across languages. After each phase and at follow-up, the participant completed a naming-by-definition task in both languages. Planned contrasts using generalized linear mixed-effects models evaluated within-language generalization, cross-linguistic transfer, cognate effects, and maintenance, with results expressed as model-based estimated probabilities and effect sizes. Outcomes & Results Therapy produced reliable improvement for trained items in the language of therapy. No generalization occurred to untreated items within language or to the untrained language, including for cognates. At follow-up, Spanish-treated items showed partial decline relative to end-of-treatment, whereas Basque performance remained stable. At the follow-up session itself, treated-versus-untreated differences were not statistically reliable in either language. Conclusions When impairment is primarily phonological and therapy targets phonological form, gains appear item-specific and language-specific, with limited evidence for cognate-driven or cross-language transfer. Clinically, improvements in both languages require direct intervention in each and systematic maintenance planning. These findings inform models of bilingual lexical access and guide evidence-based rehabilitation strategies for bilingual individuals with aphasia.

ABSTRACT Background Functional vocabulary selection is a key component of post-stroke language rehabilitation, yet limited evidence exists regarding which words are perceived as most meaningful by people with aphasia themselves. This study examined which vocabulary items are prioritised by individuals with aphasia or their relatives, as well as by chronic aphasia patients enrolled in the DULCINEA clinical trial. Methods and Procedures This cross-sectional observational study comprised two phases. In Phase 1, 15 individuals previously affected by aphasia and their relatives completed an online survey designed to identify everyday words and short phrases considered essential for functional communication. After refinement and categorisation, a base list of 183 items was generated. In Phase 2, 20 participants with chronic post-stroke aphasia selected, with support from relatives and speech and language therapists, the words they wished totrain during the DULCINEA intervention. A total of 891 trained words were analysed. The analyses were conducted at two levels and on an exploratory basis. At the word level, generalized linear mixed models (GLMMs) with a negative binomial distribution were used to examine differences across semantic categories and selected subgroups (sex, age, and depressive symptoms). At the participant level, individual proportional distributions were compared between subgroups using Mann – Whitney U tests with false discovery rate (FDR) correction. Results Conversation was the most frequently selected category in both the baseline list and the training items, followed by Series, Foods and Drinks, Emotional and Physical States, and Verbs. Descriptive variations were observed in certain categories according to sex and, to a lesser extent, age. No differences were observed according to the status of depressive symptoms. However, these subgroup differences were not statistically significant after correction for multiple comparisons and were associated with small effect sizes. Conclusions Individuals with aphasia prioritise highly functional vocabulary relevant to everyday communication, particularly conversational terms. While exploratory variations were observed across subgroups, these findings should be interpreted with caution given their lack of statistical significance, the small sample size, and the exploratory nature of the analyses. Larger studies are needed to confirm these preliminary observations and to further inform patient-centered vocabulary selection approaches in aphasia rehabilitation.

ABSTRACT Background People with aphasia experience difficulties in communication, presenting a common clinical challenge. Many instruments have been developed and validated to guide aphasia diagnosis and treatment. A comprehensive review of aphasia assessment tools for Chinese speakers is needed to identify tools with robust psychometric properties and to advance global consensus on aphasia measurement. Aim This review sought to summarize the measurement properties of existing aphasia-related instruments in Chinese speakers. Methods and Procedures Following a pre-registered protocol on the International Prospective Register of Systematic Reviews database (registration number CRD420251055822), PubMed, PsycINFO, CINAHL, Web of Science Core Collection, and three Chinese databases (CNKI, Wanfang Data and the Chinese Medical Journal Network) were searched from their inception to December 2024 to identify aphasia-related instruments that reported measurement properties in Chinese speakers. The measurement properties were extracted on Cronbach’s α, test-retest reliability, interrater reliability, and criterion validity. The risk of bias was assessed using the COSMIN Risk of Bias checklist, and the quality of evidence for measurement properties was evaluated using the COSMIN methodology for systematic reviews. Outcomes and Results A total of 41 publications (20 written in Chinese and 21 in English) with 26 instruments were identified for aphasia screening, diagnosis, linguistic assessment, neuropsychological profiling, and quality of life. Most studies (n = 32) focused on people with post-stroke aphasia. The quality assessment results and overall rating of the psychometric properties varied, with most instruments received high-evidence reliability but nearly half failed to meet the quality standard of reporting internal consistency and criterion validity. Limitations of the evidence included variable risk of bias across studies, inconsistent validity results, and inadequate internal consistency reporting. Conclusion Many Chinese instruments for people with aphasia have been developed, primarily targeting language, cognition and mood. Further research is warranted to enhance the quality and utility of Chinese assessment tools in clinic and research.

ABSTRACT Background Neglect dyslexia (ND) is an acquired reading disorder that is associated with unilateral spatial neglect (USN), typically resulting from right hemisphere damage. While the majority of related research has focused on alphabetic written languages, identifying omission and substitution errors linked to specific cognitive mechanisms, it remains unclear whether similar error patterns appear in Chinese ND, given the unique structural characteristics of the Chinese reading system. Aim This study aimed to determine (1) whether phonetic component position in pictophonetic characters modulates error types, (2) how lexicality and word length influence errors in compound words, and (3) how first versus last characters contribute to omission and substitution errors in Chinese ND. Methods and Procedures Sixteen right-hemisphere stroke patients with left USN completed a tailored reading battery comprising pictophonetic characters (left/right phonetic components), two-/three-character real words and pseudowords, and three-character real word pairs with first- or last-character substitutions. Omission and substitution error rates were quantified. Analyses included mixed-effects models, and Fisher’s exact tests. Outcomes and Results The position of the phonetic component in pictophonetic characters influenced omission errors but had no effect on substitution errors. In compound words, omission errors increased with word length and for pseudowords, reflecting attentional and lexical demands. Substitution errors showed a strong lexicality effect (near-absent in real words) but no word length effect, indicating a pre-lexical origin. The first character was critical for error patterns. Conclusions and Implications The findings reveal a double dissociation between error types in Chinese ND. Substitution errors appear to be driven by visual crowding, while omission errors are affected by structural and lexical factors. This supports error-based subtyping and tailored interventions: perceptual training for substitution errors, and spatially-guided attention training for omission errors.

ABSTRACT Background Aphasia disrupts sense of self and constrains the narrative capacity essential for identity reconstruction. While narrative co-construction approaches show promise for supporting identity development in people with aphasia, little is known about whether intervention effects persist beyond the immediate post-intervention period. Aims This longitudinal qualitative study explored participants’ lived experiences one year after completing the My Story Project, a collaborative storytelling intervention, with a focus on understanding the role their co-constructed stories played in their lives in the intervening year. Methods & Procedures Three male participants with chronic aphasia (5–6 years post-stroke, ages 56–67) who had completed the My Story Project intervention participated in semi-structured follow-up interviews 12–13 months post-intervention. Interviews explored participants’ experiences with the intervention and changes over the preceding year. Data were analyzed using reflexive thematic analysis grounded in an interpretive, constructivist paradigm. The Communication Confidence Rating Scale for Aphasia was administered to assess sustained changes in communication confidence. Outcomes & Results Three themes captured the longer-term impact: Becoming and Believing (ongoing identity development, agency, and hope); Envisioning and Achieving (translation of goals into concrete achievements including boat building and adaptive cycling); and Enduring (continued story relevance). Communication confidence gains were maintained or increased (converted score changes +3 to +9). Critically, behavioral achievements emerged six to twelve months post-intervention rather than immediately. Identity work remained active and complex, with both behavioral changes and ongoing self-doubt, suggesting identity reconstruction as a continuing process rather than fixed outcome. Conclusions The sustained transformation observed – participants building boats, riding bikes, and continuing to engage with their stories – demonstrates that narrative co-construction initiates processes that remain active long after intervention concludes. Behavioral changes emerged months after intervention rather than immediately, challenging conventional expectations for rapid outcomes and highlighting the need for extended follow-up timelines when evaluating narrative interventions. Findings position narrative intervention as addressing both internal identity work and concrete life participation outcomes essential to person-centered aphasia rehabilitation.

ABSTRACT Background Aphasia following stroke can substantially disrupt communication and family dynamics, often placing considerable demands on family caregivers. Understanding the relationship between caregiver burden and the impact of aphasia on family life is important for improving support strategies and rehabilitation outcomes. Aim This study aimed to examine the relationship between caregiver burden and the impact of aphasia on family life in family members caring for people with aphasia following stroke. Methods This cross-sectional correlational study was conducted between February 2023 and February 2024 with 150 family caregivers of people with aphasia following stroke. Data were collected using the Burden Interview and the Family Aphasia Measure of Life Impact (FAMLI). Data were analyzed using Pearson correlation coefficients and linear regression analyses. Results A statistically significant negative correlation was found between caregiver burden and the impact of aphasia on family life, indicating that higher caregiver burden was associated with poorer family functioning. Caregiver burden was negatively associated with the Health and Daily Life and Communication and Emotions subscales of the FAMLI. However, no statistically significant relationship was found between caregiver burden and the Attitude and Personal Life subscale. Conclusion The findings suggest that caregiver burden experienced by family members of people with aphasia following stroke is associated with several aspects of family life, particularly health, daily functioning, and emotional experiences.

ABSTRACT Background Given the rising global prevalence of dementia from Alzheimer’s disease, early detection at the stage of Mild Cognitive Impairment (MCI) has become increasingly critical. In countries like the United States (U.S.), speech-language pathologists (SLPs) play an essential role in early risk identification and cognitive management of MCI. However, knowledge, attitude, and practice (KAP) patterns among Indian SLPs remain underexplored in this context. It would also be of great interest to examine whether the KAP patterns of Indian SLPs regarding MCI differ from those of their U.S. counterparts, given the influence of cultural and healthcare diversities. Investigating such differences could provide valuable insights into cross-national practices, which in turn could inform the development of international guidelines for cognitive communicative services by SLPs delivering clinical care to older adults at-risk for dementia. Aim The study aimed to investigate the KAP of SLPs in India regarding MCI diagnosis and treatment and compared these findings with trends among SLPs in the U.S. Methods & Procedures A cross-sectional study employing purposive sampling was conducted. The questionnaire, adapted from a U.S. based survey by Lanzi et al. (2022), assessed Indian SLPs’ KAP related to MCI across three sections: demographics; knowledge and attitude; and clinical practice. Qualitative and quantitative analyses explored KAP patterns among Indian SLPs and then compared the results with the original American survey to examine potential culture-specific differences. Outcomes & Results Results from 94 SLPs revealed a discrepancy between knowledge and practices concerning MCI, specifically in subtypes, diagnostic criteria, and the tools used for assessment and treatment. Notable differences were observed between Indian and American SLPs, especially in assessing activities of daily living and using compensatory strategies for assessment, intervention, and goal setting. Conclusions The findings shed light on the current KAP patterns of Indian SLPs regarding MCI, identifying areas for improvement through targeted education and training. Furthermore, the cross-national comparison underscores the need for culturally sensitive, contextually relevant cognitive-communication interventions to improve the MCI management through collaboratively developed, evidence-based, culturally informed tools.

ABSTRACT Background Despite the critical roles informal/family caregivers play in the treatment and long-term rehabilitation of individuals living with aphasia, there are few empirical studies on the mental health of aphasia caregivers. The broader social science literature has shown that friendship support is generally associated with better mental health. Further, its psychosocial impacts may vary by individuals’ relational contexts. However, it remains unclear whether the positive association between friendship support and mental health differs by caregiver types (e.g., spousal and adult child caregivers), particularly among aphasia caregivers. Aims To address these knowledge gaps and advance the Life Participation Approach to Aphasia (LPAA), we aim to (1) investigate the association between friendship support and depressive symptoms among aphasia caregivers; (2) examine whether this association varies across different aphasia caregiver types (i.e., adult child, spouse, other caregivers). Methods and Procedures Using purposive sampling strategies, we conducted a cross-sectional survey of aphasia caregivers (n = 77) on their caregiving experiences, friendship support, and health. Ordinary Least Squares regression (OLS) using robust standard errors was conducted to assess the association between friendship support and depressive symptoms of aphasia caregivers and whether this association differs by caregiver type (i.e., adult child, spouse, other caregivers). To contextualize the interaction effect, we conducted marginal effect analysis to predict average depressive symptoms at varying levels of friendship support among different types of caregivers. Outcomes and Results For aim 1, results from OLS with robust standard errors show that friendship support was negatively associated with depressive symptoms (β = -5.04, p = 0.00), holding all else constant. For aim 2, the association between perceived friendship support and depressive symptoms for spousal caregivers (β = 5.32, p = 0.00) and other caregivers (β = 7.87, p = 0.01) was significantly different from that of adult-child caregivers. Accounting for perceived caregiving burden and other statistical controls, a one SD increase in friendship support was associated with a significant reduction in depressive symptoms among adult child caregivers (Δy/Δx = -8.95, p = 0.00). Spousal caregivers experienced a smaller but significant reduction in depressive symptoms (Δy/Δx = -3.64, p = 0.02). The reduction in depressive symptoms was not statistically significant among other caregivers (Δy/Δx = -1.08, p = 0.71). Conclusions Adult child caregivers’ mental health seems to be the most sensitive to the increase of perceived friendship support among all caregiver types, accounting for perceived caregiving burden and other statistical controls. Findings have implications for tailored caregiver intervention guided by LPAA.